AFP: Pain Monitor, March 2011

PAIN MONITOR
March 2011

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Action of the Month: Ask 5 People you Know to Join APF Today
Beginning this month, APF will feature an Action of the Month to engage you and those in your community to SPEAK OUT for the rights of people with pain. Forward this message to five or more of your friends and family members and ask them to join APF. The larger our number, the greater our influence! More info>>

NEWS

Pain is Tough to Treat
Doctors were harder on themselves than patients were when it came to judging their ability to minimize the pain, discomfort, or disability caused by a condition. Only 37 percent of physicians thought they were "very" effective, though 60 percent more thought they were "somewhat" effective. But 79 percent of patients said their doctor helped to minimize their pain or discomfort.

Risk of Oral Birth Defects in Children Born to Mothers Taking Topiramate
New data suggest that topiramate (topamax) increases the risk for the birth defects cleft lip and cleft palate in babies born to women who use the medication during pregnancy, the U.S. Food and Drug Administration said today.

Healing the Hurt
Some hurts are forever. But now science is pushing back.

Adverse Effects Weigh Heavily in Patients’ Medication Decisions
Adverse effects hold greater sway than the magnitude of potential benefits on older patients’ willingness to take medications for primary prevention of cardiovascular disease, researchers found.

UN Drugs Board Decries Poor Access to Pain Relief
More than 80 percent of the world's people have insufficient or no access to pain relief medications and are suffering unnecessarily because of it.

Arthritis Takes Varying Toll on Hispanics
Rates of arthritis vary among different Hispanic groups but the overall effects of the disease appear to be substantial across groups, according to an analysis of national CDC survey data.

Pain, Persistence, Family: Sickle Cell Disease
How do you live with a disease that can cause sudden episodes of extreme pain? How does a family manage the needs of a child with a chronic, untreatable illness? These are among the questions that people facing a diagnosis of sickle cell anemia have to answer.

The End of Ouch?
Historically, if people were not in immediate medical danger, their pain was considered an unfortunate side effect or a collateral consequence of solving a greater problem.

For Tendon Pain, Think Beyond the Needle
Two time-honored remedies for injured tendons seem to be falling on their faces in well-designed clinical trials.

Back Pain Has Been Around for 4 Million Years, Scientists Say
In findings presented in a talk at Cambridge University, researchers challenged the notion that a sedentary lifestyle is to blame for spine problems.

NSAID Use Tied to Men's Sexual Performance
The regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with higher odds of erectile dysfunction, a cross-sectional study showed.

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APF NEWS

Taking an Opioid? APF Unveils New Worksheets to Help
If you are prescribed an opioid for pain relief, there are many things you need to know. Two new handouts — Chronic Opioid Therapy: Preparing for Your Appointments and Opioid Dos and Don’ts to Help Avoid Problems will help you prepare for follow up medical appointments and give you tips for staying safe. Learn More >>

APF Releases Report on Cancer Pain
The American Pain Foundation (APF) is proud to release its report “Breakthrough Cancer Pain: Mending the break in the continuum of care.” This 24-page document builds upon our initial call to action released last fall.

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APF ACTION NETWORK

10,000 Voices Campaign
The 10,000 Voices campaign needs you to add your voice to the Virtual Wall of Voices. Your stories of struggle, hope and inspiration will be used to illustrate the range of experiences with pain management in America and inspire others to overcome the barriers that they face in their pain journey.

SPEAK OUT for the Rights of People with Pain!

Great news from Nebraska! The National Hospice and Palliative Care Organization (NHPCO) recently announced that the Nebraska Hospice and Palliative Care Association’s Jennifer Eurek, CSW, also an AN leader for Nebraska, has been appointed as the Central Plains regional representative for the We Honor Veterans Campaign, a national Veterans awareness campaign! Please visit www.nehospice.org for more information.

Georgia’s AN team attended the 2011 Atlanta Summit on Prescription Drug Abuse. Ashley Mahoney (Georgia AN leader) testified at the meeting presenting the voice of a person living with pain who requires  pain medicine and uses it effectively and responsibly to manage her pain. For more about this meeting please visit this site. 

Announcing Two New APF State Leaders
Angie Gravois, RN, joins us from Mississippi. Angie is both a person with pain and the health care provider. Angie has been active in awareness campaigns, research, and education on issues of fibromyalgia, and other diseases causing chronic pain, as a health care professional, a patient, and an advocate.  

