Showing papers on "Fibromyalgia published in 1992"

The fibromyalgia and myofascial pain syndromes: A preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease

Abstract: Four experts on myofascial pain syndrome (MFP) performed trigger point examinations and 4 experts on fibromyalgia performed tender point examinations on 3 groups of subjects (7 patients with fibromyalgia, 8 with MFP, and 8 healthy persons) while blinded as to diagnosis. Local tenderness was common in both disease groups (65-82%), but was elicited in a greater proportion of MFP experts' examinations (82%). Active trigger points were found in about 18% of examinations of patients with fibromyalgia and MFP, but latent trigger points were rare in all groups. A more liberal definition of trigger point, however, resulted in a 38 and 23% positive rate among patients with fibromyalgia and MFP, respectively. Taut muscle bands and muscle twitches were common (50 and 30%, respectively) and noted equally in all 3 diagnostic groups. Problems with reliability were identified for taut bands, muscle twitch, and active trigger points. Our data are exploratory and tentative, but suggest that attention to definition and reliability are required to advance our knowledge of these common syndromes.

Electroacupuncture in fibromyalgia: results of a controlled trial.

Abstract: OBJECTIVE--To determine the efficacy of electroacupuncture in patients with fibromyalgia, a syndrome of unknown origin causing diffuse musculoskeletal pain. DESIGN--Three weeks' randomised study with blinded patients and evaluating physician. SETTING--University divisions of physical medicine and rehabilitation and rheumatology, Geneva. PATIENTS--70 patients (54 women) referred to the division for fibromyalgia as defined by the American College of Rheumatology. INTERVENTIONS--Patients were randomised to electroacupuncture (n = 36) or a sham procedure (n = 34) by means of an electronic numbers generator. MAIN OUTCOME MEASURES--Pain threshold, number of analgesic tablets used, regional pain score, pain recorded on visual analogue scale, sleep quality, morning stiffness, and patient's and evaluating physician's appreciation. RESULTS--Seven of the eight outcome parameters showed a significant improvement in the active treatment group whereas none were improved in the sham treatment group. Differences between the groups were significant for five of the eight outcome measures after treatment. CONCLUSIONS--Electroacupuncture is effective in relieving symptoms of fibromyalgia. Its potential in long term management should now be studied.

Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome.

Abstract: The density of serotonin reuptake receptors on peripheral platelets from 22 patients with primary fibromyalgia syndrome (FS) and the serum serotonin concentrations in 9 patients with FS were compared with those of matched healthy controls. The mean serum serotonin concentration was lower (p = 0.01) in FS than in controls, while the binding of 3H-imipramine was higher (p = 0.035) and normalized with treatment using a combination of ibuprofen and alprazolam. Improvement in selected clinical measures of FS disease activity during treatment correlated with the change in platelet 3H-imipramine binding. These findings support the proposed hypothesis of aberrant pain perception in FS resulting from a deficiency of serotonin.

Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain.

Abstract: Objective Fibromyalgia is a common syndrome of musculoskeletal pain and fatigue. Lacking distinctive tissue or laboratory correlations, it has often been considered a form of "psychogenic rheumatism." In the present study, the notion that the stage-4 sleep anomaly typically seen in the fibromyalgia syndrome may disrupt growth hormone secretion was tested. Because growth hormone has a very short half-life, serum levels of somatomedin C were measured; somatomedin C is the major mediator of growth hormone's anabolic actions and is a prerequisite for normal muscle homeostasis. Methods Serum levels of somatomedin C were measured in 70 female fibromyalgia patients and 55 healthy controls, using a peptide-specific radioimmunoassay. Results Significantly lower levels of somatomedin C were observed in the fibromyalgia patients compared with controls (mean +/- SD 124.7 +/- 47 ng/ml versus 175.2 +/- 60 ng/ml; P = 0.000001). These results could not be explained by concomitant therapy or by weight, and in a subset of 21 patients in whom this was investigated, there was no correlation with various indices of disease activity. Conclusion These findings indicate that there is a distinctive disruption of the growth hormone-somatomedin C neuroendocrine axis in a majority of fibromyalgia patients. It is hypothesized that this abnormality may explain the link between disturbed sleep and predisposition to muscle pain.

Cognitive behavioral treatment of fibromyalgia syndrome: preliminary findings.

Abstract: We used a simple quasiexperimental design to assess the efficacy of an inpatient cognitive-behavioral treatment program for persons with fibromyalgia syndrome (FS). Twenty-five participants were assessed on 3 occasions: (1) about 5 months before admission to the program, (2) on admission and (3) at discharge. In addition, the dependent variables (pain response measures) were divided into "target" (expected to change with treatment) and "nontarget" (not expected to change) to assess potential demand characteristics. Our results showed that, whereas no changes occurred in either target or nontarget variables between the initial assessment and admission, consistent changes were observed only in target variables between admission and discharge. Our data provide preliminary support for cognitive-behavioral treatment for FS.

