Research Updates
Latest Update: August 08, 2002

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Abstracts and Studies

 
Fibromyalgia Pain Isn't All in Patients' Heads New 8/02
Source:

ANN ARBOR, MI - A new brain-scan study confirms scientifically what fibromyalgia patients have been telling a skeptical medical community for years: They're really in pain.

In fact, the study finds, people with fibromyalgia say they feel severe pain, and have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease. The squeeze's force must be doubled to cause healthy people to feel the same
level of pain - and their pain signals show up in different brain areas.

The results, published in the current issue of Arthritis & Rheumatism, the journal of the American College of Rheumatology, may offer the proof of fibromyalgia's physical roots that many doubtful physicians have sought. It may also open doors for further research on the still-unknown causes of the disease, which affects more than 2 percent of Americans, mainly women.

Lead authors Richard Gracely, Ph.D., and Daniel Clauw, M.D., did the study at Georgetown University Medical Center and the National Institutes of Health, but are now continuing the work at the University of Michigan Health System. In an editorial in the same issue, Clauw and U-M rheumatologist Leslie Crofford, M.D., stress the importance of fibromyalgia research and
care.

To correlate subjective pain sensation with objective views of brain signals, the researchers used a super-fast form of MRI brain imaging, called functional MRI or fMRI, on 16 fibromyalgia patients and 16 people without the disease. As a result, they say, the study offers the first objective
method for corroborating what fibromyalgia patients report they feel, and what's going on in their brains at the precise moment they feel it. And, it gives researchers a road map of the areas of the brain that are most - and least - active when patients feel pain.

"The fMRI technology gave us a unique opportunity to look at the neurobiology underlying tenderness, which is a hallmark of fibromyalgia," says Clauw. "These results, combined with other work done by our group and others, have convinced us that some pathologic process is making these
patients more sensitive. For some reason, still unknown, there's a neurobiological amplification of their pain signals."

Further results from the study were presented last year at the ACR annual meeting. The project will continue later this year at UMHS, joining other fMRI fibromyalgia research now under way.

For decades, patients and physicians have built a case that fibromyalgia is a specific, diagnosable chronic disease, characterized by tenderness and stiffness all over the body as well as fatigue, headaches, gastrointestinal problems and depression. Many patients with the disease find it interferes with their work, family and personal life. Statistics show that far more women than men are affected, and that it occurs mostly during the childbearing years.

The ACR released classification criteria for fibromyalgia in 1990, to help doctors diagnose it and rule out other chronic pain conditions. Clauw and Crofford's editorial looks at the current state of research, and calls for rheumatologists to take the lead in fibromyalgia care and science.

But many skeptics have debated the very existence of fibromyalgia as a clearly distinct disorder, saying it seemed to be rooted more in psychological and social factors than in physical, biological causes. Their argument has been bolstered by the failure of research to find a clear
cause, an effective treatment, or a non-subjective way of assessing patients.

While the debate has raged, neuroscientists have begun to use brain scan technology to identify the areas of the normal human brain that become most active during pain. A few studies have even assessed the blood flow in those areas in fibromyalgia patients during baseline brain scans. The new study is the first to use both high-speed scanning and a painful stimulus.

In the study, fibromyalgia patients and healthy control subjects had their brains scanned for more than 10 minutes while a small, piston-controlled device applied precisely calibrated, rapidly pulsing pressure to the base of their left thumbnail. The pressures were varied over time, using painful and
non-painful levels that had been set for each patient prior to the scan.

The study's design gave two opportunities to compare patients and controls: the pressure levels at which the pain rating given by patients and control subjects was the same, and the rating that the two different types of participants gave when the same level of pressure was applied.

The researchers found that it only took a mild pressure to produce self-reported feelings of pain in the fibromyalgia patients, while the control subjects tolerated the same pressure with little pain.

"In the patients, that same mild pressure also produced measurable brain responses in areas that process the sensation of pain," says Clauw. "But the same kind of brain responses weren't seen in control subjects until the pressure on their thumb was more than doubled."

Though brain activity increased in many of the same areas in both patients and control subjects, there were striking differences too. Patients feeling pain from mild pressure had increased activity in 12 areas of their brains, while the control subjects feeling the same pressure had activation in only
two areas. When the pressure on the control subjects' thumbs was increased, so did their pain rating and the number of brain areas activated. But only eight of the areas were the same as those in patients' brains.

