Fibromyalgia: New England

Brady DM, Schneider MJ. · Department of Clinical Sciences, University of Bridgeport College of Chiropractic, Bridgeport, CT, USA. · J Manipulative Physiol Ther. · Pubmed #11677554 No free full text.

This publication has no abstract.

Parziale JR. · Brown University School of Medicine, RI, USA. · Med Health R I. · Pubmed #10517077 No free full text.

Abstract: Fibromyalgia is characterized by chronic diffuse muscular aches, fatigue and poor sleep; it affects nearly three million individuals in the United States alone, predominantly younger women. The diagnosis of fibromyalgia requires adherence to the American College of Rheumatology criteria and the exclusion of secondary causes and systemic diseases. Treatment with sleep cycle regulators, NSAIDs, and light aerobic exercise is usually helpful. Patients must be reminded that fibromyalgia is often a chronic condition, but can be successfully treated.

Barsky AJ, Borus JF. · Division of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. · Ann Intern Med. · Pubmed #10375340 links to  free full text

Abstract: The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here.

Wennemer HK, Borg-Stein J, Gomba L, Delaney B, Rothmund A, Barlow D, Breeze G, Thompson A. · Spinal Cord Injury Unit, West Roxbury Division, VA Boston Health Care System, West Roxbury, Massachusetts 02132, USA. · Am J Phys Med Rehabil. · Pubmed #16865020 No free full text.

Abstract: OBJECTIVE: To evaluate function and disability in patients with fibromyalgia before and after participation in a functionally oriented, multidisciplinary, 8-wk treatment program. DESIGN: A total of 23 patients who met American College of Rheumatology criteria for the diagnosis of fibromyalgia were enrolled in the study. Outcome measures included: range of motion, 6-min walk test, a modified Fibromyalgia Impact Questionnaire, a modified SF-36 Physical Functioning Scale, and the Fibromyalgia Health Assessment Questionnaire. Pretreatment and posttreatment scores were analyzed using paired t tests. RESULTS: All subjects completed the program, and there were no reported injuries. Three subjects failed to complete the survey instruments at the conclusion of the study. Intention to treat analysis including these subjects was carried out but did not significantly change results. For the remaining subjects (n = 20), a significant improvement was found on the Physical Functioning Scale (P = 0.01). Trends toward improvement on the Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia Health Assessment Questionnaire (P = 0.14) were seen but did not achieve statistical significance. Range of motion testing revealed significant improvements in lumbar spine extension (P < 0.001), straight-leg raise (P < 0.001), cervical spine flexion (P < 0.01), cervical spine rotation (P < 0.05), and cervical spine side bending (P < 0.05). Distance traveled during the 6-min walk test increased significantly (P < 0.01), whereas perceived exertion as measured by the Borg scale did not change. There were no injuries or other adverse consequences of the program. CONCLUSIONS: This study utilized multiple functional outcome measures to demonstrate improved function and decreased disability in patients with fibromyalgia. Our patients reported significantly improved physical function after participation in the 8-wk intensive multidisciplinary treatment program. This progressive, functionally based exercise training program was well tolerated by all participants and outlines an effective exercise prescription for patients with fibromyalgia. Fibromyalgia patients in this study responded favorably to a treatment program that focused on function instead of pain.

Finckh A, Berner IC, Aubry-Rozier B, So AK. · Rheumatology Department, University Hospital of Vaud (CHUV), Lausanne, Switzerland. · J Rheumatol. · Pubmed #15996074 No free full text.

Abstract: OBJECTIVE: Patients with fibromyalgia (FM) consistently have adrenal hyporesponsiveness and low dehydroepiandrosterone (DHEA) levels. DHEA is promoted for and used by patients with FM. We tested the efficacy and safety of DHEA supplementation in ameliorating the symptoms of FM. METHODS: In a double-blind crossover study, postmenopausal women with FM were randomized to DHEA supplementation (50 mg/day) or placebo for 3 months, with a one-month washout period in between. Patients were assessed monthly for well-being and pain and by medical evaluations at the beginning and the end of each treatment period. The primary outcome was well being; secondary outcomes were pain, fatigue, cognition, sexuality, functional impairment, depression, and anxiety. RESULTS: A total of 52 patients were randomized, 47 patients completed the DHEA treatment period, and 45 the placebo treatment period. After 3 months of treatment with 50 mg of DHEA, median DHEA sulfate blood levels had tripled, but there was no improvement in well-being, pain, fatigue, cognitive dysfunction, functional impairment, depression, or anxiety, nor in objective measurements made by physicians. Androgenic side effects (greasy skin, acne, and increased growth of body hair) were more common during the DHEA treatment period (p = 0.02). CONCLUSION: DHEA does not improve quality of life, pain, fatigue, cognitive function, mood, or functional impairment in FM.

