Fibromyalgia: US Central Zone

Wood PB, Holman AJ, Jones KD. · Louisiana State University Health Sciences Center--Shreveport, Department of Family Medicine, Shreveport, LA 71130, USA. · Expert Opin Investig Drugs. · Pubmed #17501695 No free full text.

Abstract: Fibromyalgia is a common disorder that is characterized by chronic widespread pain, tenderness to light palpation, fatigue and sleep disturbances. The present lack of a well-accepted model of the disorder has hampered progress towards adequate treatment. A review of potential models to explain the pathophysiology underlying its primary symptom (i.e., chronic widespread pain) lends insight on the therapeutic potential of novel therapies. Following this, a mechanistic evaluation of those medications that are under consideration for the treatment of the disorder is offered. Adequate treatment will be likely to involve the identification of biologic subgroups within the greater fibromyalgia construct. Key insights from basic research are the basis for increased optimism for effective relief among patients and clinicians.

Fleischmann R. · University of Texas Southwestern Medical Center at Dallas, and Metroplex Clinical Research Center, Dallas, TX 75235, USA. · Nat Clin Pract Rheumatol. · Pubmed #17396109 No free full text.

Abstract: The performance of clinical trials can be very rewarding for the practicing or academic clinical rheumatologist. There are at least 50 new compounds - small molecules and biologics - in development for rheumatic diseases such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, scleroderma, gout and fibromyalgia. Clinical trials are important to try to determine the appropriate use of these compounds, as well as to answer questions about their safety. To carry out clinical trials effectively, the physician-investigator must be aware of, and adhere to, the regulatory requirements. The purpose of this article is to review these requirements in depth, as well as to discuss the infrastructure required to establish a successful clinical trial unit.

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

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

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

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

Nelson PJ, Holland DE, Derscheid D, Tucker SJ. · Nursing Research Division and the Psychiatric Division, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA. · Clin Nurse Spec. · Pubmed #17308445 No free full text.

Abstract: Clinical nurse specialists (CNSs) have a unique view and understanding of patients in their environment and are a valuable resource that has not been adequately engaged in research, even when CNSs assist researchers in the conduct of research. The purpose of this article is to outline activities for supporting the conduct of research that capitalize on the clinical strengths of the CNS from an ecological framework. To illustrate the contributions of CNSs in the conduct of research, 3 clinical research studies are described. Discussion of these studies within the context of an ecological framework offers a systematic approach to describing the potential involvement of the CNS in the implementation of nursing research.

Lenaerts ME, Gill PS. · Department of Neurology, Headache Section, Oklahoma University Health Sciences Center, 711 Stanton L. Young Boulevard #215, Oklahoma City, OK 73104, USA. · Curr Pain Headache Rep. · Pubmed #17087873 No free full text.

Abstract: Fibromyalgia syndrome and tension-type headache have multiple clinical features in common, and pathogenic mechanisms partly overlap. Significant differences need to be recognized as well. Studying the correlations of these often comorbid conditions represents a unique opportunity to gain insight into their pathophysiology and that of other chronic pain syndromes, to increase the accuracy of their diagnosis, and to improve the therapeutic armamentarium.

Perahia DG, Pritchett YL, Desaiah D, Raskin J. · Lilly Research Centre, Windlesham, Surrey, UK. · Int Clin Psychopharmacol. · Pubmed #17012978 No free full text.

Abstract: The evidence that the effects of the antidepressant duloxetine on painful physical symptoms in depression and chronic pain disorders are a direct analgesic effect rather than an indirect antidepressant effect is reviewed. Data from placebo-controlled acute studies of duloxetine in major depressive disorder, diabetic peripheral neuropathic pain and fibromyalgia syndrome are included in this review. In placebo-controlled studies of duloxetine in patients with major depressive disorder, non-depressed diabetic peripheral neuropathic pain, and fibromyalgia syndrome, duloxetine has a statistically significantly greater effect on pain than placebo. Path analysis suggests that in these patient populations, approximately 50, 90, and 80%, respectively, of the observed effect on pain is a direct analgesic effect rather than an indirect antidepressant effect. In fibromyalgia syndrome studies, duloxetine had similar and substantial effects on pain regardless of whether patients had comorbid major depressive disorder. Pain is a complex experience, involving both the physiological responses of the nociceptive system and the processing of that information in brain regions associated with emotion. While some effects of duloxetine on painful symptoms can be accounted for by its antidepressant action, the data strongly suggest that duloxetine also exerts a substantial direct analgesic effect over and above its antidepressant effects, in patients with major depressive disorder, diabetic peripheral neuropathic pain, and fibromyalgia syndrome.