In all, the fibromyalgia patients' brains had both some areas that were activated in them but not in controls, and some areas that stayed "quiet" in them but became active in the brains of controls feeling the same level of pain. This response suggests that patients have enhanced response to pain in some brain regions, and a diminished response in others, Clauw says.

The study was supported in part by the National Fibromyalgia Research Association, the U.S. Army and the NIH. In addition to Clauw and Gracely, the research team included Frank Petzke, M.D.; and Julie M. Wolf, BA. For more information on fibromyalgia research at UMHS, visit
.

The efficacy of dry needling and procaine in the treatment of myofascial
pain in the jaw muscles. NEW 8/02
J Orofac Pain 1997 Fall;11(4):307-14 McMillan AS, Nolan A, Kelly PJ

Department of Restorative Dentistry, University of Newcastle, Newcastle upon
Tyne, United Kingdom.

In patients with myofascial pain, painful trigger points are often treated
using dry needling and local anesthetic injections. However, the therapeutic
effect of these treatments has been poorly quantified, and the mechanism
underlying the effect is poorly understood. In a randomized, double-blind,
double-placebo clinical trial, a pressure algometer was used to measure
pain-pressure thresholds in the masseter and temporalis muscles of 30
subjects aged 23 to 53 years with myofascial pain in the jaws, before and
after a series of dry needling treatments, local anesthetic injections, and
simulated dry needling and local anesthetic treatments (treatment group A:
Procaine + simulated dry needling; treatment group B: dry needling +
simulated local anesthetic; control group C: simulated local anesthetic +
simulated dry needling). Subjects rated pain intensity and unpleasantness
using visual analogue scales, and the data were analyzed using analysis of
variance. Pain pressure thresholds increased slightly after treatment,
irrespective of the treatment modality. Pain intensity and unpleasantness
scores decreased significantly at the end of treatment in all groups. There
were no statistically significant between-group differences in pain pressure
thresholds and visual analogue scale scores at the end of treatment. The
findings suggest that the general improvement in pain symptoms was the
result of nonspecific, placebo-related factors rather than a true treatment
effect. Thus, the therapeutic value of dry needling and Procaine in the
management of myofascial pain in the jaw muscles is questionable.

Abstract - Opioids in non-cancer pain: a life-time sentence?

Dellemijn, P. L. (2001).
European Journal of Pain:Ejp 5(3): 333-9.

There is continuing reluctance to prescribe strong opioids for the
management of chronic non-cancer pain due to concerns about side-effects,
physical tolerance, withdrawal and addiction. Randomized controlled trials
have now provided evidence for the efficacy of opioids against both
nociceptive and neuropathic pain. However, there is considerable variability
in response rates, possibly depending on the type of pain, the type of
opioid and its route of administration, the time to follow-up, compliance
and the development of tolerance.

Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain
(diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases.

In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on
treatment cessation, regardless of duration of the treatment. In conclusion,
strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of
addictive behaviour.

Copyright 2001 European Federation of Chapters of the
International Association for the Study of Pain

Weather and the pain in fibromyalgia: are they related?

E A Fors1 and H Sexton2 1 Department of Psychiatry and Behavioural Medicine and Multidisciplinary
Pain Centre, University Hospital of Trondheim, Norway 2 Psychiatric Research Centre for Finnmark and Troms, Tromsö, NorwayObjectives: To examine the association between fibromyalgic pain and weather to determine the nature of their interrelationship.

Methods: The daily pain ratings of 55 female patients previously diagnosed
with fibromyalgia were recorded on visual analogue scales (VAS) over 28
days. These ratings were then related to the official weather parameters and
a composite weather variable using time series methodology. Effect sizes r
were calculated from the t values and df.

Results: A composite weather variable did not significantly predict changes
in pain, either the same day (t=-1.15, df=1483, p=0.25) or on the next day
(t=-1.55, df=1483, p=0.12)-that is, the weather was not a factor for changes
in the subjective pain of FM. Patients' pain did not predict weather change
in this sample, and neither same day (t=-0. 69, df=1483, p<0.49) nor
previous day pain (t=-1.31, df=1483, p<0.19) predicted weather changes. A
post hoc exploratory analysis showed that those with <10 years of
fibromyalgia experienced significantly greater weather sensitivity to pain
(t=- 2.73, df=389, p<0.006) than those with longer illness.

