Tagged References Listing created 04-29-2006 1 PMID- 1999999999 AU - ZZZ TI - ZZZ: Coding Conventions and Summary of this database SO - ZZZ 2049 IN - ZZZ AB - MCM: Please do not delete this overview record, which sorts as the last record in all Sort By choices except RevYR or RevUI. Subject Matter of this Database: Primary scientific/medical articles and other selected source materials relating to CFS, FM, and (more in the past than recently) neurasthenia are included in this DB plus selected citations on directly or indirectly related medical subjects such as autoimmune manifestations, post-polio syndrome, Gulf War Syndrome, etc. I have generally omitted citations of published letters. In some cases, a relationship between the stated subjects of this database (CFS, FM, and NA) and the actual subject of some of the included citations may not be obvious (and may occassionally be lacking to anyone but myself). However, a broad multidisciplinary approach to the quest for understanding is needed for these wide-ranging, interrelated, and poorly understood disorders and some references are included to follow up observations made regarding CFS (e.g., the possible diagnostic role of 2',5'-oligoadenylate synthetase or the possible role of retroviruses). Books, pamphlets, advocacy materials, unpublished conference proceedings, and nonmedical articles dealing with the politics and economics of CFS etc. are generally not included. All but a few citations are in the English language, regrettably reflecting MCM's language limitations and not a presumption of language supremacy. I have attempted to include all articles that were at some time in the past influential or meritorious (i.e, published in peer-reviwed journals), whether or not they have subsequently been discredited or become outdated. This allows the interested observer to follow the historic twists and turns reflected in the medical literature, to identify where or by whom a particular concept might have first been published, or to simply marvel at the extraordinary difficulties and challenges that research in this field has encountered. Some older materials are included from non-peer-reviewed sources. I would be pleased to be advised of significant omissions, particularly in current peer-reviewed articles that appear in MEDLINE. If you are an author who feels the abstract summary I have included does not adequately represent your paper, please email to me (mcgoo@u.washington.edu) an abstract which I may add in the abstract section for your paper. Summary of Coding Conventions for CFSFMNA.MDB: (1) Articles for which the Medline PMID is not available (for example, those entered into the DB upon my reading a journal article) are given an arbitrary PMID greater than 1 billion based on the year and month of the publication. When the Medline citation becomes available with its final PMID, the two citations are merged when possible (some duplicates may have been inadvertently overlooked). In general, I currently prefer to wait until articles have been assigned PMIDs before incorporating them into this database. (2) MCM has added key-like abbreviations in each title to insure where possible that the subject of the article that justifies its inclusion in this database is included at least somewhere in the title as one of the following capitalized abbreviations: CFS, FM, NA, SLE, PPS, SS, ACLS, ME, etc. The categorization by these abbreviations is intended to be broadly inclusive for searching and filtering purposes and does not imply that an article with title = "Chronic Fatigue [CFS]" is in fact about strictly defined CFS rather than the more general Chronic Fatigue. MCM assumes that CFS and ME are equivalent and does not always include "ME" when "CFS" is included. To see articles about FM only, use Records | Edit Filter and after adding the field TI to the grid, set its criterion to ` Like "*FM*" ' where an asterix precedes and follows the abbreviation, all in quotes (see the Access manual for more information on filtering, including creating complex AND and OR filtering). Use Records | Apply Filter to view only these articles matching the criterion chosen. Use Records | Show All Records (or press any of the "SortBy" buttons) to remove the filtering restriction. (3) Summaries and editorializations in the abstracts that were entered by MCM are usually introduced by "MCM: " but may include verbatim quotes from the article, with or without quotes. (4) Unfamiliar abbreviations introduced into the citation during transfer into this DB can usually be found in the three tables of abbreviations included with Medrefs, namely "INAbbrev", "Journals", and "TIAbbrev". (5) MCM has in some cases rearranged the order of authors listed, shortened or truncated titles (usually indicated with "..."), omitted institutions and some coauthors, editorialized, etc. If you plan to use any of these citations in a paper for publication or for other formal purpose, please confirm exact wording of all fields listed as I cannot guarantee verbatim accuracy. (6) Citations are derived from multiple sources including the National Library of Medicine Gateway (http://gateway.nlm.nih.gov, formerly Internet Grateful Med), Ovid CD Plus, personal literature reviews, and CFS-NEWS. All contributors to the creation of these sources of essential information are gratefully acknowledged. (7) Users concerned with retaining their own additions or revisions to this database when downloading an updated version may consult the information provided at my World Wide Web download site on how to accomplish this tricky task. You may find this information (as well as periodic updates to this database and to Medrefs) at my Medrefs/CFS Database Web page: http://www.mcgoodwin.net/pages/medrefs.html Michael C. McGoodwin, M.D. This descriptive record last updated 14 March September 2005 EM - 9912 2 PMID- 16413353 AU - Aydin G, Basar MM, Keles I, Ergun G, Orkun S, Batislam E TI - Relationship between sexual dysfunction & psychiatric status in premenopausal women w FM. SO - Urology. 2006 Jan;67(1):156-61. IN - D o Physical Med & Rehabilitation, U o Kirikkale Faculty o Medicine, Kirikkale, Turkey. AB - OBJECTIVES: To evaluate the possible relationship between the sexual and psychiatric status of premenopausal female patients with fibromyalgia compared with healthy controls. METHODS: A total of 48 female patients with fibromyalgia and 38 age-matched healthy controls were enrolled in the study. All the subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and the State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) for psychiatric assessment. Serum biochemical analysis was done, and the serum hormonal levels were analyzed. RESULTS: The mean BDI score for patients was significantly greater than the score for the controls (P = 0.017) and the mean FSFI score was significantly lower than the score for the controls (P = 0.001). According to the FSFI data, female sexual dysfunction was found in 26 patients (54.2%) with fibromyalgia and only 6 controls (15.8%), a significant difference (Pearson chi-square = 14.46, P = 0.000). When the subscores of each domain of FSFI were evaluated, the most common sexual problem was diminished desire in patients (n = 30, 62.5%) and controls (n = 11, 28.9%). In the correlation analysis, the FSFI score showed a significant negative correlation with the BDI (r = -0.337, P = 0.002) and STAI (r = -0.413, P = 0.004) scores. No significant correlation was revealed between the FSFI and BDI or FSFI and STAI scores in the controls. CONCLUSIONS: Depression is one of the emotional disorders commonly encountered in women with fibromyalgia, most possibly leading to sexual dysfunction. Thus, sexual dysfunction related to impaired psychiatric status should be considered a common problem in premenopausal women with fibromyalgia. 3 PMID- 16443425 AU - Blockmans D, Persoons P, Van Houdenhove B, Bobbaers H TI - Does methylphenidate reduce the Sx of CFS? SO - AJM. 2006 Feb;119(2):167.e23-30. IN - D o Internal Med, U Hosp Gasthuisberg, Leuven, Belgium. daniel.blockmans@uz.kuleuven.ac.be AB - PURPOSE: Chronic fatigue syndrome is a clinical entity consisting of prolonged and debilitating fatigue in which concentration disturbances are very frequent. Until now, no medical treatment has shown any efficacy. The objectives of this study were to investigate the short-term effects of methylphenidate, an amphetamine derivative, on fatigue, concentration disturbances, and quality of life. SUBJECTS AND METHODS: A double-blind randomized placebo-controlled crossover study was conducted in 60 patients who fulfilled the 1994 Centers for Disease Control criteria for chronic fatigue syndrome and had concentration difficulties. Patients were enrolled between March 2003 and March 2004 at the outpatient department of a university hospital referral center for chronic fatigue syndrome patients. Random assignment to 4 weeks treatment with methylphenidate 2 x 10 mg/day, followed by 4 weeks of placebo treatment, or 4 weeks of placebo treatment, followed by methylphenidate treatment. Fatigue and concentration were measured with a Checklist Individual Strength (CIS) and a Visual Analogue Scale (VAS). RESULTS: Fatigue scores fell significantly during methylphenidate intake in comparison with baseline (mean difference: -0.7, P = .010 for VAS; mean difference: -11.8, P <.0001 for CIS) and in comparison with placebo (mean difference: -1.0, P = .001 for VAS; mean difference: -9.7, P <.0001 for CIS). Concentration disturbances, measured with a VAS improved significantly under methylphenidate treatment compared with baseline (mean difference: -1.3, P <.0001) and compared with placebo (mean difference: -1.1, P <.0001). A clinical significant effect (> or =33% improvement or CIS < or =76) on fatigue was achieved in 17% of patients, who were considered responders; on concentration in 22% of patients. CONCLUSIONS: Methylphenidate at a dose of 2 x 10 mg/day is significantly better than placebo in relieving fatigue and concentration disturbances in a minority of chronic fatigue syndrome patients. Further studies are needed to investigate the long-term effects of this treatment. 4 PMID- 16454725 AU - Burckhardt CS TI - Multidisciplinary approaches for management of FM. SO - Curr Pharm Des. 2006;12(1):59-66. IN - Oregon Health & Science U, Portland, OR 97239, USA. burckhac@ohsu.edu AB - Multidisciplinary approaches to fibromyalgia syndrome (FMS) treatment are advocated for treating the complex symptoms and problems confronting many patients. Exercise and cognitive-behavioral strategies together with patient education commonly comprise the multidisciplinary approach to treatment in clinical trials. A review of the research literature suggests that they are effective for decreasing pain and FMS impact and increasing self-efficacy and physical functioning. Limitations of the current evidence base include a lack of studies that include medication treatment as part of the multidisciplinary approach as well as lack of attention to the diversity of patient psychosocial issues that may interfere with treatment effectiveness. The review recommends that further randomized clinical trials be carried out with subgroups of patients using standardized outcome measurements, adequate treatment length and sufficient length of follow-up to be able to observe and document changes in patient symptoms and behaviors over time. 5 PMID- 16393878 AU - Cabyoglu MT, Ergene N, Tan U TI - The mechanism of acupuncture & clinical applications. [FM] SO - Int J Neurosci. 2006 Feb;116(2):115-25. IN - D o Physiology, Selcuk U, Faculty o Meram Medica, Konya, Turkey. tugcab@yahoo.com AB - This study presents the result of the studies explaining the effects of acupuncture on various systems and symptoms. It has been determined that endomorphin-1, beta endorphin, encephalin, and serotonin levels increase in plasma and brain tissue through acupuncture application. It has been observed that the increases of endomorphin-1, beta endorphin, encephalin, serotonin, and dopamine cause analgesia, sedation, and recovery in motor functions. They also have immunomodulator effects on the immune system and lipolithic effects on metabolism. Because of these effects, acupuncture is used in the treatment of pain syndrome illnesses such as migraine, fibromyalgia, osteoarthritis, and trigeminal neuralgia; of gastrointestinal disorders such as disturbance at gastrointestinal motility and gastritis; of psychological illnesses such as depression, anxiety, and panic attack; and in rehabilitation from hemiplegia and obesity. 6 PMID- 16095585 AU - Chalmers RA, Jones MG, Goodwin CS, Amjad S TI - CFSUM1 & CFSUM2 in urine from pts w CFS are methodological artefacts. SO - Clin Chim Acta. 2006 Feb;364(1-2):148-58. Epub 2005 Aug 10. IN - St George's Hosp MS, Cranmer Terrace, London SW17 0RE, UK. rachalmers@cimoa.org.uk AB - McGregor et al. reported increased levels of an unidentified urinary compound (CFSUM1) in patients with chronic fatigue syndrome (CFS), with reduced excretion of another unidentified compound (CFSUM2), and suggested the possibility of chemical or metabolic 'markers' for CFS. The identity of CFSUM1 as reported was erroneous and the identities of these compounds have remained unknown until now. Urine samples were obtained from 30 patients with ME/CFS, 30 age- and sex-matched healthy controls, 20 control patients with depression and 22 control patients with rheumatoid arthritis. Samples were prepared using the published methods of McGregor et al. to produce heptafluorobutyryl-isobutyl derivatives of urinary metabolites. Alternative preparations utilised isopropyl, n-butyl and trifluoroacetyl derivatives. These were separated and identified using gas chromatography-mass spectrometry. CFSUM2 was identified as being partially derivatised [isobutyl ester-mono-heptafluorobutyryl (HFB)] serine. CFSUM1 was identified as partially derivatised pyroglutamic acid, being the isobutyl ester without formation of a HFB derivative. Both CFSUM1 and CFSUM2 are artefacts of the sample preparation procedure and previously reported quantitative abnormalities of CFSUM1 and CFSUM2 in urine from patients with ME/CFS are also artefactual. Pyroglutamic acid may be of primarily dietary origin. The methods used cannot provide reliable qualitative or quantitative data on urinary metabolites. No clinical or biochemical significance can be drawn between these compounds in ME/CFS or any other clinical conditions. 7 PMID- 16454719 AU - Clayton AH, West SG TI - Combination therapy in FM. SO - Curr Pharm Des. 2006;12(1):11-6. IN - D o Psychiatric Med, U o Virginia, Charlottesville, VA 22908-0623, USA. ahc8v@virginia.edu AB - Fibromyalgia is an enigmatic medical condition whose specific etiology remains undiscovered but currently plagues five million Americans. Research indicates that the origin of the disease is most likely multifactorial. Treatment should therefore be tailored accordingly. Thus, it is often necessary to combine different options in order to achieve the maximum benefit in patients suffering from fibromyalgia. 