Fibromyalgia: California

Wallace DJ, Shapiro S, Panush RS. · Division of Rheumatology, Cedars-Sinai/UCLA School of Medicine, USA. · Bull Rheum Dis. · Pubmed #10526425 No free full text.

This publication has no abstract.

Ridgway K. · EquiSport Center for Therapeutic Options, Sonoma, California, USA. · Vet Clin North Am Equine Pract. · Pubmed #10218251 No free full text.

Abstract: Concepts of acupuncture in traditional Chinese medicine are presented for clarity and contrast to Western medical concepts. Various acupuncture techniques and methods are discussed including dry needling, electroacupuncture, acupuncture using hypodermic needles, and injecting various solutions into the acupuncture sites. Potential complications and precautions are also presented. A type of chronic back pain is discussed that is possibly associated with a radiculopathically induced, hypersensitivity myofascial syndrome that presents as a fibromyalgia-like syndrome. Effective acupuncture treatment for the described chronic fibromyalgia-like syndrome is discussed.

Singh BB, Wu WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP, Wang CN, Lin SY. · Southern California University of Health Sciences, Whittier, USA. · Altern Ther Health Med. · Pubmed #16541995 No free full text.

Abstract: CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal disorder associated with pain, mood state alteration, and disability. A structured and effective treatment plan for palliative care has not been established. The genesis of FMS is not clear. FMS occurs primarily in adult women. DESIGN: Using a quasi-experimental clinical design and following the criteria of the American College of Rheumatology (ACR), for FMS, 21 participants completed the study. The mean age was 53.6 years. The data were collected at baseline and at 1 and 2 months. Acupuncture treatments included 17 points for FMS symptoms, and 8 outcome measures were collected. RESULTS: The Fibromyalgia Impact Questionnaire (FIQ) showed significant differences at 1 and 2 months. For the SF-12, 3 subscales showed significant differences between baseline and 2 months. Four of 6 items were significantly changed. The mean number of general health symptoms was significantly decreased by 2 months. For the Catastrophe Index, significant differences were found for baseline vs 2 months. Pain threshold scores were significantly different at end of treatment for 5 bilateral tender points. There was significant improvement in Beck Depression items for both 1- and 2-month periods. In a multivariate regression model, 5 covariates were included--age, number of weeks in treatment, number of doctors treating, number of general symptoms, and baseline FIQ score. The results indicated significant age effect. This analysis showed that the higher the FIQ score, the more positive the change experienced by study participants. Number of weeks in treatment, number of doctors who treated, and total number of general health symptoms did not have a significant effect on outcomes. CONCLUSIONS: Significant improvement was experienced by participants at 8 weeks of treatment. Acupuncture treatment as delivered was effective at reducing FMS symptoms in this outcome study.

Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, Williams DA, Mease PJ, McLean SA, Clauw DJ. · Cypress Biosciences, 4350 Executive Drive, San Diego, CA 92121, USA. · J Rheumatol. · Pubmed #16206355 No free full text.

Abstract: OBJECTIVE: Fibromyalgia (FM) is a common musculoskeletal condition characterized by widespread pain, tenderness, and a variety of other somatic symptoms. Current treatments are modestly effective. Arguably, the best studied and most effective compounds are tricyclic antidepressants (TCA). Milnacipran, a nontricyclic compound that inhibits the reuptake of both serotonin and norepinephrine, may provide many of the beneficial effects of TCA with a superior side effect profile. METHODS: One hundred twenty-five patients with FM were randomly assigned in a 3:3:2 ratio to receive milnacipran twice daily, milnacipran once daily, or placebo for 3 months in a double-blind dose-escalation trial; 92% of twice-daily and 81% of once-daily participants achieved dose escalation to the target milnacipran dose of 200 mg. RESULTS: The primary endpoint was reduction of pain. Both the once- and twice-daily groups showed statistically significant improvements in pain, as well as improvements in global well being, fatigue, and other domains. Response rates for patients receiving milnacipran were equal in patients with and without comorbid depression, but placebo response rates were considerably higher in depressed patients, leading to significantly greater overall efficacy in the nondepressed group. CONCLUSION: In this Phase II study, milnacipran led to statistically significant improvements in pain and other symptoms of FM. The effect sizes were equal to those previously found with TCA, and the drug was generally well tolerated.

Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG. · Cypress Bioscience, San Diego, CA 9212, USA. · Hum Psychopharmacol. · Pubmed #15378666 No free full text.

Abstract: Fibromyalgia syndrome is a systemic disorder of widespread pain which is thought to result from abnormal pain processing within the central nervous system. There are no currently approved treatments for this indication. Antidepressants appear, however, to be effective, especially those with an action on noradrenergic neurotransmission. The objective of the present study was to test the efficacy of the dual action noradrenaline and serotonin reuptake inhibitor antidepressant, milnacipran, in the treatment of fibromyalgia. The 125 patients, who were enrolled in a double-blind, placebo-controlled, flexible dose escalation trial, were randomized to receive placebo or milnacipran for 4 weeks of dose escalation (up to 200 mg/day), followed by 8 weeks at a constant dose. The study evaluated the efficacy and safety of milnacipran for the treatment of pain and associated symptoms such as fatigue, depressed mood and sleep. 75% of milnacipran-treated patients reported overall improvement, compared with 38% in the placebo group (p < 0.01). Furthermore, 37% of twice daily milnacipran-treated patients reported at least 50% reduction in pain intensity, compared with 14% of placebo-treated patients (p < 0.05). 84% of all milnacipran patients escalated to the highest dose (200 mg/day) with no tolerability issues. Most adverse events were mild to moderate in intensity, and transient in duration. These results suggest that milnacipran may have the potential to relieve not only pain but several of the other symptoms associated with fibromyalgia.

Astin JA, Berman BM, Bausell B, Lee WL, Hochberg M, Forys KL. · California Pacific Medical Center Research Institute, 2300 California Street, Room 207, San Francisco, CA 94115, USA. · J Rheumatol. · Pubmed #14528526 No free full text.

Abstract: OBJECTIVE: To test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome (FM). METHODS: A total of 128 individuals with FM were randomly assigned to the mind-body training program or an education support group that served as the control. Outcome measures were pain, disability (Fibromyalgia Impact Questionnaire), depression, myalgic score (number and severity of tender points), 6 minute walk time, and coping strategies, which were assessed at baseline and at 8, 16, and 24 weeks. RESULTS: Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Questionnaire, Total Myalgic Score, Pain, and Depression, and no improvement in the number of feet traversed in the 6 minute walk. However, there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group. Salutary changes occurring by the eighth week (which corresponded to the end of the mind-body and education control group sessions) were largely maintained by both groups throughout the 6 month followup period. CONCLUSION: While both groups showed improvement on a number of outcome variables, there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option. Additional randomized controlled trials are needed before interventions of this kind can be recommended for treatment of FM.

Nicassio PM, Moxham EG, Schuman CE, Gevirtz RN. · California School of Professional Psychology-San Diego, 10455 Pomerado Road, San Diego, CA 92131, USA. · Pain. · Pubmed #12467998 No free full text.

Abstract: The major objective of this research was to evaluate the predictors of fatigue in patients with fibromyalgia (FM), using cross-sectional and daily assessment methodologies. In the cross-sectional phase of the research involving a sample of 105 FM patients, greater depression and lower sleep quality were concurrently associated with higher fatigue. While pain was correlated with fatigue, it did not independently contribute to fatigue in the regression equation. For a subset of patients from the cross-sectional sample (n=63) who participated in a week of prospective daily assessment of their pain, sleep quality, and fatigue, multiple regression analysis of aggregated (averaged) daily scores revealed that previous day's pain and sleep quality predicted next day's fatigue. Depression from the cross-sectional phase was not related to aggregated daily fatigue scores. A path analytic framework was tested with disaggregated (removing between subjects variability) data in which pain was predicted to contribute to lower sleep quality which, in turn, was predicted to lead to greater fatigue. The results revealed that poor sleep quality fully accounted for the positive relationship between pain and fatigue, thus substantiating the mediational role of sleep quality. The findings are indicative of a dysfunctional, cyclical pattern of heightened pain and non-restful sleep underlying the experience of fatigue in FM.

