| |
Important Note: The following information
is provided for your education. It should not be relied upon for
personal diagnosis or treatment. If you believe that a
particular therapy applies to you or someone you care about, be
sure to consult a doctor before trying it.
Fibromyalgia Research: 2002-2006
Curr Pain Headache Rep. 2006 Oct;10(5):333-8.
Physical Therapy and OtherNonpharmacologic Approachesto
Fibromyalgia Management.
Blehm R.
Portland VA Medical Center, 3710 SW US Vets Hospital Road, P3-PM&RS, Portland,
OR 97207, USA.
Fibromyalgia is a vague and changing syndrome that comprises many symptoms. Due
to the confounding nature of fibromyalgia syndrome, there has been much debate
about which interventions and therapies should be considered as viable treatment
options. Opinions continue to shift in publication and research circles, with
little documentation to show good, long-term outcomes. Several studies have
shown promise, with initial improvement in symptoms, but in many cases, these
improvements were not lasting or the patients were then unable to
continue/replicate the program on their own. In this article, some of the more
recently published findings regarding the efficacy of exercise are explored,
specifically physical therapy and other nonpharmacologic interventions, for
managing fibromyalgia syndrome.
-----
Scand J Caring Sci. 2006 Sep;20(3):315-22.
Long-term follow up of a physical therapy programme for patients
with fibromyalgia syndrome.
Havermark AM, Langius-Eklof A.
Halsopoolens Rehabklinik, Stockholm, Sweden.
The purpose of this study was to evaluate, in a long-term perspective, the
impact of a physical therapy-based educational programme on patients with
fibromyalgia syndrome (FMS). The programme includes information about the
syndrome, information about pain and muscle physiology, training in warm water,
stretching, body awareness therapy and relaxation in groups of 15 patients twice
weekly, 2 hours during 10 weeks. A total of 240 patients with FMS participated
in the study before and immediately after the programme and at a follow up with
a mean of 35 months after the programme. Health status as measured with the
Fibromyalgia Impact Questionnaire was answered by the patients at all three
measurement points. Questionnaires concerning self-care, self-motivation and
sense of coherence (SOC) were distributed at the follow up. The results showed a
significant improvement on several symptoms when comparing before and after the
programme, and at the time of follow up the patients' rated well-being was still
improved. The results also showed that the patients' pretreatment perception of
symptoms, well-being and SOC are predictors to the perception of general health
at the follow up of a physical therapy programme. The conclusion is that a
physical therapy programme for patients with FMS may have a positive impact on
patients' general well-being but not on other symptoms.
-----
Ann Rheum Dis. 2006 Aug 17; [Epub ahead of print]
A Review of cognitive behaviour therapies and exercise programmes
for fibromyalgia patients: State of the art and future directions.
Koulil SV, Effting M, Kraaimaat FW, Lankveld WV, Helmond TV, Cats H, van Riel P,
de Jong A, Haverman J, Evers A.
Radboud University Nijmegen Medical Centre, Netherlands.
This review provides an overview of the effects of non- pharmacological
treatments for patients with fibromyalgia (FM), including cognitive behaviour
therapy, exercise training programmes or a combination of the two. After
summarizing and discussing preliminary evidence of the rationale of
non-pharmacological treatment in FM, we will review and examine controlled
trials for possible predictors of treatment success such as patient and
treatment characteristics. Despite support for their suitability in FM, the
effects of non- pharmacological interventions are limited and positive outcomes
largely disappear in the long term. However, within the various FM populations
treatment outcomes showed considerable individual variations. In particular,
specific subgroups of patients characterized by relatively high levels of
psychological distress seem to benefit most from non-pharmacological
interventions. Preliminary evidence of retrospective treatment analyses suggest
that the efficacy may be enhanced by offering tailored treatment approaches in
an early stage to patients who are at risk of developing chronic physical and
psychological impairments.
-----
Nat Clin Pract Rheumatol. 2006 Aug;2(8):416-24.
Cognitive behavioral therapy for fibromyalgia.
Bennett R, Nelson D.
Oregon Health & Science University, Portland, OR 97239, USA. bennetrob1@comcast.net
Cognitive behavioral therapy (CBT) techniques offer short-term, goal-oriented
psychotherapy. In this respect, it differs from classical psychoanalysis in
emphasizing changes in thought patterns and behaviors rather than providing
'deep insight'. Importantly, the beneficial effects of CBT can be achieved in
10-20 sessions, compared with the many years required for classical
psychoanalysis. Although CBT is often done on a one-to-one basis, it also lends
itself to a group therapeutic setting. CBT was initially used in the treatment
of mood disorders, but its use has subsequently been expanded to include various
other medical conditions, including chronic pain states. Over the past 18 years,
several chronic pain treatment programs have used CBT techniques in the
management of fibromyalgia. In this review, the results from 13 programs using
CBT, alone or in combination with other treatment modalities, are analyzed. In
most studies, CBT provided worthwhile improvements in pain-related behavior,
self-efficacy, coping strategies and overall physical function. Sustained
improvements in pain were most evident when individualized CBT was used to treat
patients with juvenile fibromyalgia. The current data indicate that CBT, as a
single treatment modality, does not offer any distinct advantage over
well-planned group programs of education or exercise, or both. Its role in the
management of fibromyalgia patients needs further research.
-----
Eur J Pain. 2006 Aug 2; [Epub ahead of print]
Effect of hypnotic suggestion on fibromyalgic pain: Comparison
between hypnosis and relaxation.
Castel A, Perez M, Sala J, Padrol A, Rull M.
Pain Clinic and UFISS Palliative Care. Hospital Universitari de Tarragona Joan
XXIII and Gestio i Prestacio de Serveis de Salut, C/Doctor Mallafre Guasch 4,
43007 Tarragona, Spain.
The main aims of this experimental study are: (1) to compare the relative
effects of analgesia suggestions and relaxation suggestions on clinical pain,
and (2) to compare the relative effect of relaxation suggestions when they are
presented as "hypnosis" and as "relaxation training". Forty-five patients with
fibromyalgia were randomly assigned to one of the following experimental
conditions: (a) hypnosis with relaxation suggestions; (b) hypnosis with
analgesia suggestions; (c) relaxation. Before and after the experimental
session, the pain intensity was measured using a visual analogue scale (VAS) and
the sensory and affective dimensions were measured with the McGill Pain
Questionnaire. The results showed: (1) that hypnosis followed by analgesia
suggestions has a greater effect on the intensity of pain and on the sensory
dimension of pain than hypnosis followed by relaxation suggestions; (2) that the
effect of hypnosis followed by relaxation suggestions is not greater than
relaxation. We discuss the implications of the study on our understanding of the
importance of suggestions used in hypnosis and of the differences and
similarities between hypnotic relaxation and relaxation training.
-----
Prog Neuropsychopharmacol Biol Psychiatry. 2006 Aug 2; [Epub ahead of print]
An open-label study of quetiapine in the treatment of
fibromyalgia.
Hidalgo J, Rico-Villademoros F, Calandre EP.
Instituto de Neurociencias, Universidad de Granada, Avda de Madrid 11, 18012
Granada, Spain.
The aim of this exploratory study was to systematically assess the potential
effectiveness and tolerability of quetiapine, an atypical antipsychotic, for the
treatment of patients with fibromyalgia. This was a unicentre, open-label study
conducted in thirty-five outpatients, 18 years or older, who met the ACR
criteria for fibromyalgia and who had not satisfactorily responded to their
previous fibromyalgia treatment. Quetiapine, flexibly dosed (25-100 mg/day), was
added to their original treatment regimen for 12 weeks. The primary outcome
measure was the mean change from baseline to endpoint in the Fibromyalgia Impact
Questionnaire (FIQ) total score. Secondary efficacy measures included mean
changes from baseline to endpoint in the scores of the Clinical Global
Impression (CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI), Beck
Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), 12-Item Short
Form Health Survey (SF-12), and individual items of the FIQ. Thirty (85.7%)
patients (mean age 47+/-7.9, 93.3% females) had a postbaseline evaluation and
constituted the intent-to-treat efficacy sample. Mean FIQ total score decreased
significantly by 10.2 points from a baseline of 63.2 to 53.0 at study endpoint
(p<0.001). A statistically significant reduction was observed in FIQ stiffness
and FIQ fatigue subscores but not in FIQ pain subscore. Large effect sizes were
observed for the FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while
moderate effect sizes (i.e.>/=0.50) were encountered in the FIQ fatigue, FIQ
stiffness and SF-12 mental component summary. Quetiapine was safely administered
and well tolerated. Despite the lack of effect on pain, the significant and
relevant improvement in overall efficacy measures and quality of life suggests
that quetiapine may be a valuable drug for treatment of patients with
fibromyalgia that should be further tested in double-blind, placebo-controlled
trials.
-----
Nat Clin Pract Rheumatol. 2006 Jul;2(7):364-72.
Therapy Insight: fibromyalgia--a different type of pain needing a
different type of treatment.
Dadabhoy D, Clauw DJ.
Chronic Pain and Fatigue Research Center, The University of Michigan, 24 Frank
Lloyd Wright Drive, Box 385, Ann Arbor, MI 48106, USA. dadabhoy@umich.edu
In the past decade, we have made tremendous progress in our understanding of
fibromyalgia, which is now recognized as one of many 'central' pain syndromes
that are common in the general population. Specific genes that might confer an
increased risk of developing fibromyalgia syndrome are beginning to be
identified and the environment (in this case exposure to stressors) might also
have a significant effect on triggering the expression of symptoms. After
developing the syndrome, the hallmark aberration noted in individuals with
fibromyalgia is augmented central pain processing. Insights from research
suggest that fibromyalgia and related syndromes require a multimodal management
program that is different from the standard used to treat peripheral pain (i.e.
acute or inflammatory pain). Instead of the nonsteroidal anti-inflammatory drugs
and opioids commonly used in the treatment of peripheral pain, the recommended
drugs for central pain conditions are neuroactive compounds that downregulate
sensory processing. The most efficacious compounds that are currently available
include the tricyclic drugs and mixed reuptake inhibitors that simultaneously
increase serotonin and norepinephrine concentrations in the central nervous
system. Other compounds that increase levels of single monoamines (serotonin,
norepinephrine or dopamine), and anticonvulsants also show efficacy in this
condition. In addition to these pharmacologic therapies, which are useful in
improving symptoms, nonpharmacologic therapies such as exercise and cognitive
behavioral therapy are useful treatments for restoring function to an individual
with fibromyalgia.
-----
Curr Opin Investig Drugs. 2006 Jul;7(7):637-42.
Clinical potential of milnacipran, a serotonin and norepinephrine
reuptake inhibitor, in pain.
Leo RJ, Brooks VL.
Department of Psychiatry, School of Medicine and Biomedical Sciences, State
University of New York at Buffalo, Erie County Medical Center, NY 14215, USA.
Rleomd@aol.com
Milnacipran is a serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor
currently available for use as an antidepressant in several countries. Phase III
clinical trials are currently underway to assess its potential role in the
treatment of fibromyalgia syndrome, and in pursuit of US Food and Drug
Administration approval for this indication. Evidence has accumulated suggesting
that in animal models, milnacipran may exert pain-mitigating influences
involving NE- and 5-HT-related processes at supraspinal, spinal and peripheral
levels of pain transmission. Preliminary evidence suggests that milnacipran may
be useful in mitigating pain and fatigue associated with fibromyalgia. However,
its role in addressing comorbidities associated with fibromyalgia, including
visceral pain and migraine, has yet to be investigated.
-----
Altern Ther Health Med. 2006 Mar-Apr;12(2):34-41.
Effectiveness of acupuncture in the treatment of fibromyalgia.
Singh BB, Wu WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP, Wang CN,
Lin SY.
Southern California University of Health Sciences, Whittier, USA.
CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal disorder
associated with pain, mood state alteration, and disability. A structured and
effective treatment plan for palliative care has not been established. The
genesis of FMS is not clear. FMS occurs primarily in adult women. DESIGN: Using
a quasi-experimental clinical design and following the criteria of the American
College of Rheumatology (ACR), for FMS, 21 participants completed the study. The
mean age was 53.6 years. The data were collected at baseline and at 1 and 2
months. Acupuncture treatments included 17 points for FMS symptoms, and 8
outcome measures were collected. RESULTS: The Fibromyalgia Impact Questionnaire
(FIQ) showed significant differences at 1 and 2 months. For the SF-12, 3
subscales showed significant differences between baseline and 2 months. Four of
6 items were significantly changed. The mean number of general health symptoms
was significantly decreased by 2 months. For the Catastrophe Index, significant
differences were found for baseline vs 2 months. Pain threshold scores were
significantly different at end of treatment for 5 bilateral tender points. There
was significant improvement in Beck Depression items for both 1- and 2-month
periods. In a multivariate regression model, 5 covariates were included--age,
number of weeks in treatment, number of doctors treating, number of general
symptoms, and baseline FIQ score. The results indicated significant age effect.
This analysis showed that the higher the FIQ score, the more positive the change
experienced by study participants. Number of weeks in treatment, number of
doctors who treated, and total number of general health symptoms did not have a
significant effect on outcomes. CONCLUSIONS: Significant improvement was
experienced by participants at 8 weeks of treatment. Acupuncture treatment as
delivered was effective at reducing FMS symptoms in this outcome study.
-----
CNS Spectr. 2006 Mar;11(3):212-22.
Antidepressants and cognitive-behavioral therapy for symptom
syndromes.
Jackson JL, O'Malley PG, Kroenke K.
Department of Medicine, Uniformed Services University of Health Sciences,
Bethesda, MD 20814, USA. jejackson@usuhs.mil
Somatic symptoms are common in primary care and clinicians often prescribe
antidepressants as adjunctive therapy. There are many possible reasons why this
may work, including treating comorbid depression or anxiety, inhibition of
ascending pain pathways, inhibition of prefrontal cortical areas that are
responsible for "attention" to noxious stimuli, and the direct effects of the
medications on the syndrome. There are good theoretical reasons why
antidepressants with balanced norepinephrine and serotonin effects may be more
effective than those that act predominantly on one pathway, though head-to-head
comparisons are lacking. For the 11 painful syndromes review in this article,
cognitive-behavioral therapy is most consistently demonstrated to be effective,
with various antidepressants having more or less randomized controlled data
supporting or refuting effectiveness. This article reviews the randomized
controlled trial data for the use of antidepressant and cognitive-behavior
therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain,
headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms,
chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic
pelvic pain. For some syndromes, the data for or against treatment effectiveness
is relatively robust, for many, however, the data, one way or the other is
scanty.
-----
Sleep Med. 2006 Mar 22; [Epub ahead of print]
Hydrotherapy and conventional physiotherapy improve total sleep
time and quality of life of fibromyalgia patients: Randomized
clinical trial.
Vitorino DF, Carvalho LB, Prado GF.
UNILAVRAS, Lavras, MG, Brazil.
OBJECTIVE: To compare hydrotherapy (HT) and conventional physiotherapy (CP) in
the treatment of fibromyalgia (FM), regarding quality of life (QOL), total sleep
time (TST), and total nap time (TNT). METHODS: Fifty outpatients, all female,
30-60 years old, diagnosed with FM, were randomly assigned to two groups to
carry out 3 weeks of treatment with HT or CP. In the beginning and in the end of
treatment, patients were evaluated with the SF-36 questionnaire to measure QOL
and the sleep diary for TST and TNT. Data analyses were blind. RESULTS: All 24
HT patients increased 1h in TST compared to 19 CP patients. TNT decreased in the
HT group. QOL improved for the two groups in all domains when pre- and
post-intervention were compared, but there was no difference between groups.
CONCLUSION: HT is more effective than CP to improve TST and to decrease TNT in
FM patients.
-----
Int J Immunopathol Pharmacol. 2006 Jan-Mar;19(1):5-10.
Fibromyalgia - new concepts of pathogenesis and treatment.
Lucas HJ, Brauch CM, Settas L, Theoharides TC.
Special Clinic for FMS and CFS, Trier, Germany.
Fibromyalgia (FMS) is a debilitating disorder characterized by chronic diffuse
muscle pain, fatigue, sleep disturbance, depression and skin sensitivity. There
are no genetic or biochemical markers and patients often present with other
comorbid diseases, such as migraines, interstitial cystitis and irritable bowel
syndrome. Diagnosis includes the presence of 11/18 trigger points, but many
patients with early symptoms might not fit this definition. Pathogenesis is
still unknown, but there has been evidence of increased corticotropin-releasing
hormone (CRH) and substance P (SP) in the CSF of FMS patients, as well as
increased SP, IL-6 and IL-8 in their serum. Increased numbers of activated mast
cells were also noted in skin biopsies. The hypothesis is put forward that FMS
is a neuro-immunoendocrine disorder where increased release of CRH and SP from
neurons in specific muscle sites triggers local mast cells to release
proinflammatory and neurosensitizing molecules. There is no curative treatment
although low doses of tricyclic antidepressants and the serotonin-3 receptor
antagonist tropisetron, are helpful. Recent nutraceutical formulations
containing the natural anti-inflammatory and mast cell inhibitory flavonoid
quercetin hold promise since they can be used together with other treatment
modalities.
-----
Rev Med Liege. 2006 Feb;61(2):109-16.
[Value of aerobic rehabilitation in the management of
fibromyalgia]
[Article in French]
Maquet D, Croisier JL, Demoulin C, Faymonville M, Crielaard JM.