Steere AC. · Harvard Medical School and Comprehensive Arthritis Center, Massachusetts General Hospital, Boston, MA 02129, USA. · JAMA. · Pubmed #12190371 No free full text.

This publication has no abstract.

Rooks DS, Silverman CB, Kantrowitz FG. · New England Baptist Bone and Joint Institute, New England Baptist Hospital, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA 02115, USA. · Arthritis Rheum. · Pubmed #11932874 No free full text.

Abstract: OBJECTIVE: To determine the safety, feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome (FMS). METHODS: Fifteen women with confirmed FMS were monitored for injury and exercise compliance, and assessed for muscle strength (1-repetition maximum technique), cardiovascular endurance (6-minute walk test), and functional status (Fibromyalgia Impact Questionnaire [FIQ]) before and after a 20-week exercise intervention. RESULTS: Zero injuries and an 81% compliance rate occurred during training. Improvement was seen in muscle strength of the lower (191 +/- 75 to 265 +/- 67 pounds; P < 0.001) and upper (61 +/- 18 to 76 +/- 18 pounds; P < 0.001) body, 6-minute walk distance (530 +/- 80 to 629 +/- 74 meters; P < 0.001), and in FIQ score (44 +/- 9 to 32 +/- 14; P < 0.01). CONCLUSION: A program of progressive strength training and cardiovascular exercise can be safe, well tolerated, and effective at improving muscle strength, cardiovascular endurance and functional status in women with FMS without exacerbating symptoms. This program may also contribute to a reduction in the severity of several symptoms.

Solomon DH, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee TH. · Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. · J Rheumatol. · Pubmed #11838857 No free full text.

Abstract: OBJECTIVE: Studies have suggested that the Arthritis Self-Management Program (ASMP) course is effective at reducing arthritis pain and health care costs in volunteer participants. There have been no reports of trials of the ASMP in the context of primary care physicians' practices, where the potential for spreading the program may be greatest. We conducted a randomized controlled trial of the ASMP course in a large primary care physician network. METHODS: Patients with osteoarthritis, rheumatoid arthritis, or fibromyalgia were recruited for the study. Subjects in the intervention practices received the 6 week course and those in the control practices received only the ASMP book, without course. Disability, pain, self-efficacy, mental health, and satisfaction were measured using validated instruments at baseline and at 4 months. RESULTS: One hundred thirteen patients were recruited for the ASMP course (intervention) and completed baseline and 4 month followup questionnaires. Eighty-four percent completed at least 4 of 6 classes. Seventy-four patients received the ASMP manual (controls) and completed both questionnaires. Patients in the intervention and control groups had similar baseline pain (p = 0.94), self-efficacy to control pain (p = 0.90), mental health (p = 0.10), and vitality scores (p = 0.21), but those in the intervention arm had slightly less disability (p = 0.04). At 4 months, there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups (all p > 0.2). Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients (all p > 0.3). All types of health care resource use were similar at baseline and followup for both intervention and control groups (all p > 0.2). CONCLUSION: While the ASMP course has been found to be effective in other patient groups, there were no significant clinical benefits noted at 4 months in patients recruited from primary care practices.

Goldenberg DL. · Department of Medicine and Rheumatology, Newton-Wellesley Hospital, Newton, MA, USA. · J Clin Psychiatry. · Pubmed #19552860 No free full text.

