Fibromyalgia: Ontario

Gordon DA. · University of Toronto, Ontario, Canada. · Baillieres Best Pract Res Clin Rheumatol. · Pubmed #10562384 No free full text.

Abstract: A systematic approach to the determination of disability in persons with chronic widespread pain is based on a careful history, examination for tender points, and special investigations to establish a firm diagnosis. Further assessment requires determination of subjective and objective measures of impairment. The causes of fibromyalgia are multifactorial and understanding them requires an appreciation of the role of physical or psychological trauma, and associated medical and psychosocial factors. Despite the presence of disability risk factors, most patients with fibromyalgia maintain a good range of normal daily activities and continue working.

White KP, Harth M. · Department of Medicine, London Health Sciences Center, Ontario, Canada. · Baillieres Best Pract Res Clin Rheumatol. · Pubmed #10562368 No free full text.

Abstract: A major problem with estimating the impact of chronic generalized pain is that the term remains undefined. It appears to encompass several distinct clinical entities, including rheumatoid arthritis and fibromyalgia, which can exist alone or together in a given individual. Nonetheless, chronic generalized pain appears to have a sizable impact on both the individual and society. Although little is known about causal relationships, demographic risk factors for chronic generalized pain are female sex, age in the forties and fifties, lower income, lower education, and being divorced or separated. Chronic generalized pain affects the individual in several ways, including physical and psychological distress, losses of function, quality of life, employment and income, and prolonged litigation for many. Its impact on society includes increased utilization of health care resources, loss of work productivity, disability and insurance costs, costs of litigation and social policy. Future research into the impact of chronic generalized pain must begin by defining this term in a way that is both valid in construct and convenient to use. Research is also warranted to develop and validate diagnostic tools that may better distinguish various subsets of chronic generalized pain, both to better understand the pathological processes involved and to allow for estimates of the relative contribution of each subset to societal costs.

Tougas G. · Digestive Diseases Research Program, Division of Gastroenterology, McMaster University, Hamilton, Canada. · Can J Gastroenterol. · Pubmed #10202203 No free full text.

Abstract: Communications along the brain-gut axis involve neural pathways as well as immune and endocrine mechanisms. The two branches of the autonomic nervous system are integrated anatomically and functionally with visceral sensory pathways, and are responsible for the homeostatic regulation of gut function. The autonomic nervous system is also a major mediator of the visceral response to central influences such as psychological stress. As defined, functional disorders comprise a constellation of symptoms, some of which suggest the presence of altered perception, while other symptoms point to disordered gastrointestinal function as the cause of the symptoms. A growing number of reports have demonstrated disordered autonomic function in subgroups of functional bowel patients. While a number of different methods were used to assess autonomic function, the reports point to a generally decreased vagal (parasympathetic) outflow or increased sympathetic activity in conditions usually associated with slow or decreased gastrointestinal motility, while other studies found either an increased cholinergic activity or a decreased sympathetic activity in patients with symptoms compatible with an increased motor activity. Under certain conditions, altered autonomic balance (including low vagal tone and increased sympathetic activity) may alter visceral perception. Autonomic dysfunction may also represent the physiological pathway accounting for many of the extraintestinal symptoms seen in irritable bowel syndrome patients and some of the frequent gastrointestinal complaints reported by patients with disorders such as chronic fatigue and fibromyalgia.

Pukall CF, Strigo IA, Binik YM, Amsel R, Khalifé S, Bushnell MC. · Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ont., Canada K7L 3N6. · Pain. · Pubmed #15836975 No free full text.

Abstract: Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Recent evidence points to the importance of the sensory component in VVS, particularly the heightened processing of tactile and pain sensation in the vulvar vestibule. The goal of the present study was to examine the neural basis of heightened sensitivity to touch (i.e. allodynia) in women with VVS. Using functional magnetic resonance imaging, we compared regions of neural activity in 14 women with VVS and 14 age- and contraceptive-matched control women in response to the application of mild and moderate pressure to the posterior portion of the vulvar vestibule. Intensity and unpleasantness ratings were recorded after each scan; these ratings were significantly higher for women with VVS than controls. All women with VVS described moderate pressure as painful and unpleasant, and 6 of the 14 women with VVS described mild pressure as painful and unpleasant. In contrast, none of the stimuli was painful for control women. Correspondingly, women with VVS showed more significant activations during pressure levels that they found to be either painful or non-painful than did controls during comparable pressure levels. During pressure described as painful by women with VVS, they had significantly higher activation levels in the insular and frontal cortical regions than did control women. These results suggest that women with VVS exhibit an augmentation of genital sensory processing, which is similar to that observed for a variety of syndromes causing hypersensitivity, including fibromyalgia, idiopathic back pain, irritable bowel syndrome, and neuropathic pain.

Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE. · University Health Network and University of Toronto, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #15593364 links to  free full text

Abstract: OBJECTIVE: To measure mood and physical function of individuals with fibromyalgia, 6 and 12 months following 23 weeks of supervised aerobic exercise. METHODS: This is a followup report of individuals who were previously enrolled in 23 weeks of land-based and water-based aerobic exercise classes. Outcomes included the 6-minute walk test, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Arthritis Self-Efficacy Scale (ASES), Fibromyalgia Impact Questionnaire (FIQ), tender point count, patient global assessment score, and exercise compliance. Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later. RESULTS: Analyses were conducted on 29 (intent-to-treat) or 18 (efficacy) subjects. Six-minute walk distances and BDI total scores were improved at followup (all analyses). BDI cognitive/affective scores were improved at the end of 23 weeks of exercise (both analyses) and at the 12-month followup (efficacy analysis only). BDI somatic scores were improved at 6-month (both analyses) and 12-month followup (intent-to-treat only). FIQ and ASES function were improved at all followup points. ASES pain was improved in efficacy analyses only (all followup points). Tender points were unchanged after 23 weeks of exercise and at followup. Exercise duration at followup (total minutes of aerobic plus anaerobic exercise in the preceding week) was related to gains in physical function (6- and 12-month followup) and mood (6-month followup). CONCLUSION: Exercise can improve physical function, mood, symptom severity, and aspects of self efficacy for at least 12 months. Exercising at followup was related to improvements in physical function and perhaps mood.

Gowans SE, DeHueck A, Abbey SE. · University Health Network, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #12522833 links to  free full text

Abstract: OBJECTIVE: To compare scales measuring exercise-induced changes in mood. METHODS: Mood changes in a randomized, 23-week controlled trial of exercise were assessed using the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire, and the Mental Health Inventory (MHI). Effect sizes and t-tests were computed on 23-week change scores. Scales were deemed to be confounded if items addressed sleep disturbances, fatigue, or effort (symptoms of both mood disturbances and fibromyalgia). RESULTS: Efficacy (15 exercise subjects) and intent-to-treat analyses (27 exercise subjects) generated medium effects for BDI (total, cognitive), MHI depression (efficacy only), and CES-D (intent-to-treat only) scales. BDI (total, cognitive), MHI (depression, positive affect, total [MHI-5]), and STAI scales distinguished exercise from control subjects at 23 weeks in all analyses. BDI somatic and CES-D scales were deemed to be confounded. CONCLUSION: We recommend the BDI cognitive, STAI, and MHI-5 scales to measure depression, anxiety, and general mood, respectively, in patients with fibromyalgia.

Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. · Department of Rehabilitation Services, University Health Network, Toronto General Hospital, Ontario, Canada. · Arthritis Rheum. · Pubmed #11762686 No free full text.

Abstract: OBJECTIVE: To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia. METHODS: Subjects were randomly assigned to an exercise (EX) or control (CTL) group. EX subjects participated in 3 30-minute exercise classes per week for 23 weeks. Subjects were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck Depression Inventory (BDI), 6-minute walk, State-Trait Anxiety Inventory (STAI), Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and a measure of tender points and knee strength. RESULTS: Fifty subjects (27 EX, 23 CTL) completed the study, and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy analyses, significant improvements were seen for EX subjects in 6-minute walk distances, BDI (total, cognitive/ affective), STAI, FIQ, ASES, and MHI (3 of 5 subscales) scores. These effects were reduced but remained during intent-to-treat analyses. CONCLUSION: Exercise can improve the mood and physical function of individuals with fibromyalgia.

Nielson WR, Jensen MP, Hill ML. · Department of Medicine, Division of Rheumatology, University of Western Ontario, ON, London, Canada. · Pain. · Pubmed #11166466 No free full text.

