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Apnea, Depression Linked in Stanford Study


STANFORD, Calif. - People with depression are five times more likely to
have a breathing-related sleep disorder than non-depressed people,
according to a study at the Stanford University School of Medicine. The
study is the first to show a link between depression and sleep apnea
along with its related disorders.
Although it remains unclear how the conditions are linked, Maurice
Ohayon, MD, PhD, said his study should encourage physicians to test
depressed patients for this type of sleep disorder.
"Physicians who see people with depression shouldn't stop at the first
diagnosis, but instead look into the presence of a breathing-related
sleep disorder," said Ohayon, an associate professor of psychiatry and
behavioral sciences. His study appears in the current issue of the
Journal of Clinical Psychiatry.
These disorders include such breathing anomalies as chronic, disruptive
snoring and obstructive sleep apnea syndrome, a disorder in which people
stop breathing for brief periods up to hundreds of times a night. Left
untreated, the disorders can lead to hypertension, stroke and cognitive
deterioration. They can also affect a person's daily routine and disrupt
his or her familial, social and professional life.
"This type of disorder increases a person's chances of feeling sleepy
and irritable, having a dispute with a family member or colleague, or
getting into a traffic accident," said Ohayon.
Several studies have suggested that obstructive sleep apnea syndrome is
associated with a higher rate of depressive disorder and that treating
sleep apnea could help control depression in patients. But no previous
study had explored this association and its risk factors in the general
To assess the impact of the two disorders in the general population,
Ohayon conducted a telephone survey with adults in five countries (the
United Kingdom, Germany, Italy, Portugal and Spain). More than 18,000
people were chosen as a representative sample of 206 million Europeans.
The participants answered questions pertaining to sleep quality and
schedules, breathing-related sleep disorders, mental disorders and
medical conditions.
After analyzing the data, Ohayon found that 2.1 percent of the people
surveyed had sleep apnea - a figure consistent with data from past
studies on selected populations - and 2.5 percent had another type of
breathing-related sleep disorder. Eighteen percent of respondents who
were experiencing a depressive disorder (4 percent of all respondents)
also had a breathing-related sleep disorder, compared with 3.8 percent
of non-depressed respondents. That represents a five-times increased
likelihood of breathing-related sleep disorders among depressed people.
"This is the first study to show the strength of the link between the
two disorders," said Ohayon, adding that even after controlling for
obesity and hypertension (important factors in each disorder) the
association remained strong.
It remains unclear whether depression occurred before or after sleep
apnea, and to what extent sleep apnea contributes to the maintenance or
aggravation of depression. Ohayon said the link between treating sleep
apnea syndrome and the evolution of depressive disorders needs further
investigation. He hopes physicians will consider the association between
the disorders and depression when treating depressed patients. "Once
people have their sleep apnea recognized, there is a lot we can do to
help them," he said.
Ohayon received funding for his research from the Medical Research
Council of Quebec and an unrestricted educational grant from the
Sanofi-Synthelabo Group, a pharmaceutical company.
Stanford University Medical Center integrates research, medical
education and patient care at its three institutions - Stanford
University School of Medicine, Stanford Hospital & Clinics and Lucile
Packard Children's Hospital. For more information, please visit the Web
site of the medical center's Office of News and Public Affairs at
Zinc Gluconate and Hand Washing Fight Colds


Expert Recommends Zinc Gluconate-Based Products to Shorten Common Cold
and Avoid Overuse of Antibiotics
PHOENIX, Dec. 3 /PRNewswire/ -- Improved hand washing techniques and
early use of zinc gluconate, the active ingredient in over-the-counter
products such as Zicam(R) Cold Remedy, are effective first-line defenses
against the common cold, according to Dr. Charles Gerba, professor of
environmental microbiology, at the University of Arizona at Tucson.
Research conducted at the University of Arizona at Tucson found that 60
percent of people will wash their hands after using a public restroom,
but only 15 percent (less than one in five individuals) will effectively
eliminate germs.
"People with colds will literally hand you the rhinovirus if you are not
careful. And, because poor hand washing habits are so prevalent in the
United States, everyone will get the common cold at some point," says
Dr. Gerba. "Unlike most over-the-counter remedies which mask cold
symptoms, clinically proven* zinc gluconate-based products, like Zicam
Cold Remedy, treat the cold itself, safely and effectively shortening
the duration and severity of the illness."
Each day, Americans come in contact with a variety of potentially
contaminated hotspots such as kitchens, bathrooms, offices, and even
other individuals that may result in exposure to the many viruses that
can cause the common cold such as rhinovirus and coronavirus. These
viruses can be transmitted with a simple wipe of the eyes or nose.
"Antibiotic resistance is one of the world's most pressing public health
problems. You can argue that we suffer from 'antibiotic abuse' in the
United States," says Dr. Gerba. "Instead of taking antibiotics to treat
the common cold, people would be better off using an over-the-counter
product such as Zicam Cold Remedy to manage their condition."
According to the Centers for Disease Control and Prevention, antibiotics
should only be used when prescribed by a doctor to treat bacterial
infections and are not effective against viral infections like the
common cold, most sore throats, and the flu. In the early stages of
sickness, it is often difficult to determine whether the symptoms are
due to a bacterial or viral infection and many patients request a
prescription for an antibiotic. Each time an antibiotic is used,
sensitive bacteria are killed, but resistant germs may remain to grow
and multiply. Decreasing inappropriate antibiotic use is the best way to
control resistance. About the Common Cold
The National Institutes of Health estimate more than 200 different
viruses, including about 110 rhinoviruses, are known to cause common
cold symptoms. Americans are expected to suffer from one billion colds
this year.
The nose is the main portal of entry for cold viruses. The highest
concentration of cold virus in nasal secretion occurs during the first
three days of infection. This is when infected persons are most
About Matrixx Initiatives, Inc.
Matrixx Initiatives, Inc. is engaged in the development, manufacture and
marketing of over-the-counter pharmaceuticals, which utilize innovative
drug delivery systems. Zicam, LLC, its wholly-owned subsidiary,
produces, markets and sells Zicam(R) Cold Remedy nasal gel, a patented,
homeopathic remedy that has been clinically proven to significantly
reduce the duration and severity of the common cold. In studies
published in the October 2000 issue of ENT -- Ear, Nose and Throat
Journal, and separately in the January 2003 issue of QJM: An
International Journal of Medicine, the Zicam Cold Remedy product was
shown to reduce significantly the duration of the common cold.
* Hirt M, Nobel S, Barron E. Zinc nasal gel for the treatment of common
cold symptoms: A double-blind, placebo-controlled trial. Ear Nose Throat
J. 2000;79:778-780, 782.
* Mossad SB. Effect of zincum gluconicum nasal gel on the duration and
symptom severity of the common cold in otherwise healthy adults. QJM.
Few experiences are as stressful as applying for Social Security
Disability or waiting on a decision after you've applied. To learn what
you need to know to more effectively pursue your benefits, read this
site and bookmark it for later reference
There is a section on fibromyaglia in the medical conditions section
****New Website to Explain Lab Tests
Although the Social Security Administration will request and obtain
copies of your medical records, you need to know what is in your file
and what your doctors are saying about you. I have seen far too many
cases hurt by a doctor who is unable or unwilling to support a patient's
disability application. Therefore, I strongly recommend that you compile
your own personal medical file.
Once you have your own medical records, the challenge is to read and
understand what is being said about you. Here are a few web sites that
can help:
- Lab Tests Online - - this is a website that
will explain most of the common lab tests your doctor may order. You can
search by test name, condition or by the age of the patient.
- Medical abbreviations - - this is a
website that will translate many of the codes used by doctors and
hospitals in medical records
Medical conditions - - this site offers easy
to understand, yet comprehensive articles about just about every disease
and condition known.

