March 16, 2003

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Self-help course registration ends soon
The next session of the CFIDS/Fibromyalgia Self-Help course begins April
7. Registration ends March 31 or whenever classes fill, whichever comes
first. (Recent classes have filled up before the end of registration.)
The class is an 8-week email discussion group that focuses on practical
strategies for managing common problems of fibromyalgia, CFIDS and
related illnesses. In this solution-oriented course, you exchange ideas
with fellow patients to learn how to pace, set realistic short-term
goals, reduce stress, manage emotions, improve relationships, and
minimize relapses.
To learn more about the course or to register online, visit our website:
AOL users: Read it here: <a href=""> CFIDS
Self-help </a>
This week's news:
1. Short Sleepers Have Higher Diabetic Risk
2. Sociodemographic characteristics, risk factors and reproductive
history in subjects with fibromyalgia
3. Fibromyalgia: Finding Treatments That Work for You
4. Treating Chronic Nonmalignant Pain: Issues and Misconceptions
5. Temporal summation of pain from mechanical stimulation of muscle
tissue in normal controls and subjects with fibromyalgia
6. Central Nervous System and FM
7. Ten Steps From Patient to Person
8. Auditory p300 event-related potentials in fibromyalgia patients.
9. Sexuality Concerns and Issues
10. Fibromyalgia or Myofascial Pain Syndrome? Understanding - and
Treating, the Differences
11. Exercise Helps In Fibromyalgia Despite Initial Pain
12 Say 'No' to Responsibility Overload
13.Antidepressants and Driver Impairment: Empirical Evidence From a
Standard On-the-Road Test
14.The positive side
*Since sleep is a problem for people with FM this article may be of
interest and also encouragement to do some preventive care by altering
your eating habits.

Short Sleepers Have Higher Diabetes Risk
By Alison McCook
NEW YORK (Reuters Health) -"People who tend to clock an average of five
hours or less or at least nine hours of sleep each night may have a
slightly higher risk of developing diabetes, new research suggests.
Investigators who followed more than 70,000 diabetes-free women over
time found that women who slept five hours every night at most were 34%
more likely than people who slept for seven or eight hours each night to
develop diabetes symptoms during the study period.
People who said they logged at least nine hours of sleep each night were
also 35% more likely to develop diabetes symptoms over a 10-year period,
the authors report in the February issue of Diabetes Care. "
AOL; <a href=
Read it here</a>

Sociodemographic characteristics, risk factors and reproductive history
in subjects with fibromyalgia - results of a population-based
case-control study.
[Article in German]
Z Rheumatol 2003 Feb;62(1):46-59 Schochat T, Beckmann C.
Universitatsklinikum Ulm Institut fur Arbeits-, Sozial- und
Frauensteige 10 89075 Ulm, Germany.
PMID: 12624804
OBJECTIVES: According to recent studies, 1.3 to 4.8% of the population
Western industrialized nations suffer from fibromyalgia, with 80 to 90%
the affected persons being women. This preponderance of women, mostly in
their reproductive years, suggests an association between fibromyalgia
sex hormones.
METHODS: Within the framework of a population-based cross-sectional
study f 3174 female residents of Bad Sackingen aged 35 to 74 years a
stratified andom sample of 653 women was clinically examined and
Thirty-six f these women fulfilled the ACR criteria of fibromyalgia.
Forty-four women suffered from chronic widespread pain without having
fibromyalgia (chronic pain group); 408 had no chronic pain (controls).
RESULTS: Compared to the control group, subjects with fibromyalgia have
3.6-fold risk, while compared to the chronic pain group, there is a
3.9-fold risk of having a lower social level. Subjects with fibromyalgia
drink less alcohol than subjects from the chronic pain group and the
control group. After adjusting for age, multivariate analyses
that, in comparison to controls, subjects with fibromyalgia have a
significantly later menarche (OR=2.2 for >14 years) and had never been
pregnant (OR=0.3). The comparison of the chronic pain group and controls
did not demonstrate these associations.
CONCLUSIONS: The associations with a low social level, low alcohol
late menarche and rare pregnancies are specific for subjects with
fibromyalgia. These factors distinguish subjects with fibromyalgia from
subjects with other chronic pain conditions as well as from subjects
no chronic pain. The same hormonal factors responsible for a delayed
menarche and a reduced fertility may be relevant in the development of
Source: Co-Cure

Fibromyalgia: Finding Treatments That Work for You
Dr. Michael Vesely, D.C.
"When you have been diagnosed with fibromyalgia you will understand that
there is not a single medication, a single exercise or a single diet
that will offer a "cure." You must experiment with different
medications, different exercises, different diets and different
lifestyle approaches until you find out what works for you. "
*The article found at the web site below offers insight into both
allopathic and alternative medicine routes that may be of help to you.
AOL: <a