Zulma Pagan is a new leader from Puerto Rico. She is a person with pain who has been living with fibromyalgia for over 14 years. She is the founder and president of a fibromyalgia support group and has campaigned for increased visibility of fibromyalgia issues in policy, healthcare, and research within the U.S and in Latin American countries.

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CONNECT

PainAid Online Support Community
PainAid provides chat rooms (regularly scheduled chats on different issues), discussion boards (threaded message boards on a broad variety of topics), and the Ask the Experts feature (pose questions to licensed health care professionals). PainAid is staffed by highly qualified volunteers with a range of backgrounds, all of whom either live with chronic pain or care for people who do. Visit PainAid for more information.

Voices of People with Pain
If you are a person with pain or know someone who lives with pain, we invite you to share your story. View others' stories or share your own.

Webinar and Teleconference Replays
All APF webinars and teleconferences are archived for on-demand viewing. Make sure to check out our chat transcripts and join us at PainAid for future daily and special chats. Sign up to receive notifications of future webinars and teleconferences.

Other ways to get involved in our efforts:

• Keep up with us on Facebook.
• Follow APF on Twitter at www.twitter.com/americanpain for the latest pain news and information and at www.twitter.com/painadvocacy for information on advocacy, policy and public awareness activities.
• Visit the Exit Wounds site to learn more about our Military and Veterans living with pain.

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SPOTLIGHT ON PAIN

The American Pain Foundation “Spotlights” are educational campaigns that highlight specific pain conditions or populations of people that experience pain. Spotlights bring focus to an issue offering a variety of ways for people to learn more about the topic, gain support, and take action. Click here for more information about our spotlights.

Back Pain

Treating Back Pain
Tips for the best solutions and treatments. (Video)

Taking Short Breaks Alleviates Back Pain
Preventing back pain might be as easy as getting up from your chair and walking every couple of hours.

The Claim: Back Pain Runs in Families
Heavy lifting, overuse and middle age are some of the most familiar risk factors for lower back pain. But for many people, predicting a lifetime of lumbar trouble could be as simple as consulting the family tree.

Cancer Pain

One-Third of Cancer Patients on Opioids Suffer Cognitive Problems
About a third of cancer patients taking opioid painkillers experience cognitive problems such as confusion, disorientation and forgetfulness, a new study finds.

Fibromyalgia

Increased Risk for Death From Suicide and Accidents Seen in People with Fibromyalgia
Although patients with fibromyalgia are not at an overall increased risk for mortality, they are at greater risk for suicide and accidents, according to a large observational study presented at the annual meeting of the American College of Rheumatology.

Let's Talk Pain

Patients Unable to Simplify Medication Schedules Themselves
Few people were able to translate prescription instructions so that they minimized the number of times a day they had to take medication, researchers found.

Shingles

People with COPD May Have Risk of Shingles
Researchers suggest people with chronic obstructive pulmonary disease get shingles vaccine.

Yoga

Believe in the Power of Movement
An increasing number of studies emphasize the health benefits of physical activity. Yoga, an ancient practice aimed at achieving tranquility and increasing flexibility, muscle tone, balance and strength is rapidly becoming the activity of choice for a large number of people who suffer from rheumatoid arthritis and other autoimmune diseases.

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SCIENCE & MEDICINE

Managing CSF Leaks During Spinal Cord Stimulation Trial
A cerebrospinal fluid leak can be a headache for anesthesiologists performing a spinal cord stimulator trial, not to mention a trigger for an excruciating post-meningeal puncture headache for the patient.

UC Davis Pain Research May Pave the Way to Understanding and Controlling Chronic Pain
Researchers at the University of California, Davis have discovered a “cross-talk” between two major biological pathways that involve pain. This research may pave the way to new approaches to understanding and controlling chronic pain.

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COMPLEMENTARY MEDICINE

Alternative Treatment Helps People with Chronic Back Pain
Non-aggressive therapy strengthens bad backs.

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PROFESSIONAL TRAINING OPPORTUNITIES

Responsible Opioid Prescribing in the Era of REMS Dinner Dialogues Series
The interactive Dinner Dialogues series discusses critical thinking strategies to help you optimize analgesia and facilitate safe and appropriate use of opioid therapy in your practice. These independent medical education activities are sponsored by the American Pain Foundation (APF) and supported through an educational grant from Endo Pharmaceuticals. Click here to register today!

Social Work Fellowship in Palliative and End-of-Life Care
A postgraduate social work fellowship in palliative and end-of-life care is available through the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center. The fellowship program provides a supervised experience in the multidimensional assessment and care of patients, in multiple practice sites (an inpatient pain, palliative care and hospice unit, inpatient consultation service and an ambulatory practice) at various points along the continuum of life-threatening illness. Fellows participate in interdisciplinary rounds, case discussions, didactic conferences and departmental meetings with the focus on multidimensional approaches to symptom management, palliative and end-of-life care.