National Pain Care Policy Act (HR1863)
The National Pain Care Policy Act (HR1863) has been introduced in
This bill would create a National Center for Pain at the NIH.
Please write your Representative in Congress and ask them to help
sponsor and pass this bill.
You can get a copy of a sample letter at:

Acute treatment of migraine. Breaking the paradigm of monotherapy
BlankBMC Neurol. 2004 Jan 28;4(1):4. Links
Krymchantowski AV.
Department of Neurology, Universidade Federal Fluminense, Rio de
Janeiro, Brazil, Headache Outpatient Service, Instituto de Neurologia
Deolindo Couto, Rio de Janeiro, Brazil, Headache Center of Rio, Rio de
Janeiro, Brazil.
BACKGROUND: Migraine is a highly prevalent disorder. The disability
provoked by its attacks results in suffering as well as considerable
economic and social losses. The objective of migraine acute treatment is
to restore the patient to normal function as quickly and consistently as
possible. There are numerous drugs available for this purpose and
despite recent advances in the understanding of the mechanisms and
different biological systems involved in migraine attacks, with the
development of specific 5-HT agonists known as triptans, current options
for acute migraine still stand below the ideal. DISCUSSION:
Monotherapeutic approaches are the rule but up to one third of all
patients discontinue their medications due to lack of efficacy, headache
recurrence, cost and/or side effects. In addition, a rationale has been
suggested for the development of polytherapeutic approaches,
simultaneously aiming at some of the biological systems involved. This
paper reviews the fundamentals for this changing approach as well as the
evidence of its better efficacy. CONCLUSION: As a conclusion, most of
the patients with a past history of not responding (no pain-free at 2
hours and/or no sustained pain-free at 24 hours) in at least 5 previous
attacks should undergo a combination therapy suiting to their individual
profile, which must include analgesics or non-steroidal
anti-inflammatory agents plus a triptan or a gastro kinetic drug. The
three-drug regimen may also be considered. In addition, changing the
right moment to take it and the choice for formulations other than oral
has also to be determined individually and clearly posted to the
PMID: 15005810 [PubMed - as supplied by publisher]
Naturopathy: A Critical Appraisal
Kimball C. Atwood IV, MD
Medscape General Medicine 5(4), 2003. C 2003 Medscape
"Naturopathic medicine" is a recent manifestation of the field of
naturopathy, a 19th-century health movement espousing "the healing power
of nature." "Naturopathic physicians" now claim to be primary care
physicians proficient in the practice of both "conventional" and
"natural" medicine. Their training, however, amounts to a small fraction
of that of medical doctors who practice primary care. An examination of
their literature, moreover, reveals that it is replete with
pseudoscientific, ineffective, unethical, and potentially dangerous
practices. Despite this, naturopaths have achieved legal and political
recognition, including licensure in 13 states and appointments to the US
Medicare Coverage Advisory Committee. This dichotomy can be explained in
part by erroneous representations of naturopathy offered by academic
medical centers and popular medical Web sites.
This article can be found at:
A Positive Attitude is within your Reach
By Jennifer Lobb
"I have had dreams and I have had nightmares,
but I have conquered my nightmares because of my dreams."
Dr. Jonas Salk
Overcoming suffering and pain is difficult-sometimes it may seem
impossible. Unfortunately, living with pain is a reality that you may
have to deal with, no matter how great your medical care is, how
supportive your family is, and how hard you work to conquer it. One
important thing to remember is that facing life with hope and optimism,
even when confronted by the enormous and numerous obstacles caused by
chronic pain, can make a difference in how you feel pain.
Of course, it's one thing for others to say "don't give up" or "snap out
of it," but actually cultivating a positive attitude is another. Some
days, optimism and hope are out of reach. It's normal to vacillate
between optimism and pessimism, anger and acceptance, and misery and
happiness. What's not normal is lacking any joy in your life and staying
angry, depressed, and sad. You may be clinically depressed and should
talk to your doctor about your feelings.
What if you're not depressed or are already being treated for your
depression? How do you cultivate hope and optimism in your life? One of
the first steps is to truly listen to your internal dialogue. The way
you think affects how you view life. Are your thoughts constantly
negative (e.g., I can't do that, I hate feeling this way, I'm
worthless)? Negative thoughts like these can bring about changes in your
pulse rate, breathing, and muscles. Such changes then affect your pain
levels. As hard as it may seem, there are different ways to look at
situations and viewing a situation in a more positive light can help you
manage feelings of frustration. How do you create an internal dialogue
that helps you instead of hinders you?
Begin by listening to your thoughts and writing down the negative
thoughts that come into your head. For each negative thought you write
down, think of a way to reframe it as a positive thought. For example,
"I can't even take care of myself anymore," could become "I'm learning
to graciously accept the help and support I'm receiving from family,
