Fibromyalgia: Michigan

Clauw DJ. · Clinical and Translational Research at University of Michigan, Ann Arbor, MI, USA. · Nat Clin Pract Rheumatol. · Pubmed #18560385 No free full text.

This publication has no abstract.

Clauw DJ. · Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. · J Clin Psychiatry. · Pubmed #19200425 No free full text.

Abstract: Fibromyalgia is a common and disabling condition that may be difficult to assess and diagnose owing to its wide range of symptoms and common comorbidities. The most common symptoms of fibromyalgia include widespread pain over the whole body, pain at specific tender points, fatigue, memory and other cognitive problems, sleep and mood disturbances, and impaired functioning. Accurately diagnosing fibromyalgia may require diagnostic testing and physical examinations such as tender points examinations; however, patients with longstanding symptoms may be diagnosed according to a symptom-based fibromyalgia criteria checklist. This activity provides a sample assessment and diagnosis in a clinical situation.

McPartland JM. · Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, MI, USA. · J Bodyw Mov Ther. · Pubmed #19083670 No free full text.

Abstract: The endocannabinoid (eCB) system, like the better-known endorphin system, consists of cell membrane receptors, endogenous ligands and ligand-metabolizing enzymes. Two cannabinoid receptors are known: CB(1) is principally located in the nervous system, whereas CB(2) is primarily associated with the immune system. Two eCB ligands, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), are mimicked by cannabis plant compounds. The first purpose of this paper was to review the eCB system in detail, highlighting aspects of interest to bodyworkers, especially eCB modulation of pain and inflammation. Evidence suggests the eCB system may help resolve myofascial trigger points and relieve symptoms of fibromyalgia. However, expression of the eCB system in myofascial tissues has not been established. The second purpose of this paper was to investigate the eCB system in fibroblasts and other fascia-related cells. The investigation used a bioinformatics approach, obtaining microarray data via the GEO database (www.ncbi.nlm.nih.gov/geo/). GEO data mining revealed that fibroblasts, myofibroblasts, chondrocytes and synoviocytes expressed CB(1), CB(2) and eCB ligand-metabolizing enzymes. Fibroblast CB(1) levels nearly equalled levels expressed by adipocytes. CB(1) levels upregulated after exposure to inflammatory cytokines and equiaxial stretching of fibroblasts. The eCB system affects fibroblast remodeling through lipid rafts associated with focal adhesions and dampens cartilage destruction by decreasing fibroblast-secreted metalloproteinase enzymes. In conclusion, the eCB system helps shape biodynamic embryological development, diminishes nociception and pain, reduces inflammation in myofascial tissues and plays a role in fascial reorganization. Practitioners wield several tools that upregulate eCB activity, including myofascial manipulation, diet and lifestyle modifications, and pharmaceutical approaches.

Clauw DJ. · Division of Rheumatology, Department of Internal Medicine, and Michigan Institute for Clinical and Health Research, University of Michigan Medical School, Ann Arbor, USA. · J Clin Psychiatry. · Pubmed #18537460 No free full text.

Abstract: Fibromyalgia is a common and disabling syndrome. Despite research detailing the efficacy of a variety of medicinal treatments, most notably, tricyclic antidepressants, serotonin-norepinephrine re-uptake inhibitors, and alpha(2)delta ligands, there is still widespread, routine use of agents that are mostly ineffective in treating the central nature of fibromyalgic pain. This article discusses pharmacotherapeutic options for fibromyalgia, including those with high-level evidence for efficacy, moderate-level evidence, and little or no evidence for efficacy. The importance of an integrated treatment approach that includes pharmacotherapy and at least one, but preferably more, of the most effective nonmedicinal treatment options available (e.g., education, aerobic exercise, and cognitive-behavioral therapy) is also discussed.

Glass JM. · Substance Abuse Section, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA. · J Clin Psychiatry. · Pubmed #18537459 No free full text.

