FIBROMYALGIA: ABSTRACTS 2001
FROM ARTICLES IN MEDICAL JOURNALS
The abstracts in this collection are
intended to provide doctors and other health professionals with a convenient overview
of trends in research on fibromyalgia published in medical journals in the year
2001. The studies were selected from the extensive literature on fibromyalgia
so as to cover a wide range of subjects in limited space.
The
following studies were published in the period January through September, 2001,
and abstracts will be added to this selection at intervals during the year.
Similar collections of abstracts published in 1999 and 2000 can be found on the
website of the National Fibromyalgia Partnership: www.fmpartnership.org.
The
abstracts are arranged in alphabetical order by lead author.
_________________________________________________
Aaron LA,
Buchwald D
A review of
the evidence for overlap among
unexplained
clinical conditions
PURPOSE: Unexplained clinical conditions share
features, including symptoms (fatigue, pain), disability out of proportion to
physical examination findings, inconsistent demonstration of laboratory
abnormalities, and an association with "stress" and psychosocial factors.
This literature review examines the nature and extent of the overlap among
these unexplained clinical conditions and the limitations of previous
research. DATA SOURCES: English-language articles were identified by a search
of the MEDLINE database from 1966 to January 2001 by using individual syndromes
and their hallmark symptoms as search terms. STUDY SELECTION: Studies that
assessed patients with at least one unexplained clinical condition and that
included information on symptoms, overlap with other unexplained clinical
conditions, or physiologic markers. Conditions examined were the chronic
fatigue syndrome, fibromyalgia, the irritable bowel syndrome, multiple chemical
sensitivity, temporomandibular disorder, tension headache, interstitial cystitis,
and the postconcussion syndrome. DATA EXTRACTION: Information on authorship,
patient and control groups, eligibility criteria, case definitions, study
methods, and major findings. DATA SYNTHESIS: Many similarities were apparent
in case definition and symptoms, and the proportion of patients with one
unexplained clinical condition meeting criteria for a second unexplained
condition was striking. Tender points on physical examination and decreased
pain threshold and tolerance were the most frequent and consistent objective
findings. A major shortcoming of all proposed explanatory models is their
inability to account for the occurrence of unexplained clinical conditions in
many affected patients. CONCLUSIONS: Overlap between unexplained clinical
conditions is substantial. Most studies are limited by methodologic problems,
such as case definition and the selection and recruitment of case-patients and
controls.
Ann Intern Med 2001 May 1; 134(9 Pt
2):868-81
Anders C, Sprott H, Scholle HC
Surface EMG of the lumbar part of the erector
trunci muscle
in patients with fibromyalgia
OBJECTIVE: To determine differences supposed
in EMG parameters of the erector trunci region between patients with fibromyalgia
and healthy subjects during defined investigation situations. METHODS: During
sitting and standing in upright position surface EMG (SEMG) from 15 subjects
with fibromyalgia and 10 healthy controls was performed using a 16-channel
technique where the electrodes were applied in a well-defined grid pattern
(gain 5000, 3 db points at 5 Hz and 700 Hz respectively). SEMG quantification
was done by Fourier algorithm using 512 measurement points for calculation.
RESULTS: An increased EMG amplitude could be recorded during rest in
fibromyalgia patients compared with controls. Spatial amplitude differences
(frequency range 100-500 Hz) in the low back region were significantly (p < 0.01) decreased in the patients' group during sitting.
CONCLUSION: It is the first time that a decreased difference in EMG amplitude
of different parts within a certain muscle could be proven in patients with
fibromyalgia. As far as is known from the literature this result seems to be a
unique finding in fibromyalgia patients.
Clin Exp Rheumatol 2001 Jul-Aug;
19(4):453 5
Anthony KK, Schanberg L
Juvenile primary fibromyalgia syndrome
Juvenile primary fibromyalgia syndrome (JPFS)
is a common musculoskeletal pain syndrome of unknown etiology characterized by
widespread persistent pain, sleep disturbance, fatigue, and the presence of
multiple discrete tender points on physical examination. Other associated
symptoms include chronic anxiety or tension, chronic headaches, subjective soft
tissue swelling, and pain modulated by physical activity, weather, and anxiety
or stress. Research and clinical observations suggest that JPFS may have a
chronic course that impacts the functional status and psychosocial development
of children and adolescents. In addition, several factors have been implicated
in the etiology and maintenance of JPFS including genetic and anatomic factors,
disordered sleep, psychological distress, and familial and environmental
influences. A multidisciplinary approach to treatment of JPFS is advocated,
including pharmacologic and nonpharmacologic interventions (e.g.,
psychotherapy, aerobic exercise, sleep hygiene).