Abstract: Patients with fibromyalgia syndrome (FS) experience a decreased ability to participate in both vocational and avocational activities. Although many treatment programs advocate activity pacing techniques, 'pacing' is a poorly understood concept for which there are no available measures. The present study describes a brief six-item pacing scale that can be administered as part of the Chronic Pain Coping Inventory (CPCI). Preliminary data indicate that this scale is a valid, reliable index of the pacing construct that is associated with physical impairment in patients with FS and is unrelated to simple task persistence.

Khostanteen I, Tunks ER, Goldsmith CH, Ennis J. · Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. · J Rheumatol. · Pubmed #11093452 No free full text.

Abstract: OBJECTIVE: A randomized controlled trial was conducted to assess reliability and accuracy in identification of fibromyalgia (FM), motivated simulation, and normal controls. METHODS: Eight female subjects with chronic FM were age matched with 19 healthy female volunteers. The volunteers were randomized to a financially motivated "simulator" group who were paid to simulate FM, or to a "normal control" group. Examiners under blinded conditions rated tender and control points, and illness behavior. Intraclass correlation coefficients and F values showed that counts of tender points significantly discriminated the 3 groups. Variance was mostly due to experimental groups and not to observer or error factors. In this study, simulators could not be discriminated from normals or FM subjects on the basis of tenderness at "control points." Examiner ratings of illness behavior (UAB), and subjects' self-ratings for pain showed that FM subjects had the highest scores, normals the lowest, and simulators had mean scores midway between the mean FM and simulator. On grip strength, the normals obtained the highest scores, the simulators the lowest, and the FM subjects had scores midway between those of the other 2 groups. Diagnostic accuracy of the blinded examiners in distinguishing FM from simulators and from normals was 80%, and for correct diagnosis the kappa value was significant at 0.69. Despite this, simulators were misidentified as FM in 1/3 of judgments, and FM was misidentified as simulators in 1/5 of judgments. CONCLUSION: Under randomized blinded conditions, examiners using the American College of Rheumatology criteria for FM and other bedside observations are able to distinguish chronic FM, normal individuals, and motivated simulators with 80% accuracy, with a good level of agreement and reliability in tender point counts. Our results do not provide a "test for malingering," and it is likely that an important minority of motivated simulators and of FM subjects will be misidentified.

Gowans SE, deHueck A, Voss S, Richardson M. · Department of Rehabilitation Services, Toronto Hospital, Ontario, Canada. · Arthritis Care Res. · Pubmed #10513500 No free full text.

Abstract: OBJECTIVE: To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia. METHODS: Forty-one subjects were randomly assigned to the program or served as waiting list controls. Program outcome was assessed with a 6-minute walk test, the Fibromyalgia Impact Questionnaire, a Self-Efficacy Scale, and a "knowledge" questionnaire (based on information provided during the educational sessions). Waiting list control subjects subsequently completed the program. Program outcome was reassessed 3 or 6 months post-program. RESULTS: The program produced significant improvements in 6-minute walk distance, well-being, fatigue, self-efficacy (for controlling pain and other symptoms), and knowledge. At followup, immediate gains in walk distance, well-being, and self-efficacy were maintained, but gains in fatigue and knowledge were lost. CONCLUSION: Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia. The benefits of our program may be due to exercise or education since both interventions were given.

Shuster J, McCormack J, Pillai Riddell R, Toplak ME. · York University, Toronto, Canada. · Pain Res Manag. · Pubmed #19547765 No free full text.

Abstract: Fibromyalgia syndrome (FMS) is a disease with a complex etiology characterized by symptoms of widespread pain and fatigue. FMS is more common in women. Both depression and anxiety have been found to be independently associated with the severity of pain in symptoms of FMS. The goal of the present study was to examine the psychosocial profile of women with FMS and to see how the attributions, perceived social support and cognitive biases of women with FMS are related to internalizing ratings of depression and anxiety. The current study included a sample of women with FMS from a local support group and a control group to examine how women with FMS differed from controls with respect to psychosocial variables, and to determine the relationship between these variables. Women with FMS reported a higher external locus of control, lower levels of adaptive cognitive bias, less perceived family support and lower mood than controls. Correlations between these variables were examined within the FMS group, and it was found that an external locus of control was significantly associated with higher ratings of anxiety and depressed mood. These results suggest that beliefs about locus of control and perceived family support of women with FMS may importantly impact their health outcomes, and that treatments related to locus of control and advocating for family support may considerably improve the quality of life of patients with FMS.