Abstract: Fibromyalgia is a common condition associated with abnormal central pain processing, chronic widespread musculoskeletal pain, tenderness at various points on the body, fatigue, and sleep abnormalities. Individuals with fibromyalgia often have comorbid anxiety, depression, and/or other pain syndromes. Multiple pharmacologic agents have demonstrated efficacy in alleviating some fibromyalgic symptoms, but pharmacology is only one piece of the puzzle in the successful management of fibromyalgia. Thorough medical and psychiatric evaluations are necessary after confirming a diagnosis of fibromyalgia, and a multidisciplinary treatment strategy including patient education, aerobic exercise, and cognitive-behavioral therapy as well as pharmacotherapy has been shown to be effective in alleviating fibromyalgic symptoms.

Cappelleri JC, Bushmakin AG, McDermott AM, Sadosky AB, Petrie CD, Martin S. · Pfizer Inc., Global Research and Development, New London, Connecticut 06320, USA. · Health Qual Life Outcomes. · Pubmed #19534799 links to  free full text

Abstract: BACKGROUND: Sleep disturbances are a common and bothersome symptom of fibromyalgia (FM). This study reports psychometric properties of a single-item scale to assess sleep quality among individuals with FM. METHODS: Analyses were based on data from two randomized, double-blind, placebo-controlled trials of pregabalin (studies 1056 and 1077). In a daily diary, patients reported the quality of their sleep on a numeric rating scale ranging from 0 ("best possible sleep") to 10 ("worst possible sleep"). Test re-test reliability of the Sleep Quality Scale was evaluated by computing intraclass correlation coefficients. Pearson correlation coefficients were computed between baseline Sleep Quality scores and baseline pain diary and Medical Outcomes Study (MOS) Sleep scores. Responsiveness to treatment was evaluated by standardized effect sizes computed as the difference between least squares mean changes in Sleep Quality scores in the pregabalin and placebo groups divided by the standard deviation of Sleep Quality scores across all patients at baseline. RESULTS: Studies 1056 and 1077 included 748 and 745 patients, respectively. Most patients were female (study 1056: 94.4%; study 1077: 94.5%) and white (study 1056: 90.2%; study 1077: 91.0%). Mean ages were 48.8 years (study 1056) and 50.1 years (study 1077). Test re-test reliability coefficients of the Sleep Quality Scale were 0.91 and 0.90 in the 1056 and 1077 studies, respectively. Pearson correlation coefficients between baseline Sleep Quality scores and baseline pain diary scores were 0.64 (p < 0.001) and 0.58 (p < 0.001) in the 1056 and 1077 studies, respectively. Correlations between the Sleep Quality Scale and the MOS Sleep subscales were statistically significant (p < 0.01), except for the MOS Snoring subscale. Across both studies, standardized effect sizes were generally moderate (0.46 to 0.52) for the 300 mg group and moderate (0.59) or moderate-to-large (0.70) for the 450 mg group. In study 1056, the effect size for the 600 mg group was moderate-to-large (0.73). In study 1077, the effect size for the 600 mg group was large (0.82). CONCLUSION: These results provide evidence of the reproducibility, convergent validity, and responsiveness to treatment of the Sleep Quality Scale and provide a foundation for its further use and evaluation in FM patients.

Recla JM, Sarantopoulos CD. · IGERT Program in Functional Genomics, The University of Maine, Orono ME 04469, USA. · Med Hypotheses. · Pubmed #19362430 No free full text.

Abstract: Fibromyalgia syndrome (FMS) is a chronic widespread pain syndrome that is estimated to affect 4-8 million US adults. The exact molecular mechanisms underlying this illness remain unclear, rendering most clinical treatment and management techniques relatively ineffective. It is now known that abnormalities in both nociceptive and central pain processing systems are necessary (but perhaps not sufficient) to condition the onset and maintenance of FMS. These same systemic abnormalities are thought to be responsible for the loss of cephalic gray matter density observed in all FMS patients groups studied to date. The current scope of FMS treatment focuses largely on analgesia and does not clearly address potential neuroprotective strategies. This article proposes a combined treatment of pregabalin and memantine to decrease the pain and rate of gray matter atrophy associated with FMS. This dual-drug therapy targets the voltage-gated calcium ion channel (VGCC) and the N-methyl d-aspartate receptor (NMDAR) (respectively), two primary components of the human nociceptive and pain processing systems.