Curr Rheumatol Rep 2001 Apr; 3(2):165-71
Barkhuizen A
Pharmacologic treatment of fibromyalgia
Fibromyalgia is a chronic syndrome
characterized by widespread pain, unrefreshed sleep, disturbed mood, and
fatigue. Until such time as we have a clearer understanding of the trigger
and/or pathophysiologic mechanisms producing these symptoms, pharmacologic
treatment should be aimed at individual symptoms. Such treatment should ideally
be offered as part of a multidisciplinary treatment program using both
pharmacologic and nonpharmacologic treatment modalities. Critical components of
any successful fibromyalgia treatment program include addressing physical fitness,
work and other functional activities, and mental health, in addition to
symptom- specific therapies. The main symptoms that should be addressed include
pain, sleep disturbances including restless leg syndrome, mood disturbances,
and fatigue. Pharmacologic therapy should also be considered for syndromes
commonly associated with fibromyalgia including irritable bowel syndrome,
interstitial cystitis, migraine headaches, temporomandibular joint
dysfunction, dysequilibrium including neurally mediated hypotension, sicca
syndrome, and growth hormone deficiency. This article provides general
guidelines in initiating a successful pharmacologic treatment program for
fibromyalgia.
Curr Pain Headache Rep 2001 Aug; 5(4):351-8
Bell IR, Baldwin CM, Stoltz E, Walsh BT,
Schwartz GE
EEG beta 1 oscillation and sucrose
sensitization
in fibromyalgia with chemical intolerance
Patients with fibromyalgia (FM) have diffuse
musculoskeletal pain; half report concomitant intolerance for low levels of
environmental chemicals (CI). Previous investigators have hypothesized that the
chronic pain and chemical intolerance reflect sensitization of different
central nervous system limbic and/or mesolimbic reward pathways. We evaluated
electroencephalographic (EEG) beta activity and blood glucose responses of FM
patients with and without CI and normals during three repeated sucrose
ingestion sessions and during a final, water-only session (testing for
conditioning). The FM with CI exhibited oscillation (reversal in direction of
change from session to session) at rest and then sensitization (progressive
amplification) of EEG beta 1 over time across the 3 sucrose sessions versus
controls. FM with CI showed sensitization of blood glucose over the 3 sucrose
sessions, which, like the EEG findings, reverted toward baseline in the final
water-only session. The data suggest that the subset of FM patients with CI
have increased susceptibility to oscillation and physiological sensitization
without conditioning, perhaps contributing to fluctuations in their chronic
course.
Int J Neurosci 2001 May; 108(1-2):31-42
Buskila D
Fibromyalgia, chronic fatigue syndrome, and
myofascial pain syndrome
The prevalence of chronic widespread pain in the
general population in Israel was comparable with reports from the USA, UK, and
Canada. Comorbidity with fibromyalgia (FM) resulted in somatic hyperalgesia in
patients with irritable bowel syndrome. One sixth of the subjects with chronic
widespread pain in the general population were also found to have a mental
disorder. Mechanisms involved in referred pain, temporal summation, muscle
hyperalgesia, and muscle pain at rest were attenuated by the
N-methyl-D-aspartate (NMDA) antagonist, ketamine, in FM patients. Delayed
corticotropin release, after interleukin-6 administration, in FM was shown to
be consistent with a defect in hypothalamic corticotropin-releasing hormone
neural function. The basal autonomic state of FM patients was characterized by
increased sympathetic and decreased parasympathetic systems tones. The
severity of functional impairment as assessed by the Medical Outcome Survey
Short Form (SF-36) discriminated between patients with widespread pain alone
and FM patients. Chronic fatigue syndrome (CFS) occurred in about 0.42% of a
random community- based sample of 28,673 adults in Chicago, Illinois. A
significant clinical overlap between CFS
and FM was reported. Cytokine dysregulation was not found to be a
singular or dominant factor in the pathogenesis of CFS. A favorable outcome of
CFS in children was reported;
two-thirds recovered and resumed normal activities. No major therapeutic trials
in FM and CFS were reported over the
past year.
Curr Opin Rheumatol 2001 Mar; 13(2):117-27
Clark SR, Jones KD, Burckhardt CS, Bennett R
Exercise for patients with fibromyalgia:
risks versus benefits
Although exercise in the form of stretching,
strength maintenance, and aerobic conditioning is generally considered
beneficial to patients with fibromyalgia (FM), there is no reliable evidence to
explain why exercise should help alleviate the primary symptom of FM, namely
pain. Study results are varied and do not provide a uniform consensus that
exercise is beneficial or what type, intensity, or duration of exercise is
best. Patients who suffer from exercise-induced pain often do not follow
through with recommendations. Evidence-based prescriptions are usually
inadequate because most are based on methods designed for persons without FM
and, therefore, lack individualization. A mismatch between exercise intensity
and level of conditioning may trigger a classic neuroendocrine stress reaction.
This review considers the adverse and beneficial effects of exercise. It also
provides a patient guide to exercise that takes into account the risks and
benefits of exercise for persons with FM.
Curr Rheumatol Rep 2001 Apr; 3(2):135-40
Clauw DJ
Elusive syndromes: treating the biologic basis
of fibromyalgia and related syndromes
Newer theories suggest that patients with fibromyalgia
have a biologic predisposition to perceiving pain with more sensitivity than
people without fibromyalgia. Several biologic triggers are implicated as
possibly initiating or worsening the symptoms of fibromyalgia. Treatments to
manage pain, help with sleep, and, when needed, treat cognitive disturbances
show some success.
