Showing papers on "Fibromyalgia published in 1994"
TL;DR: Demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS.
Abstract: Background: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features. Our objectives were to describe the similarities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control. Methods: Demographic, clinical, and psychosocial measures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practices. Variables included demographic features, symptoms characteristic of each condition, psychological complaints, a measure of health locus of control, and information on health care use. Results: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations. Conclusions: In general, demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS. Symptoms typical of each disorder are prevalent in the other two conditions. (Arch Intern Med. 1994;154:2049-2053)
364 citations
TL;DR: The results indicate that patients with FS exhibit a significant reduction in heat pain threshold when tested on the dorsal surface of the hand and a greater activation of central nervous system (CNS) pathways following noxious input.
Abstract: A decrease in mechanical pressure pain thresholds, particularly over pre-designated tender points, is one of the defining characteristics of fibromyalgia syndrome (FS); however, changes in thermal pain sensitivity have not been investigated. The present study examined heat pain thresholds and cerebral event-related potentials following CO2 laser stimulation in 10 subjects with FS and 10 age-matched control volunteers. The results indicate that patients with FS exhibit a significant reduction in heat pain threshold when tested on the dorsal surface of the hand. In accordance with previous research, we also found a decrease in mechanical pain threshold over pre-designated tender points and at control sites as well as a significantly larger mechanically induced neurogenic flare response. These measures were highly correlated with thermal pain threshold even though different anatomical sites were stimulated. Hence, it seems likely that FS patients display a multimodal change in pain sensitivity which is generalized rather than anatomically restricted. Patients with FS also displayed a significant increase in the peak-to-peak amplitude of the cerebral potential evoked by CO2 laser stimulation at pain threshold intensity and 1.5 times pain threshold intensity. These findings suggest a greater activation of central nervous system (CNS) pathways following noxious input. Putative explanations for the increased CNS response are discussed, including mechanisms of peripheral nociceptor sensitization, altered CNS function and the role of psychological factors.
299 citations
TL;DR: Tender points are a measure of general distress related to pain complaints but are seperately associated with fatigue and depression, and sleep problems are associated with tender points, although prospective studies are needed to determine whether they cause tenderness to develop.
Abstract: Objective: To determine the relation between tender points, complaints of pain, and symptoms of depression, fatigue, and sleep quality in the general population. Design: Two stage cross sectional study with an initial questionnaire about pain to classify those eligible for an examination of tender points. Setting: Two general practices in north west England. Subjects: Stratified random sample of adults from age-sex registers. Of the responders, 250 were selected for examination of tender points on the basis of their reported pain complaints; 177 subsequently participated. Main outcome measures - Tender point count (0 to 18) grouped into four categories with the highest (>=11) corresponding to the criteria of the American College of Rheumatology for fibromyalgia. Assessment of pain (chronic widespread, regional, none). Measures of depression, fatigue, and difficulty with sleeping. Results: Women had a higher median tender point count (six) than did men (three). Counts were higher in those with pain than in those who had no pain and in those with widespread compared with regional pain. Most subjects with chronic widespread pain, however, had fewer than 11 tender points (27/45; 60%). Two people with counts of 11 or more were in the group reporting no pain. Mean symptom scores for derpession, fatigue, and sleep problems increased as the tender point count rose (P value for trend Conclusions: Tender points are a measure of general distress. They are related to pain complaints but are seperately associated with fatigue and depression. Sleep problems are associated with tender points, although prospective studies are needed to determine whether they cause tenderness to develop. Fibromyalgia does not seem to be a distinct disease entity.
288 citations
TL;DR: It is concluded that a pattern of pain hyperresponsiveness, generalized across the site of noxious stimulation and across the physical nature of the stressor, is associated with fibromyalgia.