Abstract: Patients with fibromyalgia frequently complain of cognitive problems or "fibrofog." The existence of these symptoms has been confirmed by studies of the incidence of cognitive problems in fibromyalgia patients and by the results of objective tests of metamemory, working memory, semantic memory, everyday attention, task switching, and selective attention. The results of these tests show that fibromyalgia patients have impairments in working, episodic, and semantic memory that mimic about 20 years of aging. These patients have particular difficulty with memory when tasks are complex and their attention is divided. Cognitive symptoms in these patients may be exacerbated by the presence of depression, anxiety, sleep problems, endocrine disturbances, and pain, but the relationship of these factors to cognitive problems in fibromyalgia patients is unclear. Standardized tests and treatment have not yet been established for cognitive problems in fibromyalgia patients.

Clauw DJ. · Division of Rheumatology, Chronic Pain and Fatigue Research Center, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. · J Clin Rheumatol. · Pubmed #17414543 No free full text.

This publication has no abstract.

Williams DA, Gracely RH. · Chronic Pain and Fatigue Research Center, Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, University of Michigan, Ann Arbor, MI, USA. · Arthritis Res Ther. · Pubmed #17254318 links to  free full text

Abstract: Techniques in neuroimaging such as functional magnetic resonance imaging (fMRI) have helped to provide insights into the role of supraspinal mechanisms in pain perception. This review focuses on studies that have applied fMRI in an attempt to gain a better understanding of the mechanisms involved in the processing of pain associated with fibromyalgia. This article provides an overview of the nociceptive system as it functions normally, reviews functional brain imaging methods, and integrates the existing literature utilizing fMRI to study central pain mechanisms in fibromyalgia.

Dooley DJ, Taylor CP, Donevan S, Feltner D. · Department of CNS Pharmacology, Pfizer Global Research and Development, Ann Arbor, MI 48105, USA. · Trends Pharmacol Sci. · Pubmed #17222465 No free full text.

Abstract: The term 'Ca2+ channel alpha2delta ligands' has recently been applied to an evolving drug class that includes gabapentin (Neurontin) and pregabalin (Lyrica), and reflects significant progress over the past decade in elucidating the mechanism of action of these drugs: a novel, specific action at one of the subunits constituting voltage-sensitive Ca2+ channels. Binding of these ligands to the alpha2delta subunit is considered to explain their usefulness in treating several clinical disorders, including epilepsy, pain from diabetic neuropathy, postherpetic neuralgia and fibromyalgia, and generalized anxiety disorder. The evidence indicates a relationship between alpha2delta subunit binding and the modulation of processes that subserve neurotransmission. This modulation is characterized by a reduction of the excessive neurotransmitter release that is observed in certain neurological and psychiatric disorders.

Glass JM. · University of Michigan, Institute for Social Research and Department of Psychiatry, 426 Thompson Street, Room 5256, Ann Arbor, MI 48106-1248, USA. · Curr Rheumatol Rep. · Pubmed #17092441 No free full text.

Abstract: Fibromyalgia (FM) and chronic fatigue syndrome (CFS) patients often have memory and cognitive complaints. Objective cognitive testing demonstrates long-term and working memory impairments. In addition, CFS patients have slow information-processing, and FM patients have impaired control of attention, perhaps due to chronic pain. Neuroimaging studies demonstrate cerebral abnormalities and a pattern of increased neural recruitment during cognitive tasks. Future work should focus on the specific neurocognitive systems involved in cognitive dysfunction in each syndrome.

Harris RE, Clauw DJ. · Department of Medicine, Division of Rheumatology, University of Michigan Medical Center, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 18106, USA. · Curr Pain Headache Rep. · Pubmed #17087863 No free full text.

Abstract: Fibromyalgia is a common idiopathic pain condition often resulting in increased morbidity and disability in patients. The lack of peripheral abnormalities in this disease has led clinicians and researchers alike to question if this syndrome represents a valid entity. Recent genetic findings suggest that specific gene mutations may predispose individuals to develop fibromyalgia. In addition, neurobiological studies indicate that fibromyalgia patients have abnormalities within central brain structures that normally encode pain sensations in healthy pain-free controls. Future studies that focus on central neurobiological and/or genetic influences in fibromyalgia may bring insight into mechanisms of this problematic disease and ultimately result in improved treatments.