Al Dhanhani AM, Gignac MA, Su J, Fortin PR. · Toronto Western Hospital of the University Health Network, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #19248125 No free full text.

Abstract: OBJECTIVE: To determine the prevalence, accrual over time, and risk factors of work disability in patients with systemic lupus erythematosus (SLE). METHODS: We studied 432 patients from an inception cohort. Work disability was measured from a single self-report question. Data were prospectively collected and included sociodemographic information, clinical lupus features including activity (Systemic Lupus Erythematosus Disease Activity Index 2000 update [SLEDAI-2K]), damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and organ involvement, as well as health status (Short Form 36 [SF-36]), comorbidity, and medication use. Student's t-test and Wilcoxon's rank sum test were used to compare continuous variables and chi-square tests were used for dichotomous variables. Descriptive survival curves of time to work disability were presented. Bivariate and multivariate logistic regressions were used to describe the relationships between clinically relevant factors and work disability. RESULTS: Of 432 patients, 88% were women and 73% were white. Within the first year of diagnosis, 47% of patients were employed, 7% had a disability, and 7% were on sick leave. Overall, work disability was found in 98 (23%) patients. Risk factors for work disability found in the multivariate regression analysis were younger age at diagnosis, less education, fibromyalgia, hypertension, higher first-visit SLEDAI-2K score, and lower first-visit SF-36 score. CONCLUSION: Work disability is frequent in patients with SLE, with a cumulative prevalence of 23%. Work disability was associated with a complex array of health factors, including comorbidity, physical and mental health limitations, and clinical features of lupus, that warrant increased attention in future research.

Pope JE, Goodwin JL, Ouimet JM, Krizova A, Laskin M. · Division of Rheumatology, Department of Medicine, The University of Western Ontario, London, Canada. · Open Rheumatol J. · Pubmed #19088895 links to  free full text

Abstract: The etiology of scleroderma (SSc) is unknown; immunogenic stimuli such as infections and vaccinations could theoretically be risk factors for scleroderma. Our objective was to assess the relationship between viral and bacterial infec-tions, and vaccinations, prior to diagnosis of SSc compared to non-inflammatory controls. METHODS: A questionnaire was sent to individuals with SSc (n =83) and controls (n=351) with non-inflammatory musculoskeletal (MSK) disorders (os-teoarthritis, n = 204; tendonitis, n = 58; fibromyalgia, n= 89) from a rheumatology practice. Questions ascertained past in-fections, exposure to infectious agents and vaccination history. RESULTS: The response rate was 78% (SSc) and 56% (MSK controls). The mean age was 56 +/- 1.6 (SSc) and 58 +/- 0.9 (MSK); 88% (SSc) and 82% (MSK) were female. No association between prior infections and SSc was observed. In fact, controls were more likely than SSc subjects to report any infec-tion within 1-year prior to disease diagnosis (35% vs. 16%, p<0.006), or to have suffered a trauma to affected joints prior to diagnosis (44% vs. 19%, p<0.0002). Within the 1-year prior to disease diagnosis, controls reported slightly more strep-tococcal infections (p<0.2), infections with diarrhea and vomiting (p<0.3), and antibiotic use (p<0.09), although none of these results were statistically significant. Histories of any hepatitis, rubella, any bacterial infection, and having had a pre-vious positive tuberculosis skin test were not significantly different between groups and were actually more often reported by the control subjects. SSc reported slightly more hepatitis B (p<0.08), more rheumatic fever (p<0.8) in past, and herpes zoster (p<0.4), although no differences reached significance. CONCLUSION: This study does not support that self-report of symptomatic infections are more likely to occur ever (prior to diagnosis) or within 1-year prior to symptom onset of SSc, or that vaccinations in adulthood trigger SSc.

Gadalla TM. · Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. · Women Health. · Pubmed #18843837 No free full text.

Abstract: Anxiety disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness, and about twice as prevalent in women as in men. This study used data collected in the 2005 Canadian Community Health Survey (21,198 women and 20,478 men) to examine factors associated with comorbid anxiety disorders and to assess the relation of these disorders on short-term disability and suicidal ideation. Comorbid anxiety disorders were more prevalent among women who were young, single, poor, and Canadian-born, and among women with chronic fatigue syndrome; fibromyalgia, bowel disorder or stomach or intestinal ulcers, or bronchitis had the highest rates of anxiety disorders. The presence of comorbid anxiety disorders was significantly associated with short-term disability, requiring help with instrumental daily activities, and suicidal ideation. Our findings underscore the importance of early detection and treatment of anxiety disorders in the physically ill, especially those who also suffer from mood disorders.

