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The outlook for many CFIDS and fibromyalgia
patients is positive. This
week's article at the CFIDS/Fibromyalgia Self-Help program website
offers some ideas on how to increase your chances for improvement. "Will
I Get Better? Tilting the Odds in Your Favor"
Also, the site has information about the Internet self-help course and
other resources for people with fibromyalgia, CFIDS and related
Bruce Campbell, Ph.D., Director
CFIDS/Fibromyalgia Self-Help Program http://www.cfidsselfhelp.org
I have included 2 articles in this newsletter on nutrition. Some of you
may glance at these and wonder why they were included in a newsletter
devoted to educating about FM/ CFS/ MPD. No I did not get my
assignments confused and think I was doing something for the wellness
class that I teach. Editor's prerogative takes over here. I think
that focusing on nutrition is an important part of tilting the odds in
our favor. Regardless of which approach you take-the Zone Diet, the
Atkins Diet, or just following the principles of healthy, balanced
eating, what we put into our mouth has a direct influence on how we
feel. It is easy to blame our illness for our weight problems and other
health issues. But there are some things that we can control. Personal
nutrition is one of those controllable issues and probably one of the
hardest. After all this illness has taken away so much already, how can
we give up our comfort food? But maybe, just maybe, this is one of those
things that will make a difference in the way that you feel.
I was impressed with the article on the eight vicious cycles that block
Fibromyalgia and Chronic Fatigue Syndrome healing. I used this article
as a foundation for discussion in a support group that I lead. I found
that people could really grab hold of at least one thing that they could
actually do that might begin to make a difference. I hope that you too
find one thing in the cycle that you can grab onto and feel like you can
begin to make a change in that area.
What can you begin to do that will tilt the odds in your favor?
Why Stress Can Make You Sick
Interleukin-6 Levels Increased With Chronic Stress
Researchers at Ohio State University have discovered a link between
chronic stress and a body chemical that is associated with the
development of serious and even deadly conditions.
Dr. Janice Kiecolt-Glaser and colleagues studied a group of 119 men and
women who were dealing with the stress of caring for a spouse with
dementia. These individuals were compared with a control group of 106
individuals of similar age and health status who did not serve as
caregivers. Over the six-year study, blood tests showed that a chemical
known as interleukin-6 (IL-6) dramatically increased in the caregivers
as compared to the non-caregivers. IL-6 is a chemical known as a
cytokine that is involved in the body's immune system. Overproduction of
IL-6 has been associated with the development or progression of a number
of medical conditions, including heart disease, type 2 diabetes, certain
types of cancer, osteoporosis, arthritis, and functional decline. Even
if the spouse of the caregivers died, the increased levels of IL-6
persisted for several years in the group of caregiving spouses.
Why does stress increase levels of a chemical associated with disease
progression? One possible explanation is that persons under chronic
stress tend to engage in behaviors that are known to increase IL-6
production, such as smoking or gaining weight. In contrast, healthy
practices such as exercise and regular sleep patterns can help lower
These data, published in the July 2 issue of the Proccedings of the
National Academy of Sciences (USA) offer one possible explanation for
the link between stress and illness, suggesting that stress may increase
the risk of many typical age-associated diseases by altering the immune
response. The data also underscore the need for stress management and
control of chronic stressors.
Kiecolt-Glaser J, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB,
Glaser R. Chronic stress and age-related increases in the
proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A 2003 Jul 2.
WHAT CAUSES MIGRAINE HEADACHES?
Until recently, the general theory on the migraine process rested solely
on the idea that abnormalities of blood vessel (vascular) systems in the
head were responsible for migraines. Now, however, experts tend to
believe that migraine starts with an underlying central nervous system
disorder, which, when triggered by various stimuli, sets off a chain of
neurologic and biochemical events, some of which subsequently affect the
brain's vascular system. No experimental model fully explains the
There is certainly a strong genetic component in migraine with or
without auras. Researchers have located a single genetic mutation
responsible for the very rare familial hemiplegic migraine, but a number
of genes are likely to be involved in the great majority of migraine
cases. A number of chemicals, structures, nerve pathways, and other
players involved in the process are under investigation.
General Theories to Explain Migraine
Central Nervous Disorder. One theory that attempts to integrate many of
the known events in the migraine process is as follows:
The migraine process begins with over-excitation of the nerve cells in
the trigeminal pathway. (This nerve pathway runs from the brain stem to
the head and face.)
The excitation triggers the release of certain protein fragments called
peptides (including, peptides known as Substance P, calcitonin
gene-related peptide, and others).
These peptides dilate blood vessels and produce an inflammatory response
that spreads to the meninges (the membrane covering of the brain). While
the brain itself is insensitive to pain, the meninges and blood vessels
around the brain are sensitive to pain.
This reaction reaches the cerebral cortex (the outer layer of the brain)
and reduces blood flow (referred to as spreading depression). Certain
regions of reduced blood flow are associated with auras. Some experts
describe the effect as an electrical wave spreading through the brain
just as a wave of water is caused by the dropping of a pebble.
It is not clear, however, where migraine pain originates. One theory
supposes that the wave ripples across the top of the brain and down into
the brain stem where pain centers are located.
Abnormal Calcium-Channels. Some migraines may be due to abnormalities in
the channels within cells that transport the electrical ions calcium,
magnesium, sodium, and potassium. Calcium-channels appear to play a
particularly critical role in migraine patients:
Calcium-channels regulate the release of serotonin, an important
neurotransmitter in the migraine process. (A neurotransmitter is a
chemical messenger that allows communication between nerves in the
Magnesium interacts with calcium-channels and magnesium deficiencies
have been detected in the brains of migraine patients.
Calcium-channels also play a major role in cortical spreading
depression, the brain event that appears to be important in migraine
Some patients with migraine may inherit one or more factors that impair
calcium-channels, making them susceptible to headaches. For example,
mutations in a gene that encodes calcium channels appears to be
responsible for familial hemiplegic migraine.
The Role of Serotonin and Other Neurotransmitters
Neurotransmitters are chemical messengers in the brain. Two important
ones, serotonin and dopamine, appear to be critical in the processes
leading to migraine.
Serotonin. Serotonin (also called 5-hydroxytryptamine or 5-HT) is
involved in regulation of pain perception and depression, among other
important functions. A number of studies have suggested that serotonin
serves as a brake in the migraine process. To support this are the
following observations during a migraine attack:
Higher-than-normal levels of a serotonin compound are excreted in urine.
Levels of serotonin in the blood drop.