Abstract: Experimental measures of responsiveness to painful and non-painful stimuli as well as measures of typical and present clinical pain were assessed in 26 female patients with fibromyalgia and in an equal number of age-matched healthy women. Pressure pain thresholds, determined by means of a dolorimeter, were lower in the patients compared to the control subjects both at a tender point (trapezius) and at a non-tender control point (inner forearm). The same was true for the heat pain thresholds, measured using a contact thermode. In contrast, the pain thresholds for electrocutaneous stimuli were decreased only at the tender point. The detection thresholds for non-painful stimuli (warmth, cold and electrical stimuli) seemed to be less affected in the fibromyalgia patients, with only the detection threshold for cold being lower at both sites. Tender points were more sensitive than control points for mechanical pressure. The reverse was found for the other modalities which were tested. Although the 3 experimental pain thresholds showed patterns of either generalized or site-specific pain hyperresponsiveness, the between-methods correlations were not very high. While the correlations between the experimental pain thresholds and the various measures of clinical pain (Localized Pain Rating, McGill Pain Questionnaire) in the patients were generally low, there were significant negative correlations between pressure pain thresholds at the two sites and the level of present pain assessed by the Localized Pain Rating. We conclude that a pattern of pain hyperresponsiveness, generalized across the site of noxious stimulation and across the physical nature of the stressor, is associated with fibromyalgia.(ABSTRACT TRUNCATED AT 250 WORDS)
271 citations
TL;DR: FMS is very common in SLE patients, and accounts for many of the symptoms and much of the disability in these patients.
Abstract: Objective. To ascertain the prevalence of fibromyalgia syndrome (FMS) in systemic lupus erythematosus (SLE) and to evaluate its clinical impact and relationship to SLE disease activity.
Methods. A cross-sectional analysis of 102 patients from a public hospital SLE clinic. Information was obtained on symptoms of FMS, disability, tender points, pain thresholds, and SLE disease activity.
Results. Twenty-two SLE patients (22%) met the American College of Rheumatology criteria for FMS, and another 24 (23%) had clinical FMS but did not meet the classification criteria. The patients who met the criteria for FMS had a significantly increased frequency and severity of symptoms commonly associated with FMS, and were much more likely to be unable to perform daily activities. The FMS patients also were less likely to be employed, and more likely to be divorced and to be receiving welfare or medical disability benefits. However, patients with and those without FMS did not differ in measures of SLE activity.
Conclusion. FMS is very common in SLE patients, and accounts for many of the symptoms and much of the disability in these patients.
207 citations
TL;DR: Fibromyalgia symptoms improved in 67% of patients and controls after a 10 week meditation based SR-CBT program, and functional status was evaluated by the Fibromyalgia Impact Questionnaire [FIQ], and psychological status by the SCL-90-R.
Abstract: Objective: To determine the results of a stress-reduction, cognitive behavioral treatment [SR-CBT] program in fibromyalgia. Methods: Seventy-nine patients with fibromyalgia completed a 10 week meditation based SR-CBT program that met once weekly for 2 hours per session. Controls consisted of 42 fibromyalgia patients, 18 of whom had been placed on a waiting list for the treatment program and 24 randomly selected patients who had not expressed an interest in enrolling in the program. Medications and other treatments were not altered during the 10 week study. Fibromyalgia symptoms were evaluated at the beginning and at the end of the study in patients and controls by self-administered visual analog scales [VAS] for global well-being, pain, sleep, fatigue, and tiredness upon awakening. Functional status was evaluated by the Fibromyalgia Impact Questionnaire [FIQ], and psychological status by the SCL-90-R. Participants and controls were comparable at study entry. Results: Fibromyalgia symptoms improved in 67% ...
184 citations
TL;DR: There were trends suggestive of a beneficial response to aerobic walking (lower psychological and pain ratings) but limited significant findings and higher physical disability ratings, for these individuals with fibromyalgia.
Abstract: Background and Purpose. The purpose of this study was to evaluate the effect of aerobic walking on the pain, disability, and psychological symptoms of individuals with fibromyalgia. Subjects. Nineteen subjects with fibromyalgia (2 men, 17 women), aged 30 to 69 years (X=49.35, SD=11.83), participated. Methods. Ten subjects walked 20 minutes, three times per week, for 8 weeks at 60% to 70% of the predicted maximum heart rate for their age. Nine subjects served as sedentary controls. Each subject completed pretests and posttests of the McGill Pain Questionnaire (MPQ), the Sickness Impact Profile (SIP), and the Brief Symptom Inventory (BSI). Due to initial differences on all measures, final scores were adjusted and analyzed by an analysis of covariance. Results. The experimental group had lower scores on the MPQ, on two of the three BSI indexes, and on the Psychosocial Dimension scale of the SIP, but higher ratings on the Physical Dimension scale of the SIP than did the control group on final testing. Only the differences on one index of the BSI and the Physical Dimension scale of the SIP were significant. Conclusion and Discussion. The results of the study are inconclusive. There were trends suggestive of a beneficial response to aerobic walking (lower psychological and pain ratings) but limited significant findings and higher physical disability ratings, for these individuals with fibromyalgia.