8 PMID- 16469592 AU - Clemens JQ, Brown SO, Kozloff L, Calhoun EA TI - Predictors of Sx severity in pts w chr prostatitis & interstitial cystitis. [FM] SO - J Urol. 2006 Mar;175(3 Pt 1):963-6; discussion 967. IN - D o Urology, Northwestern U Feinberg School o Med, Chicago, Illinois 60611, USA. qclemens@northwestern.edu AB - PURPOSE: Numerous studies have been performed to identify potential risk factors for CP/CPPS and IC. However, few studies have been done to identify predictors of disease severity. MATERIALS AND METHODS: A total of 174 men with CP/CPPS and 111 women with IC completed questionnaires to quantify symptom severity and identify demographic, medical and psychosocial characteristics. Symptom severity was assessed with the National Institutes of Health CPSI in men, and the O'Leary-Sant ICSI and problem index in women. Univariate and multivariate analyses were performed to identify characteristics predictive of worse symptoms. RESULTS: The mean National Institutes of Health CPSI score in men was 15.32, and the mean O'Leary-Sant ICSI and problem index in women was 19.17. The most commonly reported comorbidities were allergies, sinusitis, erectile dysfunction and irritable bowel syndrome in men, and allergies, urinary incontinence, sinusitis and irritable bowel syndrome in women. In the 2 sexes self-reported urinary frequency and urgency, worse depression scores and lower education level were independent predictors of worse symptom severity. In men additional independent predictors were self-reported pelvic pain, fibromyalgia and previous heart attack, and in women an additional independent predictor was postmenopausal status. CONCLUSIONS: There are several common medical conditions associated with urological pelvic pain syndromes in men and women. Few of them were predictive of symptoms severity in this analysis. Self-reported pelvic pain symptoms, education and depression severity were the factors most strongly predictive of symptom severity in patients with CP/CPPS and IC. 9 PMID- 16514330 AU - Dobkin PL, Sita A, Sewitch MJ TI - Predictors of adherence to Rx in women w FM. SO - Clin J Pain. 2006 Mar-Apr;22(3):286-94. IN - D o Med, McGill U, Montreal, Quebec, Canada. patricia.dobkin@mcgill.ca AB - OBJECTIVES: The goal of this study was to identify predictors of general and medication adherence in women with fibromyalgia (FM). METHODS: Participants were 142 women recruited from tertiary care hospitals or the community and 10 rheumatologists. Participants' demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at the index visit. Adherence was assessed 6 months later. Multivariable generalized estimating equations were used to identify predictors of general adherence and adherence to medication. RESULTS: The average age of participants was 50.9 years (SD=10.2) and the median duration of FM was 32 months. Participants reported extensive use of health services and medications. The mean score for general adherence was 61.0 (SD=22.4; range 0-100) and 52.9% of the cohort reported at least one form of behavior reflecting nonadherence to medications. More general adherence was significantly predicted by lower patient-physician discordance on patient well-being and lower patient psychological distress. Medication adherence was significantly predicted by higher affective pain and lower patient psychological distress. CONCLUSIONS: Adherence is influenced by both clinical (patient-physician discordance and pain) and psychological (distress) factors in women with FM. Improvements in these domains may improve adherence in FM. 10 PMID- 16386400 AU - Finset A, Graugaard PK, Holgersen K TI - Salivary cortisol response after a medical interview: the impact of physician communication behaviour, depressed affect & alexithymia. [FM] SO - Patient Educ Couns. 2006 Feb;60(2):115-24. Epub 2005 Dec 28. IN - D o Behavioural Sciences, Inst o Basic Med Sciences, U o Oslo, Oslo, Norway. AB - OBJECTIVE: To explore if - and possibly how - a medical interview may affect adrenocortical activity in musculo-skeletal pain patients with and without alexithymia. METHODS: Female patients (N = 54) recruited from a patient organization for fibromyalgia completed the Toronto Alexithymia Scale (TAS-20) and subgroups with, respectively, low and high scores were selected for participation. Seven physicians conducted consultations attempting to vary their communication in accordance with given guidelines. All consultations were videotaped and analysed by The Roter Interaction Analysis System (RIAS) to evaluate the actual content of the consultations. RESULTS: An increase in depressed affect from pre- to post-interview was associated with relatively high cortisol levels 24 h after the consultation, but only in patients with alexithymia. Psychosocial questions from the physician were associated with increased depressed affect immediately following the interview, but not with cortisol responses at any time. CONCLUSION: In patients with deficient affect regulation, increase in depressed affect after a medical interview may be associated with delayed effects in adrenocortical activity, possibly mediated by rumination. PRACTICE IMPLICATIONS: Providers should be sensitive to potential deficits of affect regulation in their patients. 11 PMID- 16401454 AU - Gordon C, Emiliozzi C, Zartarian M TI - Use of a mechanical massage technique in the Rx of FM: a preliminary study. SO - Arch Phys Med Rehabil. 2006 Jan;87(1):145-7. IN - Memorial Hosp o Union County, Marysville, OH 43043, USA. AB - OBJECTIVE: To investigate how a mechanical massage technique (LPG technique) could contribute to the treatment of fibromyalgia. DESIGN: Feasibility study. SETTING: A single center. PARTICIPANTS: Ten women having a preexisting diagnosis of fibromyalgia based on American College of Rheumatology criteria were enrolled. INTERVENTION: Subjects received a total of 15 sessions of mechanical massage administered by a physical therapist once a week. MAIN OUTCOME MEASURES: The Fibromyalgia Impact Questionnaire and a physical examination scoring tender points (number, pain intensity). Evaluations were conducted at the screening visit, after 7 sessions (V7), and after completion of 15 sessions (V15). RESULTS: Most of the parameters (pain intensity, physical function, number of tender points) showed a significant improvement at V15 compared with screening. CONCLUSIONS: The findings suggest the possibility that the studied intervention might be associated with positive outcomes in women with fibromyalgia, and support the need for a controlled clinical trial to determine its efficacy. 12 PMID- 16382004 AU - Greenfield JR, Samaras K TI - Evaluation of pituitary function in the fatigued patient: a review of 59 cases. [CF] SO - Eur J Endocrinol. 2006 Jan;154(1):147-57. IN - D o Endocrinology, St Vincent's Hosp & St Vincent's Clinic & the Garvan Inst o Med Research, Sydney, Australia. AB - OBJECTIVE: The aim of this study was to review the results of dynamic pituitary testing in patients presenting with fatigue. METHODS: We reviewed clinical histories and insulin tolerance test (ITT) results of 59 patients who presented with fatigue and other symptoms of glucocorticoid insufficiency over a 4-year period. All patients referred for ITT had an early-morning cortisol level of <400 nM and a low or normal ACTH level. RESULTS: Peak cortisol and GH responses following insulin-induced hypoglycaemia were normal in only seven patients (12%). Median age of the remaining 52 patients was 47 years (range, 17-67 years); all but five were female. Common presenting symptoms were neuroglycopaenia (n = 47), depression (n = 37), arthralgia and myalgia (n = 28), weight gain (n = 25), weight loss (n = 9), postural dizziness (n = 15) and headaches (n = 13). Other medical history included autoimmune disease (n = 20; particularly Hashimoto's thyroiditis, Graves' disease and coeliac disease), postpartum (n = 8) and gastrointestinal (n = 2) haemorrhage and hyperprolactinaemia (n = 13). 31 subjects had peak cortisol levels of <500 nM (suggestive of ACTH deficiency; 18 of whom had levels < 400 nM) and a further six had indeterminate results (500-550 nM). The remaining 15 subjects had normal cortisol responses (median 654 nM; range, 553-1062 nM) but had low GH levels following hypoglycaemic stimulation (5.9 mU/l; 3-11.6 mU/l). CONCLUSION: Our results suggest that patients presenting with fatigue and symptoms suggestive of hypocortisolism should be considered for screening for secondary adrenal insufficiency, particularly in the presence of autoimmune disease or a history of postpartum or gastrointestinal haemorrhage. Whether physiological glucocorticoid replacement improves symptoms in this patient group is yet to be established. 13 PMID- 16454722 AU - Gur A TI - Physical therapy modalities in management of FM. SO - Curr Pharm Des. 2006;12(1):29-35. IN - D o Physical Med & Rehabilitation, Med Faculty, Dicle U, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr AB - The etiology of fibromyalgia syndrome (FM) is uncertain and the prognosis for symptomatic recovery is generally poor. A wide variety of interventions are used in the management of FM. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and rehabilitation are not possible. FM patients frequently use alternative therapies, indicating dissatisfaction or ineffectiveness of traditional medical therapy. Alternative therapies are generally perceived to be more "natural" and as a result, to have fewer adverse effects. Despite the positive results found, the number of publications related to the application of physical therapy modalities such as acupuncture, transcutaneous electrical stimulation, laser, biofeedback, electrotherapy and magnetic field is still scant, especially concerning FM treatment. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. Multidisciplinary approaches to management include physical and medical therapeutic strategies. Treatment modalities should be individualised for patients based on target symptoms and impairment in functioning. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. It can be concluded that there is a need for larger, more systematic and methodologically sound randomised controlled clinical trials to evaluate the effectiveness of physical therapy modalities of managing FM. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use. 14 PMID- 16361589 AU - Heesen C, Nawrath L, Reich C, Bauer N, Schulz KH, Gold SM TI - Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour? [CFS] SO - JNeurNSPsy. 2006 Jan;77(1):34-9. IN - D o Neurology, U Hosp Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. heesen@uke.uni-hamburg.de AB - BACKGROUND: Fatigue is a major complaint of multiple sclerosis (MS) patients. However, little is known about its pathophysiological mechanisms. Evidence from chronic fatigue syndrome and studies on sickness behaviour suggest that immune and neuroendocrine factors may play a causative role in the development of fatigue. METHODS: We compared whole blood stimulatory capacity for pro- (TNFalpha, IFNgamma) and anti-inflammatory cytokines (IL-10) as well as hypothalamo-pituitary-adrenal (HPA) axis function in 15 MS patients with marked fatigue and 15 patients without fatigue as determined by the Fatigue Severity Scale (FSS). RESULTS: Proinflammatory cytokines were significantly higher (TNFalpha: 478.9 v 228.2 pg/ml, p = 0.01; IFNgamma: 57.6 v 27.8 pg/ml; p = 0.01) in MS patients with fatigue. Furthermore, TNFalpha values significantly correlated with daytime sleepiness as measured by the Epworth Sleepiness Scale (r = 0.64, p = 0.001). Controlling for disease activity (as measured by the Cambridge Multiple Sclerosis Basic Score), disease duration, Expanded Disability Status Scale, and depression further increased the correlation of cytokine production and fatigue. HPA axis activity was not related to fatigue but was modestly correlated with cognitive impairment. CONCLUSION: Our data suggest that fatigue in MS is at least partially mediated through activation of proinflammatory cytokines. In line with earlier findings, HPA axis dysfunction seems not to be relevant in MS fatigue pathogenesis but appears to be linked to cognitive impairment. Our findings suggest that increased levels of inflammatory cytokines may be involved in MS fatigue. Investigation of cytokine profiles may increase the understanding of fatigue pathogenesis in MS. 15 PMID- 16385513 AU - Hughes G, Martinez C, Myon E, Taieb C, Wessely S TI - The impact of a Dx of FM on health care resource use by primary care pts in the UK: an observational study based on clinical practice. SO - Arthritis Rheum. 2006 Jan;54(1):177-83. IN - Medicines & Healthcare Products Regulatory Agency, Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK. AB - OBJECTIVE: To investigate the impact of a diagnosis of fibromyalgia (FM) in clinical practice on health care resource use in the UK. METHODS: Rates of visits, prescriptions, referral, and diagnostic testing were estimated in patients who had been diagnosed as having FM between 1998 and March 2003 in UK primary care and compared with those in matched controls. Rates were calculated in 6-month intervals from 10 years before until 4 years after the FM diagnosis. RESULTS: Patients (2260) were newly diagnosed as having FM; 81.3% were women. Their mean age was 49 years. FM patients had considerably higher rates of visits, prescriptions, and testing from at least 10 years prior to diagnosis compared with controls. By the time of diagnosis, FM patients had 25 visits and 11 prescriptions per year compared with 12 visits and 4.5 prescriptions per year in controls. Visit rates were highest for depression, followed by fatigue, chest pain, headache, and sleep disturbance. Following diagnosis, visits for most symptoms and health care use markers declined, but within 2-3 years, most visits rose to levels at or higher than those at diagnosis. CONCLUSION: Primary care patients who had been diagnosed as having FM reported higher rates of illness and health care resource use for at least 10 years prior to their diagnosis, which suggests that illness behavior may play a role. Being diagnosed as having FM may help patients cope with some symptoms, but the diagnosis has a limited impact on health care resource use in the longer term, possibly because there is little effective treatment. 