Medecine de l'Appareil locomoteur, Departement de Medecine Physique et de
Kinesitherapie-Readaptation, ULg, CHU Sart Tilman, Liege. D.Maquet@ulg.ac.be
This study assesses the influence of a muscular aerobic revalidation program on
the management of the fibromyalgia syndrome. After 3 months, benefits consisting
of increased muscle performances associated with a reduction of pain and an
improvement of quality of life were documented. This study confirms the value of
aerobic muscle exercise in fibromyalgia patients.
-----
Arthritis Rheum. 2006 Feb 15;55(1):57-65.
A randomized controlled trial of deep water running: clinical
effectiveness of aquatic exercise to treat fibromyalgia.
Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D, Neto TL, Natour
J.
Division of Rheumatology, Sao Paulo Federal University, Rua Botucatu 740,
04023-900 Sao Paulo, Brazil.
OBJECTIVE: To compare the clinical effectiveness of aerobic exercise in the
water with walking/jogging for women with fibromyalgia (FM). METHODS: Sixty
sedentary women with FM, ages 18-60 years, were randomly assigned to either deep
water running (DWR) or land-based exercises (LBE). Patients were trained for 15
weeks at their anaerobic threshold. Visual analog scale of pain, Fibromyalgia
Impact Questionnaire (FIQ), Beck Depression Inventory, Short Form 36 Health
Survey (SF-36), and a patient's global assessment of response to therapy (PGART)
were measured at baseline, week 8, and week 15. Statistical analysis included
all patients. RESULTS: Four patients dropped out from each group. Both groups
improved significantly at week 15 compared with baseline, with an average 36%
reduction in pain intensity. For PGART, 40% of the DWR group and 30% of the LBE
group answered "much better" at posttreatment. FIQ total score and FIQ
depression improvements in the DWR group were faster (week 8) than the LBE group
and kept improving (week 15; P < 0.05). Only the DWR group showed improvements
in SF-36 role emotional (P = 0.006). No significant between-group differences
were observed for peak oxygen uptake and other outcomes. CONCLUSION: DWR is a
safe exercise that has been shown to be as effective as LBE regarding pain.
However, it has been shown to bring more advantages related to emotional
aspects. Aerobic gain was similar for both groups, regardless of symptom
improvement. Therefore, DWR could be studied as an exercise option for patients
with FM who have problems adapting to LBE or lower limbs limitations.
-----
Arthritis Rheum. 2006 Feb 15;55(1):66-73.
Exercise in waist-high warm water decreases pain and improves
health-related quality of life and strength in the lower extremities in women
with fibromyalgia.
Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortega-Alonso A.
Fitness and Lifequality Laboratory, Sports Sciences Faculty, University of
Extremadura, Avenue Universidad s/n, 10071 Caceres, Spain. ngusi@unex.es
OBJECTIVE: To evaluate the short- and long-term efficacy of exercise therapy in
a warm, waist-high pool in women with fibromyalgia. METHODS: Thirty-four women
(mean +/- SD tender points 17 +/- 1) were randomly assigned to either an
exercise group (n = 17) to perform 3 weekly sessions of training including
aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a
control group (n = 17). Maximal unilateral isokinetic strength was measured in
the knee extensors and flexors in concentric and eccentric actions at 60 degrees
/second and 210 degrees /second, and in the shoulder abductors and adductors in
concentric contractions. Health-related quality of life (HRQOL) was assessed
using the EQ-5D questionnaire; pain was assessed on a visual analog scale. All
were measured at baseline, posttreatment, and after 6 months. RESULTS: The
strength of the knee extensors in concentric actions increased by 20% in both
limbs after the training period, and these improvements were maintained after
the de-training period in the exercise group. The strength of other muscle
actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was
reduced by 29% (P = 0.012) in the exercise group during the training, but pain
returned close to the pretraining level during the subsequent de-training.
However, there were no changes in the control group during the entire period.
CONCLUSION: The therapy relieved pain and improved HRQOL and muscle strength in
the lower limbs at low velocity in patients with initial low muscle strength and
high number of tender points. Most of these improvements were maintained long
term.
-----
Minerva Med. 2005 Dec;96(6):417-23.
[Fibromyalgic syndrome: new perspectives in rehabilitation and
management. A review]
[Article in Italian]
Melillo N, Corrado A, Quarta L, D'Onofrio F, Trotta A, Cantatore FP.
Clinica Reumatologica Mario Carrozzo, Universita degli Studi di Foggia, Foggia.
Fibromyalgia is a chronic syndrome, characterized by widespread body pain and
pain at specific tender points, whose etiology and pathogenesis is still
unknown. Patient can also exhibit a range of other symptoms including irritable
bowel syndrome, chest pain, anxiety, fatigue, sleep disturbance, headache. The
prevalence of fibromyalgia ranges from 1-3% in the general population, and the
condition is more common among female than males. Contrary to the situation a
few years ago, the most widely accepted hypothesis now evoke central nervous
system mechanisms, whose local functions could influence also periferical
microvascular activity at tender points. There are many findings supporting the
hypothesis of different endogenic and exogenic factors that lead to chronic
local hypoxia in muscle tissue. Currently, therapy is polipragmatic and is aimed
at reducing the pain. A range of medical treatment had been used to treat
fibromyalgia. Pharmacological therapy aims to enhance the pain threshold and to
support sleep. Nonpharmaceutical treatment modalities, such as exercise,
massage, idrotherapy can be helpful. Future studies should investigate the
possible benefits of new strategies that may combine the effects of hot pool
water, stretching exercises, massage and relaxation benefits of balneotherapy.
-----
J Psychosom Res. 2005 Nov;59(5):275-82.
A pilot study of the effects of behavioral weight loss treatment
on fibromyalgia symptoms.
Shapiro JR, Anderson DA, Danoff-Burg S.
Department of Psychology, University at Albany, State University of New York,
Albany, NY, USA.
OBJECTIVE: Previous studies have found a relation between weight loss and pain
severity in various chronic pain populations. However, there has been little
research examining the relation between body mass index (BMI) and fibromyalgia
syndrome (FMS). The purpose of this pilot study was to investigate the
relationship between BMI and FMS symptoms and to determine if FMS symptoms would
decrease following weight loss. METHODS: Overweight and obese women participated
in a 20-week behavioral weight loss treatment. RESULTS: Participants, on
average, lost 9.2 lbs (4.4% of their initial weight), and there were significant
pre-postimprovements on several outcome measures. Although weight was not
significantly related to pain at baseline, weight loss significantly predicted a
reduction in FMS, pain interference, body satisfaction, and quality of life (QOL).
CONCLUSION: Findings suggest that behavioral weight loss treatment could be
included in the treatment for overweight/obese women with FMS.
-----
Ann Pharmacother. 2005 Nov;39(11):1812-6. Epub 2005 Oct 11.
Open trial of pindolol in the treatment of fibromyalgia.
Wood PB, Kablinger AS, Caldito GS.
Department of Family Medicine, Louisiana State University Health Science
Center-Shreveport, LA.
BACKGROUND: Evidence suggests that fibromyalgia is related to both chronic
sympathetic hyperactivity and decreased levels of serotonin. OBJECTIVE: To
examine the efficacy of pindolol, a mixed serotonin (5-HT)(1A) presynaptic
autoreceptor/beta-adrenergic receptor antagonist, in the treatment of
fibromyalgia. METHODS: An open trial was conducted using 20 female patients who
met the American College of Rheumatology criteria for fibromyalgia. Treatment
was initiated with pindolol 7.5 mg/day and titrated to a maximum dose of 15
mg/day for a total of 90 days. Primary outcome measures were tender point
analysis and the Fibromyalgia Impact Questionnaire (FIQ). Anxiety and depression
were measured with the Hamilton Depression and Anxiety Scales and Beck
Depression Inventory. RESULTS: There was significant improvement in primary
outcome measures, including Tender Point Count (mean +/- SD, 16.3 +/- 2.2 vs
12.3 +/- 5.0; F = 8.9; p < 0.001), Tender Point Score (24.4 +/- 5.7 vs 17.5 +/-
9.4; F = 7.8; p < 0.001), and FIQ (45.3 +/- 10.8 vs 35.0 +/- 15.0; F = 5.6; p <
0.005). The depression and anxiety scores did not change significantly among
women who completed the study, while the impact on cardiovascular parameters was
clinically insignificant. CONCLUSIONS: While the current results are
encouraging, further studies are needed to determine whether pindolol might be
effective in the treatment of fibromyalgia. Limitations of this study include
small group size and lack of placebo control.
-----
J Rheumatol. 2005 Oct;32(10):1975-85.
Efficacy of milnacipran in patients with fibromyalgia.
Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, Williams
DA, Mease PJ, McLean SA, Clauw DJ.
Cypress Biosciences, 4350 Executive Drive, San Diego, CA 92121, USA. mgendreau1@cypressbio.com
OBJECTIVE: Fibromyalgia (FM) is a common musculoskeletal condition characterized
by widespread pain, tenderness, and a variety of other somatic symptoms. Current
treatments are modestly effective. Arguably, the best studied and most effective
compounds are tricyclic antidepressants (TCA). Milnacipran, a nontricyclic
compound that inhibits the reuptake of both serotonin and norepinephrine, may
provide many of the beneficial effects of TCA with a superior side effect
profile. METHODS: One hundred twenty-five patients with FM were randomly
assigned in a 3:3:2 ratio to receive milnacipran twice daily, milnacipran once
daily, or placebo for 3 months in a double-blind dose-escalation trial; 92% of
twice-daily and 81% of once-daily participants achieved dose escalation to the
target milnacipran dose of 200 mg. RESULTS: The primary endpoint was reduction
of pain. Both the once- and twice-daily groups showed statistically significant
improvements in pain, as well as improvements in global well being, fatigue, and
other domains. Response rates for patients receiving milnacipran were equal in
patients with and without comorbid depression, but placebo response rates were
considerably higher in depressed patients, leading to significantly greater
overall efficacy in the nondepressed group. CONCLUSION: In this Phase II study,
milnacipran led to statistically significant improvements in pain and other
symptoms of FM. The effect sizes were equal to those previously found with TCA,
and the drug was generally well tolerated.
-----
Curr Pain Headache Rep. 2005 Oct;9(5):301-6.
Pharmacologic treatment of fibromyalgia.
Baker K, Barkhuizen A.
Arthritis & Rheumatic Diseases, Oregon Health & Science University, OP-09,
Portland, OR 97239, USA. bakerk@ohsu.edu
Fibromyalgia is a syndrome of widespread pain, nonrestorative sleep, disturbed
mood, and fatigue. Optimal treatment involves a multidisciplinary approach with
a team of health care providers using pharmacologic and nonpharmacologic
treatment. Because of the heterogeneity of the illness, management should be
individualized for the patient. Pharmacologic treatment should address issues of
pain control, sleep disturbance, fatigue, and any underlying coexisting mood
disorder. Nonpharmacologic treatment should include patient education, a regular
exercise and stretching program, and cognitive behavioral therapy. All of these
are essential to improving functional capacity and quality of life. This review
provides general guidelines in initiating a successful pharmacologic treatment
program for patients with fibromyalgia.
-----
Psychosomatics. 2005 Sep-Oct;46(5):379-84.
Evaluation of reboxetine, a noradrenergic antidepressant, for the
treatment of fibromyalgia and chronic low back pain.
Krell HV, Leuchter AF, Cook IA, Abrams M.
Laboratory of Behavioral Pharmacology, UCLA Neuropsychiatric Institute, 37-452
NPI, 760 Westwood Plaza, Los Angeles, CA 90024, USA. hkrell@mednet.ucla.edu
Clinical experience supports the use of antidepressant medications to treat
chronic pain syndromes, such as low back pain and fibromyalgia. Although this
use of antidepressants is common in clinical practice, the literature supporting
this off-label use has some limitations. In this report, the authors review the
body of clinical data on the use of antidepressants in treating pain and present
a case series of depressed patients with these syndromes who experienced relief
of pain symptoms while being treated with the noradrenergic antidepressant
reboxetine. These subjects experienced significant relief of pain before any
significant improvement in actual mood symptoms. Our experience with reboxetine
suggests that this noradrenergic antidepressant may have efficacy in the
treatment of chronic pain in patients with depression.
-----
Internist (Berl). 2005 Sep 27; [Epub ahead of print]
[Fibromyalgia—An update.]
[Article in German]
Bruckle W, Zeidler H.
Rheumaklinik, Bad Nenndorf.
Fibromyalgia is a common syndrome of unknown etiology characterized by chronic
widespread pain and polysymptomatic autonomic disturbances and often mental
features. The American College of Rheumatology's classification criteria define
fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a
diagnosis of exclusion as long as stand none laboratory or technical tests. The
major role in pathogenesis appears to be central and involves the subcortical
pain modulation, psychical stress especially in early childhood,
endocrinological and genetic factors. There is no evidence of abnormalities in
muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical
function and sleep disturbance. Actual evidence of effects of pharmacological
and nonpharmacological interventions are summarized. Tricyclic agents, aerobic
exercises, patient education and combined therapies can reduce effectively
symptoms and disability.
-----
Arch Phys Med Rehabil. 2005 Sep;86(9):1713-21.
The effects of a 12-week strength-training program on strength
and functionality in women with fibromyalgia.
Kingsley JD, Panton LB, Toole T, Sirithienthad P, Mathis R, McMillan V.
Department of Nutrition, Food and Exercise Sciences, Florida State University,
Tallahassee, FL 32306, USA.
OBJECTIVE: To determine whether women with fibromyalgia benefit from strength
training. DESIGN: Randomized controlled trial. SETTING: Testing was completed at
the university and training was completed at a local community wellness
facility. PARTICIPANTS: Twenty-nine women (age range, 18-54 y) with fibromyalgia
participated. Subjects were randomly assigned to a control (n=14; wait-listed
for exercise) or strength (n=15) group. After the first 4 weeks, 7 (47%) women
dropped from the strength group. INTERVENTION: Subjects underwent 12 weeks of
training on 11 exercises, 2 times a week, performing 1 set of 8 to 12
repetitions at 40% to 60% of their maximal lifts and were progressed to 60% to
80%. MAIN OUTCOME MEASURES: Subjects were measured for strength, functionality,
tender point sensitivity, and fibromyalgia impact. RESULTS: The strength group
significantly (P< or =.05) improved upper- (strength, 39+/-11 to 42+/-12 kg;
control, 38+/-13 to 38+/-12 kg) and lower- (strength, 68+/-28 to 82+/-25 kg;
control, 61+/-25 to 61+/-26 kg) body strength. Upper-body functionality measured
by the Continuous-Scale Physical Functional Performance test improved
significantly (strength, 44+/-11 to 50+/-16U; control, 51+/-11 to 49+/-13U)
after training. Tender point sensitivity and fibromyalgia impact did not change.
CONCLUSIONS: Strength training improved strength and some functionality in women
with fibromyalgia. Interventions with resistance have important implications on
independence and quality of life issues for women with fibromyalgia.
-----
J Altern Complement Med. 2005 Aug;11(4):663-71.
Treatment of fibromyalgia with formula acupuncture: investigation
of needle placement, needle stimulation, and treatment frequency.
Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, Groner KH, Biswas
P, Gracely RH, Clauw DJ.
Department of Internal Medicine, Division of Rheumatology, University of
Michigan, Ann Arbor, MI.
Objectives: The objective of this study was to investigate whether typical
acupuncture methods such as needle placement, needle stimulation, and treatment
frequency were important factors in fibromyalgia symptom improvement.
Design/settings/subjects: A single-site, single-blind, randomized trial of 114
participants diagnosed with fibromyalgia for at least 1 year was performed.
Intervention: Participants were randomized to one of four treatment groups: (1)
T/S needles placed in traditional sites with manual needle stimulation (n = 29):
(2) T/0 traditional needle location without stimulation (n = 30); (3) N/S
needles inserted in nontraditional locations that were not thought to be
acupuncture sites, with stimulation (n = 28); and (4) N/0 nontraditional needle
location without stimulation (n = 2 7). All groups received treatment once
weekly, followed by twice weekly, and finally three times weekly, for a total of
18 treatments. Each increase in frequency was separated by a 2-week washout
period. Outcome measures: Pain was assessed by a numerical rating scale, fatigue
by the Multi-dimensional Fatigue Inventory, and physical function by the Short
Form-36. Results: Overall pain improvement was noted with 25%-35% of subjects
having a clinically significant decrease in pain; however this was not dependent
upon "correct" needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76; p
= 0.450). An overall dose effect of treatment was observed, with three sessions
weekly providing more analgesia than sessions once weekly (t = 2.10; p = 0.039).
Among treatment responders, improvements in pain, fatigue, and physical function
were highly codependent (all p </= 0.002). Conclusions: Although needle
insertion led to analgesia and improvement in other somatic symptoms, correct
needle location and stimulation were not crucial.
-----
J Psychosom Res. 2005 Nov;59(5):275-82.
A pilot study of the effects of behavioral weight loss treatment
on fibromyalgia symptoms.
Shapiro JR, Anderson DA, Danoff-Burg S.
Department of Psychology, University at Albany, State University of New York,
Albany, NY, USA.
OBJECTIVE: Previous studies have found a relation between weight loss and pain
severity in various chronic pain populations. However, there has been little
research examining the relation between body mass index (BMI) and fibromyalgia
syndrome (FMS). The purpose of this pilot study was to investigate the
relationship between BMI and FMS symptoms and to determine if FMS symptoms would
decrease following weight loss. METHODS: Overweight and obese women participated
in a 20-week behavioral weight loss treatment. RESULTS: Participants, on
average, lost 9.2 lbs (4.4% of their initial weight), and there were significant
pre-postimprovements on several outcome measures. Although weight was not
significantly related to pain at baseline, weight loss significantly predicted a
reduction in FMS, pain interference, body satisfaction, and quality of life (QOL).
