Fibromyalgia: Illinois

Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ, Clauw DJ. · Northwest Rheumatology Specialists, Elk Grove Village, IL 60007, USA. · Arthritis Res Ther. · Pubmed #18768089 links to  free full text

Abstract: Researchers studying fibromyalgia strive to identify objective, measurable biomarkers that may identify susceptible individuals, may facilitate diagnosis, or that parallel activity of the disease. Candidate objective measures range from sophisticated functional neuroimaging to office-ready measures of the pressure pain threshold. A systematic literature review was completed to assess highly investigated, objective measures used in fibromyalgia studies. To date, only experimental pain testing has been shown to coincide with improvements in clinical status in a longitudinal study. Concerted efforts to systematically evaluate additional objective measures in research trials will be vital for ongoing progress in outcome research and translation into clinical practice.

Duloy AM, Calhoun EA, Clemens JQ. · Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA. · Curr Urol Rep. · Pubmed #18519019 No free full text.

Abstract: There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.

Herndon CM, Hutchison RW, Berdine HJ, Stacy ZA, Chen JT, Farnsworth DD, Dang D, Fermo JD, Anonymous00013. · School of Pharmacy, Southern Illinois University-Edwardsville, Edwardsville, Illinois, USA. · Pharmacotherapy. · Pubmed #18503406 No free full text.

Abstract: Chronic nonmalignant pain is a major burden on the health care system in the United States. Frequently, nonsteroidal antiinflammatory drugs (NSAIDs) are used to assist in the management of various chronic pain syndromes. Although evidence is accumulating on the potential toxicities associated with NSAIDs, clear recommendations are lacking to guide the appropriate use of these drugs. Equivocal data, especially with respect to cardiovascular risk, further confuse a clear treatment pathway when assessing pharmacotherapy. Originally, cyclooxygenase selectivity appeared to be a determining factor in choosing an agent because of the presumed lack of effect on the cardiovascular and gastrointestinal renal systems. This theory, however, was recently dispelled. To provide guidance on the selection of an NSAID for various chronic pain syndromes, members of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy evaluated evidence-based use of NSAIDs for frequently encountered pain syndromes, with special focus on the adverse effects of this class of agents.

Slavin KV. · Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA. · Neurotherapeutics. · Pubmed #18164488 No free full text.

Abstract: Peripheral nerve stimulation (PNS) has been used for treatment of neuropathic pain for more than 40 years. Recent resurgence of interest to this elegant surgical modality came from the introduction of less invasive implantation techniques and the wider acceptance of neuromodulation as a treatment of medically refractory cases. This article reviews the literature on the use of PNS for neuropathic pain and describes current indications and hardware choices in frequent use. Published experience indicates that neuropathic pain responds to PNS in many patients. PNS works well in both established indications, such as post-traumatic and postsurgical neuropathy, occipital neuralgia, and complex regional pain syndromes, and in relatively new indications for neuromodulation, such as migraines and daily headaches, cluster headaches, and fibromyalgia. Future research and growing clinical experience will help in identifying the best candidates for PNS, choosing the best procedure and best hardware for each individual patient, and defining adequate expectations for patients and pain specialists.

Turk DC, Vierck CJ, Scarbrough E, Crofford LJ, Rudin NJ. · Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. · J Pain. · Pubmed #17936075 No free full text.

This publication has no abstract.

Wu SC, Wrobel JS, Armstrong DG. · Department of Surgery, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois 60064, USA. · Pain Med. · Pubmed #17714114 No free full text.

Abstract: Chronic, neuropathic pain may be secondary to myriad etiologies including diabetic peripheral neuropathy and fibromyalgia. It is a debilitating condition that imposes a significant burden on individuals and society alike. This article will review various instruments designed to assess quality of life (QoL) and key data assessing QoL of patients suffering from these diseases as well as currently available pharmacologic agents for symptomatic management. As basic and clinical science progress over the next few years, along with the introduction of novel pharmacologic agents, we anticipate greater potential for pain intervention and improvement in the quality of life of our patients.

Yunus MB. · Section of Rheumatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA. · Best Pract Res Clin Rheumatol. · Pubmed #17602995 No free full text.