Learning will be complemented by access to interdisciplinary experts and resources such as the departmental multimedia resource center where a broad range of educational materials is available. Designed to develop role models, leaders, and mentors, the social work fellowship was established with a grant from the Open Society Institute Project on Death in America through their Social Work Leadership Award and receives ongoing support through the Barbara Zirinsky Fund. The program is offered on a full-time basis for one year and includes stipend and benefits. Applications are currently being accepted and are available at this link: http://www.stoppain.org/for_professionals/content/information/training.asp

Deadline for completed applications is April 1, 2011 with fellowship year to begin in June 2011 or shortly thereafter.

Mayday Pain & Society Fellowship: A Media and Policy Initiative
The Mayday Fund, a New York City-based foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain, is interested in providing new leaders in the pain field with tools that will enable them to reach the broader public.

The Mayday Pain & Society Fellowship: A Media and Policy Initiative is a fellowship program to train physicians, nurses, pharmacists, social workers, basic, translational and clinical scientists, policy experts and legal scholars in the pain management community to go beyond their own professional pursuits to become leaders and advocates for change in the pain field in the United States and Canada. The deadline for applying to the 2011-12 program is Wednesday, June 15, 2011. More info >>

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EVENTS

Public

RSD/CRPS Awareness Quilt Project
An ongoing project to raise awareness about chronic pain conditions, especially RSD.  The organizers are gathering quilt squares to make a pain awareness quilt that will travel across the United States. For more information, visit the Facebook page.

April 28, 2011
Wounded Warrior Care- Rediscovering the Meaning of Healthcare in America Today
Washington, DC

March 18, 2011
RALLY for pain care in WA State

June 5, 2011
National Cancer Survivors Day

June 2-4, 2011
Amputee Coalition National Conference
Kansas City, MO

Professional

March 24-27, 2011
American Academy of Pain Medicine Annual Meeting
Washington, DC

April 28, 2011
RADARS System Annual Meeting
Bethesda, MD

May 19-21, 2011
American Pain Society
Austin, TX

June 2 - 5, 2011
53rd Annual Scientific Meeting American Headache Society
Washington, DC

Sept 7-10, 2011
American Society for Pain Management Nursing
Tucson, AZ

Sept 7-10, 2011
PainWeek
Las Vegas, NV

Sept 14-17
American Academy of Family Physicians Scientific Meeting
Orlando, FL

September 20 - 23, 2011
22nd Annual Clinical Meeting
American Academy of Pain Management
Exploring the Science Practicing The Art
Las Vegas, NV

For more events happening around the country or to submit an event of your own, please visit our Events page.

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Thank you to our medical/science editor Robert Twillman, PhD.

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The Pain Monitor is a monthly electronic publication of the American Pain Foundation. We want to keep you abreast of recent media attention given to topics that are related to pain care or living with pain. This information is provided for educational and information purposes only. Readers may wish to print the information and discuss it with their doctor. Always consult with health care providers before starting or changing any treatment. Above are links to news articles, feature stories and timely information that have come to our attention. Please pass them along to others who might benefit. We encourage you to send any comments you may have to the authors or publishers directly. Every voice counts when working towards improving pain care in our nation.

The American Pain Foundation is an independent, nonprofit organization that relies upon private donations to fund its programs, services and distribution of educational materials. There are millions of people who live with unrelieved chronic pain. If you can help, please make a donation to the American Pain Foundation. For other ways you can support APF’s work, please visit our website at www.painfoundation.org.

Neurology Now: Fibromyalgia is a True Neurologic Disorder

Editor’s note:  Fibromyalgia is a very real neurologic condition that affects thousands of Gulf War veterans.  The federal VA has determined that Fibromyalgia is a presumptive condition for service-connected disability for Gulf War veterans.

--Anthony Hardie

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Neurology Now: September/October 2009 - Volume 5 - Issue 5 - p 29-32.  Feature.

 

Fibromyalgia: Is Fibromyalgia Real?

SHAW, GINA

Abstract

A growing body of information suggests fibromyalgia is a true neurologic disorder.

Like many of his colleagues, John Kissel, M.D., used to think that fibromyalgia wasn't a real condition. Dr. Kissel, a neurologist and the co-director of the MDA/ALS Center at Ohio State University, thought it was a wastebasket diagnosis-a dumping ground for malingering, drug-seeking patients with unexplained pain, fatigue, and depression.