Cleve Clin J Med 2001 Oct;
68(10):830, 832-4
Crofford LJ, Appleton BE
Complementary and alternative therapies
for fibromyalgia
Fibromyalgia (FM) is a syndrome of chronic
widespread musculoskeletal pain that is accompanied by sleep disturbance and
fatigue. Clinical treatment usually includes lifestyle modifications and
pharmacologic interventions meant to relieve pain, improve sleep quality, and
treat mood disorders. These therapies are often ineffective or have been shown
in clinical studies to have only short-term effectiveness. Pharmacologic
treatments have considerable side effects. Patients may have difficulty
complying with exercise-based treatments. Thus, patients seek alternative
therapeutic approaches and physicians are routinely asked for advice about
these treatments. This article reviews nontraditional treatment alternatives,
from use of nutritional and herbal supplements to acupuncture and mind-body
therapy. Little is known about efficacy and tolerance of complementary and
alternative therapies in FM and other chronic musculoskeletal pain syndromes.
Most studies on these treatments have been performed for osteoarthritis,
rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are
scarce; the quality of these trials is often criticized because of small study
population size, lack of appropriate control interventions, poor compliance, or
short duration of follow-up. However, because of widespread and growing use of
alternative medicine, especially by persons with chronic illnesses, it is
essential to review efficacy and adverse effects of complementary and
alternative therapies.
Curr Rheumatol Rep 2001 Apr; 3(2):147-56
Elert J, Kendall SA, Larsson B, Mansson B,
Gerdle B
Chronic pain and difficulty in relaxing
postural muscles
in patients with fibromyalgia and chronic
whiplash
associated disorders
OBJECTIVE: To investigate if muscle tension
according to the surface electromyogram (EMG) of the shoulder flexors is
increased in consecutive patients with fibromyalgia (FM) or chronic whiplash
associated disorders (WAD). METHODS: A total of 59 consecutive patients with FM
(N = 36) or chronic WAD (N = 23) performed 100 maximal isokinetic contractions
combined with surface electromyography of the trapezius and infraspinatus. A
randomized group of pain-free female (N = 27) subjects served as control group.
Peak torque initially (PTi) and absolute and relative peak torque at endurance
level (PTe, PTer) were registered as output variables, together with the EMG
level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR).
RESULTS: The patient groups had a higher level of unnecessary tension initially
and at the endurance level. The patients had lower absolute output (PTi and
PTe), but the relative levels (PTer) did not differ comparing all 3 groups.
Subjects with FM had significantly higher body mass index (BMI) than the other
groups. BMI did not influence the SAR but correlated positively with PT.
CONCLUSION: The results confirmed earlier findings that groups of patients with
chronic pain have increased muscle tension and decreased output during dynamic
activity compared to pain-free controls. However, the results indicated there
is heterogeneity within groups of patients with the same chronic pain disorder
and that not all patients with chronic pain have increased muscle tension.
J Rheumatol 2001 Jun; 28(6):1361-8
Gantz NM, Coldsmith EE
Chronic fatigue syndrome and fibromyalgia
resources
on the world wide web: a descriptive journey
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.
Clin Infect Dis 2001 Mar 15; 32(6):938-48
Glass JM, Park DC
Cognitive dysfunction in fibromyalgia
Fibromyalgia is a puzzling syndrome of
widespread musculoskeletal pain. In addition to pain, patients with fibromyalgia
frequently report that cognitive function, memory, and mental alertness have
declined. A small body of literature suggests that there is cognitive
dysfunction in fibromyalgia. This article addresses several questions that
physicians may have regarding cognitive function in their patients. These
questions concern the types of cognitive tasks that are problematic for
patients with fibromyalgia, the role of psychological factors such as
depression and anxiety, the role of physical factors such as pain and fatigue,
the nature of patients' perceptions of their cognitive abilities, and whether
patients can be tested for cognitive dysfunction. Critical areas for further
investigation are highlighted.
Curr Rheumatol Rep 2001 Apr; 3(2):123-7
Goulding C, O'Connell P, Murray FE
Prevalence of fibromyalgia, anxiety and
depression
in chronic hepatitis C virus infection:
relationship
to RT-PCR status and mode of acquisition
BACKGROUND: Musculoskeletal complaints, dry
eyes, fatigue and anxiety are common symptoms in patients with hepatitis C
virus (HCV) infection, but there are few controlled data evaluating this. AIM:
To assess the prevalence of rheumatological disease, fatigue and anxiety in
different groups of patients with chronic HCV infection. PATIENTS AND METHODS:
Seventy-seven patients with HCV were evaluated. Of these, 49 (64%) had been
infected via contaminated anti-D immunoglobulin, 25 (33%) were intravenous drug
users (IVDUs), and three were transfusion related; 78% were female. Twenty-five
age- and sex-matched controls were also evaluated. Assessment was performed by
history, physical examination, the Fibromyalgia Impact Questionnaire (FIQ) and
the Hospital Anxiety and Depression Score (HADS). RESULTS: Four (5%) patients
fulfilled the criteria for fibromyalgia. All were infected via anti-D
immunoglobulin, and three were PCR positive. The mean number of tender points
in anti-D patients was 5.0 (+/- 4.07) compared with 2.8 (+/- 2.7) in controls
(p = 0.028) and 2.5 (+/- 2.2) in IVDUs (p < 0.004). There was no significant difference in the number of
tender points between PCR-positive and PCR-negative patients (p = 0.23). Anxiety and depression scores were
significantly higher in anti-D patients (p = 0.0001) and IVDUs (p = 0.005)
compared with controls. Forty per cent of the HCV patients had a positive
Schirmer test. Forty-two per cent of PCR-positive patients had a positive
rheumatoid factor (RF > 1/80). CONCLUSION: This study reveals a moderate
increase in prevalence of fibromyalgia in HCV patients. The number of tender
points was related to mode of acquisition but not to PCR status. Anxiety and
depression levels are also increased in HCV patients compared with controls.