Dadabhoy D, Clauw DJ. · Chronic Pain and Fatigue Research Center, The University of Michigan, 24 Frank Lloyd Wright Drive, Box 385, Ann Arbor, MI 48106, USA. · Nat Clin Pract Rheumatol. · Pubmed #16932722 No free full text.

Abstract: In the past decade, we have made tremendous progress in our understanding of fibromyalgia, which is now recognized as one of many 'central' pain syndromes that are common in the general population. Specific genes that might confer an increased risk of developing fibromyalgia syndrome are beginning to be identified and the environment (in this case exposure to stressors) might also have a significant effect on triggering the expression of symptoms. After developing the syndrome, the hallmark aberration noted in individuals with fibromyalgia is augmented central pain processing. Insights from research suggest that fibromyalgia and related syndromes require a multimodal management program that is different from the standard used to treat peripheral pain (i.e. acute or inflammatory pain). Instead of the nonsteroidal anti-inflammatory drugs and opioids commonly used in the treatment of peripheral pain, the recommended drugs for central pain conditions are neuroactive compounds that downregulate sensory processing. The most efficacious compounds that are currently available include the tricyclic drugs and mixed reuptake inhibitors that simultaneously increase serotonin and norepinephrine concentrations in the central nervous system. Other compounds that increase levels of single monoamines (serotonin, norepinephrine or dopamine), and anticonvulsants also show efficacy in this condition. In addition to these pharmacologic therapies, which are useful in improving symptoms, nonpharmacologic therapies such as exercise and cognitive behavioral therapy are useful treatments for restoring function to an individual with fibromyalgia.

Hayden RJ, Louis DS, Doro C. · Division of Hand, Elbow and Microsurgery, Department of Orthopaedic Surgery, University of Michigan Medical Center, 2098 South Main Street, Ann Arbor, MI 48103, USA. · Clin Occup Environ Med. · Pubmed #16647662 No free full text.

Abstract: Fibromyalgia and myofascial pain syndromes are terms used to describe a constellation of complaints ranging from generalized aches to specific tender trigger points often accompanied by fatigue, depression, and sleep disturbances. In the past 5 years, research has been directed primarily at determining the pathophysiology of fibromyalgia and myofascial pain syndromes and the treatment of patients' comorbidities to alleviate their symptomatology. Controversy exists as to whether fibromyalgia and myofascial pain syndromes represent a specific pathology or are merely terms to describe clinical conditions that provide patients with the reassurance that their symptoms are real and help clinicians with therapeutic direction. In the occupational health setting, this uncertainty can lead to significant difficulty in determining short- and long-term disability and assigning culpability to an individual's work environment.

Dadabhoy D, Clauw DJ. · Division of Rheumatology, Department of Medicine, Chronic Pain and Fatigue Research Center, The University of Michigan, 24 Frank Lloyd Wright Drive, Box 385, Ann Arbor, MI 48106, USA. · Curr Pain Headache Rep. · Pubmed #16282040 No free full text.

Abstract: Fibromyalgia is a frequent cause of chronic widespread pain and affects up to 5% of the general population. Diagnosis and treatment have been especially challenging due to limited knowledge of etiology and poor response to conventional treatment of pain. Appreciation for the interactions of neurobiologic, psychologic, and behavioral factors in the disease pathogenesis has led to improved treatment options that can be effective in individual patients. Current evidence advocates a multifaceted program emphasizing patient education, medications for improving symptoms, and aggressive use of exercise and cognitive-behavioral approaches to retain or restore function.