Oliver K, Cronan TA, Walen HR, Tomita M. · SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University, California 92120, USA. · J Rheumatol. · Pubmed #11764222 No free full text.

Abstract: OBJECTIVE: The rising costs of health care are of great concern, particularly for the chronically ill. Interventions that promote health status and well being while teaching appropriate use of the health care system have led to cost savings among patients with osteoarthritis. We carried out social support and education interventions with patients with fibromyalgia (FM) and assessed the effect on health care costs, psychosocial variables, and health status. METHODS: Participants were 600 patients with FM who were members of a health maintenance organization. They were randomly assigned to one of 2 experimental groups (social support; social support and education) or to a no-treatment control group. Assessments were conducted at baseline and following a one year intervention. Health care cost data were obtained directly from participants' medical records. RESULTS: Results indicated significant reductions in all groups' costs of prescriptions, laboratory tests, and visits to a nurse, nurse practitioner and/or physicians' assistant. All groups also showed improvements on variables assessing effect of FM, self-efficacy, depression, and knowledge of FM. The social support and education group was less helpless after one year than the other groups; differential changes for all other variables were not significant. CONCLUSION: The study did not reveal differential changes in health care costs among participants in the experimental and control groups. These findings emphasize the importance of using objective health care utilization data when calculating health care costs, as well as the value of including a no-treatment control group to prevent erroneous conclusions about treatment efficacy.

Cole SW, Kemeny ME, Weitzman OB, Schoen M, Anton PA. · Department of Medicine, University of California, Los Angeles, California 90095-1678, USA. · Brain Behav Immun. · Pubmed #10373281 No free full text.

Abstract: To determine whether altered cellular immune response might mediate the increased health risks associated with social inhibition, we examined delayed type hypersensitivity (DTH) responses in 36 adults under conditions of low and high intensity social engagement. Participants come from a study of psychological factors in functional bowel disease and fibromyalgia. Under high engagement conditions, socially inhibited individuals showed significantly increased induration in response to intradermal tetanus toxoid. Under low engagement conditions, these individuals showed less pronounced DTH responses that did not differ in magnitude from those of uninhibited individuals. This pattern of results was found using two different measures of social inhibition and was independent of social inhibition's definition as a continuously distributed trait vs a discrete category. These data are consistent with the general hypothesis that social inhibition represents a predisposition to physiologic hyperresponsiveness that requires an exogenous social trigger for expression.

Stahl SM, Briley M. · Department of Psychiatry, University of California, San Diego, USA. · Hum Psychopharmacol. · Pubmed #19479908 No free full text.

This publication has no abstract.

Stahl SM. · Department of Psychiatry, University of California, San Diego, CA, USA. · Hum Psychopharmacol. · Pubmed #19479906 No free full text.

Abstract: Fibromyalgia is a syndrome of widespread chronic pain associated with sleep disorders, depressed mood, cognitive impairment and fatigue. Its etiology and pharmacopathology are poorly understood but it is thought to result from a dysfunction of central pain processing mechanisms leading to generalised pain sensitisation. Pain perception is the result of a bidirectional process of ascending and descending pathways. Nociceptive input from peripheral afferent neurons is sent via the dorsal horn of the spinal cord to the higher brain centres involved in pain perception. Some descending inhibitory projections to the spinal cord attenuate the nociceptive effects. Numerous neurotransmitters including serotonin, dopamine, noradrenaline and substance P are involved in these processes. In other neuronal pathways in the brain, the same neurotransmitters are involved in mood control, sleep regulation and cognitive function providing a neurochemical substrate for the wide range of symptoms seen in fibromyalgia. Attenuation of neuronal hyperactivity through ligands acting at the alpha2-delta subunits of voltage-dependent calcium channels and increased inhibitory activity of the descending pathways by inhibition of serotonin and noradrenaline reuptake are two mechanisms that are currently exploited by new medication for the treatment of fibromyalgia.