148 citations
TL;DR: The original pain behavior scoring methodology is appropriate for use with the FS population and should not be modified to include the pain behavior ‘stretching’, which was found to be negatively associated with self‐reported pain.
Abstract: Given the lack of objective physical measures for assessing fibromyalgia syndrome (FS), the role of pain assessment is particularly important. The role of psychological factors is controversial among FS patients. This study was designed to better understand the relationship between pain behaviors and psychological variables. Specifically, this study (1) refined a pain behavior observation (PBO) methodology for use with FS patients, (2) determined whether stretching is a valid pain behavior, and (3) assessed whether psychological variables including self-efficacy and/or depression can predict pain behaviors after controlling for disease severity and age. The 73 FS subjects meeting the American College of Rheumatology classification system completed questionnaires measuring self-efficacy, depression, and pain. Trained physicians conducted tender-point examinations. Subjects were video-taped using a standardized procedure. Two trained raters independently coded all pain behaviors. Kappa coefficients and correlations among pain behaviors and self-reported pain indicated that the PBO method was both reliable and valid. However, the newly defined pain behavior 'stretching' was found to be negatively associated with self-reported pain. Hierarchical multiple regression (MR) analyses revealed that depression did not predict pain behavior over and above myalgic scores and age; however, in 3 separate MR analyses, self-efficacy for function, pain, and other symptoms each predicted pain behavior over and above myalgic scores and age. This study indicated that the original pain behavior scoring methodology is appropriate for use with the FS population and should not be modified to include the pain behavior 'stretching'. Self-efficacy was related to pain behavior while depression was not among this FS sample.
136 citations
Journal Article•
TL;DR: Community FMS has a better prognosis than the literature suggests and simple intervention may be associated with good outcome in a significant number of patients with FMS.
Abstract: OBJECTIVE To review the outcome of patients with fibromyalgia syndrome (FMS) diagnosed and treated with minimal intervention in community rheumatology practice. METHODS Forty-four ambulant patients with FMS, first seen in a 2-month period and treated with a simple management program, were identified and reviewed 2 years after diagnosis. A variety of clinical and psychological features were assessed using standard techniques. RESULTS Forty-seven percent no longer fulfilled Smythe or ACR criteria for FMS. Remission was objectively identified in 24.2% of assessed patients. Significant differences in objective clinical signs, in symptoms, and in self-described disability were found between patients with and without FMS. Regular physical exercise, rather than drug or specific physical therapies, correlated highly with low FMS activity scores. Analysis of mood and coping strategies at the 2-year review showed low correlations with current FMS activity. CONCLUSION Community FMS has a better prognosis than the literature suggests. Simple intervention may be associated with good outcome in a significant number of patients with FMS.
136 citations
TL;DR: It is confirmed that fibromyalgia, once established, is a non-remitting syndrome and the social consequences were constant over time.
Abstract: Fifty-six patients with fibromyalgia, previously studied in 1984, were followed up after five years, using a mail questionnaire and a global health assessment instrument, the Sickness Impact Profile. The aim was to investigate the patients' perception of their symptoms and to describe the consequences for everyday life. Half of the patients reported that pain, fatigue and sleep problems had increased, less than 20% reported improvements, and 30–40%, no change. In spite of this, 25% reported that their overall condition had improved. Motor tasks were somewhat less difficult to manage. The symptoms had severe consequences for the patients' ability to manage everyday life activities. The study confirms that fibromyalgia, once established, is a non-remitting syndrome. Also, the social consequences were constant over time.
128 citations
TL;DR: Study subjects were asked to compare the use of the following for the first 2 yr after onset as well as the year preceding the current evaluation: biofeedback, medications, physical therapy, manipulation, massage therapy and tenderpoint injections.
