FMS Community Newsletter #38
Wednesday, February 22, 2003

 

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Featured link: When All Else Fails, Take a Nap

This week's article at the CFIDS/Fibromyalgia Self-Help program
(http://www.cfidsselfhelp.org) is "When All Else Fails, Take a Nap." Guest
author Lisa Lorden sings the praises of daytime rest. Her article is the
latest in our series "Coping Strategies." Other series include:

Success Stories: Personal accounts of successful coping and recovery.

Ten Keys to Coping and Recovery: Strategies for managing chronic illness and
improving chances for recovery

Check it out: http://www.cfidsselfhelp.org
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This week's news:
1) Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia
2) Acupuncture Works for Chronic Pain
3) APS Develops Agenda
4) Are Joint Hypermobility & Fibromyalgia Connected?
5) DoctorsForPain.com
6) Latest clinical trials on Osteoporosis
7) 'Write' The Wrongs In Your Life
8) Drug shows promise as treatment for fibromyalgia
9) More Research Needed on Melatonin
10) Make the Most Of It! A One Day Conference for Patients and Health Care
Professionals
11) Italian Scientists Discover Migraine Gene
12) The pain vigilance and awareness questionnaire

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1) Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia

Kent Holtorf, M.D.

Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are illnesses that
often coexist and affect millions of Americans. Symptoms vary amongst
individuals and commonly include severe fatigue, sleep disturbances,
cognitive problems (commonly called ‘brain fog’), muscle pain and multiple
infections. Unfortunately, many individuals and physicians continue to deny
that these syndromes are legitimate diseases.

The medical literature is, however, very clear that these are legitimate
diseases and individuals with these syndromes have measurable hypothalamic,
pituitary, immune and coagulation dysfunction. These abnormalities then
result in a cascade of further abnormalities, in which stress plays a role.

The pituitary and hypothalamic dysfunction results in multiple hormonal
deficiencies that are often not detected with standard blood tests, and
autonomic dysfunction, including neurally mediated hypotension.

The immune dysfunction, which includes natural killer cell dysfunction,
results in opportunistic infections and yeast overgrowth, making the
symptoms worse. Recent studies have shown that the coagulation dysfunction
is usually initiated by a viral infection and has genetic predisposition.
This abnormal coagulation results in increased blood viscosity (‘slugging’)
and a deposition of soluble fibrin monomers along the capillary wall. This
results in tissue and cellular hypoxia, resulting in fatigue, and decreased
cognition (brain fog). Neurotransmitter abnormalities and macro and micro
nutrient deficiencies have also been shown to occur with these disorders.

Gulf War Syndrome, which is almost identical to CFS and FM, was found to
have a parallel cause. The cause was determined to be from multiple
vaccinations under stressful conditions in susceptible individuals. These
vaccines, which are viral mimics, resulted in the same coagulation cascade
and the deposition of fibrin monomers, resulting in the same tissue hypoxia
that occurs in FM and CFS. As a result, these multiple injections are being
discontinued by the armed forces.

Current research suggests that many triggers can initiate a cascade of
events, causing the hypothalamic, pituitary, immune and coagulation
dysfunction. The most common initiating cause is a viral infection, which
is very commonly Epstein-Barr Virus, Cytomegalovirus or HHV6. These are
found in 80% of CFS and FM patients. Many people with these syndromes can
pinpoint the onset of the disease(s) to a viral infection that never got
better. Also, stress seems to be a contributing factor. Effective
treatment, with 80 to 90 percent of individuals achieving significant
clinical benefits, can be achieved by simultaneously treating the above
problems that an individual is found to have.

The mix of treatments needed varies from patient to patient. There are some
abnormalities that are common. For instance, close to 100% of individuals
with these syndromes have low thyroid. This is, however, usually not picked
up on the standard blood tests because the TSH is not elevated in these
individuals due to pituitary dysfunction. Many of these individuals will
also have high levels of the anti-thyroid reverse T3, which is usually not
measured on standard blood tests. In addition, the majority of individuals
can also have a thyroid receptor resistance that is not detected on the
blood tests. Consequently, thyroid treatment, especially with timed release
T3, is effective for many patients. T4 preparations (inactive thyroid) such
as Synthroid and Levoxyl do not work well for these conditions.

Adrenal insufficiency and growth hormone deficiency are also very common
with these disorders, and supplementation with these hormones can often
have profound effects. As with thyroid testing, these deficiencies are,
unfortunately, usually not detected with the standard screen blood tests
and require more specific testing.

When an individual is found to have one of the viruses discussed above,
these can be treated with resulting improvement in symptoms. There are a
number of drugs, including anti-viral medication, that are currently
undergoing phase III clinical trials at clinics, including ours [Hormone
and Longevity Medical Center], for FDA approval in the treatment of FM and
CFS.

Although a concept that is sometimes uncomfortable and foreign to
traditional medical styles of thinking, the need for multiple interventions
is effective when an illness affects a critical control center (such as the
hypothalamus), which impacts the multiple systems noted above.
Unfortunately, there is not a single treatment that reverses hypothalamic
dysfunction directly. Thus, this situation is different from illnesses that
affect a single target organ and which can be treated with a single
intervention.