Prevalence of RF was higher in PCR-positive patients compared with controls and
those who had cleared the virus.
Eur J Gastroenterol Hepatol 2001 May; 13(5):507-11
Granot M, Buskila D, Granovsky Y, Sprecher E,
Neumann L, Yarnitsky D
Simultaneous recording of late and ultra-late
pain evoked potentials in fibromyalgia
OBJECTIVE: To characterize laser evoked
potentials (LEP), pain psychophysics and local tissue response in fibromyalgia
patients. METHODS: LEP were recorded in 14 women with fibromyalgia in response
to bilateral stimulation of tender and control points in upper limbs by 4
blocks of 20 stimuli at each point. Subsequently, heat pain thresholds were
measured and supra-threshold magnitude estimations of heat pain stimuli were
obtained on a visual analogue scale. Finally, the extent of the local tissue
response induced by the previous stimuli was evaluated. RESULTS: Laser stimuli
elicited two long latency waves: A late wave (mean latency 368.9+/-66.9 ms) in
most patients (13/14) from stimuli at all points, and an ultra-late wave (mean
latency 917.3+/-91.8 ms) in 78.5% of the patients at the control points and in
71.4% at the tender points. Amplitude of ultra-late waves was higher at the
tender points (20.67+/-11.1 &mgr;V) than at the control points (10.47+/-4.1
&mgr;V) (p = 0.016). Pain
thresholds were lower in the tender (41.2+/-2.7 degrees C) than the control
points (43.9+/-3.2 degrees C) (p = 0.008). Local tissue response was
significantly more intense at tender than control points (p = 0.004). CONCLUSIONS: Ultra-late laser evoked
potentials can be recorded simultaneously with late potentials. Our findings
are compatible with presence of peripheral C-fiber sensitization, mostly at
tender points, probably combined with generalized central sensitization of pain
pathways in fibromyalgia.
Clin Neurophysiol 2001 Oct; 112(10):1881-7
Jentoft ES, Kvalvik AG, Mengshoel AM
Effects of pool-based and land-based aerobic
exercise on
women with fibromyalgia/chronic widespread
muscle pain
OBJECTIVE: To examine the effects of pool-based
(PE) and land-based (LE) exercise programs on patients with fibromyalgia.
METHODS: The outcomes were assessed by the Fibromyalgia Impact Questionnaire,
the Arthritis Self-Efficacy Scale, and tests of physical capacity. RESULTS:
Eighteen subjects in the PE group and 16 in the LE group performed a structured
exercise program. After 20 weeks, greater improvement in grip strength was seen
in the LE group compared with the PE group (p< 0.05). Statistically significant improvements were seen
in both groups in cardiovascular capacity, walking time, and daytime fatigue.
In the PE group improvements were also found in number of days of feeling good,
self-reported physical impairment, pain, anxiety, and depression. The results
were mainly unchanged at 6 months follow-up. CONCLUSION: Physical capacity can
be increased by exercise, even when the exercise is performed in a warm-water
pool. PE programs may have some additional effects on symptoms.
Arthritis Rheum 2001 Feb; 45(1):42-7
Klerman EB, Goldenberg DL, Brown EN,
Maliszewski AM, Adler GK
Circadian rhythms of women with fibromyalgia
Fibromyalgia syndrome is a chronic and
debilitating disorder characterized by widespread nonarticular musculoskeletal
pain whose etiology is unknown. Many of the symptoms of this syndrome,
including difficulty sleeping, fatigue, malaise, myalgias, gastrointestinal
complaints, and decreased cognitive function, are similar to those observed in
individuals whose circadian pacemaker is abnormally aligned with their
sleep-wake schedule or with local environmental time. Abnormalities in
melatonin and cortisol, two hormones whose secretion is strongly influenced by
the circadian pacemaker, have been reported in women with fibromyalgia. We
studied the circadian rhythms of 10 women with fibromyalgia and 12 control
healthy women. The protocol controlled factors known to affect markers of the
circadian system, including light levels, posture, sleep-wake state, meals, and
activity. The timing of the events in the protocol were calculated relative to
the habitual sleep-wake schedule of each individual subject. Under these
conditions, we found no significant difference between the women with
fibromyalgia and control women in the circadian amplitude or phase of rhythms
of melatonin, cortisol, and core body temperature. The average circadian phases
expressed in hours posthabitual bedtime for women with and without fibromyalgia
were 3:43 +/- 0:19 and 3:46 +/- 0:13, respectively, for melatonin; 10:13 +/-
0:23 and 10:32 +/- 0:20, respectively for cortisol; and 5:19 +/- 0:19 and 4:57
+/- 0:33, respectively, for core body temperature phases. Both groups of women
had similar circadian rhythms in self-reported alertness. Although pain and
stiffness were significantly increased in women with fibromyalgia compared with
healthy women, there were no circadian rhythms in either parameter. We suggest
that abnormalities in circadian rhythmicity are not a primary cause of
fibromyalgia or its symptoms.