16 PMID- 16291298 AU - Husser D, Bollmann A, Kuhne C, Molling J, Klein HU TI - Evaluation of noncardiac chest pain: diagnostic approach, coping strategies & quality of life. [FM] SO - Eur J Pain. 2006 Jan;10(1):51-5. IN - D o Cardiology, U Hosp Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany. AB - BACKGROUND: Approximately 30% of coronary angiograms are negative for significant coronary artery disease and patients are classified as having noncardiac chest pain (NCCP). So far, no systematic diagnostic approach to patients with NCCP investigating for possible esophageal, psychiatric and musculoskeletal abnormalities exists. Furthermore, coping strategies and quality of life are poorly characterized in NCCP patients. METHODS AND RESULTS: A simple diagnostic approach was applied to 37 consecutive patients (21 female, age 61+/-12 years) with angina-like chest pain and normal coronary angiograms. Twenty-one patients were found to suffer from psychiatric disorders (combined anxiety (A) and depression (D): n = 10, D: n = 5, panic disorder (P): n = 3, somatization (S): n = 3) based on their Symptom Check List 90 scores and according to DSM IV-R criteria. Sixteen patients had an improvement of their chest pain after oral esomeprazole (40 mg for 7 days) and were therefore diagnosed with gastroesophageal reflux disease (GERD). Musculoskeletal abnormalities including chostochondritis (n = 4), thoracic spondylodynia (n = 1), and fibromyalgia (n = 1) were found in six patients. Multiple diagnoses were confirmed in six patients with GERD (additional D n = 3, additional musculoskeletal disorders n = 3). Patients with psychiatric disorders showed a diminished quality of life (MOS-SF 36), more frequent chest pain, less treatment satisfaction (Seattle Angina Questionnaire) and more rumination (Trier Coping Scales) compared to GERD patients. CONCLUSIONS: Immediate combined psychiatric and orthopedic evaluation as well as esomeprazole administration following exclusion of coronary artery disease may confirm the causes of noncardiac chest pain. Identification of psychiatric disorders seems especially warranted since these patients experience a reduced quality of life and exhibit pathologic coping strategies. 17 PMID- 16464229 AU - Iovino P, Tremolaterra F, Consalvo D, Sabbatini F, Mazzacca G, Ciacci C TI - Perception of electrocutaneous stimuli in irritable bowel syndrome. [FM] SO - Am J Gastroenterol. 2006 Mar;101(3):596-603. Epub 2006 Feb 8. IN - Servizio di Endoscopia Digestiva, Universita Federico II, via Pansini 5, 80131 Naples, Italy. AB - BACKGROUND AND AIM: Irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) are common conditions with some similarities, but different perceptual responses to somatic and visceral stimuli. The purpose of this study was to assess in a large group of IBS patients the somatic perception by transcutaneous electrical nerve stimulation (TENS) and its relation to the level of severity and presence of FMS. METHODS: In 99 patients grouped by the validated functional bowel disorder severity index (FBDSI) in mild, moderate, and severe IBS and in 33 healthy controls (HC), we studied discomfort thresholds and perception of somatic stimuli at control (hands and elbows) and active (trapezius) sites by TENS and by using a specific questionnaire. RESULTS: The use of TENS showed that IBS showed significant higher thresholds and lower perception cumulative score compared to HC. The severity of IBS is significantly associated with age and mean control site values for discomfort and borderline associated with gender in the ordinal model constructed for the ascending series protocol. The severity of IBS is also significantly associated with the active cumulative perception score in the long stimulus protocol. Due to limited sample size of IBS men with FMS, analyses of discomfort thresholds and cumulative perception score by FMS were done only for women. IBS women without FMS had significantly higher mean control site values for discomfort and significantly lower active cumulative perception score than HC. IBS women with FMS had significantly lower mean active site values for discomfort thresholds than IBS women without FMS (Dunn's test p < 0.05). CONCLUSIONS: IBS patients showed somatic hypoalgesia to electrical stimuli. The severity of IBS and the presence of FMS influence the perception of somatic stimuli induced by TENS. 18 PMID- 16139959 AU - Kajantie E, Phillips DI TI - The effects of sex & hormonal status on the physiological response to acute psychosocial stress. [FM] SO - Psychoneuroendocrinology. 2006 Feb;31(2):151-78. Epub 2005 Sep 1. IN - D o Epidemiology & Health Promotion, The Nat Public Health Inst, Mannerheimintie 166, 00300 Helsinki, Finland. eero.kajantie@helsinki.fi AB - Whether one is male or female is one of the most important determinants of human health. While males are more susceptible to cardiovascular and infectious disease, they are outnumbered by women for many autoimmune disorders, fibromyalgia and chronic pain. Recently, individual differences in the physiological response to stress have emerged as a potentially important risk factor for these disorders. This raises the possibility that sex differences in prevalence of disease could at least in part be explained by sex differences in the nature of the physiological response to stress. In a psychophysiological laboratory, the autonomic nervous system response can be provoked by many different stressors including physical, mental and psychosocial tasks, while the hypothalamic-pituitary-adrenal axis (HPAA) response seems to be more specific to a psychosocial challenge incorporating ego involvement. The responses of both systems to different psychosocial challenges have been subject to extensive research, although in respect of sex differences the HPAA response has probably been more systematically studied. In this review, we focus on sex differences in HPAA and autonomic nervous system responses to acute psychosocial stress. Although some differences are dependent on the stressor used, the responses of both systems show marked and consistent differences according to sex, with the phase of the menstrual cycle, menopausal status and pregnancy having marked effects. Between puberty and menopause, adult women usually show lower HPAA and autonomic responses than men of same age. However, the HPAA response is higher in the luteal phase, when for example post stress free cortisol levels approach those of men. After menopause, there is an increase in sympathoadrenal responsiveness, which is attenuated during oral hormone replacement therapy, with most evidence suggesting that HPAA activity shows the same trends. Interestingly, pregnancy is associated with an attenuated response of the sympathoadrenal and HPAA systems at least as assessed by biochemical stimulation. It is likely that these sex differences in autonomic function are a result of estrogen exposure which attenuates sympathoadrenal responsiveness. The HPAA is however somewhat more complex and evidence now suggests the influence of other modifiers such as arginine vasopressin (AVP) and the regulation of circulating cortisol bioavailability by corticosteroid-binding globulin (CBG). The pronounced and multi-faceted sex differences in stress responsiveness suggest that they are a product of a strong evolutionary pressure. We hypothesise that this has to a great deal been driven by the need to protect the fetus from the adverse effects of maternal stress responses, in particular excess glucocorticoid exposure. Studying this hypothesis may have a fundamental impact on our understanding about how adult health is set during early life and how adult disease could be prevented in men and women. 19 PMID- 16423291 AU - Kassam A, Patten SB TI - Major depression, FM & labour force participation: a population-based cross-sectional study. SO - BMC Musculoskelet Disord. 2006 Jan 19;7:4. IN - Health Services Research D, Inst o Psychiatry, King's Coll, London, UK. aliya.kassam@iop.kcl.ac.uk AB - BACKGROUND: Previous studies have documented an elevated frequency of depressive symptoms and disorders in fibromyalgia, but have not examined the association between this comorbidity and occupational status. The purpose of this study was to describe these epidemiological associations using a national probability sample. METHODS: Data from iteration 1.1 of the Canadian Community Health Survey (CCHS) were used. The CCHS 1.1 was a large-scale national general health survey. The prevalence of major depression in subjects reporting that they had been diagnosed with fibromyalgia by a health professional was estimated, and then stratified by demographic variables. Logistic regression models predicting labour force participation were also examined. RESULTS: The annual prevalence of major depression was three times higher in subjects with fibromyalgia: 22.2% (95% CI 19.4 - 24.9), than in those without this condition: 7.2% (95% CI 7.0 - 7.4). The association persisted despite stratification for demographic variables. Logistic regression models predicting labour force participation indicated that both conditions had an independent (negative) effect on labour force participation. CONCLUSION: Fibromyalgia and major depression commonly co-occur and may be related to each other at a pathophysiological level. However, each syndrome is independently and negatively associated with labour force participation. A strength of this study is that it was conducted in a large probability sample from the general population. The main limitations are its cross-sectional nature, and its reliance on self-reported diagnoses of fibromyalgia. 20 PMID- 16385512 AU - Katz RS, Wolfe F, Michaud K TI - FM Dx: a comparison of clinical, survey, & American College of Rheumatology criteria. SO - Arthritis Rheum. 2006 Jan;54(1):169-76. IN - Rush U Med Ctr, Chicago, IL, USA. AB - OBJECTIVE: The American College of Rheumatology (ACR) criteria for fibromyalgia are the de facto criteria used for research. However, ACR criteria are not generally utilized by nonrheumatologists, and rheumatologists may diagnose fibromyalgia in patients who do not satisfy the ACR criteria. We undertook this study to determine concordance between ACR criteria and clinician diagnosis and between proposed survey criteria and clinician diagnosis. METHODS: Consecutive patients in a clinical practice setting were evaluated by tender point examination, survey criteria for fibromyalgia (Regional Pain Scale score > or =8 and fatigue score > or =6), and clinical diagnosis. RESULTS: Among the 206 patients, the clinician diagnosed fibromyalgia in 49.0%, while 29.1% satisfied ACR criteria and 40.3% satisfied survey criteria. Clinical and survey criteria were concordant in 74.8% of cases (kappa = 0.49 [95% confidence interval 0.36, 0.60]). Clinical criteria and ACR criteria were concordant in 75.2% of cases (kappa = 0.50 [95% confidence interval 0.35, 0.59]), and survey criteria and ACR criteria were concordant in 72.3% (kappa = 0.40 [95% confidence interval 0.25, 0.51]). The ACR tender point criterion (> or =11) was not a factor in clinical and survey criteria. However, the tender point count was useful in clinical diagnosis. CONCLUSION: Clinical diagnosis and ACR and survey criteria are moderately concordant (72-75%) and address a common pool of symptoms and physical findings. Because there is no gold standard for fibromyalgia diagnosis and because fibromyalgia is often viewed as a trait diagnosis, all methods of diagnosis have utility. The survey method has the advantage that it does not require physical examination. 21 PMID- 16454723 AU - Kurtais Y, Kutlay S, Ergin S TI - Exercise & cognitive-behavioural Rx in FM syndrome. SO - Curr Pharm Des. 2006;12(1):37-45. IN - D o Physical Med & Rehabilitation, Faculty o Medicine, Ankara U, 06530 Ankara, Turkey. kurtais@medicine.ankara.edu.tr AB - Fibromyalgia syndrome is a nonarticular rheumatic disorder characterised by diffuse musculoskeletal pain, stiffness, fatigue, disturbed sleep and tender points. The pathophysiology is not well understood and treatment remains a challenge. Although pharmacological therapy is still the primary treatment choice, a long-term effective intervention has not been demonstrated yet. Thus, besides pharmacotherapy, other multimodal interventions are often used. Exercise and cognitive-behavioural treatments which exist in the multimodal approach and encompass largely self-managed strategy, are reviewed in this article. Although, there is a great number of exercise studies, the large diversity of outcome measures and measurement instruments that have been used in studies, varying intensity and types of exercises, small sample sizes, high attrition rates, large variability in baseline function, symptom severity and psychosocial status limit to come to a conclusion about the efficacy of exercise in the treatment of fibromyalgia syndrome. There are also inconclusive results about the efficacy of cognitive-behavioural treatment because of limited number of studies with small sample sizes of patients with fibromyalgia syndrome. However, the results of the trials overall demonstrate the beneficial effects of both different types of exercise and cognitive-behavioural treatment, on the other hand, there is still a need for larger, more systematic and randomised controlled trials to evaluate the effectiveness. 22 PMID- 16395760 AU - Leavitt F, Katz RS TI - Distraction as a key determinant of impaired memory in pts w FM. SO - J Rheumatol. 2006 Jan;33(1):127-32. IN - D o Psychology, Rush Med Coll, Chicago, Illinois 60612-3833, USA. Frank_Leavitt@rush.edu AB - OBJECTIVE: Patients with fibromyalgia (FM) frequently complain of poor memory, severe enough to affect job performance and to lead to disability. Yet common practices in neurocognitive examinations often fail to document cognitive abnormalities that match the severity of their memory complaints. Often, neuropsychologists gauge memory competence with measures free of distraction and produce high rates of normality on neurocognitive examination. We hypothesized that neurocognitive tests encoded with a source of stimulus competition that interferes with the processing and/or absorption of information would be better than others in gauging FM memory competence. METHODS: Thirty-five patients with FM and 35 controls, matched for age and sex, and presenting with complaints of memory loss, completed cognitive measures with and without stimulus competition. RESULTS: Eleven (31.4%) patients with FM showed impairment on at least one measure of memory encoded free of stimulus competition. By comparison, 30 (85.7%) showed impairment on at least one measure encoded with a source of stimulus competition. The Auditory Consonant Trigram detected impairment in 29 (82.6%) cases, and was by far the most sensitive measure. FM patients lost information at a 58% rate following a 9 second distraction. This loss was disproportionate to the loss shown by both age matched controls with memory problems (40%) and to normative values (20%) based on individuals free of memory problems. CONCLUSION: The findings validate the perception of failing memory in patients with FM and are the first psychometric based evidence to our knowledge of short-term memory problems in FM linked to interference from a source of distraction. Adding a source of distraction caused the majority of FM patients to retain new information poorly, and may be integral to an understanding of FM memory problems. Much needs to be learned about why new information is disproportionately lost by FM populations when a source of distraction enters the experiential field. 