For example, pituitary dysfunction itself often requires treatment with
several hormones. This effect is multiplied in hypothalamic dysfunction,
which affects several critical systems in addition to the pituitary gland.
An integrated treatment approach based on simultaneously treating the above
problems is significantly beneficial in CFS and FMS. Individuals with these
devastating syndromes can “get their lives back” despite the fact that they
were previously told, “There is nothing that can be done,” or “It is all in
your head.”

Kent Holtorf, M.D.
Hormone and Longevity Medical Center
(310) 375-2705

http://www.immunesupport.com
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2) Acupuncture Works for Chronic Pain

People all across the country turn to this traditional medicine for relief
and healing

By David Blaiwas, M. Ac. L. Ac. Dipl.Ac.

A medical system that has been practiced for over 3,000 years is becoming
increasingly popular with people suffering with chronic pain conditions.
Acupuncture and Chinese Medicine have brought pain relief and healing of
symptoms to hundreds of thousands of people living with conditions such as:
low back pain, fibromyalgia, arthritis, carpal tunnel syndrome, tendonitis,
and many others.   In recent years, numerous research studies have
documented the effectiveness of acupuncture for these pain conditions, and
in 1997 a conference report from the National Institutes of Health (NIH)
stated that ..."there are other situations such as... tennis elbow,
fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel
syndrome... in which acupuncture may be useful as an adjunct treatment or an
acceptable alternative or be included in a comprehensive management
program."    But what was omitted from this NIH conference report is that
people receiving acupuncture care experience more than the relief of
physical pain, they also benefit from relief of the emotional stress and
mental strain that usually accompany chronic pain conditions.

A holistic medicine that heals more than just the physical body.

Most of the chronic pain patients in my practice tell me that their physical
pain is only part of the problem they are facing. Lack of sleep, anger and
frustration at how the pain limits their lives, digestive disorders,
headaches, and the constant fear around "how much pain will I have?" are
just some of the issues they deal with every day. Acupuncture and Chinese
Medicine is a system that is designed to treat the physical body, and the
mental and emotional impact which can result from long-term chronic pain.
It recognizes that the body, mind, and emotions are inseparable parts of
human beings, and that when one of these aspects is suffering, the others
will experience some breakdown in normal functioning. In fact, if the
mental and emotional impact of pain is not treated along with the physical
symptoms, then an important aspect of the pain response will go unnoticed.

When a person is in pain, they soon begin to experience emotional stress.
This stress can take the form of anger, fear, depression, worry... they all
result in a systemic stress response. When a person experiences moderate to
severe emotional stress, there is an involuntary tightening of virtually
all the muscles and tendons in the body. When the pain stops or is
relieved, this stress response eases, and after a period of time the
connective tissues will again relax. But if the pain is continuous, as it
is with chronic pain conditions, then the stress response will continue to
worsen the tightening of muscles and tendons, and this tightness in
connective tissue actually can and does increase the physical pain the
person feels.

There are centuries-old treatment techniques in acupuncture that have shown
to significantly reduce physical pain. But this is only part of the
healing benefits of this medicine. Because in addition to providing relief
of physical pain, there are acupuncture treatments specifically to help
the emotional system relax and reset - even in the presence of some
physical pain. For many of the patients in my practice this holistic
approach to healing the body, mind, and emotions often results in a 40-50%
decrease in the severity of the pain in addition to significantly fewer
pain episodes after 5 or 6 acupuncture treatments. They also report
noticeable improvement in the duration and quality of their sleep, the
ability to relax in their body, and a return of a sense of 'well-being'
and peace of mind which many of them never thought they could experience
again.

A different perspective on pain...

In Chinese Medicine, pain in the body is a signal that something is out of
balance in the energy system that helps us maintain health, vitality, and
heal our physical structure. If these pain 'signals' are not listened to
and treated right away, then the imbalance can grow more severe, thus
causing more intense and frequent pain as time goes on. The job of the
acupuncturist is to diagnose and treat the cause of the pain - the root or
source of the body's imbalance. Thus, acupuncture treatments do not seek
to 'mask' the pain response as most pharmaceutical drugs do, but rather to
treat and resolve what is causing the pain to occur in the person's body,
and in so doing the pain will be relieved and resolved because the reason
the pain had appeared has been healed.

This is not to say that acupuncture treatments do not have analgesic or pain
relief effects.   Because it has been practiced for over 30 centuries, there
are many very effective treatment techniques for rapid pain relief which
have been developed. But the real gift of acupuncture for people suffering
with chronic pain is this ability to restore balance and harmony in the
body's energy - which the Chinese call "Qi" or "Ch'i".   By treating and
correcting the cause of the manifestation of pain, the issue of chronic pain
can be resolved once and for all.