Abstract: This report describes a follow-up study of 176 individuals seen between 1980 and 1990, in whom a diagnosis of post-traumatic fibromyalgia was made. Sixty-seven people completed a lengthy questionnaire and underwent a confirmatory physical examination using the American College of Rheumatology Criteria to confirm or deny the presence of fibromyalgia at the time of follow-up. A total of 60.7% noted the onset of symptoms after a motor vehicle accident, 12.5% after a work injury, 7.1% after surgery, 5.4% after a sports-related injury and 14.3% after other various traumatic events. Fifty-six of 67 individuals had 11 or more tenderpoints (average, 13.5), 3 had 10 tenderpoints, and 7 had fewer than 10 or no tenderpoints. Study subjects were asked to compare the use of the following for the first 2 yr after onset as well as the year preceding the current evaluation: biofeedback, medications, physical therapy, manipulation, massage therapy and tenderpoint injections. In addition, we asked detailed questions regarding symptoms commonly seen in association with fibromyalgia (fatigue, sleep disturbance, etc.). Symptoms of traumatically induced fibromyalgia are quite similar to spontaneous fibromyalgia. There was a dramatic reduction in the use of all forms of physical treatments. Fifty-four percent continued to use over-the-counter pain medications, and 39% were on antidepressants. Eighty-five percent of the patients continued to have significant symptoms and clinical evidence of fibromyalgia.
TL;DR: Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.
Abstract: Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue. The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy). Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.
TL;DR: The coficept of affective spectrum disorder is described, and the evidence that fibromyalgia and other syndromes of chronic fatigue and pain may be part of the affective Spectrum disorder family is proposed.
Abstract: Fibromyalgia syndrome is characterized primarily by diffuse musculoskeletal pain. However, the musculoskeletal pain does not present in isolation, but rather as a part of a broader syndrome, with prominent associated symptoms of fatigue, sleep disturbance, depression, anxiety, headache and functional bowel disturbance (Yunus et al, 1981; Wolfe et al, 1990). Indeed, fibromyalgia syndrome is associated not only with these specific symptoms, but very often with well-defined, full-scale syndromes of chronic fatigue, mood and anxiety disorders, migraine and irritable bowel. What is the nature of the relationship between musculoskeletal pain and the other symptoms associated with fibromyalgia syndrome? And what is the nature of the relationship between the fibromyalgia syndrome and the other syndromes which are so frequently comorbid with it? We have proposed that fibromyalgia and these frequently comorbid syndromes (listed in Table 1) may all be members of a family of related disorders, which we have termed 'affective spectrum disorder' (Hudson and Pope, 1989, 1990). In this chapter, we shall describe the coficept of affective spectrum disorder, and the evidence that fibromyalgia and other syndromes of chronic fatigue and pain may be part of the affective spectrum disorder family.
TL;DR: This study suggests that fibromyalgia is a chronic muscular pain disorder with muscle pain, fatigue and stiffness as the main symptoms, and the muscle function is markedly reduced.
Abstract: Objective: Fifty-five patients with fibromyalgia were followed by means of routine visits for a mean of 8 years. The patients were all invited for a special follow-up study. Methods: Clinical symptoms, tender points, laboratory tests and muscle function were studied. Results: Fibromyalgia symptoms were stable, with fluctuations but few remissions. Muscle function tests showed a marked reduction of muscle strength and muscle endurance as compared to healthy controls. Histocompatibility antigens did not differ from the normal population. One patient developed rheumatoid arthritis. One patient developed rheumatoid arthritis. One patient was free of symptoms. Conclusions: This study suggests that fibromyalgia is a chronic muscular pain disorder with muscle pain, fatigue and stiffness as the main symptoms. Symptoms remain stable over years. The muscle function is markedly reduced. The condition has a marked impact on work capacity.
TL;DR: It is concluded that many of the symptoms of patients that suffer from late whiplash syndrome conform with the criteria of other specific diagnoses.
Abstract: Thirty-eight patients with late whiplash syndrome were investigated with regard to symptoms which conform with the criteria for other specific diagnoses. All had pain and tender points in the neck and 37 (97.4%) suffered from headache. Seven patients (18.4%) had occipital neuralgia in accordance with the IHS criteria and 16 (42.1%) if the IASP criteria were used. Four patients (10.5%) had oromandibular dysfunction, 20 (52.6%) had periarticular shoulder disorder, and 12 (31.6%) had thoracic outlet syndrome. Five (13.2%) had chronic mechanical low back pain and two (5.3%) segmental instability of the lumbar spine. Four (10.5%) had symptoms concurring with the diagnosis of fibromyalgia. It is concluded that many of the symptoms of patients that suffer from late whiplash syndrome conform with the criteria of other specific diagnoses.