The effects of 20 weeks of physical fitness training in female patients with fibromyalgia.

Abstract: During a period of 20 weeks 18 female patients with fibromyalgia participated in a 60-minute exercise program twice a week. A control group, comprising 17 patients, was told not to change their physical activity level. Eleven patients in the training group and fourteen in the control group completed the study. The results at entry were compared to those after 20 weeks, as well as being compared to the results of the control group. No statistically significant changes or differences in general pain, pain coping and fatigue were seen after 20 weeks. Improved dynamic endurance work performance for the upper extremity was found, however, in the training group, measured as the strength of the first (p = 0.01) and the last repetition (p = 0.003). These results differed from the results of the control group (p = 0.02 and p = 0.003). It is concluded that fibromyalgia patients may undergo low-intensity dynamic endurance training without experiencing exacerbation of their general pain and fatigue symptoms.

Reactive fibromyalgia syndrome

Abstract: Objective. To determine the frequency of a precipitating event occurring prior to the onset of fibromyalgia syndrome, in a consecutive series of patients. Outcome in patients in whom there was a causative factor was compared with that in patients with primary fibromyalgia. Methods. Records of patients presenting over a 4-year period who fulfilled criteria for fibromyalgia were reviewed, and patients were classified as having reactive fibromyalgia if a specific event prior to the onset of illness could be identified. Outcome features, including employment status and disability compensation, were compared in patients with reactive fibromyalgia versus those with primary fibromyalgia. Results. Twenty-nine of 127 patients (23%) with a primary rheumatologic diagnosis of fibromyalgia reported having trauma, surgery, or a medical illness before the onset of fibromyalgia, and were classified as having reactive fibromyalgia. Patients in this group were more disabled than those with primary fibromyalgia, resulting in loss of employment in 70%, disability compensation in 34%, and reduced physical activity in 45% Conclusion. The development of fibromyalgia after a precipitating event may represent the onset of a prolonged and disabling pain syndrome with considerable social and economic implications.

The prevalence of fibromyalgia among women aged 20-49 years in Arendal, Norway

Abstract: In an epidemiological survey of females aged 20-49 years in Arendal, Norway, a prevalence of fibromyalgia according to the ACR criteria of 1990 of 10.5% was found. Thirty-four out of 40 women with fibromyalgia (85.0%) had, prior to the present population study, consulted a physician because of widespread pain and/or stiffness. Of these 34 women, 14 cases (41.2%) had been given a diagnosis of fibromyalgia. It is concluded that fibromyalgia represents one of the major causes of pain in the locomotor system, and unfortunately, the condition often remains undiagnosed for long periods.

Sleep, Epstein-Barr virus infection, musculoskeletal pain, and depressive symptoms in chronic fatigue syndrome.

Abstract: Sleep physiology, viral serology and symptoms of 14 patients with chronic fatigue syndrome (CFS) were compared with 12 healthy controls. All patients described unrefreshing sleep and showed a prominent alpha electroencephalographic nonrapid eye movement (7.5-11.0 Hz) sleep anomaly (p less than or equal to 0.001), but had no physiologic daytime sleepiness. There were no group differences in Epstein-Barr virus (EBV) antibody titers. The patient group had more fibrositis tender points (p less than 0.0001), described more somatic complaints (p less than 0.0001), and more depressive symptoms (p less than 0.0001). Patients with CFS do not show evidence for a specific chronic EBV infection, but show altered sleep physiology, numerous tender points, diffuse pain, and depressive symptoms. These features are similar to those found in fibromyalgia syndrome.

Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity

Abstract: This study was performed to test the existing notion that an increased muscle sympathetic nerve discharge is part of the underlying mechanism for the chronic pain syndrome of primary fibromyalgia. Muscle sympathetic nerve activity was recorded in the peroneal nerve in eight patients with primary fibromyalgia and eight age-matched controls. No difference in baseline sympathetic activity was observed between patients and controls. Furthermore, patients did not show exaggerated sympathetic nerve responses to static handgrip or jaw muscle contractions, postcontraction ischemia or mental stress. Thus the results do not indicate muscle sympathetic nerve overactivity in primary fibromyalgic patients.