Ali A, Njike VY, Northrup V, Sabina AB, Williams AL, Liberti LS, Perlman AI, Adelson H, Katz DL. · Prevention Research Center, Yale University School of Medicine, Derby, CT 06418, USA. · J Altern Complement Med. · Pubmed #19250003 No free full text.

Abstract: OBJECTIVES: Intravenous micronutrient therapy (IVMT), and specifically the Myers' Cocktail, is a popular approach for treating fibromyalgia syndrome (FMS) among complementary and alternative medicine practitioners, but its efficacy is uncertain. This trial assessed the feasibility, safety, and provided insights into the efficacy of this therapy. DESIGN: This was a randomized, double-blind, placebo-controlled pilot study. LOCATIONS: The study locations were an academic research center, teaching hospital, and affiliated Integrative Medicine Center in Derby, CT. SUBJECTS: The subjects were 34 adults with American College of Rheumatology (ACR)-defined FMS. INTERVENTION: Subjects were randomly assigned either to treatment (weekly infusions of IVMT) or to placebo (weekly infusions of lactated Ringer's solution) for 8 weeks. OUTCOME MEASURES: Primary outcome was change in the Tender Point Index, assessed 8 and 12 weeks after initiation. Secondary measures included a Visual Analog Scale to assess global pain, and validated measures of physical function (Fibromyalgia Impact Questionnaire), mood (Beck Depression Index), and quality of life (Health Status Questionnaire 2.0). RESULTS: Clinically significant improvements were noted (of a magnitude similar to other effective interventions). However, in part because of the high placebo response and the small sample size, no statistically significant differences were seen between groups, in any outcome measure, at 8 and 16 weeks. Statistically significant within-group differences were seen in both the intervention and placebo groups, demonstrating a treatment effect for both IVMT and placebo. At 8 weeks, the IVMT group experienced significantly improved tender points, pain, depression, and quality of life directly following treatment (all p < or = 0.02), while the placebo group experienced significantly improved tender points only (p < or = 0.05). The treatment effects of IVMT persisted at 4 weeks postintervention for tender points, pain, and quality of life, while placebo effects persisted only for tender points. A single minor adverse event was noted in one subject in the intervention group. CONCLUSIONS: This first controlled pilot study established the safety and feasibility of treating FMS with IVMT. Most subjects experienced relief as compared to baseline, but no statistically significant differences were seen between IVMT and placebo. The efficacy of IVMT for fibromyalgia, relative to placebo, is as yet uncertain.

Reisine S, Fifield J, Walsh S, Forrest DD. · Department of Oral Health and Diagnostic Science and Division of Behavioral Sciences and Community Health, University of Connecticut, Farmington, CT 06030-3910, USA. · Arthritis Rheum. · Pubmed #19035427 No free full text.

Abstract: OBJECTIVE: To assess changes in health status of women with fibromyalgia (FM) over 5 years and determine whether baseline employment status influences health outcomes adjusting for other baseline factors. METHODS: Two hundred eighty-seven women with FM were recruited from a national sample of rheumatologists and interviewed by phone at baseline and annually for 4 years. Data were collected on pain, fatigue, Center for Epidemiologic Studies Depression Scale and Modified Health Assessment Questionnaire (M-HAQ) scores, demographic characteristics, and employment status. At the end of the study, 211 participants remained. Data were analyzed using multilevel modeling techniques. Bootstrap methods adjusted for the cluster sampling. RESULTS: The participants' mean +/- SD age was 47 +/- 11 years, their mean +/- SD education level was 14 +/- 2 years, 90% were white, 50% employed, 64% married, and their median household income was >or=$50,000. Mean +/- SD scores at baseline were 57.2 +/- 24 for pain, 75.4 +/- 22 for fatigue, 22.9 +/- 13 for depression, and 0.73 +/- 0.5 for the M-HAQ. Multilevel modeling indicated that all health status measures declined significantly over time except for pain. Rates of change varied from -1.22 for fatigue to -0.03 for the M-HAQ. Except for pain, patients who were employed at baseline had better health status over time. The employment and time interaction was not significant, indicating that health status changed at the same rate regardless of employment status. Other significant factors were age and income. CONCLUSION: Employed women with FM have better health status at baseline and maintain that advantage over time. Employment does not seem to provide a protective health benefit.