Stephens S, Feldman BM, Bradley N, Schneiderman J, Wright V, Singh-Grewal D, Lefebvre A, Benseler SM, Cameron B, Laxer R, O'Brien C, Schneider R, Silverman E, Spiegel L, Stinson J, Tyrrell PN, Whitney K, Tse SM. · The Hospital for Sick Children, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #18821656 No free full text.

Abstract: OBJECTIVE: To determine the feasibility of conducting a randomized controlled trial of a 12-week exercise intervention in children with fibromyalgia (FM) and to explore the effectiveness of aerobic exercise on physical fitness, function, pain, FM symptoms, and quality of life (QOL). METHODS: FM patients ages 8-18 years were randomized to a 12-week exercise intervention of either aerobics or qigong. Both groups participated in 3 weekly training sessions. Program adherence and safety were monitored at each session. Data were collected at 3 testing sessions, 2 prior to and 1 after the intervention, and included FM symptoms, function, pain, QOL, and fitness measures. RESULTS: Thirty patients participated in the trial. Twenty-four patients completed the program; 4 patients dropped out prior to training and 2 dropped out of the aerobics program. Better adherence was reported in the aerobics group than in the qigong group (67% versus 61%). Significant improvements in physical function, functional capacity, QOL, and fatigue were observed in the aerobics group. Anaerobic function, tender point count, pain, and symptom severity improved similarly in both groups. CONCLUSION: It is feasible to conduct an exercise intervention trial in children with FM. Children with FM tolerate moderate-intensity exercise without exacerbation of their disease. Significant improvements in physical function, FM symptoms, QOL, and pain were demonstrated in both exercise groups; the aerobics group performed better in several measures compared with the qigong group. Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM.

Gadalla T. · Faculty of Social Work at the University of Toronto. · Chronic Dis Can. · Pubmed #18625088 links to  free full text

Abstract: Mood disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness. These disorders amplify the disability associated with the physical condition and adversely affect its course, thus contributing to occupational impairment, disruption in interpersonal and family relationships, poor health and suicide. This study used data collected in the Canadian Community Health Survey, cycle 3.1 (2005) to examine factors associated with comorbid mood disorders and to assess their association with the quality of life of individuals living in Ontario. Results indicate that individuals with chronic fatigue syndrome, fibromyalgia, bowel disorder or stomach or intestinal ulcers had the highest rates of mood disorders. The odds of having a comorbid mood disorder were higher among women, the single, those living in poverty, the Canadian born and those between 30 and 69 years of age. The presence of comorbid mood disorders was significantly associated with short-term disability, requiring help with instrumental daily activities and suicidal ideation. Health care providers are urged to proactively screen chronically ill patients for mood disorders, particularly among the subgroups found to have elevated risk for these disorders.

Busse JW, Kulkarni AV, Badwall P, Guyatt GH, Anonymous00246. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · BMC Complement Altern Med. · Pubmed #18513441 links to  free full text

Abstract: BACKGROUND: The frequent use of chiropractic, naturopathic, and physical and occupational therapy by patients with fibromyalgia has been emphasized repeatedly, but little is known about the attitudes of these therapists towards this challenging condition. METHODS: We administered a cross-sectional survey to 385 senior Canadian chiropractic, naturopathic, physical and occupational therapy students in their final year of studies, that inquired about attitudes towards the diagnosis and management of fibromyalgia. RESULTS: 336 students completed the survey (response rate 87%). While they disagreed about the etiology (primarily psychological 28%, physiological 23%, psychological and physiological 15%, unsure 34%), the majority (58%) reported that fibromyalgia was difficult to manage. Respondants were also conflicted in whether treatment should prioritize symptom relief (65%) or functional gains (85%), with the majority (58%) wanting to do both. The majority of respondents (57%) agreed that there was effective treatment for fibromyalgia and that they possessed the required clinical skills to manage patients (55%).Chiropractic students were most skeptical in regards to fibromyalgia as a useful diagnostic entity, and most likely to endorse a psychological etiology. In our regression model, only training in naturopathic medicine (unstandardized regression coefficient = 0.33; 95% confidence interval = 0.11 to 0.56) and the belief that effective therapies existed (unstandardized regression coefficient = 0.42; 95% confidence interval = 0.30 to 0.54) were associated with greater confidence in managing patients with fibromyalgia. CONCLUSION: The majority of senior Canadian chiropractic, naturopathic, physical and occupational therapy students, and in particular those with naturopathic training, believe that effective treatment for fibromyalgia exists and that they possess the clinical skillset to effectively manage this disorder. The majority place high priority on both symptom relief and functional gains when treating fibromyalgia.

