FMS Community Newsletter #36
Monday, January 20, 2003



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FMS Community Newsletter #36
Monday, January 20, 2003
1983 subscribers and 11 new subscribers. Welcome!
Featured link: Living a Good Life With Fibromyalgia

This week's article at the CFIDS/Fibromyalgia Self-Help program is
"Living with Fibromyalgia: What Helps Me." Read Kathy Gamble's
description of the many strategies she uses to create a good life with
fibromyalgia. Her article is the latest in our series "Success Stories,"
personal accounts of successful coping and recovery.

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This week's news:
1) Measuring exercise-induced mood changes in fibromyalgia: A comparison
of several measures.
2) Doctor calls for improved understanding of FMS
3) Infliximab Shows Promise Against Active Primary Sjogren's Syndrome
4) Pain Isn't the Same Between the Sexes
5) Relationship between fibromyalgia features and smoking.
6) Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue
syndrome and health under psychological, physiological, and
pharmacological stimulation.
7) Chinese Herbal Medicines May Contain Modern Drugs
8) Sleep and pain.
9) Possible influence of defenses and negative life events on patients
with chronic fatigue syndrome: a pilot study.
10) Chronic fatigue in a population-based study of Gulf War veterans.

1) Measuring exercise-induced mood changes in fibromyalgia: A comparison
of several measures.

Arthritis Rheum 2002 Dec 15;47(6):603-9

Gowans SE, DeHueck A, Abbey SE.

University Health Network and University of Toronto, Toronto, Ontario,

PMID: 12522833

OBJECTIVE: To compare scales measuring exercise-induced changes in mood.

METHODS: Mood changes in a randomized, 23-week controlled trial of
exercise were assessed using the Beck Depression Inventory (BDI), Center
for Epidemiologic Studies Depression Scale (CES-D), State Trait Anxiety
Inventory (STAI), Fibromyalgia Impact Questionnaire, and the Mental
Health Inventory (MHI). Effect sizes and t-tests were computed on
23-week change
scores. Scales were deemed to be confounded if items addressed sleep
disturbances, fatigue, or effort (symptoms of both mood disturbances and

RESULTS: Efficacy (15 exercise subjects) and intent-to-treat analyses
(27 exercise subjects) generated medium effects for BDI (total,
cognitive), MHI depression (efficacy only), and CES-D (intent-to-treat
only) scales. BDI (total, cognitive), MHI (depression, positive affect,
total [MHI-5]), and STAI scales distinguished exercise from control
subjects at 23 weeks in all analyses. BDI somatic and CES-D scales were
deemed to be confounded.

CONCLUSION: We recommend the BDI cognitive, STAI, and MHI-5 scales to
measure depression, anxiety, and general mood, respectively, in patients
with fibromyalgia.
2) Doctor calls for improved understanding of FMS

I. Jon Russell, M.D., Ph.D., writes, "Fibromyalgia (FMS) is a common
syndrome of widespread soft tissue pain that is substantially
underserved by the medical profession and the pharmaceutical industry.
This field of inquiry and the patients with FMS would be better served
by an improved understanding of the biologic and physiologic processes
responsible for the symptoms of FMS."

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3) Infliximab Shows Promise Against Active Primary Sjogren's Syndrome

NEW YORK (Reuters Health) Jan 07 - In patients with active primary
Sjogren's syndrome, treatment with infliximab, a tumor necrosis factor
(TNF) antagonist, may provide lasting relief, Brussels, Belgium-based
researchers report.

In an initial 3-month pilot study of 16 such patients, infliximab (3
mg/kg) given in three separate infusions at weeks 0, 2, and 6, was safe
and led to rapid and sustained improvement in all clinical and
functional parameters.

These successful results led Dr. Serge D. Steinfeld and colleagues from
Erasme University Hospital to extend the protocol to test the safety and
efficacy of infliximab as a maintenance regimen. They administered
additional infusions of infliximab approximately every 12 weeks for 1
year to 10 of the original 16 subjects.

In the December issue of Arthritis and Rheumatism, the team reports that
the clinical improvements induced by the three original infusions lasted
9 weeks before the first symptoms of Sjogren's reemerged. The most
common recurrent symptom was dry mouth.