By using sterilized acupuncture needles- -- about one-inch in length, and no
larger than a single human hair-acupuncturists can direct and control the
movement of Qi throughout the body. Moving it from areas where it has
become stuck, which people often experience as a sharp, fixed pain, or
enhancing the Qi in areas where it is deficient, which often manifests as a
constant and severe dull ache. These breakdowns in the movement of Qi
through the body, or insufficient amounts of Qi present in one or more areas
are often the root-source of many pain conditions. The pathways, or
'meridians' by which Qi moves through the body exist not only on the
body's surface, but also run deeply through all the muscles, tendons, bones
and internal organs of our system. In this way, acupuncture can be
effective for pain relief in virtually any area of the body: be it muscular
conditions, inflammation of the joints and spine, or pain that occurs in
the internal organs.

Growing scientific evidence for acupuncture and pain relief.

The hundreds of thousands of people across the country who report relief
from pain due to their acupuncture treatments has lead to a dramatic
increase in the number of scientific research studies on acupuncture for a
wide-range of pain conditions. The results of one of these recent studies
in the Clinical Journal of Pain 1 found acupuncture to be a safe and
effective procedure for low-back pain, without producing the negative
side-effects that can accompany standard pain remedies.

For this research doctors assembled a group of 50 people suffering with
chronic low back pain who had tried a variety of other therapies ( nerve
blocks, drugs, physiotherapy, etc.) with little or no results. These
patients were divided into three study groups: a placebo group, a manual
acupuncture group, and an electro-acupuncture group. Each of the two groups
treated by acupuncture received the same treatment points, and the same
number of treatments over the same period of time. The patients recorded
their pain levels in personal pain diaries to track their progress.

Analysis of these pain diaries revealed significant differences between the
acupuncture groups and placebo patients at one, three, and six month
intervals. For the acupuncture groups, the amount of pain experienced in
the morning and evening were lower than the baseline pain score (the level
of pain each patient reported at the beginning of the study), and these
pain levels continued to decrease over the course of their treatments. The
placebo group on the other hand reported pain scores that were several
points higher than their baseline after one month of treatment. The study
goes on to report that in the acupuncture groups:

*6 of the patients who were on disability sick leave due to pain had
returned to part-time or full-time work

*patients reported decreased episodes of sleep disturbance

*patients also reported that their intake of analgesic drugs dropped
dramatically: from an average of 31

pills per week at the start of the study, down to an average of 23 pills per
week after six months

The final results of the study revealed that after one month of treatment,
16 acupuncture patients were judged to be improved, compared to only 2
placebo patients. After 6 months, 14 acupuncture patients continued to
improve, and that both forms of acupuncture (manual and electro) worked
effectively to relieve the low-back pain.

Another interesting research study measured how trained pain specialists
feel abut the use of acupuncture and complementary therapies for pain
relief. This study published in the journal Pain2   showed that 69% of the
pain specialists who responded to the study either employ acupuncture in
their own practice or refer patients to an acupuncturist.   Even more
revealing was the study result that showed 84% of the specialists who
responded believed acupuncture to be a "legitimate medical practice" for the
relief of pain conditions.

It is clear from successful results patients report about acupuncture for
pain conditions, and the mounting evidence of effectiveness from the
medical research community that people suffering from chronic pain
conditions should consider acupuncture treatments as part of their medical
care.

For more information on Acupuncture and Chinese Herbal Medicine,

Please call 301-270-2117, or e-mail: dbla-@earthlink.net

(bio)

David Blaiwas, M. Ac. L.. Ac. Dipl. Ac. is a Licensed Acupuncturist
practicing in Takoma Park, and Columbia, Maryland. He is Nationally Board
Certified in Acupuncture, and holds a certificate in Chinese Herbal
Medicine.

Mr. Blaiwas is President of the Maryland Acupuncture Society, and holds the
post of Division Chair, Masters of Acupuncture Program at The Traditional
Acupuncture Institute.

Notes:

1.      Carlsson C., Sjolund B., Acupuncture for chronic low back pain: a
randomized placebo-controlled study with long-term follow up. Clinical
Journal of Pain, 2001;17 (4);296-305

2.      Berman BM., Bausell RB. The use of non-pharmacological therapies by
pain specialists. Pain 2000; 85;313-315

http://www.painfoundation.org/enews01/acupuncture.htm
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3) APS Develops Agenda

The American Pain Society (APS) has a Task Force that is developing an
agenda to advocate for pain care, education and research during the Decade
of Pain. The agenda has short-term and long-term goals for the Decade and
is divided into four broad area: research, professional awareness, public
policy, and public awareness.

For a review of their agenda, go to the APS website at:

http://www.ampainsoc.org/pub/bulletin/jul02/pres.htm
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4) Are Joint Hypermobility & Fibromyalgia Connected?

By Kathy Longley BSc (HONS)

Could there be a possible link between joint hypermobility and fibromyalgia?
Or do these two syndromes simply overlap and mimic each other? They
certainly share the same symptoms of wide spread musculoskeletal pain and
stiffness, but does the liaison end there or do they share a similar
underlying disease process? The jury is still out within the medical
community, but research teams across the world are in the process of finding
out.

