FMS Community Newsletter #32
Monday, November 25, 2002

 

Hot Topics

Medication

Must Have" Books

How You Can Help

Home

Main Archive Index 



Main Archive Index 

FMS Community Newsletter #32
Monday, November 25, 2002
Subscription update: 1993 subscribers and 14 new subscribers. Welcome!
=====================================================
=====================================================
Featured link: Strategies for minimizing relapses

Relapses are an inevitable and often demoralizing part of chronic
illness. This week's article at the CFIDS/Fibromyalgia Self-Help program
describes strategies used by students in our program to reduce the
frequency and severity of setbacks. The article is the last in the
series "What Works for Managing CFIDS and Fibromyalgia." Other series
include:

Success Stories: Personal accounts of successful coping and recovery
Coping Strategies: Practical techniques for reducing symptoms and
improving quality of life
Ten Keys to Coping and Recovery: Strategies for managing chronic illness
and improving chances for recovery.

Check it out: http://www.cfidsselfhelp.org
AOL users: <a href="http://www.cfidsselfhelp.org">Read it here</a>
=====================================================
=====================================================
This week's news:
1) Last call for story submissions: Living Well With CFS & FM
2) Too Much Screen Time Can Make Computer Users Sick
3) Study: Inflammation triggers heart attacks
4) Serving up a healthy holiday
5) Make yourself a priority
6) Mental health quiz: Learning the basics
7) Pharmacy resources on the web
8) Therapy of circadian rhythm disorders in chronic fatigue syndrome: no
symptomatic improvement with melatonin or phototherapy.
9) Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue
syndrome-a randomised controlled trial.
10) Personality Characteristics of Women with Fibromyalgia and of Women
with
Chronic Neck, Shoulder, or Low Back Complaints in Terms of Minnesota
Multiphasic Personality Inventory and Defense Mechanism Technique
Modified
=====================================================
1) Last call for story submissions: Living Well With CFS & FM

Attention CFS and Fibro Patients!

A best-selling author really needs your help with a
new book on chronic fatigue syndrome and fibromyalgia.
The book, Living Well with Chronic Fatigue Syndrome &
Fibromyalgia, is the third in Mary Shomon's
best-selling series, and will be published by Harper
Collins in 2003. Her first book, Living Well With
Hypothyroidism, is currently in its 16th printing.

The book will feature lots of stories and quotes from
CFS/FM patients, and that's where you come in. We
need your personal stories and experiences on topics
such as:

* how you got diagnosed
* frustrations with physicians, the diagnostic or
treatment process
* what treatments have worked and haven't worked for you
(both prescription and alternative approaches)
* Chiari surgery
* frustrations with the process of diagnosis
* frustrations with the treatment process
* success stories of all sorts -- spiritual, physical,
mental, etc
* how you live with your illness, "secrets of success," etc.
* humorous stories
* your opinions on the name change issue

You don't have to be "a writer" and you don't have to
write a lot--a couple of paragraphs would be welcome,
though if you want to write more you can. You might
even want to share just a few words of wisdom (e.g.
"My secret to success is I laugh every day.") Stories
of inspiration and success are great, but if you want
to rant and rave, we want to hear that too. All
submissions will remain strictly confidential. If you
volunteer to send a submission and it (or an excerpt)
is included in the book, you will remain completely
anonymous--unless you specifically request otherwise.

We need your stories and quotes right away. All
selections will be chosen within the next three weeks.
So if you'd like to contribute, you can do so in an
email to mailto:cfsfib-@yahoo.com. Please send
all contributions ASAP, but no later than Dec. 3, 2002.

Please help make this book a real and accurate
portrayal of CFS/FM by making your voices heard!
=====================================================
2) Too Much Screen Time Can Make Computer Users Sick

The more time an office worker toils in front of a computer, the more
likely he or she is to
suffer a host of physical, mental and sleep-related ills, Japanese
researchers report.

Check it out: http://abclocal.go.com/kabc/news/110502_nw_technology.html
AOL users: <a
href="http://abclocal.go.com/kabc/news/110502_nw_technology.html">Read
it here</a>
=====================================================
3) Study: Inflammation triggers heart attacks

Simmering, painless inflammation deep within the body is the single most
powerful trigger of heart attacks, worse even than high cholesterol, a
landmark study concludes.