Psychosomatic Syndromes and Somatic Symptoms

Abstract: Psychosomatic Syndromes. Fibromyalgia, fibrositis, and myofascial pain syndrome. Chronic fatigue and chronic fatigue syndrome. Globus and fear of choking. Dysphagia and esophageal motility disorders. Non-ulcer dyspepsia. Irritable bowel syndrome. Urethral syndrome. Behavior-induced physiological changes: hyperventilation and aerophagia. Chronic pain syndromes. Mechanisms of Bodily Complaints. Somatization. Hysteria. Deception. Mechanisms of bodily complaints: main conclusions.

Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients.

Abstract: Lyme encephalopathy, primarily manifested by disturbances in memory, mood, and sleep, is a common late neurologic manifestation of Lyme disease. We compared 20 patients with Lyme encephalopathy with 11 fibromyalgia patients and 11 nonpsychotically depressed patients using the California Verbal Learning Test, Wechsler Memory Scale, Rey-Osterrieth Complex Figure Test, Minnesota Multiphasic Personality Inventory (MMPI), and Beck Depression Inventory. Compared with patients with fibromyalgia or depression, the Lyme encephalopathy group showed mild, but statistically significant, memory deficits on two of the three memory tests. In contrast, the patients with fibromyalgia scored significantly higher than both other groups on the MMPI scale most sensitive to somatic concerns (scale l), while the depressed patients scored higher than the Lyme patients on the scales most sensitive to depression (scale 2) and anxiety (scale 7). Physical complaints and depression were not major factors in memory performance among Lyme patients. These data support the hypothesis that Lyme encephalopathy is caused by CNS dysfunction and cannot be explained as a psychological response to chronic illness.

Idiopathic musculoskeletal pain syndromes in children.

Abstract: Between 1982 and 1990, 81 children with localized or diffuse musculoskeletal pain, for which no cause could be found were seen in a pediatric rheumatology clinic. Forty-one children had localized idiopathic pain and 40 had diffuse idiopathic pain. Twenty-four of the patients with localized idiopathic pain fulfilled criteria for definite reflex neurovascular dystrophy. Thirty-five patients with diffuse idiopathic pain fulfilled criteria for fibromyalgia. Four patients with localized idiopathic pain (10%) developed diffuse idiopathic pain during followup; four patients with diffuse idiopathic pain (10%) had a history of localized idiopathic pain and one patient had previously been diagnosed as having Tietze's syndrome. Recurrences or persistence of pain was very common. Many children had potentially important stressors including single parent families, histories of sexual abuse, and learning difficulties. Idiopathic musculoskeletal pain is a common cause of referral to a pediatric rheumatology clinic and is often associated with significant morbidity.

Management of Fibromyalgia: Rationale for the Use of Magnesium and Malic Acid

Abstract: Primary fibromyalgia (FM) is a common clinical condition affecting mainly middle-aged women. of the etiologies previously proposed, chronic hypoxia seems the one best supported by recent biochemica...

Plasma and urinary catecholamines in primary fibromyalgia: a controlled study.

Abstract: Plasma and urinary catecholamines were measured in a blinded manner among 30 patients with primary fibromyalgia (PF) and 30 healthy controls without significant pain to determine possible elevations of catecholamines in PF, as well as their correlations with psychological and clinical variables in this syndrome. Results showed no significant differences between fibromyalgia and control groups in any of the catecholamines measured, nor was there a correlation between catecholamine levels and any of the clinical features or psychologic measures.

A comparison of pain perceptions in women with fibromyalgia and rheumatoid arthritis: relationship to depression and pain extent.

Abstract: Two studies were conducted to characterize the pain of fibromyalgia syndrome (FMS); to compare it to rheumatoid arthritis (RA) pain; and to examine the relationships between depression, pain extent, and pain description. Two methods of administering the McGill Pain Questionnaire (MPQ) were used. When the MPQ was administered in the standard manner, FMS pain could not be distinguished from RA pain. When participants were allowed to select as many words from an adapted MPQ as they wished, significant differences in word choice emerged. Depression and pain extent were major predictors of group differences in the evaluation of pain. However, depression scores contributed only 50% of the explanation for the differences in pain extent, with group membership contributing the other 50%. These findings suggest that the character and extent of pain in FMS are at least partially due to peripheral sensory components and not simply centrally controlled pain amplification secondary to depression.

Lyme Arthritis as the Incorrect Diagnosis in Pediatric and Adolescent Fibromyalgia

Abstract: In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis"

Fibromyalgia: a time-series analysis of the stressor-physical symptom association.

Abstract: The purpose of this study was to investigate the association among daily stressors, cognitive rumination, and fibromyalgia symptoms using time-series methodology and to determine whether autocorrelation was present in the self-report data. Twelve female fibromyalgia subjects monitored their daily level of stressors, cognitive rumination, and fibromyalgia symptoms for 30–35 days. Time-series regression analyses indicated that there was a positive association between previous-day stressors and fibromyalgia symptoms for one subject and between previous-day cognitive rumination and fibromyalgia symptoms for four subjects. For 7 out of 12 subjects autocorrelation was present, and generalized least-squares methods were used with these subjects. These results indicate that ordinary least-squares methods may often not be appropriate for within-subject designs with self-report data. These results also question the often reported stressor-physical symptom association. This study illustrates a useful methodology and analysis to investigate psychosocial-physical symptom associations.