Read it here <a/>



For as long as people have been aware of weather, they've pondered its
impact on their health. The Greeks noted the effect of "hot and cold
winds" on pain and illness 2,400 years ago. During the Civil War,
physicians wrote about amputee soldiers sensing pain in their "phantom"
limbs when the weather changed. And folk wisdom tells of people who
"feel the weather in their bones."
This is an interesting sub-section of the Weather Channel. You can type
in your zip code and it will give you an "aches & pains" prediction for
the next 10 days.
AOL: <a
ns101/index.html?from=aplocalfcst" Read it here </a>

Treating Chronic Nonmalignant Pain: Issues and Misconceptions
This text-based teaching module reviews chronic malignant pain versus
acute and malignant pain, common barriers to optimal pain management,
recommended components for pain assessment, controversies and concerns
regarding opioid use and strategies for pain management.
AOL users: <a href=
=10"> Read it here </a>

Temporal summation of pain from mechanical stimulation of muscle tissue
in normal controls and subjects with fibromyalgia syndrome.
Pain 2003 Mar;102(1-2):87-95
Staud R, Cannon RC, Mauderli AP, Robinson ME, Price DD, Vierck CJ.
Department of Medicine, McKnight Brain Institute, University of Florida
College of Medicine, 1600 SW Archer Rd, P.O. Box 100221, 32610-0221,
Gainesville, FL, USA
PMID: 12620600
Individuals diagnosed with fibromyalgia syndrome (FMS) report chronic
pain that is frequently worsened by physical activity and improved by
rest. Palpation of muscle and tendinous structures suggests that
nociceptors in deep tissues are abnormally sensitive in FMS, but methods
of controlled mechanical stimulation of muscles are needed to better
characterize the sensitivity of deep tissues.
Accordingly, force-controlled mechanical stimulation was applied to the
flexor digitorum muscle of the forearm in a series of brief contacts (15
stimuli, each of 1s duration, at 3 or 5s interstimulus intervals).
Repetitive stimulation was utilized to determine whether temporal
summation of deep muscular pain would occur for normal subjects and
would be enhanced for FMS subjects.
Moderate temporal summation of deep pain was observed for normal
controls (NC), and temporal summation was greatly exaggerated for FMS
subjects. Temporal summation for FMS subjects occurred at substantially
lower forces and at a lower frequency of stimulation. Furthermore,
painful after-sensations were greater in amplitude and more prolonged
for FMS subjects. These observations complement a previous demonstration
that temporal summation of pain and after-sensations elicited by thermal
stimulation of the skin are moderately enhanced for FMS subjects.
Abnormal input from muscle nociceptors appears to underlie production of
central sensitization in FMS that generalizes to input from cutaneous
Source: Co-Cure

Although central nervous system dysfunction frequently occurs in
fibromyalgia (FM) patients, proprioceptive [nerve ending] disturbances
might also explain some of the abnormalities observed. Rosenhall et al
(1996) reported that 72% of 168 FM patients studied suffered from
vertigo/dizziness, 15% were afflicted with sensorineural hearing loss,
30% had evidence of brainstem dysfunction, 28% had abnormal saccades and
58% had pathological smooth pursuit eye movements in oculomotor studies,
and 45% had a pathological electronystagmography [method of recording
muscle activity outside the eye.] On the other hand, Heller et al (1998)
reported that 28% of 80 patients with sudden deafness and progressive
hearing losses displayed symptoms typical for FM and CFS disorders,
including fatigue, myalgia, arhtralgia, depression, sicca symptoms, and
(Source: The Concise Encyclopedia of Fibromyalgia and Myofascial Pain,
by Roberto Patarca-Montero, M.D., Ph.D.)

Ten Steps From Patient to Person

Making the journey from patient to person takes time. The isolation and
fear that can overwhelm a person with chronic pain grows over time. And
the return to a fuller, more rewarding life also takes time.
It's a journey with many phases. The ACPA (American Chronic Pain Assoc.)
describes these phases as Ten Steps.
The ACPA's Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there
may be no current cure and accept that you will need to deal with the
fact of pain in your life.
STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice
and ask what you can do to move from a passive role into one of
partnership in your own health care.
STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life.
List the things that you would like to do. Setting priorities can help
you find a starting point to lead you back into a more active life.
STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to
accomplish or break a larger goal down into manageable steps. And take
time to enjoy your successes.
STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with
respect, to say no without guilt, to do less than humanly possible, to
make mistakes, and to not need to justify your decisions, with words or
STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well
being. By acknowledging and dealing with your feelings, you can reduce
stress and decrease the pain you feel.
STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of
reclaiming control of your body. Deep breathing, visualization, and
other relaxation techniques can help you to better manage the pain you
live with.
STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel
more pain than toned flexible ones. With your doctor, identify a modest
exercise program that you can do safely. As you build strength, your
pain can decrease. You'll feel better about yourself, too.
STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights,
deal with your feelings, relax, and regain control of your body, you
will see that pain does not need to be the center of your life. You can
choose to focus on your abilities, not your disabilities. You will grow
stronger in your belief that you can live a normal life in spite of
chronic pain.
STEP 10: Reach Out
It is estimated that one person in three suffers with some form of
chronic pain. Once you have begun to find ways to manage your chronic
pain problem, reach out and share what you know. Living with chronic
pain is an ongoing learning experience. We all support and learn from
each other.