friends and health care professionals." Practice positive affirmations
and write them down. It may feel awkward at first, but if you practice
reframing negative thoughts into positive ones, eventually it will
become a habit.
Communicate your feelings and be open to listening to your family
members' and friends' feelings. Chronic pain affects not only you, but
those around you as well. You may be tempted to retreat into yourself,
but holding your feelings in can create hostility and resentment. Be
aware that others may be holding their feelings in to avoid hurting your
feelings. Your pain affects your family members and friends - they too
feel anger, guilt, sadness, frustration, and more. Sharing your feelings
in a respectful and thoughtful manner helps open the communication doors
and increases understanding of living with chronic pain.
Find pleasure in the simple things - maybe it's feeling the sunshine on
your face, seeing the trees starting to bloom, or listening to a
favorite song that makes you smile, even if just for a minute or two.
These simple pleasures can help change your attitude - not every day or
all the time, but in little ways when you need it.
Help others - there's no doubt that pain may limit the ways in which you
can help others, but helping others can be vital to your self-esteem and
well being. Be creative in defining how you help others. Can you share
your coping mechanisms with a support group? Can you write a letter to
your congressional representatives in support of HR 1863? These ideas
may seem inconsequential, but may be invaluable to others.
Take care of yourself - viewing your body as a whole and paying
attention to all aspects of health, including the physical, mental, and
spiritual aspects, will fortify your body and spirit and help you live
better and with less pain. Eat right, move around when you can, even if
it's to get the mail, and cultivate your spirituality through
Cultivating a positive attitude doesn't mean you have to be happy or
positive every minute of every day. It means you are working on
improving an aspect of your life that you can control. You may not have
control over your pain, but you can control how you think about your
Pain in Older Adults
By Debra K. Weiner, MD
Pain is a common part of the lives of many older adults. Researchers
estimate that as many as one half of older adults who live independently
and three-fourths of those who live in nursing homes suffer from
persistent pain, that is, pain that does not go away.(1) Most often,
this type of pain is caused by arthritis, nerve damage, and muscular
problems. What can be done to help older adults with persistent pain?
There are a wide variety of treatment options available to help older
adults with persistent pain. Unfortunately, health care providers often
do not receive the proper education regarding how to help older adults
who suffer with persistent pain. There are a lot of misunderstandings
and myths about pain in older people. The purpose of this article is to
dispel some of these myths and give you some basic information to take
to your primary care provider so that you can get the kind of help that
you need.

Myth #1: Persistent pain is a normal part of aging.
Reality: While persistent pain certainly becomes more common as people
age, it is not normal to hurt. The presence of pain means that there is
something causing it. Sometimes the cause may be relatively simple such
as muscular strain, but sometimes it is more complicated, and an entire
team of specialists such as pain doctors, physical therapists, and
psychologists may need to treat you to help you to get better. Pain
should never be accepted as normal.

Myth #2: Tests usually are needed to determine the cause of pain.
Reality: Often, health care providers order tests such as x-rays, MRIs
and blood tests to evaluate pain problems. Most of the time, however,
these sorts of tests are not necessary. Health care providers usually
can determine and prescribe the most appropriate treatment by talking
with and examining the patient. If your health care provider orders
special tests, ask him or her how the results of the tests will change
the treatment he or she prescribes. X-rays and MRIs often are ordered
for older adults with low back pain. Many research studies, however,
have shown that these tests are not helpful because many of the same
"abnormalities" seen in patients with low back pain also are seen in
people who are pain-free.(2)(3) X-rays and MRIs often are more useful
for determining what is not causing a person's pain.

Myth #3: Most persistent pain in older adults is caused by arthritis,
so the most sensible treatment is arthritis medications.
Reality: Arthritis is very common in older adults, but most people have
evidence of arthritis on x-rays but do not have pain. Muscular strain
and irritation-known as myofascial pain-also is extremely common in
patients with a variety of persistent pain conditions, but often is not
recognized by primary health care providers as a cause of pain.
Diagnosing myofascial pain, which can be done simply with a physical
examination, is important because medications often are not the most
effective treatment for this condition. Muscle-related pain is treated
most effectively with various types of modalities administered by a
physical therapist such as heat, ice, gentle stretching, myofascial
release techniques, or electrical stimulation. Shots in the tight
muscles known as trigger point injections also might be helpful. These
kinds of treatments have much fewer side effects and less risk than most
pain medications.