Check it out: http://www.msnbc.com/news/834632.asp#BODY
AOL users: <a href="http://www.msnbc.com/news/834632.asp#BODY">Read it
here</a>
=====================================================
4) Serving up a healthy holiday

During the holidays, you may be tempted to disregard your healthy eating
habits and indulge your taste buds. Whether you're trying to stick to a
weight loss program or you follow a special diet, holiday meals and
celebrations can test even the strongest willpower.

But you don't need to sacrifice taste or your traditions to stay on
track. The key is to be sensible and use moderation.

Check it out:
http://www.mayoclinic.com/invoke.cfm?id=NU00257&si=1590&printpage=true
AOL users: <a
://www.mayoclinic.com/invoke.cfm?id=NU00257&si=1590&printpage=true">Read
it here</a>
=====================================================
5) Make yourself a priority

by Tracy Parker, R.D.
eDiets Staff Writer

Who's number one in your life? For many Americans, balancing a career
and family obligations means there's little time left over for that
special someone -- you!

And while it's not uncommon for the traditional "caregiver" to put
everyone else first, it's not the healthiest way to live -- and it can
make the battle to lose weight even harder. So make yourself, your
weight and your health a priority in five easy steps, then get the
results you're seeking!

Step 1: Get over the guilt. Don’t feel guilty for making time for
yourself. It's not selfish to make yourself a priority. Neglecting
yourself can mean having less than 100 percent to give back to everyone
else. The first step toward more balance in life is to believe you are
number one and your needs are important. So, congratulate yourself for
identifying the fact that you are a priority. This way both you and
others will reap the benefits of your better health.

Step 2: Do everything better. Reality-check time: A poor diet can weaken
your immune system, making you more susceptible to every little germ
that comes your way. In the long-term, eating well and exercising can
seriously reduce your risks for heart disease, cancer and diabetes,
which means you'll be around to take care of the ones you love for a
long time to come. And did we mention that you’ll also feel more
energetic?

Step 3: Make your workout an escape. If your life is really harried,
making time to unwind is essential. At present, that may mean vegging
out in front of the TV or indulging in your favorite dessert. Instead,
relieve daily stress and sleep better at night with the best method
there is: exercise. Health experts agree physical activity is one of the
most effective ways to lift physical tension and clear your head.
Whether you make it a stress-relieving way to wake up, a calming force
at mid-day, or your evening closer, you'll be better prepared to do
everything the next day.

Step 4: Realize that there will never be a better time. Unless you're
nearing retirement or about to send the kids out into the world, your
life will probably only get busier with time. That said, don't put off
weight loss. If you really want to lose weight, it will take some time
and planning. There is no magic pill that will melt away pounds. The
extra care it takes to make meals healthier will be worth it, we assure
you.

Step 5: Don't let anything stand in your way. Mark down your exercise
schedule in non-negotiable permanent ink -- not pencil -- and resolve to
get it done, no matter what. If you like to exercise on your own, you
may have to learn how to delegate tasks to free up some extra time for
yourself (and also accept that things will be done to different
standards!). Otherwise, find time to exercise as a family --
togetherness pays off. It is prime bonding time and it helps everyone
stay more motivated to keep going.
=====================================================
6) Mental health quiz: Learning the basics

Mental illness is a pervasive health problem. But how much do you really
know about it? Do you know how many children are affected? What
substances play a role in depression? Whether more people die from
suicide or homicide? Our quiz puts your knowledge to the test.

Check it out: http://www.mayoclinic.com/invoke.cfm?id=QZ00064&si=1578
AOL users: <A
HREF="http://www.mayoclinic.com/invoke.cfm?id=QZ00064&si=1579">Read it
here.</A>
=====================================================
7) Pharmacy resources on the web

The following websites might be useful additions to one's collection.
(Editor's note: Many thanks to our tireless researcher Mary for this
excellent contribution!)

This one gives information on new drugs that are being researched:
Check it out: http://www.rxfactstat.com
AOL users: <a href="http://www.rxfactstat.com">Read it here</a>

This one you can search by disease/disorder or medication. There is
also a patient assistance program at this web site.
Check it out: http://www.phrma.org/
AOL users: <a href="http://www.phrma.org">Read it here</a>

Approved drug products with therapeutic equivalence evaluations; in
other words all pharmacy companies that formulate by generic name .
Check it out: http://www.fda.gov/cder/ob/default.htm
AOL users: <a href="http://www.fda.gov/cder/ob/default.htm">Read it
here</a>
=====================================================
8) Therapy of circadian rhythm disorders in chronic fatigue syndrome: no
symptomatic improvement with melatonin or phototherapy.