Nielson WR, Jensen MP, Ehde DM, Kerns RD, Molton IR. · Department of Medicine, University of Western Ontario and the Beryl and Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care London, Ontario, Canada. · J Pain. · Pubmed #18337183 No free full text.

Abstract: This study describes further development of the Multidimensional Pain Readiness to Change Questionnaire (MPRCQ2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. Clinical samples were recruited from a Fibromyalgia Day Program (n = 139) and an Arthritis Day Program (n = 51) as well as 2 survey samples with pain resulting from either a spinal cord injury (n = 127) or an amputation (n = 120). The results indicate preliminary support for the reliability and validity of the MPRCQ2. The MPRCQ2 may be helpful in future research investigating the relationship between readiness to change pain-related coping and adoption of coping behaviors and adjustment to chronic pain. PERSPECTIVE: This study describes the development of a revised version of the MPRCQ, the MPRCQ2, in 4 patient samples. The results support the reliability and validity of the MPRCQ2 in individuals with fibromyalgia syndrome, arthritis, acquired amputation, and spinal cord injury and improve on some aspects of the instrument.

Kuriya B, Gladman DD, Ibañez D, Urowitz MB. · University of Toronto Lupus Clinic Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #18240183 links to  free full text

Abstract: OBJECTIVE: To determine whether quality of life in patients with systemic lupus erythematosus (SLE) measured by the Short Form 36 (SF-36) changes over time and which patient- and disease-related factors influence such change. METHODS: SLE patients who had > or =6 SF-36 evaluations during followup were identified from a database. Outcomes were slopes of scores of the 8 SF-36 domains as well as the physical and mental component scores. Based on the direction of the slope, patients were designated as unchanged, improved, or worsened. Linear regression models were used to test the contribution of risk factors to slopes. Nonparametric tests were used to evaluate risk factors between patterns of clinical change. RESULTS: A total of 146 patients had > or =6 SF-36 evaluations in 1,047 visits over a mean +/- SD period of 8.2 +/- 1.1 years. During the interval, the majority of patients showed no change in the SF-36 domains and only a small minority demonstrated improvement. Physical and mental component scores were unchanged in 84.3% and 87.7% of patients whereas 4.1% and 7.5% improved, respectively. According to slopes of the domains and summary scores, only physical functioning demonstrated a significant decrease over time. There were no lupus disease features associated with decline in physical functioning except for the presence of fibromyalgia. CONCLUSION: The SF-36 in SLE patients with established disease changed little over an 8-year period. Changes in the SF-36 were not affected by disease activity, steroids, or damage accumulation during the interval, but were affected by the presence of fibromyalgia.

Thomas AW, Graham K, Prato FS, McKay J, Forster PM, Moulin DE, Chari S. · Bioelectromagnetics, Imaging Program, Lawson Health Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada. · Pain Res Manag. · Pubmed #18080043 links to  free full text

Abstract: Exposure to a specific pulsed electromagnetic field (PEMF) has been shown to produce analgesic (antinociceptive) effects in many organisms. In a randomized, double-blind, sham-controlled clinical trial, patients with either chronic generalized pain from fibromyalgia (FM) or chronic localized musculoskeletal or inflammatory pain were exposed to a PEMF (400 microT) through a portable device fitted to their head during twice-daily 40 min treatments over seven days. The effect of this PEMF on pain reduction was recorded using a visual analogue scale. A differential effect of PEMF over sham treatment was noticed in patients with FM, which approached statistical significance (P=0.06) despite low numbers (n=17); this effect was not evident in those without FM (P=0.93; n=15). PEMF may be a novel, safe and effective therapeutic tool for use in at least certain subsets of patients with chronic, nonmalignant pain. Clearly, however, a larger randomized, double-blind clinical trial with just FM patients is warranted.

