Fibromyalgia: Pennsylvania

Shah MA, Feinberg S, Krishnan E. · The Reading Hospital and Medical Center, West Reading, Pennsylvania, USA. · J Clin Rheumatol. · Pubmed #17149057 No free full text.

Abstract: BACKGROUND: In clinical practice, polysomnograms ("sleep studies") are seldom ordered for patients with fibromyalgia, although sleep issues dominate the symptom complex. One reason for this is the lack of understanding how information from these studies could aid clinical decisions. METHODS: The authors conducted a chart review of one rheumatologist's community-based practice where polysomnograms were offered routinely to all women who met the American College of Rheumatology criteria for fibromyalgia. Interpretation of these standardized protocol-based polysomnograms was performed by a board-certified neurologist using standard criteria. RESULTS: Mean age of the study subjects (n = 23) was 45 (standard deviation, 7.8) years. Median body mass index was 27 kg/m2 (interquartile range 20-48). These women had poor sleep with many arousals (median arousal index 23), apnea-hypopneas (median apnea-hypopnea index 22, interquartile range 17-30). Desaturation was common with half the patients having nadir oxygen saturation less than 87%. Restless legs were detected in polysomnograms among many women who clinically denied it (mean leg movement index 5.8). CONCLUSIONS: A large proportion of women with fibromyalgia in a general rheumatology practice had sleep-disordered breathing, which can be detected using sleep polysomnograms. Studies are needed to examine if treatment of the commonly detected sleep apnea will have a beneficial effect on symptoms of fibromyalgia.

Mahaney PE, Vu AT, McComas CC, Zhang P, Nogle LM, Watts WL, Sarkahian A, Leventhal L, Sullivan NR, Uveges AJ, Trybulski EJ. · Chemical and Screening Sciences, Discovery Medicinal Chemistry, Wyeth Research, 500 Arcola Road, Collegeville, PA 19426, USA. · Bioorg Med Chem. · Pubmed #16973367 No free full text.

Abstract: Compounds with a combination of norepinephrine and serotonin reuptake inhibition have been approved in the US and Europe for a number of indications, including major depressive disorder and pain disorders such as diabetic neuropathy and fibromyalgia. Efforts to design selective norepinephrine reuptake inhibitors based on SAR from the aryloxypropanamine series of monoamine reuptake inhibitors have led to the identification of a potent new class of dual acting norepinephrine and serotonin reuptake inhibitors, namely the 3-(1H-indol-1-yl)-3-arylpropan-1-amines.

Weiner DK, Sakamoto S, Perera S, Breuer P. · Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · J Am Geriatr Soc. · Pubmed #16420193 No free full text.

Abstract: OBJECTIVES: To develop a structured physical examination protocol that identifies common biomechanical and soft-tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. DESIGN: Cross-sectional survey and examination. SETTING: Older adult pain clinic. PARTICIPANTS: One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free. MEASUREMENTS: Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms. Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. RESULTS: Scoliosis was prevalent in those with (77.5%) and without pain (60.0%), but prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) was significantly different between groups (P < .001). Interrater reliability was excellent for SIJ pain (0.81), number of fibromyalgia tender points (0.84), and TFL pain (0.81); good for scoliosis (0.43), kyphosis (0.66), lumbar movement pain (0.75), piriformis pain (0.71), and hip disease by internal rotation (0.56); and marginal for leg length (0.00) and paravertebral pain (0.39). CONCLUSION: Biomechanical and soft tissue pathologies are common in older adults with CLBP, and many can be assessed reliably using a brief physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering.

Safman BL. · Arkansas Specialty Care Centers, PA, USA. · J Ark Med Soc. · Pubmed #16296419 No free full text.

This publication has no abstract.

Marcus DA, Bernstein C, Rudy TE. · Department of Anesthesiology, University of Pittsburgh Medical Center, PA, USA. · Clin Rheumatol. · Pubmed #15902517 No free full text.