Robinson RL, Jones ML. · Eli Lilly and Company, US Medical Division, Outcomes Research, Lilly Corporate Center, Indianapolis, IN 46285, USA. · Expert Opin Pharmacother. · Pubmed #16722813 No free full text.

Abstract: Fibromyalgia is characterised by chronic widespread pain of unknown aetiology and affects approximately 2% of the population. It can cause significant patient disability, sizeable economic costs, complex management decisions and controversy for healthcare providers. In lieu of uniformly approved treatments for fibromyalgia, patients may try multiple pharmacological and non-pharmacological therapies with questionable efficacy. The literature lacks pharmacoeconomic studies that balance the cost and benefit of interventions. In the absence of this work, cost outcomes are reviewed in this paper. Due to inconclusive results, further study is needed on fibromyalgia treatment cost-effectiveness. These analyses could provide useful information for policy and evidence-based practice guidelines toward optimal disease management. Medical professionals should be a driving force in understanding the clinical and economic challenges of fibromyalgia.

June L. · Rheumatology Associates, 4213 Maryknoll Lane, Louisville, KY 40207, USA. · Clin Occup Environ Med. · Pubmed #16647656 No free full text.

Abstract: Rheumatic illnesses are a common cause for musculoskeletal complaints in the general population. All ages can be affected, including people in the prime of their working years. Secondary problems, such as entrapment neuropathies, enthesopathies, and Raynaud's syndrome, can be associated with various inflammatory arthritides. A detailed history and physical are the most important tools in screening for potential inflammatory disease in workers with upper extremity complaints.

Wood PB. · Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA. · Int Rev Neurobiol. · Pubmed #16291022 No free full text.

This publication has no abstract.

Buesing AR. · Strawberry Point Medical Center, Manchester, Iowa, USA. · JAAPA. · Pubmed #16184869 No free full text.

This publication has no abstract.

Crofford LJ. · University of Kentucky, Lexington, Kentucky 40536, USA. · J Rheumatol Suppl. · Pubmed #16078360 No free full text.

Abstract: The appropriateness and utility of considering fibromyalgia syndrome (FM) and other syndromes without anatomically localized pathology of the nervous system as neuropathic pain syndromes is uncertain. In this afterword, a synthesis of the information presented in these proceedings and opinion as to how FM relates to classical neuropathic pain syndromes is provided.

Bradley LA. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham 805 FOT, 510 20th Street South, Birmingham, AL 35222, USA. · Curr Pain Headache Rep. · Pubmed #15745615 No free full text.

Abstract: This review examines the current literature regarding psychiatric comorbidities associated with fibromyalgia. The aim of this review is to enhance understanding of psychiatric disorders that, alone or in combination with other physiologic (eg, neuroendocrine dysfunction) and psychosocial factors (eg, poor coping skills), may contribute to abnormal pain sensitivity and other illness behaviors of individuals with fibromyalgia. The review first identifies the psychiatric comorbidities that are associated most often with fibromyalgia and tend to aggregate within families of individuals with this disorder. It then examines the literature regarding the extent to which psychiatric illness, environmental stressors, or other psychosocial factors may contribute to the development of fibromyalgia. The review also presents recent findings concerning the extent to which psychosocial factors may contribute to treatment-related outcomes in pain and other health status variables among patients with fibromyalgia.

Peterson J. · Cumberland Regional Health Center, Cumberland, WI, USA. · Nurse Pract. · Pubmed #15644727 No free full text.

This publication has no abstract.

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

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

Fricton JR. · Department of Diagnostic and Surgical Sciences, University of Minnesota School of Dentistry, 6-320 Moos Tower, Minneapolis, MN 55455, USA. · Curr Pain Headache Rep. · Pubmed #15361319 No free full text.

Abstract: Although most cases of temporomandibular disorders (TMD) are mild and self-limiting, approximately 10% of patients develop severe disorders associated with chronic pain. It has been found that the widespread pain, depression, and sleep disorders associated with fibromyalgia (FM) may play a significant role in the chronicity of patients with TMD. This paper reviews the characteristics and relationship between TMD and FM and discusses how the similar mechanisms and diagnostic and treatment strategies for both disorders suggest that there is a close relationship between them.