Joint hypermobility can be defined as having supple joints that have the
ability to perform movements beyond the normal range. It is most common in
young women and its prevalence can vary between populations. For example,
it is believed to affect about 5 % of the Caucasian population compared to
a frequency 38 % of Middle Eastern women (1).

Joint hypermobility can be diagnosed by asking an individual to perform a
series of hyperextensive movements. For example, placing their palms on the
floor by leaning forward without bending their knees or placing the palm of
their hand on the table and extending their fifth finger backwards by
90 degrees. If a person can perform a certain number of these abnormal
ranges of movement then they are diagnosed as having hypermobile joints.

It is believed that hypermobile joints can be genetically determined or
physically acquired, possibly through sport or work activities or
performing constant repetitive actions with a specific joint (1). The
majority of people with joint hypermobility suffer no ill effects, however,
the laxity of the joints can predispose some individuals to develop
musculoskeletal pain and stiffness in their joints and muscles. The
underlying cause of this condition is not precisely understood, but current
research points towards defective collagen fibres (2) and some researchers
now consider hypermobility to be a heritable disorder of connective tissue
(3).

Fibromyalgia is a syndrome characterized by a range of symptoms including
widespread pain, sleep disturbance, fatigue, exercise intolerance,
cognitive difficulties, anxiety and irritable bowel complaints. It is most
frequently observed among women and recent surveys have revealed that it
affects 2% of the population (3.4 % of women and 0.5 % of men) (4).

Fibromyalgia can be diagnosed using criteria proposed by the American
College of Rheumatology (ARC) in 1990. Individuals should have a history of
widespread pain for at least three months and exhibit tenderness in at
least 11 of 18 specific tender points sites when pressed upon with a force
of about
4 kg (5). The exact underlying disease processes of fibromyalgia are as yet
unknown, however, there is increasing evidence to support mechanisms of
faulty pain perception and a lack of deep sleep.
The constant interruption of deep sleep during the night disrupts the
release of growth hormone, which is responsible for repairing and restoring
the body from the day's activities (6). Any tiny tears in the muscles or
imbalance of chemicals that have built up during the day are left
unchecked.
It is like living in a body that is never fully MOTed, leaving you stiff and
sore and feeling totally unrefreshed when you awake in the morning.

Faulty pain perception arises from high levels of the chemical substance P,
used to transmit pain signals, combined with low levels of serotonin that
work to depress pain, causing all pain messages to be greatly amplified
(7). It is like the brain receiving the messages at full blast with no
control over the volume switch. This state of play is referred to as
central sensitization.

How do these two syndromes compare in the field of research? Current
research studies have come up with conflicting results. Researchers
Acasuso-Diaz and Collantes-Estevez from Cordoba in Spain believe the two
disorders are associated and that mobile joints may play an important role
in the underlying cause of fibromyalgia. Their study in 1998 compared 66
women with fibromyalgia to 70 women diagnosed with other rheumatic
diseases. Statistical analysis revealed a significant difference between
these two groups, with 27 % of the women with fibromyalgia having
hypermobile joints compared to only 11.4 % of the women with other
rheumatic disorders (8).

This conclusion is supported by a study in 1993 by Buskila et al from
Beer-Sheva in Israel working in association with A. Gedalia based in New
Orleans, USA (9). In this study 338 children between the ages of 9-15 were
assessed for symptoms of joint hypermobility and fibromyalgia. Children who
could perform at least three hypermobile movements were considered to have
hypermobility and those who fulfilled ARC criteria were diagnosed as having
fibromyalgia. In total, 43 children were found to display hypermobility and
21 fulfilled the criteria for fibromyalgia. 40 % of the 43 children with
joint hypermobility also had fibromyalgia and the authors concluded by
statistical analysis that the two conditions were highly associated in
children (9).

In contrast to these results researcher Karaaslan and his colleagues from
Ankara in Turkey did not find a strong association between fibromyalgia and
joint hypermobility. They began their studies with 88 women with widespread
pain diagnosed as fibromyalgia and 84 healthy controls. On independent
examination of the fibromyalgia participants they found that only 56 of the
88 fulfilled the ARC diagnostic criteria.

When the reduced number of fibromyalgia participants was tested for
hypermobile joints, 8 % displayed the symptoms of joint hypermobility
compared to 6 % of the healthy controls. Interestingly though, out of the
32 remaining participants with widespread pain who did not fulfill the ARC
criteria, 31% displayed hypermobile joints (2).