Abstract: Fibromyalgia is defined by widespread body pain, tenderness to palpation of tender point areas, and constitutional symptoms. The literature reports headache in about half of fibromyalgia patients. The current epidemiological study was designed to determine the prevalence and characteristics of headache in fibromyalgia patients. Treatment-seeking fibromyalgia patients were evaluated with measures for fibromyalgia, chronic headache, quality of life, and psychological distress. Multivariate analysis of variance (MANOVA) and t-tests were used to identify significant differences, as appropriate. A total of 100 fibromyalgia patients were screened (24 fibromyalgia without headache and 76 fibromyalgia with headache). International Headache Society diagnoses included: migraine alone (n = 15 with aura, n = 17 without aura), tension-type alone (n = 18), combined migraine and tension-type (n = 16), post-traumatic (n = 4), and probable analgesic overuse headache (n = 6). Fibromyalgia tender point scores and counts and most measures of pain severity, sleep disruption, or psychological distress were not significantly different between fibromyalgia patients with and without headache. As expected, the fibromyalgia patients with headache scored higher on the Headache Impact Test (HIT-6) (62.1 +/- 0.9 vs 48.3 +/- 1.6, p < 0.001). HIT-6 scores were >60 in 80% of fibromyalgia plus headache patients, representing severe impact from headache, and 56-58 in 4%, representing substantial impact. In summary, chronic headache was endorsed by 76% of treatment-seeking fibromyalgia patients, with 84% reporting substantial or severe impact from their headaches. Migraine was diagnosed in 63% of fibromyalgia plus headache patients, with probable analgesic overuse headache in only 8%. General measures of pain, pain-related disability, sleep quality, and psychological distress were similar in fibromyalgia patients with and without headache. Therefore, fibromyalgia patients with headache do not appear to represent a significantly different subgroup compared to fibromyalgia patients without headache. The high prevalence and significant impact associated with chronic headache in fibromyalgia patients, however, warrants inclusion of a headache assessment as part of the routine evaluation of fibromyalgia patients.

Schaefer KM. · Department of Nursing, College of Health Professions, Temple University, 3307 N Broad St, Philadelphia, PA 19140, USA. · Holist Nurs Pract. · Pubmed #15736726 No free full text.

Abstract: This study aimed to learn what it is like for African American women to live with fibromyalgia. Van Manen's phenomenological method of writing and rewriting guided the inquiry. The sample included 10 women, who were interviewed for 30 to 60 minutes each. Two agreed to second interviews, for a total of 12 interviews for data analysis. Data analysis revealed the following themes: (a) managing the symptoms, (b) becoming a self-advocate, (c) medications camouflage the pain, (d) coming to grips with the illness means making changes, (e) being accused of "taking a free ride" angers them, (f) support comes from self and spiritual connections, and (g) a certain amount of secrecy makes it easier to live with the illness. Recommendations focus on using a holistic approach to help African American women achieve or maintain their integrity.

Derbyshire SW, Whalley MG, Stenger VA, Oakley DA. · Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. · Neuroimage. · Pubmed #15325387 No free full text.

Abstract: The continuing absence of an identifiable physical cause for disorders such as chronic low back pain, atypical facial pain, or fibromyalgia, is a source of ongoing controversy and frustration among pain physicians and researchers. Aberrant cerebral activity is widely believed to be involved in such disorders, but formal demonstration of the brain independently generating painful experiences is lacking. Here we identify brain areas directly involved in the generation of pain using hypnotic suggestion to create an experience of pain in the absence of any noxious stimulus. In contrast with imagined pain, functional magnetic resonance imaging (fMRI) revealed significant changes during this hypnotically induced (HI) pain experience within the thalamus and anterior cingulate (ACC), insula, prefrontal, and parietal cortices. These findings compare well with the activation patterns during pain from nociceptive sources and provide the first direct experimental evidence in humans linking specific neural activity with the immediate generation of a pain experience.