J Clin Endocrinol Metab 2001 Mar; 86(3):1034-9
Landis CA, Lentz MJ, Rothermel J, Riffle SC,
Chapman D,
Buchwald D, Shaver JL
Decreased nocturnal levels of prolactin and
growth hormone
in women with fibromyalgia
Fibromyalgia (FM) is a complex syndrome,
primarily of women, characterized by chronic pain, fatigue, and sleep
disturbance. Altered function of the somatotropic axis has been documented in
patients with FM, but little is known about nocturnal levels of prolactin
(PRL). As part of a laboratory study of sleep patterns in FM, we measured the
serum concentrations of GH and PRL hourly from 2000 0700 h in a sample of 25
women with FM (mean, 46.9 +/- 7.6 yr) and in 21 control women (mean, 42.6 +/-
8.1 yr). The mean (+/-SEM ) serum concentrations (micrograms per L) of GH and
of PRL during the early sleep period were higher in control women than in
patients with FM [GH, 1.6 +/- 0.4 vs. 0.6 +/- 0.2 (p < 0.05); PRL, 23.2 +/- 2.2 vs. 16.9 +/- 2.0 (p <0.025)]. The mean serum concentrations of GH and PRL increased
more after sleep onset in control women than in patients with FM [GH, 1.3 +/-
0.4 vs. 0.3 +/- 0.2 (p <0.05); PRL,
16.2 +/- 2.4 vs. 9.7 +/- 1.5 (p < 0.025)].
Sleep efficiency and amounts of sleep or wake stages on the blood draw night
were not different between groups. There was a modest inverse relationship
between sleep latency and PRL and a direct relationship between sleep
efficiency and PRL in FM. There was an inverse relationship between age and GH
most evident in control women.
J Clin Endocrinol Metab 2001 Apr; 86(4):1672-8
Legangneux E, Mora JJ, Spreux-Varoquaux O,
Thorin I,
Herrou M, Alvado G, Gomeni C
Cerebrospinal fluid biogenic amine
metabolites,
plasma-rich platelet serotonin and
[(3)H]imipramine
reuptake in the primary fibromyalgia syndrome
BACKGROUND: Primary fibromyalgia syndrome
(PFS) is a chronic disorder commonly seen in rheumatological practice. The
pathophysiological disturbances of this syndrome, which was defined by the
American College of Rheumatology in 1990, are poorly understood. This study
evaluated, in 30 patients, the hypothesis that PFS is a pain modulation
disorder induced by deregulation of serotonin metabolism. OBJECTIVES: To compare platelet
[(3)H]imipramine binding sites and serotonin (5-HT) levels in plasma-rich
platelets (PRP) of PFS patients with those of matched healthy controls and to
compare the levels of biogenic amine metabolites in the cerebrospinal fluid
(CSF) of PFS patients with those of matched controls. METHODS: Platelet
[(3)H]imipramine binding sites were defined by two criteria, B(max) for their
density and K(d) for their affinity.
PRP 5-HT and CSF metabolites of 5-HT (5-hydroxyindoleacetic acid, 5-HIAA), norepinephrine (3-methoxy,
4-hydroxy phenylglycol, MHPG) and dopamine (homovanillic acid, HVA) were
assayed by reversed-phase high-performance liquid chromatography with
coulometric detection. RESULTS:
[(3)H]imipramine platelet binding was similar (p = 0.43 for B(max) and p = 0.30
for K(d)) in PFS patients (B(max)=901+/-83 fmol/mg protein, K(d)=0.682+/-0.046)
and in matched controls (B(max)=1017+/-119 fmol/mg protein,
K(d)=0.606+/-0.056). PRP 5-HT was significantly higher (p = 0.0009) in PFS patients (955+/-101
ng/10(9) platelets) than in controls (633+/-50 ng/10(9) platelets). When
adjusted for age, the levels of all CSF metabolites were lower in PFS patients.