Conclusion: A statistically significant relationship between fibromyalgic
pain and the weather was not found in this sample, although it is possible
that a group of patients with less chronic fibromyalgia might be weather
sensitive. Correspondence to: Dr E A Fors, Department of Psychiatry and Behavioural Medicine, NTNU, PO Box 3008 Lade, NO-7441 Trondheim, Norway;

Benefits of Tegaserod for IBS

Tegaserod: A New 5-HT4 Agonist Brian E. Lacy, Ph.D. , M.D. ; Shaoyong Yu, M.D.
From the Marvin M. Schuster Center for Digestive and Motility Disorders,
Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Journal of Clinical Gastroenterology 2002;34:27-33

Tegaserod is a medication that has been shown to be of benefit in women with
irritable bowel syndrome (IBS) associated with abdominal pain, bloating, and
constipation. Tegaserod is a selective serotonin receptor subtype 4 partial
agonist designed to interact with the network of cells and nerves throughout
the gastrointestinal tract that use serotonin. Tegaserod has been shown to
modulate both gastrointestinal motility and visceral sensitivity.
Specifically, it increases the peristaltic reflex and decreases visceral
sensitivity. Clinical studies have shown that tegaserod improves symptoms of
abdominal pain, bloating, and constipation in women with IBS. This article
discusses the role of serotonin in gastrointestinal tract physiology, the
structure and pharmacokinetic profile of tegaserod, and clinical
applications of this new drug.

Fluoxetine Effective In Women With Fibromyalgia

The American Journal of Medicine 2002;112(3):191-197 "A randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia" 03/28/2002 09:33:18 AM
By Robert Short
 

The SSRI fluoxetine is effective and generally well tolerated in women with fibromyalgia.

A randomized, placebo-controlled, double-blind flexible-dose study of fluoxetine in 60 women with fibromyalgia was carried out by Dr Lesley Arnold and colleagues. Dr Arnold is based at the Women's Health Research program, Department of Psychiatry, University of Cincinnati Medical Center, Cincinnati, Ohio, United States.

The intent-to-treat analysis in women who had received fluoxetine showed significant improvement in the Fibromyalgia Impact Questionnaire (FIQ) total score, compared with women who received placebo (difference of -12). The FIQ pain score was also 2.2 points lower in fluoxetine-treated women compared with the control group. Similarly, the FIQ fatigue and depression scores were lower in the treated group compared with women who received placebo. Fluoxetine-treated women also showed significant improvement in the McGill Pain Questionnaire, relative to the placebo group of women.

The effects of fluoxetine on tender points and myalgic scores were not so clear-cut. Said Dr Arnold, "Although counts for the number of tender points and total myalgic scores improved more in the fluoxetine group than in the placebo group, these differences were not statistically significant."

Dr Arnold concluded, "Fluoxetine was found to be effective on most outcome measures and generally well tolerated in women with fibromyalgia."

Relief of FM symptoms following discontinuation of dietary excitotoxins (MSG, Aspartame)

Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother 2001 Jun;35(6):702-6 Smith JD, Terpening CM, Schmidt SO, Gums JG. Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA. PMID:

BACKGROUND: Fibromyalgia is a common rheumatologic disorder that is often difficult to treat effectively.

CASE SUMMARY: Four patients diagnosed with fibromyalgia syndrome for two to  17 years are described. All had undergone multiple treatment modalities with  limited success. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. All patients were women with multiple comorbidities prior to elimination of MSG. All have had recurrence of symptoms whenever MSG is ingested.

DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate, that act  as excitatory neurotransmitters, and can lead to neurotoxicity when used in  excess. We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or,   alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia. We suggest that identification of similar patients and research with larger numbers of patients must be performed before definitive conclusions can be made.

CONCLUSIONS: The elimination of MSG and other excitotoxins from the diets of   patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.