Drugs that target receptors in the brain for serotonin are generally
effective in stopping a migraine.
The receptors for serotonin implicated in migraine are found on the
trigeminal nerve endings. Serotonin appears to block the peptides
involved in over-stimulating nerves and producing inflammation.
Dopamine. Dopamine, another important neurotransmitter, may act as a
stimulant of the migraine process. Some evidence suggests that certain
genetic factors make people over-sensitive to the effects of dopamine,
which include nerve cell excitation. Such nerve-cell over-activity could
trigger the events in the brain leading to migraine. The prodromal
symptoms (mood changes, yawning, drowsiness), for example, have been
associated with increased dopamine activity. Dopamine receptors are also
involved in regulation of blood flow in the brain.
Other Factors Involved in Migraine
Reduced Magnesium Levels. Researchers have also noted a drop in
magnesium levels before or during a migraine attack. Magnesium plays a
role in nerve cell function; reduced levels could be a destabilizing
factor, causing the nerves in the brain to misfire, possibly even
accounting for the auras that many sufferers experience.
Female Hormones. The female hormones progesterone and estrogen appear to
play some role but it appears that it is their fluctuation, not their
presence, that is associated with migraines. More research is needed to
determine each hormone's precise effects.
Hypotension. One study suggested that some migraine headaches might be
precipitated by a sudden drop in blood pressure (hypotension).
(Conversely, some cases have suggested that migraine can also cause
A wide range of events and conditions can alter conditions in the brain
that bring on nerve excitation and trigger migraines. They include, but
are not limited to the following:
Emotional stress (although the headaches often erupt after the stress
Intense physical exertion (such as after lifting, athletic endeavor, and
even bowel movements or sexual activity).
Abrupt weather changes (such as Chinook winds).
Bright or flickering lights.
Changes in sleep patterns.
Low blood sugar has been known to trigger headaches and fasting can
often precipitate migraines.
Chemicals found in certain foods may trigger headaches in some people.
More than 100 foods have the capacity to trigger migraine headache.
C 2001 Nidus Information Services, Inc.
Richard Podell, M.D., on Reversing Eight Vicious Cycles that Block
Fibromyalgia and Chronic Fatigue Syndrome Healing ImmuneSupport.com
People with any chronic illness tend to develop a set of self-defeating
vicious cycles, which conventional medical approaches too often
overlook. My practice places high priority on reversing these
self-defeating cycles, as they are major obstacles to healing.
Vicious Cycle #1: Non-restorative Sleep
Both Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS)
disrupt sleep quality. Poor sleep, in turn, worsens physical and mental
stamina. Poor sleep also increases sensitivity to pain. These, of
course, further disrupt sleep.
Vicious Cycle #2: Disordered Breathing Rhythms
More than half of our patients with FMS or CFS develop a disordered
pattern of breathing. They take very small rapid breaths using the small
muscles of their chest instead of slow, deep breathing with the large
muscles of the abdomen. These changes are subtle and most people who
"hyperventilate" in this manner don't realize that their breathing
pattern is out-of-synch.
Shallow chest breathing makes people feel tense. Slow, deep abdominal
breathing creates feelings of calmness. Disordered breathing can also
cause a broad array of frightening symptoms including mental fog,
dizziness, irritability, chest pain, feeling numb and more. Worsening
symptoms then disrupt breathing further.
Vicious Cycle #3: Inactivity Leads to Progressive Loss of Physical
People with FMS and CFS often feel too ill to exercise, and if they push
themselves, they get worse. However, not exercising at all is also a
mistake. With inactivity, fitness fades. This increases a patient's
vulnerability (i.e., it takes less and less exertion before you're
pushed beyond your limits). This leads to less activity, which, in turn,
leads to lower blood pressure and blood volume. Blood sugar becomes
unstable. Disruptive stress hormones increase (e.g., adrenalin and
cortisone). People feel worse, so they can do even less. And the cycle
Vicious Cycle #4: Magnesium Loss in the Urine
Both physical pain and mental distress cause magnesium loss through the
urine. Low magnesium, in turn, turns up pain volume and also heightens
vulnerability to stress. This brings about further magnesium loss.
Vicious Cycle #5: Hormonal Imbalances
Both physical and mental distress trigger the release of hormones such
as cortisol that promote tissue breakdown. At the same time, distress
depresses the output of hormones that promote growth (e.g., DHEA growth
hormone). Thyroid and sex-hormones may also be affected. These hormonal
disturbances undermine healing, which then leads to further hormone
Vicious Cycle #6: Blood Sugar Instability
The five vicious cycles just discussed all have adverse effects on the
body's blood sugar and insulin system. Blood sugar tends to rise higher
after eating carbohydrates, and then falls rapidly lower, which is the
"hypoglycemic" reaction. Actually, low blood sugar per se is not the
direct cause of symptoms. Rather, falling blood sugar causes "stress
hormones" to surge, including adrenalin and cortisol. These disruptive
hormones are actually the cause of most "hypoglycemia" symptoms. These
symptoms include: mood instability, depression, light-headedness, foggy
brain, fluid retention and fatigue.
Vicious Cycle #7: Mind/Body Tension
Feeling bad for so long makes people "tighten up," both literally in
their muscles and figuratively in their mind. Muscle tension increases
pain and stiffness. Mental tension creates feelings of anxiety, and a
sense of not being in control. This causes more physical and mental
tension, reinforcing the illness.
Vicious Cycle #8: Losing Perspective, Losing Hope
People who are chronically ill tend to lose optimism and also their
sense of perspective and proportion. Small set backs feel like
catastrophes. Dips feel like they are taking forever. Anger suppresses
immune function. A patient experiencing these lows may lose hope and
stop trying. This heavy burden adds to the illness.
What tools do we have to reverse these vicious cycles?
. For sleep quality, we have many options including behavioral training,
nutritional supplements, herbs and medicines.
. For disordered breathing, we teach how to restore rhythmic breathing.
This can be mastered in just two or three training sessions.
. To improve physical fitness, the Goldilocks Principle applies - not
too much exercise and not too little, but just the right amount. Within
a few months this usually improves fitness, function and symptoms.
. For low magnesium, we offer a specialized test of magnesium status,
and aggressively replace deficiencies.
. For hormone imbalances, we measure relevant hormones and consider the
pros and cons of hormonal supplements.
. We treat blood sugar instability with the traditional
anti-hypoglycemia diet plus several important new wrinkles.
. To reduce physical and mental tension, we teach a broad set of
practical relaxation skills.