Lynn J, Knight AK, Kamoun M, Levinson AI. · Pulmonary Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. · J Allergy Clin Immunol. · Pubmed #15316525 No free full text.

Abstract: A 55-year-old white man with a history of hypertension, fibromyalgia, and colonic polyps presented with unrelenting plantar warts on his hands and feet for the past 4 years. He was otherwise healthy and without a history of recurrent infections. Physical examination was unremarkable except for extensive warts on his hands and feet. Pertinent laboratory findings included hypoalbuminemia, hypogammaglobulinemia, and lymphopenia most severely affecting CD4(+) T cells. Testing for HIV infection was negative. This clinical and laboratory presentation suggested a combined humoral and cellular immunodeficiency syndrome that could be best explained by loss of lymphocytes, immunoglobulins, and other serum proteins. Additional immunologic testing revealed a marked reduction in peripheral blood naive (CD4(+)CD45RA(+)) T cells. A 24-hour stool collection showed a markedly elevated alpha(1)-antitrypsin level. These findings were most consistent with the diagnosis of intestinal lymphangiectasia, a type of protein-losing enteropathy associated with hypoalbuminemia, hypogammaglobulinemia, and lymphopenia, characterized by a preferential loss of naive CD4(+) T cells into the gastrointestinal tract. This case illustrates the importance of considering intestinal loss of immunoglobulins and lymphocytes in the differential diagnosis of the adult patient who presents with laboratory evidence of a combined humoral and cellular immunodeficiency. It also underscores the diagnostic utility of the clinical immunology laboratory and how flow cytometry, in particular, can contribute to an understanding of pathogenic mechanisms.

Schaefer KM. · Temple University, College of Health Professions, Department of Nursing, Philadelphia, PA, USA. · MCN Am J Matern Child Nurs. · Pubmed #15238752 No free full text.

Abstract: PURPOSE: To describe what it is like for women with fibromyalgia (FM) to breastfeed their infants. STUDY DESIGN AND METHODS: Nine women with FM who chose to breastfeed their infants were the sample for this qualitative study. van Manen's phenomenological method of reflection, writing, and rewriting was used to analyze the data collected through in-depth tape-recorded interviews and written stories. RESULTS: All nine women felt that they were not successful in their attempts to breastfeed, and felt frustrated. Themes included (a) muscle soreness, pain, and stiffness made it difficult to breastfeed the baby; (b) fatigue interfered with the breastfeeding process; (c) the need for medication, perceived insufficient milk supply, and sore nipples led to forced unplanned weaning; and (d) being forced to wean the infant when not ready to do so created sadness and a feeling of depression. CLINICAL IMPLICATIONS: Nurses who work with women with FM who choose to breastfeed need to be proactive in providing informational, emotional, and physical support to facilitate a successful breastfeeding experience for these women. Knowing that the pain, muscle soreness, stiffness, and fatigue of FM may affect breastfeeding can direct nurses to help women with FM plan for support after childbirth and learn techniques to control/reduce the muscle pain and stiffness. Nurses are encouraged to refer breastfeeding women with FM to lactation consultants and support groups for encouragement and validation regarding their concerns about breastfeeding. It is important that nurses continue to serve as advocates for breastfeeding women with FM and keep other healthcare providers informed about the issues related to breastfeeding for women with FM.

Menefee LA, Cohen MJ, Anderson WR, Doghramji K, Frank ED, Lee H. · Jefferson Medical College, Department of Psychiatry, Philadelphia, PA, USA. · Pain Med. · Pubmed #15101904 No free full text.

Abstract: Sleep disturbance is an important clinical complaint for individuals with nonmalignant pain conditions. This review is a broad introduction to the literature on sleep disturbance and chronic pain conditions. The article critically reviews studies of sleep disturbance in musculoskeletal pain, arthritis, headache, and fibromyalgia. Current neurobiological hypotheses regarding the pathogenesis of sleep disturbance and chronic pain, common comorbid disorders, and pharmacologic and non-pharmacologic treatments for sleep disturbance are reviewed.