Younger JW, Zautra AJ, Cummins ET. · Department of Anesthesia, Stanford University School of Medicine, Palo Alto, California, United States of America. · PLoS One. · Pubmed #19365548 links to  free full text

Abstract: The pathophysiological mechanisms underlying fibromyalgia are still unknown, although some evidence points to endogenous opioid dysfunction. We examined how endogenous opioid antagonism affects pain and mood for women with and without fibromyalgia. Ten women with fibromyalgia and ten age- and gender-matched, healthy controls each attended two laboratory sessions. Each participant received naltrexone (50mg) at one session, and placebo at the other session, in a randomized and double-blind fashion. Participants were tested for changes in sensitivity to heat, cold, and mechanical pain. Additionally, we collected measures of mood and opioid withdrawal symptoms during the laboratory sessions and at home the night following each session. At baseline, the fibromyalgia group exhibited more somatic complaints, greater sensory sensitivity, more opioid withdrawal somatic symptoms, and lower mechanical and cold pain-tolerance than did the healthy control group. Neither group experienced changes in pain sensitivity due to naltrexone administration. Naltrexone did not differentially affect self-reported withdrawal symptoms, or mood, in the fibromyalgia and control groups. Consistent with prior research, there was no evidence found for abnormal endogenous opioid activity in women with fibromyalgia.

Silverman S, Dukes EM, Johnston SS, Brandenburg NA, Sadosky A, Huse DM. · University of California, Los Angeles, CA, USA. · Curr Med Res Opin. · Pubmed #19220165 No free full text.

Abstract: OBJECTIVE: To quantify and compare direct costs, utilization, and the rate of comorbidities in a sample of patients with fibromyalgia (FM), a poorly understood illness associated with chronic widespread pain that is commonly treated by rheumatologists, to patients with rheumatoid arthritis (RA), a well studied rheumatologic illness associated with inflammatory joint pain. Patients with both illnesses were isolated and reported as a third group. A secondary analysis of work loss was performed for an employed subset of these patients. RESEARCH DESIGN AND METHODS: Retrospective cohort analysis of Thomson Reuters MarketScan administrative healthcare claims and employer-collected absence and disability data for adult patients with a diagnosis of FM (ICD-9-CM 729.1) and/or RA (ICD-9-CM 714.0x,-714.3x) on at least one inpatient or two outpatient claims during 2001-2004. MAIN OUTCOME MEASURES: The 12-month healthcare utilization, expenditures, and rates of comorbidities were quantified for all study-eligible patients; absence and short-term disability days and costs were quantified for an employed subset. RESULTS: The sample included 14034 FM, 7965 RA, and 331 FM+RA patients. Patients with FM had a higher prevalence of several comorbidities and greater emergency department (ED) utilization than those with RA. Mean annual expenditures for FM patients were $10911 (SD=$16075). RA patient annual expenditures were similar to FM: $10716 (SD= $16860). Annual expenditures were almost double in patients with FM+RA ($19395, SD= $25440). A greater proportion of patients with FM had any short-term disability days than those with RA (20 vs. 15%); and a greater proportion of patients with RA had any absence days (65 vs. 80%). Mean costs for absence from work and short-term disability in the FM and RA groups were substantial and similar. The FM+RA group was of insufficient sample size to report on work loss.Limitations: The availability of newer and more expensive FDA-approved medications since 2004 is not reflected in our findings. This analysis was restricted to commercially insured patients and therefore may not be generalizable to the entire U.S. population. CONCLUSIONS: The burden of illness in FM is substantial and comparable to RA. Patients with FM incurred direct costs approximately equal to RA patients. Patients with FM had more ED, physician, and physical therapy visits than RA patients. Patients in both groups had several comorbidities. Patients with FM+RA incurred direct costs almost double those of the patients with either diagnosis alone. FM and RA patients incurred similar overall absence and short-term disability costs.

Jones J, Rutledge DN, Jones KD, Matallana L, Rooks DS. · Health Sciences, California State University, Fullerton, California 92834-6870, USA. · Womens Health Issues. · Pubmed #18723374 No free full text.

Abstract: OBJECTIVE: We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS: We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS: More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS: The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.

Chaban VV. · Department of Biomedical Sciences, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA 90095, USA. · Ethn Dis. · Pubmed #18646315 No free full text.