Myth #4: Older adults should not take opioids because of the potential
for addiction.
Reality: Opioids, commonly known as narcotics, are strong pain
medications that may be necessary to treat severe pain. When used
carefully, these medications, including morphine, hydrocodone,
oxycodone, fentanyl patches, and methadone, can do a very good job of
controlling pain without serious side effects. As with any medication,
patients who take these medications should be carefully monitored by
their doctors. Patients frequently express concern when their health
care provider suggests taking these medications because they fear
addiction, but this problem is quite uncommon. The word "addiction"
means that patients develop a psychological craving for medication even
when they do not have a physical need for it. Most older adults with
persistent pain conditions have a real need for pain medication, so the
likelihood of becoming addicted is less than 1 in 200.(4)

Myth #5: Persistent pain in older adults is not likely to get better, so
these patients need to learn to live with it.
Reality: Actually, many effective treatments are available for most
kinds of pain that occur in older patients. Medications are only one
small part of pain treatment. The main goal of pain treatment is to
maximize the patient's ability to be active and engaged in life. Studies
have shown that even though persistent pain usually cannot be completely
eliminated (that is, even with excellent treatment, pain that is
persistent is not likely to go away), patients can still enjoy
significant improvements in their function and quality of life.(5) In
other words, even if pain treatment results in only a modest reduction
in pain, it is still likely that function and quality of life can
improve significantly.

Myth #6: Activity is harmful in the older adult with pain.
Reality: Maintaining an active lifestyle is actually one of the major
goals of pain treatment. Patients with some types of pain, such as that
associated with nerve damage (known as neuropathy), actually experience
less pain when they are active. Those with arthritis and muscular pain
also benefit from activity. Often patients ask, "How much activity is
too much?" Typically the most accurate answer to this question lies with
the patient's own individual experience. Activity that is followed by
significant worsening of pain should be treated with rest the following
day, and probably less intense activity on a routine basis. Before
engaging in vigorous physical activity like running, biking, or
fast-paced walking, patients should get their doctor's approval.

Myth #7: Older adults with pain and depression will experience
improvement in their mood when their pain has improved.
Reality: Not necessarily. People with persistent pain often experience
feelings of sadness, irritability, and poor sleep. Sometimes these
feelings improve when pain improves. If these feelings are strong,
however, it is important that they be treated with antidepressant
medications. If they are ignored, it may be more difficult to treat the
pain. In other words, pain and depression can become part of a vicious
cycle, and unless all parts of the cycle are addressed, neither pain nor
depression can be treated effectively.

Myth #8: As long as pain is not caused by cancer, it is not harmful.
Reality: Persistent pain, no matter what the underlying cause, can have
a wide range of effects on patients. Some of the more common include
difficulty performing activities of daily living like bathing, dressing,
and cooking; depression and anxiety; impaired appetite; difficulty
concentrating; and trouble sleeping. Patients with persistent pain also
tend to make visits to emergency rooms and doctors' offices more often
than other people. So, persistent pain is not just an inconvenience - it
deserves to be treated aggressively and effectively.

Myth #9: If physical therapy previously caused worsening of pain, it
should not be prescribed in the future.
Reality: Nothing could be further from the truth. There are a wide
variety of physical therapy techniques, and a wide range of physical
therapists with different training and clinical experience. The best
therapists from whom to seek treatment for persistent pain conditions
are those who have a lot of experience in treating these conditions. If
physical therapy is administered too aggressively or in not quite the
proper way, for example, patients may feel worse instead of better. This
is particularly true for certain types of muscular conditions and back
problems. If you have had physical therapy in the past and it was either
not helpful or made you worse, do not take this as an indication that
physical therapy cannot help you.

Myth #10: If certain medications were tried before and didn't help,
there is no point in prescribing them again.
Reality: This is not necessarily true. Often, medications are prescribed
incorrectly. That is, the doses previously used may not have been high
enough. Or, side effects may have resulted if the dose was increased too
rapidly. The decision about whether a medication should be tried again
depends on the specific set of circumstances of each patient, but as
with other aspects of pain management described in Myths 1-9, it is
important to remain open-minded about the possibility of a positive

Debra K. Weiner, M.D., is associate professor of medicine, psychiatry
and anesthesiology in the division of geriatric medicine at the
University of Pittsburgh School of Medicine and is Director of the Older
Adult Pain Management Program at the University of Pittsburgh Pain
Medicine Program. Dr. Weiner is the chief editor of Persistent Pain in
Older Adults: An Interdisciplinary Guide for Treatment and has written
numerous journal articles on the subject. She is board certified in
internal medicine, rheumatology, and geriatric medicine and is a
licensed acupuncturist.
1. Farrell, M. J.; Gibson, S. J.; Helme, R. D. Chronic nonmalignant pain
in older people. Pain in the Elderly. Seattle: IASP Press; 1996. pp.
2. Weiner DK, Distell B, Studenski S, Martinez S, Lomasney L, Bongiorni
D. Does radiographic oseoarthritis correlate with flexibility of the
lumbar spine? Journal of the American Geriatrics Society 1994;42:257-63.
3. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal
magnetic-resonance scans of the lumbar spine in asymptomatic subjects -
a prospective investigation. J Bone Joint Surg Am 1990;72(3):403-8.
4. Porter J, Jick H. Addiction rare in patients treated with narcotics
(letter). New Engl J Med 1980;302:123.
5. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain
treatment centers: a meta-analytic review. Pain 1992;49:221-30.
Copyright C 2004 The National Pain Foundation