Three patients remained completely free of symptoms for 1 year after the
initial infliximab treatment regimen. With a median age of 37.3 years,
these patients were younger than the other patients and had shorter
disease duration (<3 years).

The maintenance regimen was generally well tolerated. The main side
effect was mild self-limited infusion reactions. After 1 year, all 10
patients experienced a "statistically significant decrease in global and
local disease manifestations," Dr. Steinfeld's team reports.
"Interestingly," they write, "retreatment induced an improvement that
was comparable with the response seen at week 14 of the pilot study."

The team adds that a controlled trial is needed to define the optimal
reinfusion regimen.

Arthritis Rheum 2002;46:3301-3303.

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Pain Isn't the Same Between the Sexes

HealthScoutNews - Proteins called GIRKS play a major role in male and
female differences in sensitivity to pain and painkillers, say two new

The information may help scientists develop pain treatments specifically
designed for each gender, say researchers from the University of Texas
at Austin.

Men typically can endure more pain than women, and painkillers seem to
affect men and women differently. However, the biological reasons for
those differences isn't clear.

In the first study, researchers studied pain sensitivity and responses
to analgesic drugs in mutant mice that lacked a protein called GIRK2.
This protein plays an important role in electrical communication between

The study found that the male mutant mice, but not the females, had
lower pain thresholds than a control group of normal mice. That showed
that the removal of the GIRK2 protein eliminated gender differences in
baseline pain sensitivity.

The study also found that both types of analgesic tested -- clonidine
and morphine -- were less effective in treating pain in mice that lacked
the GIRK2 protein.

The second study used the same kind of GIRK2-deficient mice and tested
their response to the analgesic effects of several kinds of drugs,
including alcohol, nicotine and cannabinoids, which is the active
ingredient in marijuana.

The researchers found the lack of GIRK2 eliminated the analgesic effects
of some of these drugs in the mutant male mice, but not in the mutant
female mice.

The combined findings of these studies indicates that the GIRK2 protein
may be a critical part of the pain pathway that accounts for gender
differences in pain sensitivity and response to analgesics. The protein
may also offer a promising new target for pain treatment.

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5) Relationship between fibromyalgia features and smoking.

Scand J Rheumatol 2002;31(5):301-5
Yunus MB, Arslan S, Aldag JC.
Section of Rheumatology, University of Illinois College of Medicine at
Peoria, IL 61656, USA.
PMID: 12455822

OBJECTIVE: The objective of this study was to examine a possible
relationship between smoking and fibromyalgia features among 233 female
patients with fibromyalgia syndrome.

METHODS: Data on clinical and psychological features were collected by a
protocol. Smoking status was evaluated by a question inquiring about the
packs of cigarettes smoked per day. Differences between the smokers and
non-smokers were tested by Mann Whitney U test. To adjust data for age
and education, a partial correlation test was used. A p value of < or =
0.01 was accepted as the level of significance.

RESULTS: Fifty-one patients (21.9%) smoked. After adjustment for age and
education, significantly positive relationship was found between smoking
and pain, patient global severity, functional disability, and numbness.
There was no difference between smokers and non-smokers for fatigue,
morning fatigue, sleep difficulties, tender points (TP), depression,
anxiety and stress.

CONCLUSIONS: Smokers reported significantly more pain, numbness, patient
global severity, and functional difficulties than non-smokers. There was
no significant difference between smokers and non-smokers for fatigue
and TP.
6) Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue
syndrome and health under psychological, physiological, and
pharmacological stimulation.

Journal: Psychosom Med 2002 Nov-Dec;64(6):951-62

Authors: Gaab J, Huster D, Peisen R, Engert V, Heitz V, Schad T,
Schurmeyer TH, Ehlert U.

Affiliation: Center for Psychobiological and Psychosomatic Research
(J.G., D.H., R.P., V.E., V.H., T.S., T.H.S., U.E.), University of Trier,
Trier, Germany.