. There are also techniques for regaining perspective and realistic hope
without long-term psychotherapy. Cognitive Behavioral Therapy (CBT) is a
brief educational technique that teaches you how to "reframe" practical
problems so that you deal with them more effectively.
Our strategy is to first reverse one vicious cycle, then the next and
the next. This removes obstacles that perpetuate illness, thereby
strengthening the body's natural abilities to heal.
Nutrition's Sacred Cow
Don't mess with carbohydrates...
Do you want to drive a nutritionist crazy? Suggest that carbohydrates
The trend in popular diets for the past several years has been doing
just that. "It isn't dietary fat that makes you fat...", the new books
say, "...it's carbohydrate!" One by one - new books with the same basic
anti-carbohydrate, high-protein message hit the shelves: from Dr.
Atkins' New Diet Revolution, to the Sugar Busters Diet, to Protein Power
and the Carbohydrate Addict's Program. They all tell you to ignore the
dietary recommendations from the USDA, the American Heart Association,
the American Dietetic Association and the American Diabetes Association.
In steps Oprah. Since she aired a show last month where she agreed to go
on the Carbohydrate Addict's Program - the book soared to the top 5 most
sold books online. Meanwhile, Oprah's trainer Bob Greene tries to keep
balance while maintaining that the food guide pyramid is still healthy.
The result? Confusion.
For years the message for healthy eating was clear: decrease fat,
increase complex carbohydrates, and eat moderate amounts of protein.
These recommendations were - and still are - based on good scientific
evidence that eating so will decrease risks of chronic disease and
increase health. While high-fiber diets rich in fruits and vegetables
are shown consistently to decrease chronic diseases, high-beef diets
continue to raise concern of possible increased cancer risks.
The problem, according to some, is that we've taken it too far. While no
nutritionist ever suggested that the American diet be converted to a
hog-style feeding on carbohydrates - the result of lowfat processed
foods, according to these authors, is just that. As a result, some
researchers are taking another look. Just a few months ago, Harvard
researchers published findings that showed a diet with twice the amount
of recommended protein intake actually had a decreased risk for ischemic
Not every nutritionist is convinced that the higher-protein diets are
entirely bad. Mr. Douglas Kalman, MS, RD - a nutritionist, researcher,
and registered dietitian who specializes in advanced medical nutrition
therapy, sports nutrition and metabolism has a unique perspective on
We recently had the opportunity to interview him.
What is your definition of a high-protein diet?
This is a great question, because I do not believe that there is one
definition of a "high" protein diet. I do believe that there is too much
emphasis placed on carbohydrates. In respect to that, knowing what the
healthier carbohydrates are (i.e., quinoa, whole grains, natural wheats,
etc.) and than translating these foods into easy accessible foods for
the mass market has not occurred. Instead what is available are bagels,
muffins, cookies, white bleached fiber and other poor foods.
Re-emphasizing protein foods, and lean protein sources helps to deflect
people from focusing in on wasteful empty carbohydrates.
At least two major concerns continue to be raised regarding high-protein
diets: an increase in saturated fats (and increased heart disease risk),
and the possibility of long-term damage to the kidneys. What is your
take on these?
This question is one that many nutritionists and even physicians should
not answer. I strongly believe that when people say that they are
following a "high" protein diet, we should not dismiss them right away
as following a high fat/saturated fat diet. Food science has been
wonderful to us - today, we have egg whites that come in a container,
whey/egg/soy protein powder, chicken, turkey, 96% fat free red meat, and
In terms of these protein diets causing alterations in lipid profiles,
there actually have been no randomized clinical trials lasting over one
year evaluating the truth to these claims. We know it true that that the
older Atkin's diets promoted high saturated fat foods, but he has tamed
with his age and so has his diet. The newer diet is higher in mono and
polyunsaturated fats, and includes soy and fiber. Other diets, such as
the Greenwich Diet, promote high fiber, high natural vitamin and mineral
intake, lean protein sources and are very low in saturated fat. I ask,
where is the evidence about long term damage to the kidneys? People with
a family history of renal disease or that have renal problems should
avoid high protein diets.
One of the arguments is that the weight loss from these diets is merely
a result of water loss and possible depletion of lean body mass as the
body works on creating glucose and ketones. Is this true?
To tell you the truth, these diets do lead to a mild dieresis that
results in a water loss during the first few weeks. However, over the
long term, as long as there is an adequate intake of calories, weight
loss should not be from lean body mass. In addition, protein is hard to
breakdown - by itself it can cause up to a 25% increase in basal
metabolic rate. Thus, in short, high protein meals make the body burn
more calories during digestion and metabolism than high fat or high
Based on your research - are high-protein diets safe for long-term
health? Are there any populations who should avoid them altogether?
People with kidney problems or a strong family history of kidney
problems should avoid these diets. As far as if these diets are safe for
long term use, with all things being equal...we have to define what
constitutes a high protein diet. Research to date indicates that in a
normal person these diets appear to be safe.
Do you think that high-protein diets are here to stay - or just a fad?
Some of them are here to stay. We just have to accept it and work on
making them healthier versions of their old self.
To date, no major healthcare organization embraces these diets. In fact,
during an annual conference in Atlanta last month, the American Dietetic
Association took advantage of the time to publicly denounce the
Nevertheless, high-protein diets sweep the country - over and over - and
have done so for the past 30+ years. Why? Because they, indeed, decrease
body weight: which seems to be the primary goal of Americans. So,
despite repeated warnings of potential long-term health risks from many
institutions - desperate weight-loss hopefuls will continue to flock to
Mr. Kalman serves as the Director of Clinical Research for Peak
Wellness, Inc. During the past three years, his research group has
published over 30 scientific papers and has given over 50 lectures at
hospitals, national conferences and related meetings.
Preparing Healthy Food: How To Modify A Recipe
Just because a recipe calls for a specific ingredient doesn't mean you
must use that ingredient. Your favorite recipes can be modified to make
them more nutritious or lower in fat by reducing or substituting
ingredients that are more acceptable. This fact sheet will show you a
few ways to decrease the amount of fat, calories, sugar and salt in your
recipes. It will also tell you how to increase the fiber in your recipes
to make your food more nutritious. Remember that recipes are only
guidelines - not rules - for preparing food. Don't be afraid to
Instead of modifying your existing recipes, you can also find other
recipes that are similar to your recipes but have less fat or sugar and
more nutritious ingredients. Another way to control the amount of fats
you consume is to reduce the amount of food you eat. Remember: fat
should be 30% or less of your overall calorie intake.