SUPPLEMENTAL DEXTROMETHORPHAN IN THE TREATMENT OF FIBROMYALGIA: A DOUBLE BLIND,PLACEBO CONTROLLED STUDY OF EFFICICACY AND SIDE-EFFECTS.
Sharon R Clark, Robert M Bennett Portland OR  November 01, 2000

Dexromethorphan (DM) is a cough suppressant that is also an NMDA receptor antagonist. NMDA receptor activation is involved in the perpetuation of chronic pain states and dextromethorphan has been successfully used in the treatment of post herpetic neuralgia (Nelson, Neurology 48:1212,1997). In the current study we investigated the efficacy of DM in the treatment of fibromyalgia pain.

Patients and Methods: Forty eight female fibromyalgia patients (age ) who were taking a stable dose of tramadol (~ 200 mg/d) were given an escalating dose of DM (50 mg to 200 mg/d) at a rate increase of 50 mg every 3 days. They were instructed to stabilize the dose either when they achieved a worthwhile improvement in pain or if they experienced unacceptable side-effects.

Subjects reporting a 25% improvement on a pain VAS were then randomized into a double blind protocol in which they either continued on the same number of DM capsules or took and active placebo (PL)(diphenhydramine 2mg / capsule). They were instructed to return in 30 days or when their pain level returned to the pre-study level. The primary outcome measure was time to drop out.

Results: Forty six patients entered the study, 2 failed to follow-up. Twenty (45%) experienced a 25% improvement in pain without significant side effects and entered the double blind phase (DB). Reasons for not proceeding to DB were lack of efficacy ([pound]10) and adverse events ([pound]10). The most common AEs were dizziness, mental fog, nausea and fatigue.

Eleven subjects entered the DM arm (final dose 173168 mg/d) and 9 the PL arm of the DB (final dose 156173 mg/d). One subject in the placebo arm (placebo responder) and 6 subjects in the dextromethorphan arm completed the study (Fischer exact test P=0.07). The 6 DM responders reduced their pain VAS by 43% (P<0.001) and had a global improvement of 51%. The 5DM non-responders increased their pain VAS by 4% (P=0.7) and reported a global worsening of 8%.

Conclusion: Dextromethorphan added to tramadol either does not benefit or is not tolerated by the majority of FM patients. However some 14% of those starting this study experienced an impressive improvement in pain and most have continued to use supplemental DM. Supplemental dextromethorphan may have a therapeutic role in a small subset of fibromyalgia patients.

Plasma oxytocin levels in female fibromyalgia syndrome patients.
Z Rheumatol 2000 Dec;59(6):373-9 Anderberg UM, Uvnas-Moberg K Department of Neuroscience, Psychiatry University Hospital, 75185 Uppsala, Sweden.

OBJECTIVES: Fibromyalgia syndrome (FMS) is a chronic pain disorder, where 90% of
the patients struck by the disorder are women. The neuropeptide oxytocin is known to have antinociceptive and analgesic, as well as anxiolytic and antidepressant effects, which makes this neuropeptide of interest in fibromyalgia research. The aim of this study was to assess oxytocin concentrations in female FMS patients with different hormonal status and in depressed and non depressed patients and relate oxytocin concentrations to adverse symptoms as pain, stress, depression, anxiety and to the positive item happiness.

METHODS: Thirty-nine patients and 30 controls registered these symptoms daily during 28 days and blood samples for the assessment of oxytocin were drawn twice in all patients and controls. Besides the daily ratings, depression was also estimated with the self-rating instrument Beck Depression Inventory (BDI).

RESULTS: Depressed patients according to the BDI differed significantly with low levels of oxytocin compared to the non-depressed patients and the controls. Low levels of oxytocin were also seen in high scoring pain, stress and depression patients according to the daily ratings; however, these subgroups were small. A negative correlation was found between the scored symptoms depression and anxiety and oxytocin concentration, and a positive correlation between the item happiness and oxytocin. The oxytocin concentration did not differ between the hormonally different subgroups of patients or controls.

CONCLUSION: The results suggest that the neuropeptide oxytocin may, together with other neuropeptides and neurotransmitters, play a role in the integration of the stress axes, monoaminergic systems and the pain processing peptides in the pathophysiologic mechanisms responsible for the symptoms in the FMS.

Exercise for Patients with Fibromyalgia: Risks versus Benefits.