CONCLUSION: Findings suggest that behavioral weight loss treatment could be
included in the treatment for overweight/obese women with FMS.
-----
Ann Pharmacother. 2005 Nov;39(11):1812-6. Epub 2005 Oct 11.
Open trial of pindolol in the treatment of fibromyalgia.
Wood PB, Kablinger AS, Caldito GS.
Department of Family Medicine, Louisiana State University Health Science
Center-Shreveport, LA.
BACKGROUND: Evidence suggests that fibromyalgia is related to both chronic
sympathetic hyperactivity and decreased levels of serotonin. OBJECTIVE: To
examine the efficacy of pindolol, a mixed serotonin (5-HT)(1A) presynaptic
autoreceptor/beta-adrenergic receptor antagonist, in the treatment of
fibromyalgia. METHODS: An open trial was conducted using 20 female patients who
met the American College of Rheumatology criteria for fibromyalgia. Treatment
was initiated with pindolol 7.5 mg/day and titrated to a maximum dose of 15
mg/day for a total of 90 days. Primary outcome measures were tender point
analysis and the Fibromyalgia Impact Questionnaire (FIQ). Anxiety and depression
were measured with the Hamilton Depression and Anxiety Scales and Beck
Depression Inventory. RESULTS: There was significant improvement in primary
outcome measures, including Tender Point Count (mean +/- SD, 16.3 +/- 2.2 vs
12.3 +/- 5.0; F = 8.9; p < 0.001), Tender Point Score (24.4 +/- 5.7 vs 17.5 +/-
9.4; F = 7.8; p < 0.001), and FIQ (45.3 +/- 10.8 vs 35.0 +/- 15.0; F = 5.6; p <
0.005). The depression and anxiety scores did not change significantly among
women who completed the study, while the impact on cardiovascular parameters was
clinically insignificant. CONCLUSIONS: While the current results are
encouraging, further studies are needed to determine whether pindolol might be
effective in the treatment of fibromyalgia. Limitations of this study include
small group size and lack of placebo control.
-----
J Rheumatol. 2005 Oct;32(10):1975-85.
Efficacy of milnacipran in patients with fibromyalgia.
Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, Williams
DA, Mease PJ, McLean SA, Clauw DJ.
Cypress Biosciences, 4350 Executive Drive, San Diego, CA 92121, USA. mgendreau1@cypressbio.com
OBJECTIVE: Fibromyalgia (FM) is a common musculoskeletal condition characterized
by widespread pain, tenderness, and a variety of other somatic symptoms. Current
treatments are modestly effective. Arguably, the best studied and most effective
compounds are tricyclic antidepressants (TCA). Milnacipran, a nontricyclic
compound that inhibits the reuptake of both serotonin and norepinephrine, may
provide many of the beneficial effects of TCA with a superior side effect
profile. METHODS: One hundred twenty-five patients with FM were randomly
assigned in a 3:3:2 ratio to receive milnacipran twice daily, milnacipran once
daily, or placebo for 3 months in a double-blind dose-escalation trial; 92% of
twice-daily and 81% of once-daily participants achieved dose escalation to the
target milnacipran dose of 200 mg. RESULTS: The primary endpoint was reduction
of pain. Both the once- and twice-daily groups showed statistically significant
improvements in pain, as well as improvements in global well being, fatigue, and
other domains. Response rates for patients receiving milnacipran were equal in
patients with and without comorbid depression, but placebo response rates were
considerably higher in depressed patients, leading to significantly greater
overall efficacy in the nondepressed group. CONCLUSION: In this Phase II study,
milnacipran led to statistically significant improvements in pain and other
symptoms of FM. The effect sizes were equal to those previously found with TCA,
and the drug was generally well tolerated.
-----
Curr Pain Headache Rep. 2005 Oct;9(5):301-6.
Pharmacologic treatment of fibromyalgia.
Baker K, Barkhuizen A.
Arthritis & Rheumatic Diseases, Oregon Health & Science University, OP-09,
Portland, OR 97239, USA. bakerk@ohsu.edu
Fibromyalgia is a syndrome of widespread pain, nonrestorative sleep, disturbed
mood, and fatigue. Optimal treatment involves a multidisciplinary approach with
a team of health care providers using pharmacologic and nonpharmacologic
treatment. Because of the heterogeneity of the illness, management should be
individualized for the patient. Pharmacologic treatment should address issues of
pain control, sleep disturbance, fatigue, and any underlying coexisting mood
disorder. Nonpharmacologic treatment should include patient education, a regular
exercise and stretching program, and cognitive behavioral therapy. All of these
are essential to improving functional capacity and quality of life. This review
provides general guidelines in initiating a successful pharmacologic treatment
program for patients with fibromyalgia.
-----
Psychosomatics. 2005 Sep-Oct;46(5):379-84.
Evaluation of reboxetine, a noradrenergic antidepressant, for the
treatment of fibromyalgia and chronic low back pain.
Krell HV, Leuchter AF, Cook IA, Abrams M.
Laboratory of Behavioral Pharmacology, UCLA Neuropsychiatric Institute, 37-452
NPI, 760 Westwood Plaza, Los Angeles, CA 90024, USA. hkrell@mednet.ucla.edu
Clinical experience supports the use of antidepressant medications to treat
chronic pain syndromes, such as low back pain and fibromyalgia. Although this
use of antidepressants is common in clinical practice, the literature supporting
this off-label use has some limitations. In this report, the authors review the
body of clinical data on the use of antidepressants in treating pain and present
a case series of depressed patients with these syndromes who experienced relief
of pain symptoms while being treated with the noradrenergic antidepressant
reboxetine. These subjects experienced significant relief of pain before any
significant improvement in actual mood symptoms. Our experience with reboxetine
suggests that this noradrenergic antidepressant may have efficacy in the
treatment of chronic pain in patients with depression.
-----
Internist (Berl). 2005 Sep 27; [Epub ahead of print]
[Fibromyalgia - An update.]
[Article in German]
Bruckle W, Zeidler H.
Rheumaklinik, Bad Nenndorf.
Fibromyalgia is a common syndrome of unknown etiology characterized by chronic
widespread pain and polysymptomatic autonomic disturbances and often mental
features. The American College of Rheumatology's classification criteria define
fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a
diagnosis of exclusion as long as stand none laboratory or technical tests. The
major role in pathogenesis appears to be central and involves the subcortical
pain modulation, psychical stress especially in early childhood,
endocrinological and genetic factors. There is no evidence of abnormalities in
muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical
function and sleep disturbance. Actual evidence of effects of pharmacological
and nonpharmacological interventions are summarized. Tricyclic agents, aerobic
exercises, patient education and combined therapies can reduce effectively
symptoms and disability.
-----
Arch Phys Med Rehabil. 2005 Sep;86(9):1713-21.
The effects of a 12-week strength-training program on strength
and functionality in women with fibromyalgia.
Kingsley JD, Panton LB, Toole T, Sirithienthad P, Mathis R, McMillan V.
Department of Nutrition, Food and Exercise Sciences, Florida State University,
Tallahassee, FL 32306, USA.
OBJECTIVE: To determine whether women with fibromyalgia benefit from strength
training. DESIGN: Randomized controlled trial. SETTING: Testing was completed at
the university and training was completed at a local community wellness
facility. PARTICIPANTS: Twenty-nine women (age range, 18-54 y) with fibromyalgia
participated. Subjects were randomly assigned to a control (n=14; wait-listed
for exercise) or strength (n=15) group. After the first 4 weeks, 7 (47%) women
dropped from the strength group. INTERVENTION: Subjects underwent 12 weeks of
training on 11 exercises, 2 times a week, performing 1 set of 8 to 12
repetitions at 40% to 60% of their maximal lifts and were progressed to 60% to
80%. MAIN OUTCOME MEASURES: Subjects were measured for strength, functionality,
tender point sensitivity, and fibromyalgia impact. RESULTS: The strength group
significantly (P< or =.05) improved upper- (strength, 39+/-11 to 42+/-12 kg;
control, 38+/-13 to 38+/-12 kg) and lower- (strength, 68+/-28 to 82+/-25 kg;
control, 61+/-25 to 61+/-26 kg) body strength. Upper-body functionality measured
by the Continuous-Scale Physical Functional Performance test improved
significantly (strength, 44+/-11 to 50+/-16U; control, 51+/-11 to 49+/-13U)
after training. Tender point sensitivity and fibromyalgia impact did not change.
CONCLUSIONS: Strength training improved strength and some functionality in women
with fibromyalgia. Interventions with resistance have important implications on
independence and quality of life issues for women with fibromyalgia.
-----
J Altern Complement Med. 2005 Aug;11(4):663-71.
Treatment of fibromyalgia with formula acupuncture: investigation
of needle placement, needle stimulation, and treatment frequency.
Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, Groner KH, Biswas
P, Gracely RH, Clauw DJ.
Department of Internal Medicine, Division of Rheumatology, University of
Michigan, Ann Arbor, MI.
Objectives: The objective of this study was to investigate whether typical
acupuncture methods such as needle placement, needle stimulation, and treatment
frequency were important factors in fibromyalgia symptom improvement.
Design/settings/subjects: A single-site, single-blind, randomized trial of 114
participants diagnosed with fibromyalgia for at least 1 year was performed.
Intervention: Participants were randomized to one of four treatment groups: (1)
T/S needles placed in traditional sites with manual needle stimulation (n = 29):
(2) T/0 traditional needle location without stimulation (n = 30); (3) N/S
needles inserted in nontraditional locations that were not thought to be
acupuncture sites, with stimulation (n = 28); and (4) N/0 nontraditional needle
location without stimulation (n = 2 7). All groups received treatment once
weekly, followed by twice weekly, and finally three times weekly, for a total of
18 treatments. Each increase in frequency was separated by a 2-week washout
period. Outcome measures: Pain was assessed by a numerical rating scale, fatigue
by the Multi-dimensional Fatigue Inventory, and physical function by the Short
Form-36. Results: Overall pain improvement was noted with 25%-35% of subjects
having a clinically significant decrease in pain; however this was not dependent
upon "correct" needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76; p
= 0.450). An overall dose effect of treatment was observed, with three sessions
weekly providing more analgesia than sessions once weekly (t = 2.10; p = 0.039).
Among treatment responders, improvements in pain, fatigue, and physical function
were highly codependent (all p </= 0.002). Conclusions: Although needle
insertion led to analgesia and improvement in other somatic symptoms, correct
needle location and stimulation were not crucial.
-----
Arthritis Rheum. 2005 Aug 15;53(4):519-27.
Impact of fibromyalgia pain on health-related quality of life
before and after treatment with tramadol/acetaminophen.
Bennett RM, Schein J, Kosinski MR, Hewitt DJ, Jordan DM, Rosenthal NR.
Oregon Health and Science University, Portland.
OBJECTIVE: To assess health-related quality of life (HRQOL) in patients with
moderate-to-severe fibromyalgia pain compared with the general population, and
to assess the relationship between pain severity and HRQOL before and after
treatment with an analgesic. METHODS: Data were obtained from a randomized,
double-blind study of patients with moderate-to-severe fibromyalgia pain.
Patients received either tramadol/acetaminophen or placebo 4 times/day as needed
for 91 days. HRQOL was measured with the Short Form 36 Health Survey (SF-36) and
the Fibromyalgia Impact Questionnaire (FIQ). Baseline HRQOL scores were compared
with a national sample of noninstitutionalized adults and a sample of patients
with impaired HRQOL due to congestive heart failure. Patients with fibromyalgia
were divided into tertiles by change in pain severity, and SF-36 scores were
compared across the tertiles. Mean changes in SF-36 and FIQ scores were compared
between treatment groups. RESULTS: Patients with fibromyalgia scored lower than
the US norm on all SF-36 scales (P < 0.0001) and lower than patients with
congestive heart failure on most scales. More severe pain was associated with
greater impairment of HRQOL compared with less severe pain (P < 0.0001).
Patients in the highest tertile for improved pain severity had greater
improvement in HRQOL scores than patients in the lower tertiles. Compared with
patients who received placebo (n = 157), patients treated with tramadol/acetaminophen
(n = 156) showed greater improvement on SF-36 physical functioning, role
physical, bodily pain, and physical summary scales, as well as FIQ scales for
ability to do job, pain, and stiffness (P < 0.01). CONCLUSION:
Moderate-to-severe fibromyalgia pain significantly impairs HRQOL, and effective
pain relief in these patients significantly increases HRQOL.
-----
J Rheumatol Suppl. 2005 Aug;75:6-21.
Fibromyalgia syndrome: review of clinical presentation,
pathogenesis, outcome measures, and treatment.
Mease P.
>From the Seattle Rheumatology Associates, Division of Rheumatology Clinical
Research, Swedish Hospital Medical Center, University of Washington School of
Medicine, Seattle, Washington, USA.
Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at
least 2% of the adult population in the USA and other regions in the world where
FM is studied. Prevalence rates in some regions have not been ascertained and
may be influenced by differences in cultural norms regarding the definition and
attribution of chronic pain states. Chronic, widespread pain is the defining
feature of FM, but patients may also exhibit a range of other symptoms,
including sleep disturbance, fatigue, irritable bowel syndrome, headache, and
mood disorders. Although the etiology of FM is not completely understood, the
syndrome is thought to arise from influencing factors such as stress, medical
illness, and a variety of pain conditions in some, but not all patients, in
conjunction with a variety of neurotransmitter and neuroendocrine disturbances.
These include reduced levels of biogenic amines, increased concentrations of
excitatory neurotransmitters, including substance P, and dysregulation of the
hypothalamic-pituitary-adrenal axis. A unifying hypothesis is that FM results
from sensitization of the central nervous system. Establishing diagnosis and
evaluating effects of therapy in patients with FM may be difficult because of
the multifaceted nature of the syndrome and overlap with other chronically
painful conditions. Diagnostic criteria, originally developed for research
purposes, have aided our understanding of this patient population in both
research and clinical settings, but need further refinement as our knowledge
about chronic widespread pain evolves. Outcome measures, borrowed from clinical
research in pain, rheumatology, neurology, and psychiatry, are able to
distinguish treatment response in specific symptom domains. Further work is
necessary to validate these measures in FM. In addition, work is under way to
develop composite response criteria, intended to address the multidimensional
nature of this syndrome. A range of medical treatments, including
antidepressants, opioids, nonsteroidal antiinflammatory drugs, sedatives, muscle
relaxants, and antiepileptics, have been used to treat FM. Nonpharmaceutical
treatment modalities, including exercise, physical therapy, massage,
acupuncture, and cognitive behavioral therapy, can be helpful. Few of these
approaches have been demonstrated to have clear-cut benefits in randomized
controlled trials. However, there is now increased interest as more effective
treatments are developed and our ability to accurately measure effect of
treatment has improved. The multifaceted nature of FM suggests that multimodal
individualized treatment programs may be necessary to achieve optimal outcomes
in patients with this syndrome.
-----
J Rheumatol. 2005 Aug;32(8):1594-602.
Efficacy of cognitive-behavioral intervention for juvenile
primary fibromyalgia syndrome.
Kashikar-Zuck S, Swain NF, Jones BA, Graham TB.
>From the Cincinnati Children's Hospital Medical Center, Department of
Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
OBJECTIVE: There are currently no controlled studies of behavioral interventions
for juvenile primary fibromyalgia syndrome (JPFM). In this small-sample
randomized study, we tested the efficacy of a behavioral intervention, i.e.,
coping skills training (CST), for the treatment of adolescents with JPFM.
Outcomes tested in this study were functional disability, pain intensity,
pain-coping efficacy, and depressive symptoms. METHODS: Thirty patients with
JPFM were randomly assigned to 8 weeks of either CST or self-monitoring.
Adolescents in the CST condition received training in active pain-coping
techniques, while those in the self-monitoring condition monitored daily pain
intensity and sleep quality with no instructions about behavior change. After
posttreatment assessment, subjects were crossed over into the opposite treatment
arm for 8 weeks (so that all adolescents eventually received both CST and
self-monitoring) and were reassessed at Week 16. RESULTS: At Week 8, adolescents
in both conditions showed significant decrease in depressive symptoms and
functional disability. Those who received CST showed significantly greater
ability to cope with pain than those in the self-monitoring condition and a
trend toward decreased pain intensity. At Week 16, adolescents had significantly
lower levels of disability and depressive symptoms compared to baseline, but
those who received self-monitoring followed by CST seemed to receive the most
benefit. CONCLUSION: CST can lead to improved functioning among JPFM patients.
Although some of the improvement may be due to increased monitoring and
attention, CST provides the specific benefit of improving adolescents' ability
to cope with pain.
-----
Arthritis Rheum. 2005 Aug;52(8):2495-505.
A randomized, double-blind, placebo-controlled trial of
pramipexole, a dopamine agonist, in patients with fibromyalgia receiving
concomitant medications.
Holman AJ, Myers RR.
Pacific Rheumatology Associates, Renton, Washington.