NLM Citation: PMID: 12461200

OBJECTIVES: Subtle alterations of the hypothalamic-pituitary-adrenal
(HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a
shared pathway linking numerous etiological and perpetuating processes
with symptoms and observed physiological abnormalities. Because the HPA
axis is involved in the adaptive responses to stress and CFS patients
experience a worsening of symptoms after physical and psychological
stress, we tested HPA axis functioning with three centrally acting
stress tests.

METHODS: We used two procedures mimicking real-life stressors and
compared them with a standardized pharmacological neuroendocrine
challenge test. CFS patients were compared with healthy control subjects
regarding their cardiovascular and endocrine reactivity in a
psychosocial stress test and a standardized exercise test, and their
endocrine response in the insulin tolerance test (ITT).

RESULTS: Controlling for possible confounding variables, we found
significantly lower ACTH response levels in the psychosocial stress test
and the exercise test, and significantly lower ACTH responses in the
ITT, with no differences in plasma total cortisol responses. Also,
salivary-free cortisol responses did not differ between the groups in
the psychosocial stress test and the exercise test but were
significantly higher for the CFS patients in the ITT. In all tests CFS
patients had significantly reduced baseline ACTH levels.

CONCLUSIONS: These results suggest that CFS patients are capable of
mounting a sufficient cortisol response under different types of stress
but that on a central level subtle dysregulations of the HPA axis exist.

Chinese Herbal Medicines May Contain Modern Drugs

LONDON (Reuters Health) - Chinese herbal medicines may sometimes
work--and may sometimes cause serious harm--because they are adulterated
with synthetic drugs, a British research group has said.

The Bandolier organization, which specializes in reviewing healthcare
studies, said Chinese herbal medicines were becoming more popular and
there was even evidence that some might work.

"One of the problems, though, is that these herbal medicines are not
standardized, and usually contain many ingredients. A review tells us
that some of those ingredients can be synthetic drugs, responsible both
for good effects, and for serious harm."

The review, published on Bandolier's web site, found that a wide range
of adulterants were used, including steroids, nonsteroidal
anti-inflammatory drugs, anticonvulsants, benzodiazepines, hypoglycemic
agents and even Viagra.

While it was not clear what proportion of remedies contained
adulterants, analysis of 2,600 samples in Taiwan showed that 24%
contained at least one synthetic medicine. In the US it was 7%.

Case reports showed that two or more adulterants were present in 14 of
15 Chinese herbal medicines.

"There was one death reported in these reports, and at least six
potentially life-threatening events," the organization said.

"Suspicion of adulteration was based not only on adverse effects, but
suspiciously good efficacy. Chinese herbal medicines may work because of
the adulterants," according to the review.

It warned of the potential for adverse events, especially when other
treatments were being prescribed at the same time.

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Sleep and pain.

Sleep Med Rev 2001 Oct;5(5):385-396
Moldofsky H.
Professor Emeritus, University of Toronto, Canada
PMID: 12531004

Noxious stimuli and painful disorders interfere with sleep, but
disturbances in sleep also contribute to the experience of pain.Chronic
paroxysmal hemicrania and possibly cluster headaches are related to REM
sleep. Whereas headache is associated with snoring and sleep apnea,
morning headaches are not specific for any primary sleep disorder.
Nevertheless, the management of the sleep disorder ameliorates both
morning headache and migraine.

Noxious stimuli administered into muscles during slow-wave sleep (SWS)
result in decreases in delta and sigma but an increase in alpha and beta
EEG frequencies during sleep. Noise stimuli that disrupt SWS result in
unrefreshing sleep, diffuse musculoskeletal pain, tenderness, and
fatigue in normal healthy subjects.

Such symptoms accompany alpha EEG sleep patterns that often occur in
patients with fibromyalgia. The alpha EEG patterns include phasic and
tonic alpha EEG sleep as well as periodic K alpha EEG sleep or frequent
periodic cyclical alternating pattern. Moreover, alpha EEG sleep, as
well as sleep-related breathing disorder and periodic limb movement
disorder, occur in some patients with fibromyalgia, rheumatoid arthritis
and osteoarthritis.