Consumer groups to panel: Imported drugs a reality
New Medicare law calls for report
WASHINGTON (AP) -- A government panel exploring whether prescription
drugs can be safely imported got a clear answer Friday from consumer
advocates who said Americans already are doing it to cope with
skyrocketing drug bills.
"It's a reality now because the United States government has failed to
develop a model that assures drugs are affordable to Americans," Gail
Shearer of Consumers Union said at the panel's first meeting at Food and
Drug Administration headquarters in suburban Maryland.
Laurie Young of the Older Women's League said her members are angry
about FDA's "refusal to make what is a common practice legal."
The new Medicare prescription drug law mandated that the Bush
administration give Congress a report by December 1 on whether and how
drugs could be safely imported. Some lawmakers have called for the
report sooner, and Health and Human Services Secretary Tommy Thompson
has said it could be done by the summer.
Future hearings will include health care providers and pharmaceutical
company representatives, who oppose legalizing drug imports.
The 11 administration officials said little about their own views on
drug imports, although one of them, Mark McClellan, has been the
administration's leading opponent of allowing prescription drugs from
abroad. McClellan, the FDA commissioner, is about to take over the
federal agency that runs the Medicare program.
Surgeon General Richard Carmona, the panel's chairman, said the issues
surrounding drug imports are complex. "We start with many more questions
than answers. We start with many more beliefs about what is possible
than facts," Carmona said.
But many advocates said the government could safely remove legal
barriers to importation without compromising safety. "This problem is
not rocket science," said Dianne Sterenbuch of the National Alliance for
the Mentally Ill.
Several pointed to legislation that passed the House last year that
would allow importing FDA-approved drugs from FDA-approved facilities in
Canada, the European Union and seven other nations. The measure also
would require imported medicine to be shipped in anti-tampering and
anti-counterfeiting packaging.
The administration opposed the House bill last year. Similar legislation
is pending in the Senate.
There was also a widely held view that drug imports were themselves just
a temporary solution to the problem of high drug costs.
"We can't go to any part of the country where we don't hear people
complaining about the high cost of drugs," AARP's David Certner said.
AARP provided crucial support for the Medicare legislation last year,
but has been campaigning for changes to it, including allowing imported
drugs and giving Medicare the authority to negotiate directly with
pharmaceutical companies.
Some consumer groups urged caution on opening U.S. borders to drug
imports, saying counterfeiting would inevitably worsen and drug
companies would have less incentive to develop new products.
"Is the cure -- drug importation -- worse than the disease -- high
prices?" said Frances Smith of Consumer Alert.

Roland Staud
Abstract and Introduction
Purpose of review: Fibromyalgia Syndrome (FMS) is a chronic pain
condition of unknown origin. Multiple abnormalities have been described,
including peripheral tissue and central nervous system changes. The
relation of these mechanisms, however, is likely bidirectional. FMS pain
clearly depends on peripheral nociceptive input as well as abnormal
central pain processing. This review will focus on the role of
peripheral nociceptive input for pain in FMS.
Recent findings: There is strong evidence for abnormal central pain
processing in FMS. Sensitized spinal cord neurons in the dorsal horn are
responsible for augmented pain processing of nociceptive signals from
the periphery. In addition, glial activation, possibly by cytokines and
excitatory amino acids may play a role in the initiation and
perpetuation of this sensitized state.
Summary: Nociceptive input clearly plays an important role in FMS. Acute
or repetitive tissue injury has been associated with FMS pain. Cytokines
related to such injuries may be responsible for long-term activation of
spinal cord glia and dorsal horn neurons, thus resulting in central
sensitization. A better understanding of these important neuro-immune
interactions may provide relevant insights into future effective
Chronic pain and tenderness exist as a continuum in the general
population and the severity of these symptoms appears to be normally
distributed with more women than men affected. In 1990 the American
College of Rheumatology convened a group of experts to better
characterize the large number of chronic musculoskeletal pain patients
diagnosed with Fibrositis that crowded the offices of rheumatologists.
The experts agreed on several criteria for the new syndrome
Fibromyalgia, which captures this chronic pain population with excellent
sensitivity and specificity.[1] In addition, the new FMS criteria of
widespread chronic pain (> 3 months) and tender points (>/= 11 of 18)
provide a useful characterization of patients with chronic
musculoskeletal pain for research studies. The use of the same FMS
criteria for clinical practice, however, turned out to be problematic
because chronic musculoskeletal pain patients fulfilling the FMS
criteria differ mostly in symptom severity from pain patients who do not
satisfy the same criteria. Although this criticism has led many
physicians to question the usefulness of the FMS criteria for clinical
practice, they nevertheless seem to capture the most afflicted patients.
Similar to FMS, several other clinically important syndromes also
represent extremes of a continuum of symptoms including hypertension and
diabetes. The particular usefulness of the latter syndromes, however,
relies on their ability to predict significant morbidity and mortality
in large numbers of patients. Although in the past the diagnosis of FMS
appeared only predictive for increased dysfunction and emotional
distress, recent epidemiological studies provided important evidence for
excessive mortality in patients with widespread chronic pain syndromes
like FMS.[2,3**] These findings seem to support the relevance of FMS as
a distinct clinical syndrome and provide impetus for the identification
of relevant FMS
To read the entire article go to:

Effectiveness of Exercise in Management of FibromyalgiaSusan E. Gowans;
Amy deHueck
Curr Opin Rheumatol 16(2):138-142, 2004. C 2004 Lippincott Williams &
Posted 03/24/2004
Abstract and Introduction
Purpose of Review: Exercise was established as an integral part of the
nonpharmacological treatment of fibromyalgia approximately 20 years ago.
Since then many studies have investigated the effects of exercise-either
alone or in combination with other interventions. This review will
discuss the benefits of exercise alone and provide practical suggestions
on how patients can exercise without causing a long-term exacerbation of
their pain.
Recent Findings: Short-term exercise programs for individuals with
fibromyalgia have consistently improved physical function, especially
physical fitness, and reduced tenderpoint pain. Exercise has also
produced improvements in self-efficacy. These effects can persist for
periods of up to 2 years but may require participants to continue to
exercise. Most exercise studies have examined the effects of moderately
intense aerobic exercise. Only in the past 2 years have
muscle-strengthening programs, in isolation, been evaluated. To be well
tolerated, exercise programs must start at a level just below the
capacity of the participants and then progress slowly. Even with these
precautions, exercise may still produce tolerable, short-term increases
in pain and fatigue that should abate within the first few weeks of
Summary: Future studies should investigate the possible benefits of
low-intensity exercise and test strategies that may enhance long-term
compliance with exercise. Individuals with fibromyalgia also need to be
able to access community exercise programs that are appropriate for
them. This may require community instructors to receive instruction on
exercise prescription and progression for individuals with fibromyalgia.
Fibromyalgia is a condition characterized by widespread pain and pain at
specific tender points.[1] Typically, individuals with fibromyalgia are
also inactive and unfit.[2,3] Exercise was established as an integral
part of the nonpharmacological treatment for individuals with
fibromyalgia less than 20 years ago by the demonstration that patients
randomized to 20 weeks of high-intensity exercise had greater
improvements in fitness, tender point pain thresholds, and
patient/physician global assessment ratings than patients randomized to
20 weeks of flexibility training.[4] Since then, an escalating number of
randomized controlled trials have evaluated the benefits of exercise for
individuals with fibromyalgia. Subsequent exercise trials have, by and
large, examined the benefit of moderately intense aerobic exercise,
either alone, or in combination with other interventions, such as muscle
strengthening or education. Only in the past 2 years have a limited
number of studies examined the effect of muscle strengthening, in
isolation, for individuals with fibromyalgia. Four meta-analyses have
also examined the benefits of exercise for individuals with
fibromyalgia: 3 meta-analyses examined the effects of exercise in
reviews with other nonpharmacological interventions[5-7*] and a recent,
fourth meta-analysis focused solely on the effects of exercise.[8**]
This fourth meta-analysis limited its study to exercise interventions
that met or exceeded established criteria for improving aerobic
conditioning or strengthening.
This review summarizes the literature on exercise for individuals with
fibromyalgia and highlights relevant exercise studies that have been
published between January 2002 and September 2003.
To view the article go to:
"Fibro-friendly" Activities
Time with your significant other and your family
by, Diane R. Isaacs, Ph.D., MFT
...Let us open our hearts and look at what this disease does to
relationships and how people can manage and accommodate.
You can have a healthy relationship. In saying that, partners, husbands,
wives children and extended families must understand that Fibromyalgia
is a family disease, non-fatal, but can be a pain, in more ways than
one. We must maintain a positive attitude. Maybe sometimes we can't do
things that other people take for granted, but the family must not be in
denial. Keep the communication healthy by setting time aside to talk
about the issues that face the Fibromyalgia patient. Healthy activities
together matched with open communication can strengthen your
relationships with each other.
I will share with you some fun activities you can do as a couple or a
family, and that can give you inspiration, increase your strength, and
share time with your loved ones.
Dance - Your local neighborhood has dancing lessons. Put yourself out
there and go join a class with your significant other or as a family.
You do not have to do the Tango, but you can learn social dancing, folk
dancing. It is not only good exercise, but you are doing something fun
together. Dancing gets endorphins moving, it provides an opportunity to
touch a loved one, it inspires camaraderie. Also, dancing is another
form of communication, it allows you to focus on something other than
yourself while allowing your body to move and loosen those muscles. You
will feel lighter when you come home.

Exercise - Exercise comes first. You will feel good and proud of
yourself. Join the YMCA or local gym. Ask your doctor first. Exercise
also stimulates endorphin production, and moves your joints, muscles and
ligaments preventing stiffness. In addition, when you exercise on a
weekly basis you will feel better about yourself, more confident, and
have an elevated self-esteem. Exercising outside in the sunlight
elevates mood. If you are not in an area where there is much sunlight,
there are indoor lights that you can buy to provide similar benefits.
Exercise earlier in the day, not right before bed because you will have
trouble sleeping.
When you are exercising together with your family or significant other,
you are sharing an experience, motivating each other, and experiencing
sensory stimulation. Try following your exercise activity with massage
or hot tub. Walk on the beach, in a park, in nature - Gets your mind on
nature and your surroundings. This activity will get you out of the
house and around other people. It is important to be in contact with
other people. Make it a group outing and become involved with other
couples while steering clear of isolation.

Massage - A stress reliever that you can do with each other or have done
professionally. Communicate with your partner or massage therapist and
it can be performed in such a way that addresses specific tender points.
If you have restless leg syndrome, ask your partner to rub your legs or
your feet. Share the experience and rub your partner. Sensory touch is
soothing and can quiet your breathing and induce relaxation. The sensory
touch to your partner can bring you closer together. Massage takes you
to a hypnotic level if you allow yourself to let go and enjoy the
relaxing music and the touching sensation. Drink a glass of water
afterward to release the toxins. If you feel worse the first day, you
will feel better the second.

