Fibromyalgia: Bradley LA

Arnold LM, Bradley LA, Clauw DJ, Glass JM, Goldenberg DL. · Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. · J Clin Psychiatry. · Pubmed #19192431 No free full text.

Abstract: Fibromyalgia is a common and disabling chronic pain syndrome that is often accompanied by other chronic pain and/or psychiatric comorbidities, which impact fibromyalgia course and outcome. Although a primary care provider will likely take the lead in caring for patients with fibromyalgia, psychiatrists and other mental health professionals may play a role in the diagnosis, evaluation, and management of fibromyalgia. Psychiatrists' familiarity with many of the pharmacologic and nonpharmacologic treatments that are currently being used for fibromyalgia make them valuable partners in the multidisciplinary team of clinicians addressing fibromyalgia and its comorbidities. In this activity, experts on fibromyalgia discuss the nature of the syndrome and its diagnosis and evaluation.

Bradley LA. · Division of Clinical Immunology and Rheumatology, Department of Medicine, and Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama, Birmingham, USA. · J Clin Psychiatry. · Pubmed #18537457 No free full text.

Abstract: This article reviews current findings regarding the pathophysiologic abnormalities that contribute to the enhanced pain responses of individuals with fibromyalgia as well as the relationships between fibromyalgia and commonly co-occurring disorders. Risk factors for fibromyalgia or enhanced pain responses include genetic and family influences, environmental triggers, and abnormal neuroendocrine and autonomic nervous system function. These risk factors also are associated with several disorders that frequently co-occur with fibromyalgia, such as major depressive disorder, migraine, and irritable bowel syndrome. Indeed, fibromyalgia and these co-occurring conditions may be part of a group of affective spectrum disorders that share important common, and perhaps heritable, causal factors. Recent research strongly suggests that alterations in central processing of sensory input also contribute to the cardinal symptoms of fibromyalgia, persistent widespread pain and enhanced pain sensitivity. Exposure to psychosocial and environmental stressors, as well as altered autonomic nervous system and neuroendocrine responses, also may contribute to alterations in pain perception or pain inhibition. Understanding the pathophysiology of fibromyalgia and co-occurring disorders may help clinicians provide the most appropriate treatment to their patients.

Bradley LA. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham 805 FOT, 510 20th Street South, Birmingham, AL 35222, USA. · Curr Pain Headache Rep. · Pubmed #15745615 No free full text.

Abstract: This review examines the current literature regarding psychiatric comorbidities associated with fibromyalgia. The aim of this review is to enhance understanding of psychiatric disorders that, alone or in combination with other physiologic (eg, neuroendocrine dysfunction) and psychosocial factors (eg, poor coping skills), may contribute to abnormal pain sensitivity and other illness behaviors of individuals with fibromyalgia. The review first identifies the psychiatric comorbidities that are associated most often with fibromyalgia and tend to aggregate within families of individuals with this disorder. It then examines the literature regarding the extent to which psychiatric illness, environmental stressors, or other psychosocial factors may contribute to the development of fibromyalgia. The review also presents recent findings concerning the extent to which psychosocial factors may contribute to treatment-related outcomes in pain and other health status variables among patients with fibromyalgia.

Bradley LA, McKendree-Smith NL, Alarcón GS, Cianfrini LR. · University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, 475 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35294, USA. · Curr Pain Headache Rep. · Pubmed #11872181 No free full text.

Abstract: Fibromyalgia (FM) is characterized by abnormal pain sensitivity in response to diverse stimuli as well as persistent widespread pain and other symptoms such as fatigue and sleep disturbance. Progress has been made in identifying factors that contribute to the etiopathogenesis of abnormal pain sensitivity, but there is no single model of pathophysiology or treatment of FM that has gained wide acceptance among health care professionals. We review the literature on the etiopathogenesis of abnormal pain sensitivity in FM and describe an explanatory model that serves as a source of testable hypotheses in our laboratory. This model posits that interactions of exogenous (e.g., environmental stressors) and endogenous (e.g., neuroendocrine dysfunction) abnormalities in genetically predisposed individuals lead to a final common pathway, i.e., alterations in central nervous system function and neuropeptide production that underlie central sensitization and abnormal pain sensitivity. This model also suggests that efforts to develop and evaluate treatments for FM should focus on interventions with direct or indirect effects on central functions that influence pain sensitivity.