The researchers concluded that those participants fulfilling the ARC
criteria for fibromyalgia showed little association with joint
hypermobility, demonstrating an almost equal frequency when compared with
the healthy controls. Whereas those with widespread pain showed a much
closer link and could in fact have joint hypermobility, which has been
misdiagnosed as fibromyalgia. They reasoned hypermobility most likely plays
a role in musculoskeletal pain in some individuals, but not necessarily in
fibromyalgia.(1)

It seems evident from all three studies that joint hypermobility is linked
to widespread musculoskeletal pain in some individuals. However, the
research studies conflict as to whether there is a direct link to
fibromyalgia. It is feasible that joint hypermobility could mimic and be
misdiagnosed as fibromyalgia, underlining the importance of the ARC
criteria. Nevertheless, rheumatologists tend to differ in opinion as to
whether strict adherence to ARC criteria is beneficial, but in the light of
the evident overlap in symptoms some criteria need to be in place to
prevent misdiagnosis.

Interestingly, joint hypermobility has also been linked to osteoarthritis
(1&10). It is believed that these two conditions may share the same defects
in connective tissue or the increased risk of trauma to the joints in
individuals with hypermobility may increase the risk of developing
osteoarthritis (1). This additional connection suggests that hypermobile
joints are unlikely to have a singular connection with fibromyalgia. It also
detracts from the results by Acasuso-Diaz et al who compared the frequency
of joint hypermobility in fibromyalgia with a group consisting of a range
of rheumatic conditions, including, osteoarthritis, rheumatoid arthritis,
lupus, carpel tunnel syndrome, tendonitis and osteoporosis. Perhaps if they
had compared the frequency in fibromyalgia with the same number of
participants with osteoarthritis a similar or even stronger association may
have been found between hypermobility and the latter.

How could joint hypermobility predispose to fibromyalgia? It is suggested
that excessive or inappropriate physical activity undertaken by people with
joint hypermobility can lead to hyperextension of the joint capsule with
repeated microtrauma to the ligament structures and surrounding muscles.
This idea is supported by studies of hypermobile military recruits who
suffer muscular and ligament lesions due to the excessive physical activity
(1). If the microtrauma to the muscles and ligaments is constantly
repeated, this could lead to over activation of the pain receptors around
the joints causing them to become hypersensitive. This hypersensitivity
could lead to amplification of the pain signals, eventually creating a more
widespread pain syndrome and triggering the additional symptoms of
fibromyalgia. It is suggested that good muscle tone could protect
hypermobile joints and physical conditioning with regular but not excessive
exercise could help prevent the development of musculoskeletal pain.

In summary, Mary-Ann FitzCharles a rheumatologist from McGill University in
Montreal states that, "There is increasing evidence that at least a
sub-group of patients with soft tissue musculoskeletal pain, widespread
pain, or fibromyalgia are hypermobile. Clearly, hypermobility is not the
only or the major factor in the development of widespread pain or
fibromyalgia, but rather a contributing mechanism in some individuals."(1)
Further research is the only way forward to shed more light on this issue
and it will be interesting to see what is discovered over the next decade.

REFERENCES

1. Fiztcharles 2000, Is Hypermobility a Factor in FM?
Journal of Rheumatology, Vol:27, No.7, pp1587-1589.

2. Karaaslan et al 2000, Joint Hypermobility & FM: A Clinical Enigma.
Journal of Rheumatology, Vol:27, No.7, pp1774-1776.

3. Grahame et al 2000, The Revised Criteria for the Diagnosis of Benign
Joint   Hypermobility Syndrome. Journal of Rheumatology, Vol:27, No.7,
pp1777-1779.

4. Wolfe et al 1995, The prevalence & characteristics of FM in the general
population. Arthritis & Rheumatology, Vol:38, pp19-28.

5. Wolfe F et al 1990, The American College of Rheumatology
1990 Criteria for the Classification of FM. Arthritis & Rheumatism, Vol. 33,
No. 2, pp 160-172.

6. Paiva et al 1994, Sleep cycles and alpha-delta sleep in fibromyalgia.
Journal of Rheumatology, Vol. 21, pp 1103 - 7.

7. Russell J 1994, Elevated cerebrospinal fluid levels of substance P in
patients with FM.
Arthritis & Rheumatism, 1994, Vol. 37, No. 11, pp 1593-1601.

8. Acasuso-Diaz & Collantes-Estevez 1998, Joint Hypermobility in Patients
with FM. Arthritis Care & Research, Vol:11, No.1, pp39-42.

9. Buskila et al 1993, Joint Hypermobility & FM in Schoolchildren. Annals
of Rheumatic Diseases, Vol:52, pp494-496.

10. Hudson et al 1995, Diagnostic Associations with Hypermobility in
Rheumatology Patients.
Vol:34, pp1157-1161.

11. P. Klemp 1997, Hypermobility. Annals of Rheumatic Diseases, Vol:56,
pp573-575.

Website http://www.ukfibromyalgia.com
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The home of the FaMily ezine-The UK's leading monthly resource for FM
sufferers
Email mailto:fam-@UKFibromyalgia.com

Source: Co-Cure: http://www.co-cure.org
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5) DoctorsForPain.com

A Physician's Location Directory for chronic pain patients, actively online
for a little over a year, ranked high on the major search engines and have
over 12,000 hits per day and growing.