23 PMID- 16454718 AU - Littlejohn GO, Guymer EK TI - FM syndrome: which antidepressant drug should we choose. SO - Curr Pharm Des. 2006;12(1):3-9. IN - Departments Rheumatology & Med, Monash U at Monash Med Centre, Level 3 Block E, 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia. geoff.littlejohn@med.monash.edu.au AB - Fibromyalgia syndrome [FM] has core clinical features of widespread pain and widespread abnormal tenderness. The specific cause of the altered neurophysiology that underpins these clinical manifestations remains unclear. However, increased sensitisation of neural networks that relates to pain, as well as interacting mechanoreceptors, appear important targets for modulation by pharmacological agents. Further, many FM patients have emotional distress and some are depressed. Antidepressant agents have therapeutic benefits in FM. If depression is present antidepressant drugs will provide typical benefits to mood but not always to other key outcome measures, such as pain or tenderness. Selective serotonin receptor reuptake blockers are not as effective for overall FM improvement as drugs that block both serotonin and norepinephrine in a relatively balanced way. Thus tricyclic antidepressants will improve many important FM outcomes but are effective in only about 40 percent of individuals. Newer agents of this class, such as duloxetine and milnacipran, show improvement in key FM outcomes in about 60 percent of patients. Longer term studies will indicate the durability of these responses and the overall tolerance of the drugs. Any drug therapy will need to be integrated with appropriate education, exercise and attention to psychological modulatory factors to achieve best results. 24 PMID- 16442982 AU - Mannerkorpi K, Svantesson U, Broberg C TI - Relationships between performance-based tests & pts' ratings of activity limitations, self-efficacy, & pain in FM. SO - Arch Phys Med Rehabil. 2006 Feb;87(2):259-64. IN - D o Rheumatology & Inflammation Research, Sahlgrenska Academy at Goteborg U, Sweden. Kaisa.mannerkorpi@rheuma.gu.se AB - OBJECTIVE: To investigate the relationship between performance-based tests, ratings of activity limitations, self-efficacy, and pain in fibromyalgia. DESIGN: Descriptive. SETTING: University hospital. PARTICIPANTS: Sixty-nine women with fibromyalgia (mean age, 45+/-7.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The patients completed 4 performance-based tests focusing on muscle power function and 3 unloaded arm movements. The patients rated their activity limitations by means of the subscales of physical function (PF) and pain on the Fibromyalgia Impact Questionnaire (FIQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Arthritis Self-Efficacy Scale (ASES). Spearman correlation coefficient (rho) and multivariate regression analysis were conducted. RESULTS: The highest correlations were found between the 6-minute walk test (6MWT) (rho range, -.48 to .68) and the activity limitations and between hand grip strength (rho range, -.34 to .57) and the activity limitations. The regression analysis indicated that hand grip strength explained 25% of the variation in the SF-36 PF scale. The 6MWT plus endurance of the shoulder muscles explained 24% of the variation in the FIQ PF scale and the 6MWT plus active abduction of the shoulder explained 48% of the variation in the ASES function scale. Correlations between the performance-based tests and the activity limitations tended to be higher than those between performance and pain. CONCLUSIONS: The majority of the performance-based tests and the patients' subjective ratings of activity limitations showed significant relationships. The 6MWT and hand grip strength, reflecting activity limitations in the SF-36, FIQ, and ASES, are recommended for use in clinical research and in the clinical examination when planning treatment for patients with fibromyalgia. 25 PMID- 16376018 AU - McIver KL, Evans C, Kraus RM, Ispas L, Sciotti VM, Hickner RC TI - NO-mediated alterations in skeletal muscle nutritive blood flow & lactate metabolism in FM. SO - Pain. 2006 Jan;120(1-2):161-9. Epub 2005 Dec 22. IN - Human Performance Laboratory, D o Exercise & Sport Science, East Carolina U, Greenville, NC 27858, USA. AB - The purpose of these investigations was to determine if differences exist in skeletal muscle nutritive blood flow and lactate metabolism in women with fibromyalgia (FM) compared to healthy women (HC); furthermore, to determine if differences in nitric oxide-mediated systems account for any detected alterations in blood flow and lactate metabolism and contribute to exertional fatigue in FM. FM (n = 8) and HC (n = 8) underwent a cycle ergometry test of aerobic capacity, a muscle biopsy for determination of nitric oxide synthase (eNOS, nNOS, iNOS) content, and microdialysis for investigation of muscle nutritive blood flow and lactate metabolism. During prolonged (3h) resting conditions, the ethanol outflow/inflow ratio (inversely related to blood flow) increased in FM over time compared to HC (P < 0.05). FM also exhibited a reduced nutritive blood flow response to aerobic exercise (P < 0.05). There was an increase in dialysate lactate in response to acetylcholine in FM, and to sodium nitroprusside in both groups, with a greater rise in dialysate lactate in FM (P < 0.05). The iNOS protein content was higher in FM and was negatively correlated with total exercise time (r(2) = 0.462, P < 0.05). In conclusion: (1) There is reduced nutritive flow response to aerobic exercise and reduced maximal exercise time in FM that might relate to higher iNOS protein content and contribute to exertional fatigue in FM; (2) The increased dialysate lactate in FM in response to stimulation of NOS or a nitric oxide donor suggest that FM may be more sensitive than HC to the suppressive effect of nitric oxide on oxidative phosphorylation. 26 PMID- 16150550 AU - Mommersteeg PM, Heijnen CJ, Verbraak MJ, van Doornen LJ TI - Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test. [CFS] SO - Psychoneuroendocrinology. 2006 Feb;31(2):216-25. Epub 2005 Sep 16. IN - D o Health Psychology, Utrecht U, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands. p.mommersteeg@fss.uu.nl AB - Burnout is presumed to be the result of chronic stress, and chronic stress is known to affect the HPA-axis. To date, studies on HPA-axis functioning in burnout have showed inconsistent results. In the present study, a large sample (n=74) of clinically diagnosed burnout individuals, mostly on sick-leave, were included and compared with 35 healthy controls. Salivary cortisol was sampled on 2 days to determine the cortisol awakening response (CAR) and the day-curve. In addition, the dexamethasone suppression test (DST) was applied to assess the feedback efficacy of the HPA-axis. There were no differences observed in the CAR, day-curve or CAR after DST in the burnout group as compared to a healthy control group. Burnout shows overlap in symptoms with chronic fatigue syndrome (CFS) and depression. Therefore, differential changes in HPA-axis functioning that resemble the hypo-functioning of the HPA-axis in CFS, or rather the hyper-functioning of the HPA-axis in depression, might have obscured the findings. However, no effect of fatigue or depressive mood on HPA-axis functioning was found in the burnout group. We concluded that HPA-axis functioning in clinically diagnosed burnout participants as tested in the present study, seems to be normal. 27 PMID- 16454726 AU - Ozgocmen S TI - New strategies in evaluation of therapeutic efficacy in FM syndrome. SO - Curr Pharm Des. 2006;12(1):67-71. IN - D o Physical Med & Rehabilitation, Div o Rheumatology, Firat U, Faculty o Medicine, 23119 Elazig, Turkey. sozgocmen@hotmail.com AB - Fibromyalgia (FM) is continuing to be a challenging and confusing disorder for researchers and clinicians with its diverse symptoms, poorly understood etiology and pathophysiology. The use of multiple outcome variables reflecting the complexity of FM and co-morbid syndromes, makes it difficult to evaluate the efficacy or effectiveness of the treatment in clinical trials. Additionally researchers inevitably rely on patients' self-reported outcome data, which is prone to error and bias. In this paper, new researches in the field of FM and practical issues on methodology of pain assessment (visual analogue scales, paper or electronic diaries and compliance), core outcome domains in chronic pain assessment (IMMPACT recommendations), and advances in neuroimaging techniques like functional magnetic resonance imaging have been reviewed. Consequently, clinicians and researchers have various highly validated and adequate outcome domains to assess FM symptoms and new researches continue to add new valuable domains. Nevertheless the current problem is to conclude, which treatment works best for whom and which are the outcome domains suitable for FM patients or patients' subgroups with different prominent features. Standardised and appropriate core outcome domains for FM clinical trails will encourage more complete investigations, relevant outcome reporting and well-designed multicenter trials. 28 PMID- 16503466 AU - Parker NR, Barralet JH, Bell AM TI - Q fever. [CFS] SO - Lancet. 2006 Feb 25;367(9511):679-88. IN - Darling Downs Public Health Unit, Queensland Health, Australia. neil_parker@health.qld.gov.au AB - Q fever is a zoonosis with many manifestations. The most common clinical presentation is an influenza-like illness with varying degrees of pneumonia and hepatitis. Although acute disease is usually self-limiting, people do occasionally die from this condition. Endocarditis is the most frequent chronic presentation. Although Q fever is widespread, practitioner awareness and clinical manifestations vary from region to region. Geographically limited studies suggest that chronic fatigue syndrome and cardiovascular disease are long-term sequelae. An effective whole-cell vaccine is licensed in Australia. Live and acellular vaccines have also been studied, but are not currently licensed. 29 PMID- 16443043 AU - Prins JB, van der Meer JW, Bleijenberg G TI - CFS. SO - Lancet. 2006 Jan 28;367(9507):346-55. IN - D o Med Psychology, Radboud U Nijmegen Med Centre, Nijmegen, Netherlands. j.prins@mps.umcn.nl AB - During the past two decades, there has been heated debate about chronic fatigue syndrome (CFS) among researchers, practitioners, and patients. Few illnesses have been discussed so extensively. The existence of the disorder has been questioned, its underlying pathophysiology debated, and an effective treatment opposed; patients' organisations have participated in scientific discussions. In this review, we look back on several controversies over CFS with respect to its definition, diagnosis, pathophysiology, and treatment. We review issues of epidemiology and clinical manifestations, focusing on the scientific status of CFS. Modern neuroscience and genetics research offer interesting findings for new hypotheses on the aetiology and pathogenesis of the illness. We also discuss promising future issues, such as psychopathophysiology and mechanisms of improvement, and suggest multidisciplinary prospective studies of CFS and fatigue in the general population. These studies should pay particular attention to similarities to and differences from functional somatic syndromes and other fatiguing conditions. 30 PMID- 16438814 AU - Saidi G, Haines L TI - The management of children w CFS-like illness in primary care: a cross-sectional study. SO - Br J Gen Pract. 2006 Jan;56(522):43-7. IN - Research Div, Royal Coll o Paediatrics & Child Health, 50 Hallam Street, London W1W 6DE, UK. AB - BACKGROUND: Most studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management in primary care. AIM: To describe the characteristics of patients aged 5-19 years with CFS-like illness in primary care and to examine how GPs investigate and manage patients. DESIGN OF STUDY: Descriptive retrospective questionnaire study. SETTING: Sixty-two UK GP practices in the MRC General Practice Research Framework (GPRF). METHOD: One hundred and twenty-two practices were approached; 62 identified 116 patients consulting a GP with severe fatigue lasting over 3 months. Practice nurses and GPs completed questionnaires from medical notes and patients completed postal questionnaires. RESULTS: Ninety-four patients were considered by a clinical panel, blind to diagnosis, to meet the Oxford CFS criteria with a fatigue duration of 3 months. Seventy-three per cent were girls, 94% white, mean age was 12.9 years and median illness duration 3.3 years. GPs had principal responsibility for 62%. A diagnosis of CFS/ME was made in 55%, 30% of these within 6 months. Fifty per cent had a moderate illness severity. Paediatric referrals were made in 82% and psychiatric referrals in 46% (median time of 2 and 13 months respectively). Advice given included setting activity goals, pacing, rest and graded exercise. CONCLUSIONS: Patient characteristics are comparable to those reported in tertiary care, although fewer are severe cases. GPs have responsibility for the majority of patients, are diagnosing CFS/ME within a short time and applying a range of referral and advice strategies. 31 PMID- 16454724 AU - Sarac AJ, Gur A TI - Complementary & alternative medical therapies in FM. SO - Curr Pharm Des. 2006;12(1):47-57. IN - D o Physical Med & Rehabilitation, Med Faculty, Dicle U, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr AB - This article describes the studies that have been performed evaluating complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM). There is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. CAM has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications). Another CAM therapy such as chiropractic care has neither well-designed studies nor positive results and is not currently recommended for FM treatment. Once CAM therapies have been better evaluated for safety and long-term efficacy in randomised, placebo-controlled trials, they may prove to be beneficial in treatments for FM. It would then be important to assess studies assessing cost-benefit analyses comparing conventional therapies and CAM. 32 PMID- 16541995 AU - Singh BB, Wu WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP, Wang CN, Lin SY TI - Effectiveness of acupuncture in the Rx of FM. SO - Altern Ther Health Med. 2006 Mar-Apr;12(2):34-41. IN - Southern California U o Health Sciences, Whittier, USA. AB - 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. 33 PMID- 16454721 AU - Staud R TI - Are tender point injections beneficial: the role of tonic nociception in FM. SO - Curr Pharm Des. 2006;12(1):23-7. IN - Division o Rheumatology & Clinical Immunology, U o Florida, PO Box 100221, Gainesville, FL 32610-0221, USA. staudr@ufl.edu AB - Characteristic symptoms of fibromyalgia syndrome (FM) include widespread pain, fatigue, sleep abnormalities, and distress. FM patients show psychophysical evidence for mechanical, thermal, and electrical hyperalgesia. To fulfill FM criteria, the mechanical hyperalgesia needs to be widespread and present in at least 11 out of 18 well-defined body areas (tender points). Peripheral and central abnormalities of nociception have been described in FM and these changes may be relevant for the increased pain experienced by these patients. Important nociceptor systems in the skin and muscle seem to undergo profound changes in FM patients by yet unknown mechanisms. These changes may result from the release of algesic substances after muscle or other soft tissue injury. These pain mediators can sensitize important nociceptor systems, including the transient receptor potential channel, vanilloid subfamily member 1 (TRPV1), acid sensing ion channel (ASIC) receptors, and purino-receptors (P2X3). Subsequently, tissue mediators of inflammation and nerve growth factors can excite these receptors and cause substantial changes in pain sensitivity. FM pain is widespread and does not seem to be restricted to tender points (TP). It frequently comprises multiple areas of deep tissue pain (trigger points) with adjacent much larger areas of referred pain. Analgesia of areas of extensive nociceptive input has been found to provide often long lasting local as well as general pain relief. Thus interventions aimed at reducing local FM pain seem to be effective but need to focus less on tender points but more on trigger points (TrP) and other body areas of heightened pain and inflammation. 