Chronic Fatigue Syndrome: Perrot S

Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, Da Silva JA, Danneskiold-Samsøe B, Dincer F, Henriksson C, Henriksson KG, Kosek E, Longley K, McCarthy GM, Perrot S, Puszczewicz M, Sarzi-Puttini P, Silman A, Späth M, Choy EH, Anonymous00148. · Academic Rheumatology Unit, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. · Ann Rheum Dis. · Pubmed #17644548 No free full text.

Abstract: OBJECTIVE: To develop evidence-based recommendations for the management of fibromyalgia syndrome. METHODS: A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. RESULTS: 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. CONCLUSIONS: Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

Perrot S. · Service de Médecine Interne et Centre de la Douleur, Hôtel-Dieu, Paris, France. · Curr Opin Support Palliat Care. · Pubmed #18685409 No free full text.

Abstract: PURPOSE OF REVIEW: Fibromyalgia is considered the most common chronic pain syndrome. This syndrome is poorly understood and not widely accepted as a distinct clinical entity but an increasing number of pharmacological and nonpharmacological treatments are being developed for its management. RECENT FINDINGS: The clinical description of fibromyalgia is now well established, but controversies on diagnostic criteria are increasing. Pathophysiological studies suggest that fibromyalgia is a painful rheumatic disorder in which pain primarily stems from central sensitization and from other neuronal changes, including alterations in peripheral neuronal systems. Central sensitization may also underlie associated symptoms, including anxiety, sleep disorders, fatigue, and other dysfunctions such as irritable bowel syndrome and bladder instability.Several agents, including serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipran), weak opioids (tramadol), and anticonvulsants (pregabalin), as well as nonpharmacological approaches, have been recently evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement of core symptoms (i.e., fatigue and sleep disturbance). SUMMARY: Despite the fact that pathophysiology and diagnostic criteria remain unclear, the level of scientific data collected on this recently described condition should convince clinicians of the existence of this syndrome, allowing improved management of the many patients suffering from chronic pain.

Perrot S, Dickenson AH, Bennett RM. · Center de la Douleur et Service de Médecine Interne, Hôtel-Dieu, University Paris 5 Descartes, Paris, France. · Pain Pract. · Pubmed #18363616 No free full text.

Abstract: This review summarizes the present and emerging knowledge base on the pathophysiology, diagnosis, and management of fibromyalgia. EPIDEMIOLOGY: Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Historically, contemporary concepts of fibromyalgia have evolved in terms of its clinical description and parallel advances in the understanding of its pathophysiology. PATHOPHYSIOLOGY: A generally accepted paradigm postulates that fibromyalgia is the clinical expression of a rheumatologic disorder in which the associated pain is driven primarily by central sensitization and possibly through changes in several neuronal systems but not necessarily reliant on peripheral processes. MANAGEMENT: Several agents, including serotonin-norepinephrine reuptake inhibitors (ie, duloxetine and milnacipran), opioids (ie, tramadol), and the alpha2-delta ligand pregabalin, which recently received U.S. regulatory approval for the treatment of fibromyalgia, have been evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement in core symptoms (ie, fatigue and sleep disturbance). The European League Against Rheumatism has developed updated guidelines for the management of fibromyalgia.

Passard A, Attal N, Benadhira R, Brasseur L, Saba G, Sichere P, Perrot S, Januel D, Bouhassira D. · INSERM U-792, Boulogne-Billancourt F-92100 France. · Brain. · Pubmed #17872930 links to  free full text

Abstract: Non-invasive unilateral repetitive transcranial magnetic stimulation (rTMS) of the motor cortex induces analgesic effects in focal chronic pain syndromes, probably by modifying central pain modulatory systems. Neuroimaging studies have shown bilateral activation of a large number of structures, including some of those involved in pain processing, suggesting that such stimulation may induce generalized analgesic effects. The goal of this study was to assess the effects of unilateral rTMS of the motor cortex on chronic widespread pain in patients with fibromyalgia. Thirty patients with fibromyalgia syndrome (age: 52.6 +/- 7.9) were randomly assigned, in a double-blind fashion, to two groups, one receiving active rTMS (n = 15) and the other sham stimulation (n = 15), applied to the left primary motor cortex in 10 daily sessions. The primary outcome measure was self-reported average pain intensity over the last 24 h, measured at baseline, daily during the stimulation period and then 15, 30 and 60 days after the first stimulation. Other outcome measures included: sensory and affective pain scores for the McGill pain Questionnaire, quality of life (assessed with the pain interference items of the Brief Pain Inventory and the Fibromyalgia Impact Questionnaire), mood and anxiety (assessed with the Hamilton Depression Rating Scale, the Beck Depression Inventory and the Hospital Anxiety and Depression Scale). We also assessed the effects of rTMS on the pressure pain threshold at tender points ipsi- and contralateral to stimulation. Follow-up data were obtained for all the patients on days 15 and 30 and for 26 patients (13 in each treatment group) on day 60. Active rTMS significantly reduced pain and improved several aspects of quality of life (including fatigue, morning tiredness, general activity, walking and sleep) for up to 2 weeks after treatment had ended. The analgesic effects were observed from the fifth stimulation onwards and were not related to changes in mood or anxiety. The effects of rTMS were more long-lasting for affective than for sensory pain, suggesting differential effects on brain structures involved in pain perception. Only few minor and transient side effects were reported during the stimulation period. Our data indicate that unilateral rTMS of the motor cortex induces a long-lasting decrease in chronic widespread pain and may therefore constitute an effective alternative analgesic treatment for fibromyalgia.