Clark SR, Jones KD, Burckhardt CS, Bennett R. 1: Curr Rheumatol Rep 2001 Apr;3(2):135-40 Oregon Health Sciences University, 3181 SW Sam Jackson, L323,
Portland, OR 97201, USA.
Although exercise in the form of stretching, strength maintenance, and aerobic conditioning is generally considered beneficial to patients with fibromyalgia (FM), there is no reliable evidence to explain why exercise should help alleviate the primary symptom of FM, namely pain. Study results are varied and do not provide a uniform consensus that exercise is beneficial or what type, intensity, or duration of exercise is best. Patients who suffer from exercise-induced pain often do not follow through with recommendations. Evidence-based prescriptions are usually inadequate because most are based on methods designed for persons without FM and, therefore, lack individual-ization. A mismatch between exercise intensity and level of conditioning may trigger a classic neuroendocrine stress reaction. This review considers the adverse and beneficial effects of exercise. It also provides a patient guide to exercise that takes into account the risks and benefits of exercise for persons with FM. PMID:
 

Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS).

J Endocrinol Invest 2001 Mar;24(3):173-7 Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Department of Physiology and Pharmacology V. Erspamer, Medical Faculty, University of Rome La Sapienza, Italy.

Although irritable bowel syndrome (IBS) can be considered a biopsychological disorder in which an association between life stress and physiological changes leading to bowel irregularity is present, there is a lack of data concerning possible modifications of the adrenal function during the disease. The aim of the present study was to measure biological and psychological variables related to the activity of the hypothalamo-pituitary-adrenal axis in IBS patients compared to healthy subjects. Cortisol was measured in the saliva (obtained by a stress-free, non invasive collection procedure) of 55 IBS outpatients and 28 matched controls. Moreover, each subject completed the following self-administered questionnaires: the Rome Burnout Inventory (RBI) in its physical (RBI-PE) and emotional-mental exhaustion (RBI-EME) components, Beck Depression Inventory, State and Trait Anxiety Inventory (STAI), Perceived Social Support Scale (PSSS) and a Scale for the Assessment of Perceived Actual Work-Non Work Stress. Compared with controls, IBS subjects showed significantly higher levels of cortisol in the morning and lower in the evening, while they maintained the physiological circadian fluctuation (i.e. cortisol morning level higher than in the evening). Moreover, IBS patients presented a significant difference from controls in RBI-PE scores, which confirms the presence of fatigue, a symptom frequently reported by the patients. Compared with controls, no differences were found in IBS patients with respect to other psychological parameters. These findings suggest a dysregulation of the adrenal activity in IBS patients. The results may be relevant considering that changes in cortisol levels have been shown to be sensitive indicators of psychosocial stress and coping patterns in both laboratory and life situations.
 

Patients' perceptions of medical care in chronic fatigue syndrome.
1: Soc Sci Med 2001 Jun;52(12):1859-64 Deale A, Wessely S.
Academic Department of Psychological Medicine, Guy's, King's and St  Thomas's School of Medicine, Kings College, University of London, UK.

This study investigated perceptions of medical care among patients with chronic fatigue syndrome (CFS) referred to a specialist clinic. Sixty-eight patients completed a questionnaire survey on their overall satisfaction with medical care received since the onset of their illness, and their views on specific aspects of care. Two-thirds of patients were dissatisfied with the quality of medical care received. Dissatisfied patients were significantly more likely to describe delay, dispute or confusion over diagnosis; to have received and rejected a psychiatric diagnosis; to perceive doctors as dismissive, skeptical or not knowledgeable about CFS and to feel that the advice given was inadequate or conflicting. Satisfied patients were significantly more likely to perceive doctors as caring, supportive and interested in their illness; to state that they did not expect their doctors to cure CFS and to perceive their GP or hospital doctor as the source of greatest help during their illness. Many patients were critical of the paucity of treatment, but this was not associated with overall satisfaction. The findings suggest that medical care was evaluated less on the ability of doctors to treat CFS, and more on their interpersonal and informational skills. Dissatisfaction with these factors is likely to impede the development of a therapeutic doctor-patient alliance, which is central to the effective management of CFS. The findings suggest a need for better communication and better education of doctors in the diagnosis and management of CFS. PMID:
 

Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.1: J Rheumatol 2001 Jun;28(6):1361-8 
Elert J, Kendall SA, Larsson B, Mansson B, Gerdle B. Department of Rehabilitation Medicine, INR, Faculty of Health Sciences, Pain and Rehabilitation Centre, University Hospital, Linkoping, Sweden.