To decrease your total fat and calories
Reduce fat in baked products
Reduce the amount of fat in baked products by 1/4 to 1/3. For example,
if a cookie, quick bread or muffin recipe calls for 1-cup oil, use 2/3
cup instead. (Do not use this method for yeast breads and pie crusts.)
Use vegetable oil instead of solid fats
Instead of using solid fats such as shortening, lard and butter, use
vegetable oil in your recipes. Types of vegetable oils include corn oil,
canola oil and peanut oil. To substitute liquid oil for solid fats, use
about 1/4 less than the recipe calls for. For example, if a recipe calls
for 1/4 cup shortening or butter (4 tablespoons), use 3 tablespoons oil
Use plain lowfat or nonfat yogurt instead of sour cream
In baking, use plain lowfat or nonfat yogurt in the same proportion as
sour cream and save on saturated fat calories. You can also substitute
buttermilk or blended lowfat cottage cheese. This method produces a
savings of 44 grams of fat!
1 cup sour cream = 495 calories = 48 grams total fat = 30 grams
1 cup lowfat yogurt = 145 calories = 4 grams total fat = 2.3 grams
Use skim or 1% milk instead of whole milk or half and half Another way
to decrease the amount of fat and calories in your recipes is to use
skim milk or 1% milk instead of whole milk or half and half. For extra
richness, try evaporated skim milk. This method produces a savings of 25
grams of fat!
1 cup half/half = 315 calories = 28 grams total fat = 17.3 grams
1 cup 1% milk = 100 calories = 3 grams total fat = 1.6 grams saturated
To decrease sodium
Use low sodium or unsalted ingredients
To decrease the amount of sodium in your foods, use low sodium or
unsalted ingredients in your recipes. Sodium intake for adults should be
1,100 - 3,300 mg per day. This equals about 1/2 to 11/2 teaspoons salt.
(Do not omit salt in yeast breads because it controls the rising action
1 teaspoon salt = 2,130 milligrams sodium
1 teaspoon soda = 820 milligrams sodium
1 teaspoon baking powder = 330 milligrams sodium
To decrease sugar
Reduce sugar in baked goods and desserts
Reduce sugar by 1/4 to 1/3 in baked goods and desserts. Cookies, quick
breads and cakes can be successfully baked this way. Substitute flour
for the omitted sugar. (Do not decrease sugar in yeast breads because
sugar feeds the yeast.)
Increase the use of some spices for flavor
In addition to reducing the amount of sugar in your recipes, you can
increase the use of some spices for flavor. Adding cardamon, cinnamon,
nutmeg or vanilla to your recipes will enhance the impression of
To increase fiber
Choose whole grain for part of your ingredients instead of highly
Use whole wheat flour, oatmeal and whole cornmeal. Whole wheat flour can
be substituted for up to 1/2 of all purpose flour. For example, if a
recipe calls for 2 cups of flour, try 1 cup all purpose flour and 1 cup
minus 1 tablespoon whole wheat flour.
An Overview of Fibromyalgia for Newly Diagnosed Patients
Robert Bennett MD
Fibromyalgia (fi-bro-my-AL-ja) syndrome (FMS) is a very common
condition of widespread muscular pain and fatigue. Seven to ten million
Americans suffer from FMS. It affects women much more than men in an
approximate ratio of 20:1. It is seen in all age groups from young
children through old age, although in most patients the problem begins
during their 20s or 30s. Recent studies have shown that fibromyalgia
syndrome occurs world wide and has no specific ethnic predisposition.
The Symptoms of Fibromyalgia Syndrome
Fibromyalgia syndrome patients have widespread body pain which often
seems to arise in the muscles. Some FMS patients feel their pain
originates in their joints. Pain that emanates from the joints is called
arthritis; extensive studies have shown FMS patients do not have
arthritis. Although many fibromyalgia syndrome patients are aware of
pain when they are resting, it is most noticeable when they use their
muscles, particularly with repetitive activities. Their discomfort can
be so severe it may significantly limit their ability to lead a full
life. Patients can find themselves unable to work in their chosen
professions and may have difficulty performing everyday tasks. As a
consequence of muscle pain, many FMS patients severely limit their
activities including exercise routines. This results in their becoming
physically unfit - which eventually makes their fibromyalgia syndrome
In addition to widespread pain, other common symptoms include a
decreased sense of energy, disturbances of sleep, and varying degrees of
anxiety and depression related to patients' changed physical status.
Furthermore, certain other medical conditions are commonly associated
with fibromyalgia, such as: tension headaches, migraine, irritable bowel
syndrome, irritable bladder syndrome, premenstrual tension syndrome,
cold intolerance and restless leg syndrome. Patients with established
rheumatoid arthritis, lupus (SLE) and Sjogren's often develop during the
course of their disease. The combination of pain and multiple other
symptoms often leads doctors to pursue an extensive course of
investigations - which are nearly always normal.
Diagnosing Fibromyalgia Syndrome
There are no blood tests or x-rays which show abnormalities diagnostic
of FMS. This initially led many doctors to consider the problems
suffered by FMS patients were all "in their heads" or that fibromyalgia
syndrome patients had a form of masked depression or hypochondriasis.
Extensive psychological tests have shown these impressions were
unfounded. A physician's diagnosis of FMS is based on taking a careful
history and the finding of tender areas in specific areas of muscle.
These locations are called "tender points" or "trigger points". They
tender to palpation and often feel somewhat hardened if the muscle is
stroked. Frequently, pressure over one of these areas will cause pain in
a more peripheral distribution, hence the term trigger point.
The Long Term Outcome for Fibromyalgia Syndrome
Musculoskeletal pain and fatigue experienced by fibromyalgia syndrome
patients is a chronic problem which tends to have a waxing and waning
intensity. There is currently no generally accepted cure for this
condition. According to recent research, most patients can expect to
have this problem lifelong. However, worthwhile improvement may be
obtained with appropriate treatment, as will be discussed later in this
brochure. There is often concern on the part of patients, and sometimes
physicians, that FMS is the early phase of some more severe disease,
such as multiple sclerosis, systemic lupus erythematosus, etc. Long term
follow up of fibromyalgia patients has shown that it is very unusual for
them to develop another rheumatic disease or neurological condition.