Then he saw patients that began to change his mind. He still remembers one woman in her 40s, a professional trial attorney from Columbus, OH. She had developed debilitating fatigue and horrible muscle pain and tenderness about a month after getting over a mild case of the flu.

After performing a number of tests, I went in to speak with her and mentioned fibromyalgia, Dr. Kissel recalls. She asked, 'What's that?' I said, 'You haven't heard of fibromyalgia? People are talking about it all over the place.' She said to me, 'I work 14 hours a day as a trial attorney-I don't do outside reading.' She wasn't depressed. She was still working. But she had all the typical symptoms of fibromyalgia. That was a formative experience in my thinking about the condition.

Today, more and more neurologists are coming around to the idea that fibromyalgia is a real disorder, and one that should be managed, or at least co-managed, by neurologists who care for chronic pain-not only the rheumatologists who originally identified the condition some 100 years ago.

Neurologists have become more educated about the diagnosis and treatment of fibromyalgia. - LYNNE MATALLANA, FOUNDER OF THE NATIONAL FIBROMYALGIA ASSOCIATION

Fibromyalgia has long presented a puzzle for doctors. It's considered a syndrome-a collection of related symptoms and problems without an identifiable cause-rather than a disease. Those related symptoms include:

* Chronic widespread pain, often accompanied by numbness, tingling, and burning

* Multiple tender points throughout the body

* Severe fatigue

* Sleep problems

Pain networks in the brains of fibromyalgia patients seem to be more easily activated than in people without the disorder.

To be diagnosed with fibromyalgia, a person must have had widespread pain in all four quadrants of the body for at least three months, and tenderness or pain when pressure is applied in at least 11 of 18 identified tender points.

Fibromyalgia was originally thought to be a rheumatologic condition because-like diseases such as rheumatoid arthritis-it is characterized by musculoskeletal pain. But research has since shown that there are no abnormalities in the musculoskeletal system in people with fibromyalgia. Instead, the problem appears to lie in the pain processing pathways of our central nervous system-the bailiwick of neurologists. Today, both rheumatologists and neurologists treat fibromyalgia.

The National Fibromyalgia Association estimates that between three percent and six percent of the population has fibromyalgia-mostly women, but some men and children as well. However, with a flimsier body of research than many other chronic conditions and no blood test to diagnose the disorder, controversy has swirled around fibromyalgia for years. It's also easily confused with other conditions, such as rheumatoid arthritis and lupus (in fact, some patients have both).

Lynne Matallana, the founder and president of the National Fibromyalgia Association, originally saw a rheumatologist for her fibromyalgia. Recently she has also been seeing a neurologist to help with the overlapping conditions, such as migraines and restless leg syndrome, that also cause her distress.

Just like everyone with fibromyalgia, I have to deal with comorbid conditions that are often treated by neurologists, Matallana says. When I started experiencing insomnia and daytime sleepiness, for example, I was referred to a neurologist who specialized in sleep disorders. Unlike several years ago, neurologists have become more interested and educated about the diagnosis and treatment of fibromyalgia. As a patient this is extremely exciting because they bring a new perspective.

 

LONGSTANDING SKEPTICISM

In the past, there has been legitimate reason for skepticism about fibromyalgia, Dr. Kissel acknowledges. The majority of research in fibromyalgia was not adequate, he says. Studies would pick some parameter and look at it only in patients with fibromyalgia and sometimes in normal controls, without comparing them to people with other chronic pain conditions, patients with depression, or to patients with other muscle diseases.

What's more, some physicians tended to view it as a grab-bag condition, diagnosed only when the doctor couldn't find anything else. Patients would come in and say, 'I have muscle pain.' The doctor would do all kinds of tests-electromyography [a test for abnormal electrical activity in the muscles], blood work, muscle biopsies, and imaging, and if all that was negative, then voilà, it was fibromyalgia, he says.

But that's not the way you diagnose, Dr. Kissel stresses. It's as if someone came in with a classic migraine headache and you gave the patient scans, brainwave tests, and arteriograms [imaging of the blood vessels], and if you still didn't know what it was, you said they had migraine. You diagnose migraine by what patients tell you and the way they look in the exam room, and that's the way you diagnose fibromyalgia, too.