OBJECTIVE: To investigate if muscle tension according to the surface electromyogram (EMG) of the shoulder flexors is increased in consecutive patients with fibromyalgia (FM) or chronic whiplash associated disorders (WAD).

METHODS: A total of 59 consecutive patients with FM (n = 36) or chronic WAD (n =23) performed 100 maximal isokinetic contractions combined with surface electromyography of the trapezius and infraspinatus. A randomized group of pain-free female (n = 27) subjects served as control group. Peak torque initially (Pti) and absolute and relative peak torque at endurance level (PTe, PTer) were registered as output variables, together with the EMG level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR).

RESULTS: The patient groups had a higher level of unnecessary tension initially and at the endurance level. The patients had lower absolute output (PTi and PTe), but the relative levels (PTer) did not differ comparing all 3 groups. Subjects with FM had significantly higher body mass index (BMI) than the other groups. BMI did not influence the SAR but correlated positively with PTi.

CONCLUSION: The results confirmed earlier findings that groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls. However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension. 

Fibromyalgia developed after administration of gonadotrophin-releasing hormone analogue. Clin Rheumatol 2001;20(2):150-2   Toussirot E, Wendling D.
University Hospital Jean Minjoz, Besancon, France. We report the case of a woman treated with a gonadotrophin-releasing hormone analogue for endometriosis who developed typical clinical features of fibromyalgia, with widespread musculoskeletal pain, sleep difficulties, neuropsychological complaints and tender points on clininal examination. The gonadotrophin-releasing hormone analogue treatment probably induced disturbances in the neuroendocrine system and the secretion of neurotransmitters, and may be suspected to be the cause of this case of fibromyalgia. PMID:

Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Bendtsen L, Jensen R. Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.


Comparison of viral antibodies in 2 groups of patients with fibromyalgia. 1: J Rheumatol 2001 Mar;28(3):601-3 Wittrup IH, Jensen B, Bliddal H, Danneskiold-Samsoe B, Wiik A.Parker Research Institute, Department of Rheumatology, Frederiksberg University Hospital, Copenhagen, Denmark.

OBJECTIVE: The etiologies of fibromyalgia (FM) are unknown. In some cases an acute onset following a flu-like episode is described; in other cases patients report slowly developing disease. We previously found increased prevalence of enterovirus IgM antibodies in patients with acute onset of FM compared to healthy controls. We looked for differences in antimicrobial IgM antibodies in acute versus nonacute onset FM.

METHODS: Two well defined, comparable groups of patients with FM (acute 19, nonacute 20) were studied for antibodies in serum to an array of viruses including IgM antibodies.

RESULTS: In most viruses no IgM antibodies were found. However, about 50% of the
patients with acute FM onset had IgM antibodies against enterovirus compared to only 15% of the slow onset patients.
 
CONCLUSION: The higher prevalence of IgM antibodies against enterovirus in patients with acute onset of FM may indicate a difference in the etiology or the immune response in these patients.

EMG activity and pain development in fibromyalgia
EMG activity and pain development in fibromyalgia patients exposed to mental stress of long duration. Scand J Rheumatol 2001;30(2):92-8 Bansevicius D, Westgaard RH, Stiles T.
Norwegian University of Science and Technology, Division of Organization and Work Science, Trondheim. PMID:

OBJECTIVE: To examine the distribution of stress-induced upper-body pain in fibromyalgia patients, and the possible association of pain with electromyographic activity in muscles near the sites of pain development.

METHODS: Fifteen fibromyalgia patients and 15 pain-free subjects were exposed to low-level mental strain over a one-hour period. EMG was recorded from frontalis, temporalis, trapezius, and splenius capitis. Pain in the corresponding locations was recorded before the test, every 10 minutes during the test, and the 30-minute posttest period.

RESULTS: The fibromyalgia patients developed pain during the test in all the above body locations. Pain development in all locations associated with trapezius EMG activity, but not with EMG activity in underlying muscles for forehead, temples, and neck.

CONCLUSION: Stress-induced pain in fibromyalgia patients is not generally caused by muscle activity. The trapezius EMG response may be part of a general stress response that cause pain independently of motor activity in muscles.