The CSF metabolite of norepinephrine (MHPG) was lower (p = 0.003) in PFS
patients (8.33+/-0.33 ng/ml) than in
matched controls (9.89+/-0.31 ng/ml) and 5-HIAA was lower (p = 0.042) in PFS
female patients (22.34+/-1.78 ng/ml)
than in matched controls (25.75+/-1.75 ng/ml). For HVA in females, the
difference between PFS patients (36.32+/-3.20 ng/ml) and matched controls
(38.32+/-2.90 ng/ml) approached statistical significance (p = 0.054). CONCLUSION: Changes in
metabolites of CSF biogenic amines appear to be partially correlated to age but
remained diagnosis- dependent. High levels of PRP 5-HT in PFS patients were associated
with low CSF 5-HIAA levels in female patients but were not accompanied by any
change in serotonergic uptake as assessed by platelet [(3)H]imipramine binding
sites. These findings do not allow us to confirm that serotonin metabolism is
deregulated in PFS patients.
Rheumatology (Oxford) 2001 Mar; 40(3):290-6
Mueller HH, Donaldson CC, Nelson DV, Layman M
Treatment of fibromyalgia incorporating
EEG-driven
stimulation: A clinical outcomes study
Thirty patients from a private clinical
practice who met the 1990 American College of Rheumatology criteria for
fibromyalgia syndrome (FS) were followed prospectively through a
brainwave-based intervention known as electroencephalograph (EEG)-driven
stimulation or EDS. Patients were initially treated with EDS until they
reported noticeable improvements in mental clarity, mood, and sleep.
Self-reported pain, then, having changed from vaguely diffuse to more
specifically localized, was treated with very modest amounts of physically
oriented therapies. Pre- to post-treatment and extended follow-up comparisons
of psychological and physical functioning indices, specific FS symptom ratings,
and EEG activity revealed statistically significant improvements. EDS appeared
to be the prime initiator of therapeutic efficacy. Future research is justified
for controlled clinical trials and to better understand disease mechanisms.
J Clin Psychol 2001 Jul;
57(7):933-52
Naschitz JE, Rozenbaum M, Rosner I, Sabo E,
Priselac RM,
Shaviv N, Ahdoot A, Ahdoot M, Gaitini L, Eldar
S, Yeshurun D
Cardiovascular response to upright tilt in
fibromyalgia
differs from that in chronic fatigue syndrome
OBJECTIVE: To compare the cardiovascular
response during postural challenge of patients with fibromyalgia (FM) to those
with chronic fatigue syndrome (CFS). Age and sex matched patients were studied,
38 with FM, 30 with CFS, and 37 healthy subjects. Blood pressure (BP) and heart
rate (HR) were recorded during 10 min of recumbence and 30 min of head-up tilt.
Differences between successive BP values and the last recumbent BP, their
average, and standard deviation (SD) were calculated. Time curves of BP
differences were analyzed by computer and their outline ratios (OR) and fractal
dimensions (FD) were measured. HR differences were determined similarly. Based
on the latter measurements, each subject's discriminant score (DS) was
computed. RESULTS: For patients and controls average DS values were: FM: -3.68
(SD 2.7), CFS: 3.72 (SD 5.02), and healthy controls: -4.62 (SD 2.24). DS values
differed significantly between FM and CFS
(p < 0.0001). Subgroups of FM
patients with and without fatigue had comparable DS values. CONCLUSION: The
DS confers numerical expression to the
cardiovascular response during postural challenge. DS values in FM were significantly different from DS in CFS, suggesting
that homeostatic responses in FM and CFS are dissimilar.This observation
challenges the hypothesis that FM and CFS share a common derangement of the
stress-response system.
J Rheumatol 2001 Jun;
28(6):1356-60
Pall ML
Common etiology of posttraumatic stress
disorder,
fibromyalgia, chronic fatigue syndrome and
multiple
chemical sensitivity via elevated nitric
oxide/peroxynitrite
Three types of overlap occur among the disease
states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical
sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common
symptoms. Many patients meet the criteria for diagnosis for two or more of
these disorders and each disorder appears to be often induced by a relatively
short-term stress which is followed by a chronic pathology, suggesting that the
stress may act by inducing a self-perpetuating vicious cycle. Such a vicious
cycle mechanism has been proposed to explain the etiology of CFS and MCS, based
on elevated levels of nitric oxide and its potent oxidant product,
peroxynitrite. Six positive feedback loops were proposed to act such that when
peroxynitrite levels are elevated, they may remain elevated. The biochemistry
involved is not highly tissue-specific, so that variation in symptoms may be
explained by a variation in nitric oxide/peroxynitrite tissue distribution. The
evidence for the same biochemical mechanism in the etiology of PTSD and FM is
discussed here, and while less extensive than in the case of CFS and MCS, it is
nevertheless suggestive. Evidence supporting the role of elevated nitric
oxide/peroxynitrite in these four disease states is summarized, including
induction of nitric oxide by common apparent inducers of these disease states,
markers of elevated nitric oxide/ peroxynitrite in patients and evidence for an
inductive role of elevated nitric oxide in animal models. This theory appears
to be the first to provide a mechanistic explanation for the multiple overlaps
of these disease states and it also explains the origin of many of their common
symptoms and similarity to both Gulf War syndrome and chronic sequelae of
carbon monoxide toxicity. This theory suggests multiple studies that should be
performed to further test this proposed mechanism. If this mechanism proves
central to the etiology of these four conditions, it may also be involved in
other conditions of currently obscure etiology and criteria are suggested for
identifying such conditions.