Abstract: Patients with widespread pain or fibromyalgia syndrome have many symptoms besides musculoskeletal pain: e.g. fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches and restless legs syndrome. There is evidence for central sensitization in these conditions, but further studies are needed. Anxiety, stress and depression are also present in 30-45% of patients. Other factors that may contribute to symptoms include endocrine dysfunction, psychosocial distress, trauma, and disrupted sleep. Evaluation of a patient presenting with widespread pain includes history and physical examination to diagnose both fibromyalgia and associated or concomitant conditions. Fibromyalgia should be diagnosed by its own characteristic features. Some patients with otherwise typical symptoms of fibromyalgia may have as few as four to six tender points in clinical practice. Patients with rheumatoid arthritis and systemic lupus erythematosus should be evaluated for fibromyalgia, since 20-30% of them have associated fibromyalgia, requiring a different treatment approach.

Norman HR. · Center for Pain Studies, Rehabilitation Institute of Chicago, 446 E. Ontario St, Suite 1011, Chicago, IL 60611, USA. · Am J Phys Med Rehabil. · Pubmed #17370371 No free full text.

Abstract: This article summarizes the evidence for two major clinical syndromes of muscle pain: fibromyalgia and myofascial pain syndrome. The evidence for diagnostic and treatment approaches is reviewed.

Yunus MB. · Section of Rheumatology, The University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA. · Semin Arthritis Rheum. · Pubmed #17350675 No free full text.

Abstract: OBJECTIVES: To discuss fibromyalgia syndrome (FMS) and overlapping conditions, eg, irritable bowel syndrome, headaches, and chronic fatigue syndrome, within the concept of central sensitivity syndromes (CSS). METHODS: A critical overview of the literature and incorporation of the author's own views. RESULTS: The concept of CSS seems viable. It is based on mutual associations among the CSS conditions as well as the evidence for central sensitization (CS) among several CSS members. However, such evidence is weak or not available in other members at this time, requiring further studies. The biology of CSS is based on neuroendocrine aberrations, including CS, that interact with psychosocial factors to cause a number of symptoms. CONCLUSIONS: CSS is an important new concept that embraces the biopsychosocial model of disease. Further critical studies are warranted to fully test this concept. However, it seems to have important significance for new directions for research and patient care involving physician and patient education. Each patient, irrespective of diagnosis, should be treated as an individual considering both the biological and psychosocial contributions to his or her symptoms and suffering.

Inanici F, Yunus MB. · Department of Medicine, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA. · Curr Pain Headache Rep. · Pubmed #15361321 No free full text.

Abstract: Fibromyalgia syndrome (FMS) is now a recognized clinical entity causing chronic and disabling pain. For several centuries, muscle pains have been known as rheumatism and then as muscular rheumatism. The term fibrositis was coined by Gowers in 1904 and was not changed to fibromyalgia until 1976. Smythe laid the foundation of modern FMS in 1972 by describing widespread pain and tender points. The first sleep electroencephalogram study was performed in 1975. The first controlled clinical study with validation of known symptoms and tender points was published in 1981. This same study also proposed the first data-based criteria. The important concept that FMS and other similar conditions are interconnected was proposed in 1984. The first American College of Rheumatology criteria were published in 1990 and neurohormonal mechanisms with central sensitization were developed in the 1990s. Serotonergic/norepinephric drugs were first shown to be effective in 1986.

Shaver JL. · University of Illinois at Chicago, College of Nursing, M/C 802, 845 South Damen Avenue, Chicago, IL 60612-7350, USA. · Nurs Clin North Am. · Pubmed #15062736 No free full text.

Abstract: Many more women than men experience the chronically fatiguing condition of fibromyalgia syndrome (FMS), a growing diagnosis in the United States. Estimates are that upwards of 2% to 6% of adults have been diagnosed with FMS, and at high societal costs. In this article, common manifestations are described to guide assessment and various lines of research are explored as a basis for under-standing contributing factors and potential treatments for FMS and other chronic disorders, such as chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and temporomandibular disorders (TMD), and the effectiveness of current treatment options.

Lash AA, Ehrlich-Jones L, McCoy D. · Northern Illinois University School of Nursing, DeKalb, IL, USA. · Medsurg Nurs. · Pubmed #12861752 No free full text.

Abstract: During the last 10 years, fibromyalgia (FM) research shifted focus from psychological and behavioral issues to sleep, nociception, and neuroendocrinology. Although there are still no definitive markers of the disease, a barrage of studies in physiological, psychological, and behavioral sciences have now dispelled the belief that FM is solely psychosomatic. Studies in the late 1990s as well as in the early part of the current decade reaffirm earlier research that sleep abnormalities and alterations in nociception may partly be responsible for FM. While sleep research shows that FM patients typically are deficient in stage IV (restorative) sleep, most current studies in nociception now affirm that patients with FM exhibit low serum serotonin in combination with increased substance P levels in the cerebrospinal fluid. Although there is still no cure, treatment aimed at promoting sleep, interrupting nociception, and actively involving patient and family in FM management can bring lifetime control for the disease.