However, it is quite common for patients with "well established"
rheumatic diseases, such as rheumatoid arthritis, systemic lupus and
Sjogren's syndrome to also have fibromyalgia. It is important for their
doctor to realize they have such a combination of problems, as specific
therapy for rheumatoid arthritis and lupus, etc. does not have any
effect on FMS symptoms. Patients with fibromyalgia syndrome do not
become crippled with the condition, nor is there any evidence it effects
the duration of their expected life span. Nevertheless, due to varying
levels of pain and fatigue, there is an inevitable contraction of
social, vocational and avocational activities which leads to a reduced
quality of life. As with many chronic diseases, the extent to which
patients succumb to the various effects of pain and fatigue are
dependent upon numerous factors, in particular their psycho-social
support, financial status, childhood experiences, sense of humor and
determination to push on.
The Treatment of Fibromyalgia Syndrome
The treatment of FMS is frustrating for both patients and their
physicians. In general, drugs used to treat musculoskeletal pain, such
as aspirin, non-steroidals (e.g. ibuprofen) and cortisone are not
particularly helpful in this situation. As in any chronic pain
condition, education is an essential component that helps patients
understand what can or can't be done as well as teaching them to help
It is important for a patient's physician to discover whether there is a
cause for sleep disturbances. Such sleep problems include sleep apnea,
restless leg syndrome and teeth grinding. If the cause for a patient's
sleep disturbance cannot be determined, low doses of an anti-depressive
group of drugs, called tricyclic anti-depressants or short acting
sleeping medications such as zolpidem (Ambien), may be beneficial.
Patients need to understand these medications are not addictive when
used in low dosages (eg., Amitriptyline 10 mg at night) and have very
few side effects. In general, routine use of sleeping pills such as
Halcion, Restoril, Valium, etc. should be avoided as they impair the
quality of deep sleep. Ambien (zolpidem), is claimed to avoid this
There is increasing evidence that a regular exercise routine is
essential for all fibromyalgia syndrome patients. This is easier said
than done because increased pain and fatigue caused by repetitive
exertion makes regular exercise quite difficult. However, those patients
who do get into an exercise regimen experience worthwhile improvement
and are reluctant to give up. In general, FMS patients must avoid impact
loading exertion such as jogging, basketball, aerobics, etc. Regular
walking, the use of a stationary exercycle and pool therapy utilizing an
Aqua Jogger (a floatation device which allows the user to walk or run in
the swimming pool while remaining upright) seem to be the most suitable
activities for FMS patients to pursue. Supervision by a physical
therapist or exercise physiologist is of benefit wherever possible. In
general, 20 minutes of physical activity, 3 times a week at 70% of
maximum heart rate (220 minus your age) is sufficient to maintain a
reasonable level of aerobic fitness.
Drugs such as aspirin and Advil are not particularly effective and
seldom do more than take the edge off FMS pain. Opioid analgesics (
propoxyphene, codeine, morphine,oxycodone, methadone) may provide a
worthwhile relief of pain in a subgroup of severely afflicted patients,
but fibromyalgia patients seem especially sensitive to opioid side
effects (nausea, constipation, itching and mental blurring) and often
decide against the long term use of these drugs. The use of opioid
analgesics (narcotics) in the management of non-malignant pain has been
a controversial issue for many doctors - the usually cited reasons for
concern being addiction, oversight by state medical boards and criminal
diversion of drugs. However recent research has shown that addiction
seldom occurs when these medications are use in chronic pain states. It
is important to understand the difference between addiction and
dependence (which occurs with all these drugs in the majority of
patients (see Addiction/Dependence). Two particularly useful weak
opioids in the management of FM pain are tramadol (Ultram) and the
combination of tramadol with acetaminophen (Ultracet). Neither of these
2 medications is a FDA scheduled drug (i.e. they have minimal addiction
potential) Particularly painful areas often may be helped for a short
time (2-3 months) by trigger point injections. This involves injecting a
trigger point with a local anesthetic (usually 1% Procaine) and then
stretching the involved muscle with a technique called spray and
stretch. It should be noted the injection of a tender point is quite
painful (indeed, if it is not painful the injection is seldom
successful). After the injection, there is typically a 2-4 day lag
before any beneficial effects are noted. Other techniques which directly
help the tender areas on a transient basis are heat, massage, gentle
stretching and acupuncture. About 20% of FMS patients have a co-existing
depression or anxiety state which needs to be appropriately treated with
therapeutic doses of anti-depressants or anti-anxiety drugs often in
conjunction with the help of a clinical psychologist or psychiatrist.
Basically, patients who have a concomitant psychiatric problem have a
double burden to bear. They will find it easier to cope with their FMS,
if the psychiatric condition is appropriately treated. It is important
to understand fibromyalgia syndrome itself is not a psychogenic pain
problem and that treatment of any underlying psychological problems does
not cure the fibromyalgia.
Most FMS patients quickly learn there are certain things they do on a
daily basis that seem to make their pain problem worse. These actions
usually involve the repetitive use of muscles or prolonged tensing of a
muscle, such as the muscles of the upper back while looking at a
computer screen. Careful detective work is required by the patient to
note these associations and where possible to modify or eliminate them.
Pacing of activities is important; we have recommended patients use a
stop watch that beeps every 20 minutes. Whatever they are doing at that
time should be stopped and a minute should be taken to do something
else. For instance, if they are sitting down, they should get up and
walk around or vice versa.
Patients who are involved in fairly vigorous manual occupations often
need to have their work environment modified and may need to be
retrained in a completely different job. Certain people are so severely
affected, that consideration must be given to some form of monetary
disability assistance. This decision requires careful consideration, as
disability usually causes adverse financial consequences as well as a
loss of self esteem. In general, doctors are reluctant to declare
fibromyalgia patients disabled and most FMS applicants are initially
turned down by the Social Security Administration at the first review.
However, each patient needs to be evaluated on an individual basis
before any recommendations for or against disability are made.
Botulinum toxin for the treatment of musculoskeletal pain and spasm.
Curr Pain Headache Rep 2002 Dec;6(6):460-9 Sheean G. EMG and
Neuromuscular Service, University of California, San Diego, 200 West
Arbor Drive, San Diego 92103-8465, USA. firstname.lastname@example.org
The impressive pain relief experienced by sufferers of dystonia and
spasticity from intramuscular injections of botulinum toxin suggested
that patients with other chronic, musculoskeletal pain conditions also
may benefit. However, there have been relatively few placebo-controlled
studies of botulinum toxin in such non-neurologic conditions as
myofascial pain syndrome, chronic neck and low back pain, and
fibromyalgia; the results of these studies have not been impressive. One
explanation for the lack of positive findings may be the lack of
clinically evident muscle spasms (overactivity), despite the presence of
muscle tenderness, tightness, or trigger points. Clinical observations
of pain relief from injections of botulinum toxin for dystonia and
spasticity and its apparent efficacy in treating migraine suggest an
anti-nociceptive action independent of its neuromuscular
junction-blocking action. Evidence from animal experiments supports this
notion, and other data provide plausible physiologic mechanisms in the
periphery and central nervous systems. These involve modulation of the
activity of the neurotransmitters glutamate, substance P, calcitonin
gene-related peptide, enkephalins, and others. However, even if
botulinum toxin is firmly established as an analgesic, there is
insufficient clinical evidence of its efficacy in treating
non-neurologic, chronic, musculoskeletal pain conditions.