Med Hypotheses 2001 Jul; 57(2):139-45
Staud R, Vierck CJ, Cannon RL, Mauderli AP,
Price DD
Abnormal sensitization and temporal summation
of pain
(wind-up) in patients with fibromyalgia
syndrome
Although individuals with fibromyalgia
syndrome (FMS) consistently report widespread pain, clear evidence of structural
abnormalities or other sources of chronic stimulation of pain afferents in the
involved body areas is lacking. Without convincing evidence for peripheral
tissue abnormalities in FMS patients, it seems likely that a central
pathophysiological process is at least partly responsible for FMS, as is the
case for many chronic pain conditions. Therefore, the present study sought to
obtain psychophysical evidence for the possibility that input to central
nociceptive pathways is abnormally processed in individuals with longstanding
FMS. In particular, temporal summation of pain (wind-up) was assessed, using
series of repetitive thermal stimulation of the glabrous skin of the hands.
Although wind-up was evoked both in control and FMS subjects, clear differences
were observed. The perceived magnitude of the sensory response to the first
stimulus within a series was greater for FMS subjects compared to controls, as
was the amount of temporal summation within a series. Within series of stimuli,
FMS subjects reported increases in sensory magnitude to painful levels for
interstimulus intervals of 2 5 s, but pain was evoked infrequently at intervals
greater than 2 s for control subjects. Following the last stimulus in a series,
after-sensations were greater in magnitude, lasted longer and were more
frequently painful in FMS subjects. These results have multiple implications
for the general characterization of pain in FMS and for an understanding of the
underlying pathophysiological basis.
Pain 2001 Mar;
91(1-2):165-75
Thomas AW, White KP, Drost DJ, Cook CM, Prato
FS
A comparison of rheumatoid arthritis and
fibromyalgia
patients and healthy controls exposed to a
pulsed (200
microT) magnetic field: effects on normal
standing balance
Specific weak time-varying pulsed magnetic
fields (MF) have been shown to alter animal and human behaviors, including pain
perception and postural sway. Here we demonstrate an objective assessment of
exposure to pulsed MF's on Rheumatoid Arthritis (RA) and Fibromyalgia (FM)
patients and healthy controls using standing balance. 15 RA and 15 FM patients
were recruited from a university hospital outpatient Rheumatology Clinic and 15
healthy controls from university students and personnel. Each subject stood on
the center of a 3-D forceplate to record postural sway within three square
orthogonal coil pairs (2 m, 1.75 m, 1.5 m) which generated a spatially uniform
MF centered at head level. Four 2-min exposure conditions (eyes open/eyes
closed, sham/MF) were applied in a random order. With eyes open and during sham
exposure, FM patients and controls appeared to have similar standing balance,
with RA patients worse. With eyes closed, postural sway worsened for all three
groups, but more for RA and FM patients than controls. The Romberg Quotient (eyes
closed/eyes open) was highest among FM patients. Mixed design analysis of
variance on the center of pressure (COP) movements showed a significant
interaction of eyes open/closed and sham/MF conditions [F = 8.78 (1,42), p < 0.006]. Romberg Quotients of COP movements improved
significantly with MF exposure [F = 9.5 (1,42), p < 0.005] and COP path length showed an interaction approaching
significance with clinical diagnosis [F = 3.2 (1,28), p < 0.09]. Therefore RA and FM patients, and healthy controls,
have significantly different postural sway in response to a specific pulsed MF.
Neurosci Lett 2001 Aug 17;
309(1):17-20
Wallace DJ, Hallegua DS
Quality-of-life, legal-financial, and
disability issues
in fibromyalgia
Patients with fibromyalgia have an altered
quality of life that is hard to quantitate using existing indices. The
principal legal issues associated with the syndrome are: Does fibromyalgia
exist? Can it be caused by or flared by stress or trauma? Does disability apply
to fibromyalgia and if so, how? These issues are critically reviewed.
Curr Pain Headache Rep 2001 Aug;
5(4):313-9
Wallace DJ, Linker-Israeli M, Hallegua D,
Silverman S,
Silver D, Weisman MH
Cytokines play an aetiopathogenetic role in fibromyalgia:
a hypothesis and pilot study
OBJECTIVE: To measure soluble factors having a
possible role in fibromyalgia (FM) and compare the profiles of patients with
recent onset of the syndrome with patients with chronic FM. METHODS: The
production of cytokines, cytokine-related molecules, and a CXC chemokine,
interleukin (IL-8), was examined. Fifty-six patients with FM (23 with < 2 yr
and 33 with > 2 yr of symptoms) were compared with age- and sex-matched
healthy controls. Cytokines and cytokine-related molecules were measured in
sera and in supernatants of peripheral blood mononuclear cells (PBMC) that were
incubated with and without lectins and phorbol myristate acetate (PMA).