Bradley LA, McKendree-Smith NL. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 35294, USA. · Curr Opin Rheumatol. · Pubmed #11790996 No free full text.

Abstract: Pain is one of the most important and challenging consequences of musculoskeletal disorders. This article examines the role of central nervous system structures in the physiology of pain. It also describes the neuromatrix, a construct that provides a framework for understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain. This construct suggests that behavioral and psychologic interventions may alter the pain experience primarily through their effects on emotional states and cognitive processes. The literature on cognitive-behavioral interventions for patients with rheumatoid arthritis and osteoarthritis indicates that they are well-established treatments for these disorders. However, the efficacy of these interventions for patients with fibromyalgia has not been established. It is anticipated that the development of valid measures of readiness for behavioral change may allow investigators to identify the patients with musculoskeletal disorders who are most likely to benefit from cognitive-behavioral intervention.

Bradley LA, McKendree-Smith NL, Alberts KR, Alarcón GS, Mountz JM, Deutsch G. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, BDB 475, 1808 7th Ave S, Birmingham, Alabama 35294-0012. · Curr Rheumatol Rep. · Pubmed #11123051 No free full text.

Abstract: This paper examines the use of neuroimaging to measure change in regional cerebral blood flow (rCBF) produced by pain in patients with fibromyalgia and in healthy individuals. Fibromyalgia patients differ from healthy persons in rCBF distribution in several brain structures involved in pain processing and pain modulation both at rest and during experimental pain induction. These abnormalities may contribute to abnormal pain sensitivity as well as the maladaptive pain behaviors that characterize many patients with fibromyalgia. We anticipate that future neuroimaging studies will enhance our understanding of abnormal pain sensitivity and of pain management interventions aimed at altering central nervous system function in patients with fibromyalgia.

Bradley LA, McKendree-Smith NL, Alarcón GS. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, School of Medicine, 475 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35294, USA. · Curr Rev Pain. · Pubmed #10998728 No free full text.

Abstract: Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia. We identify the abnormalities in the neuroendocrine axes that are common to FM and CFS as well as the abnormalities in central neuropeptide levels and functional brain activity that differentiate these disorders. These two sets of factors, respectively, may account for the similarities and differences in the pain experiences of persons with FM and CFS.

Bradley LA, Alberts KR. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, USA. · Rheum Dis Clin North Am. · Pubmed #10083965 No free full text.

Abstract: This article reviews the efficacy of the psychological and behavioral pain management interventions that have been evaluated among adult patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Using published criteria for empirically validated interventions, it is concluded that cognitive-behavioral therapies and the Arthritis Self-Management Program represent well-established treatments for pain among patients with RA and OA. These interventions involve education, training in relaxation and other coping skills, and rehearsal of these skills in patients' home and work environments. There currently are no psychological or behavioral interventions for pain among FM patients that can be considered as well-established treatments. Future intervention research should use clinically meaningful change measures in addition to conventional tests of statistical significance, attend to the pain management needs of children, and assess whether outcomes produced in university-based treatment centers generalize to those in local treatment settings.

Arnold LM, Bradley LA, Clauw DJ, Glass JM, Goldenberg DL. · Division of Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. · J Clin Psychiatry. · Pubmed #19203485 No free full text.

Abstract: Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, sleep abnormalities, and common comorbidity with psychiatric and medical disorders. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Sensitive and appropriate methods of diagnosis and an integrated treatment plan including proper patient education, aerobic exercise, and cognitive-behavioral therapy have been shown effective in alleviating fibromyalgic symptoms. The development of a comprehensive, multidisciplinary disease management strategy is a difficult but essential challenge facing clinicians treating patients with fibromyalgia.

Bradley LA, Kersh BC, DeBerry JJ, Deutsch G, Alarcón GA, McLain DA. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 805 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA. · Novartis Found Symp. · Pubmed #15283455 No free full text.

Abstract: Fibromyalgia (FM) is a disorder that is characterized by widespread, musculoskeletal pain and abnormal pain sensitivity at multiple anatomic sites. Laboratory studies involving psychophysical and neuroimaging methods suggest that central augmentation of low intensity stimulation may contribute to abnormal pain sensitivity in FM. Recently, several investigators, using similar laboratory methods, have shown that patients with knee or hip osteoarthritis (OA) exhibit abnormal pain sensitivity or abnormal pain inhibition at anatomic sites distal to affected joints. Consistent with animal models of central sensitization, differences between patients and healthy controls in pain processing and pain inhibition at these distal sites are eliminated after nociceptive input is eliminated following total joint replacement surgery. This paper reviews these findings from our laboratory and those of independent investigators. It also presents verbal, psychophysical and neuroimaging data concerning ethnic group differences in affective and cognitive pain responses among patients with knee OA. We suggest that central sensitization as well as centrally-mediated cognitive and affective factors influence the pain responses of patients with knee OA. In addition, ethnic group differences in pain cognition and affect may contribute to differences among these groups in preferences for healthcare interventions such as total joint replacement.