OBJECTIVE: To assess the efficacy and safety of pramipexole, a dopamine 3
receptor agonist, in patients with fibromyalgia. METHODS: In this 14-week,
single-center, double-blind, placebo-controlled, parallel-group, escalating-dose
trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo)
to receive 4.5 mg of pramipexole or placebo orally every evening. The primary
outcome was improvement in the pain score (10-cm visual analog scale [VAS]) at
14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire
(FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain
improvement scale, the tender point score, the 17-question Hamilton Depression
Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities
and disability were not excluded. Stable dosages of concomitant medications,
including analgesics, were allowed. RESULTS: Compared with the placebo group,
patients receiving pramipexole experienced gradual and more significant
improvement in measures of pain, fatigue, function, and global status. At 14
weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the
placebo arm (treatment difference -1.77 cm). Forty-two percent of patients
receiving pramipexole and 14% of those receiving placebo achieved >/=50%
decrease in pain. Secondary outcomes favoring pramipexole over placebo included
the total FIQ score (treatment difference -9.57) and the percentages of
improvement in function (22% versus 0%), fatigue (29% versus 7%), and global
(38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes
showed a better trend for pramipexole treatment than for placebo, but failed to
reach statistical significance, including improvement in the tender point score
(51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%),
the BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end
points showed a better trend for the placebo arm. The most common adverse events
associated with pramipexole were transient anxiety and weight loss. No patient
withdrew from the study because of inefficacy or an adverse event related to
pramipexole. CONCLUSION: In a subset of patients with fibromyalgia,
approximately 50% of whom required narcotic analgesia and/or were disabled,
treatment with pramipexole improved scores on assessments of pain, fatigue,
function, and global status, and was safe and well-tolerated.
-----
Rheumatology (Oxford). 2005 Jul 19; [Epub ahead of print]
A randomized clinical trial of an individualized home-based
exercise programme for women with fibromyalgia.
Da Costa D, Abrahamowicz M, Lowensteyn I, Bernatsky S, Dritsa M, Fitzcharles MA,
Dobkin PL.
Division of Clinical Epidemiology, McGill University Health Centre, Montreal,
Canada; Department of Medicine, McGill University, Montreal, Canada.
Objective. To determine the efficacy of a 12-week individualized home-based
exercise programme on physical functioning, pain severity and psychological
distress for women with fibromyalgia (FM). Methods. Seventy-nine women with a
primary diagnosis of FM were randomized to a 12-week individualized home-based
moderate-intensity exercise programme or to a usual care control group. Outcomes
were functional capacity (Fibromyalgia Impact Questionnaire), pain severity and
psychological distress. Outcomes were measured at study entry, at the end of the
12-week intervention, and at 3 and 9 months following completion of the
intervention. Results. On the basis of intention-to-treat analyses, a
significant improvement in functional capacity at 3 and 9 months following
treatment for participants in the exercise group who were more functionally
disabled at study entry was observed. At both 3 and 9 months post-treatment, the
mean estimated benefit of the intervention was more than 10 points [-12.3 (95%
CI, -21.9 to -2.8); -10.8 (95% CI, -21.5 to -0.2)]. Compared with the control
group, statistically significant improvements in upper body pain were evident in
the exercise group at post-treatment. These between-group differences in upper
body pain were maintained at 3 and 9 months post-treatment. No statistically
significant group differences on lower body pain and psychological distress were
found. Conclusions. Home-based exercise, a relatively low-cost treatment
modality, has the potential to improve important health outcomes in FM.
-----
Ann Intern Med. 2005 Jul 5;143(1):10-9.
A randomized clinical trial of acupuncture compared with sham
acupuncture in fibromyalgia.
Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D.
The Group Health Cooperative Center for Health Studies, and University of
Washington, Seattle, Washington, USA.
BACKGROUND: Fibromyalgia is a common chronic pain condition for which patients
frequently use acupuncture. OBJECTIVE: To determine whether acupuncture relieves
pain in fibromyalgia. DESIGN: Randomized, sham-controlled trial in which
participants, data collection staff, and data analysts were blinded to treatment
group. SETTING: Private acupuncture offices in the greater Seattle, Washington,
metropolitan area. PATIENTS: 100 adults with fibromyalgia. INTERVENTION:
Twice-weekly treatment for 12 weeks with an acupuncture program that was
specifically designed to treat fibromyalgia, or 1 of 3 sham acupuncture
treatments: acupuncture for an unrelated condition, needle insertion at
nonacupoint locations, or noninsertive simulated acupuncture. MEASUREMENTS: The
primary outcome was subjective pain as measured by a 10-cm visual analogue scale
ranging from 0 (no pain) to 10 (worst pain ever). Measurements were obtained at
baseline; 1, 4, 8, and 12 weeks of treatment; and 3 and 6 months after
completion of treatment. Participant blinding and adverse effects were
ascertained by self-report. The primary outcomes were evaluated by pooling the 3
sham-control groups and comparing them with the group that received acupuncture
to treat fibromyalgia. RESULTS: The mean subjective pain rating among patients
who received acupuncture for fibromyalgia did not differ from that in the pooled
sham acupuncture group (mean between-group difference, 0.5 cm [95% CI, -0.3 cm
to 1.2 cm]). Participant blinding was adequate throughout the trial, and no
serious adverse effects were noted. LIMITATIONS: A prescription of acupuncture
at fixed points may differ from acupuncture administered in clinical settings,
in which therapy is individualized and often combined with herbal
supplementation and other adjunctive measures. A usual-care comparison group was
not studied. CONCLUSION: Acupuncture was no better than sham acupuncture at
relieving pain in fibromyalgia.
-----
J Rheumatol. 2005 Jul;32(7):1336-40.
A randomized controlled trial of dehydroepiandrosterone in
postmenopausal women with fibromyalgia.
Finckh A, Berner IC, Aubry-Rozier B, So AK.
Rheumatology Department, University Hospital of Vaud (CHUV), Lausanne,
Switzerland. afinckh@post.harvard.edu
OBJECTIVE: Patients with fibromyalgia (FM) consistently have adrenal
hyporesponsiveness and low dehydroepiandrosterone (DHEA) levels. DHEA is
promoted for and used by patients with FM. We tested the efficacy and safety of
DHEA supplementation in ameliorating the symptoms of FM. METHODS: In a
double-blind crossover study, postmenopausal women with FM were randomized to
DHEA supplementation (50 mg/day) or placebo for 3 months, with a one-month
washout period in between. Patients were assessed monthly for well-being and
pain and by medical evaluations at the beginning and the end of each treatment
period. The primary outcome was well being; secondary outcomes were pain,
fatigue, cognition, sexuality, functional impairment, depression, and anxiety.
RESULTS: A total of 52 patients were randomized, 47 patients completed the DHEA
treatment period, and 45 the placebo treatment period. After 3 months of
treatment with 50 mg of DHEA, median DHEA sulfate blood levels had tripled, but
there was no improvement in well-being, pain, fatigue, cognitive dysfunction,
functional impairment, depression, or anxiety, nor in objective measurements
made by physicians. Androgenic side effects (greasy skin, acne, and increased
growth of body hair) were more common during the DHEA treatment period (p =
0.02). CONCLUSION: DHEA does not improve quality of life, pain, fatigue,
cognitive function, mood, or functional impairment in FM.
-----
Disabil Rehabil. 2005 Jun 17;27(12):725-8.
Body awareness therapy for patients with fibromyalgia and chronic
pain.
Gard G.
Department of Health Sciences, Lulea University, Hedenbrovagen, 961 3b, Boden,
Sweden. gunvord.gard@Hu.se
There are several therapies designed to increase body awareness. They are
commonly known as body awareness therapies (BAT) and include Basic BAT,
Mensendieck and Feldenkrais therapy. A focus on emotions is important in all
these therapies. In this article the aim and development of Basic BAT is
described together with evaluations of treatments including Basic BAT.
Multidisciplinary studies have shown that Basic BAT can increase health-related
quality of life and cost-effectiveness. However Basic BAT needs to be further
studied in relation to patients with fibromyalgia (FM) and chronic pain. Studies
so far indicate that Basic BAT has positive effects.
-----
Disabil Rehabil. 2005 Jun 17;27(12):711-23.
Rehabilitation approaches in fibromyalgia.
Adams N, Sim J.
Centre for Research in Health Care, Liverpool John Moores University, Great
Crosshall Street, Liverpool, UK. j.sim@keele.ac.uk
PURPOSE: This paper provides an overview of the evidence for the principal
approaches taken to the rehabilitation of patients with fibromyalgia (FM):
exercise, psychologically-based approaches, multimodal approaches,
self-management approaches, and complementary and alternative therapies. METHOD:
A review of current published evidence. RESULTS: Owing to factors such as
methodological shortcomings of existing studies, and the lack of evidence on
individual modalities, it is difficult to draw definitive conclusions as to
which is the most appropriate rehabilitation approach in FM. However, there is
growing evidence for the role of exercise training, and clear indications that
if appropriately prescribed, this can be undertaken without adverse effects.
Similarly, psychologically-based interventions such as cognitive-behavioural
therapy have received some support from the literature. Evidence for other
interventions is more equivocal. CONCLUSIONS: It appears that a combination of
interventions, in a multimodal approach (e.g., exercises combined with education
and psychologically-based interventions) is the most promising means of managing
patients with FM.
-----
Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jan;29(1):161-4.
Atypical antipsychotics in the treatment of fibromyalgia: a case
series with olanzapine.
Rico-Villademoros F, Hidalgo J, Dominguez I, Garcia-Leiva JM, Calandre EP.
Biometrica, Departamento Medico, Eloy Gonzalo 27, 28010 Madrid, Spain.
Fibromyalgia is a common and disabling chronic pain syndrome. Although a wide
array of symptomatic pharmacological treatments has been used to treat this
condition, only modest results have been obtained. Olanzapine has been proven
effective in some chronic pain conditions. The authors present a case series of
patients suffering from fibromyalgia who received olanzapine as add-on therapy
during a 3-month period. Olanzapine (2.5-20.0 mg/day) was administered to 25
consecutive patients (24 females, 1 male) meeting the American College of
Rheumatology diagnostic criteria for fibromyalgia, and who were receiving
nonsteroidal anti-inflammatory drugs (NSAIDs; 68%), benzodiazepines/zolpidem
(48%), antidepressants (32%), and cyclobenzaprine (4%), either alone or in
combination. Overall, 6 of the 14 patients (43%) who completed the 12-week trial
reported to be much or very much improved ('responders'), according to the
Clinical Global Impression (CGI) scale and 7 of them (50%) reported a good or
very good sense of well-being. Olanzapine's modal dose among responders was 10.0
mg/day. It was discontinued in 11 patients (44%) due to adverse reactions, most
commonly weight gain (n=5, 20%). Our preliminary findings suggest a possible
role for olanzapine in treating fibromyalgia. Unfortunately, the beneficial
outcome of olanzapine was largely obscured by its poor tolerability, which could
be explained by the greater propensity of patients with fibromyalgia to adverse
drug reactions, and the greater risk of antipsychotic-induced weight gain among
women. Whether other atypical antipsychotics will provide similar symptomatic
relief, while showing a better tolerability profile than olanzapine in patients
with fibromyalgia, should be further investigated.
-----
Arthritis Rheum. 2004 Dec 15;51(6):890-8.
Six-month and one-year followup of 23 weeks of aerobic exercise
for individuals with fibromyalgia.
Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE.
University Health Network and University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: To measure mood and physical function of individuals with
fibromyalgia, 6 and 12 months following 23 weeks of supervised aerobic exercise.
METHODS: This is a followup report of individuals who were previously enrolled
in 23 weeks of land-based and water-based aerobic exercise classes. Outcomes
included the 6-minute walk test, Beck Depression Inventory (BDI), State-Trait
Anxiety Inventory, Arthritis Self-Efficacy Scale (ASES), Fibromyalgia Impact
Questionnaire (FIQ), tender point count, patient global assessment score, and
exercise compliance. Outcomes were measured at the start and end of the exercise
classes and 6 and 12 months later. RESULTS: Analyses were conducted on 29
(intent-to-treat) or 18 (efficacy) subjects. Six-minute walk distances and BDI
total scores were improved at followup (all analyses). BDI cognitive/affective
scores were improved at the end of 23 weeks of exercise (both analyses) and at
the 12-month followup (efficacy analysis only). BDI somatic scores were improved
at 6-month (both analyses) and 12-month followup (intent-to-treat only). FIQ and
ASES function were improved at all followup points. ASES pain was improved in
efficacy analyses only (all followup points). Tender points were unchanged after
23 weeks of exercise and at followup. Exercise duration at followup (total
minutes of aerobic plus anaerobic exercise in the preceding week) was related to
gains in physical function (6- and 12-month followup) and mood (6-month followup).
CONCLUSION: Exercise can improve physical function, mood, symptom severity, and
aspects of self efficacy for at least 12 months. Exercising at followup was
related to improvements in physical function and perhaps mood.
-----
JAMA. 2004 Nov 17;292(19):2388-95.
Management of fibromyalgia syndrome.
Goldenberg DL, Burckhardt C, Crofford L.
Department of Rheumatology, Newton-Wellesley Hospital, Newton, Mass 02462, USA.
dgoldenb@massmed.org
CONTEXT: The optimal management of fibromyalgia syndrome (FMS) is unclear and
comprehensive evidence-based guidelines have not been reported. OBJECTIVE: To
provide up-to-date evidence-based guidelines for the optimal treatment of FMS.
DATA SOURCES, SELECTION, AND EXTRACTION: A search of all human trials
(randomized controlled trials and meta-analyses of randomized controlled trials)
of FMS was made using Cochrane Collaboration Reviews (1993-2004), MEDLINE
(1966-2004), CINAHL (1982-2004), EMBASE (1988-2004), PubMed (1966-2004),
Healthstar (1975-2000), Current Contents (2000-2004), Web of Science
(1980-2004), PsychInfo (1887-2004), and Science Citation Indexes (1996-2004).
The literature review was performed by an interdisciplinary panel, composed of
13 experts in various pain management disciplines, selected by the American Pain
Society (APS), and supplemented by selected literature reviews by APS staff
members and the Utah Drug Information Service. A total of 505 articles were
reviewed. DATA SYNTHESIS: There are major limitations to the FMS literature,
with many treatment trials compromised by short duration and lack of masking.
There are no medical therapies that have been specifically approved by the US
Food and Drug Administration for management of FMS. Nonetheless, current
evidence suggests efficacy of low-dose tricyclic antidepressants, cardiovascular
exercise, cognitive behavioral therapy, and patient education. A number of other
commonly used FMS therapies, such as trigger point injections, have not been
adequately evaluated. CONCLUSIONS: Despite the chronicity and complexity of FMS,
there are pharmacological and nonpharmacological interventions available that
have clinical benefit. Based on current evidence, a stepwise program emphasizing
education, certain medications, exercise, cognitive therapy, or all 4 should be
recommended.
-----
Am J Manag Care. 2004 Nov;10(11 Pt 1):794-800.
A review of fibromyalgia.
Nampiaparampil DE, Shmerling RH.
Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114,
USA. dnampiaparampil@partners.org
Characterized by chronic widespread joint and muscle pain, fibromyalgia is a
syndrome of unknown etiology. The American College of Rheumatology's
classification criteria for fibromyalgia include diffuse soft tissue pain of at
least 3 months' duration and pain on palpation in at least 11 of 18 paired
tender points. Symptoms are often exacerbated by exertion, stress, lack of
sleep, and weather changes. Fibromyalgia is primarily a diagnosis of exclusion,
established only after other causes of joint or muscle pain are ruled out. The
initial workup for patients who present with widespread musculoskeletal pain
should include a complete blood count, erythrocyte sedimentation rate, liver
function tests, hepatitis C antibody, calcium, and thyrotropin. The
musculoskeletal system, the neuroendocrine system, and the central nervous
system, particularly the limbic system, appear to play major roles in the
pathogenesis of fibromyalgia. The goal in treating fibromyalgia is to decrease
pain and to increase function without promoting polypharmacy. Brief
interdisciplinary programs have been shown to improve subjective pain.
Fibromyalgia is a complex syndrome associated with significant impairment on
quality of life and function and substantial financial costs. Once the diagnosis
is made, providers should aim to increase patients' function and minimize pain.
This can be accomplished through nonpharmacological ahd pharmacological
interventions. With proper management, the rate of disability appears to be
significantly reduced.
-----
Scand J Rheumatol Suppl. 2004;(119):72-5.
Intravenous treatment of fibromyalgia with the 5-HT3 receptor
antagonist tropisetron in a rheumatological practice.
Tolk J, Kohnen R, Muller W.
Rheumatology practice, Kiel, Germany. JochenTolk@aol.com
In 223 fibromyalgia (FM) patients in a rheumatology practice, a follow-up postal
survey was carried out 0.5-2 years after a 5-day intravenous (i.v.) treatment
with 5 mg of the 5-HT3 receptor antagonist tropisetron daily on the effect of
this treatment. 121 patients returned the completed questionnaire. After
subtraction of 22 undeliverable questionnaires, this represented 60.2% of
patients contacted for whom an assessment of the tropisetron treatment was
possible. A good to very good effect of the treatment on the pain was reported
by 45% of the patients, and only 25% reported an unsatisfactory effect. The
effect of tropisetron IV lasted between one day and 12 weeks (mean 8.6 +/- 13.6
d). Sleep and general condition were also assessed as good or very good by
almost half of the patients. The tolerance of tropisetron was generally good. In
comparison with the current treatment and the best treatment with other drugs
ever received, tropisetron was rated as more efficacious in almost half of the
cases, though an unsatisfactory effect of tropisetron compared to other
treatments was reported in 30% of the cases. Considered in comparison to less or
at most equally efficacious alternatives, according to this open respective
study, IV tropisetron treatment represents a promising option for the treatment
of FM even though the study design incorporated many imponderables. Particularly
the question of whether the success of treatment can be improved further with a
longer lasting treatment or a selection of the patients still needs to be
settled.