Napadow V, Ahn A, Longhurst J, Lao L, Stener-Victorin E, Harris R, Langevin HM. · Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charleston, MA 02129, USA. · J Altern Complement Med. · Pubmed #18803495 No free full text.

Abstract: On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark NIH [National Institutes of Health] Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of basic and translational acupuncture research. Specific areas include the scientific assessment of acupuncture points and meridians, the neural mechanisms of cardiovascular regulation by acupuncture, mechanisms for electroacupuncture applied to persistent inflammation and pain, basic and translational research on acupuncture in gynecologic applications, the application of functional neuroimaging to acupuncture research with specific application to carpal-tunnel syndrome and fibromyalgia, and the association of the connective tissue system to acupuncture research. In summary, mechanistic models for acupuncture effects that have been investigated experimentally have focused on the effects of acupuncture needle stimulation on the nervous system, muscles, and connective tissue. These mechanistic models are not mutually exclusive. Iterative testing, expanding, and perhaps merging of such models will potentially lead to an incremental understanding of the effects of manual and electrical stimulation of acupuncture needles that is solidly rooted in physiology.

Berger A, Sadosky A, Dukes E, Martin S, Edelsberg J, Oster G. · Policy Analysis, Inc., Brookline, MA 02445, USA. · Curr Med Res Opin. · Pubmed #18664319 No free full text.

Abstract: OBJECTIVE: To examine characteristics and patterns of healthcare utilization of patients with fibromyalgia (FM) under the care of general practitioners (GPs) in Germany. RESEARCH DESIGN AND METHODS: Retrospective cohort study, using a large electronic database with information on GP encounters in Germany (IMS MediPlus). We identified all patients, aged > or =18 years, with any encounters for FM (ICD-10 diagnosis code M79.7) between February 1, 2004 and January 31, 2007. We also constituted a comparison group consisting of randomly selected patients with one or more GP encounters - but none for FM - during this period, who we matched to FM patients based on age and sex. Characteristics and healthcare utilization of patients in the FM and comparison groups were then examined over the 1-year period, February 1, 2006-January 31, 2007. MAIN OUTCOME MEASURES: Prevalence of co-morbidities; use of pain-related pharmacotherapy; number of GP office visits; number of specialist referrals; and number of sick notes (physician-excused absences from work). RESULTS: The study sample consisted of 4983 FM patients and an identical number in the comparison group. Mean age was 58 years; 87% were women. The prevalence of various co-morbidities was greater among FM patients, including painful neuropathies (33% vs. 18% for comparison group) and depression (20% vs. 5%) (both p<0.01); more FM patients also received pain-related pharmacotherapy (67% vs. 28%; p<0.01). Compared with patients in the comparison group, FM patients averaged approximately twice as many GP visits (11.4 [SD=10.1] vs. 5.8 [7.5]), referrals (4.5 [5.2] vs. 2.2 [3.6]), and sick notes (0.6 [1.8] vs. 0.3 [1.1]) (all p<0.01). LIMITATIONS: Information in the study database is limited to GP encounters, and the sensitivity and specificity of our case-finding methods are unknown. CONCLUSIONS: Patients with FM under the care of GPs in Germany have comparatively more co-morbidities and higher levels of healthcare utilization.

Alnwick GM. · Genesis Rehabilitation Services, Gorham Outpatient Clinic, 4 Woodbound Rd, Gorham, NH 03581, USA. · Phys Ther. · Pubmed #18420814 links to  free full text