Masi AT, White KP, Pilcher JJ. · Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA. · Semin Arthritis Rheum. · Pubmed #12430098 No free full text.

Abstract: OBJECTIVES: To describe complex interactions of multiple factors believed to contribute to fibromyalgia syndrome (FMS) at a person-centered level to enhance approaches to care, teaching, and research. The main factors addressed were central nervous system sensory sensitization, autonomic nervous system (ANS) activation, neurohumoral perturbations, and psychosocial and environmental stressors. A person-centered approach is defined as attention to major biopsychosocial issues of affected individuals. METHODS: Literature on classification, mechanistic pathways, course and outcomes, and management of FMS was reviewed to assess applications of person-centered approaches to care, teaching, and research. Various biopsychosocial influences were considered in relation to the heterogeneous subjective manifestations of this illness, including central hyperalgesia, ANS and other neurohumoral perturbations, functional hyperexcitability, nonrestorative sleep, and psychologic distress. RESULTS: A person-centered approach to FMS can expand on and strengthen traditional biomedical concepts. Adding such a focus can help to untangle current controversies in the course, outcomes, and treatment of FMS. A person-centered approach can also help in the subgrouping of affected patients for greater specificity in care programs and in improved clinical investigations. In the biomedical model, diverse symptoms of FMS are often addressed separately and apart from their interconnectedness and linkages to the patient's individualized biopsychosocial factors. However, the causes of FMS symptomatology are not likely to be caused by uniform biologic abnormalities across populations. Rather, the syndrome likely results from personal reactivities to varied multifactorial biopsychosocial influences. Common denominators among individuals may include varying degrees of ANS activation (or personal susceptibility to ANS activation), nonrestorative sleep, negative affectivity, and other central pain sensitization mechanisms, among the pathways reviewed. CONCLUSIONS: Innovative analytical methodologies will need to be developed to more effectively investigate complex interacting biopsychosocial dynamics at a person-centered level, including qualitative research, and multifactorial and multilevel techniques. Adding person-centered approaches to biopsychosocial concepts of FMS promises to show new physiopathogenetic insights and more effective treatment than current biomedical models alone. Person-centered approaches enhance patient-physician relationships and help prioritize patients' goals in mutually derived treatment plans.

Yunus MB. · Section of Rheumatology, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA. · Rheum Dis Clin North Am. · Pubmed #12122914 No free full text.

Abstract: Fibromyalgia syndrome (FMS) is a common and distressful condition. It is imperative that all physicians do their best to help these suffering patients with understanding and respect, since the primary responsibility of a physician is to ameliorate suffering of a patient, irrespective of the type of the disease or the illness. (The authors use the terms "disease" and "illness" synonymously, since any distinction between these two terms are really pointless because the word "disease" means lack of ease or presence of suffering.) It is clear that a physician cannot optimize management of a patient with FMS without a thorough medical and psychologic evaluation. A good evaluation helps to make a proper diagnosis, assess severity, recognize aggravating and relieving factors of symptoms, appraise psychologic factors, evaluate relevant associated or concomitant conditions, document individualized problems in a given patient, and subsequently formulate proper and individualized management. This article focuses on the major elements of a comprehensive medical evaluation, with some reference to psychologic aspects--are covered in detail in the article by Turk et al in this issue.

Yunus MB. · Section of Rheumatology, University of Illinois College of Medicine at Peoria, 1 Illini Dr, PO Box 1649, Peoria, IL 61656, USA. · J Gend Specif Med. · Pubmed #11974674 No free full text.

Abstract: Fibromyalgia syndrome is characterized by widespread musculoskeletal pain, fatigue, poor sleep, and tenderness on palpation at multiple sites called tender points. It occurs mostly among women; only about 10% of patients are men. Two recent studies showed that women had significantly more common fatigue, morning fatigue, "hurt all over," a greater total number of symptoms, as well as a greater number of tender points. Gender differences have also been reported in other related syndromes such as tension headache, migraine, irritable bowel syndrome, chronic fatigue syndrome, and temporomandibular disorder. Although the mechanisms of gender differences in these illnesses are not fully understood, they are likely to involve an interaction between biology, psychology, and sociocultural factors.