-----
Scand J Rheumatol Suppl. 2004;(119):63-6.
Treatment of fibromyalgia with tropisetron--dose and efficacy
correlations.
Spath M, Stratz T, Farber L, Haus U, Pongratz D.
Friedrich-Baur-Institute, University of Munich, Munich, Germany. michael.spaeth@lrz.uni-muenchen.de
Previous studies evaluating the efficacy and tolerance of tropisetron for the
treatment of fibromyalgia (FM) used the drug either intravenously or orally, and
at different dosage levels ranging from 2 mg to 15 mg daily. The shortest
treatment was a single dose and the longest treatment period covered 28 days. A
significant reduction of the pain intensity was achieved by using tropisetron 5
mg per day. Apart from the fact that treatment periods were different, the
efficacy of oral and intravenous administration did not differ significantly.
Tropisetron was well tolerated; but in the 15 mg group in one of the studies,
the decrease in pain was less than in the placebo group, however, the frequency
of constipation and other gastrointestinal symptoms increased. Furthermore, it
was hypothesized that due to the impacts of CYP2D6 activities, a daily dose of
tropisetron 2 mg may be efficacious in slow metabolizers only. Although
tropisetron proved to be efficacious in a group of fibromyalgia patients, the
dose-response curves cannot yet be explained in a fully satisfactory manner,
which may encourage research focusing on possible subgroups of FM.
-----
Tidsskr Nor Laegeforen. 2004 Oct 7;124(19):2475-8.
[Fibromyalgia—effect of exercise]
[Article in Norwegian]
Kurtze N.
HUNT forskningssenter, Institutt for samfunnsmedisin, Det medisinske fakultet,
Norges teknisk-naturvitenskapelige universitet, Neptunveien 1 7650 Verdal.
nanna.kurtze@medisin.ntnu.no
BACKGROUND: Fibromyalgia is a chronic widespread unexplained musculoskeletal
pain syndrome with decreased pain threshold. Because the etiology of
fibromyalgia is unknown and the pathogenesis is unidentified, treatment is
largely symptomatic and not standardised. The pain and fatigue reported by
individuals with fibromyalgia results in a relative sedentary lifestyle, hence
also a decrease in the fitness level of skeletal muscles. MATERIAL AND METHODS:
In order to assess the effect of exercise in fibromyalgia, the Cochrane
Controlled Trials Register was reviewed; 17 studies of exercise interventions on
cardiorespiratory endurance, muscle strength and/or flexibility were selected.
RESULTS: The results from the studies are inconsistent but low-intensity aerobic
exercise regimens were found to be one of the few effective treatments. In these
studies, however, subjective pain levels fail to show significant improvement,
although improvements are seen on other parameters such as improvement in the
number of tender points, in total myalgic scores and reduced tender point
tenderness, improved aerobic capacity, physical function, subjective well-being
and self-efficacy. INTERPRETATION: The group exercises varied from 1-3 times per
week, sessions from 25 minutes to 90 minutes; the duration of the programmes
from 6 weeks to 6 month. Most of the programmes were low-intensity dynamic
endurance training with a working rate at 50-70 % of maximal heart rate in
relation to age.
-----
Hum Psychopharmacol. 2004 Oct;19 Suppl 1:S27-35.
A double-blind placebo-controlled trial of milnacipran in the
treatment of fibromyalgia.
Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG.
Cypress Bioscience, San Diego, CA 9212, USA. ovitton@cypressbio.com
Fibromyalgia syndrome is a systemic disorder of widespread pain which is thought
to result from abnormal pain processing within the central nervous system. There
are no currently approved treatments for this indication. Antidepressants
appear, however, to be effective, especially those with an action on
noradrenergic neurotransmission. The objective of the present study was to test
the efficacy of the dual action noradrenaline and serotonin reuptake inhibitor
antidepressant, milnacipran, in the treatment of fibromyalgia. The 125 patients,
who were enrolled in a double-blind, placebo-controlled, flexible dose
escalation trial, were randomized to receive placebo or milnacipran for 4 weeks
of dose escalation (up to 200 mg/day), followed by 8 weeks at a constant dose.
The study evaluated the efficacy and safety of milnacipran for the treatment of
pain and associated symptoms such as fatigue, depressed mood and sleep. 75% of
milnacipran-treated patients reported overall improvement, compared with 38% in
the placebo group (p < 0.01). Furthermore, 37% of twice daily milnacipran-treated
patients reported at least 50% reduction in pain intensity, compared with 14% of
placebo-treated patients (p < 0.05). 84% of all milnacipran patients escalated
to the highest dose (200 mg/day) with no tolerability issues. Most adverse
events were mild to moderate in intensity, and transient in duration. These
results suggest that milnacipran may have the potential to relieve not only pain
but several of the other symptoms associated with fibromyalgia. 2004 John Wiley
& Sons, Ltd.
-----
Eur J Pain. 2004 Aug;8(4):371-6.
Electroconvulsive therapy in patients with depression and
fibromyalgia.
Huuhka MJ, Haanpaa ML, Leinonen EV.
Department of Psychogeriatrics, Tampere University Hospital, Pitkaniemi
Fin-33380, Finland.
The effect of electroconvulsive therapy (ECT) on depression and other symptoms
of fibromyalgia was studied in a prospective 3-month trial in 13 patients with
fibromyalgia and concomitant depression. All the patients met the DSM-IV
diagnostic criteria for Major Depressive Disorder and fulfilled the American
College of Rheumatology diagnostic criteria for fibromyalgia. The Montgomery and
Asberg Depression Rating Scale (MADRS) and the clinical global impression scale
(CGI) were used to assess the severity of depression and the clinical change of
the patients. The fibromyalgia impact questionnaire (FIQ) was used to evaluate
the severity of the fibromyalgia symptoms. The intensity of pain was evaluated
using a 6-point scale (0=no pain, 5=very severe pain), and tender point
palpation. All assessments were performed at baseline and at follow-up visits,
which took place one week, one month and three months after ECT. There was a
significant improvement in depression after ECT according to MADRS. Using CGI,
six patients were much or very much improved, while four patients were minimally
improved and three patients had no change. There was significant improvement in
four out of ten FIQ item scores, "feel good", "fatigue", "anxiety" and
"depression". No significant change was found in the FIQ item scores "physical
function", "pain", "stiffness" and "morning tiredness" or number of tender
points and self-reported pain. We conclude that ECT is a safe and effective
treatment for depression in fibromyalgia patients, but has no effect on the pain
or other physical symptoms of these patients.
-----
MCN Am J Matern Child Nurs. 2004 Jul-Aug;29(4):248-253.
Breastfeeding in Chronic Illness: The Voices of Women With
Fibromyalgia.
Schaefer KM.
Karen Moore Schaefer is an Assistant Professor, Temple University, College of
Health Professions, Department of Nursing, Philadelphia, PA. She can be reached
via e-mail at karen.schaefer@temple.edu.
PURPOSE:: To describe what it is like for women with fibromyalgia (FM) to
breastfeed their infants. STUDY DESIGN AND METHODS:: Nine women with FM who
chose to breastfeed their infants were the sample for this qualitative study.
van Manen's phenomenological method of reflection, writing, and rewriting was
used to analyze the data collected through in-depth tape-recorded interviews and
written stories. RESULTS:: All nine women felt that they were not successful in
their attempts to breastfeed, and felt frustrated. Themes included (a) muscle
soreness, pain, and stiffness made it difficult to breastfeed the baby; (b)
fatigue interfered with the breastfeeding process; (c) the need for medication,
perceived insufficient milk supply, and sore nipples led to forced unplanned
weaning; and (d) being forced to wean the infant when not ready to do so created
sadness and a feeling of depression. CLINICAL IMPLICATIONS:: Nurses who work
with women with FM who choose to breastfeed need to be proactive in providing
informational, emotional, and physical support to facilitate a successful
breastfeeding experience for these women. Knowing that the pain, muscle
soreness, stiffness, and fatigue of FM may affect breastfeeding can direct
nurses to help women with FM plan for support after childbirth and learn
techniques to control/reduce the muscle pain and stiffness. Nurses are
encouraged to refer breastfeeding women with FM to lactation consultants and
support groups for encouragement and validation regarding their concerns about
breastfeeding. It is important that nurses continue to serve as advocates for
breastfeeding women with FM and keep other healthcare providers informed about
the issues related to breastfeeding for women with FM.
-----
J Altern Complement Med. 2004 Jul;10(3):468-80.
Clinical research on acupuncture: part 1. What have reviews of
the efficacy and safety of acupuncture told us so far?
Birch S, Hesselink JK, Jonkman FA, Hekker TA, Bos A.
Foundation for the Study of Traditional East Asian Medicine, Amsterdam, The
Netherlands.
Overview and methods: This paper discusses those medical conditions in which
clinical trials of acupuncture have been conducted, and where meta-analyses or
systematic reviews have been published. It focuses on the general conclusions of
these reviews by further examining official reviews conducted in the United
States, United Kingdom, Europe, and Canada each of which examined available
systematic reviews. While all reviews agree that the methodological rigor of
acupuncture clinical trials has generally been poor and that higher quality
clinical trials are necessary, this has not completely hampered the
interpretation of the results of these clinical trials. In some conditions the
evidence of efficacy has clearly reached a sufficient critical mass from enough
well-designed studies to draw clear conclusions; for the rest, the evidence is
difficult to clearly interpret. This paper also examines conclusions from the
same international reviews on the safety and adverse effects of acupuncture.
Here, conclusions are more easily drawn and there is good agreement about the
safety of acupuncture. Results and conclusions: General international agreement
has emerged that acupuncture appears to be effective for postoperative dental
pain, postoperative nausea and vomiting, and chemotherapy-related nausea and
vomiting. For migraine, low-back pain, and temporomandibular disorders the
results are considered positive by some and difficult to interpret by others.
For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and
tennis elbow the evidence is considered promising, but more and better quality
research is needed. For conditions such as chronic pain, neck pain, asthma, and
drug addiction the evidence is considered inconclusive and difficult to
interpret. For smoking cessation, tinnitus, and weight loss the evidence is
usually regarded as negative. Reviews have concluded that while not free from
serious adverse events, they are rare and that acupuncture is a relatively safe
procedure.
-----
Pain. 2004 Jun;109(3):233-41.
Relationship between changes in coping and treatment outcome in
patients with Fibromyalgia Syndrome.
Nielson WR, Jensen MP.
Department of Medicine (Division of Rhematolody), University of Western Ontario,
London, Ont. Canada. warren.nielson@sjhc.london.on.ca
The present study utilized a sample of 198 individuals with Fibromyalgia
Syndrome (FMS) to examine the association between treatment process variables
(beliefs, coping strategies) and treatment outcomes (pain severity, activity
level, emotional distress and life interference) related to a 4-week
multidisciplinary fibromyalgia treatment program. Multiple regression analyses
were utilized to evaluate these relationships pretreatment to posttreatment as
well as from pretreatment to 3- and 6-month follow-ups. The results indicated
that outcomes were most closely related to: (1) an increased sense of control
over pain, (2) a belief that one is not necessarily disabled by FM, (3) a belief
that pain is not necessarily a sign of damage, (4) decreased guarding, (5)
increased use of exercise, (6) seeking support from others, (7) activity pacing
and (8) use of coping self-statements. These findings are consistent with a
cognitive-behavioural model of fibromyalgia, and suggest targets for therapeutic
change.
-----
Holist Nurs Pract. 2004 May-Jun;18(3):142-51.
Touch the pain away: new research on therapeutic touch and
persons with fibromyalgia syndrome.
Denison B.
Wichita State University and the Kansas Heart Hospital, Wichita, KS, USA.
bdenison@sbcusa.com
This pilot study tested the effectiveness of 6 therapeutic touch treatments on
the experience of pain and quality of life for persons with fibromyalgia
syndrome. Its findings support that subjects who received therapeutic touch had
a statistically significant decrease in pain for each pretherapeutic to
posttherapeutic touch treatment, as well as significant improvement in quality
of life from pre-first to pre-sixth treatment. Therapeutic touch may be an
effective treatment for relieving pain and improving quality of life in this
specific population of persons with fibromyalgia syndrome.
-----
J Int Med Res. 2004 May-Jun;32(3):263-7.
A new treatment modality for fibromyalgia syndrome: hyperbaric
oxygen therapy.
Yildiz S, Kiralp MZ, Akin A, Keskin I, Ay H, Dursun H, Cimsit M.
GATA Haydarpasa Military Hospital, Istanbul, Turkey. senolyildiz@hotmail.com
Fibromyalgia syndrome (FMS) is characterized by longstanding multifocal pain
with generalized allodynia/hyperalgesia. There are several treatment methods but
none has been specifically approved for this application. We conducted a
randomized controlled study to evaluate the effect of hyperbaric oxygen (HBO)
therapy in FMS (HBO group: n = 26; control group: n = 24). Tender points and
pain threshold were assessed before, and after the first and fifteenth sessions
of therapy. Pain was also scored on a visual analogue scale (VAS). There was a
significant reduction in tender points and VAS scores and a significant increase
in pain threshold of the HBO group after the first and fifteenth therapy
sessions. There was also a significant difference between the HBO and control
groups for all parameters except the VAS scores after the first session. We
conclude that HBO therapy has an important role in managing FMS.
-----
Pharmacotherapy. 2004 May;24(5):621-9.
Treatment of pain syndromes with venlafaxine.
Grothe DR, Scheckner B, Albano D.
Global Medical Communications, Neuroscience, Wyeth Pharmaceuticals,
Collegeville, Pennsylvania 19426, USA.
Major depressive disorder (MDD) and anxiety disorders such as generalized
anxiety disorder (GAD) are often accompanied by chronic painful symptoms.
Examples of such symptoms are backache, headache, gastrointestinal pain, and
joint pain. In addition, pain generally not associated with major depression or
an anxiety disorder, such as peripheral neuropathic pain (e.g., diabetic
neuropathy and postherpetic neuralgia), cancer pain, and fibromyalgia, can be
challenging for primary care providers to treat. Antidepressants that block
reuptake of both serotonin and norepinephrine, such as the tricyclic
antidepressants (e.g., amitriptyline), have been used to treat pain syndromes in
patients with or without comorbid MDD or GAD. Venlafaxine, a serotonin and
norepinephrine reuptake inhibitor, has been safe and effective in animal models,
healthy human volunteers, and patients for treatment of various pain syndromes.
The use of venlafaxine for treatment of pain associated with MDD or GAD,
neuropathic pain, headache, fibromyalgia, and postmastectomy pain syndrome is
reviewed. Currently, no antidepressants, including venlafaxine, are approved for
the treatment of chronic pain syndromes. Additional randomized, controlled
trials are necessary to fully elucidate the role of venlafaxine in the treatment
of chronic pain.
-----
J Rheumatol. 2004 Apr;31(4):783-4.
No effect of antiviral (valacyclovir) treatment in fibromyalgia:
a double blind, randomized study.
Kendall SA, Schaadt ML, Graff LB, Wittrup I, Malmskov H, Krogsgaard K, Bartels
EM, Bliddal H, Danneskiold-Samsoe B.
Parker Institute, Department of Rheumatology, Frederiksberg Hospital,
Frederiksberg, Denmark.
OBJECTIVE: To investigate the effect of an antiviral compound, valacyclovir, on
pain and tenderness in patients with the fibromyalgia (FM) syndrome. METHODS:
Sixty patients were randomized into a double blind, placebo controlled 6 week
trial. Primary outcome was pain intensity change (on visual analog scale).
Secondary outcome measures were tender points (myalgic score) and Fibromyalgia
Impact Questionnaire (FIQ). RESULTS: Fifty-two patients completed the study. The
numbers of dropouts due to adverse events were equal in valacyclovir (2) and
placebo (2) groups. The effect of valacyclovir on pain and tenderness and FIQ
did not differ from placebo. CONCLUSION: Valacyclovir cannot be recommended as a
therapy for FM at this point.
-----
Arthritis Rheum. 2004 Apr 15;51(2):184-92.
Long-term efficacy of therapy in patients with fibromyalgia: a
physical exercise-based program and a cognitive-behavioral approach.
Redondo JR, Justo CM, Moraleda FV, Velayos YG, Puche JJ, Zubero JR, Hernandez
TG, Ortells LC, Pareja MA.
Instituto Provincial de Rehabilitacion, Hospital Universitario Gregorio Maranon,
Madrid, Spain. javierrivera@ser.es
OBJECTIVE: To analyze the long-term efficacy of 2 interventions for female
fibromyalgia (FM) patients: 1) cognitive-behavioral therapy (CBT), and 2) a
physical exercise (PE)-based strategy. METHODS: We conducted a prospective,
long-term, randomized, parallel clinical trial. The outcome variables are
physical activity, aerobic capacity, and results of the Fibromyalgia Impact
Questionnaire (FIQ), Short Form 36, Beck Anxiety and Depression Inventory,
Chronic Pain Self-Efficacy Scale, and Chronic Pain Coping Inventory. All were
measured at baseline, posttreatment, 6 months, and 1 year. The duration of both
treatments was 8 weeks. RESULTS: Some items of the FIQ and some strategies to
cope with pain improved significantly in both groups after treatment. All
variables measuring functional capacity improved significantly in the PE group,
whereas only physical activity of the vertebral column improved in the CBT
group. There were no differences in anxiety, depression, and self efficacy after
treatment in either group. After 1 year of followup, most of the parameters had
returned to baseline values in both groups. However, in the PE group, functional
capacity remained significantly better. CONCLUSIONS: PE and CBT improve clinical
manifestations in FM patients only for short periods of time. Improvement in
self efficacy and physical fitness are not associated with improvement in
clinical manifestations.