Primary Fibromyalgia Syndrome and 5-Hydroxy-L-Tryptophan: A 90-Day Open Study

Abstract: The efficacy and tolerability of 5-hydroxy-L-tryptophan (5-HTP) were studied in an open 90-day study in 50 patients affected by primary fibromyalgia syndrome. When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement (P less than 0.001). The overall evaluation of the patient condition assessed by the patient and the investigator indicated a 'good' or 'fair' clinical improvement in nearly 50% of the patients during the treatment period. A total of 15 (30%) patients reported side-effects but only one patient was withdrawn from the treatment for this reason. No abnormality in the laboratory evaluation was observed. It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains its efficacy throughout the 90-day period of treatment.

Lack of association between fibromyalgia and sleep apnoea syndrome.

Abstract: To determine whether sleep disorders can cause a fibromyalgia syndrome, 30 patients with sleep apnoea syndrome were studied. All presented an important reduction in deep sleep stages (-93.1 (SD 17.9)% of stage IV and -77.2 (45.7)% of stage III) and frequent episodes of wakening ('arousals'), factors which are involved in fibromyalgia. One patient (3%) met the criteria for fibromyalgia; the estimated prevalence of fibromyalgia for patients attending a general medical clinic is 6%. No significant correlation was found between the number of points which were tender upon pressure and the various sleep parameters studied. It is concluded that sleep disorders alone are not able to produce a fibromyalgia syndrome.

Peripheral arthralgic presentation of fibrositis/fibromyalgia syndrome.

Abstract: Of 216 consecutive new referrals to a general rheumatology clinic 22 (10.2%) had generalized fibromyalgia syndrome (FS). In 12 cases (5.6% of all referrals, 54.5% of patients with FS) the initial presentation was with pain in the region of the hand or wrist joints, but many other joints were painful or tender. Although there may be initial confusion with rheumatoid or osteoarthritis, the positive features of FS confirm the correct diagnosis.

Chronic rhinitis: an underrecognized association with fibromyalgia

Abstract: We prospectively studied 47 consecutive patients with either seasonal or perennial allergic rhinitis or nonallergic rhinitis in a general allergy clinic. A diagnostic questionnaire was administered for symptoms of rhinitis and fibromyalgia, and patients were examined for tender points. A history of congestion was present in 91%, rhinorrhea in 87%, and postnasal drip in 83%. Forty-nine percent had a history of diffuse, aching pain, or tiredness for at least 3 months; 49% percent had 11 or more tender points; and 38% had both a history of widespread pain plus 11 or more tender points (the 1990 criteria of the American College of Rheumatology for fibromyalgia). This frequency is much higher than the expected 4 to 5% prevalence of fibromyalgia in a general population. Seventy-nine percent of all subjects were skin-test positive to inhalant allergens, but positive skin tests alone did not correlate with the number of tender points or criteria for fibromyalgia. Rhinitis, rather than atopy, is associated with fibromyalgia and may be an underdiagnosed, but important causative factor.

Fibromyalgia in Japanese.

Abstract: Fifty Japanese patients were diagnosed as having fibromyalgia. This group was compared with 50 Japanese control patients and 293 North American patients with fibromyalgia. In comparison of pain complaints and symptoms for fibromyalgia in Japanese and North Americans, ["pain all over" (98%), fatigue (98%), anxiety (66%), irritable bowel syndrome (50%) and sicca symptoms (71%)] were more frequently found in the Japanese patients. However, the major components of fibromyalgia were not wholly different in Japanese individuals compared with North Americans.

Biochemical clues to a fibromyalgia-depression link: imipramine binding in patients with fibromyalgia or depression and in healthy controls.

Abstract: Both fibromyalgia and depression may be related to disturbed serotonin metabolism, and an association between the 2 disorders has been postulated. We measured 3H-imipramine binding (IB), a biochemical indicator of serotonin uptake, pretreatment, in 10 nondepressed women with fibromyalgia, 14 subjects with major depression, and 10 volunteer controls. Our objective was to determine if IB in the 2 patient groups differed and in the same direction from the control values. Compared with depressed women, IB was significantly lower both in the women with fibromyalgia and in the men with depression. However, no women with fibromyalgia or men with depression had IB levels that were significantly different from control women and men. There was a trend for higher IB levels in depressed compared to control women.