Our mission: To help chronic pain patients locate a pain specialist in their
area. And, In an effort to help them better understand their
illness/disease, we have provided information regarding chronic pain,
history of pain, types of treatments available, helpful medical and support
links, self-help suggestions, forms and a variety of information that may be
beneficial. We have tried to keep all information in an easy-to-understand
format and easy to navigate.

http://www.doctorsforpain.com/
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6) Latest clinical trials on Osteoporosis

A research study that will test two FDA approved, marketed medications for
the treatment of osteoporosis. Women who are past menopause and at least 40
years old may be eligible to participate. Research site located in
Philadelphia, Pennsylvania.

More Information:

Please see http://www.centerwatch.com/patient/studies/cat111.html
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7) 'Write' The Wrongs In Your Life

by Ellen DeLalla, R.N., L.M.H.C.
Special For eDiets

In recent years, more and more experts direct people to journal. It tells
your story; allows you to track the patterns that often get you into
trouble. It’s one of those tools of recovery that many people resist -- but
once they start -- they are amazed at the therapeutic value.

Journaling remains an essential avenue for you to communicate with yourself
about your troubles and plan your triumphs. In a paper submitted for the
American Anorexia and Bulimia Association, Sondra Kronberg, President of
the Eating Disorder Council of Long Island, shares the goals and purpose of
journaling:

Writing, in whatever form it takes, is an expression of whom we are and what
we need to say. The process of writing may serve to soothe, comfort,
create, distract, exhilarate and often diminish pain, while bringing focus
and awareness to our inner thoughts, feelings and behaviors.

Writing is a canvas for the thoughts and feelings we may not be ready to
express verbally and for clarifying those thoughts and feelings, which are
vague or not yet tangible. It's a window to our soul, our inner core and
our self-truths. Writing allows time for reflection and offers a precious
opportunity for self-observation and awareness.

Although all forms of writing are healing and wonderful tools for
self-discovery and self-realization, journal writing is a particularly
effective and critical tool in the presence of a poor body image.

Journaling can be an important multi-purpose tool for fostering growth. Keep
a journal of everything that goes on during the day. The goal is to observe
yourself as if you were an on-the-spot reporter, keeping track of
everything that happens. Your job is to observe and record what you notice,
what is happening to and around you (both the facts and the feelings).
Observe, do not evaluate or judge. It's important that this be a discovery
process, not a beat up, blaming, bashing or shaming event.

This is an exploration, an investigation to unearth more about you. The
journal is a way of focusing in, listening to your behaviors and inner
dialogue. Writing it down makes it clearer and often more visible. It helps
you see your actions with greater precision and enables you to make the
correlation between your thoughts, feelings, and behaviors.

It often assists in bringing subconscious thought to a more conscious level
and helps you connect your thoughts and feelings to body image and
sexuality. Journaling brings continued awareness and continued opportunity
to challenge old beliefs and behaviors; therefore, enabling you to develop
your potential and maximize your worth and abilities.

In addition to the journal being a tool for observation, which leads to
self-growth, the journal writing process ideally serves many purposes. It
becomes a vehicle for expression, a mechanism for soothing, a means of
release and a form of creative discipline.

Each writer must find the ways and means of journaling that are rewarding.
Not all tools will benefit everyone in the same way or to the same degree,
but this is one tool that will move you miles if you are willing to commit
to taking the trip. Often old thoughts about writing can get in the way of
you being able to make that commitment.

You may feel that you don’t have time to journal, or that journaling feels
like yet one more job to do. Resistance to journal writing is a resistance
to self-care. Those who persist and push past these barriers ultimately
learn that journaling can be a conduit for self-discovery, self-empathy,
engagement and enrichment throughout their lives.

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8) Drug shows promise as treatment for fibromyalgia: Pregabalin slows the
release of brain chemicals that may cause the chronic pain.

By Linda Marsa
LA Times Staff Writer

Conventional medications, such as Tylenol, Motrin or even morphine, provide
little relief to sufferers of fibromyalgia, a mysterious and debilitating
pain disorder for which there is no effective treatment. But a new drug may
be able to thwart the nerve signals that scientists now believe trigger the
pain.

"This is a real breakthrough not only because it works, but it proves
fibromyalgia can be treated," says Dr. Leslie Crofford, a rheumatologist at
the University of Michigan in Ann Arbor who has studied the new drug,
pregabalin.

The syndrome, which affects an estimated 5.6 million Americans, the majority
of whom are women, is characterized by pervasive muscle aches and pain so
intense that many people are unable to work or perform the simplest of
tasks. Because the syndrome can't be diagnosed with conventional laboratory
tests, such as blood tests or CAT scans, and is resistant to treatment,
some physicians have thought that sufferers were hypochondriacs or simply
depressed.

"Patients got a bad rap because doctors felt they didn't want to get
better," says Crofford, "and that there was nothing that could make them
get better."

The underlying cause of this condition is still unknown. But newer, more
precise imaging tools can now map out the nerve pathways in the brain that
are responsible for pain. This has given scientists some insights into why
fibromyalgia sufferers are so exquisitely sensitive.