The fact that abnormalities don't show up on standard neurological tests like electromyelograms and nerve-conduction studies (tests that measure how fast electrical impulses travel between nerves) is not evidence that fibromyalgia doesn't exist, says John Farrar, M.D., Ph.D., a neurologist and pain specialist at the University of Pennsylvania School of Medicine. There may be a few people in the world who complain of [fibromyalgia] in order to get drugs and attention, but the number of real malingerers is relatively small. The patients I see have very real pain, and it's up to us as doctors to figure out what the underlying major contributors to that pain are.

It hasn't just been doctors who are skeptical of fibromyalgia-many patients have been, too. Just recently I saw two patients who had both been to the Cleveland Clinic previously. One was the wife of a physician. They had both been told that they had fibromyalgia but neither wanted to accept it, despite the fact that they had all the criteria, says Dr. Kissel. Probably three-quarters of the patients I now see with fibromyalgia have been diagnosed by another doctor, but neither the doctor nor the patient is satisfied with the diagnosis. They want another diagnosis that they think will be more treatable.

 

NEW CLUES FROM BRAIN RESEARCH

New and better research pointing to possible underlying causes of fibromyalgia seems to be winning over at least some of the skeptics. Using tools like functional MRI, which show the brain's response to pressure and heat stimuli, researchers have been able to measure how people with fibromyalgia process stimuli like pain and pressure. Some key differences have been discovered between fibromyalgia patients and those without the condition.

Researchers at the University of Michigan in Ann Arbor have found that patients with fibromyalgia have what's called a hyperexcitable nervous system. In other words, pain networks in their brains are more easily activated than people who don't have fibromyalgia. Other researchers have also found impairments in a specific brain region that helps to inhibit the body's response to pain among people with fibromyalgia.

So on the one hand, people with fibromyalgia process any somatic sensory information-for example, light to moderate pressure-as painful, which comes as the result of hyperexcitability in the central nervous system, says pain specialist Miroslav Backonja, M.D., a professor of neurology, anesthesiology, and rehabilitation medicine at the University of Wisconsin School of Medicine and Public Health. Making the problem even worse, the body's pain modulation fails to engage. The body's pain modulation system can help to dial down just how intensely we perceive a painful stimulus.

In this way, fibromyalgia is somewhat similar to epilepsy. There's hyperexcitability in the nervous system on the one hand, and a failure of inhibition on the other, Dr. Backonja says. Which helps explain why pregabalin-a medication that is used to control epilepsy-can also be used to relieve fibromyalgia pain.

Yunxia Wang, M.D., used to be a fibromyalgia-skeptical neurologist as well-until treating a patient with pregabalin helped to change her mind. Four or five years ago, a patient came to see me with a diagnosis of fibromyalgia, says Dr. Wang, a neurologist at the University of Kansas who says that about 15 percent of her practice now involves patients with fibromyalgia. She also had multiple sclerosis. While treating her for MS, I realized that she was using her steroid medication too much. She told me it was because of pain. I wondered if it was because of the fibromyalgia, so I added her on pregabalin without changing her MS treatment. For over a year and a half, she hasn't had an attack and she's doing much better with her pain. So a patient could have an underlying neurologic disease and also have fibromyalgia.

I think there's really been a shift, and the brain imaging is what's doing it, says Matallana. We're seeing changes in the brain in fibromyalgia, and finally the neurologists are saying, 'You're talking my talk. This is interesting and I don't want to be left out.'

Not all neurologists are embracing fibromyalgia, however. It's a difficult condition to take care of. The patients have chronic pain, they call a lot, and they tend to have a lot of comorbidities, says Dr. Kissel. Comorbidities are other conditions that exist alongside the main disorder-with fibromyalgia they often include depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, lupus, and rheumatoid arthritis. They're very much like chronic headache patients in this regard.

Matallana agrees that the interest in fibromyalgia among neurologists at this point is largely among researchers, pain specialists, and those at academic centers. I don't think it's trickled down to the average neurologist in practice yet, she says. But that may change soon.

 

Same Stimulus, More Pain

These pictures show functional magnetic resonance imaging (fMRI) responses to pressure applied to the left thumb in patients with fibromyalgia versus those without. The chart shows that for fibromyalgia patients, low pressure produced a high pain level (red triangle); for those without fibromyalgia (blue square), similar pressure produced a low level of rated pain. The brain images show common regions of activation in fibromyalgia patients (red) who received low pressure versus non-patients (green) who received high pressure. The similar pain intensities produced by significantly less pressure in the patients resulted in overlapping areas (shown in yellow).

 

Figure. STIMULI RES...
Image Tools

 

OPTIONS FOR TREATMENT

But Dr. Backonja argues that neurologists, especially those who specialize in pain, have a responsibility to take fibromyalgia on. It would be scary and sad for our profession if mounting scientific information were ignored, he says. There's a growing body of information clearly pointing to this as a neurological disorder, and while we can't cure it, there is a pretty reasonable way to apply treatment strategies.