Yunus MB. · College of Medicine at Peoria, University of Illinois, One Illini Drive, PO Box 1649, Peoria, IL 61656, USA. · Curr Rheumatol Rep. · Pubmed #11286669 No free full text.

Abstract: Fibromyalgia syndrome (FMS), characterized by widespread pain and tenderness on palpation (tender points), is much more common in women than in men in a proportion of 9:1. Two recent studies have shown important gender differences in various clinical characteristics of FMS. In a community and a clinic sample, women experienced significantly more common fatigue, morning fatigue, hurt all over, total number of symptoms, and irritable bowel syndrome. Women had significantly more tender points. Pain severity, global severity and physical functioning were not significantly different between the sexes, nor were psychologic factors, eg, anxiety, stress, and depression. Gender differences have also been observed in other related syndromes, eg, chronic fatigue syndrome, irritable bowel syndrome, and headaches. The mechanisms of gender differences in these illnesses are not fully understood, but are likely to involve an interaction between biology, psychology, and sociocultural factors.

Harden RN, Revivo G, Song S, Nampiaparampil D, Golden G, Kirincic M, Houle TT. · Center for Pain Studies, Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. · Pain Med. · Pubmed #17305686 No free full text.

Abstract: OBJECTIVE: To pilot methodologies designed to critically assess the American College of Rheumatology's (ACR) diagnostic criteria for fibromyalgia. DESIGN: Prospective, psychophysical testing. SETTING: An urban teaching hospital. SUBJECTS: Twenty-five patients with fibromyalgia and 31 healthy controls (convenience sample). INTERVENTIONS: Pressure pain threshold was determined at the 18 ACR tender points and five sham points using an algometer (dolorimeter). OUTCOME MEASURES: The patients "algometric total scores" (sums of the patients' average pain thresholds at the 18 tender points) were derived, as well as pain thresholds across sham points. RESULTS: The "algometric total score" could differentiate patients with fibromyalgia from normals with an accuracy of 85.7% (P < 0.001). Even a single tender point had a diagnostic accuracy between 75% and 89%. Although fibromyalgics had less pain across sham points than across ACR tender points, sham points also could be used for diagnosis (85.7%; Ps < 0.001). Hierarchical cluster analysis showed that three points could be used for a classification accuracy equivalent to the use of all 18 points. CONCLUSIONS: There was a significant difference in the "algometric total score" between patients with fibromyalgia and controls, and we suggest this quantified (although subjective) approach may represent a significant improvement over the current diagnostic scheme, but this must be tested vs other painful conditions. The points specified by the ACR were only modestly superior to sham points in making the diagnosis. Most importantly, this pilot suggests single points, smaller groups of points, or sham points may be as effective in diagnosing fibromyalgia as the use of all 18 points, and suggests methodologies to definitively test that hypothesis.

Yunus MB, Young CS, Saeed SA, Mountz JM, Aldag JC. · University of Illinois College of Medicine at Peoria, IL 61656, USA. · Arthritis Rheum. · Pubmed #15334421 links to  free full text

Abstract: OBJECTIVE: Abnormal brain findings have previously been described in fibromyalgia syndrome (FMS) by single-photon-emission computed tomography. Our goal was to investigate change in regional cerebral glucose metabolism in people with FMS by positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG). METHODS: Twelve patients with FMS and no comorbid psychiatric diagnosis and 7 healthy pain-free controls were studied with FDG-PET in a blinded manner. Those with a psychiatric diagnosis were excluded. Brain scans were obtained using a PET scanner. Semiquantitative analysis of regional 18F-FDG uptake was performed in both cortical and subcortical brain structures. RESULTS: In the resting state, there were no significant differences in 18F-FDG uptake between patients and controls for all brain structures measured. CONCLUSION: FDG-PET scan findings in FMS were not significantly different from healthy controls. Normal results in our study may be explained by discordance between regional cerebral blood flow and regional cerebral glucose metabolism.

Leavitt F, Katz RS. · Rush Medical College, Chicago, Illinois, USA. · Arthritis Rheum. · Pubmed #19479690 No free full text.