"The slightest sensory stimulation -- even being touched when putting on
clothes -- can be highly painful in people with fibromyalgia," says
Laurence A. Bradley, a fibromyalgia expert at the University of Alabama at
Birmingham. "We suspect there are abnormalities in both the pain
transmission and pain inhibition system."

Pregabalin reduces the release of specific brain chemicals, such as
glutamate and noradrenaline, that may cause pain, says Terry Griesing, a
neurology researcher with Pfizer Inc. in New York, the company that makes
pregabalin. "This is our best understanding of what is happening," she
says.

Early studies of the drug demonstrated that it was effective in controlling
pain due to nerve damage, such as that suffered by people with shingles and
diabetics with hand and foot pain. Because scientists suspect that
fibromyalgia is caused by a similar mechanism, Griesing says, "the decision
was made to test it for fibromyalgia."

In a recent eight-week study of pregabalin in 529 fibromyalgia patients, 29%
of the pregabalin-treated volunteers reported at least a 50% reduction in
pain, and their sleep quality and fatigue levels were significantly
improved. Patients who took the highest doses of the drug had the best
responses, Crofford says.

Pregabalin has already completed pivotal tests as a treatment for
generalized anxiety disorder, nerve pain and epilepsy. Pfizer hopes to file
for approval from the Food and Drug Administration for these uses within 12
months, according to a spokesman. The drug could be on the market as early
as 2004. Once it's approved, doctors can also prescribe it for other
conditions, such as fibromyalgia.

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9) More Research Needed on Melatonin, Say Scientists

By Patricia Reaney

LONDON (Reuters) - Melatonin is widely used to relieve the effects of jet
lag but better safety standards and more research on it is needed,
scientists said on Thursday.

Millions of people already take melatonin, which is sold in pharmacies and
health food stores in the United States, Thailand, Singapore and on the
Internet, but only a handful of studies have been done on it.

"We know that it works. We would like to know more about what doses to use
for different groups of people," said Andrew Herxheimer of the Cochrane
Center, which publishes reviews on healthcare treatments.

"We need safety data. We need to find out what happens with anticoagulants
(blood thinners), blood coagulation and brain rhythms, especially in people
with epilepsy," he added in an interview.

Side effects from melatonin are very rare but Herxheimer said people taking
blood-thinning drugs or those who suffer from epilepsy should avoid
melatonin until more is known about it.

Melatonin is a hormone that is produced by the pineal gland in the brain
when the body is exposed to light.

Herxheimer said there is no financial incentive for drug companies to
conduct research into melatonin so he and Jim Waterhouse, of John Moores
University in Liverpool, England, are calling for public funding because
governments, the armed forces and the public could benefit from using it
for jet lag.

"If the use of the drug is in the public interest, then public funds should
be used to get it properly tested and licensed," they said in a report in
the British Medical Journal.

Jet lag results when various body rhythms, such as sleep and activity, and
environmental rhythms are out of step due to flying across times zones. It
usually takes a few days for the body clock to shift to the new time zone.
Melatonin eases the transition and relieves jet lag.

Herxheimer is also concerned that there are no official standards of purity
for melatonin.

"Four of six melatonin products bought in health food shops in the United
States were found to contain unidentified impurities," he said in the
journal report.

To minimize the effects of jet lag, he advised people traveling westward to
stay awake during daylight at their destination and to sleep when it gets
dark.

People going in the opposite direction should avoid bright light in the
morning and be outdoors as much as possible in the afternoon.

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10) Make the Most Of It! - A One Day Conference for Patients and Health
Care Professionals

Treating and Living with Fibromyalgia, Chronic Fatigue Syndrome and
Myofascial Pain Syndrome

For The First Time Top-notch Medical and Legal Professionals From Across The
Country Join Together For A One-Day Conference.

A One Day Conference for Patients and Health Care Professionals

For Patients:

If you suffer from FMS, CFS OR MPS, you need to attend. This is the first
time that five of the top experts in the field will all be together in one
place. You will learn the latest trends in treatment as well as be brought
up to date on related legal and disability issues by two top notch
attorneys.

Health Care Professionals (Doctors, Nurses, Physical Therapists,
Psychologist, Chiropractors, Massage Therapist, Body Workers, etc.)

You owe it to yourself and your patients to attend our special educational
sessions for healthcare professionals. Our serious of renowned speakers
will explore Disability Issues & the Latest Advance in Effective Treatment
for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain Syndrome.

Saturday, March 22, 2003
8:00AM to 6:00 PM Clarion Hotel
5901 Pfeiffer Road Cincinnati, Ohio

Featured Speakers Include:

Hal Blatman, M.D.
Founder and medical director of the Blatman Pain Clinic. Author of the
forthcoming book "The Art of Body Maintenance: The Winner's Guide To Pain
Relief.

Scott E. Davis, JD Scott has earned a nationwide reputation for his work
representing clients diagnosed with Fibromyalgia and/or Chronic Fatigue
Syndrome who are seeking Social Security and long term disability benefits.