There are now three medications approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia. In addition to pregabalin, which was the first to gain approval, duloxetine and milnacipran can also be prescribed for fibromyalgia. Duloxetine is also approved for the treatment of depression, anxiety, and painful diabetic neuropathy; and milnacipran for the treatment of depression. Doctors may also prescribe low doses of antidepressants to boost serotonin levels, helping to improve sleep and relieve pain.

In addition to medication, the patient needs to be engaged in figuring out how to help him- or herself, says Dr. Farrar. This can include physical therapy, rehabilitative exercise, yoga, self-hypnosis, biofeedback-things that allow the brain to be retrained to help deal with the pain. None of these are right for everybody, of course. For example, some people prefer exercise therapy to yoga.

How successful are these treatments? For people initially diagnosed with fibromyalgia, Dr. Farrar says that the chances of neurologists being able to help make them at least somewhat better or manage their pain are high-about 75-to 90-percent. By the time someone comes to see a specialist, they have probably had some of the simpler therapies, so the likelihood may have gone down a bit. But we're always able to help people in some way. We work with the patient to focus on what works and what doesn't, helping them to manage their discomfort and disability.

More options are on the horizon, as scientists learn more about pain and the nervous system in general and fibromyalgia in particular. We're learning a lot more about nerve-related pain, and although there aren't any obvious pathways that are focused on fibromyalgia, there are still some new agents that I think will allow us to begin to treat patients for underlying abnormalities, says Dr. Farrar.

He predicts that the prospects for at least two or three additional therapies for fibromyalgia over the next 10 years are very good. That said, people shouldn't set their expectations too high, he says. I doubt we'll be able to get to the point where there is zero pain, but we can make it like arthritis-the pain is there, but people are functional and can do the things they need to do.

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Source: Neurology Now, http://journals.lww.com/neurologynow/Fulltext/2009/05050/Fibromyalgia__Is_Fibromyalgia_Real_.24.aspx 

Daily Record-Keeping May Boost Fibromyalgia Care

 

(drugs.com) - THURSDAY, Feb. 3 -- Daily electronic records of symptoms can help fibromyalgia patients and their doctors better understand the condition, a new study shows.

Researchers gave 81 women with fibromyalgia a personal digital assistant (PDA) device. The patients used their PDA to report pain, sleep problems, emotional distress and other issues three times a day for 30 days.

The researchers at the University of Utah and University of Washington believed that this ability to immediately report symptoms would prove more effective than asking patients to recall symptoms at their periodic visits with their doctors.

The study is published in the January issue of The Journal of Pain.

The results showed that being able to analyze several measures of multiple symptoms over time can help clarify relationships among symptoms, the researchers said in a news release from the American Pain Society. For example, the records kept by patients in this study showed that: previous pain is a significant predictor of both fatigue and emotional distress; prior worsening of fatigue predicts current increased pain; and a previous rise in emotional distress predicts current fatigue.

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SOURCE:  drugs.com, http://www.drugs.com/news/daily-record-keeping-may-boost-fibromyalgia-care-29326.html

USA TODAY: Study links obesity to greater pain, weakness in fibromyalgia patients

Fibromyalgia is a “presumptive” condition for Gulf War veterans

Written by Maureen Salamon, HealthDay, USA Today

(HealthDay, USA Today) - Obese fibromyalgia patients suffer more severe symptoms such as pain, reduced flexibility and sleep disturbances than those of normal weight, a new study indicates.

But the good news is that losing weight may bring a modicum of relief, other research suggests.

Noting that pain issues are common in obese people, researchers from the University of Utah analyzed 215 patients with fibromyalgia, a chronic musculoskeletal pain disorder afflicting between 3% and 5% of Americans, most of them women.

Nearly half of the study participants were obese, and another 30% were overweight, with the obese patients experiencing much greater pain to the touch in lower body areas, according to the research. One of the cardinal features of fibromyalgia is extreme pain upon palpation of at least 11 of 18 so-called tender points across the body.

The obese fibromyalgia patients were also more likely than the other study participants to have reduced physical strength, less flexibility in the lower body, a shorter sleeptime and greater restlessness when they did sleep, the study found.

Study author Akiko Okifuji, a professor of anesthesiology at the University of Utah's Pain Research and Management Center, said several effects of obesity on the body may heighten fibromyalgia pain, including increased loading on joints and bones.