Perruccio AV, Power JD, Badley EM. · Department of Public Health Sciences, University of Toronto, Toronto Western Research Institute, 399 Bathurst St., MP10-316, Toronto, ON, Canada, M5T 2S8. · J Epidemiol Community Health. · Pubmed #18000127 No free full text.

Abstract: STUDY OBJECTIVE: Previous estimates of individual and population attributable risks for adverse outcomes due to chronic conditions have considered only a limited number of conditions and outcomes, with some studies using inappropriate formulae or methods of estimation. This study re-examines the magnitude of individual and population attributable risks for a wide range of conditions and various health outcomes. DESIGN: Log-Poisson regression was used to calculate prevalence ratios as an indicator of individual risk and population-associated fractions of 13 chronic conditions, examining activity limitations, self-rated health and physician visits. The effect of multimorbidity on prevalence ratios was examined. SETTING: Canada, 2000-01. PARTICIPANTS: Nationally representative sample of Canadians aged 12+ years (n _ 130 880). MAIN RESULTS: At the individual level, fibromyalgia/chronic fatigue syndrome and cancer, and to a lesser extent stroke and heart disease, were associated with an increased risk of both activity limitations and a self-rated health status of fair or poor; high blood pressure was associated with four or more physician visits in the previous 12 months. In contrast, population attributable fractions were substantial for arthritis/rheumatism, heart disease, back problems and high blood pressure across all outcomes. Adjustment for multimorbidity resulted in a marked decreases in prevalence ratios. CONCLUSIONS: Differences in the ranking of individual risks and population attributable fractions for different diseases and outcomes are substantial. This needs to be taken into account when setting priorities, as interventions may need to be targeted to different conditions depending on which aspects of health are being considered, and whether the focus is on individuals, such as in clinical care, or improving the health of the population.

Munce SE, Stansfeld SA, Blackmore ER, Stewart DE. · Women's Health Program, University Health Network, Toronto, Ontario, Canada. · J Occup Environ Med. · Pubmed #17993924 No free full text.

Abstract: OBJECTIVE: This study examined whether depression is associated with absenteeism in a sample of individuals with chronic pain. METHODS: Data were obtained from the Canadian Community Health Survey Cycle 1.2. Key variables were chronic pain, defined as fibromyalgia, arthritis/rheumatism, back problems, and migraine headaches, absenteeism, and depression. The sample comprised 9,238,154 individuals who reported at least one chronic pain condition and were absent from their job in the previous week because of illness or disability. RESULTS: Nineteen percent of absent individuals met criteria for major depression versus 7.9% of non-absent individuals. The presence of major depression represented a three-fold risk of absenteeism. Other risk factors for absenteeism included younger age, higher income, and more education. CONCLUSIONS: Comorbid depression and chronic pain represents a significant source of disability in the workforce.

Munce SE, Stewart DE. · University Health Network, Women's Health Program, 200 Elizabeth St., University of Toronto, Ontario, Canada M5G 2C4. · Psychosomatics. · Pubmed #17878497 links to  free full text

Abstract: The authors explored gender differences in the prevalence of depression in four chronic pain conditions and pain severity indices in a national database. In 131,535 adults, the prevalence of depression in women (9.1%) was almost twice that of men (5%). One-third (32.8%) had a chronic pain condition (fibromyalgia, arthritis/rheumatism, back problems, and migraine headaches). The prevalence of depression in individuals with chronic pain conditions was 11.3%, versus 5.3% in those without. Women reported higher rates of chronic pain conditions and depression and higher pain severity than men. Depression and chronic pain conditions represent significant sources of disability, especially for women.

Bellamy N, Klestov A, Muirden K, Kuhnert P, Do KA, O'gorman L, Martin N. · London Health Sciences Centre - Victoria Campus, The University of Western Ontario, Suite 303, Colb. Bldg.3, 375 South Street, N6A 4G5, London, Canada. · Inflammopharmacology. · Pubmed #17657445 No free full text.

Abstract: The clinical diagnosis of osteoarthritis in the peripheral skeleton is dependent on the skilled examination of several features characteristic of the condition. However, we have previously observed that even highly experienced rheumatologists in Australia and Canada may not completely agree on the clinical examination in individuals with osteoarthritis (OA), rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, scleroderma and painful shoulder.

Park J, Knudson S. · Health Statistics Division, Statistics Canada, Ottawa, Ontario. · Health Rep. · Pubmed #17441443 No free full text.

This publication has no abstract.