Schaefer KM. · Department of Nursing, College of Health Professions, Temple University, Philadelphia, PA, USA. · Rehabil Nurs. · Pubmed #15052746 No free full text.

Abstract: Fibromyalgia (FM) is a chronic, potentially disabling, cluster of symptoms that manifests as pain for 3 months or more and pain with pressure on 11 of 18 tender points throughout the body. Because there is no known cause, and therefore, no cure, treatment focuses on the control or relief of symptoms. Many patients are referred to rehabilitation settings for physical or exercise therapy. While exercise is helpful in the control of the pain, stiffness, fatigue, sleep disorders, and mood changes, a holistic approach to treatment is more effective. Rehabilitation nurses provide major support for patients with FM. Validation of the patients' experiences is essential for achieving quality of life. Many patients have a history of being undertreated because of a lack of credibility and invisibility of the illness. This article provides background information about FM, summarizes the FM trajectory, reviews approaches to management, and discusses the role of rehabilitation nurses in a holistic approach to care of clients with FM.

Guo W. · Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia 19104-6021, USA. · Biometrics. · Pubmed #11890306 No free full text.

Abstract: In this article, a new class of functional models in which smoothing splines are used to model fixed effects as well as random effects is introduced. The linear mixed effects models are extended to nonparametric mixed effects models by introducing functional random effects, which are modeled as realizations of zero-mean stochastic processes. The fixed functional effects and the random functional effects are modeled in the same functional space, which guarantee the population-average and subject-specific curves have the same smoothness property. These models inherit the flexibility of the linear mixed effects models in handling complex designs and correlation structures, can include continuous covariates as well as dummy factors in both the fixed or random design matrices, and include the nested curves models as special cases. Two estimation procedures are proposed. The first estimation procedure exploits the connection between linear mixed effects models and smoothing splines and can be fitted using existing software. The second procedure is a sequential estimation procedure using Kalman filtering. This algorithm avoids inversion of large dimensional matrices and therefore can be applied to large data sets. A generalized maximum likelihood (GML) ratio test is proposed for inference and model selection. An application to comparison of cortisol profiles is used as an illustration.

Fetrow CW, Avila JR. · Pharmacy Services, University of Pittsburgh Medical Center, Passavant Hospital, PA 15237-5842, USA. · Ann Pharmacother. · Pubmed #11724095 No free full text.

Abstract: OBJECTiVE: To review existing published clinical evidence surrounding the dietary supplement SAMe (S-adenosyl-L-methionine). DATA SOURCES: The majority of information was obtained from primary published literature identified through MEDLINE search (1966-February 2001). Information was also obtained through secondary and tertiary sources when available. STUDY SELECTION AND DATA EXTRACTION: All articles identified from data sources were evaluated and all relevant information included in this review. DATA SYNTHESIS: The majority of clinical trial evidence surrounds the application of SAMe for various depressive disorders, osteoarthrits, and fibromyalgia. Sample sizes of these trials and the dose employed have varied considerably. Several reviews and at least two meta-analyses have examined the available evidence surrounding SAMe in the therapy of depression for trials completed prior to 1994 and concluded that SAMe was superior to placebo in treating depressive disorders and approximately as effective as standard tricyclic antidepressants. Much of this information exists in the form of isolated case reports or solitary clinical trials. SAMe appears to be well tolerated, with the majority of adverse effects presenting as mild to moderate gastrointestinal complaints. However, it is apparent that this agent is not without risk of more significant psychiatric and cardiovascular adverse events. Information documenting drug or food interactions with SAMe is very limited. CONCLUSIONS: Consumers should be instructed to avoid unmonitored consumption of this dietary supplement until sufficient discussion has taken place with their primary healthcare provider. Although there exists significant potential for therapeutic application of SAMe, its uncertain risk profile precludes definitive recommendation at this time. Healthcare providers and consumers should likely temper their enthusiasm for this dietary supplement until sufficient information becomes available.