Steven P. Krafchick, MPH, JD One of the most experienced trial attorneys in
the nation representing clients seeking long term disability insurance
benefits and clients with tort claims that involve Fibromyalgia, CFIDS, and
related conditions.

Devin J. Starlanyl Best Selling Author of Fibromyalgia and Chronic
Myofascial Pain: A Survival Manual and The Fibromyalgia Advocate

Jacob Teitelbaum, M.D.
Director-Annapolis Research Center for Effective CFS/FMS Therapies.
Best Selling Author of From Fatigued to Fantastic!
and senior author of the recently published Landmark Study Effective
Treatment Of Chronic Fatigue Syndrome and Fibromyalgia.
His new Book, Three Steps to Happiness: Healing Through Joy has just been
released.

Pamela Gilchrist, APR, CPT An inspirational speaker, professional
communicator and FMS/MPS survivor

Hosted By:
The Blatman Pain Clinic
Conference Register by March 14, 2003

Online: http://www.blatmanpainclinic.com
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Phone: 513-956-3200

Chip Davis, Jane Kohler and Nancy Solo from the FMS Community will be there.
Hope to see you too!

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11) Italian Scientists Discover Migraine Gene

By Rachel Sanderson

MILAN, Italy (Reuters) - Two Italian scientists have discovered a gene
linked to severe migraines, a finding they say could pave the way to
banishing not only migraines but everyday headaches as well.

Geneticist Giorgio Casari and neuroscientist Roberto Marconi of Milan's San
Raffaele Institute spent four years screening the genetic makeup of six
generations of a migraine-prone family and found they all had a gene in
common.

"We have discovered a new gene related to migraines and this opens a pathway
... to new therapeutic approaches," Casari told Reuters from his Milan
office Tuesday.

The research is set to be published online by the journal Nature Genetics.

Found in chromosome 1--one of the most well-documented chromosomes of the
human body--the ATP1A2 gene causes a malfunction of the pump that shifts
sodium and potassium through the cell, the scientists said.

Rather than healthy, polygon-shaped cells, the mutant cells were rounded and
swollen, leading to the pain, flashing lights and sensation of tingling
hair that debilitates severe "aura" migraine sufferers.

"The chromosome is so well researched, it will not be difficult or take long
to find a therapy for it," Casari said.

Current pills for headaches tend to numb the pain but not mend the cause,
and targeting the faulty pump action could head off the pain at its source,
helping not only sufferers of hard-hitting migraines but those who get
common headaches too.

"A milder form of the mutation could be responsible for a milder headache,"
Marconi said.

Hundreds of trial patients are lined up to participate in the next round of
research, which will look into whether the gene is also responsible for
milder headaches, the scientists said.

Casari and Marconi are ready to work with drug developers to find a
treatment to fix the faulty pump action. They say the right drug could
already be available but existing treatments need to be tested for
suitability.

The pair are the latest Italian scientists to carry out breakthrough
research on a shoe-string budget, overcoming reams of red tape--a
predicament that has caused many of Italy's best scientific minds to flee
the country.

Casari said the research cost around $100,000, a trickle compared with the
rivers of funds available to US and British scientists.

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12) The pain vigilance and awareness questionnaire (PVAQ):
Further psychometric evaluation in fibromyalgia and other chronic pain
syndromes.

Pain 2003 Feb;101(3):299-306

Roelofs J, Peters ML, McCracken L, Vlaeyen JW.

Department of Medical, Clinical and Experimental Psychology, Maastricht
University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

PMID: 12583873

In chronic pain patients, preoccupation with or attention to pain is
associated with pain-related fear and perceived pain severity. The current
study investigated psychometric properties of the pain vigilance and
awareness questionnaire (PVAQ).

An exploratory factor analysis on Dutch fibromyalgia patients indicated that
a two-factor solution was most suitable. The first factor could be referred
to as attention to pain and the second factor was interpreted as attention
to changes in pain. A confirmatory factor analysis, testing three different
factor structures in two independent samples (Dutch fibromyalgia patients
and American pain patients with various diagnoses) showed that the
goodness-of-fit indicators for all models were satisfactory.

The existence of the previously reported intrusion subscale of the PVAQ as a
unique construct within the PVAQ was discussed. This subscale should be
further extended by non-reverse-keyed items. With regard to the convergent
validity, the PVAQ was highly correlated with related constructs such as
the pain catastrophizing scale (PCS), pain anxiety symptoms scale (PASS),
and Tampa scale of kinesiophobia (TSK). The attention to pain subscale was
significantly stronger associated with these pain-related measures than the
attention to changes in pain subscale, indicating that attention to changes
in pain is a distinctive construct. The uniqueness of the attention to
changes in pain subscale was also supported by an exploratory factor
analysis on all items of the PVAQ, PCS, PASS, and TSK which showed that all
items from that scale loaded on one separate factor.

Overall, the PVAQ showed good internal consistency. Implications for future
research and treatment interventions are discussed.

 

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