Auditory p300 event-related potentials in fibromyalgia patients.
Yonsei Med J 2003 Feb;44(1):89-93
Yoldas T, Ozgocmen S, Yildizhan H, Yigiter R, Ulvi H, Ardicoglu O.
Firat University, Tip Fakultesi, Noroloji Anabilim Dali, 23119, Elazig,
PMID: 12619180
This study assessed the cognitive brain function measured by the
cognitive P300 auditory event-related potentials (ERPs) in female
fibromyalgia (FM)patients and compared the results with those from
healthy age and
education-matched controls. The relationship of the P300 potentials to
pain threshold of patients was also investigated.
The P300 component of the auditory ERPs were studied in 11 female FM
patients and 10 age and education-matched healthy controls. None of the
patients were taking antidepressants such as amitriptyline or
serotonin-reuptake inhibitors.
The P300 latencies of the patients were not significantly different
the N2P3 amplitudes were significantly lower than the controls. The P300
latencies in the patients negatively correlated with the total myalgic
scores (TMS) (r= -0.73) and the control point scores (CPS) (r=-0.85). On
the other hand, the P300 amplitudes showed a significant correlation
the TMS (r=0.61) and the CPS (r=0.60). There was no significant
between the anxiety and depression scores with the P300 latency or
These results showed cognitive impairment, which was mainly expressed by
the lower N2P3 amplitudes in patients with FM, and its clinical
requires further research.

*Although this article and web site are related to arthritis many of the
same issues involved in sexual intimacy effect people with FM as well.

The physical and emotional concerns related to sexuality and arthritis
can weigh heavily on someone who thinks he, or she, is the only one with
doubts or uncertainties. If this is you, rest easy - you are not alone.
Our request for your questions on this topic brought hundreds of
letters. To get you the information and support you need, we gathered a
group of experts who would honestly and sensitively answer the most
commonly asked questions.
The experts Arthritis Today consulted - both the professionals and the
people with arthritis - believe there are solutions. Though familiar
with the challenges, vulnerabilities and frustrations that you wrote
about, not one had any doubt that a healthy, satisfying sex life is
possible for everyone with arthritis or a related condition. You and
your partner can learn to adapt and communicate in ways that may make
your desire stronger, your experience more fulfilling, and your
relationship even deeper than it has ever been.
AOL users: <a href=
.asp" Read it here <a/>

Fibromyalgia or Myofascial Pain Syndrome? Understanding - and Treating,
the Differences
By Bernard E. Filner, M.D.
Are you confused about the differences between Fibromyalgia and
Myofascial Pain Syndrome? Probably your doctor is also! This article may
be of assistance to both of you.
AOL users: <a href=
"" Read it here