Peres MF, Young WB, Kaup AO, Zukerman E, Silberstein SD. · Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA. · Neurology. · Pubmed #11591860 No free full text.

Abstract: Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

Gantz NM, Coldsmith EE. · Division of Infectious Diseases, Department of Medicine, Pinnacle Health System, Harrisburg, PA 17110, USA. [corrected] · Clin Infect Dis. · Pubmed #11247716 No free full text.

Abstract: A wealth of information on chronic fatigue syndrome (CFS) and fibromyalgia is available on the World Wide Web for health care providers and patients. These illnesses have overlapping features, and their etiologies remain unknown. Multiple Web sites were reviewed, and selected sites providing useful information were identified. Sites were classified according to their content and target audience and were judged according to suggested standards of Internet publishing. Fifty-eight sites were classified into groups as follows: comprehensive and research Web sites for CFS and fibromyalgia, meetings, clinical trials, literature search services, bibliographies, journal, and CFS and fibromyalgia Web sites for the patient.

Tayag-Kier CE, Keenan GF, Scalzi LV, Schultz B, Elliott J, Zhao RH, Arens R. · Division of Pulmonary Medicine and Sleep Disorders Center, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4399, USA. · Pediatrics. · Pubmed #11061807 links to  free full text

Abstract: OBJECTIVES: Fibromyalgia has been recently recognized in children and adolescents as juvenile fibromyalgia (JF). In adult fibromyalgia, subjective complaints of nonrestorative sleep and fatigue are supported by altered polysomnographic findings including a primary sleep disorder known as periodic limb movements in sleep (PLMS) in some subjects. Although poor sleep is a diagnostic criterion for JF, few reports in the literature have evaluated specific sleep disturbances. Our objectives were to evaluate in a controlled study the polysomnographic findings of children and adolescents with JF for alterations in sleep architecture as well as possible PLMS not previously noted in this age group. METHODS: Sixteen consecutive children and adolescents (15.0 +/- 2.6 years of age) diagnosed with JF underwent overnight polysomnography. Polysomnography was also performed on 14 controls (14.0 +/- 2.2 years of age) with no history of an underlying medical condition that could impact on sleep architecture. Respiratory variables, sleep stages, and limb movements were measured during sleep in all subjects. RESULTS: JF subjects differed significantly from controls in sleep architecture. JF subjects presented with prolonged sleep latency, shortened total sleep time, decreased sleep efficiency, and increased wakefulness during sleep. In addition, JF subjects exhibited excessive movement activity during sleep. Six of the JF subjects (38%) were noted to have an abnormally elevated PLMS index (>5/hour), indicating PLMS in these subjects. CONCLUSION: Our study demonstrated abnormalities in sleep architecture in children with JF. We also noted PLMS in a significant number of subjects. This has not been reported previously in children with this disorder. We recommend that children who are evaluated for JF undergo polysomnography including PLMS assessment. juvenile fibromyalgia; periodic limb movement in sleep; restless legs syndrome.

Chu J. · Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. · Electromyogr Clin Neurophysiol. · Pubmed #10907596 No free full text.

Abstract: OBJECTIVE: To show in a pilot group of patients that electrodiagnostically derived new treatment techniques (automated twitch-obtaining intramuscular stimulation (ATOIMS) and electrical twitch-obtaining intramuscular stimulation (ETOIMS) methods) have a role in the control of radiculopathy related myofascial pain and fibromyalgia. METHOD: Retrospective analysis of six patients treated between 6-96 and 10-98. All received sequential treatments with ETOIMS and combined ATOIMS and ETOIMS of which four began treatments with standard TOIMS (StdTOIMS). The StdTOIMS utilized manual oscillation of a monopolar electromyographic (EMG) pin at tender muscle sites. ETOIMS employed microelectrical stimulation at 2 Hz for two seconds/site. The ATOIMS device automatically inserts and retracts a monopolar EMG pin after oscillating it at 2 Hz for three cycles/two seconds/site. Obtaining forceful muscle twitches were the goals of all three treatments. Treatment included multiple points in bilateral multiple myotomes. Patients received weekly treatments and recorded daily visual analog pain levels. RESULTS: Significant reductions in pain levels occurred with the use of ETOIMS compared to that achieved with StdTOIMS. The combined use of ATOIMS and ETOIMS was more effective in reducing pain than StdTOIMS or ETOIMS only treatments. CONCLUSIONS: Control of radiculopathy related myofascial pain and fibromyalgia using the ETOIMS with ATOIMS methods seem promising. Reduction of mechanical tension through muscle relaxation is the proposed basis for the pain relief. There is a need for prospective studies to document efficacy in myofascial pain control.