TL;DR: In both groups a correlation was found between pain score and psychometric scoring, and in both groups the fibromyalgia patients scored significantly higher on pain than the controls.
Abstract: The objective of the study was to evaluate the presence of psychopathology in fibromyalgia patients compared with a control group of other rheumatologic patients with pain. Forty-nine fibromyalgia patients and 33 control patients were interviewed blinded, using standardized psychometric scales. Pain was scored on a visual analogue scale. Fibromyalgia patients scored significantly higher than the controls on the Bech-Rafaelsen Melancholia Scale, the Atypical Depression Scale and the Hamilton Anxiety Rating Scale. On the Newcastle Depression Scale there was no difference. In both groups a correlation was found between pain score and psychometric scoring. The fibromyalgia patients scored significantly higher on pain than the controls. After correcting for this difference, the fibromyalgia patients still scored higher on anxiety and depression.
TL;DR: A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had chronic fatigue syndrome (CFS), was conducted by as mentioned in this paper.
Abstract: Objective: To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists. Design: A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had CFS. Setting: A university-based referral clinic devoted to the evaluation and management of chronic fatigue. Patients: 348 CFS patients who had undergone complete medical evaluations. Measures: Clinical variables included symptoms, physical examination findings, and laboratory results. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Shortform General Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, the Multidimensional Health Locus of Control, and measures of attribution, social support, and coping. Main results: Overall, few gender-related differences were identified. Women had a higher frequency of tender or enlarged lymph nodes (60% versus 33%, p≤0.01) and fibromyalgia (36% versus 12%, p≤0.001) and lower scores on the physical functioning subscale of the Medical Outcomes Study Short-form General Health Survey (37.6 versus 52.2, p<0.01); men more often had pharyngeal inflammation (42% versus 22%, p≤0.001) and reported a higher lifetime prevalence of alcoholism (20% versus 9%, p≤0.01). Conclusions: In general, demographic, clinical, and psychosocial factors do not distinguish men from women CFS patients.
TL;DR: The clinical features and the spectrum of associated conditions in fibromyalgia syndrome, characterized by widespread pain, multiple tender points, and fatigue, are reviewed.
Abstract: Objectives: To review the clinical features and the spectrum of associated conditions in fibromyalgia syndrome [FMS]. Results: FMS is characterized by widespread pain, multiple tender points, fatig...
Book•
01 Jan 1994
TL;DR: This book discusses the management of Fibromyalgia Syndrome, the role of Ergonomics in the Prevention and Treatment of Myofascial Pain, and the Practical Application of Trigger Point Work in Physical Therapy.
Abstract: Foreword Preface Part I - General Considerations * Fibromyalgia Syndrome - Clinical Features, Diagnosis, and Biopathophysiologic Mechanisms Muhammad B. Yunnus, M.D. and Fatma Inanici, M.D. * Management of Fibromyalgia Syndrome Fatma Inanici, M.D. and Muhammad B. Yunnus, M.D. * Unusual Aspects of Musculoskeletal Pain in the Pediatric Population Joan Gold, ..D. * Metabolic and Endocrine Causes of Muscle Syndromes Louis F. Amorosa, M.D. * Psychological Considerations in Myofascial Pain, Fibromyalgia, and Related Musculoskeletal Pain Roy C. Gresiak, PhD. * Disability Evaluation and Management of Myofascial Pain Matthew Monsein. M.D. * Functional Diagnosis of Musculoskeletal Pain and Evaluation of Treatment Results by Quantitative and Objective Techniques Andrew Fischer, M.D. * Diagnosis and Management of Facial Pain Harold V. Cohen,D.D.S., Richard A. Pertes, D.D.S. Part II - Trigger Point Management * Trigger Points Edward S. Rachlin * History and Physical Examination for Myofascial Pain Syndromes Edward S. Rachlin * Trigger Point Management Edward S. Rachlin, Isabel S. Rachlin * Injection of Specific Trigger Points Edward S. Rachlin * New Injection Techniques for the Treatment of Musculoskeletal Pain Andrew Fischer * Nerve Block Therapy for Myofascial Pain Management Winston C. V. Parris Part III - Physical Therapy and Rehabilitation * Muscle Deficiency Hans Kraus * Physical Therapy Treatment Approaches for Myofascial Pain Syndromes and Fibromyalgia Isabel S. Rachlin * Manual Therapy and Treatment of Myofascial Pain and Dysfunction Brian Miller * The Practical Application of Trigger Point Work in Physical Therapy Beth N. Paris * Electrical Modalities in the Treatment of Myofascial Conditions Joseph Kahn * The Role of Ergonomics in the Prevention and Treatment of Myofascial Pain Elseyed Abdel-Moty, Tarek H-Khalil, Renee Steele-Rosomoff, Hubert L. Rosomoff, Shilhan S. Asfair
TL;DR: No differences could be found, either in the quality of pain, the psychological symptoms accompanying it, in sleep quality or in pain behaviour, between two established non-medicinal treatment methods in patients with fibromyalgia.