Abstract: In women, clinical studies suggest that functional pain syndromes such as irritable bowel syndrome, interstitial cystitis, and fibromyalgia, are co-morbid with endometriosis, chronic pelvic pain, and others diseases. One of the possible explanations for this phenomenon is visceral cross-sensitization in which increased nociceptive input from inflamed reproductive system organs sensitize neurons that receive convergent input from an unaffected visceral organ to the same dorsal root ganglion (DRG). The purpose of this study was to determine whether primary sensory neurons that innervate both visceral organs--the uterus and the colon--express nociceptive ATP-sensitive purinergic (P2X3) and capsaicin-sensitive vanilloid (TRPV1) receptors. To test this hypothesis, cell bodies of colonic and uterine DRG were retrogradely labeled with fluorescent tracer dyes micro-injected into the colon/rectum and uterus of rats. Ganglia were harvested, cryo-protected, and cut in 20-microm slices for fluorescent microscopy to identify positively stained cells. Up to 5% neurons were colon-specific or uterus-specific, and 10%-15% of labeled DRG neurons innervate both viscera in the lumbosacral neurons (L1-S3 levels). We found that viscerally labeled DRGs express nociceptive P2X3 and TRPV1 receptors. Our results suggest a novel form of visceral sensory integration in the DRG that may underlie co-morbidity of many functional pain syndromes.

Lorig KR, Ritter PL, Laurent DD, Plant K. · Stanford University School of Medicine, Stanford, California, USA. · Arthritis Rheum. · Pubmed #18576310 links to  free full text

Abstract: OBJECTIVE: To determine the efficacy of an Internet-based Arthritis Self-Management Program (ASMP) as a resource for arthritis patients unable or unwilling to attend small-group ASMPs, which have proven effective in changing health-related behaviors and improving health status measures. METHODS: Randomized intervention participants were compared with usual care controls at 6 months and 1 year using repeated-measures analyses of variance. Patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia and Internet and e-mail access (n = 855) were randomized to an intervention (n = 433) or usual care control (n = 422) group. Measures included 6 health status variables (pain, fatigue, activity limitation, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 5 utilization variables (physician visits, emergency room visits, chiropractic visits, physical therapist visits, and nights in hospital), and self-efficacy. RESULTS: At 1 year, the intervention group significantly improved in 4 of 6 health status measures and self-efficacy. No significant differences in health behaviors or health care utilization were found. CONCLUSION: The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP.

Jegede AB, Gilbert C, Tulkin SR. · California School of Professional Psychology, Alliant International University, San Francisco, CA, USA. · NeuroRehabilitation. · Pubmed #18560138 No free full text.

Abstract: PURPOSE: To explore agonist and antagonist muscle characteristics, depression and physical functioning of patients with Fibromyalgia Syndrome (FMS). METHOD: Individuals with FMS (N=34) and chronic pain (N=36) were recruited from a chronic pain program. Normal controls (N=37) were recruited from the general community. MEASURES: Demographic data (age, gender, marital status, ethnicity, and employment status), self-report physical and psychological functioning, current level of pain, level of depression, and agonist and antagonist muscle activity (SCM, Biceps/triceps, Forearm flexor/extensor, Lower leg tibialis anterior/gastrocnemius) were measured with sEMG. RESULTS: There was a significant difference in upper arm muscle contra-activation between the FMS patients and normal controls but not between the non-FMS chronic pain patients and normal controls. When compared to normal controls, the FMS group reported more depression and a higher level of physical functioning problems, but it was not significantly different from the mean score for the non-FMS chronic pain group. Problems with physical functioning and depression did not predict strength of contra-activation in the upper arm muscle. CONCLUSION: These findings suggest presence of unusual muscle activity occurring in the bicep muscle of FMS and non-FMS chronic pain patients, which establishes a possible link between muscle dysfunction, mood and pain.

Zhang Z, Cherryholmes G, Mao A, Marek C, Longmate J, Kalos M, Amand RP, Shively JE. · Division of Immunology, Beckman Research Institute of the City of Hope, 1450 E. Duarte Road, Duarte, CA 91010, USA. · Exp Biol Med (Maywood). · Pubmed #18535166 No free full text.