"Both fibromyalgia and obesity are clearly big public health concerns. Both conditions seriously impact quality of life," Okifuji said. "It's very difficult to do effective weight management.if you have fibromyalgia. Clearly, if you can do effective weight management, it's better for your overall health."

Obesity is quite common among those with fibromyalgia, with previous research reporting that up to 50% of patients are obese and another 21% to 28% are overweight.

The study, reported in the December 2010 issue of The Journal of Pain, said the poorer sleep quality affecting obese fibromyalgia patients appears to contribute significantly to their fatigue and pain. Obesity is also a risk factor for shorter sleep duration in the general population, according to the study.

Study participants had suffered from fibromyalgia for an average of 12.7 years and were an average of 45 years old, with a mean weight of 184 pounds. Only 47 of the 215 patients had body-mass indexes (BMIs) in the normal range, with four below normal.

In addition to a tender point exam, the participants underwent a home sleep assessment and physical performance tests that included treadmill walking, leg raises, standing push-ups and range-of-motion flexes.

Vitaly Napadow, an assistant professor of radiology at Harvard Medical School who was not connected to the study, said the link between obesity and greater pain in fibromyalgia creates a "vicious cycle" because the pain poses a barrier to exercise, which could reduce weight.

"I think the study was interesting in that it was a larger sample size than the authors studied in the past," said Napadow, also an assistant in neuroscience at Massachusetts General Hospital. "It needs to be recognized that there are these subpopulations in fibromyalgia, and obesity is another burden that needs to be dealt with."

Okifuji said study participants were not asked which condition they had developed first, obesity or fibromyalgia, but noted that each one is a risk factor for the other. Researchers also noted that the study did not determine causality and that its definition of obesity was based on the BMI, which doesn't take into account age or ethnic differences.

"I think the study ended up bringing up more questions than answers," she said.

Both Okifuji and Napadow said a multi-pronged approach to treating obese fibromyalgia patients, including medication, proper nutrition and exercise, needs to be incorporated to maximize symptom relief. Other research has suggested that weight loss may bring some relief from fibromyalgia symptoms, the researchers noted.

"If they're not able to walk because of pain, (perhaps) we can devise upper-body exercise regimens ... that are not difficult for them to do," Napadow said. "That's one kind of intriguing possibility."

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SOURCE:  USA Today

Gulf War Presumptive Chronic Pain Condition and Costochondritis: Pain the Chest and Ribs

From Fibromyalgia & CFS Blog

  By Adrienne Dellwo, Fibromyalgia & Chronic Fatigue Guide

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Do you get a horrible burning pain in your chest and ribcage? Have you thought you were having a heart attack, only to have doctors say your heart is fine? If so, you may have costochondritis.

This was actually my first fibromyalgia-related pain. When it hit, I ended up in the ER with a suspected heart attack. The doctor ruled out anything cardiac or intestinal, then poked a few spots where my ribs and breastbone come together. That hurt like crazy, so he said I had an injury there and that it would heal in a few days.

Of course, it didn't heal. It comes and goes, causing the worst of my pains and a lump on my breast bone that looks like half a golf ball. In the medical community, it's a debate as to whether this is costochondritis, somehow made chronic by fibromyalgia, or just another symptom of fibromyalgia that mimics costochonritis. Personally, I think it's a separate condition. My chest pain is accompanied by a lump on my breastbone that gets better with ice and anti-inflammatories. That doesn't sound like fibromyalgia to me!

Note: If you start getting chest pain, don't assume it's costochondritis or fibromyalgia! Always treat chest pain as a possible heart problem and get it checked out immediately.

Learn more about costochondritis, its symptoms, how it's diagnosed, and how you can treat it:

• Fibromyalgia & Costochondritis

Do you have costochondritis? How bad is it? Do you think it's part of FMS or a separate condition? Leave your comments below!

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Nat’l Fibromyalgia Assoc. Needs Help on Xyrem Approval for Fibromyalgia

October 1, 2010

Dear NFA Supporter,

On August 20, 2010 the Food and Drug Administration (FDA) convened an Advisory Panel, made up of the Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee to contemplate support for the approval of Jazz Pharmaceuticals Xyrem (sodium oxybate), as a fibromyalgia treatment.

At the hearing the panel made up of medical professionals heard testimony from researchers, physicians, and patients relevant to the benefits of this medication in the treatment of fibromyalgia symptoms, especially pain. Positive scientific outcomes were expounded by the researchers. Medical doctors described the exemplary patient treatment outcomes associated with sodium oxybate.