Abstract: In the present study, two established non-medicinal treatment methods are compared with regard to their effect on various psychological pain parameters in patients with fibromyalgia. Twelve patients underwent hydrogalvanic baths, 13 patients the Jacobson relaxation training. Statistical evaluation showed only one significant difference in the different dimensions of pain measured at the beginning and end of the therapy. In comparison with patients receiving Jacobson-therapy, there is a significantly higher decrease in pain intensity in the period from breakfast till lunch in patients receiving bath-therapy. Apart from this, no differences between the two treatment groups could be found, either in the quality of pain, the psychological symptoms accompanying it, in sleep quality or in pain behaviour.
TL;DR: Children who met fibromyalgia criteria had a statistically greater degree of subjective muscle pain, sleep disturbance, and neurological symptoms than did those who did not meet the fibromy arthritis criteria.
Abstract: Chronic fatigue syndrome (CFS) and primary juvenile fibromyalgia syndrome (PJFS) are illnesses with a similar pattern of symptoms of unknown etiology. Twenty-seven children for whom CFS was diagnosed were evaluated for fibromyalgia by the presence of widespread pain and multiple tender points. Eight children (29.6%) fulfilled criteria for fibromyalgia. Those children who met fibromyalgia criteria had a statistically greater degree of subjective muscle pain, sleep disturbance, and neurological symptoms than did those who did not meet the fibromyalgia criteria. There was no statistical difference between groups in degree of fatigue, headache, sore throat, abdominal pain, depression, lymph node pain, concentration difficulty, eye pain, and joint pain. CFS in children and PJFS appear to be overlapping clinical entities and may be indistinguishable by current diagnostic criteria.
TL;DR: Initial data supporting the notion that patients with exposure to silicone gel are experiencing a new illness is presented, and the alterations in plasma proteins facilitate the ingestion of silicone by macrophages that initiate an immunological response characterized by a chronic inflammatory state that is associated with the production of autoantibody and cytokines.
TL;DR: The strongest relationship was found between weather beliefs and self-reported pain scores, and subjects with high weather sensitivity tended to have more functional impairment and psychological distress.
Abstract: Objective. This investigation 1) examined the relationships among actual weather, disease severity, and symptoms for individuals with fibromyalgia, 2) assessed subjects' beliefs about weather affecting their symptoms, and 3) examined differences between individuals with high and low “weather sensitivity.”
Methods. Eighty-four individuals meeting Yunus' criteria for the diagnosis of fibromyalgia participated. Subjects completed the Weather and Pain Questionnaire (WPQ), the Arthritis Impact Measurement Scales (AIMS), the Symptom Checklist-90-Revised (SCL-90-R), and a Visual Analog Scale (VAS) assessing pain. A tender point index and a myalgic score were also obtained.
Results. Subjects reported that weather affected musculoskeletal symptoms predominantly. The strongest relationship was found between weather beliefs and self-reported pain scores. Subjects with high weather sensitivity tended to have more functional impairment and psychological distress.
Conclusions. Individuals with fibromyalgia believe that weather worsens their symptoms, but it is unlikely that physiologic changes are associates with actual weather.
TL;DR: The clinical features of the syndrome are presented, and the relevance of muscle dysfunction in the etiopathogenesis of the disorder is explored, but the evidence for involvement of muscle pathophysiology as a primary mechanism mediating the onset of symptoms is not compelling.
TL;DR: Fibromyalgia tender point counts correlate uniquely with RA patients' reports of daily stress, and depression was not significantly related when daily stress was controlled for.
Abstract: Objective. We investigated the relationship of fibromyalgia (FM) tender points to other manifestations of rheumatoid arthritis (RA).