-----
Schmerz. 2004 Apr;18(2):118-24.
[Fibromyalgia]
[Article in German]
Biewer W, Conrad I, Hauser W.
Internistisch-rheumatologische Schwerpunktpraxis, Saarbrucken. Drwerner@biewer.com
Within clinical practice fibromyalgia is diagnosed according to the
classification criteria of the American College of Rheumatology. The examination
of the tender points is still to be standardized. By using additional diagnostic
criteria fibromyalgia changes into a polysymptomatic syndrom with multiple
functional and psychic symptoms. The prevalence of FMS is estimated to range
between 1,3-4,8% in the general population. Relative hypocortisolism, sensory
hypervigilance, adverse life experiences and psychiatric disorders are discussed
as main pathophysiological mechanisms. There are no evidence-based guidelines of
scientific societies for the management of fibromyalgia available. Patient
education, medical training therapy, physical therapy (heat or cold) and
relaxation therapy are recommended. There is a moderate evidence for the
effectiveness of tricyclic antidepressants and aerobic training. The
effectiveness of multicomponent therapy in fibromyalgia is still to be
demonstrated.
-----
Eur J Pain. 2004;8(2):163-71.
Peripheral effects of needle stimulation (acupuncture)
on skin and muscle blood flow in fibromyalgia.
Sandberg M, Lindberg LG, Gerdle B.
Department of Biomedical Engineering, Linkoping University, Linkoping
SE-581 85, Sweden.
Acupuncture has become a widely used treatment modality in
various musculoskeletal pain conditions. Acupuncture is also shown
to enhance blood flow and recovery in surgical flaps. The mechanisms
behind the effect on blood flow were suggested to rely on vasoactive
substances, such as calcitonin gene-related peptide, released
from nociceptors by the needle stimulation. In a previous study
on healthy subjects, one needle stimulation into the anterior
tibial muscle was shown to increase both skin and muscle blood
flow. The aim of this study was to examine the effect of needle
stimulation on local blood flow in the anterior tibial muscle
and overlying skin in patients suffering from a widespread chronic
pain condition. Fifteen patients with fibromyalgia (FM) participated
in the study. Two modes of needling, deep muscle stimulation and
subcutaneous needle insertion were performed at the upper anterior
aspect of the tibia, i.e., in an area without focal pathology
or ongoing pain in these patients. Blood flow changes were assessed
non-invasively by photoplethysmography (PPG). The results of the
present study were partly similar to those earlier found at a
corresponding site in healthy female subjects, i.e., deep muscle
stimulation resulted in larger increase in skin blood flow (mean
(SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared
to baseline, than did subcutaneous insertion (mean (SE) skin blood
flow increase: 26.4% (6.2); muscle blood flow increase: 46.1%
(10.2)). However, in FM patients subcutaneous needle insertion
was followed by a significant increase in both skin and muscle
blood flow, in contrast to findings in healthy subjects where
no significant blood flow increase was found following the subcutaneous
needling. The different results of subcutaneous needling between
the groups (skin blood flow: [Formula: see text]; muscle blood
flow: [Formula: see text] ) may be related to a greater sensitivity
to pain and other somatosensory input in FM.
-----
Ann Rheum Dis. 2004 Mar;63(3):290-6.
Fibromyalgia: a randomised, controlled trial of
a treatment programme based on self management.
Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen
P, Finckh A, Allaz AF, Vischer TL.
Division of Rheumatology, Geneva University Hospital, 1211 Geneva,
Switzerland. Christine.Cedraschi@hcuge.ch
OBJECTIVE: To evaluate the efficacy of a treatment programme
for patients with fibromyalgia (FM) based on self management,
using pool exercises and education. METHODS: Randomised controlled
trial with a 6 month follow up to evaluate an outpatient multidisciplinary
programme; 164 patients with FM were allocated to an immediate
6 week programme (n = 84) or to a waiting list control group (n
= 80). The main outcomes were changes in quality of life, functional
consequences, patient satisfaction and pain, using a combination
of patient questionnaires and clinical examinations. The questionnaires
included the Fibromyalgia Impact Questionnaire (FIQ), Psychological
General Well-Being (PGWB) index, regional pain score diagrams,
and patient satisfaction measures. RESULTS: 61 participants in
the treatment group and 68 controls completed the programme and
6 month follow up examinations. Six months after programme completion,
significant improvements in quality of life and functional consequences
of FM were seen in the treatment group as compared with the controls
and as measured by scores on both the FIQ (total score p = 0.025;
fatigue p = 0.003; depression p = 0.031) and PGWB (total score
p = 0.032; anxiety p = 0.011; vitality p = 0.013,). All four major
areas of patient satisfaction showed greater improvement in the
treatment than the control groups; between-group differences were
statistically significant for "control of symptoms",
"psychosocial factors", and "physical therapy"
No change in pain was seen. CONCLUSION: A 6 week self management
based programme of pool exercises and education can improve the
quality of life of patients with FM and their satisfaction with
treatment. These improvements are sustained for at least 6 months
after programme completion.
-----
Am J Med. 2003 May;114(7):537-45.
Tramadol and acetaminophen combination tablets
in the treatment of fibromyalgia pain: a double-blind, randomized,
placebo-controlled study.
Bennett RM, Kamin M, Karim R, Rosenthal N.
Department of Medicine, Oregon Health and Science University,
Portland 97201, USA. bennetro@ohsu.edu
PURPOSE: To evaluate the efficacy and safety of a combination
analgesic tablet (37.5 mg tramadol/325 mg acetaminophen) for the
treatment of fibromyalgia pain. METHODS: This 91-day, multicenter,
double-blind, randomized, placebo-controlled study compared tramadol/acetaminophen
combination tablets with placebo. The primary outcome variable
was cumulative time to discontinuation (Kaplan-Meier analysis).
Secondary measures at the end of the study included pain, pain
relief, total tender points, myalgia, health status, and Fibromyalgia
Impact Questionnaire scores. RESULTS: Of the 315 subjects who
were enrolled in the study, 313 (294 women [94%], mean [+/- SD]
age, 50 +/- 10 years) completed at least one postrandomization
efficacy assessment (tramadol/acetaminophen: n = 156; placebo:
n = 157). Discontinuation of treatment for any reason was less
common in those treated with tramadol/acetaminophen compared with
placebo (48% vs. 62%, P = 0.004). Tramadol/acetaminophen-treated
subjects also had significantly less pain at the end of the study
(53 +/- 32 vs. 65 +/- 29 on a visual analog scale of 0 to 100,
P <0.001), and better pain relief (1.7 +/- 1.4 vs. 0.8 +/-
1.3 on a scale of -1 to 4, P <0.001) and Fibromyalgia Impact
Questionnaire scores (P = 0.008). Indexes of physical functioning,
role-physical, body pain, health transition, and physical component
summary all improved significantly in the tramadol/acetaminophen-treated
subjects. Discontinuation due to adverse events occurred in 19%
(n = 29) of tramadol/acetaminophen-treated subjects and 12% (n
= 18) of placebo-treated subjects (P = 0.09). The mean dose of
tramadol/acetaminophen was 4.0 +/- 1.8 tablets per day. CONCLUSION:
A tramadol/acetaminophen combination tablet was effective for
the treatment of fibromyalgia pain without any serious adverse
effects.
-----
J Natl Med Assoc. 2003 Apr;95(4):278-85.
A practical approach to fibromyalgia.
Cymet TC.
Johns Hopkins School of Medicine, Section Head, Family Medicine,
Sinai Hospital of Baltimore, Maryland 21215, USA.
Fibromyalgia is the name given to a collection of symptoms
with no clear physiologic cause, The constellation of symptoms
are clearly recognizable as a distinct pathologic entity. The
diagnosis is made through clinical observations made by the examiner.
Differential diagnosis must include other somatic syndromes as
well as disease entities like hepatitis, hypothyroidism, diabetes
mellitus, electrolyte imbalance, multiple sclerosis, and cancer.
Diagnostic criteria are given as guidelines for the diagnosis,
not as absolute requirements. Treatment of this condition remains
individualized and relies heavily on having a therapeutic relationship
with a provider. Treatment of this syndrome needs to be looked
at as an ongoing process. Goal oriented treatment aimed at maintaining
specific functions can be directed at helping a patient get restorative
sleep, alleviating the somatic pains that ail the patient, keeping
a person productive, regulating schedules or through goal oriented
agreements made with the patient. Since this syndrome is chronic
and may effect all areas of a persons functioning the family and
social support system of the person being treated need to be evaluated.
Patients often seek alternative medical treatments for this problem
including diet therapy, acupuncture, and herbal therapy. Treatment
must involve more than just the symptoms presented and the patient
can only be treated successfully if they are willing to work at
changing their own perceptions, and ways of relating to stressors
in their world.
-----
Arthritis Rheum. 2003 Jun 15;49(3):314-20.
Operant behavioral treatment of fibromyalgia:
a controlled study.
Thieme K, Gromnica-Ihle E, Flor H.
Department of Psychosomatic and Psychotherapeutic Medicine, University
of Heidelberg, Central Institute of Mental Health, Mannheim, Germany.
thieme@zi-mannheim.de
OBJECTIVE: To evaluate the efficacy of operant pain treatment
for fibromyalgia syndrome (FMS) in an inpatient setting. METHODS:
Sixty-one patients who fulfilled the American College of Rheumatology
criteria for FMS were randomly assigned to the operant pain treatment
group (OTG; n = 40) or a standardized medical program with an
emphasis on physical therapy (PTG; n = 21). Pain assessments were
performed before, immediately after, 6 months after, and 15 months
after treatment. RESULTS: The OTG patients reported a significant
and stable reduction in pain intensity, interference, solicitous
behavior of the spouse, medication, pain behaviors, number of
doctor visits, and days at a hospital as well as an increase in
sleeping time. Sixty-five percent of the OTG compared with none
of the patients in the PTG showed clinically significant improvement.
CONCLUSION: These results suggest that operant pain treatment
provided in an inpatient setting is an effective treatment for
FMS, whereas a purely somatically oriented program may lead to
a deterioration of the pain problem.
-----
Medsurg Nurs. 2003 Jun;12(3):145-59, 190; quiz 160.
Fibromyalgia: evolving concepts and management
in primary care settings.
Lash AA, Ehrlich-Jones L, McCoy D.
Northern Illinois University School of Nursing, DeKalb, IL, USA.
During the last 10 years, fibromyalgia (FM) research shifted
focus from psychological and behavioral issues to sleep, nociception,
and neuroendocrinology. Although there are still no definitive
markers of the disease, a barrage of studies in physiological,
psychological, and behavioral sciences have now dispelled the
belief that FM is solely psychosomatic. Studies in the late 1990s
as well as in the early part of the current decade reaffirm earlier
research that sleep abnormalities and alterations in nociception
may partly be responsible for FM. While sleep research shows that
FM patients typically are deficient in stage IV (restorative)
sleep, most current studies in nociception now affirm that patients
with FM exhibit low serum serotonin in combination with increased
substance P levels in the cerebrospinal fluid. Although there
is still no cure, treatment aimed at promoting sleep, interrupting
nociception, and actively involving patient and family in FM management
can bring lifetime control for the disease.
-----
IDrugs. 2003 Jul;6(7):668-73.
Fibromyalgia Syndrome: An overview of potential
drug targets.
Briley M, Moret C.
NeuroBiz Consulting and Communications, Les Grezes, La Verdarie,
81100 Castres, France. mike.briley@neurobiz.com
Fibromyalgia syndrome (FMS) is a chronic disease of widespread
and debilitating pain. The cause of FMS is unknown and its risk
factors are poorly understood. It occurs frequently in the general
population where it is often co-morbid with other rheumatoid and
pain disorders, and psychiatric disorders such as anxiety and
depression, making diagnosis particularly difficult. Several types
of drugs are used to treat FMS, but none are specifically approved
for this indication. FMS appears to be strongly associated with
depression or at least with some symptoms of depression, and antidepressants
appear to be effective in the treatment of this disorder. The
advent of new classes of antidepressants with fewer side effects
than older drugs has suggested new avenues of therapy for patients
diagnosed with FMS.
-----
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S147-54.
Botulinum toxin in pain management of soft tissue
syndromes.
Smith HS, Audette J, Royal MA.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
15213, USA.
Botulinum toxin is approved for the treatment of muscle overactivity
associated with several disorders, such as dystonias. However,
control of muscle spasm often results in pain relief as well.
Effective relief of pain associated with myofascial pain syndrome
provides a model for the use of botulinum toxin to relieve pain
associated with other types of soft-tissue syndromes, such as
fibromyalgia. Although the mechanisms that trigger the pain in
these syndromes vary, recent data suggest that a central neuroplastic
mechanism may contribute to many complex pain syndromes. Botulinum
toxin therapy may be particularly useful in soft-tissue syndromes
that are refractory to traditional treatment with physical therapy,
electrical muscle stimulation, and other approaches. Although
not used as first-line therapy for pain relief, botulinum toxin
may decrease pain long enough for patients to resume more conservative
therapy. A primary benefit of treatment with botulinum toxin is
its long duration of action. Several studies have demonstrated
the efficacy of botulinum toxin types A and B in treating several
neuropathic pain disorders. Proper patient selection, injection
technique, and dosing are critical to obtaining the best outcomes
in managing pain with botulinum toxin. Additional study is needed
to better characterize its use for the treatment of pain.
-----
Best Pract Res Clin Rheumatol. 2003 Aug;17(4):667-83.
Complementary and alternative medicine in fibromyalgia
and related syndromes.
Holdcraft LC, Assefi N, Buchwald D.
Department of Psychiatry and Behavioral Sciences, Harborview Medical
Center, University of Washington School of Medicine, Box 359797,
325 Ninth Ave, 98104-2499, Seattle, WA, USA
Complementary and alternative medicine (CAM) has gained increasing
popularity, particularly among individuals with fibromyalgia syndrome
(FMS) for which traditional medicine has generally been ineffective.
A systematic review of randomized controlled trials (RCTs) and
non-RCTs on CAM studies for FMS was conducted to evaluate the
empirical evidence for their effectiveness. Few RCTs achieved
high scores on the CONSORT, a standardized evaluation of the quality
of methodology reporting. Acupuncture, some herbal and nutritional
supplements (magnesium, SAMe) and massage therapy have the best
evidence for effectiveness with FMS. Other CAM therapies have
either been evaluated in only one RCT with positive results (Chlorella,
biofeedback, relaxation), in multiple RCTs with mixed results
(magnet therapies), or have positive results from studies with
methodological flaws (homeopathy, botanical oils, balneotherapy,
anthocyanidins, dietary modifications). Lastly, other CAM therapies
have neither well-designed studies nor positive results and are
not currently recommended for FMS treatment (chiropractic care).
-----
Best Pract Res Clin Rheumatol. 2003 Aug;17(4):649-65.
Psychological and behavioural therapies in fibromyalgia
and related syndromes.
Williams DA.
University of Michigan, Room 5510D, MSRB-1, 1150 W. Medical Center
Dr., 48109-0680, Ann Arbor, MI, USA
Psychological and behavioural therapies are being applied to
patients with fibromyalgia (FM) with increasing frequency. The
rationale for including psychological therapies is not for the
treatment of co-morbid mood disorders, but rather to manage the
many non-psychiatric psychological and social factors that comprise
pain perception and its maintenance. This chapter reviews the
involvement of mental health professionals under both the biomedical
and biopsychosocial models of illness and describes cognitive
behavioural therapy (CBT), a commonly used form of psychological
therapy in the management of chronic pain conditions. The empirical
literature supports the use of CBT with FM in producing modest
outcomes across multiple domains, including pain, fatigue, physical
functioning and mood. Greatest benefits appear to occur when CBT
is used adjunctively with exercise. While the benefits are not
curative or universally obtained by all patients, the benefits
are sufficiently large to encourage future refinement of CBT for
this population of patients.
-----
Best Pract Res Clin Rheumatol. 2003 Aug;17(4):629-47.
Physical exercise in fibromyalgia and related
syndromes.
Mannerkorpi K, Iversen MD.
Department of Rheumatology and Inflammation Research, Goteborg
University, and Department of Health Sciences, Division of Physical
Therapy, Lulea University of Technology, Sweden
Fibromyalgia and related syndromes are characterized by chronic
pain and fatigue. This chapter identifies the types of exercise
that are effective for these patients and provides recommendations
for exercise prescriptions. Based on a systematic review of randomized
controlled studies of exercise, we suggest that low-intensity
aerobic exercise, such as walking, can improve function and symptoms.
Aerobic exercise performed twice a week at moderate intensity
can improve aerobic capacity and reduce tenderness. Pool exercise
can improve function, distress and symptoms. Strength training
at adequate load can improve strength without exacerbation of
symptoms. Most patients tolerate low-intensity exercise. High-intensity
exercise should be undertaken with caution. Due to the large variability
of functioning and symptom severity in patient populations, exercise
prescriptions should be individualized and should include a long-term
plan to maximize functioning and wellbeing. Studies with larger
populations, allowing subgroup analyses regarding benefits and
adverse effects of programmes, are needed.
-----
Best Pract Res Clin Rheumatol. 2003 Aug;17(4):611-27.