PMID: 12413405 [PubMed - indexed for MEDLINE]
Supplemental Folate May Ease Depression
07-14-2003 By Garret Condon / Hartford Courant
Depressed? Maybe you need more liver, chickpeas, fortified breakfast
cereal or a multivitamin.
All are good sources of folate, a B vitamin that occurs naturally in
many foods. The synthetic version is called folic acid. It has been
added to some foods since the late 1990s to help prevent certain birth
defects. The current recommendation for pregnant women is 600 micrograms
per day. Women who lack adequate folate around the time of conception
are more likely to have a child with birth defects and are at higher
risk for low-weight and premature babies, according to the National
Institutes of Health.
Some studies have shown supplemental folate also helps depressed people.
A recently published study suggests how this might work.
Martha Morris, an epidemiologist with the Jean Mayer USDA Human
Nutrition Research Center on Aging at Tufts University, and four
colleagues studied data on nearly 3,000 people, ages 15 to 39. They
found that those who had experienced major depression had lower
concentrations of folate in their bloodstream and red blood cells than
those who had never been depressed. In addition, those with chronic
low-level depression -- also known as dysthymia -- had lower red blood
cell levels than the nondepressed.
Morris says folate levels were not particularly low among people who
said they were currently depressed. "Low folate didn't occur until some
months after the symptoms had disappeared," she says. "It does tend to
suggest that low folate status is a consequence of depression." She
notes that low levels of folate can cause such symptoms as fatigue,
which is often part and parcel of depression. Improving such conditions
using folate or folic acid, she says, might help lift the spirits.
The study, published in the March-April (2003) issue of Psychotherapy
and Psychosomatics, was accompanied by an editorial written by Dr.
Ingvar Bjelland and two colleagues from the University of Bergen,
Norway. They say that while studies on folate and antidepressant
treatment are promising, scientists do not yet know which patients
should receive folate supplements, in what dose or for how long.
Furthermore, the safety of high-dosage supplementation has not been
established. The information analyzed by Morris and her associates was
gathered before folic acid was added to many foods.
Morris says she's not sure what result she'd get from the
post-fortification population. The National Institutes of Health reports
adult diets now contain recommended amounts of either folate or folic
acid. In other words, most Americans are probably getting enough. The
Institute of Medicine's Food and Nutrition Board recommends 400
micrograms, or 0.4 milligrams, per day for adult men and women, 600
micrograms for pregnant women and 500 for lactating women.
Some medicines and medical conditions -- including alcohol abuse -- can
cause folate deficiency. Doctors may put such people on folic acid
supplements. For those not identified as low on folate, a multivitamin
with folic acid or an extra helping of folic-acid-fortified foods might
However, some individuals may be at risk from folic acid supplements.
People with vitamin B12 deficiency, for example, can develop both anemia
and damage to the central nervous system. Taking folic acid can cure the
anemia but not the central nervous system effects. The folic acid
supplement, therefore, could mask the B12 deficiency and delay
diagnosis. The National Institutes of Health's Office of Dietary
Supplements recommends people 50 or older have their doctors check their
B12 status before they begin using a folic-acid supplement.
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DEPRESSION-THE INVISIBLE ILLNESS
Depression is a serious medical condition. In contrast to the normal
emotional experiences of sadness, loss, or passing mood states, clinical
depression is persistent and can interfere significantly with an
individual's ability to function. There are three main types of
depressive disorders: major depressive disorder, dysthymic disorder, and
bipolar disorder (manic-depressive illness). Symptoms and Types of
Depression Symptoms of depression include sad mood, loss of interest or
pleasure in activities that were once enjoyed, change in appetite or
weight, difficulty sleeping or oversleeping, physical slowing or
agitation, energy loss, feelings of worthlessness or inappropriate
guilt, difficulty thinking or concentrating, and recurrent thoughts of
death or suicide. A diagnosis of major depressive disorder is made if a
person has 5 or more of these symptoms and impairment in usual
functioning nearly every day during the same two-week period. Major
depression often begins between ages 15 to 30 but also can appear in
children. 1 Episodes typically recur. Some people have a chronic but
less severe form of depression, called dysthymic disorder, which is
diagnosed when depressed mood persists for at least 2 years (1 year in
children) and is accompanied by at least 2 other symptoms of depression.
Many people with dysthymia develop major depressive episodes.
Episodes of depression also occur in people with bipolar disorder. In
this disorder, depression alternates with mania, which is characterized
by abnormally and persistently elevated mood or irritability and
symptoms including overly-inflated self-esteem, decreased need for
sleep, increased talkativeness, racing thoughts, distractibility,
physical agitation, and excessive risk taking. Because bipolar disorder
requires different treatment than major depressive disorder or
dysthymia, obtaining an accurate diagnosis is extremely important.
Thyroid and Bipolar Disorder
There is a clear connection between the process of thyroid hormone
regulation and bipolar disorder. The problem is, this connection is only
just now beginning to become evident, and how the connection works is
basically a mystery. One study recently showed a strikingly high rate of
autoimmune-caused thyroid problems in people with bipolar disorder, far
more than you would expect to find.Kupka Thyroid problems are more
common in the complex forms of bipolar disorder (mixed states and rapid
cycling) than in classic bipolar manic patients.Chang And another study
recently showed that people with low thyroid levels were less likely to
get better when treated for their bipolar depression, whereas the ones
with higher levels responded pretty well.Cole The mystery is
intensifying at least, if not getting clearer yet. At least we can say
that thyroid function looks more and more implicated in some kinds of
Continues at: http://www.psycheducation.org/thyroid/introduction.htm
BRUXISM AND STRESS
The habit of tooth grinding, grating, or clenching is termed bruxism,
and millions of adults and children are affected by this condition.