McLean SA, Clauw DJ, Abelson JL, Liberzon I. · Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA. · Psychosom Med. · Pubmed #16204439 links to  free full text

Abstract: OBJECTIVES: Persistent pain and psychological sequelae are common after motor vehicle collision (MVC), but their etiology remains poorly understood. Such common sequelae include whiplash-associated disorders (WAD), fibromyalgia, and posttraumatic stress disorder (PTSD). Increasing evidence suggests that these disorders share overlapping epidemiologic and clinical features. A model is proposed in which central neurobiological systems, including physiologic systems and neuroanatomical structures involved in the stress response, are an important substrate for the development of all 3 disorders and interact with psychosocial and other factors to influence chronic symptom development. METHODS: Epidemiologic and clinical characteristics regarding the development of these disorders after MVC are reviewed. Evidence suggesting a role for stress response systems in the development of these disorders is presented. RESULTS: Contemporary evidence supports a model of chronic symptom development that incorporates the potential for interactions between past experience, acute stress responses to trauma, post-MVC behavior, and cognitive/psychosocial consequences to alter activity within brain regions which process pain and to result in persistent pain, as well as psychological sequelae, after MVC. Such a model incorporates factors identified in prior biopsychosocial theories and places them in the landscape of our rapidly developing understanding of stress systems and CNS pain-modulating pathways. CONCLUSION: New models are needed to stimulate deeper examination of the interacting influences of initial tissue damage, acute pain, psychosocial contingencies, and central stress pathways during chronic symptom development after MVC. Deeper understanding could contribute to improved treatment approaches to reduce the immense personal and societal burdens of common trauma-related disorders.

McLean SA, Williams DA, Clauw DJ. · Department of Emergency Medicine and The Chronic Pain and Fatigue Research Center, University of Michigan Medical Center, Ann Arbor, Michigan, USA. · Traffic Inj Prev. · Pubmed #16019393 No free full text.

Abstract: OBJECTIVE: Assess currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of fibromyalgia (FM). METHODS: Consensus standards developed by the American College of Rheumatology Environmental Disease Study Group were used to assess the ability of an MVC to trigger FM. RESULTS: Increasing evidence suggests that FM and related disorders are characterized by abnormalities in central nervous system function related to sensory processing, autonomic regulation, and neuroendocrine function. MVC trauma appears capable of triggering FM, but generally not through direct biomechanical injury. Instead, the evidence suggests that MVC trauma can act as a "stressor," which in concert with other factors, such as an individual's biologic vulnerability, psychosocial factors, cultural factors, and so on, may result in the development of chronic widespread pain and other somatic symptoms. MVC trauma is only one of many stressors which can trigger such disorders, and the environment within which the stressor is experienced (biological and psychosocial) may largely determine whether there is an adverse physiologic result or not. CONCLUSIONS: The evidence that MVC trauma may trigger FM meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders.

McLean SA, Clauw DJ. · University of Michigan Chronic Pain and Fatigue Research Center, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA. · Disabil Rehabil. · Pubmed #16012058 No free full text.

Abstract: PURPOSE: Fibromyalgia (FM) and chronic widespread pain (CWP) are common, but the etiology of these disorders remains poorly understood. A large body of data indicates a neurobiological basis for these disorders, but this information has not been effectively transmitted to many medical professionals. METHODS: Contemporary data on the epidemiologic characteristics of FM and CWP are reviewed, and evidence for a neurobiological basis for these disorders is presented. In addition, possible predisposing, triggering, and maintaining factors for the development of these disorders are discussed. RESULTS: Approximately 10% of the population have CWP, and approximately 4% have FM. The tender point criteria for FM have resulted in the common misconception among health care professionals that this spectrum of disorders is limited to women with high degrees of psychological distress. A hallmark of FM is the presence of non-nociceptive, central pain. There is evidence of centrally augmented pain processing, which can be detected both with sensory testing and by more objective measures (e.g., evoked potentials, functional neuroimaging). DISCUSSION: An appreciation of the neurobiological basis for these disorders, and an understanding of some of the abnormalities of pain processing present in patients with FM, will hopefully provide greater understanding of these patients. It may also serve to decrease the level of frustration and improve the care experience of both chronic pain patients and physicians.

Crofford LJ. · Division of Rheumatology, University of Michigan, Room 5510, MSRB-I, 1150 W. Medical Center Dr., Ann Arbor, MI 48109-0680, USA. · Curr Rheumatol Rep. · Pubmed #15251075 No free full text.