Exercise Helps In Fibromyalgia Despite Initial Pain
A series of controlled graded aerobic exercise is a simple, cheap, and
effective treatment for patients with fibromyalgia.
A major problem at the beginning of an exercise program is convincing
patients it will work because they suffer initial increases in pain and
stiffness immediately after exercise. This may convince many patients at
the beginning that exercise will worsen their condition, warns Dr.
Selwyn Richards and colleagues at the Department of Rheumatology at
Poole Hospital, Poole, Dorset, England.
Conventional medical treatment of fibromyalgia with analgesics,
non-steroidal anti-inflammatory drugs, and antidepressants is relatively
ineffective, the clinicians said. Several randomized controlled trials
of exercise therapy in fibromyalgia produced generally positive results,
but were under-powered, excluded many cases, and were supervised in
hospitals by highly experienced healthcare professionals.
One hundred and thirty two men and women with fibromyalgia, selected
from an initial population of 7,806 patients attending the hospital
rheumatology clinic, were enrolled over a one year period into a
randomized controlled trial. The patients were randomly assigned to
either aerobic exercise classes or relaxation classes, twice weekly for
12 weeks. Classes were carried out by personal trainers with no special
experience in providing exercise for people with ill health.
The clinicians then gauged results based on the men and women who
reported on their improvement, plus tender point count, impact of
condition measured by fibromyalgia impact questionnaire, and short form
McGill pain questionnaire.
The exercise program, when compared with the relaxation program, led to
significantly more men and women rating themselves as much, or very
much, better at three months. These benefits were maintained, or even
improved in some patients, when they were assessed a year later,
especially the fall in tender point counts.
The researchers said exercise treatment has limitations, especially with
compliance by the men and women when they suffer pain after beginning
the exercise program. "Future strategies to increase the efficacy of
exercise as an intervention should confront the issue of compliance,"
they conclude.
Source: BMJ 2002; 325:185-187. ) 2002 British Medical Journal (BMJ).
Objectives: To evaluate cardiovascular fitness exercise in people with
Design: Randomised controlled trial.
Setting: Hospital rheumatology outpatients. Group based classes took
place at a "healthy living centre."
Participants: 132 patients with fibromyalgia.
Interventions: Prescribed graded aerobic exercise (active treatment) and
relaxation and flexibility (control treatment).
Main outcome measures: Participants' self assessment of improvement,
tender point count, impact of condition measured by fibromyalgia impact
questionnaire, and short form McGill pain questionnaire.
Results: Compared with relaxation, exercise led to significantly more
participants rating themselves as much or very much better at three
months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or
improved at one year follow up when fewer participants in the exercise
group fulfilled the criteria for fibromyalgia (31/69 v 44/67, P=0.01).
People in the exercise group also had greater reductions in tender point
counts (4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact
questionnaire (4.0 v 0.6, P=0.07).
Conclusions: Prescribed graded aerobic exercise is a simple, cheap,
effective, and potentially widely available treatment for fibromyalgia.
Source: BMJ 2002;325:18

*Learning to manage our stress is one of the keys to learning to manage
our illness. And it is probably one of the most difficult. Perhaps this
article will offer some insights as to how to manage the stress in your

Say 'No' to Responsibility Overload
"An interesting fact is that many "stressed out" people are not poor
stress managers- they are simply overloaded with commitments and
responsibilities. In this case stress arises from an overbooked schedule
or a greater number of responsibilities than one can reasonably handle.
As with all changes and improvements, learning to free yourself from
overloaded and unwanted responsibilities is a skill you can improve with
time, leading ultimately to a more balanced life and better stress
AOL users: <a href=
"" Read it here <a/>

*Be careful out there!

Antidepressants and Driver Impairment: Empirical Evidence From a
Standard On-the-Road Test
Ramaekers JG
Journal of Clinical Psychiatry. 2003;64(1):20-29
Antidepressant medications are one of the most commonly prescribed
psychiatric medications in the United States. The authors attempted to
evaluate the effects of this group of medications on driving skills.
They reviewed 10 studies published from 1983 to 2000 that evaluated the
effect of antidepressant medications on driving performance using a
standard test that primarily measured vehicular weaving through a
measurement labeled as "standard deviation of lateral position (SDLP)."
Nine of the studies were conducted with healthy volunteers and one of
the studies was conducted with depressed patients on antidepressant
medications. The authors found that sedating medications such as the
tricyclic antidepressants amitriptyline, imipramine, and doxepin cause
significant increase in SDLP during the first week of taking the
medications comparable with the amount of SDLP seen in the volunteers
after ingesting enough alcohol to reach a blood alcohol level of 0.8.
However, driving performance improved as the individuals became tolerant
to the medications after that initial week. The nonsedating
antidepressants such as the SSRIs, venlafaxine, and nefazodone did not
generally appear to affect SDLP. The authors also looked at studies that
added benzodiazepines to antidepressant medications and discovered that
there were significantly increased SDLP measurements in patients on
combinations of nonsedating antidepressants and benzodiazepines that
interacted with each other via the cytochrome P-450 system. Lastly, the
authors found that there was a strong correlation between the subjective
complaint of patients stating that their medications were causing
somnolence and driving impairment. The authors concluded that such
driving skills studies were very important in the evaluation of the
safety profile of pharmacologic agents.
AOL users: < a href=" ">
Read it here <a/>

The Positive Side
Rather than living on the negative side of life, put yourself
on the positive side. When you sense yourself becoming negative,
stop and think about what it would mean to apply that negative
energy in the opposite direction.

Rather than being annoyed, let yourself be amused. Instead of
feeling envy toward others, transform it into admiration. If you
feel yourself becoming embittered or angry, put that energy into
positive, productive determination. Take the sadness that you feel
and turn it into caring.

Imagine being able to extract the positive energy from a
negative situation. With such an approach, nothing can hold you
back for long.

For everything that can bring you down, there is a positive
side that can lift you up. Look for a way to turn the negativity
around, know with confidence that it is there, and you'll find it.

Ralph Marston


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