Abstract: Fibromyalgia (FMS), a predominantly female (85%) syndrome, affects an estimated 2% of the US population with skeletal muscle ache, fatigue, headache, and sleep disorder. The pathogenesis of FMS is unknown and there is no laboratory test for diagnosis. In this study, plasma levels of 25 cytokines and chemokines in 92 female patients with FMS and 69 family members were measured compared to 77 controls. Trans-endothelial migration of normal leukocytes in response to FMS plasma and the cytokine profile of human myoblasts were analyzed. High levels of MCP-1 (P<0.001) and eotaxin (P<0.01) were found in patients and family members compared to controls. Patients (56/92) treated with the single agent guaifenesin (>3 months) had higher levels of eotaxin than those not treated (P<0.01). Diluted plasma from patients increased the migration of normal eosinophils and monocytes, but not neutrophils, through an endothelial/Matrigel barrier only when mast cells are included in the lower wells (P<0.05). Furthermore, myoblasts can secrete MCP-1, eotaxin, and IP-10, while treatment with MCP-1 caused secretion of IL-1beta, eotaxin and IP-10. FMS is associated with inflammatory chemokines, that MCP-1 and eotaxin may contribute to the symptoms of FMS, and that similar cytokine profiles found in family members support the idea that FMS has a genetic component. Furthermore, the chemokine profile associated with FMS has direct effects on the migration of eosinophils and monocytes in the presence of mast cells, and skeletal muscle itself may secrete.

Khasar SG, Burkham J, Dina OA, Brown AS, Bogen O, Alessandri-Haber N, Green PG, Reichling DB, Levine JD. · Department of Oral and Maxillofacial Surgery, University of California, San Francisco, California 94143-0440, USA. · J Neurosci. · Pubmed #18509033 links to  free full text

Abstract: Stress dramatically exacerbates pain in diseases such as fibromyalgia and rheumatoid arthritis, but the underlying mechanisms are unknown. We tested the hypothesis that stress causes generalized hyperalgesia by enhancing pronociceptive effects of immune mediators. Rats exposed to nonhabituating sound stress exhibited no change in mechanical nociceptive threshold, but showed a marked increase in hyperalgesia evoked by local injections of prostaglandin E(2) or epinephrine. This enhancement, which developed more than a week after exposure to stress, required concerted action of glucocorticoids and catecholamines at receptors located in the periphery on sensory afferents. The altered response to pronociceptive mediators involved a switch in coupling of their receptors from predominantly stimulatory to inhibitory G-proteins (G(s) to G(i)), and for prostaglandin E(2), emergence of novel dependence on protein kinase C epsilon. Thus, an important mechanism in generalized pain syndromes may be stress-induced coactivation of the hypothalamo-pituitary-adrenal and sympathoadrenal axes, causing a long-lasting alteration in intracellular signaling pathways, enabling normally innocuous levels of immune mediators to produce chronic hyperalgesia.

Coffey SM, Cook K, Tartaglia N, Tassone F, Nguyen DV, Pan R, Bronsky HE, Yuhas J, Borodyanskaya M, Grigsby J, Doerflinger M, Hagerman PJ, Hagerman RJ. · Department of Pediatrics, University of California at Davis Medical Center, Sacramento, California 95817, USA. · Am J Med Genet A. · Pubmed #18348275 No free full text.

Abstract: Fragile X-associated tremor/ataxia syndrome (FXTAS) is generally considered to be uncommon in older female carriers of premutation alleles (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene; however, neither prevalence, nor the nature of the clinical phenotype, has been well characterized in female carriers. In this study, we evaluated 146 female carriers (mean, 42.3 years; range, 20-75 years) with and without core features of FXTAS (tremor; gait ataxia), and 69 age-matched controls (mean, 45.8 years; range, 21-78 years). Compared with controls, carriers with definite or probable FXTAS had greater medical co-morbidity, with increased prevalence of thyroid disease (P = 0.0096), hypertension (P = 0.0020), seizures (P = 0.0077), peripheral neuropathy (P = 0.0040), and fibromyalgia (P = 0.0097), in addition to the typical symptoms of FXTAS-tremor (P < 0.0001) and ataxia (P < 0.0001). The non-FXTAS premutation group had more complaints of chronic muscle pain (P = 0.0097), persistent paraesthesias in extremities (P < 0.0001), and history of tremor (P < 0.0123) than controls. The spectrum of clinical involvement in female carriers with FXTAS is quite broad, encompassing a number of medical co-morbidities as well as the core movement disorder. The remarkable degree of thyroid dysfunction (17% in the non-FXTAS group and 50% in the FXTAS group) warrants consideration of thyroid function studies in all female premutation carriers, particularly those with core features of FXTAS.