Relaxation - Try having quiet time together practicing yoga, listening
to mood music, or just lying together under a blanket. Purchase a CD or
tape of mood music, the ocean, the forest, birds, whatever you prefer.
Practice visualization exercises and step outside of yourself for that
moment in time.

Take a nap with your spouse or alone - Give yourself a present and
sleep. Take a nap in the middle of the day and try enjoying your
relaxation music as you rest. It is usually best to nap around 2:00 or
4:00 p.m. Keep your nap to 20 minutes. Too long of a nap can make you
groggy. Make a habit of napping at the same time so you can get used to
this short rejuvenating ritual.

Hot tub - Slip into the hot tub together and soothe those sore muscles
and ligaments. Play a relaxation tape to set the mood. Remember not to
sit in the hot tub too long or you can feel groggy. If you don't have
access to a hot tub, or if it is too cold to go outside, buy a jet for
your own tub in your house. Hot tubbing with your partner can be
relaxing, provide the opportunity for sensory touch, and can be further
enjoyed with a soothing drink of hot cocoa or tea.

Healthy eating - Have a goal of eating healthy together. Have
strawberries for dessert instead of a chocolate torte. Snack on fresh
fruit and vegetables instead of chips and cookies. You will feel better
and inspire each other to stick with it! We should all be eating

Learn - One of the most important components to a relationship is being
able to understand the other person in the relationship and his/her
special needs. If your family or spouse is not educated on fibromyalgia,
learn more about it together. What about the other partner? Does he/she
have special needs that have not been addressed? Learn and discover
together how you can help one another.

Education is power - the more you learn how to deal with this, the more
you have power over your life.
I maintain a marriage and family practice, specializing in relationship
problems, grief, and marital issues dealing with Fibromyalgia. Life is a
journey, and it is the path that we choose, that lights our way. We have
the choices. Fibromyalgia can lead your life, or you can manage & lead
Fibromyalgia. Don't let it take over your life.
You have probably heard this before, but life is not a rehearsal, this
is the real thing. Live your life. And, to end on...Today is in the
present, yesterday is in the past, and tomorrow is a mystery...
Another ...Yesterday is gone, live in today the present, and tomorrow
remains an unknown mystery.
Handle Your Frustrations & Move On
"I feel so frustrated!" As a human being, chances are you've said this
many times, either out loud or in your mind. The great thing about
accepting you're frustrated is that you've identified and acknowledged
what's going on. It's too easy to carry on struggling with something and
being unaware that it's causing you frustration. Once you've realised
that you're frustrated, you're free to make choices about how you handle
it. The way you handle your frustrations is a key to successfully moving
One of the first choices you need to make is to shift away from being a
victim and from saying "Why me?" or "Why did this have to happen?" Being
a victim wastes your time and energy and often leaves you feeling even
more frustrated. Instead, make the shift to tapping into your own
resourcefulness and discover solutions. Part of the reason we often stay
stuck and frustrated is that we don't believe we can do something about
it. You are more resourceful than you think.
The first step is to identify specifically what you're feeling
frustrated about. It may seem obvious but often when we feel
frustration, we start to pile other unrelated things on top of it and
this clouds the issue. Specifically naming your frustration is half the
Once you've identified this specifically, then be an observer of
yourself. This isn't an opportunity to beat yourself up. It's an
opportunity to observe what's going on without judgement, leaving you
able to make effective choices. As an observer, you'll often see a
different perspective. As you're observing yourself, see what you most
need, what's truly important to you and what it will take to move
forward quickly. Observe the chatter that's going on in your mind. Is
your mind chatter keeping you stuck? What is worth listening to?
One of the best ways to be an observer and to see the situation more
clearly is to take a break. Once you've stepped back from the
frustration, you'll find it easier to tap into your creativeness and
come up with ideas and solutions. Tap into the creative and resourceful
part of yourself by asking empowering questions. Empowering questions
such as "What is important to me about this?", "What is the intended
result?", "What choices are available to me?", or "What is the next
action I need to take?" When you're asking these questions, listen
carefully for your ownresponse. This is where your own personal
resourcefulness will show up and give you the answers and solutions to
enable you to move forward. You'll quickly move beyond the frustration
and get back to achieving what you want.
When frustrations have occurred, it's well worth getting to the source
so that you can handle it once and for all. What often leaves us
frustrated is when the same problems come up time and time again. Get to
the source of your frustration and from that, learn what needs to change
or needs to be done differently in the future. Frustrations can also
present an opportunity, although it may not feel like it at the time.
They're an opportunity for growth and improvement. Next time you feel
frustrated, I invite you to see it as an opportunity.
AOL Users -> <a
href="">read more</a>

Neuropsychological impairment in fibromyalgia. Relation to depression,
fatigue, and pain.
FM patients have more memory complaints and report more fatigue, pain,
and depression than other groups.
More info:
Lack of Vitamin D Linked to Pain
01-19-2004 Study Shows Limited Sun Exposure Has Health Benefits

By Salynn Boyles
WebMD Medical News

Dec. 10, 2003 -- There is new evidence that small amounts of unprotected
sun exposure could be good for you. Earlier studies have linked vitamin
D deficiency with an increased risk for several cancers. Now comes word
that it may also be a major cause of unexplained muscle and bone pain.

In a study involving 150 children and adults with unexplained muscle and
bone pain, almost all were found to be vitamin D deficient; many were
severely deficient with extremely low levels of vitamin D in their

Humans tend to get most of their vitamin D from exposure to sunlight, so
those who avoid the sun completely or who always wear sunscreen to
protect themselves against skin cancers are at risk for vitamin D
deficiencies, says Michael Holick, MD. Holick runs the Vitamin D
Research Lab at Boston University Medical Center.