RESULTS: No differences between FMS and controls were found by measuring IL-1beta,
IL-2, IL-10, serum IL-2 receptor (sIL-2R), interferon gamma (IFN-gamma), and
tumour necrosis factor alpha (TNF-alpha). Levels of IL-1R antibody (IL-1Ra) and
IL-8 were significantly higher in sera, and IL-1Ra and IL-6 were significantly
higher in stimulated and unstimulated FM
PBMC compared with controls. Serum IL-6 levels were comparable to those
in controls, but were elevated in supernatants of in vitro-activated PBMC
derived from patients with > 2 yr of symptoms. In the presence of PMA, there
were additional increases in IL-1Ra, IL-8 and IL-6 over control values.
CONCLUSIONS: In patients with FM we found increases over time in serum levels
and/or PBMC-stimulated activity of soluble factors whose release is stimulated
by substance P. Because IL-8 promotes sympathetic pain and IL-6 induces
hyperalgesia, fatigue and depression, it is hypothesized that they may play a
role in modulating FM symptoms.
Rheumatology (Oxford) 2001 Jul;
40(7):743-9
Werle E, Fischer HP, Muller A, Fiehn W, Eich W
Antibodies against serotonin have no
diagnostic relevance
in patients with fibromyalgia syndrome
OBJECTIVE: To determine the prevalence and
potential diagnostic relevance of autoantibodies against serotonin,
thromboplastin, and ganglioside Gm1 in patients with fibromyalgia syndrome
(FM). METHODS: Sera from 203 patients with FM and 64 pain-free control subjects
were analyzed with enzyme immunoassays. Clinical and psychometric data of the
patients were analyzed for the presence or absence of autoantibodies. RESULTS:
Compared with control subjects patients with FM had a significantly higher
prevalence of autoantibodies against serotonin (20% vs 5%; p = 0.003) and
thromboplastin (43% vs 9%; p < 0.001), but
not against ganglioside Gm1 (15% vs 9%; p = 0.301). Differences in autoantibody
prevalence between controls and FM patients were not related to age or sex. No
association was found between autoantibody pattern and clinical or psychometric
data, e.g., pain, depression, pain related anxiety, and activities of daily
living. CONCLUSION: There is an elevated prevalence of antibodies against
serotonin and thromboplastin in patients with FM. The pathophysiological
significance of this finding is unknown. Calculation of positive predictive
values of antiserotonin antibodies shows that measurement of these antibodies
has no diagnostic relevance.
J Rheumatol 2001 Mar; 8(3):595-600
Wittrup IH, Jensen B, Bliddal H,
Danneskiold-Samsoe B, Wiik A
Comparison of viral antibodies in 2 groups of
patients
with fibromyalgia
OBJECTIVE
: The etiologies of fibromyalgia (FM) are unknown. In some cases an acute onset
following a flu-like episode is described; in other cases patients report
slowly developing disease. We previously found increased prevalence of
enterovirus IgM antibodies in patients with acute onset of FM compared to
healthy controls. We looked for differences in antimicrobial IgM antibodies in
acute versus nonacute onset FM. METHODS: Two well defined, comparable groups of
patients with FM (acute 19, nonacute 20) were studied for antibodies in serum
to an array of viruses including IgM antibodies. RESULTS: In most viruses no
IgM antibodies were found. However, about 50% of the patients with acute FM
onset had IgM antibodies against enterovirus compared to only 15% of the slow
onset patients. CONCLUSION: The higher prevalence of IgM antibodies against
enterovirus in patients with acute onset of FM may indicate a difference in the
etiology or the immune response in these patients.
J Rheumatol 2001 Mar; 8(3):601-3
Worrel LM, Krahn LE, Sletten CD, Pond GR
Treating fibromyalgia with a brief
interdisciplinary program:
initial outcomes and predictors of response
OBJECTIVES: To evaluate the efficacy of a
brief, intense treatment program for fibromyalgia and to determine which
patient characteristics are associated with a better treatment response.
PATIENTS AND METHODS: Two self-report measures, the Fibromyalgia Impact
Questionnaire (FIQ) and the Multidimensional Pain Inventory (MPI), were
administered before patients completed treatment and 1 month after
participating in the program. The main outcome measure was the difference in
FIQ score and MPI scale before and after program participation. RESULTS: Of 139
patients who met the American College of Rheumatology criteria for
fibromyalgia, 100 chose to participate in the 1 1/2-day Fibromyalgia Treatment
Program at the Mayo Clinic, Rochester, Minn. Of these 100 patients, 74
completed the follow-up surveys. Patients were less affected by fibromyalgia
after participation in the treatment program. This was demonstrated by a
post-treatment improvement in the total FIQ score (p < .001), the MPI pain severity score (p < .001), and the MPI interference score (p = .01). The 1
patient characteristic found to be significantly associated (p < .001) with a better response to treatment was a high
pretreatment level of impairment from fibromyalgia, as measured by the
pretreatment FIQ score. CONCLUSIONS: A brief interdisciplinary program for
treating fibromyalgia reduced some associated symptoms. Patients more severely
affected by fibromyalgia may benefit most from this approach. Clinicians may
apply these findings to develop beneficial and convenient treatment programs
for patients with fibromyalgia.
Mayo Clin Proc 2001 Apr; 76(4):384