Rao SG, Gendreau JF, Kranzler JD. · Cypress Bioscience, Inc., in San Diego, CA. · Psychopharmacol Bull. · Pubmed #18227777 No free full text.

Abstract: The fibromyalgia syndrome (FMS) is the most frequent cause of chronic, widespread pain. This review, which is targeted at the psychiatry and psychopharmacology communities, summarizes the state-of-the-art as it relates to both the pathophysiology and treatment of FMS. Toward this end, the anatomy and physiology of pain pathways are summarized, followed by a review of the altered biology of pain processing, neurotransmitter function, and neuroendocrine systems in FMS. The categories of current drugs employed to treat the disorder are detailed, along with a critical review of the literature supporting such use.

Caro XJ, Winter EF, Dumas AJ. · Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · Rheumatology (Oxford). · Pubmed #18208823 No free full text.

Abstract: OBJECTIVES: The aetiopathogenesis of the fibromyalgia syndrome (FMS) remains unknown. Recent reports, however, suggest that a subgroup of FMS subjects has an immune-mediated disease. Therefore, our primary objective was to study FMS subjects for evidence of an immune-mediated demyelinating polyneuropathy. Our secondary objective was to determine the effects of treating these FMS subjects with the immune modulator, intravenous immunoglobulin (IVIg). METHODS: Fifty-eight FMS subjects, 26 rheumatic non-FMS subjects and 52 non-rheumatic non-FMS subjects were studied. Subjective measures of paraesthesias, weakness, stocking hypaesthesia, pain, fatigue and stiffness were made. Objective measures of tenderness, proximal muscle strength and electrodiagnostic (EDX) evidence of polyneuropathy and demyelination were also made. Eleven other FMS subjects underwent sural nerve biopsy. RESULTS: Paraesthesias, subjective weakness and stocking hypaesthesia were more common in FMS than in rheumatic non-FMS (P < or = 0.0001). Proximal muscle strength was less in FMS than in rheumatic non-FMS (P < or = 0.0001). EDX demonstrated a distal demyelinating polyneuropathy, suggestive of chronic inflammatory demyelinating polyneuropathy (CIDP), in 33% of FMS subjects. No rheumatic non-FMS subject had polyneuropathy (P = 0.005), or demyelination (P = 0.05). Fifteen FMS/CIDP subjects were subsequently treated with IVIg (400 mg/kg each day for 5 days). Pain (P = 0.01), tenderness (P = 0.001) and strength (P = 0.04) improved significantly. Fatigue and stiffness trended towards improvement. CONCLUSIONS: A significant subset of FMS subjects have clinical and EDX findings suggestive of CIDP. IVIg treatment shows promise in treating this subset. These observations have implications for better understanding and treating some FMS patients.

Rutledge DN, Jones CJ. · Department of Nursing, California State University, Fullerton, CA 92834-6868, USA. · J Altern Complement Med. · Pubmed #18166121 No free full text.

Abstract: OBJECTIVES: We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN: This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. Settings: Settings included community sites in southern California. SUBJECTS: The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS: Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES: Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS: The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS: Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.

Rutledge DN, Jones K, Jones CJ. · California State University, Fullerton, CA, USA. · J Nurs Scholarsh. · Pubmed #18021131 No free full text.

Abstract: PURPOSE: The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM). DESIGN: Cross-sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005. METHODS: The survey indicated self-reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression. FINDINGS: Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods. CONCLUSIONS: People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.

Tsao JC, Meldrum M, Kim SC, Jacob MC, Zeltzer LK. · Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, John C. Liebeskind History of Pain Collection, Louise M. Darling Biomedical Library, UCLA and Department of History, UCLA USA. · Evid Based Complement Alternat Med. · Pubmed #17965769 links to  free full text

Abstract: CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years +/- 2.4; range = 8-18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.