34 PMID- 16504053 AU - Tanaka M, Sadato N, Okada T, Mizuno K, Sasabe T, Tanabe HC, Saito DN, Onoe H, Kuratsune H, Watanabe Y TI - Reduced responsiveness is an essential feature of CFS: a fMRI study. SO - BMC Neurol. 2006 Feb 22;6:9. IN - D o Physiology, Osaka City U Graduate School o Med, 1-4-3 Asahimachi, Osaka 545-8585, Japan. masa-t@msic.med.osaka-cu.ac.jp AB - BACKGROUND: Although the neural mechanism of chronic fatigue syndrome has been investigated by a number of researchers, it remains poorly understood. METHODS: Using functional magnetic resonance imaging, we studied brain responsiveness in 6 male chronic fatigue syndrome patients and in 7 age-matched male healthy volunteers. Responsiveness of auditory cortices to transient, short-lived, noise reduction was measured while subjects performed a fatigue-inducing continual visual search task. RESULTS: Responsiveness of the task-dependent brain regions was decreased after the fatigue-inducing task in the normal and chronic fatigue syndrome subjects and the decrement of the responsiveness was equivalent between the 2 groups. In contrast, during the fatigue-inducing period, although responsiveness of auditory cortices remained constant in the normal subjects, it was attenuated in the chronic fatigue syndrome patients. In addition, the rate of this attenuation was positively correlated with the subjective sensation of fatigue as measured using a fatigue visual analogue scale, immediately before the magnetic resonance imaging session. CONCLUSION: Chronic fatigue syndrome may be characterised by attenuation of the responsiveness to stimuli not directly related to the fatigue-inducing task. 35 PMID- 16444659 AU - Tharakan B, Manyam BV TI - Botanical therapies in chr fatigue. [CF] SO - Phytother Res. 2006 Feb;20(2):91-5. IN - Plummer Movement Disorders Ctr, D o Neurology, Scott & White Clinic & the Texas A&M U System, HSC Coll o Med, Temple, Texas, USA. AB - Chronic fatigue often occurs in aging and in various neurological, psychiatric and systemic diseases. The available therapies in modern medicine are limited. The exploration of potential alternative therapies from traditional medicine is reviewed, as there are several botanicals with experimental evidence of efficacy based on animal models and clinical studies. 36 PMID- 16420393 AU - van Heukelom RO, Prins JB, Smits MG, Bleijenberg G TI - Influence of melatonin on fatigue severity in pts w CFS & late melatonin secretion. SO - Eur J Neurol. 2006 Jan;13(1):55-60. IN - D o Neurology, Sleep-Wake Disorders & Chronobiology, Hosp De Gelderse Vallei, Ede, & D o Med Psychology, Radbound U Med Centre, Nijmegen, The Netherlands. AB - The effect of melatonin, a chronobiotic drug, was explored in 29 patients with chronic fatigue syndrome (CFS) and Dim Light Melatonin onset (DLMO) later than 21.30 hours, reflective of delayed circadian rhythmicity. The patients took 5 mg of melatonin orally, 5 h before DLMO during 3 months. Their responses to the checklist individual strength (CIS), a reliable questionnaire measuring the severity of personally experienced fatigue, were assessed twice with a 6-week interval immediately before the treatment and once after 3 months treatment. In the pre-treatment period the fatigue sub-score improved significantly. After treatment, the total CIS score and the sub-scores for fatigue, concentration, motivation and activity improved significantly. The sub-score fatigue normalized in two of the 29 patients in the pre-treatment period and in eight of 27 patients during treatment. This change was significant. In the patients with DLMO later than 22.00 hours (n=21) the total CIS score and the sub-scores for fatigue, concentration and activity improved significantly more than in the patients (n=8) with DLMO earlier than 22.00 hours. Melatonin may be an effective treatment for patients with CFS and late DLMO, especially in those with DLMO later than 22.00 hours. 37 PMID- 16515400 AU - Vernon SD, Whistler T, Aslakson E, Rajeevan M, Reeves WC TI - Challenges for molecular profiling of CFS. SO - Pharmacogenomics. 2006 Mar;7(2):211-8. IN - Center for Infectious Diseases, Div o Viral & Rickettsial Diseases, Nat Centers for Disease Control & Prevention, Atlanta, GA 30333, USA. svernon@cdc.gov AB - Chronic fatigue syndrome (CFS) is prevalent, disabling and costly. Despite extensive literature describing the epidemiology and clinical aspects of CFS, it has been recalcitrant to diagnostic biomarker discovery and therapeutic intervention. This is due to the fact that CFS is a complex illness defined by self-reported symptoms and diagnosed by the exclusion of medical and psychiatric diseases that may explain the symptoms. Studies attempting to dissect the pathophysiology are challenging to design as CFS affects multiple body systems, making the choice of which system to study dependent on an investigators area of expertise. However, the peripheral blood appears to be facilitating the molecular profiling of several diseases, such as CFS, that involve bodywide perturbations that are mediated by the CNS. Successful molecular profiling of CFS will require the integration of genetic, genomic and proteomic data with environmental and behavioral data to define the heterogeneity in order to optimize intervention. 38 PMID- 16454720 AU - Wallace DJ TI - Is there a role for cytokine based therapies in FM. SO - Curr Pharm Des. 2006;12(1):17-22. IN - Cedars-Sinai/David Geffen School o Med at UCLA, Los Angeles, CA, USA. dwallace@ucla.edu AB - Cytokines are glycoproteins that serve as chemical messengers between cells. They assist in the regulation of cell growth and repair and also have immune modulating properties. Cytokines play a role in diverse clinical processes and phenomena such as fatigue, fever, sleep, pain, stress and aching. A review of the fibromyalgia literature and related studies suggest that IL-1, IL-6 and IL-8 are dysregulated in the syndrome. Therapies directed against these cytokines may be of potential importance in the management of fibromyalgia. 39 PMID- 16420193 AU - Weiner DK, Sakamoto S, Perera S, Breuer P TI - Chronic low back pain in older adults: prevalence, reliability, & validity of physical examination findings. [FM] SO - J Am Geriatr Soc. 2006 Jan;54(1):11-20. IN - D o Med, Div o Geriatric Medicine, U o Pittsburgh, Pittsburgh, Penn, USA. dweiner@pitt.edu AB - OBJECTIVES: To develop a structured physical examination protocol that identifies common biomechanical and soft-tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. DESIGN: Cross-sectional survey and examination. SETTING: Older adult pain clinic. PARTICIPANTS: One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free. MEASUREMENTS: Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms. Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. RESULTS: Scoliosis was prevalent in those with (77.5%) and without pain (60.0%), but prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) was significantly different between groups (P < .001). Interrater reliability was excellent for SIJ pain (0.81), number of fibromyalgia tender points (0.84), and TFL pain (0.81); good for scoliosis (0.43), kyphosis (0.66), lumbar movement pain (0.75), piriformis pain (0.71), and hip disease by internal rotation (0.56); and marginal for leg length (0.00) and paravertebral pain (0.39). CONCLUSION: Biomechanical and soft tissue pathologies are common in older adults with CLBP, and many can be assessed reliably using a brief physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering. 40 PMID- 16318995 AU - Wik G, Fischer H, Finer B, Bragee B, Kristianson M, Fredrikson M TI - Retrospenial cortical deactivation during painful stimulation of fibromyalgic pts. [FM] SO - Int J Neurosci. 2006 Jan;116(1):1-8. IN - D o Clinical Neuroscience, Karolinska Inst & Hosp, Stockholm, Sweden. Gustav.Wik@psyk.uib.no AB - To study fibromyalgic pain this article contrasts positron emission tomographic measures of regional cerebral blood flow (rCBF) during externally induced acute pain and rest in eight fibromyalgia syndrome patients. An expected pattern of frontal and parietal cortical activation during acute pain as compared to rest was observed. However, reduced rCBF was additionally found in the retrosplenial cortex during acute pain as compared to rest. This may reflect that externally induced pain inhibits fibromyalgic pain and syndrome-related evaluative processes located in the retrosplenial cortex, and that fibromyalgic pain results from exaggerated attention to sub-noxious pain signaling, that is, secondary hyperalgesia. 41 PMID- 16357736 AU - Adak B, Tekeoglu I, Ediz L, Budancamanak M, Yazgan T, Karahocagil K, Demirel A TI - FM frequency in hepatitis B carriers. SO - J Clin Rheumatol. 2005 Jun;11(3):157-9. IN - D o Physical Therapy & Rehabilitation, Faculty o Med, U o Yuzuncu Yil., Van, Turkey. AB - BACKGROUND: Fibromyalgia (FM) is characterized by diffuse musculoskeletal pain, fatigue, morning stiffness, and sleep disturbance. Chronic viral infections may trigger FM symptoms. OBJECTIVES: In this study, we aimed to evaluate whether there was an association between HBsAg seropositivity and fibromyalgia syndrome. METHODS: Fifty hepatitis B carriers (HBsAg positivity and anti-HBs negativity in sera for at least 6 months) and 50 age- and sex-matched HbsAg-negative control subjects were enrolled in this study. The hepatitis B carriers with normal or slightly elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were recruited from the infectious diseases outpatient clinic and the control group was recruited from the physical medicine and rehabilitation outpatient clinic. The relationship between groups was calculated by independent Student t test, chi-squared test, and Fisher exact test for comparing proportions. Alpha criterion for significance was set at P < 0.05. RESULTS: There was no statistically significant difference between the groups according to sex, mean age, body mass index, serum ALT, and AST levels (P > 0.05). FM syndrome and FM-associated symptoms were much more prevalent in the hepatitis B group (P < 0.001). CONCLUSION: The present study suggests that chronic hepatitis B carriage appears to increase the risk of FM and many of the typically associated symptoms. Whether this association is related to altered liver function, viral infection, concerns associated with chronic disease, or other factors, physicians should be aware of this apparent association. 42 PMID- 16012064 AU - Adams N, Sim J TI - Rehabilitation approaches in FM. SO - Disabil Rehabil. 2005 Jun 17;27(12):711-23. IN - Centre for Research in Health Care, Liverpool John Moores U, Great Crosshall Street, Liverpool, UK. j.sim@keele.ac.uk AB - 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. 43 PMID- 15898360 AU - Adiels AM, Helkimo M, Magnusson T TI - Tactile stimulation as a complementary Rx of temporomandibular disorders in pts w FM syndrome. A pilot study. SO - Swed Dent J. 2005;29(1):17-25. IN - D o Stomatognathic Physiology, The Inst for Postgraduate Dental Education, Jonkoping, Sweden. anne-marie.adiels@vgregion.se AB - Pain of long duration is a common suffering in modern man. One such pain condition is fibromyalgia syndrome (FMS). Opinions about what treatment regimen that are to be used in these patients are diverging, and many of the treatments suggested are not, or only poorly, scientifically investigated. The aim of this pilot investigation was to evaluate if FMS patients with signs and symptoms of temporomandibular disorders (TMDs) refractory to conservative TMD treatment would respond positively to tactile stimulation in respect of local and/or general symptoms.Ten female patients fulfilling the inclusion criteria received such treatment once a week during a 10-week period. At the end of treatment, a positive effect on both clinical signs and subjective symptoms of TMD, as well as on general body pain, was registered. Eight out of 10 patients also perceived an improved quality of their sleep. At follow-ups after 3 and 6 months some relapse of both signs and symptoms could be seen, but there was still an improvement compared to the initial degree of local and general complaints. At the 6-months follow-up, half of the patients also reported a lasting improvement of their sleep quality. One hypothetical explanation to the positive treatment effect experienced by the tactile stimulation might be the resulting improvement of the patients' quality of sleep leading to increased serotonin levels. The results of the present pilot study are so encouraging that they warrant an extended, controlled study. 44 PMID- 15639063 AU - Adler GK, Geenen R TI - Hypothalamic-pituitary-adrenal & autonomic nervous system functioning in FM. SO - Rheum Dis Clin North Am. 2005 Feb;31(1):187-202, xi. IN - Division o Endocrinology, Diabetes, & Hypertension, D o Med, Brigham & Women's Hosp, Harvard MS, 221 Longwood Avenue, Boston, MA 02115, USA. gadler@partners.org AB - In general, there seems to be a reduction in some neuroendocrine and autonomic nervous system (ANS) responses to applied stresses in individuals who have fibromyalgia. This article presents an overview and discussion of these findings with respect to the role of the ANS and the neuroendocrine system in the response to stress, with emphasis on the hypothalamic-pituitary-adrenal axis and the possible implication to fibromyalgia. 45 PMID- 15630724 AU - Akkasilpa S, Goldman D, Magder LS, Petri M TI - Number of FM tender points is associated w health status in pts w SLE. SO - J Rheumatol. 