Benca RM, Ancoli-Israel S, Moldofsky H. · University of Wisconsin, Madison, USA. · J Clin Psychiatry. · Pubmed #15153065 No free full text.

Abstract: Patients with insomnia who also have chronic pain or depression or who are elderly represent segments of the population that are particularly difficult to treat. These populations tend to be at higher risk for experiencing difficulty sleeping and are more likely to experience chronic insomnia, sleep maintenance problems, and/or nonrestorative sleep. Worsening insomnia may exacerbate other somatic and psychological symptoms and vice versa. Conversely, there is evidence that appropriate recognition and management of the sleep complaint may alleviate other symptoms related to the associated condition and help interrupt this vicious cycle.

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

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

Rudin NJ. · Department of Orthopedics and Rehabilitation, University of Wisconsin Medical School, 5249 East Terrace Drive, Mail Code 9950, Madison, WI 53718-8339, USA. · Curr Pain Headache Rep. · Pubmed #14604502 No free full text.

Abstract: Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear.

Warnock JK, Clayton AH. · Department of Psychiatry, University of Oklahoma Health Sciences Center-Tulsa, 4502 East 41st Street, Tulsa, OK 74135-2553, USA. · Psychiatr Clin North Am. · Pubmed #14563106 No free full text.

Abstract: Chronic episodic disorders, such as depressive disorders, IBS, migraine, and FMS, have important commonalities, including cormorbidities, an absence of classic anatomic pathology in the tissues, a lack of objective findings on physical examination, and a lack of abnormal findings by routine laboratory and radiologic tests. These CED are more prevalent in women (perhaps due to changes in estrogen levels), are generally worsened by stress (with resultant hyperactivity of the HPA axis), and often improve with aerobic exercise and common classes of medications affecting serotonin function, such as antidepressants. Thus, an increased understanding of the CED may result in improved treatment and functioning of many patients.

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

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

Kroenke K. · Department of Medicine and Regenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, USA. · Int J Methods Psychiatr Res. · Pubmed #12830308 No free full text.

Abstract: Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms.

Davis GC. · College of Nursing, Texas Woman's University, Denton, Tex 76204, USA. · Holist Nurs Pract. · Pubmed #12784896 No free full text.

Abstract: Studies indicate that pain interferes with sleep and, in turn, sleep disturbances increase pain. Statistics show that up to 60% of those with arthritis experience pain during the night. But despite these findings, sleep is not generally addressed as a major treatment concern among this population. This article reviews the relationship between pain and sleep; sleep issues as they relate to 3 common types of arthritis--osteoarthritis, rheumatoid arthritis, and fibromyalgia; and holistic approaches that may be used by the patient in the self-management of pain and sleep.

Nash J, Cheng JS, Meyer GA, Remler BF. · Medical College of Wisconsin, Milwaukee, Wis., USA. · WMJ. · Pubmed #12557611 No free full text.

Abstract: Chiari Type I malformation (Chiari I) is a congenital hindbrain anomaly characterized by downward displacement of the cerebellar tonsils through the foramen magnum. This can lead to compression of cerebellar components, the lower brainstem, and the upper cervical spinal cord. In turn, a variety of neurological deficits and permanent nervous system damage may evolve. This review article discusses the etiology, diagnosis, and treatment of patients with Chiari I malformation. Its protean manifestations cause significant overlap with multiple sclerosis, chronic fatigue syndrome, and numerous other conditions. Accordingly, the diagnosis of Chiari I is difficult to establish by clinical evaluation alone. Demonstration of the characteristic hindbrain abnormalities, however, is easily accomplished with magnetic resonance imaging. Neuroimaging should therefore be considered in patients with cerebellar, brainstem, and cervical cord dysfunction. Surgical treatment is indicated in symptomatic patients with radiographic evidence of hindbrain abnormalities. Posterior fossa decompression has also been performed in patients with fibromyalgia and chronic fatigue syndrome based solely on overlapping symptoms with Chiari I. This practice remains controversial. Appraisal of surgical outcome requires postoperative neuroimaging and long-term patient follow-up to assess the permanency of improvement. Preliminary study results of the impact of surgical technique on patient outcome are reported. Ongoing research is devoted to a better understanding of the pathophysiology of Chiari I malformation and the development of more effective medical and surgical treatments.

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

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