Sprott H, Salemi S, Gay RE, Bradley LA, Alarcón GS, Oh SJ, Michel BA, Gay S. · WHO Collaborating Centre for Molecular Biology and Novel Therapeutic Strategies for Rheumatic Diseases, Department of Rheumatology and Institute of Physical Medicine, University Hospital, Gloriastrasse 25, CH-8091 Zürich, Switzerland. · Ann Rheum Dis. · Pubmed #14962957 links to  free full text

Abstract: OBJECTIVE: To determine whether there is evidence of increased DNA fragmentation and ultrastructural changes in muscle tissue of patients with fibromyalgia (FM) compared with healthy controls. METHODS: Muscle tissues from 10 community residents with FM and 10 age and sex matched healthy controls were examined "blindly" for the presence of DNA fragmentation by two different methods: terminal deoxynucleotidyl transferase (TdT) staining (TUNEL) and the FragEL-Klenow DNA fragmentation detection kit. Ultrastructural analysis of tissue was performed by electron microscopy. RESULTS: DNA fragmentation was detected by both methods in 55.4 (SEM 2.5)% of the nuclei in muscle tissue of patients with FM compared with 16.1 (4.1)% (p<0.001) of the nuclei in healthy controls. Contrary to expectation, no typical features of apoptosis could be detected by electron microscopy. The myofibres and actin filaments were disorganised and lipofuscin bodies were seen; glycogen and lipid accumulation were also found. The number of mitochondria was significantly lower in patients with FM than in controls and seemed to be morphologically altered. CONCLUSION: The ultrastructural changes described suggest that patients with FM are characterised by abnormalities in muscle tissue that include increased DNA fragmentation and changes in the number and size of mitochondria. These cellular changes are not signs of apoptosis. Persistent focal contractions in muscle may contribute to ultrastructural tissue abnormalities as well as to the induction and/or chronicity of nociceptive transmission from muscle to the central nervous system.

Kersh BC, Bradley LA, Alarcón GS, Alberts KR, Sotolongo A, Martin MY, Aaron LA, Dewaal DF, Domino ML, Chaplin WF, Palardy NR, Cianfrini LR, Triana-Alexander M. · Division of Clinical Immunology and Rheumatology, University of Alabama School of Medicine, University of Alabama at Birmingham, 35294-0006, USA. · Arthritis Rheum. · Pubmed #11501724 links to  free full text

Abstract: OBJECTIVE: To determine whether variables derived from the self-regulatory model of health and illness behavior accurately predict status as a patient or nonpatient with fibromyalgia (FM). METHODS: Subjects were 79 patients who met American College of Rheumatology (ACR) criteria for FM and 39 community residents who met ACR criteria for FM but had not sought medical care for their symptoms (nonpatients). Subjects were administered 14 measures that produced 6 domains of variables: background demographics and pain duration; psychiatric morbidity; and personality, environmental, cognitive, and health status factors. These domains were entered in 4 different hierarchical logistic regression analyses to predict status as patient or nonpatient. RESULTS: The full regression model was statistically significant (P < 0.0001) and correctly identified 90.7% of the subjects with a sensitivity of 92.4% and a specificity of 87.2%. The best individual predictors of group status were self-reports of self-efficacy, negative affect, recent stressful events, and perceived pain. Relative to nonpatients, patients reported higher levels of negative affect and perceived pain and a greater number of recent stressful experiences, as well as lower levels of self-efficacy. CONCLUSION: Consistent with the self-regulatory model of health and illness behavior, psychosocial and health status variables predict health care-seeking behavior in persons with FM independently of background demographics and psychiatric morbidity. These variables may influence the severity of symptoms experienced by persons with this disorder as well as their health care-seeking behavior, but they are not necessary to produce abnormal pain sensitivity in FM.

Bradley LA, Alarcón GS. · No affiliation provided · Arthritis Rheum. · Pubmed #10616028 links to  free full text

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