Ernberg M, Voog U, Alstergren P, Lundeberg T, Kopp S. J Orofac Pain. 2000 Winter;14(1):37-46.
PMID:

Arthritis Rheum. 2001 Jan;44(1):222-30.PMID:

. Bennett RM, Cook DM, Clark SR, Burckhardt CS, Campbell SM Department of Medicine, Oregon Health Sciences University, Portland, USA.

Scand J Rheumatol Suppl 2000;113:63-5

  Image Analysis Quantification of Substance P Immunoreactivity in the Trapezius Muscle of Patients with Fibromyalgia and Myofascial Pain Syndrome   Journal of Rheumatology

Rev Neurol (Paris) 2000 Dec;156 Suppl 4:4S10-4S14  [Article in French]
Boureau F, Delorme T, Doubrere JF Centre d'Evaluation et de Traitement de la Douleur, Hopital Saint-Antoine.
[Record supplied by publisher]
The aim of this paper is to review available data and current hypotheses concerning myofascial pain syndrome pathophysiology and implications for clinical practice. A muscular hypothesis has been proposed for episodic and chronic tension headache as well as for myofascial syndrome and fibromyalgia. These different syndromes may be compared as, besides their frequent combination, they have common features characterized by spontaneous pain, painful points, and lack of objective findings. They must be distinguished because each has its own diagnostic criteria.

Stratz T, Muller W  Scand J Rheumatol Suppl 2000;113:66-71

Treatment of chronic fatigue syndrome with 5-HT3 receptor antagonists--preliminary results. Spath M, Welzel D, Farber L Friedrich-Baur-Institut, University of Munich, MunchenGermany.    Scand J Rheumatol Suppl 2000;113:72-7

. Scand J Rheumatol Suppl 2000;113:32-6.



. Scand J Rheumatol Suppl 2000;113:78-85.

   Elevated serum levels of HA in women w/ FM

1999. Indicates that the size of the adrenals in CFS patients are smaller than normal Psychoneuroendocrinology 1999 Oct;24(7):759-68

. Kuratsune H, Yamaguti K, Sawada M, Kodate S, Machii T, Kanakura Y, Kitani TDepartment of Hematology and Oncology, Osaka University Medical School, Suitacity, Osaka 565, Japan.

Upper Quarter Myofascial Pain Syndrome in Singapore: Characteristics and Treatment. Journal of Musculoskeletal Pain, Vol. 8(4), pp. 49-56 Authors: Alan Tay, BSc;  Karen Chua, MBBS, MRCP;  Kay-Fei Chan, MBBS, MRCP, FAMS ABSTRACT. Objectives: To study regional muscle distribution, pain intensity, and treatment outcome in upper quarter myofascial pain syndrome [UQMPS].

   Elevated serum levels of HA in women w/ FM

  

of Fibromyalgia Patients Treated With EEG-Driven Stimulation and Myofascial Physical Therapies

 







 

: A    2-Year Follow-up

Image Analysis Quantification of Substance P Immunoreactivity in the Trapezius Muscle of Patients with Fibromyalgia and Myofascial Pain Syndrome RENATO De STEFANO, ENRICO SELVI, MARCELLO VILLANOVA, ELENA FRATI, STEFANIA
MANGANELLI, ELEONORA FRANCESCHINI, GIOVANNI BIASI, and ROBERTO MARCOLONGO

(Contact your local library for a complete copy of this study, ask for J Rheumatol 2000;27:2906-10)

ABSTRACT. Objective. Substance P (SP), a neurotransmitter stored within the afferent nociceptive fibers, is likely to be involved in the pathogenesis of musculoskeletal pain. We investigated SP immunoreactive (SP-ir) nerve fibers in the upper trapezius of patients with fibromyalgia (FM) and myofascial pain syndrome (MPS) by immunochemistry.

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. This is an information gathering list only. It is non-interactive, you may not post. It is geared towards research and finding a cure for CFS/FMS. Very Informative. To subscribe send a message to the above address. leave the subject line blank and in the body of the message put SUBSCRIBE CO-CURE your first name Your last name

   is the first and only international sleep portal on the Internet. It brings together professionals, corporations and the general public from around the world who seek information and knowledge about sleep health and sleep disorders. New 6/02