2005 Jan;32(1):48-50. IN - Division o Rheumatology, Johns Hopkins U School o Med, Baltimore, Maryland 21205, USA. AB - OBJECTIVE: To ascertain the association between fibromyalgia (FM) tender points (TP) and health status in patients with systemic lupus erythematosus (SLE). METHODS: We performed a cross-sectional study of 173 SLE patients enrolled in the Hopkins Lupus Cohort. Patients were examined for FM TP and asked to complete the Health Assessment Questionnaire (HAQ) at the same visit. RESULTS: We found 38.2% of patients had no TP, 44.5% had 1-10 TP, and 17.3% had > or = 11 TP. No significant association was found between the number of FM TP and age, sex, race, or level of education. The mean score of the HAQ was 1.3 +/- 0.4. There were significant associations between FM TP and HAQ (no TP 1.1 +/- 0.3, 1-10 TP 1.4 +/- 0.4, > or = 11 TP 1.6 +/- 0.6; p = 0.0001). CONCLUSION: A strong association between the number of FM TP and health status was found in patients with SLE. The number of TP, and not just the presence/absence of FM, is associated with health status in SLE. 46 PMID- 14986061 AU - Alanoglu E, Ulas UH, Ozdag F, Odabasi Z, Cakci A, Vural O TI - Auditory event-related brain potentials in FM syndrome. SO - Rheumatol Int. 2005 Jun;25(5):345-9. Epub 2004 Feb 21. IN - Physical Therapy & Rehabilitation D, Social Security Hosp o Ankara, Diskapi, Ankara, Turkey. ecealanoglu@hotmail.com AB - OBJECTIVE: The aim of this study was to investigate cognitive functions using auditory event-related brain potentials (ERP) in fibromyalgia syndrome (FMS). METHODS: The P300 component of ERP was studied in 36 female FMS patients and 22 control subjects. The short form 36 (SF-36) medical outcome study was used to determine quality of life. Number of tender points and disease duration were noted. Cognitive functions were evaluated with P300. RESULTS: The symptoms were discrepant in FMS (P<0.001). The scores of the eight SF-36 subgroups in FMS patients were significantly lower than in the control group (P<0.001). Fibromyalgia syndrome patients had prolonged latency and reduced amplitude of P300 (P<0.001). No correlation was found between the subgroups of SF-36, tender point count, disease duration, and P300. CONCLUSION: The results of our study reveal that FMS affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials. 47 PMID- 15820381 AU - Anthony KK, Schanberg LE TI - Pediatric pain syndromes & management of pain in children & adolescents w rheumatic disease. [FM] SO - PedClNA. 2005 Apr;52(2):611-39, vii. IN - Division o Med Psychology, D o Psychiatry & Behavioral Sciences, Duke U Med Ctr, DUMC Box 3527, Durham, NC 27710, USA. AB - This article introduces important issues related to pain in children with musculoskeletal pain syndromes and rheumatic disease, using juvenile primary fibromyalgia syndrome (JPFS) and juvenile idiopathic arthritis (JIA) as models. A brief summary of the prevalence of pain in healthy children is followed by a summary of existing pain-assessment techniques. The remainder of the article describes the pain experience of children with JPFS and JIA and discusses issues related to pain management. 48 PMID- 16298061 AU - Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S, Wernicke JF TI - A randomized, double-blind, placebo-controlled trial of duloxetine in the Rx of women w FM w or without major depressive disorder. SO - Pain. 2005 Dec 15;119(1-3):5-15. Epub 2005 Nov 17. IN - Women's Health Research Program, D o Psychiatry, U o Cincinnati Coll o Med, Cincinnati, OH 45219, USA. lesley.arnold@uc.edu AB - This was a 12-week, randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, in 354 female patients with primary fibromyalgia, with or without current major depressive disorder. Patients (90% Caucasian; mean age, 49.6 years; 26% with current major depressive disorder) received duloxetine 60 mg once daily (QD) (N=118), duloxetine 60 mg twice daily (BID) (N=116), or placebo (N=120). The primary outcome was the Brief Pain Inventory average pain severity score. Response to treatment was defined as >or=30% reduction in this score. Compared with placebo, both duloxetine-treated groups improved significantly more (P<0.001) on the Brief Pain Inventory average pain severity score. A significantly higher percentage of duloxetine-treated patients had a decrease of >or=30% in this score (duloxetine 60 mg QD (55%; P<0.001); duloxetine 60 mg BID (54%; P=0.002); placebo (33%)). The treatment effect of duloxetine on pain reduction was independent of the effect on mood and the presence of major depressive disorder. Compared with patients on placebo, patients treated with duloxetine 60 mg QD or duloxetine 60 mg BID had significantly greater improvement in remaining Brief Pain Inventory pain severity and interference scores, Fibromyalgia Impact Questionnaire, Clinical Global Impression of Severity, Patient Global Impression of Improvement, and several quality-of-life measures. Both doses of duloxetine were safely administered and well tolerated. In conclusion, both duloxetine 60 mg QD and duloxetine 60 mg BID were effective and safe in the treatment of fibromyalgia in female patients with or without major depressive disorder. 49 PMID- 16084464 AU - Asmundson GJ, Wright KD, Hadjistavropoulos HD TI - Hypervigilance & attentional fixedness in chr musculoskeletal pain: consistency of findings across modified stroop & dot-probe tasks. [FM] SO - J Pain. 2005 Aug;6(8):497-506. IN - Faculty o Kinesiology & Health Studies, D o Psychology, U o Regina, Regina, Saskatchewan, Canada. gordon.asmundson@uregina.ca AB - Results from modified Stroop and dot-probe tasks have provided mixed evidence regarding attentional biases for sensory and affect pain stimuli in chronic pain patients. No studies have compared the same groups of chronic pain and healthy control participants on both tasks. We tested 36 patients with chronic musculoskeletal pain and 29 healthy control subjects on the modified Stroop and dot-probe tasks. Stimuli comprised affect pain, sensory pain, physical catastrophe, and neutral words. There was no evidence to suggest differential processing of threat cues by patients and control subjects on the modified Stroop task. All participants did, however, show differential processing of affect pain words. This was evident on both masked and unmasked presentation formats. There were no significant interactions between clinical status and threat word type observed for any of the indices of selective attention derived from the dot-probe task, but all participants had difficulty disengaging attention from affective pain and health catastrophe words. Findings were not influenced by individual differences in mood, anxiety, or fear of pain. Correlational analyses of the standard (unmasked) Stroop interference index and dot-probe indices of selective attention revealed a consistent lack of significant association, suggesting that the 2 tasks might be measuring different phenomena. Taken together, these findings provide evidence that chronic pain patients and healthy control participants do not differ in the way they attend to threatening linguistic stimuli. PERSPECTIVE: Some patients with chronic pain might have trouble paying attention to anything other than the affective components of pain and associated catastrophic health consequences. Interventions that specifically target this attentional fixedness might facilitate shifting attention to other targets and thereby reduce pain-specific anxiety and fear. 50 PMID- 15998750 AU - Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D TI - A randomized clinical trial of acupuncture compared w sham acupuncture in FM. SO - Ann Intern Med. 2005 Jul 5;143(1):10-9. IN - The Group Health Cooperative Ctr for Health Studies, & U o Washington, Seattle, Washington, USA. AB - 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. 51 PMID- 15982993 AU - Badawy AA, Morgan CJ, Llewelyn MB, Albuquerque SR, Farmer A TI - Heterogeneity of serum tryptophan concentration & availability to the brain in pts w the CFS. SO - J Psychopharmacol. 2005 Jul;19(4):385-91. IN - Cardiff & Vale NHS Trust, Biomedical Research Laboratory, Whitchurch Hosp, Cardiff, Wales, UK. Abdulla.Badawy@cardiffandvale.wales.n AB - We assessed the serotonin status of patients with the chronic fatigue syndrome (CFS). Tryptophan (Trp) availability to the brain, expressed as the ratio of concentration of serum Trp to the sum of those of its five competitors (CAA), and other parameters of Trp disposition were compared in 23 patients with the CFS and 42 healthy controls. The serum [free Trp]/[CAA] ratio was 43% higher in CFS patients, due to a 48% higher [free Trp]. [Total Trp] was also significantly higher (by 19%) in CFS patients, and, although the [total Trp]/[CAA] ratio did not differ significantly between the control and patient groups, the difference became significant when the results were co-varied with age and gender. [CAA] was not significantly different between groups, but was significantly lower in females, compared to males, of the CFS patient group. We have established normal ranges for Trp disposition parameters and propose criteria for defining the serotonin-biosynthetic status in humans. We have provisionally identified two subgroups of CFS patients, one with normal serotonin and the other with a high serotonin status. The relevance of our findings to, and their implications for, the pharmacological and other therapies of the chronic fatigue syndrome are discussed. 52 PMID- 16157056 AU - Baker K, Barkhuizen A TI - Pharmacologic Rx of FM. SO - Curr Pain Headache Rep. 2005 Oct;9(5):301-6. IN - Arthritis & Rheumatic Diseases, Oregon Health & Science U, OP-09, Portland, OR 97239, USA. bakerk@ohsu.edu AB - 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. 53 PMID- 16321154 AU - Baraniuk JN, Casado B, Maibach H, Clauw DJ, Pannell LK, Hess S S TI - A CFS - related proteome in human cerebrospinal fluid. SO - BMC Neurol. 2005 Dec 1;5:22. IN - Georgetown U Proteomics Laboratory, Div o Rheumatology, Immunology & Allergy, Room B-105, Lower Level Kober-Cogan Building, Georgetown University, Washington, DC 20007-2197, USA. baraniuj@georgetown.edu AB - BACKGROUND: Chronic Fatigue Syndrome (CFS), Persian Gulf War Illness (PGI), and fibromyalgia are overlapping symptom complexes without objective markers or known pathophysiology. Neurological dysfunction is common. We assessed cerebrospinal fluid to find proteins that were differentially expressed in this CFS-spectrum of illnesses compared to control subjects. METHODS: Cerebrospinal fluid specimens from 10 CFS, 10 PGI, and 10 control subjects (50 mul/subject) were pooled into one sample per group (cohort 1). Cohort 2 of 12 control and 9 CFS subjects had their fluids (200 mul/subject) assessed individually. After trypsin digestion, peptides were analyzed by capillary chromatography, quadrupole-time-of-flight mass spectrometry, peptide sequencing, bioinformatic protein identification, and statistical analysis. RESULTS: Pooled CFS and PGI samples shared 20 proteins that were not detectable in the pooled control sample (cohort 1 CFS-related proteome). Multilogistic regression analysis (GLM) of cohort 2 detected 10 proteins that were shared by CFS individuals and the cohort 1 CFS-related proteome, but were not detected in control samples. Detection of >or=1 of a select set of 5 CFS-related proteins predicted CFS status with 80% concordance (logistic model). The proteins were alpha-1-macroglobulin, amyloid precursor-like protein 1, keratin 16, orosomucoid 2 and pigment epithelium-derived factor. Overall, 62 of 115 proteins were newly described. CONCLUSION: This pilot study detected an identical set of central nervous system, innate immune and amyloidogenic proteins in cerebrospinal fluids from two independent cohorts of subjects with overlapping CFS, PGI and fibromyalgia. Although syndrome names and definitions were different, the proteome and presumed pathological mechanism(s) may be shared. 54 PMID- 15477496 AU - Baraniuk JN, Petrie KN, Le U, Tai CF, Park YJ, Yuta A, Ali M, Vandenbussche CJ, Nelson B TI - Neuropathology in rhinosinusitis. [CFS] SO - Am J Respir Crit Care Med. 2005 Jan 1;171(1):5-11. Epub 2004 Oct 11. IN - Division o Rheumatology, Immunology & Allergy, Georgetown U, 3800 Reservoir Road, N.W., Washington, DC 20007-2197, USA. baraniuj@georgetown.edu AB - Pathophysiologic differences in neural responses to hypertonic saline (HTS) were investigated in subjects with acute sinusitis (n = 25), subjects with chronic fatigue syndrome (CFS) with nonallergic rhinitis (n = 14), subjects with active allergic rhinitis (AR; n = 17), and normal (n = 20) subjects. Increasing strengths of HTS were sprayed into their nostrils at 5-minute intervals. Sensations of nasal pain, blockage, and drip increased with concentration and were significantly elevated above normal. These parallels suggested activation of similar subsets of afferent neurons. Urea and lysozyme secretion were dose dependent in all groups, suggesting that serous cell exocytosis was one source of urea after neural stimulation. Only AR and normal groups had mucin dose responses and correlations between symptoms and lysozyme secretion (R(2) = 0.12-0.23). The lysozyme dose responses may represent axon responses in these groups. The neurogenic stimulus did not alter albumin (vascular) exudation in any group. Albumin and mucin concentrations were correlated in sinusitis, suggesting that nonneurogenic factors predominated in sinusitis mucous hypersecretion. CFS had neural hypersensitivity (pain) but reduced serous cell secretion. HTS nasal provocations identified significant, unique patterns of neural and mucosal dysregulation in each rhinosinusitis syndrome. 55 PMID- 15947511 AU - Bazelmans E, Prins JB, Lulofs R, van der Meer JW, Bleijenberg G TI - Cognitive behaviour group therapy for CFS: a non-randomised waiting list controlled study. SO - Psychother Psychosom. 2005;74(4):218-24. IN - D o Med Psychology, U Med Centre Nijmegen, Nijmegen, The Netherlands. E.Bazelmans@cukz.umcn.nl AB - BACKGROUND: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome (CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored. METHODS: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). RESULTS: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve. CONCLUSIONS: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given. 56 PMID- 16179967 AU - Beck CA, Patten SB, Williams JV, Wang JL, Currie SR, Maxwell CJ, El-Guebaly N TI - Antidepressant utilization in Canada. [FM] SO - Soc Psychiatry Psychiatr Epidemiol. 2005 Oct;40(10):799-807. IN - Dept. o Psychiatry, U o Calgary, Calgary, Alberta, Canada. cindy.beck@calgaryhealthregion.ca AB - OBJECTIVE: Antidepressant utilization can be used as an indicator of appropriate treatment for major depression. The objective of this study was to characterize antidepressant utilization in Canada, including the relationships of antidepressant use with sociodemographic variables, past-year and lifetime depression, number of past depressive episodes, and other possible indications for antidepressants. METHOD: We examined data from the Canadian Community Health Survey (CCHS) Cycle 1.2. The CCHS was a nationally representative mental health survey (N=36,984) conducted in 2002 that included a diagnostic instrument for past-year and lifetime major depressive episodes and other psychiatric disorders and a record of past-year antidepressant use. RESULTS: Overall, 5.8% of Canadians were taking antidepressants, higher than the annual prevalence of major depressive episode (4.8%) in the survey. Among persons with a past-year major depressive episode, the frequency of antidepressant use was 40.4%. After application of adjustments for probable successful outcomes of treatment, the estimated frequency of antidepressant use for major depression was more than 50%. Frequency of antidepressant treatment among those with a history of depression but without a past-year episode increased with the number of previous episodes. Among those taking antidepressants over the past year, only 33.1% had had a past-year episode of major depression. Migraine, fibromyalgia, anxiety disorder, or past depression was present in more than 60% of those taking antidepressants without a past-year episode of depression. CONCLUSIONS: The CCHS results suggest that antidepressant use has increased substantially since the early 1990s, and also that these medications are employed extensively for indications other than depression. 