Journal: Eur J Clin Invest 2002 Nov;32(11):831-837
Authors: Williams G, Waterhouse J, Mugarza J, Minors D, Hayden K.
Affiliations: University Hospital Aintree, Liverpool, UK, John Moores
University, Liverpool, UK, School of Biological Sciences, University of
Manchester, UK.
NLM Citation: PMID: 12423324

BACKGROUND: Patients with chronic fatigue syndrome (CFS) show evidence
of
circadian rhythm disturbances. We aimed to determine whether CFS
symptoms
were alleviated by melatonin and bright-light phototherapy, which have
been shown to improve circadian rhythm disorders and fatigue in jet-lag
and shift workers.

DESIGN: Thirty patients with unexplained fatigue for > 6 months were
initially assessed using placebo and then received melatonin (5 mg in
the
evening) and phototherapy (2500 Lux for 1 h in the morning), each for 12
weeks in random order separated by a washout period. Principal symptoms
of CFS were measured by visual analogue scales, the Shortform (SF-36)
Health Survey, Mental Fatigue Inventory and Hospital Anxiety and
Depression Scale. We also determined the circadian rhythm of body
temperature, timing of the onset of melatonin secretion, and the
relationship between these.

RESULTS: Neither intervention showed any significant effect on any of
the
principal symptoms or on general measures of physical or mental health.
Compared with placebo, neither body temperature rhythm nor onset of
melatonin secretion was significantly altered by either treatment,
except
for a slight advance of temperature phase (0.8 h; P = 0.04) with
phototherapy.

CONCLUSION: Melatonin and bright-light phototherapy appear ineffective
in
CFS. Both treatments are being prescribed for CFS sufferers by medical
and alternative practitioners. Their unregulated use should be
prohibited
unless, or until, clear benefits are convincingly demonstrated.
=====================================================
9) Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue
syndrome-a randomised controlled trial.

Journal: Eur J Pain 2002 Dec;6(6):455-466
Authors: Zachrisson O, Regland B, Jahreskog M, Jonsson M, Kron M,
Gottfries CG.
Affiliation: Psychiatry Section, Institute of Clinical Neuroscience,
Goteborg University, Goteborg, Sweden
NLM Citation: PMID: 12413434

We have previously conducted a small treatment study on staphylococcus
toxoid in fibromyalgia (FM) and chronic fatigue syndrome (CFS). The aim
of the present study was to further assess the efficacy of the
staphylococcus toxoid preparation Staphypan Berna (SB) during 6 months
in
FM/CFS patients.

One hundred consecutively referred patients fulfilling the ACR criteria
for FM and the 1994 CDC criteria for CFS were randomised to receive
active drug or placebo. Treatment included weekly injections containing
0.1ml, 0.2ml, 0.3ml, 0.4ml, 0.6ml, 0.8ml, 0.9ml, and 1.0ml SB or
coloured
sterile water, followed by booster doses given 4-weekly until endpoint.
Main outcome measures were the proportion of responders according to
global ratings and the proportion of patients with a symptom reduction
of

/=50% on a 15-item subscale derived from the comprehensive

 

psychopathological rating scale (CPRS).

The treatment was well tolerated. Intention-to-treat analysis showed
32/49 (65%) responders in the SB group compared to 9/49 (18%) in the
placebo group (P<0.001). Sixteen patients (33%) in the SB group reduced
their CPRS scores by at least 50% compared to five patients (10%) in the
placebo group (P<0.01). Mean change score on the CPRS (95% confidence
interval) was 10.0 (6.7-13.3) in the SB group and 3.9 (1.1-6.6) in the
placebo group (P<0.01). An increase in CPRS symptoms at withdrawal was
noted in the SB group.