Chu J. · Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA. · Electromyogr Clin Neurophysiol. · Pubmed #10627937 No free full text.

Abstract: OBJECTIVE: To show that the monopolar pin electrode has a role in the control of radiculopathy related myofascial pain and fibromyalgia using the automated twitch-obtaining intramuscular stimulation (ATOIMS) and electrical twitch-obtaining intramuscular stimulation (ETOIMS) methods. METHOD: A hand-held ATOIMS device facilitated the insertion, oscillation and retraction of the monopolar pin into motor end-plate regions. The device oscillated the pin at 2 Hz for three times in two seconds. ETOIMS method employed micro-stimulation at 2 Hz for two seconds/point. Obtaining muscle twitches were the goals of both treatments. This is a retrospective study of two patients with fibromyalgia who received these treatments. Patient #1 with chronic low back > neck pain, underwent treatments which included the L2-S1 myotomes and patient #2 with chronic neck pain > low back pain, received treatments to the bilateral C2-T1 myotomes. Both received treatments also to bilateral C3-S1 paraspinal muscles. Treatments to both began with ETOIMS for two months and five months respectively. Following this period, they both received ATOIMS and ETOIMS to the same muscles in the same treatment session. The combined procedure sessions continued for the same treatment duration as for ETOIMS only sessions. Both patients recorded daily visual analog pain levels. RESULTS: Significant reductions in pain levels occurred with the increase in number of ETOIMS treatment sessions. More significant pain level reductions occurred with combined ATOIMS & ETOIMS treatments than with ETOIMS only treatments. The monopolar pin served both procedures well and there were no complications. CONCLUSIONS: The monopolar pin has a very promising role in the management of radiculopathy related myofascial pain using the ATOIMS and ETOIMS methods.

Chun A, Desautels S, Slivka A, Mitrani C, Starz T, DiLorenzo C, Wald A. · University of Pittsburgh Medical Center, Division of Gastroenterology, Pennsylvania 15213, USA. · Dig Dis Sci. · Pubmed #10080161 No free full text.

Abstract: Visceral hyperalgesia has been demonstrated in patients with irritable bowel syndrome who are seen in tertiary care centers. It has been hypothesized that visceral hyperalgesia may be related to psychological distress associated with health care seeking behavior in these patients. Patients with fibromyalgia and sphincter of Oddi dysfunction, type III, share many demographic and psychosocial characteristics with patients with irritable bowel syndrome and provide an opportunity to test the hypothesis that rectal hyperalgesia is unique to IBS. Fifteen patients with IBS, 10 patients with fibromyalgia, 10 with sphincter of Oddi dysfunction, type III, and 12 controls underwent evaluation of rectal pain perception in response to phasic distensions and psychological testing with a self-report instrument. Patients with irritable bowel syndrome demonstrated significantly lower rectal pain thresholds and increased levels of psychologic distress compared to controls. Although sphincter of Oddi dysfunction patients also exhibited increased psychologic distress, rectal pain perception was similar to controls. Patients with fibromyalgia exhibited rectal algesia that was not significantly different from either controls or IBS. In conclusion, rectal hyperalgesia is not a function of chronic functional pain, health care seeking behavior, or psychological distress. However, it may not be specific for IBS.