Abstract: OBJECTIVE: To examine the impact of distraction on the retention of rehearsed information in patients with fibromyalgia syndrome (FMS). METHODS: Data refer to the neurocognitive examination of 134 patients (91 with FMS and 43 control subjects) presenting with memory loss. Four neurocognitive measures free of distraction, along with 2 measures with added distraction, were completed. Differences in the retention of rehearsed and unrehearsed information with a source of distraction present were calculated. RESULTS: Patients with FMS showed normal cognitive functioning on verbal memory tests free of distraction. Adding a source of distraction caused unrefreshed information to be lost at a disproportionate rate in patients with FMS. Over 87% of patients with FMS scored in the impaired range on a task of unrehearsed verbal memory. Adding a source of distraction to well-rehearsed information produced a normal rate of recall in FMS. CONCLUSION: Rehearsal mechanisms are intact in patients with FMS and play beneficial roles in managing interference from a source of distraction. In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied-upon neurocognitive measures. We present a theory to promote understanding of the cognitive deficit of people with FMS based on reduced speed of lexical activation and poor recall after distraction.

Shaver JL, Wilbur J, Lee H, Robinson FP, Wang E. · University of Illinois at Chicago, College of Nursing, 845 S. Damen M/C 802, Chicago, IL 60612, USA. · J Womens Health (Larchmt). · Pubmed #19445618 No free full text.

Abstract: METHODS: Using a telephone survey of 434 women who self-reported having and 198 women, who denied having fibromyalgia (FM) (aged 18-80 years), we compared women on self-reported number, major types, and effectiveness of currently taken conventional medications and herbs/supplements. RESULTS: Ninety-three percent of women with FM reported taking at least one medication (1855 total, 499 types, on average 4.6 per person) compared with 56% of women without FM (269 total, 172 types, 1.4 per person on average). Half (n = 217) of the women with FM reported taking antidepressant drugs; more reported selective serotonin reuptake inhibitors (SSRI)-type with moderate effectiveness than tricyclic amines deemed to have strong effectiveness. Few were taking dual uptake inhibitors or the now approved pregabalin. Nearly 30% reported taking nonsteroidal anti-inflammatory drugs (NSAID), which have weak efficacy evidence. Less than 8% of controls reported taking either antidepressants or NSAID. Having FM was associated with these medications plus guaifenesen, anticonvulsants, muscle relaxants, narcotics, other analgesics, and benzodiazepines. Highest effectiveness scores were for opioid narcotics and guaifenesin. Forty-three percent of women with FM reported taking at least one herb/supplement compared with 23% of control women. The most common types were omega esterified fatty acids, glucosamine, and gingko. No particular type distinguished between the groups. Both groups tended to rate overall effectiveness lower for herbs/supplements than for conventional medications. CONCLUSIONS: Substantial numbers of women with FM were taking pain medications that often lacked evidence for effectiveness. The variety of medications being taken by women with FM compared with women without FM indicates that there are few medications that consistently provide symptom alleviation for this condition.

Anema C, Johnson M, Zeller JM, Fogg L, Zetterlund J. · Purdue University Calumet, South Holland, IL 60473, USA. · Res Theory Nurs Pract. · Pubmed #19418885 No free full text.

Abstract: This study examined relationships among symptom pattern variability, uncertainty, spiritual well-being, and psychosocial adaptation in individuals with fibromyalgia syndrome (FMS). A survey design was used with 58 individuals with FMS. The Fibromyalgia Symptom Pattern Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, Spiritual Well-Being Scale, and Psychosocial Adjustment to Illness Scale-Self Report were used to collect data. Positive relationships were found between symptom pattern variability and uncertainty and between uncertainty and poor psychosocial adaptation; spiritual well-being moderated the relationship between uncertainty and psychosocial adaptation. A positive sense of well-being aided adaptation to symptoms and uncertainties of FMS. Spiritual well-being had a greater effect on the relationship between symptom pattern variability and uncertainty than expected.

Leavitt F, Katz RS. · Department of Behavioral Sciences, Section of Rheumatology, Rush Medical College, Chicago, IL, USA. · J Clin Rheumatol. · Pubmed #18636019 No free full text.