Pharmacological therapies in fibromyalgia.
Rao SG, Bennett RM.
Cypress Bioscience, 4350 Executive Drive, Suite 325, 92121, San
Diego, CA, USA
The fibromyalgia syndrome (FMS) is a common, chronic, widespread
pain disorder that mainly affects middle-aged women. In addition
to pain complaints, fatigue and disturbed sleep are symptoms frequently
reported by these patients. Many FMS patients also meet diagnostic
criteria for mood disorders (e.g. depression) as well as other
so-called 'functional somatic syndromes', including irritable
bowel syndrome, temporomandibular joint disorder, and subsets
of chronic low-back pain. A wide variety of medications are used
to manage the eclectic symptomatology of FMS patients, although
relatively few have been rigorously tested. This chapter provides
a contemporary update of the state of FMS pharmacotherapy, with
an emphasis on compounds that have been tested in double-blind,
randomized, controlled trials. Particular attention is paid to
the efficacy of these therapies on the associated symptoms and
co-morbid syndromes commonly seen in FMS patients.
-----
Scand J Rheumatol. 2002;31(5):306-10.
Six- and 24-month follow-up of pool exercise therapy
and education for patients with fibromyalgia.
Mannerkorpi K, Ahlmen M, Ekdahl C.
Department of Physical Therapy, Sahlgrenska University Hospital,
Goteborg, Sweden. Kaisa.Mannerkorpi@vgregion.se
OBJECTIVE: To follow patients with fibromyalgia six and 24
months after they finished a six-month treatment programme. The
programme comprised pool exercise therapy, adjusted to the patients'
limitations, and education based on their health problems. METHODS:
Twenty-six patients were examined six and 24 months after the
completion of the treatment programme with the Fibromyalgia Impact
Questionnaire (FIQ), SF-36, the 6-minute walk test, and the Grippit
measure. The values obtained at the follow-up examinations were
compared with the baseline and post-treatment values. RESULTS:
As compared with baseline, symptom severity (FIQ, SF-36), physical
function (FIQ, SF-36, 6-minute walk test) and quality of life
(SF-36) still showed improvements six months after the completion
of treatment (p <0.05). Pain (FIQ, SF-36), fatigue (FIQ, SF-36),
walking ability, and social function (SF-36) still showed improvements
2 years after the completion of the programme as compared with
the baseline values (p < 0.05). No significant changes were
found for these variables, when the values obtained at the two
follow-up examinations were compared with those of the post-treatment
examination. CONCLUSIONS: Improvements in symptom severity, physical
function and social function were still found six and 24 months
after the completed treatment programme.
-----
Altern Med Rev. 2002 Oct;7(5):389-403.
Intravenous nutrient therapy: the "Myers'
cocktail".
Gaby AR.
Building on the work of the late John Myers, MD, the author
has used an intravenous vitamin-and-mineral formula for the treatment
of a wide range of clinical conditions. The modified "Myers'
cocktail," which consists of magnesium, calcium, B vitamins,
and vitamin C, has been found to be effective against acute asthma
attacks, migraines, fatigue (including chronic fatigue syndrome),
fibromyalgia, acute muscle spasm, upper respiratory tract infections,
chronic sinusitis, seasonal allergic rhinitis, cardiovascular
disease, and other disorders. This paper presents a rationale
for the therapeutic use of intravenous nutrients, reviews the
relevant published clinical research, describes the author's clinical
experiences, and discusses potential side effects and precautions.
-----
Clin J Pain. 2002 Sep-Oct;18(5):324-36.
Systematic review of randomized controlled trials
of nonpharmacological interventions for fibromyalgia.
Sim J, Adams N.
Primary Care Sciences Research Center, Keele University, Keele,
Staffordshire, UK. pta05@keele.ac.uk
OBJECTIVE: Little is known of the effectiveness of nonpharmacological
interventions for fibromyalgia syndrome (FMS). The authors therefore
carried out a systematic review from 1980 to May 2000 of randomized
controlled trials (RCTs) of nonpharmacological interventions for
FMS. METHOD: A search of computerized databases was supplemented
by hand searching of bibliographies of key publications. The methodological
quality of studies included in the review was evaluated independently
by two researchers according to a set of formal criteria. Discrepancies
in scoring were resolved through discussion. RESULTS: The review
yielded 25 RCTs, and the main categories of interventions tested
in the studies were exercise therapy, educational intervention,
relaxation therapy, cognitive-behavioral therapy, acupuncture,
and forms of hydrotherapy. Methodological quality of studies was
fairly low (mean score = 49.5/100). Most studies had small samples
(median for individual treatment groups after randomization =
20), and the mean power of the studies to detect a medium effect
( > or = 0.5) was 0.36. Sixteen studies had blinded outcome
assessment, but patients were blinded in only 6 studies. The median
longest follow-up was 16 weeks. Statistically significant between-group
differences on at least one outcome variable were reported in
17 of the 24 studies. CONCLUSIONS: The varying combinations of
interventions studied in the RCTs and the wide range of outcome
measures used make it hard to form conclusions across studies.
Strong evidence did not emerge in respect to any single intervention,
though preliminary support of moderate strength existed for aerobic
exercise. There is a need for larger, more methodologically rigorous
RCTs in this area.
-----
Rheumatol Int. 2002 Sep;22(5):188-93. Epub 2002 Jul 06.
Effects of low power laser and low dose amitriptyline
therapy on clinical symptoms and quality of life in fibromyalgia:
a single-blind, placebo-controlled trial.
Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Ataoglu S.
Department of Physical Medicine and Rehabilitation, Dicle University
School of Medicine, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr
The purpose of this study was to examine the effectiveness
of low power laser (LPL) and low-dose amitriptyline therapy and
to investigate effects of these therapy modalities on clinical
symptoms and quality of life (QOL) in patients with fibromyalgia
(FM). Seventy-five patients with FM were randomly allocated to
active gallium-arsenide (Ga-As) laser (25 patients), placebo laser
(25 patients), and amitriptyline therapy (25 patients). All groups
were evaluated for the improvement in pain, number of tender points,
skin fold tenderness, morning stiffness, sleep disturbance, muscular
spasm, and fatigue. Depression was evaluated by a psychiatrist
according to the Hamilton Depression Rate Scale and DSM IV criteria.
Quality of life of the FM patients was assessed according to the
Fibromyalgia Impact Questionnaire (FIQ). In the laser group, patients
were treated for 3 min at each tender point daily for 2 weeks,
except weekends, at each point with approximately 2 J/cm(2) using
a Ga-As laser. The same unit was used for the placebo treatment,
for which no laser beam was emitted. Patients in the amitriptyline
group took 10 mg daily at bedtime throughout the 8 weeks. Significant
improvements were indicated in all clinical parameters in the
laser group (P = 0.001) and significant improvements were indicated
in all clinical parameters except fatigue in the amitriptyline
group (P = 0.000), whereas significant improvements were indicated
in pain (P = 0.000), tender point number (P = 0.001), muscle spasm
(P = 0.000), morning stiffness (P = 0.002), and FIQ score (P =
0.042) in the placebo group. A significant difference was observed
in clinical parameters such as pain intensity (P = 0.000) and
fatigue (P = 0.000) in favor of the laser group over the other
groups, and a significant difference was observed in morning stiffness
(P = 0.001), FIQ (P = 0.003), and depression score (P = 0.000)
after therapy. A significant difference was observed in morning
stiffness (P = 0.001), FIQ (P = 0.003), and depression (P = 0.000)
in the amitriptyline group compared to the placebo group after
therapy. Additionally, a significant difference was observed in
depression score (P = 0.000) in the amitriptyline group in comparison
to the laser group after therapy. Our study suggests that both
amitriptyline and laser therapies are effective on clinical symptoms
and QOL in fibromyalgia and that Ga-As laser therapy is a safe
and effective treatment in cases with FM. Additionally, the present
study suggests that the Ga-As laser therapy can be used as a monotherapy
or as a supplementary treatment to other therapeutic procedures
in FM.
-----
Curr Pain Headache Rep. 2002 Oct;6(5):379-83.
Pain treatment with acupuncture for patients with
fibromyalgia.
Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT,
Imamura ST.
Division of Physical Medicine, Department of Orthopedics and Traumatology,
University of Sao Paulo School of Medicine, Ave. Giovanni Gronchi,
1106 San Paulo, Brazil. ucklrsu@ucl.ac.uk
Fibromyalgia is a chronic, painful musculoskeletal syndrome
of unknown etiopathogenesis. In addition to medicamentous and
physical and psychologic therapies, several other adjunct therapies
have been used as alternatives in the attempt to obtain analgesia
and decrease the symptoms that are characteristic of this problem.
This article presents a literary review on the use of acupuncture
as an adjunct or chief treatment for patients with fibromyalgia,
comparing it with an ongoing clinical experience that has been
carried out at Hospital das Clinicas in the city of Sao Paulo.
The results were found by applying traditional acupuncture, which
demonstrated positive rates in the Visual Analogue Scale, myalgic
index, number of tender points, and improvement in quality of
life based on the SF-36 questionnaire.
--
BMJ. 2002 Jul 27;325(7357):185.
Prescribed exercise in people with fibromyalgia:
parallel group randomised controlled trial.
Richards SC, Scott DL.
Poole Hospital NHS Trust, Poole, Dorset BH15 2JB. srichards@poole-tr.swest.nhs.uk
OBJECTIVES: To evaluate cardiovascular fitness exercise in
people with fibromyalgia. DESIGN: Randomised controlled trial.
Setting: Hospital rheumatology outpatients. Group based classes
took place at a "healthy living centre." PARTICIPANTS:
132 patients with fibromyalgia. INTERVENTIONS: Prescribed graded
aerobic exercise (active treatment) and relaxation and flexibility
(control treatment). MAIN OUTCOME MEASURES: Participants' self
assessment of improvement, tender point count, impact of condition
measured by fibromyalgia impact questionnaire, and short form
McGill pain questionnaire. RESULTS: Compared with relaxation exercise
led to significantly more participants rating themselves as much
or very much better at three months: 24/69 (35%) v 12/67 (18%),
P=0.03. Benefits were maintained or improved at one year follow
up when fewer participants in the exercise group fulfilled the
criteria for fibromyalgia (31/69 v 44/67, P=0.01). People in the
exercise group also had greater reductions in tender point counts
(4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact questionnaire
(4.0 v 0.6, P=0.07). CONCLUSIONS: Prescribed graded aerobic exercise
is a simple, cheap, effective, and potentially widely available
treatment for fibromyalgia.
-----
Cochrane Database Syst Rev. 2002;(3):CD003786.
Exercise for treating fibromyalgia syndrome.
Busch A, Schachter CL, Peloso PM, Bombardier C.
1121 College Drive, Saskatoon, Saskatchewan, Canada, S7N 0W3.
angela.busch@usask.ca
BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic
widespread body pain which leads to reduced physical function
and frequent use of health care services. Exercise training is
commonly recommended as a treatment. OBJECTIVES: The objective
of this systematic review was to examine the efficacy of exercise
training as an treatment for FMS. SEARCH STRATEGY: We searched
6 electronic bibliographies for studies of exercise training in
FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR
(1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000)
and the Cochrane Controlled Trials Register (2000, issue 4). We
also reviewed the reference lists from identified articles including
reviews and meta-analyses of treatment studies. SELECTION CRITERIA:
Randomized trials focused on cardiorespiratory endurance, muscle
strength and/or flexibility as treatment for FMS were selected.
DATA COLLECTION AND ANALYSIS: Two reviewers independently identified
trials meeting inclusion criteria, rated the methodologic quality
using 2 standardized validated instruments, evaluated the adequacy
of the exercise training stimulus using the American College of
Sports Medicine (ACSM) criteria and evaluated the results. Disagreements
were resolved through active discussion and consensus. High quality
training studies had scores of 50% or greater on van Tulder methodologic
criteria and met the minimum training standards of ACSM. Outcome
variables were grouped into 7 constructs: pain, tender points,
physical function, global well being, self efficacy, fatigue &
sleep, and psychological function. Two reviewers independently
extracted data on study characteristics, results and point estimates
for selected variables, and used consensus to address discrepancies.
MAIN RESULTS: Sixteen trials involving a total of 724 participants
were assigned at random to: exercise intervention groups (n=379),
control groups (n=277), or groups receiving an alternate treatment
(n=68). Seven studies were high quality training studies: 4 aerobic
training, 1 a mixture of aerobic, strength and flexibility training,
1 strength training and 2 with exercise training as part of a
composite treatment. Flexibility protocols were never described
in sufficient detail to allow evaluation. The four high quality
aerobic training studies reported significantly greater improvements
in the exercise groups versus control groups in aerobic performance
(17.1% increase in aerobic performance with exercise versus 0.5%
increase in the control groups), tender point pain pressure threshold
(28.1% increase versus 7.0% decrease) and improvements in pain
(11.4% decrease in pain versus 1.6% increase). Poor description
of exercise protocols was common, with insufficient information
on intensity, duration, frequency and mode of exercise. Adverse
events were also poorly reported. REVIEWER'S CONCLUSIONS: Supervised
aerobic exercise training has beneficial effects on physical capacity
and FMS symptoms. Strength training may also have benefits on
some FMS symptoms. Further studies on muscle strengthening and
flexibility are needed. Research on the long-term benefit of exercise
for FMS is needed.
-----
Rheum Dis Clin North Am. 2002 May;28(2):405-17.
The management of fibromyalgia-associated syndromes.
Silver DS, Wallace DJ.
Division of Rheumatology, Cedars-Sinai Medical Center, UCLA School
of Medicine, Los Angeles, CA 90048, USA. davids@omcresearch.org
Most of the six million Americans with fibromyalgia have at
least one associated syndrome which mandates specialized attention
in addition to traditional therapeutic approaches. These include
localized procedures, regional blocks, antiinflammatory or antimicrobial
regimens, attention to non soft tissue sources of psychosocial
distress, and classes of medicines not usually prescribed for
fibromyalgia. The successful treatment of fibromyalgia-associated
syndromes improves the symptoms, quality of life, and prognosis
of fibromyalgia.
-----
Rheum Dis Clin North Am. 2002 May;28(2):291-304.
Nonpharmacologic management strategies in fibromyalgia.
Burckhardt CS.
School of Nursing, SN-5N, Oregon Health and Science University,
3181 SW Sam Jackson Park Road, Portland, OR 97201, USA. burckhac@ohsu.edu
Clinicians using the results of the extant research base can
take an optimistic view of the role of nonpharmacologic treatment
strategies for fibromyalgia. There were no negative outcomes in
any of the reviewed studies, although in a few studies the experimental
treatment did not prove to be more effective than the attention
control. Rather than viewing this negatively, one could look more
closely at the attention control groups and attempt to better
understand what they contained that worked as an active treatment.
A number of trials include a follow-up component and all but one
of them find maintenance of at least one outcome change. Maintenance
of changes is more likely to occur when the patient continues
to participate in the experimental activity long-term. Patients
especially need strategies that help them continue in exercise
regimens. Unlike cognitive skills strategies that once learned
are likely to become part of a person's coping repertoire, both
exercise and behavioral strategies, like progressive muscle relaxation,
need to be performed on a consistent basis in order to have their
effect. The goals of increased self-efficacy, symptom reduction,
increased functional status and quality of life along with decreased
inappropriate use of health care resources are realistic when
patients persevere in their use of strategy combinations and receive
support from their providers.
-----
J Am Osteopath Assoc. 2002 Jun;102(6):321-5.
Osteopathic manipulative treatment in conjunction
with medication relieves pain associated with fibromyalgia syndrome:
results of a randomized clinical pilot project.
Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR.
Department of Osteopathic Manipulative Medicine, Texas College
of Osteopathic Medicine, University of North Texas Health Science
Center, Fort Worth 76107, USA. rgamber@hsc.unt.edu
Osteopathic physicians caring for patients with fibromyalgia
syndrome (FM) often use osteopathic manipulative treatment (OMT)
in conjunction with other forms of standard medical care. Despite
a growing body of evidence on the efficacy of manual therapy for
the treatment of selected acute musculoskeletal conditions, the
role of OMT in treating patients with chronic conditions such
as FM remains largely unknown. Twenty-four female patients meeting
American College of Rheumatology criteria for FM were randomly
assigned to one of four treatment groups: (1) manipulation group,
(2) manipulation and teaching group, (3) moist heat group, and
(4) control group, which received no additional treatment other
than current medication. Participants' pain perceptions were assessed
by use of pain thresholds measured at each of 10 bilateral tender
points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory,
and the Present Pain Intensity Rating Scale. Patients' affective
response to treatment was assessed using the Self-Evaluation Questionnaire.
Activities of daily living were assessed using the Stanford Arthritis
Center Disability and Discomfort Scales: Health Assessment Questionnaire.
Depression was assessed using the Center for Epidemiological Studies
Depression Scale. Significant findings between the four treatment
groups on measures of pain threshold, perceived pain, attitude
toward treatment, activities of daily living, and perceived functional
ability were found. All of these findings favored use of OMT.
This study found OMT combined with standard medical care was more
efficacious in treating FM than standard care alone. These findings
need to be replicated to determine if cost savings are incurred
when treatments for FM incorporate nonpharmacologic approaches
such as OMT.
-----
Rheumatol Int. 2002 Jun;22(2):56-9. Epub 2002 Mar 29.
The effects of balneotherapy on fibromyalgia patients.
Evcik D, Kizilay B, Gokcen E.