While its exact cause is unknown, most experts believe that it can occur
as a response to increased psychological stress. Bruxism involves any
type of forceful contact between the teeth, whether silent and
clenching, or loud and grating. Estimates vary regarding the number of
people who suffer from this condition and range from 50-95% of the adult
population. Approximately 15% of all children also acquire this
condition. Many people are not aware that they have this condition and
grind their teeth at night while asleep, although bruxism can occur
during daytime hours as well. Stress is thought to play an important
role in the causation of this condition, along with feelings of anxiety,
anger, and pain. Certain sleep disorders are accompanied by bruxism, and
drinking alcohol and taking certain medications (for example,
anti-depressants) may worsen the condition. Malocclusion (improper
alignment of teeth or bite) may also play a causative role. Children may
develop bruxism as a response to a cold or other infection and are more
likely to develop it when their parents are affected. Some studies show
that persons whose personalities may be described as compulsive,
controlling, precise, or aggressive have an increased incidence of
bruxism. Symptoms and signs of bruxism can vary from mildly irritating
to medically dangerous, depending on the severity of the condition, and
include: signs of tooth wear, such as fractures of teeth and fillings
facial or jaw pain
making sounds of clenching or grating teeth while sleeping, often
noticeable to a sleeping partner
Treatment of bruxism involves either behavior modification, such as
stress management therapy, or mechanical devices such as mouthguards to
protect the teeth from the forces of contact. Hypnosis has also been
used with success in some individuals with bruxism. Talk to your dentist
if you believe you may be suffering from bruxism, especially if you are
experiencing unpleasant symptoms. He/she will be able to evaluate the
severity of the problem, correct any existing damage, and help you
decide among treatment alternatives.
Evaluation and Treatment of Orthostatic Hypotension
JOHN W. ENGSTROM, M.D., and MICHAEL J. AMINOFF, M.D.
University of California, San Francisco, School of Medicine
San Francisco, California
Orthostatic hypotension is defined as a decrease of at least 20 mm Hg in
systolic blood pressure when an individual moves from a supine position
to a standing position. Nonneurogenic causes of orthostatic hypotension
are related to cardiac pump failure, reduced intravascular volume,
venous pooling or a medication side effect. Neurogenic causes include
both central and peripheral nervous system lesions. The diagnostic
evaluation requires a systematic review of medications and coexisting
medical conditions along with a neurologic examination to search for
treatable factors that may be contributing to orthostatic hypotension.
Specific testing of autonomic function is useful for detecting
subclinical orthostatic hypotension or for monitoring autonomic function
over a period of time. Treatment is directed at improving the patient's
symptoms rather than achieving arbitrary blood pressure goals. Read the
complete article at http://www.aafp.org/afp/971001ap/engstrm.html
[AOL: <a href="http://www.aafp.org/afp/971001ap/engstrm.html">Read it
Highlights of the 45th Annual Scientific Meeting of the American
Stephen D. Silberstein, MD
Medscape Neurology & Neurosurgery 5(2), 2003. C 2003 Medscape
This material is part of the scientific program of the 45th Annual
Scientific Meeting of the American Headache Society, held from June
21-23, 2003, in Chicago, Illinois. This report reviews presentations
related to migraine diagnosis, sensitization and headache, menstrual
migraine, preventive treatment, organic headache, and pathophysiology.
Despite its relatively high prevalence, migraine is an underdiagnosed
disorder. Because most patients who seek medical care for headaches
present in the primary care setting, a self-administered screening
instrument could improve recognition of migraine both among patients and
their primary care providers, thereby improving the treatment of
migraine. In a study presented at this year's meeting, Lipton, from the
Albert Einstein College of Medicine, Bronx, New York, and colleagues
established the validity and reliability of a brief, self-administered
screening instrument for identifying patients with migraine in the
primary care setting. Patients who had visited outpatient primary care
for any reason; experienced headaches that interfered with their work,
study, or quality of life; or those who presented for a discussion with
their physician about their headaches, and who completed a screening
questionnaire, were included in the study. Eligible participants were
then seen by headache specialists who assigned diagnoses based on
International Headache Society (IHS) criteria; specialists were blinded
to the initial screening results. The 9-item screening instrument
included 8 items that paralleled the IHS features that defined migraine
(pain descriptors, aura, nausea, photophobia, and phonophobia), and 1
item quantified the patient's disability. A total of 433 patients
completed the screening and headache specialist evaluations. Of the 9
screening questions, a subset of 3 questions describing disability,
nausea, and sensitivity to light performed best for predicting migraine
diagnosis, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a
specificity of 0.75 (95% CI, 0.64 to 0.84), and a positive predictive
value of 93.3% (95% CI, 89.9 to 95.8). The sensitivity and specificity
of these 3 questions held up regardless of sex, age, presence of other
headache, or previous diagnoses. Because this tool is easy to use, quick
to administer, and highly accurate, it could significantly improve the
recognition of migraine headaches in the primary care setting.
Sensitization and Headache Burstein and associates from Harvard
Medical School in Boston have shown that most patients develop cutaneous
allodynia (CA) (ie, pain resulting from a nonnoxious stimulus to normal
skin) during migraine attacks and proposed that the underlying mechanism
is sensitization of central trigeminovascular neurons. To prove this,
they used repeated quantitative sensory testing to examine patients
during an early stage of a migraine attack, administering triptans
(5HT1b/1d agonist) before CA was established, and during a late-stage
migraine, administering triptans after CA was established. They found
that before allodynia was established, triptan therapy completely
relieved the headache and prevented later development of allodynia. By
contrast, triptan therapy provided little or no relief from the headache
and could not suppress allodynia if given after allodynia was
established. Late triptan therapy did prevent the worsening of pain upon
bending over and throbbing, despite the continuing presence of headache
pain and allodynia. The article continues at:
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West Nile Virus Occasionally Causes Polio-Like Syndrome
NEW YORK (Reuters Health) Jul 24 - Although many patients who develop
neurologic manifestation of West Nile virus (WNV) recover fully, some
patients who present with acute flaccid paralysis sometimes develop an
irreversible poliomyelitis-like syndrome, investigators report in the
Journal of the American Medical Association for July 23/30. According to
lead author Dr. James J. Sejvar of the US Centers for Disease Control
and Infection in Atlanta, and colleagues, retrospectives studies have
failed to identify signs and symptoms that distinguish WNV from other
viral encephalitides. Therefore, they prospectively examined the records
from 39 patients in Louisiana with suspected WNV infection in the summer
of 2002. Serologic testing confirmed WNV infection in 16 patients, 5 of
whom were diagnosed with meningitis. Eight had WNV encephalitis and 3
had acute flaccid paralysis. Fifteen of the 16 patients exhibited
tremor, myoclonus and features of parkinsonism. One patient died. "These
movement disorders may, in the proper setting, be indicative of West
Nile virus as opposed to other viral encephalitides," Dr. Sejvar told
Reuters Health. The 15 patients with WNV who survived were re-examined
at 8 months. Eleven were able to function independently, but fatigue,
myalgias and headache persisted in 10 patients. Five patients continued
to have problems with daily activities, such as housekeeping and
mobility. "It does seem clear that some patients who have very severe
encephalitis initially then go on to do very well," Dr. Sejvar added.