In conclusion, treatment with staphylococcus toxoid injections over 6
months led to significant improvement in patients with FM and CFS.
Maintenance treatment is required to prevent relapse.
=====================================================
10) Personality Characteristics of Women with Fibromyalgia and of Women
with
Chronic Neck, Shoulder, or Low Back Complaints in Terms of Minnesota
Multiphasic Personality Inventory and Defense Mechanism Technique
Modified

Journal: J of Musculoskeletal Pain, Vol. 10(3) 2002, pp. 33-55
Authors: Tomas Trygg, Gunnar Lundberg, Elisabeth Rosenlund, Toomas
Timpka,
Björn Gerdle
Affiliations: Tomas Trygg is affiliated with the Department of Social
Medicine, Faculty of Health Sciences, Linköping University, and the
Department of Psychology, Lund University, Sweden.
Gunnar Lundberg is affiliated with the Department of Rehabilitation
Medicine, Faculty of Health Sciences, Linköping University, and the
Ergonomicentrum, Nyköping, Sweden.
Elisabeth Rosenlund is affiliated with the Department of Psychology,
Lund
University, Sweden.
Toomas Timpka is affiliated with the Department of Social Medicine,
Faculty
of Health Sciences, Linköping University, Sweden.
Björn Gerdle, MD, PhD, is affiliated with the Department of
Rehabilitation
Medicine, Faculty of Health Sciences, Linköping University, and the Pain
and Rehabilitation Centre, University Hospital, Linköping, Sweden.
Address correspondence to: Professor Björn Gerdle, Department of
Rehabilitation Medicine, Faculty of Health Sciences, Linköping
University,
SE-581 85 Linköping, Sweden.
Submitted: February 23,2001.
Revision accepted: November 12, 2001.

ABSTRACT.
Objectives: To compare personality features of fibromyalgia patients
with
those of a disease control group with regional pain.

Methods: A group of 33 women with fibromyalgia [FMS-group] was compared
on
the Minnesota Multiphasic Personality Inventory [MMPI] and the Defense
Mechanism Technique modified [DMTm] with 31 women [C-group] without this
diagnosis who had localized chronic pain in their neck, shoulder, and/or
low back areas and were very similar in chronological age, intelligence,
and basic personality patterns.

Results: As hypothesized the FMS-group scored higher than the C-group on
the MMPI-scales of Hypochondriasis, Depression, and Hysteria. They also
scored higher on Admission of symptoms, Psychasthenia, Anxiety,
Schizophrenia, Social introversion, and a number of nonclinical
subscales.
The differences were not found to be due to differences in pain
intensity.
The only statistically significant difference in DMTm between the groups
was that of FMS patients more often reporting the projected self to be
positive and/or to be afraid, suggesting them to be more vulnerable than
the comparison group to threatening experiences. Significant
relationships
between the disability level and the number of tender points, group
membership, pain intensity, and various of the MMPI scales were found.

Conclusions: There were no signs on the MMPI of serious psychological
disturbances in either group, and at the "deeper" psychological level,
assessed in DMTm, there were no marked differences between the two
groups,
a proneness to somaticize psychological pain being found in
both groups. Both the MMPI and the DMTm results were interpreted as
suggesting that a cognitive coping strategy program be considered for
rehabilitation. The fact that both different symptoms and signs had
importance when regressing disability might indicate that univariate
approaches is not sufficient when investigating factors of importance
for
disability.

KEYWORDS. Disability, Defense Mechanism Technique modified,
fibromyalgia,
Minnesota Multiphasic Personality Inventory, pain


INTRODUCTION

The American College of Rheumatology [ACR] 1990 criteria for the
diagnosis
of fibromyalgia syndrome [FMS] require: a. widespread chronic [ > three
months] pain in the upper, lower, left, and right parts of the body, as
well as axial pain, and b. the presence of at least 11 out of 18 tender
points (1). Bennett (2) summarizes basic conceptions regarding FMS as
follows: "The current paradigm is that of a complex hyperalgesic pain
syndrome, in which abnormalities of central sensory processing interact
with peripheral pain generators and psychoneuroendocrine dysfunction to
generate a wide spectrum of patient symptomatology and distress." The
etiology of FMS is to a large extent unknown (2,3). In the 1950s and the
1960s, FMS was often considered to be a manifestation of hysteria and
was
equated with psychological rheumatism (4,5). There are studies providing
evidence both for and against psychological factors playing an important
role in the initiation and maintenance of FMS (2,3,6).

Chronic pain appears to be associated with an increase in the
prevalences
of depression or depressive symptoms. Unfortunately, depression has been
used in the literature to label different phenomena: affect, a mood, a
symptom, or a syndrome. In several studies, depressive symptoms or
depression have also been found to be prevalent in FMS (4,5,7-11). On
the
other hand, Clark (12) found no differences in depressive symptomatology
between an FMS group and a control group, which included subjects with
musculoskeletal pain. Different explanations for the high prevalence of
depression among patients with chronic pain have been suggested (13-16).
Longitudinal studies are inconclusive regarding the causal relationship
between chronic pain and depression (17,18).