57 PMID- 16385767 AU - Bell IR, Brooks AJ, Baldwin CM, Fernandez M, Figueredo AJ, Witten ML TI - JP-8 jet fuel exposure & divided attention test performance in 1991 Gulf War veterans. [FM] SO - Aviat Space Environ Med. 2005 Dec;76(12):1136-44. IN - Research Service, Southern Arizona VA Health Care System, USA. ibell@u.arizona.edu AB - INTRODUCTION: Previous research indicates that a large cohort of veterans from the 1991 Gulf War report polysymptomatic conditions. These syndromes often involve neurocognitive complaints, fatigue, and musculoskeletal symptoms, thus overlapping with civilian illnesses from low levels of environmental chemicals, chronic fatigue syndrome, and fibromyalgia. METHODS: To test for time-dependent changes over repeated intermittent exposures, we evaluated objective performance on a computerized visual divided attention test in chronically unhealthy Gulf War veterans (n = 22 ill with low-level chemical intolerance (CI); n = 24 ill without CI), healthy Gulf War veterans (n = 23), and healthy Gulf War era veterans (n = 20). Testing was done before and after each of three weekly, double blind, low-level JP-8 jet fuel or clean air sham exposure laboratory sessions, including acoustic startle stimuli. RESULTS: Unhealthy veterans receiving jet fuel had faster mean peripheral reaction times over sessions compared with unhealthy veterans receiving sham clean air exposures. Unhealthy Gulf veterans with CI exhibited faster post- vs. pre-session mean central reaction times compared with unhealthy Gulf veterans without CI. Findings were controlled for psychological distress variables. DISCUSSION: These data on unhealthy Gulf veterans show an acceleration of divided attention task performance over the course of repeated low-level JP-8 exposures. The present faster reaction times are consistent with rat neurobehavioral studies on environmental toxicant cross-sensitization and nonlinear dose-response patterns with stimulant drugs, as well as some previous civilian studies using other exposure agents. Together with previous research findings, the data suggest involvement of central nervous system dopaminergic pathways in affected Gulf veterans. 58 PMID- 15813284 AU - Bellanti JA, Sabra A, Castro HJ, Chavez JR, Malka-Rais J, de Inocencio JM TI - Are attention deficit hyperactivity disorder & CFS allergy related? what is FM? SO - Allergy Asthma Proc. 2005 Jan-Feb;26(1):19-28. IN - Departments o Pediatrics , Georgetown U Med Ctr, Washington, D.C. 20057, USA. AB - Despite the progress made in the field of allergy-immunology in recent years, there are a group of diseases that the allergist-immunologist may be called on to manage in which their precise etiologies have not been identified but that appear to be initiated or exacerbated by allergic mechanisms. Attention deficit hyperactivity disorder (ADHD), chronic fatigue syndrome (CFS), and fibromyalgia (FM) fall into this category of disorders. Although the precise etiology of ADHD still remains unknown, the most prevalent theory is that it represents a neurobiologically based developmental disability leading to inadequate production of the neurotransmitter dopamine. In patients with CFS, there appears to be a fundamental dysfunction of the neuroendocrine-immunological system with deficiencies of immunological and neurological function, which, together with chronic viral infection, may lead to a sequence of events responsible for the symptoms of this disorder. FM appears to be a variant of CFS with a predominance of hypothalamic pituitary axis dysfunction. The disorder is characterized by chronic widespread pain and the finding of 11/18 tender points on examination. Now, there is emerging evidence to suggest that adverse reactions to foods or food components also may be associated with behavioral disturbances that may play a role in each of these disorders. An understanding of the interactive responses involved in the neuroendocrine-immunological network is essential for a comprehension of the pathophysiology of ADHD, CFS, and FM and the role of allergies appears to be an important triggering event in each of the disorders. 59 PMID- 15710315 AU - Benbadis SR TI - A spell in the epilepsy clinic & a history of "chronic pain" or "FM" independently predict a Dx of psychogenic seizures. SO - Epilepsy Behav. 2005 Mar;6(2):264-5. IN - Comprehensive Epilepsy Program, U o South Florida & Tampa General Hosp, Tampa, FL, USA. sbenbadi@hsc.usf.edu AB - The clinical suspicion for psychogenic nonepileptic seizures (PNES) is based on multiple features obtained in the history. We reviewed the records of all patients evaluated over 5 years in a single epilepsy clinic for refractory seizures who eventually underwent EEG/video monitoring. We designated two groups: (1) patients with a diagnosis of "fibromyalgia" or "chronic pain" and (2) patients who had a seizure during the visit, either in the waiting area or in the examining room. Of 36 patients with "fibromyalgia" or "chronic pain," 27 (75%) were found to have PNES. Of 13 patients who had a "seizure" during their clinic visit, 10 (75%) were found to have PNES. We conclude that each of these findings has a predictive value of 75%. 60 PMID- 16174485 AU - Bennett R TI - FM: present to future. SO - Curr Rheumatol Rep. 2005 Oct;7(5):371-6. IN - D o Med, Oregon Health & Science U, Portland, OR 97201, USA. bennetrob1@comcast.net AB - There has been a dramatic increase in our understanding of fibromyalgia throughout the past 14 years since the publication of the 1990 American College of Rheumatology classification criteria. Before 1990, and for most of the 20th century, fibromyalgia was considered to be predominantly a muscle disorder; now the critical abnormality is described as "central sensitization." However, central sensitization has to have an initial genesis and nociceptive stimuli from painful foci in muscle are increasingly recognized as being relevant to the development of fibromyalgia. Clinicians also recognize an association between the initiation of fibromyalgia and chronic psychologic stressors and inflammatory disorders. It has been more difficult to understand how two such apparently diverse events could affect central pain physiology. However, some clues are emerging from the role of diverse stimuli in activating glial cells and the role of disordered cytokine networks. Some predictions about future developments in fibromyalgia are ventured based on the current state of knowledge. 61 PMID- 16157062 AU - Bennett R TI - Growth hormone in musculoskeletal pain states. [FM] SO - Curr Pain Headache Rep. 2005 Oct;9(5):331-8. IN - D o Med (OP09), Oregon Health & Science U, Portland, OR 97201, USA. bennetrob1@comcast.net AB - Growth hormone is essential for normal linear growth and the attainment of an adult mature height. It also plays an important role in cartilage growth and the attainment of normal bone mass. There is only one rheumatic disorder, namely acromegaly, in which abnormalities of growth hormone production play a major etiologic role. However, there is increasing appreciation that suboptimal growth hormone secretion, leading to a state of adult growth hormone deficiency, may occur in the setting of chronic inflammatory disease, chronic corticosteroid use, and fibromyalgia. Therefore, the evaluation and effective management of growth hormone oversecretion and undersecretion is relevant to practicing rheumatologists. 62 PMID- 16082646 AU - Bennett RM, Schein J, Kosinski MR, Hewitt DJ, Jordan DM, Rosenthal NR TI - Impact of FM pain on health-related quality of life before & after Rx w tramadol/acetaminophen. SO - Arthritis Rheum. 2005 Aug 15;53(4):519-27. IN - Oregon Health & Science U, Portland, OR 97239, USA. bennetro@ohsu.edu AB - 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. 63 PMID- 16273800 AU - Bennett R TI - The FM Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics & uses. SO - Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S154-62. IN - D o Med (OP09), Oregon Health & Science U, Portland, OR 97329, USA. bennetrob1@comcast.net AB - The Fibromyalgia Impact Questionnaire (FIQ) was developed in the late 1980s by clinicians at Oregon Health & Science University in an attempt to capture the total spectrum of problems related to fibromyalgia and the responses to therapy. It was first published in 1991 and since that time has been extensively used as an index of therapeutic efficacy. Overall, it has been shown to have a credible construct validity, reliable test-retest characteristics and a good sensitivity in demonstrating therapeutic change. The original questionnaire was modified in 1997 and 2002, to reflect ongoing experience with the instrument and to clarify the scoring system. The latest version of the FIQ can be found at the web site of the Oregon Fibromyalgia Foundation (www.myalgia.com/FIQ/FIQ). The FIQ has now been translated into eight languages, and the translated versions have shown operating characteristics similar to the English version. 64 PMID- 15889950 AU - Bentler SE, Hartz AJ, Kuhn EM TI - Prospective observational study of Rxs for unexplained chr fatigue. [CF] SO - J Clin Psychiatry. 2005 May;66(5):625-32. IN - D o Family Med, Coll o Medicine, U o Iowa, Iowa City, IA 52242-1097, USA. AB - BACKGROUND: Unexplained chronic fatigue is a frequent complaint in primary care. A prospective observational study design was used to evaluate whether certain commonly used therapies for unexplained chronic fatigue may be effective. METHOD: Subjects with unexplained chronic fatigue of unknown etiology for at least 6 months were recruited from the Wisconsin Chronic Fatigue Syndrome Association, primary care clinics, and community chronic fatigue syndrome presentations. The primary outcome measure was change in a 5-question fatigue score from 6 months to 2 years. Self-reported interventions tested included prescribed medications, non-prescribed supplements and herbs, lifestyle changes, alternative therapies, and psychological support. Linear regression analysis was used to test the association of each therapy with the outcome measure after adjusting for statistically significant prognostic factors. RESULTS: 155 subjects provided information on fatigue and treatments at baseline and follow-up. Of these subjects, 87% were female and 79% were middle-aged. The median duration of fatigue was 6.7 years. The percentage of users who found a treatment helpful was greatest for coenzyme Q10 (69% of 13 subjects), dehydroepiandrosterone (DHEA) (65% of 17 subjects), and ginseng (56% of 18 subjects). Treatments at 6 months that predicted subsequent fatigue improvement were vitamins (p = .08), vigorous exercise (p = .09), and yoga (p = .002). Magnesium (p = .002) and support groups (p = .06) were strongly associated with fatigue worsening from 6 months to 2 years. Yoga appeared to be most effective for subjects who did not have unclear thinking associated with the fatigue. CONCLUSION: Certain alternative therapies for unexplained chronic fatigue, especially yoga, deserve testing in randomized controlled trials. 65 PMID- 16012060 AU - Bergman S TI - Psychosocial aspects of chr widespread pain & FM. SO - Disabil Rehabil. 2005 Jun 17;27(12):675-83. IN - Research & Development Centre, Spenshult, Oskarstrom, Sweden. stefan.bergman@spenshult.se AB - PURPOSE: To study the impact on health status as measured by SF-36 in groups of subjects having chronic musculoskeletal pain with different degree of generalization: No chronic pain (NCP), chronic regional pain (CRP), chronic widespread pain (CWP), CWP with a stricter 'Manchester' definition (CWP-M), and clinically defined fibromyalgia (FM). The study also examines the association between psychosocial and lifestyle background variables, and these pain-groups. METHOD: A cross-sectional study with a postal survey to 3928 subjects, constituting a representative sample of the adult general population, followed by clinical examination in a selected group of subjects with CWP. CWP and FM were diagnosed according to ACR 1990 fibromyalgia criteria. Health status was measured by SF-36 Health Survey. RESULTS: Patients with CWP, CWP-M, and FM were found to present with more severe impairment of health status than the other two population groups. Several psychosocial factors, such as belonging to a lower socio-economic group, being an immigrant, living in a compromised housing area, having lower educational level, experiencing lower social support and having a family history of chronic pain, were associated with the populations with CWP and FM. CONCLUSIONS: The spectrum of impact on health and association to background variables, with respect to a stricter definition of CWP, indicates that these factors are important to attend to in the understanding and management of CWP and FM. 66 PMID- 15729611 AU - Bernatsky S, Dobkin PL, De Civita M, Penrod JR TI - Co-morbidity & physician use in FM. SO - Swiss Med Wkly. 2005 Feb 5;135(5-6):76-81. IN - Division o Clinical Epidemiology, McGill U Health Ctr, Montreal, Quebec, Canada. AB - OBJECTIVE: To describe comorbidity in women with FM, and to examine the effects of different types of comorbidity on physician use. METHODS: Women (n = 180) with primary FM were evaluated at baseline and 6 months later for self-reported health resource use and covariates. Reported comorbidity was classified into 4 categories: medical, psychiatric, "functional", and unknown. The category for "functional" conditions included disorders that have been classified by previous authors as medically unexplained symptoms such as the irritable bowel and chronic fatigue syndromes. Logistic regression models were developed to examine associations between types of comorbidity and physician use. RESULTS: Comorbid conditions were reported by over 90% of the sample. Total number of comorbid complaints was associated with high number of physician visits. In logistic regression models (controlling for age, ethnicity, education, disability, pain, and psychological vulnerability) medical comorbidity was a much stronger determinant of high number of physician visits than was "functional" comorbidity. CONCLUSIONS: Comorbidity with other disorders, both functional and medical, was high in this sample. Medical and psychiatric comorbidity were stronger determinants of high physician use than "functional" comorbidity. 