Abstract: OBJECTIVE: Abnormal processing of information in fibromyalgia may hold clues to brain abnormalities in this illness. The purpose of this study is to examine the speed of mental operations in people with the fibromyalgia syndrome (FMS) under the pressure of time. The central question addresses whether FMS is associated with processing speed deficits across a spectrum of speeded tasks. METHODS: Sixty-seven patients with fibromyalgia with a history of memory complaints and 51 controls presenting with complaints of memory loss completed 10 timed cognitive measures of processing speed. Controls were patients with memory complaints who did not have FMS. RESULTS: The majority of FMS patients (>70%) performed within 1 standard deviation of the norm on 7 or more of 10 speeded measures. However, more than 49% of FMS patients tested as impaired (>1.67 SD below normative mean) on 2 specific validated speed tasks (reading words and naming colors). Compared with controls, the number of FMS patients showing impairment was 2.0 times greater for reading speed, and 1.6 times greater for color naming speed. A mean time delay of 203 milliseconds was recorded for reading words and 285 milliseconds for naming colors in the FMS impaired sample. A 203 milliseconds delay in reading words represents a 48% (203/417) time increase over the normal time for reading the same stimulus word. CONCLUSION: Abnormalities in naming speed are an unappreciated feature of FMS. Selective deficits in naming speed in association with otherwise well preserved global processing speed set patients with FMS apart from controls with memory complaints. Clinicians would be wise to specifically request adding a rapid naming test such as the Stroop Test to the cognitive battery; to document cognitive dysfunction in FMS patients who otherwise appear to test normally, despite often intense complaints of memory and concentration difficulties that can affect job performance and increase disability.

Yunus MB. · Section of Rheumatology, The University of Illinois College of Medicine at Peoria, Peoria, Illinois 61605, USA. · Semin Arthritis Rheum. · Pubmed #18191990 No free full text.

Abstract: OBJECTIVES: To discuss the current terminologies used for fibromyalgia syndrome (FMS) and related overlapping conditions, to examine if central sensitivity syndromes (CSS) is the appropriate nosology for these disorders, and to explore the issue of disease versus illness. METHODS: A literature search was performed through PubMed, Web of Science, and ScienceDirect using a number of keywords, eg, functional somatic syndromes, somatoform disorders, medically unexplained symptoms, organic and nonorganic, and diseases and illness. Relevant articles were then reviewed and representative ones cited. RESULTS: Terminologies currently used for CSS conditions predominantly represent a psychosocial construct and are inappropriate. On the other hand, CSS seems to be the logical nosology based on a biopsychosocial model. Such terms as "medically unexplained symptoms," "somatization," "somatization disorder," and "functional somatic syndromes" in the context of CSS should be abandoned. Given current scientific knowledge, the concept of disease-illness dualism has no rational basis and impedes proper patient-physician communication, resulting in poor patient care. The concept of CSS is likely to promote research, education, and proper patient management. CONCLUSION: CSS seems to be a useful paradigm and an appropriate terminology for FMS and related conditions. The disease-illness, as well as organic/non-organic dichotomy, should be rejected.

Brown MM, Jason LA. · Department of Psychology, DePaul University, Center for Community Research, Chicago, IL, USA. · Dyn Med. · Pubmed #17663779 links to  free full text

This publication has no abstract.

Brown MM, Jason LA. · Department of Psychology, DePaul University, Center for Community Research, Chicago, IL, USA. · Dyn Med. · Pubmed #17540028 links to  free full text

Abstract: BACKGROUND: Chronic fatigue syndrome (CFS), multiple chemical sensitivity (MCS), and fibromyalgia (FM) commonly co-occur. Some propose that CFS, MCS, and FM are manifestations of the same illness based on high rates of co-occurrence and overlapping diagnostic criteria. This study seeks to differentiate these diagnoses by comparing individuals with one or more illness on functioning, psychiatric comorbidity, coping style, and in vivo physical measures. METHODS: Participants included 114 men and women who met criteria for CFS. FM was diagnosed during a physical examination, and MCS was assessed using a questionnaire. Participants were divided into four groups: CFS alone, CFS-MCS, CFS-FM, and CFS-MCS-FM. Self-report measures, a psychiatric interview, and in vivo physical measures were given. RESULTS: 43.9% met criteria for CFS alone, 23.7% met criteria for CFS-MCS, 15.8% met criteria for CFS-FM, and 16.7% met criteria for CFS-MCS-FM. The CFS-MCS-FM group was more disabled than the CFS alone group on measures of physical functioning, general health, and bodily pain. In vivo measures did not differ, but the CFS-MCS-FM group rated exertion higher than the CFS alone group. CONCLUSION: Individuals with CFS alone were the highest functioning group across several domains, such as disability, depression, and severity of symptoms. Participants with three diagnoses experienced the greatest amount of disability. While substantial co-occurrence of these illnesses was found, this study provides evidence that having more than one illness exacerbates one's disability beyond CFS alone.