Abstract: BACKGROUND AND PURPOSE: With increased use of serotonergic medications, a condition triggered by serotonin excess within the brain and spinal cord has emerged and may be gaining prevalence. The purposes of this case report are to describe how to identify serotonin syndrome in a patient who is taking citalopram (a selective serotonin reuptake inhibitor) on the basis of signs and symptoms and to promote the ability of physical therapists to recognize such signs and symptoms. CASE DESCRIPTION: The patient was a 42-year-old woman referred for physical therapy with a diagnosis of fibromyalgia. The physical therapist recognized that the patient's symptoms did not resemble those of fibromyalgia and recommended referral to a neurologist for further diagnostic testing. OUTCOMES: The patient was referred to a neurologist, who diagnosed serotonin syndrome related to the use of citalopram. The patient was weaned off citalopram and made a successful recovery, with scores on the Oswestry Disability Index decreasing from 70% to 28% at discharge from the physical therapy treatment and to 0% at the 6-month follow-up. The patient has since returned to her prior activity level, which includes skiing, motorcycle riding, and working at her consulting firm. DISCUSSION: This case report demonstrates how careful evaluation by the physical therapist indicated that signs and symptoms were not consistent with fibromyalgia, and further medical evaluation revealed the actual diagnosis of serotonin syndrome.

Javaras KN, Pope HG, Lalonde JK, Roberts JL, Nillni YI, Laird NM, Bulik CM, Crow SJ, McElroy SL, Walsh BT, Tsuang MT, Rosenthal NR, Hudson JI. · Department of Biostatistics, Harvard School of Public Health, Boston, Mass., USA. · J Clin Psychiatry. · Pubmed #18348600 No free full text.

Abstract: BACKGROUND: Prior studies suggest that certain psychiatric and medical disorders co-occur with binge eating disorder (BED). However, there has been no large, community-based study with diagnoses made by clinician interviewers. We used data from that type of study to assess the co-occurrence of various psychiatric and medical disorders with DSM-IV BED and with subthreshold BED. METHOD: From October 2002 to July 2004, we interviewed 150 probands with BED, 150 probands without BED, and 888 of their first-degree relatives (135 of whom had BED, and 54 of whom met specific partial criteria for BED that we defined as subthreshold BED). Study participants were interviewed using the Structured Clinical Interview for DSM-IV to assess BED and other psychiatric disorders and a supplemental structured interview to assess certain medical disorders; participants also completed a self-report questionnaire, the Bad Things Scale. For each psychiatric and medical disorder, we calculated the age- and sex-adjusted co-occurrence odds ratio: the odds of having that disorder in one's lifetime among individuals with (full or subthreshold) lifetime BED compared to individuals without lifetime BED. We also used subjects' responses to the Bad Things Scale to adjust for adversity over-reporting, a type of response bias that could result in spurious findings of co-occurrence. RESULTS: Full BED co-occurred significantly with bipolar disorder, major depressive disorder, bulimia nervosa but not anorexia nervosa, most anxiety disorders, substance use disorders, body dysmorphic disorder, kleptomania, irritable bowel syndrome, and fibromyalgia. These results changed little after correcting for adversity over-reporting. Subthreshold BED co-occurred significantly with many, but not all, of the significantly co-occurring disorders for full BED. CONCLUSION: BED and, to a lesser degree, subthreshold BED exhibit substantial lifetime co-occurrence with psychiatric and medical disorders.

Washington TA, Fanciullo GJ, Sorensen JA, Baird JC. · Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. · Pain Med. · Pubmed #18346065 No free full text.

Abstract: BACKGROUND: The Web not only can play a role in helping patients learn about their chronic pain, but can also be a source of misleading or untrue information. This study evaluates the quality of Internet information available concerning chronic pain at different sites, and determines the relation between quality and the source and character of the Websites. METHODS: A survey was conducted of patients seen at the Pain Management Center at Dartmouth-Hitchcock Medical Center (DHMC). Patients with access to the Internet identified the five most common keywords they used to look up information: pain, chronic pain, back pain, arthritis, and fibromyalgia. A focus group of pain clinicians at DHMC then chose the quality criteria to evaluate Websites. The criteria consisted of 16 items in five domains: etiology, diagnosis, goals of treatment, treatment options, and substance abuse. The first two pages of links displayed by each of three major search engines then were assessed for quality. RESULTS: A total of 240 Websites were evaluated. The mean score, the Quality Website Index (QWI), was 2.17 (SD = 3.3), (range from -16 [poorest] to +16 [best]). The overall quality of this group of Websites is rather poor, although there were several excellent sites. Websites located on the main search page had a significantly higher score than those in the sponsored section, and Websites based on standards had a significantly higher score than those that were not. CONCLUSION: Based on QWI scores, clinicians can recommend chronic pain Websites to provide their patients with accurate and pertinent information.