Depression and not alpha EEG sleep are features of somatoform pain
disorder. Disturbances in sleep, pain behaviour and psychological
distress influence return to work in workers who have suffered a soft
tissue injury, e.g. low back pain. Patients with irritable bowel
disorder have disturbed sleep and have increased REM sleep.

In conclusion, there is a reciprocal relationship between sleep quality
and pain. The recognition of disturbed or unrefreshing sleep influences
the management of painful medical disorders.
Possible influence of defenses and negative life events on patients with
chronic fatigue syndrome: a pilot study.

Journal: Psychol Rep 2002 Dec;91(3 Pt 1):963-78
Authors: Sundbom E, Henningsson M, Holm U, Soderbergh S, Evengard B.
Affiliation: Department of Psychology, Umea University, Sweden.
NLM Citation: PMID: 12530752

13 patients with a diagnosis of chronic fatigue syndrome and two
contrast groups of conversion disorder patients (n = 19) and healthy
controls (n = 13) were assessed using the projective perceptual Defense
Mechanism Test to investigate if specific defense patterns are
associated with chronic fatigue syndrome. Another objective was to
assess the possible influence of perceived negative life events prior
the onset of the illness.

The overall results showed significant differences in defensive
strategies among groups represented by two significant dimensions in a
Partial Least Squares analysis. Compared to the contrast groups the
patients with chronic fatigue syndrome were distinguished by a defense
pattern of different distortions of aggressive affect, induced by an
interpersonal anxiety-provoking stimulus picture with short exposures.
Their responses suggested the conversion group was characterized by a
nonemotionally adapted pattern and specific constellations of defenses,
associated with interior reality orientation compared to the patients
with chronic fatigue syndrome and the healthy controls.

Rated retrospectively, the group with chronic fatigue syndrome reported
significantly more negative life events prior to the onset of their
illness than healthy controls. For instance, 5 of the 13 patients
reported sexual assault or physical battery as children or teenagers
compared to none of the healthy controls. A significant association was
found between defense pattern and frequency of reported negative life

However, these retrospective reports might be confounded to some extent
by the experience of the patients' illness; for example, the reports may
be interpreted in terms of present negative affect.
Chronic fatigue in a population-based study of Gulf War veterans.

Journal: Arch Environ Health 2002 Jul-Aug;57(4):340-8
Authors: McCauley LA, Joos SK, Barkhuizen A, Shuell T, Tyree WA,
Bourdette DN.
Affiliation: Center for Research on Occupational and Environmental
Toxicology, Oregon Health & Science University Portland, Oregon
NLM Citation: PMID: 12530602

Fatigue has been associated with illness in veterans of the Gulf War;
however, few studies have confirmed self-reported fatigue by using
clinical evaluation, and symptomatic veterans have not been evaluated
with established criteria for Chronic Fatigue Syndrome (CFS). The
authors describe the frequency and clinical characteristics of CFS in a
sample of veterans residing in the northwestern United States.

The sample was selected randomly from U.S. Department of Defense
databases of troops deployed to southwest Asia during the Gulf War. The
selected individuals were invited to participate in a clinical
case-control study of unexplained illness. Of 799 survey respondents
eligible for clinical evaluation, 178 had fatigue symptoms. Of the 130
veterans who were evaluated clinically, 103 had unexplained fatigue, and
44 veterans met the 1994 U.S. Centers for Disease Control criteria for
CFS. In this population, the authors estimated a minimum prevalence of
any unexplained fatigue to be 5.1%, and of CFS to be 2.2%. The estimated
prevalence was greater among females than among males. Cases were
similar to healthy controls, as determined by laboratory tests and
physical findings.

In comparison to several clinical studies of CFS patients, the authors
of this study found a lower proportion of veterans who reported a
sudden onset of symptoms (19%) vs. a gradual onset (50%). Although it
has previously been suggested that veterans of the Gulf War suffer from
higher rates of chronic fatigue than the general population, the study
results described herein -- on the basis of clinical examination of a
population-based sample of veterans -- actually indicate that an
increased rate may indeed exist.

Gulf War veterans with unexplained fatigue should be encouraged to seek
treatment so that the impact of these symptoms on overall quality of
life can be reduced.


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