A.K.U. Arastirma Hastanesi, Fiziksel Tip ve Reh A.D. Inonu Bulvan;
03200 Afyon, Turkey. ezgievcik@ixir.c
Fibromyalgia syndrome (FMS) is a very common rheumatological
diagnosis. There are various treatment modalities. This study
was planned to investigate the effects of balneotherapy in the
treatment of FMS. A total of 42 primary fibromyalgia patients
diagnosed according to American College of Rheumatology criteria
were included in the study. Their ages ranged between 30 and 55
years. Patients were randomly assigned to two groups. None of
them had had a cardiovascular disease before. Group 1 n=22) received
20-min bathing, once a day and five times per week. Patients participated
in the study for 3 weeks (total of 15 sessions). Group 2 (n=20)
was accepted as the control group. Patients were evaluated by
the number of tender points, Visual Analogue Scale for pain, Beck's
Depression Index for depression, and Fibromyalgia Impact Questionnaire
for functional capacity. Measurements were assessed initially,
after the therapy, and at the end of the 6th month. In group 1,
there were statistically significant differences in numbers of
tender points, Visual Analogue scores, Beck's Depression Index,
and Fibromyalgia Impact Questionnaire scores after the therapy
program (P<0.001). Also, 6 months later in group 1, there was
still an improvement in the number of tender points (P<0.001),
Visual Analogue scores, and Fibromyalgia Impact Questionnaire
(P<0.005). But there was not a statistical difference in Beck's
Depression Index scores compared to the control group (P>0.05).
Patients with FMS mostly complain about pain, anxiety, and the
difficulty in daily living activities. This study shows that balneotherapy
is effective and may be an alternative method in treating fibromyalgia
patients.
-----
J Rheumatol. 2002 Jun;29(6):1280-6.
Improving physical functional status in patients
with fibromyalgia: a brief cognitive
behavioral intervention.
Williams DA, Cary MA, Groner KH, Chaplin W, Glazer LJ,
Rodriguez AM, Clauw DJ.
Department of Psychiatry, Georgetown University Medical Center,
Washington, DC 20007, USA. daw27@georgetown.edu
OBJECTIVE: Sustained improvement in physical functional status
was the primary goal of a brief, 6 session cognitive behavioral
therapy (CBT) protocol for fibromyalgia (FM). METHODS: One hundred
forty-five patients with FM were randomly assigned to either (1)
standard medical care that included pharmacological management
of symptoms and suggestions for aerobic fitness, or (2) the same
standard medical treatment plus 6 sessions of CBT aimed at improving
physical functioning. Outcome measures included the Medical Outcome
Study Short Form-36 Physical Component Score and McGill ratings
of pain. Outcomes were treated dichotomously using a preestablished
criterion for clinically significant success based upon the reliability
of change index from baseline to one year posttreatment. RESULTS:
Twenty-five percent of the patients receiving CBT were able to
achieve clinically meaningful levels of longterm improvement in
physical functioning, whereas only 12% of the patients receiving
standard care achieved the same level of improvement. There were
no lasting differences on pain ratings between groups. CONCLUSION:
Lasting improvements in physical functioning have been among the
most difficult outcomes to obtain in studies of FM. These data
suggest that the inclusion of CBT to a standard medical regimen
for FM can favorably influence physical functioning in a subset
of patients.
-----
J Rheumatol. 2002 May;29(5):1041-8.
A randomized controlled trial of muscle strengthening
versus flexibility training in fibromyalgia.
Jones KD, Burckhardt CS, Clark SR, Bennett RM, Potempa
KM.
School of Nursing, The Oregon Health and Science University, Portland
97201, USA. joneskim@ohsu.edu
OBJECTIVE: To determine the effectiveness of a muscle strengthening
program compared to a stretching program in women with fibromyalgia
(FM). METHODS: Sixty-eight women with FM were randomly assigned
to a 12 week, twice weekly exercise program consisting of either
muscle strengthening or stretching. Outcome measures included
muscle strength (main outcome variable), flexibility, weight,
body fat, tender point count, and disease and symptom severity
scales. RESULTS: No statistically significant differences between
groups were found on independent t tests. Paired t tests revealed
twice the number of significant improvements in the strengthening
group compared to the stretching group. Effect size scores indicated
that the magnitude of change was generally greater in the strengthening
group than the stretching group. CONCLUSION: Patients with FM
can engage in a specially tailored muscle strengthening program
and experience an improvement in overall disease activity, without
a significant exercise induced flare in pain. Flexibility training
alone also results in overall improvements, albeit of a lesser
degree.
-----
Ann Pharmacother. 2002 Apr;36(4):707-12.
Serotonergic agents in the treatment of fibromyalgia
syndrome.
Miller LJ, Kubes KL.
Pharmacy Department, Memorial Hermann Southwest Hospital, Houston,
TX 77074, USA. lisa_miller@mhhs.org
OBJECTIVE: To evaluate literature that discusses the treatment
of fibromyalgia syndrome (FMS) with agents that involve the neurotransmitter
serotonin. DATA SOURCES: Biomedical literature accessed through
MEDLINE (1966-August 2001) and International Pharmaceutical Abstracts.
DATA SYNTHESIS: The cause and pathophysiology of FMS remain elusive,
although abnormalities in the serotonin pathway have been implicated.
Several serotonergic agents have been studied for use in FMS.
Trials and case reports focusing on the use of newer agents: the
selective serotonin reuptake inhibitors, venlafaxine and tramadol,
were reviewed. CONCLUSIONS: Current research suggests that the
serotonergic agents may reduce at least some of the symptoms of
FMS. However, medications that act on multiple neurotransmitters
may prove to be more effective in symptom management. Additional
long-term studies are required in order to validate these results.
-----
J Rheumatol. 2002 Mar;29(3):582-7.
High or low intensity aerobic fitness training
in fibromyalgia: does it matter?
van Santen M, Bolwijn P, Landewe R, Verstappen F, Bakker
C, Hidding A, van Der Kemp D, Houben H, van der Linden S.
Department of Internal Medicine, University Hospital, Maastricht,
The Netherlands. msa@sint.azm.nl
OBJECTIVE: To determine the efficacy of training in fibromyalgia
(FM), we compared the effects of high intensity fitness training
(HIF) and low intensity fitness training (LIF). METHODS: Thirty-seven
female patients with FM were randomly allocated to either a HIF
group (n = 19) or a LIF group (n = 18). Four patients (1 HIF group,
3 LIF group) refused to participate after randomization but before
the start of the intervention. They were excluded from the analysis.
Assessments were performed at baseline and after 20 weeks of HIF
or LIF. The primary outcome was patient's global assessment [on
100 mm visual analog scale (VAS)]. Secondary endpoints were pain,
number of tender points, total myalgic score, physical fitness,
health status, and psychological distress. RESULTS: One patient
in the HIF group (n = 18) and 2 in the LIF group (n = 15) stopped
training sessions during the course of the study. Nine of 18 patients
in the HIF group compared to 8 of 15 patients in the LIF group
achieved a participation rate of 67% or more. Most important reasons
for nonadherence were postexercise pain and fatigue, time consumption,
and stress. The VAS for global well being improved slightly from
64 to 56 mm in the HIF group, and did not change in the LIF group
(58 to 61 mm) (p = 0.07). The Wmax (physical fitness) changed
modestly from 110 to 123 watt in the HIF group, and from 97 to
103 watt in the LIF group (p = 0.3). VAS for pain increased from
53 to 64 mm in the HIF group and from 52 to 54 mm in the LIF group.
The large standard deviations around mean change in global assessments,
number of tender points, total myalgic score, and psychological
distress (by SCL-90) severely influenced the power to detect within-
and between-group differences. Analysis limited to those patients
who accomplished a high attendance rate (> 67%) showed similar
results. CONCLUSION: High intensity physical fitness training
compared to low intensity physical fitness training leads to only
modest improvements in physical fitness and general well being
in patients with FM, and does not positively affect psychological
status and general health.
-----
J Rheumatol. 2002 Mar;29(3):575-81.
A randomized clinical trial comparing fitness
and biofeedback training versus basic treatment in patients with
fibromyalgia.
van Santen M, Bolwijn P, Verstappen F, Bakker C, Hidding
A, Houben H, van der Heijde D, Landewe R, van der Linden S.
Department of Internal Medicine, University Hospital Maastricht,
The Netherlands. msa@sint.azm.nl
OBJECTIVE: To compare the therapeutic effects of physical fitness
training or biofeedback training with the results of usual care
in patients with fibromyalgia (FM). METHODS: One hundred forty-three
female patients with FM (American College of Rheumatology criteria)
were randomized into 3 groups: a fitness program (n = 58), biofeedback
training (n = 56), or controls (n = 29). Half the patients in
the active treatment groups also received an educational program
aimed at improving compliance. Assessments were done at baseline
and after 24 weeks. The primary outcome was pain [visual analog
scale (VAS)]. Other endpoints were the number of tender points,
total myalgic score (dolorimetry), physical fitness, functional
ability (Arthritis Impact Measurement Scale and Sickness Impact
Profile), psychological distress (Symptom Checklist-90-Revised),
patient global assessment (5 point scale), and general fatigue
(VAS). RESULTS: Baseline scores were similar in all 3 groups.
Altogether 25 (17.5%) patients dropped out; they were similarly
distributed over all groups: 14 patients after randomization and
11 (8%) during the study. A true high impact level for fitness
training was not attained by any patient. After treatment, no
significant differences in change scores of any outcome were found
between the groups (ANOVA, p > 0.05). All outcome measures
showed large variations intra- and interindividually. The educational
program did not result in higher compliance with training sessions
(62% vs 71%). Analysis of the subgroup of subjects with a high
attendance rate (> 67%) also showed no improvement. CONCLUSION:
In terms of training intensity and maximal heart rates, the high
impact fitness intervention had a low impact benefit. Therefore
effectiveness of high impact physical fitness training cannot
be demonstrated. Thus compared to usual care, the fitness training
(i.e., low impact) and biofeedback training had no clear beneficial
effects on objective or subjective patient outcomes in patients
with FM.
-----
Drugs. 2002;62(4):577-92.
Management of fibromyalgia: what are the best
treatment choices?
Forseth K KO, Gran JT.
Department of Rheumatology, Betanien Hospital, Skien, Norway.
karin.forseth@tss.telemax.no
Fibromyalgia still represents an enigma to modern medicine
and the aetiopathogenesis is far from explored. The management
of patients with fibromyalgia is thus mostly based on empirical
research, and only a few controlled studies have been performed.
Basic drug therapy rests on the administration of amitriptyline
and conventional analgesics. Such therapy should be initiated
only after careful patient information and delineation of therapeutic
goals are provided. Any drug therapy should be administered in
combination with physical treatment and cognitive behavioural
therapy. Because of the appearing contours of pathogenic mechanisms,
hopefully a number of new drugs will be available to the patients
with this complex pain syndrome in the near future.
-----
J Psychiatr Res. 2002 May-Jun;36(3):179-87.
The effect of guided imagery and amitriptyline
on daily fibromyalgia pain: a prospective, randomized, controlled
trial.
Fors EA, Sexton H, Gotestam KG.
Department of Psychiatry and Behavioural Medicine, Norwegian University
of Science and Technology (NTNU), PO Box 3008 Lade, NO-7441, Trondheim,
Norway. eafors@online.no
OBJECTIVE: The effectiveness of an attention distracting and
an attention focusing guided imagery as well as the effect of
amitriptyline on fibromyalgic pain was studied prospectively.
METHODS: Fifty-five women with previously diagnosed fibromyalgia
were monitored for daily pain (VAS) in a randomized, controlled
clinical trial. One group received relaxation training and guided
instruction in "pleasant imagery" (PI) in order to distract
from the pain experience (n=17). Another group received relaxation
training and attention imagery upon the "active workings
of the internal pain control systems", "attention imagery"
(AI) (n=21). The control group (CG) received treatment as usual
(n=17). Patients were also randomly assigned to 50-mg amitriptyline/day
or placebo. Some psychological and socio-demographic variables
were also measured initially. The slopes of diary pain ratings
over a 4-week period were used as the outcome measures. RESULTS:
We found significant differences of the pain-slopes between the
three psychological conditions (P=0.0001). The pleasant imagery
(P<0.005), but not the attention imagery group's slope, declined
significantly when compared with the control group (P>0.05).
There was neither a difference between the amitriptyline and placebo
slopes (main effects, P=0.98) nor a significant amitriptyline
x psychological interaction (P=0.76). CONCLUSION: Pleasant imagery
(PI) was an effective intervention in reducing fibromyalgic pain
during the 28-day study period. Amitriptyline had no significant
advantage over placebo during the study period.
-----
Lasers Med Sci. 2002;17(1):57-61.
Efficacy of low power laser therapy in fibromyalgia:
a single-blind, placebo-controlled trial.
Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E.
Physical Medicine and Rehabilitation, School of Medicine, Dicle
University, Diyarbakir, Turkey. alig@dicle.edu.tr
Low energy lasers are widely used to treat a variety of musculoskeletal
conditions including fibromyalgia, despite the lack of scientific
evidence to support its efficacy. A randomised, single-blind,
placebo-controlled study was conducted to evaluate the efficacy
of low-energy laser therapy in 40 female patients with fibromyalgia.
Patients with fibromyalgia were randomly allocated to active (Ga-As)
laser or placebo laser treatment daily for two weeks except weekends.
Both the laser and placebo laser groups were evaluated for the
improvement in pain, number of tender points, skinfold tenderness,
stiffness, sleep disturbance, fatigue, and muscular spasm. In
both groups, significant improvements were achieved in all parameters
(p<0.05) except sleep disturbance, fatigue and skinfold tenderness
in the placebo laser group (p>0.05). It was found that there
was no significant difference between the two groups with respect
to all parameters before therapy whereas a significant difference
was observed in parameters as pain, muscle spasm, morning stiffness
and tender point numbers in favour of laser group after therapy
(p<0.05). None of the participants reported any side effects.
Our study suggests that laser therapy is effective on pain, muscle
spasm, morning stiffness, and total tender point number in fibromyalgia
and suggests that this therapy method is a safe and effective
way of treatment in the cases with fibromyalgia.
-----
Curr Opin Rheumatol. 2002 Jan;14(1):45-51.
Central nervous system mechanisms of pain in fibromyalgia
and other musculoskeletal disorders: behavioral and psychologic
treatment approaches.
Bradley LA, McKendree-Smith NL.
Division of Clinical Immunology and Rheumatology, University of
Alabama at Birmingham, 35294, USA. Larry.Bradley@ccc.uab.edu
Pain is one of the most important and challenging consequences
of musculoskeletal disorders. This article examines the role of
central nervous system structures in the physiology of pain. It
also describes the neuromatrix, a construct that provides a framework
for understanding the interaction between physiologic mechanisms
and psychosocial factors in the development and maintenance of
chronic pain. This construct suggests that behavioral and psychologic
interventions may alter the pain experience primarily through
their effects on emotional states and cognitive processes. The
literature on cognitive-behavioral interventions for patients
with rheumatoid arthritis and osteoarthritis indicates that they
are well-established treatments for these disorders. However,
the efficacy of these interventions for patients with fibromyalgia
has not been established. It is anticipated that the development
of valid measures of readiness for behavioral change may allow
investigators to identify the patients with musculoskeletal disorders
who are most likely to benefit from cognitive-behavioral intervention.
-----
Clin Exp Rheumatol. 2001 Nov-Dec;19(6):697-702.
A double-blind, randomized, controlled study of
amitriptyline, nortriptyline and placebo in patients with fibromyalgia.
An analysis of outcome measures.
Heymann RE, Helfenstein M, Feldman D.
Department of Medicine, Federal University of Sao Paulo, Escola
Paulista de Medicina, SP, Brazil.
OBJECTIVE: To study the efficacy and tolerability of amitriptyline
and nortriptyline in a Brazilian population with fibromyalgia
and to evaluate the instruments used to measure the efficacy of
the treatment. METHODS: A total of 118 fibromyalgia patients were
randomly assigned to 3 groups: amitriptyline (AM, n = 40), nortriptyline
(NOR, n =38) and placebo (PL, n = 40), and were blindly given
25 mg at bedtime of the assigned treatment for 8 weeks. Clinical
evaluation before and at the end of the study included the number
of tender points (NTP), FIQ score (FIQ), and global improvement
as reported by the patients on a verbal scale (VSGI). RESULTS:
The 3 groups were comparable at baseline for all the parameters
studied. After 8 weeks, the 3 groups improved in all parameters:
(36.5% AM, 26.7% NOR and 24% PL patients improved on FIQ; 13.9%
AM, 19.5% NOR and 8.57% PL patients improved on NTP; 86.5% AM,
72.2% NOR and 57.6% PL patients improved on VSGI). Only the AM
group differed from the PL group on VSGI. Side effects were noted
among the groups, but none were serious (16 in the AM group, 31
in the NOR group, and 25 in the PL group). CONCLUSION: All three
groups improved after treatment. Only the patient's subjective
global assessment of improvement differed between the AM patients
and the PL group (p < or = 0.03). In fibromyalgia, placebo
groups are important in drug trials. Different measures of therapeutic
effect are not better than the patient's self assessment.
©Copyright 1992-date by The
Center for Current Research. The Fibromyalgia File is a
proprietary compilation of the Center for Current Research. The
information in the File is solely for your use, and the use of
your family, friends, and doctors. The information is the
property of the individual researchers and institutions that
produced it. It is an infringement of copyright law to attempt
to "resell" the information as it is presented here.
|