White LA, Birnbaum HG, Kaltenboeck A, Tang J, Mallett D, Robinson RL. · Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA. · J Occup Environ Med. · Pubmed #18188077 No free full text.

Abstract: OBJECTIVES: To compare 2005 health care resources among matched samples of employees with fibromyalgia (FM), osteoarthritis (OA), and controls. METHODS: Using a claims database of privately insured individuals, FM and OA samples were derived from those with two or more disease-specific claims in 1999 to 2005 (> or =1 in 2002 to 2005). RESULTS: Total costs for employees with FM ($10,199) approached OA costs ($10,861, P = 0.3758) and were significantly higher than controls ($5274, P < 0.0001). Cost components varied across disease-specific samples (direct medical: FM $7286 vs OA $8325, P < 0.0287; pharmacy: FM $1630 vs OA $1341; indirect: FM $2913 vs OA $2537, P < 0.0001). Employees with FM had more claims than OA for psychiatric diagnoses, chronic fatigue, and most pain conditions. Use of multiple prescription drug classes was common in both samples. CONCLUSIONS: FM imposes significant economic burden. Work loss contributes substantially to the impact.

Thimineur M, De Ridder D. · Pain Management Division, Department of Anesthesiology, Griffin Hospital, Derby, Connecticut 06418, USA. · Pain Med. · Pubmed #18028042 No free full text.

Abstract: BACKGROUND: Fibromyalgia (FM), a disorder characterized by diffuse pain, fatigue, and a variety of other symptoms, is thought to derive from dysfunction of the central nervous system. Neuromodulation is a technique to treat pain from a variety of causes, including disorders of the central nervous system (CNS). Occipital nerve stimulation is a neuromodulation technique currently under study to treat various migraine headache disorders. This study examines a technique of neurostimulation that appears to affect the pain and symptoms of FM. OBJECTIVE: To evaluate the effect of a new technique of peripheral neurostimulation of the C2 scalp area on pain, fatigue, depression, and quality of life in FM patients. METHODS: In total, 12 patients (nine females and three males; mean age 48 years) who met criteria for FM, and with comorbid headache disorder, were trialed and implanted with this C2 area stimulation technique. Outcome was prospectively studied with standard evaluation tools at baseline, 3 and 6 months post implant. RESULTS: Visual Analog Scale (VAS) pain levels for FM-related pain decreased significantly at 6 months, and pain-drawing total area and number of areas colored in also decreased dramatically. Chronic fatigue and depression as assessed by the Beck Depression Inventory and Fatigue Impact Scale were markedly improved. Overall quality of life as assessed by the Health Survey Short Form 36 (SF-36) was markedly improved. There were no infectious or technical complications. CONCLUSION: C2 area scalp stimulation may diminish pain and related symptoms in patients with FM.

Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, Goldenberg DL, Iversen MD, Katz JN. · Novartis Institutes for Biomedical Research, Inc, Translational Medicine, 400 Technology Square, Cambridge, MA 02139, USA. · Arch Intern Med. · Pubmed #17998491 links to  free full text

Abstract: BACKGROUND: Self-management has increasingly been recommended as part of standard care for fibromyalgia, a common, poorly understood condition with limited treatment options. Data that assess popular self-management recommendations are scarce. We evaluated and compared the effectiveness of 4 common self-management treatments on function, symptoms, and self-efficacy in women with fibromyalgia. METHODS: A total of 207 women with confirmed fibromyalgia were recruited from September 16, 2002, through November 30, 2004, and randomly assigned to 16 weeks of (1) aerobic and flexibility exercise (AE); (2) strength training, aerobic, and flexibility exercise (ST); (3) the Fibromyalgia Self-Help Course (FSHC); or (4) a combination of ST and FSHC (ST-FSHC). The primary outcome was change in physical function from baseline to completion of the intervention. Secondary outcomes included social and emotional function, symptoms, and self-efficacy. RESULTS: Improvements in the mean Fibromyalgia Impact Questionnaire score in the 4 groups were -12.7 for the ST-FSHC group, -8.2 for the AE group, -6.6 for the ST group, and -0.3 for the FSHC group. The ST-FSHC group demonstrated greater improvement than the FSHC group (mean difference, -12.4; 95% confidence interval [CI], -23.1 to -1.7). The ST-FSHC (mean difference, 13.6; 95% CI, 2.3 to 24.9) and AE (mean difference, 13.1; 95% CI, 1.6 to 25.6) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey. Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC (14.8), AE (13.2), and ST (5.7) groups. Social function, mental health, fatigue, depression, and self-efficacy also improved. The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months. CONCLUSIONS: Progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with fibromyalgia actively being treated with medication. The benefits of exercise are enhanced when combined with targeted self-management education. Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia.