Outcomes were the worst in the three patients with acute focal
paralysis. Limb weakness remained, although bladder and bowel symptoms
had resolved, and one patient was troubled by persistent dyspnea.
"Appropriate diagnostic testing should be pursued in patients who are
presenting with asymmetric flaccid paralysis," Dr. Sejvar said. For
example, electromyography and nerve conduction studies can differentiate
patients with WNV whose disease process affects anterior horn cells from
other viral disorders causing axonal and demyelinating neuropathy. In a
summary article in the same issue of JAMA, Dr. Lyle R. Petersen, with
the CDC in Fort Collins, Colorado, and colleagues point out that less
than 1% of individuals infected with WNV develop severe neurologic
disease. They also note that WNV and St. Louis encephalitis virus are
ecologically similar, suggesting a common epidemiologic pattern. They
note that, compared with St. Louis encephalitis virus, WNV produces
extremely high level viremia in birds, many mosquito species are vectors
for WNV, and human infections continue to occur once it appears in an
area. "These facts suggest that WNV has greater epidemic potential than
St. Louis encephalitis virus," Dr. Petersen's team concludes. JAMA
TEN MINUTES A DAY TO REDUCED STRESS AND BETTER HEALTH
If you have ten free minutes a day, you can reduce stress, improve
insomnia, lessen anxiety and depression, and decrease your chances of
developing cardiovascular disease. Sound too good to be true? In fact,
the meditative technique known as the "relaxation response" was
described a quarter century ago by Harvard physician Herbert Benson,
M.D. and has been scientifically proven not only to reduce stress and
anxiety but also to improve symptoms of cancer, AIDS, and other
Dr. Benson's 1975 book The Relaxation Response, reissued in 2000), has
become the definitive work on the mind/body connection and the effects
of stress on our physical well-being. Since its description, the
relaxation response has been accepted as a valuable tool by physicians
and therapists worldwide, and relaxation response techniques are taught
in medical schools and are an accepted part of therapy for many medical
conditions. Just what is the relaxation response? Simply put, it is the
opposite of the "adrenaline rush" we associate with stress and anxiety.
Physiologically, our bodies respond to perceived threatening situations
with an increased release of the hormones epinephrine and
norepinephrine, leading to increased heart rate, increased blood
pressure, accelerated breathing rate and increased blood flow to the
muscles. Because these reactions prepare our bodies to flee the
situation or to fight, this reaction has been termed the
"fight-or-flight" response. The relaxation response described by Dr.
Benson and his colleagues is a state in which our bodies undergo an
opposite reaction - leading to decreased breathing rate, heart rate,
blood pressure, and metabolism. Almost anyone can learn to elicit the
relaxation response, and no special equipment is necessary. The
relaxation response technique consists of the repetition of a word,
sound, phrase, etc. while sitting quietly with eyes closed. Intruding
thoughts are dismissed by passively returning to the repetition. This
should be practiced for 10-20 minutes a day in a quiet environment free
of distractions. A seated position is recommended to avoid falling
asleep, and you may open your eyes to check the time but do not set an
alarm. Don't feel discouraged in the beginning if it is difficult to
banish intruding thoughts or worries; this technique requires practice.
With consistency and time the relaxation response will occur
effortlessly and smoothly. For maximum benefits you should schedule time
to practice the relaxation response into your daily routine. Many people
find it helpful to practice this technique at approximately the same
time each day; for example, upon returning home after a busy work day it
may ease your transition to a relaxed and enjoyable evening. For more
information about Dr. Benson's work on the mind/body connection, you can
read more of his books, including his most recent works, The Wellness
Book: The Comprehensive Guide to Maintaining Health and Treating
Stress-Related Illness and Timeless Healing
What is Carpal Tunnel Syndrome?
Facts on this Common Work-Related Condition
Carpal tunnel syndrome, often abbreviated CTS, is a chronic condition in
which nerve compression in the wrist leads to abnormal sensations, pain,
or loss of function in parts of the hand. The bones in the wrist joint
are known as the carpals, and these form a tunnel-like structure through
which pass the tendons that control finger movement. An important nerve
to the hand, called the median nerve, also passes through this channel.
When pressure in this channel is increased, the median nerve can become
compressed. Compression of this nerve leads to the characteristic
symptoms of CTS.
The most common cause of carpal tunnel syndrome is likely an
inflammation and/or scarring of the tendons and ligaments in the carpal
area. Repetitive wrist movements, such as those involved in assembly
work, are believed to play a role in the development of inflammation and
swelling of the tendons and their sheaths, a condition known as
tenosynovitis, resulting in increased pressure on the median nerve.
In general, CTS is thought to result from, or is associated with, a
number of conditions and environmental factors, including:
job tasks requiring repetitive wrist movements; in particular, butchers,
writers, grocery checkers, carpenters, musicians, and housekeepers are
considered to be at risk.
repeated use of vibrating tools such as in construction work
poor wrist posture
pregnancy and menopause, due to hormonal changes affecting fluid
overactivity of the pituitary gland
imbalance in thyroid hormone levels, particularly with low levels
a possible congenital predisposition to a narrow channel through the
Symptoms of Carpal Tunnel Syndrome
The signs and symptoms of CTS resulting from the increased pressure on
the median nerve may include:
a painful or tingling feeling in one or both hands, most often in the
thumb, index, and ring fingers
a feeling that the fingers are swollen
a feeling of "uselessness" in the fingers or that the hand is "asleep"
inability to make a fist
frequently dropping things or decreased ability to perform daily tasks
such as telephoning, cooking, grooming, etc.
decreased power in the wrist
a possible inability to discriminate hot from cold by touching
pain with wrist or finger movement
Many people report that the first symptoms of CTS occur at night, since
many persons tend to sleep with the wrists in a flexed position. The
nighttime symptoms can be so severe as to disrupt sleep. Symptoms and
signs of CTS tend to develop gradually over time and result in a chronic
(ongoing) condition. More of this article:
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