Patients gave personal testimonies revealing their positive responses to the drug. However, even with these affirmative testimonies and shared outcome data from scientific research studies from two previous phase III trials involving a total of more than 1,000 fibromyalgia patients, that demonstrated efficacy in significantly decreasing pain and fatigue and improving daily function, the Panel voted 20 to 2 against approving sodium oxybate for the treatment of fibromyalgia.

Concerns raised by the Panel members included doing additional studies measuring sodium oxybate’s effectiveness against other FDA approved fibromyalgia drugs and instigating more Risk-Evaluation and Mitigation Strategies (REMS) control methods. Sodium oxybate is already approved by the FDA for the treatment of excessive daytime sleepiness and cataplexy (the sudden loss of muscle tone) in adult patients with narcolepsy. It is listed as a schedule III drug and its distribution is restricted through the Patient Success Program, already one of the most stringent REMS processes. Currently, it can only be purchased from a central, mail-order pharmacy and patients are first required to read a letter as well as a brochure plus watch a video about safety precautions and how to appropriately take the medication.

In response to the Panel’s rejection of sodium oxybate, Jazz Pharmaceuticals has created an even more stringent REMS program to address delivery and safety issues. It is also working with the FDA to satisfy the research questions raised by the panel.

On October 11, the next important step in the process for FDA approval of sodium oxybate will take place. Fibromyalgia patients deserve the opportunity for access to sodium oxybate to relieve their pain and other symptoms. Scientific research has shown this medication to be the most efficacious drug ever tested for people with fibromyalgia.

The NFA encourages you to please take a minute and access one of the attached letters in support of FDA approval of sodium oxybate, sign it and send it to the FDA at the provided address.

Click HERE if you are a person with fibromyalgia who has taken sodium oxybate

Click HERE if you are a person with fibromyalgia who supports FDA approval of sodium oxybate

Thank you joining us, as we take action to improve the lives of people living with fibromyalgia.

Sincerely,

Rae Marie Gleason
Executive Director, National Fibromyalgia Association

Neurologic Signs Common with Chronic Pain Condition

Editor's Note:  Fibromyalgia is a presumptive condition for federal VA service-connected disability compensation for Gulf War veterans.


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Written by Michelle Rizzo, Reuters Health

NEW YORK (Reuters Health) - Fibromyalgia isn't all in your head, new research suggests.

In a study, researchers found that people with fibromyalgia were more likely than those without the chronic pain condition to have poor balance, tingling and weakness in the arms and legs, and other "neurologic" signs and symptoms.

Fibromyalgia, a debilitating pain syndrome that affects 2 to 4 percent of the population, is characterized by chronic pain, fatigue and difficulty sleeping. It's a somewhat mysterious condition with no clear-cut cause. Many people with fibromyalgia have faced the question of whether the condition is real.

The new findings, reported in the latest issue of Arthritis and Rheumatism, support a growing body of literature suggesting that the condition is real and also support the possibility that a "neuroanatomical" cause may underlie fibromyalgia.

Dr. Nathaniel F. Watson, of the University of Washington Medicine Sleep Institute at Harborview, Seattle, and colleagues studied 166 people with fibromyalgia and 66 pain-free controls.

All of them were examined by a neurologist who was unaware of their disease status. All study participants also completed a standard questionnaire on neurologic symptoms.

In 27 of 29 neurological categories tested, significantly more neurologic symptoms were seen in the fibromyalgia group than in the control group, Watson and colleagues found.

The greatest differences were found for light sensitivity, or "photophobia," seen in 70 percent of fibromyalgia patients but in only 6 percent of pain-free controls; poor balance, which plagued 63 percent of fibromyalgia patients but only 4 percent of controls; and weakness and tingling in the arms or legs, seen in more than half of fibromyalgia patients but in only around 4 percent of controls.

In addition, those with fibromyalgia had greater dysfunction than controls in certain nerves in the brain. They also had more "sensory" problems, motor abnormalities and gait problems.

Within the fibromyalgia group, there were significant correlations between several neurologic signs and symptoms. For example, numbness in any part of the body or tingling in the arms or legs correlated with neurologic test findings. Poor balance, poor coordination and weakness in the arms or legs also correlated with objective findings on neurologic tests.

These observations, Watson told Reuters Health, underscore the need for "careful neurological examinations in all fibromyalgia patients, particularly those with neurological complaints."

Watson cautioned that this study does not confirm a neuroanatomical basis for fibromyalgia and that much more work is necessary before this can be known with certainty.

SOURCE: Arthritis and Rheumatism, September 2009.