Ring D, McCarthy M. · Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 525, 15 Parkman St., Boston, MA 02114, USA. · J Surg Orthop Adv. · Pubmed #17963652 No free full text.

This publication has no abstract.

Provenzano DA, Fanciullo GJ, Jamison RN, McHugo GJ, Baird JC. · Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. · Pain Med. · Pubmed #17877526 No free full text.

Abstract: OBJECTIVE: In order to establish a diagnosis of chronic pain, emphasis is placed on a patient's report of the pain's intensity, location, and character. The aim of this study was to evaluate the feasibility of a computer assessment method to collect self-reports of pain that were then used in discriminant analyses to distinguish among chronic pain diagnoses. METHODS: A convenience sample of 511 patients from two university-based pain clinics completed a computer pain assessment battery that elicited demographic information, pain drawings, pain and emotion intensity ratings, and intensity ratings of verbal descriptors. Patients classified themselves into one of six chronic pain diagnoses. Discriminant analyses were performed in an attempt to identify the unique features of patients' pain experience associated with each of the diagnostic categories. RESULTS: Pain drawings successfully classified patients into three of the diagnostic categories (back, head, and neck pain). In a second analysis, two pain descriptors (cramping and stabbing) separated rheumatoid arthritis patients from those with either fibromyalgia or neural pain. One descriptor of pain (cramping) and one descriptor of emotion (frustration) together distinguished between fibromyalgia and neural pain. CONCLUSIONS: 1) Computer assessment of a range of patient symptoms is feasible in the pain clinic. 2) Discriminant analysis based on pain drawings can distinguish among patient-reported diagnoses of back pain, headache, and neck pain. 3) Discriminant analysis based on three verbal descriptors can help to distinguish among diagnoses of fibromyalgia, neuralgia, and rheumatoid arthritis. 4) However, in general, most computerized descriptive information is not useful in distinguishing differences among pain patient diagnostic groups.

Berger A, Dukes E, Martin S, Edelsberg J, Oster G. · Policy Analysis, Inc., Brookline, MA 02445, USA. · Int J Clin Pract. · Pubmed #17655684 links to  free full text

Abstract: PURPOSE: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice. MATERIALS AND METHODS: Using a US health-insurance database, we identified all patients, aged > or = 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study). RESULTS: The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. $3291 ($13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001). CONCLUSIONS: Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.

Silberbogen AK, Janke EA, Hebenstreit C. · Department of Veterans Affairs (VA) Boston Healthcare System, Psychology Service (116B), 150 South Huntington Avenue, Boston, MA 02130, USA. · J Rehabil Res Dev. · Pubmed #17551875 No free full text.

Abstract: An association between the hepatitis C virus (HCV) and various pain diagnoses, including arthritis, fibromyalgia, and peripheral neuropathy, has been reported. In this article, we review the literature on the relationship between HCV and pain, highlighting current knowledge as well as methodological issues that exist in many studies. We also present preliminary findings from a survey conducted at two Department of Veterans Affairs facilities to assess the scope and impact of pain on functioning in veterans with HCV. Our results indicate that pain is very prevalent within this population and that HCV-positive veterans who experience persistent pain have significant depressive symptoms and engage in high-risk behaviors, such as cigarette smoking and alcohol use. Finally, we draw upon our review and preliminary results to propose areas of future rehabilitative research and to address the implications for clinicians working with patients with comorbid HCV and pain.