Abstract: Fibromyalgia syndrome (FMS) is a chronic multisymptom illness characterized by widespread pain and associated with neuropsychological symptoms including fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression. A discreet cause of FMS has not been identified. It is likely that multiple mechanisms give rise to symptom expression. Understanding specific etiologic factors and pathogenic mechanisms in individual patients will allow clinicians to determine treatments that are most effective for a given patient. Available evidence implicates the central nervous system as key in maintaining pain and other core symptoms of FMS. The approach to treatment of pain will typically address these central mechanisms. Nonpain symptoms may be treated by drugs affecting similar central neurochemicals. This paper will review the rationale for the different types of pharmaceutical treatments that may be useful for the treatment of FMS and issues regarding new drug development for this indication.

Smith M, Gokula RR, Weismantel A, Malaty W. · Michigan State University College of Human Medicine, East Lansing, Michigan, USA. · J Fam Pract. · Pubmed #12967546 No free full text.

This publication has no abstract.

Ambrose K, Lyden AK, Clauw DJ. · Chronic Pain and Fatigue Research Program, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 385, Ann Arbor, MI 48109-0483, USA. · Curr Pain Headache Rep. · Pubmed #12946287 No free full text.

Abstract: Fibromyalgia, chronic fatigue syndrome, and related illnesses fall under the spectrum of chronic multisymptom illnesses (CMI). This constellation of syndromes often is defined by chronic pain, unremitting fatigue, cognitive difficulties, and various other symptoms. In treating these illnesses, pharmacotherapy generally is the mode of choice, with exercise being overlooked often. However, research has shown that exercise is quite beneficial in reducing pain and fatigue in this population and should be included as part of a multimodal therapy regimen. This article reviews the exercise and CMI literature and provides a model for applying these evidence-based guidelines to a clinical population.

Clauw DJ, Crofford LJ. · Division of Rheumatology, Department of Medicine, University of Michigan Medical School, 101 Simpson, Ann Arbor, MI 48109-0723, USA. · Best Pract Res Clin Rheumatol. · Pubmed #12849719 No free full text.

Abstract: Fibromyalgia (FM) is currently defined as the presence of both chronic widespread pain (CWP) and the finding of 11/18 tender points on examination. Only about 20% of individuals in the population with CWP also have 11/18 tender points; these individuals are considerably more likely to be female, and have higher levels of psychological distress. There is no clear clinical diagnosis for the other 80% of individuals with less than 11/18 tender points, but it is likely that these persons, like FM patients, also have pain that is 'central' (i.e. not due to inflammation or damage of structures) rather than peripheral in nature. Research into FM has taught us a great deal about the confluence of neurobiological, psychological and behavioural factors that can cause chronic central pain. These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioural therapy. In contrast to drugs that work for peripheral pain due to damage or inflammation (e.g. NSAIDs, corticosteroids), neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain.

Williams DA. · University of Michigan, Room 5510D, MSRB-1, 1150 W. Medical Center Dr., Ann Arbor, MI 48109-0680, USA. · Best Pract Res Clin Rheumatol. · Pubmed #12849717 No free full text.

Abstract: Psychological and behavioural therapies are being applied to patients with fibromyalgia (FM) with increasing frequency. The rationale for including psychological therapies is not for the treatment of co-morbid mood disorders, but rather to manage the many non-psychiatric psychological and social factors that comprise pain perception and its maintenance. This chapter reviews the involvement of mental health professionals under both the biomedical and biopsychosocial models of illness and describes cognitive behavioural therapy (CBT), a commonly used form of psychological therapy in the management of chronic pain conditions. The empirical literature supports the use of CBT with FM in producing modest outcomes across multiple domains, including pain, fatigue, physical functioning and mood. Greatest benefits appear to occur when CBT is used adjunctively with exercise. While the benefits are not curative or universally obtained by all patients, the benefits are sufficiently large to encourage future refinement of CBT for this population of patients.