Methods. Sixty-seven RA patients completed questionnaires at study entry and described symptoms, emotionally significant events, and mood every evening for 75 days. Joint and tender point examinations were conducted every 2 weeks.
Results. Controlling for joint tenderness, the tender point count correlated with the degree of daily stress. Depression was not significantly related when daily stress was controlled for.
Conclusion. We conclude that FM tender point counts correlate uniquely with RA patients' reports of daily stress.
TL;DR: The physical medicine and rehabilitation medicine approaches for treating patients with fibromyalgia and the myofascial pain syndromes have been presented, and the importance of approaching these patients from a holistic and multidisciplinary standpoint has been stressed.
Abstract: In summary, we have presented the physical medicine and rehabilitation medicine approaches for treating patients with fibromyalgia and the myofascial pain syndromes. The importance of approaching these patients from a holistic and multidisciplinary standpoint has been stressed, paying attention to the physical, emotional, spiritual and behavioural components of the presentation. Although fibromyalgia and the myofascial pain syndromes are two distinct conditions, they often overlap, and when they do the myofascial component should be treated first. However, the clinician should remember that pain, tissue dysfunction and disability from pain are all separate issues and should be treated as such. Treatment in all cases should be individualized and comprehensive. It is imperative to make the patient an active participant in his care and to establish mutually agreed upon goals at the outset of treatment. It is important to establish an adequate and appropriate home exercise programme to supplement formal treatment. A good home exercise programme should stress both stretching and strengthening. Formal treatment programmes should not be geared to pain relief alone but rather to restoration of function, and return to functioning lifestyles. The clinician has available a wide array of modalities and tools to control pain, but the major goal of all treatment programmes is to restore individuals to functional lifestyles and to promote both physical and emotional flexibility, balance and 'wellness'. It is often necessary to involve the family unit as an inherent and critical part of the treatment team, particularly with the patient who continues to be dysfunctional despite apparently appropriate treatment. Although treatment always starts at the tissue level, a good treatment programme must always be holistic in nature and treat the tissues, the patient as a whole, and his or her environmental stressors and contingencies as well.
TL;DR: No differences in clinical appearance were found between patients with and without cold-induced vasospasm in both the fibromyalgia and low back pain group.
Abstract: Using capillary videomicroscopy of the nail fold, the frequency of cold-induced vasospasm and capillary hemodynamic parameters were studied after application of cold in 50 patients with primary fibromyalgia, 50 patients with chronic low back pain, and 50 healthy controls. Cold-induced vasospasm was detected in 38% of the patients with fibromyalgia. In this group it was significantly more frequent than in the patients with chronic low back pain (20%, p < 0.05) and healthy subjects (8%, p < 0.001). In the fibromyalgia group, the magnitude of vasospasm as measured by the capillary blood flow deceleration after cold application correlated negatively with the pain intensity as measured by pain score (r = -0.3839, p < 0.01). No differences in clinical appearance were found between patients with and without cold-induced vasospasm in both the fibromyalgia and low back pain group.
TL;DR: This study suggests that capsaicin cream may be a useful therapy for pain associated with primary fibromyalgia; however, additional confirmatory studies are needed.
TL;DR: Compared to an important PL response and moderate analgesia with AMI, pain and associated symptoms improved moderately with SER282, and polysomnographic recordings showed that SER282 tended to promote stage 4 sleep, while AMI and PL had few--if any--effect on sleep.
Abstract: The results of a double-blind, randomized, therapeutical trial with SER282, an antidiencephalon immune serum (Serolab, Lausanne, Switzerland), in 36 women, aged 24-56 years, with primary fibromyalgia are presented. Treatment was ambulatory and consisted of either SER282 (20 mg/ml) or amitryptiline (AMI, 50 mg) or placebo (PL) over an 8-week treatment course. Clinical and sleep EEG polygraphic data were obtained at baseline and after 4 and/or 8 weeks of therapy. Compared to an important PL response and moderate analgesia with AMI, pain and associated symptoms improved moderately with SER282. In contrast, polysomnographic recordings showed that SER282 tended to promote stage 4 sleep, while AMI and PL had few--if any--effect on sleep. These results are discussed together with the clinical characteristics of the patients and the relations between pain, associated symptoms, and sleep parameters in our patient population.