"I think the current message that all unprotected sun exposure is bad
for you is too extreme," he tells WebMD. "The original message was that
people should limit their sun exposure, not that they should avoid the
sun entirely. I do believe that some unprotected exposure to the sun is
important for health."

Dermatologists Disagree

Holick claims there is now a strong epidemiological case linking vitamin
D deficiency with a host of cancers including those of the prostate,
colon, and breast; and he says vitamin D may also help protect against
heart disease, autoimmune diseases, and even type 1 diabetes.

He will present the evidence in a book scheduled for publication next
spring, but the nation's largest dermatology group remains unconvinced.
In a recent press release, American Academy of Dermatology officials
wrote that they were "deeply concerned" that the message that
unprotected sun exposure may have health benefits could "mislead the
public about the very real danger of sun exposure, the leading cause of
skin cancer."

Patients Should Be Tested

In the latest study, Gregory A. Plotnikoff, MD, of the University of
Minnesota Medical School found a much higher incidence of vitamin D
deficiency in the patients with unexplained muscle and skeletal pain
than expected, regardless of their ages.

All of the African Americans, East Africans, Hispanics, and Native
Americans who participated in the study were vitamin D deficient, as
were all of the patients under the age of 30.

The researcher says it was a big surprise that the worst vitamin D
deficiencies occurred in young people -- especially women of
childbearing age. The findings are reported in the December issue of the
journal Mayo Clinic Proceedings.

"The message here is that unexplained pain may very well be linked to a
vitamin D deficiency," Plotnikoff tells WebMD. "My hope is that patients
with unexplained pain will be tested for vitamin D status, and treated,
if necessary."

Food and Pills

Although it is possible to get vitamin D through foods or supplements,
both researchers say it is not easy. A glass of fortified milk or
fortified orange juice has about 100 international units (IU) of vitamin
D and a multivitamin typically has 400 IU. Holick believes most people
need about 1000 IU of vitamin D each day. The recommended dietary
allowance (RDA) for vitamin D varies with age, sex, and various medical
conditions but in general is 200-600 IU per day.

Other sources of vitamin D include:

. Cod Liver Oil. 1 tablespoon=1360 IU of vitamin D

. Salmon. 3 ounces=425 IU of vitamin D

. Herring. 3 ounces=765 IU of vitamin D

. Sardines. Canned, 3 ounces=255 IU of vitamin D

Multivitamin supplements commonly provide 200-400 IU of vitamin D daily.

He says a light-skinned person wearing a swimsuit at the beach will have
absorbed about 20,000 IU of vitamin D in the time it takes their skin to
get lightly pink.

The amount of sun exposure needed to get the proper dose of vitamin D
depends on a person's skin type, where they live, and time of year, and
time of day the exposure occurs. Holick says it is difficult for people
living in northern climates to get the vitamin D they need from the sun
in the winter, but in the summer a light-skinned person at the beach
should get all the vitamin D they need in about five minutes.

"The trick is getting just enough sun to satisfy your body's vitamin D
requirement, without damaging the skin," he says. "It is difficult to
believe that this kind of limited exposure significantly increases a
person's risk of skin cancer."

SOURCES: Plotnikoff, G. Mayo Clinic Proceedings, December 2003; vol. 78:
pp. 1463-1470. Gregory A. Plotnikoff, MD, MTS, departments of internal
medicine and pediatrics, University of Minnesota Medical School,
Minneapolis. Michael Holick, MD, department of medicine, Boston
University School of Medicine, Boston. News release, American Academy of
Dermatology, July 3, 2003; "Vitamin D + Sunshine + Bad Medicine."

C 2003 WebMD Inc. All rights reserved. C2000 Pro Health, Inc.

From The Dumps To Bountiful Restoration

"Call to Me and I will answer you and tell you great
and unsearchable things you do not know"(Jeremiah 33:3 NIV).
I received a lovely handcrafted card at a very stressful time in my
life. In it was this verse from Jeremiah. I was due for my annual
evaluation at my
part-time job as a nurse, had to take my "ACLS" (Acute Care License)
test for the first time, and many other things were burdening me.
I went for a drive into a rural part of town. I stopped to pray. When I
was done, I drove down a road and saw a sign that said "Bountiful Lake".
I have
lived in Utah for 33 years and didn't know this lake existed! This
peaceful lake was located just around the corner from the dump. There
were men fishing, and 12 ducks lined up in a row sitting next to the
It was such an amazing sight. It was like God reassuring me that while I
was feeling like garbage, just around the corner was refreshment. Soon I
get all my "ducks in a row".
The stranger who made the card is now a friend that has since blessed me
with much encouragement. I got a pay increase. Passed my test, and had
an answer to prayer come to pass.
The heading to Jeremiah 33 says: "Promise of Restoration". In verse 11
it talks about a "desolate waste" being restored, and where "the sounds
of joy
and gladness...and the voices of those who bring thank offerings to the
house of the Lord" say:
"Give thanks to the LORD Almighty for the LORD is good his love endures
Dear Father, I thank you for pulling me out from the miry pit and
restoring my soul. Bless those who may be feeling like garbage right now
to trust in your promise of restoration.
--Lori Mortensen
Compliments of Rest Ministries, serving people
Who live with chronic illness or pain.
Rest Ministries, Inc.
PO Box 502928, San Diego, CA 92150
toll-free 1-888-751-REST (7378)
copyright 2003

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