Fibromyalgia syndrome patients appear to have significantly elevated
scores
on several scales of the Minnesota Multiphasic Personality Inventory
[MMPI]
(19-21). Ahles et al. (19) reported elevated scores on the depression,
hysteria, and hypochondriasis scales. Payne et al. (21) found nearly all
the MMPI scales to be higher in a FMS group than in two control groups.
The
higher MMPI scale scores of FMS than of rheumatoid arthritis [RA]
patients
could not be explained by differences in pain intensity (20). The
central
features of FMS have been found to be independent of psychological
status
as assessed by the MMPI and have been suggested to be related to FMS
itself
(22).

The Defense Mechanism Technique modified [DMTm] is a percept-genetic
technique (23) used to study personality, one that has been employed
earlier to gain insight into patients with FMS (24). As with the
percept-genetic approach to studying personality generally, the
following
three elements can be said to be involved (25): 1. the percept-genetic
situation, one of transference, in which the subject, presented
tachistoscopically with certain pictures having a symbolic content, can
be
said to reconstruct his or her personality; 2. the subject's current
life
situation, in which possible symptoms, behaviors, ambitions, and the
like
are explored; and 3. a developmental model or theory [about the original
conditions of the mind] used to interpret the relationships assumed to
be
found between the subject's current "symptomatic" situation and the
percept-genetic report.

Jacobsson (24) found that a group of patients who had a diagnosis of FMS
both initially and at discharge tended to display a particular
combination
of defenses in the DMTm, referred to as hero[ine]-repression, denial,
and
denial through reversal II 3 [specified in Table 2, shown in the Results
section]. Jacobsson suggests that FMS may be a form of masked
depression.
It is thus rather noteworthy that Hallborg (26), in a study of depressed
patients, found the combination of DMTm defenses just mentioned to be
more
frequent among men who were high in inertial psychomotor retardation and
also to be more frequent among women who were high in
nondivertability/depressive delusions.

Disability involves difficulties in connection with a composite of
activities and behaviors generally accepted as constituting major
components of everyday life (27). Fibromyalgia syndrome patients
frequently
report disability with respect both to activities of daily living [ADL]
and
to work (3,28). A great majority of FMS patients have been found to
report
changes in habits and routines as a consequence of their condition (29).
Fibromyalgia syndrome patients have been found to be more concerned
about
minor daily problems and activities than RA and controls, despite their
reporting lower levels of major life stress (30,31). Fibromyalgia
syndrome
patients have also been found to receive more practical help from
significant others and to experience greater limitations concerning ADL
than patients with RA (32). Greater discrepancies between self-reported
and
observed functional disability in patients with FMS than in patients
with
RA or ankylosing spondylitis have been reported (33).

Clinical signs have generally been considered to be of little relevance
for
the outcome of the disability level in patients with chronic pain
(34-37).
In contrast, however, some studies report significant correlations in
low
back pain and FMS patients between certain clinical signs or symptoms
and
the degree of disability (28,38).

The present study aimed to investigate the following:

a. possible differences in DMTm, particularly signs of hero [ine
]-repression in combination with denial and denial through reversal II
3,
between a group of patients with FMS [FMS-group] and a comparison group
[C-group] with more localized chronic pain [neck, shoulder, and/or low
back
pain];

b. possible differences in MMPI scores between the FMS-group and the
C-group after normalization for differences in pain intensity;

c. to what extent disability [mainly physical] is influenced by pain
intensity, number of tender points, diagnostic group [FMS or C], and
psychological status [in terms of MMPI].


© 2002 by The Haworth Press, Inc. All rights reserved.


Copies of the complete article are available for a fee from The Haworth
Document Delivery Service: 1-800-HAWORTH.
E-mail address: mailto:geti-@haworthpressinc.com
Website: http://www.HaworthPress.com/store/product.asp?sku=J094
AOL users: <a
href="http://www.HaworthPress.com/store/product.asp?sku=J094 ">Read it
here</a>

[Note: It is also possible that your local library can help you obtain a
copy of this article via one of its interlibrary loan agreements.]
=====================================================

 

 

Main Archive Index