Gracely RH, Grant MA, Giesecke T. · Department of Medicine, University of Michigan Health System, Ann Arbor VAMC, Ann Arbor, MI 48109-0483, USA. · Best Pract Res Clin Rheumatol. · Pubmed #12849714 No free full text.

Abstract: Fibromyalgia is defined by widespread pain and tenderness at a minimum of 11 of 18 defined tender points. Current evidence indicates that tender points are not unique to fibromyalgia and are simply regions in the body where all people are more tender. Tenderness (i.e. sensitivity to pressure) is widespread in fibromyalgia rather than being confined to tender points, and patients are also more sensitive to heat, cold and electrical stimulation. Using the number of painful tender points as a measure of tenderness is clinically expedient but is theoretically vulnerable to bias and is influenced by subjective distress. Other means of assessing tenderness (e.g. pressure dolorimeter devices, or more elaborate psychophysical methods) demonstrate the same increased pain sensitivity in fibromyalgia that is noted with tender point assessments, but these measures are relatively independent of biasing factors or distress. Fibromyalgia is one of only a few syndromes defined by the presence of both spontaneous (i.e. clinical) and evoked (i.e. experimental) pain. While the issues associated with the evaluation of spontaneous pain are shared with all chronic pain syndromes, the issues associated with the evaluation of evoked pain sensitivity are specific to fibromyalgia and related musculoskeletal disorders. This chapter focuses on the evaluation of altered pain sensitivity in fibromyalgia. It describes current measurement methodology, briefly reviews studies of sensitivity to experimentally evoked painful and non-painful sensations, analyses the factors assessed by different measurement methodologies, and concludes with recommendations for future diagnostic criteria and measurement methods.

Crofford LJ. · Department of Internal Medicine and Rheumatology, University of Michigan, Room 5510, MSRB I, 1150 W. Medical Center Dr., An Arbor, MI 48109-0680, USA. · Endocrinol Metab Clin North Am. · Pubmed #12055982 No free full text.

Abstract: Many studies have demonstrated altered HPA axis activity in patients with rheumatic diseases. In the case of autoimmune inflammatory diseases, circumstantial evidence suggests that failure of the neuroendocrine-immune regulatory loop may lead to insufficient production of endogenous glucocorticoid. Nevertheless, in human autoimmune disease, it is not possible to determine if altered HPA axis activity predates the onset of chronic inflammation. Animal studies and some early genetic studies in RA patients lend credibility to the argument that insufficient HPA axis response to inflammatory stimuli may increase susceptibility to, or severity of, these diseases. Most patients with rheumatic diseases complain of musculoskeletal pain. There is evidence of HPA axis involvement in acute and chronic pain. In the case of FM, pain cannot be explained on the basis of inflammation or altered musculoskeletal anatomy. This has led to the hypothesis that central nervous system mechanisms contribute to the symptom of somatic pain. Again, it is unclear if the observed HPA axis abnormalities reflect pre-existing vulnerability to the FM spectrum of disease, or whether chronic somatic symptoms alter HPA axis activity. Availability of technology to study better central components of the HPA axis may shed further light on its role in the pathogenesis of inflammatory autoimmune rheumatic diseases and musculoskeletal pain syndromes.

Dush DM. · Department of Psychology, 118 Sloan Hall, Central Michigan University, Mt Pleasant, MI 48859, USA. · Ann Rheum Dis. · Pubmed #11406518 links to  free full text

Abstract: Studies of disease outcomes have not produced an explanation or an intervention for the symptoms and complaints that some women have attributed to breast implants. Reviews of the literature have found no increased risk of specific systemic disease, and no treatment recommendations have emerged. However, similar symptoms in fibromyalgia, chronic fatigue, and other contexts have been considered to be stress or behaviourally mediated, and a number of promising behavioural interventions have been developed. Aetiological, research, and treatment implications may follow from the consideration of such symptoms within a behavioural medicine model that allows for the interaction of physical and psychological influences. In the case of implants, a mass somatisation model may also help to discern the potential effects of litigation and other social influences.

Ebell MH, Beck E. · Michigan State University, USA. · J Fam Pract. · Pubmed #11350702 No free full text.

This publication has no abstract.