67 PMID- 16262574 AU - Bingol U, Altan L, Yurtkuran M TI - Low-power laser Rx for shoulder pain. [FM] SO - Photomed Laser Surg. 2005 Oct;23(5):459-64. IN - Faculty o Med, Ataturk Rehabilitation Ctr, Rheumatic Disease & Hydrotherapy Sect, Uludaa U, Cekirge, Bursa, Turkey. ubingol@uludag.edu.tr AB - OBJECTIVE: The objective of this study is to investigate the effect of low-power gallium-arsenide laser treatment on the patients with shoulder pain. BACKGROUND DATA: Low-energy laser therapy has recently been popularized in the treatment of various rheumatologic, neurologic, and musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, fibromyalgia, carpal tunnel syndrome, rotator cuff tendinitis, and chronic back pain syndromes. METHODS: A total of 40 patients who applied to our clinic with shoulder pain and complied with the selection criteria were included in the study. The patients were randomly assigned into Group I (n = 20, laser treatment) and Group II (n = 20, control). In Group I, patients were given laser treatment and an exercise protocol for 10 sessions during a period of 2 weeks. Laser was applied over tuberculum majus and minus, bicipital groove, and anterior and posterior faces of the capsule, regardless of the existence of sensitivity, for 1 min at each location at each session with a frequency of 2000 Hz using a GaAs diode laser instrument (Roland Serie Elettronica Pagani, wavelength 904 nm, frequency range of 5-7000 Hz, and maximum peak power of 27 W, 50 W, or 27 x 4 W). In Group II, placebo laser and the same exercise protocol was given for the same period. Patients were evaluated according to the parameters of pain, palpation sensitivity, algometric sensitivity, and shoulder joint range of motion before and after treatment. RESULTS: Analysis of measurement results within each group showed a significant posttreatment improvement for some active and passive movements in both groups, and also for algometric sensitivity in Group I (p < 0.05-0.01). Posttreatment palpation sensitivity values showed improvement in 17 patients (85%) for Group I and six patients (30%) for Group II. Comparison between two groups showed superior results (p < 0.01 and p < 0.001) in Group I for the parameters of passive extension and palpation sensitivity but no significant difference for other parameters. CONCLUSIONS: The results of our study have shown better results in palpation sensitivity and passive extension, but no significant improvement in pain, active range, and algometric sensitivity in laser treatment group compared to the control group in the patients with shoulder pain. 68 PMID- 15694694 AU - Blanco LE, de Serres FJ, Fernandez-Bustillo E, Kassam DA, Arbesu D, Rodriguez C, Torre JC TI - alpha1-Antitrypsin & FM: new data in favour of the inflammatory hypothesis of FM. SO - Med Hypotheses. 2005;64(4):759-69. IN - D o Internal Med, Hosp Valle del Nalon, 33920 Riano-Langreo, Principado de Asturias, Spain. ignacio.blanco@sespa.princast.es AB - alpha1-Antitrypsin (AAT) circulates in high serum concentrations, and impregnates most body tissues. AAT has a broad anti-inflammatory spectrum, and modulates most inflammatory reactions occurring in human body. Recently, a possible relationship between AAT deficiency (AAT-D) and fibromyalgia (FM) has been raised, with the finding that intravenous infusions of purified human AAT efficiently controlled FM symptoms in two patients with severe hereditary AAT-D. On the other hand, functional magnetic resonance imaging has detected a significant greater activity in pain sensitive areas of the brain in patients with FM, in response to cutaneous stimuli, providing further evidence for a physiological explanation for FM pain. In recent studies abnormal profiles of inflammation markers in serum and biopsies have been found in FM patients. Since most of these inflammation mediators can be inhibited by AAT, these observations would suggest that at least a subset of the FM syndrome could be related to an inflammatory process, possibly due to an imbalance between inflammatory and anti-inflammatory substances, in the soft body tissues. Future directions of research would be: (1) to develop epidemiological studies to determine the gene frequency of AAT deficiency alleles in FM patients; (2) implementation of a double-blind placebo-controlled clinical trial to determine the specific role of AAT augmentation therapy in AAT-D patients with FM; (3) identification of specific laboratory markers for diagnostic and clinical evaluation purposes in FM; (4) application of the newest medical imaging techniques for diagnosis; and (5) identification of genetic, familial, and environmental risk factors suspected to participate in the FM syndrome development. 69 PMID- 16173250 AU - Blotman F, Thomas E, Myon E, Andre E, Caubere JP, Taieb C TI - Awareness & knowledge of FM among French rheumatologists & general practitioners. SO - Clin Exp Rheumatol. 2005 Sep-Oct;23(5):697-700. IN - Rheumatology D, Lapeyronie Hosp, Montpellier, France. francis.blotman@wanadoo.fr AB - OBJECTIVES: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and fatigue. Its prevalence is estimated to be at 3.4% in women and 0.5% in men. It is a major cause of morbidity. Our objective was to evaluate, using a self-questionnaire sent by mail, the level of knowledge of French physicians, general practitioners, and rheumatologists on fibromyalgia and to analyse their therapeutic approach. METHODS: The demographic characteristics of a sample of general practitioners and rheumatologists were compared to those of the overall data available. This comparison demonstrated the good representativeness of our sample. RESULTS: Fibromyalgia was considered as a disease by 23% of rheumatologists and 33% of general practitioners. While on average, each rheumatologist followed 30 fibromyalgia patients, each general practitioner followed 6.1 patients (i.e., 2 to 5% of their practice's patient base). Among rheumatologists, 6.4% made no distinction between this disease and depression vs. 13.1% of general practitioners. The diagnosis of fibromyalgia was made based on tenderness that occurs in precise, localized areas of the body (trigger points) by 94% of rheumatologists and 79.1% of general practitioners. Of general practitioners and rheumatologists, 93.7% and 73.7% respectively, have not received any medical school training on fibromyalgia or chronic fatigue syndrome. CONCLUSION: Given the lack of medical school training and continuing professional education concerning fibromyalgia (rare use of pain rating scales, confusion in the classification of rheumatic diseases), there is an urgent need to initiate an explicit teaching effort on chronic pain, and on fibromyalgia in particular. 70 PMID- 15271773 AU - Boonen A, van den Heuvel R, van Tubergen A, Goossens M, Severens JL, van der Heijde D, van der Linden S TI - Large differences in cost of illness & wellbeing between pts w FM, chr low back pain, or AS. SO - Ann Rheum Dis. 2005 Mar;64(3):396-402. Epub 2004 Jul 22. IN - D o Internal Med, Div o Rheumatology, U Hosp Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands. aboo@sint.azm.nl AB - OBJECTIVE: To compare the cost of illness of three musculoskeletal conditions in relation to general wellbeing. METHODS: Patients with fibromyalgia, chronic low back pain (CLBP), and ankylosing spondylitis who were referred to a specialist and participated in three randomised trials completed a cost diary for the duration of the study, comprising direct medical and non-medical resource utilisation and inability to perform paid and unpaid work. Patients rated perceived wellbeing (0-100) at baseline. Univariate differences in costs between the groups were estimated by bootstrapping. Regression analyses assessed which variables, in addition to the condition, contributed to costs and wellbeing. RESULTS: 70 patients with fibromyalgia, 110 with chronic low back pain, and 111 with ankylosing spondylitis provided data for the cost analyses. Average annual disease related total societal costs per patient were 7813 euro for fibromyalgia, 8533 euro for CLBP, and 3205 euro for ankylosing spondylitis. Total costs were higher for fibromyalgia and CLBP than for ankylosing spondylitis, mainly because of cost of formal and informal care, aids and adaptations, and work days lost. Wellbeing was lower in fibromyalgia (mean, 48) and low back pain (mean, 42) than in ankylosing spondylitis (mean, 67). No variables other than diagnostic group contributed to differences in costs or wellbeing. CONCLUSIONS: In patients under the care of a specialist, there were marked differences in costs and wellbeing between those with fibromyalgia or CLBP and those with ankylosing spondylitis. In particular, direct non-medical costs and productivity costs were higher in fibromyalgia and CLBP. 71 PMID- 15805128 AU - Bowen J, Pheby D, Charlett A, McNulty C TI - CFS: a survey of GPs' attitudes & knowledge. SO - Fam Pract. 2005 Aug;22(4):389-93. Epub 2005 Apr 1. IN - Health Protection Agency Primary Care Unit, Gloucester, UK. jill.whiting@hpa.org.uk AB - BACKGROUND: GPs need evidence and guidance to help them diagnose and manage Chronic Fatigue Syndrome (CFS)/ME appropriately. OBJECTIVES: The aim of this survey was to obtain baseline data and identify the factors associated with GPs' attitudes to and knowledge of CFS/ME. The attitude of GPs to the condition is an important indicator of likely prognosis. METHODS: A postal questionnaire was sent to 1054 GPs served by Taunton, Bristol and Gloucester laboratories. GPs' attitudes to nine statements about CFS/ME were assessed and the factors associated with positive or negative responses were determined. Knowledge of the clinical features was also assessed. RESULTS: 811 GPs (77%) returned the questionnaire. 48% of GPs did not feel confident with making a diagnosis of CFS/ME and 41% did not feel confident in treatment. 72% of GPs accepted CFS/ME as a recognisable clinical entity and those GPs had significantly more positive attitudes. Three other key factors that were significantly, positively associated with GPs' attitudes were knowing someone socially with CFS/ME, being male and seeing more patients with the condition in the last year. CONCLUSION: Despite the publication of guidance for GPs on CFS/ME, confidence with making a diagnosis and management was found to be low. Educational initiatives and guidance for GPs should stress the importance of accepting CFS/ME as a recognisable clinical entity, as this is linked to having a positive attitude and could lead to improved confidence to make a diagnosis and treat CFS/ME patients. 72 PMID- 15788958 AU - Bracha HS, Ralston TC, Williams AE, Yamashita JM, Bracha AS TI - The clenching-grinding spectrum & fear circuitry disorders: clinical insights from the neuroscience/paleoanthropology interface. [CFS/FM] SO - CNS Spectr. 2005 Apr;10(4):311-8. IN - National Ctr for Posttraumatic Stress Disorder, Dept. o Veterans Affairs, Pacific Islands Health Care System, Spark M. Matsunaga Med Center, 1132 Bishop Street, Ste, 307, Honolulu, HI 96813, USA. H.Bracha@med.va.gov AB - This review discusses the clenching-grinding spectrum from the neuropsychiatric/neuroevolutionary perspective. In neuropsychiatry, signs of jaw clenching may be a useful objective marker for detecting or substantiating a self-report of current subjective emotional distress. Similarly, accelerated tooth wear may be an objective clinical sign for detecting, or substantiating, long-lasting anxiety. Clenching-grinding behaviors affect at least 8 percent of the population. We argue that during the early paleolithic environment of evolutionary adaptedness, jaw clenching was an adaptive trait because it rapidly strengthened the masseter and temporalis muscles, enabling a stronger, deeper and therefore more lethal bite in expectation of conflict (warfare) with conspecifics. Similarly, sharper incisors produced by teeth grinding may have served as weaponry during early human combat. We posit that alleles predisposing to fear-induced clenching-grinding were evolutionarily conserved in the human clade (lineage) since they remained adaptive for anatomically and mitochondrially modern humans (Homo sapiens) well into the mid-paleolithic. Clenching-grinding, sleep bruxism, myofacial pain, craniomaxillofacial musculoskeletal pain, temporomandibular disorders, oro-facial pain, and the fibromyalgia/chronic fatigue spectrum disorders are linked. A 2003 Cochrane meta-analysis concluded that dental procedures for the above spectrum disorders are not evidence based. There is a need for early detection of clenching-grinding in anxiety disorder clinics and for research into science-based interventions. Finally, research needs to examine the possible utility of incorporating physical signs into Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition posttraumatic stress disorder diagnostic criteria. One of the diagnostic criterion that may need to undergo a revision in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is Criterion D (persistent fear-circuitry activation not present before the trauma). Grinding-induced incisor wear, and clenching-induced palpable masseter tenderness may be examples of such objective physical signs of persistent fear-circuitry activation (posttraumatic stress disorder Criterion D). 73 PMID- 15745615 AU - Bradley LA TI - Psychiatric comorbidity in FM. SO - Curr Pain Headache Rep. 2005 Apr;9(2):79-86. IN - Division o Clinical Immunology & Rheumatology, U o Alabama at Birmingham 805 FOT, 510 20th Street South, Birmingham, AL 35222, USA. Braddog@uab.edu AB - This review examines the current literature regarding psychiatric comorbidities associated with fibromyalgia. The aim of this review is to enhance understanding of psychiatric disorders that, alone or in combination with other physiologic (eg, neuroendocrine dysfunction) and psychosocial factors (eg, poor coping skills), may contribute to abnormal pain sensitivity and other illness behaviors of individuals with fibromyalgia. The review first identifies the psychiatric comorbidities that are associated most often with fibromyalgia and tend to aggregate within families of individuals with this disorder. It then examines the literature regarding the extent to which psychiatric illness, environmental stressors, or other psychosocial factors may contribute to the development of fibromyalgia. The review also presents recent findings concerning the extent to which psychosocial factors may contribute to treatment-related outcomes in pain and other health status variables among patients with fibromyalgia. 74 PMID- 16173249 AU - Breuer GS, Orbach H, Elkayam O, Berkun Y, Paran D, Mates M, Nesher G TI - Perceived efficacy among pts of various methods of complementary alternative medicine for rheumatologic diseases. [FM] SO - Clin Exp Rheumatol. 2005 Sep-Oct;23(5):693-6. IN - Rheumatology Service, D o Internal Med, Shaare-Zedek Med Ctr & the Hebrew U MS, Jerusalem, Israel. AB - OBJECTIVE: The purpose of this cross-sectional survey was to obtain and analyze data on self-perceived efficacy of different types of complementary alternative medicine (CAM) by patients with various rheumatologic conditions. METHODS: Patients followed in rheumatology outpatient clinics were screened for the use of CAM. Patients reporting the use of CAM were asked to participate in face-to-face structured interviews, specifying the various CAM types they used, and grading their subjective impression of efficacy of each CAM type on a scale of 1-10. RESULTS: 350 consecutive patients were screened and 148 reported using CAM. In general, homeopathy and acupuncture were the most commonly used CAM types (44% and 41% of the CAM users, respectively). The mean number of different CAM methods used by a CAM user was 1.9 +/- 1.1. Patients with fibromyalgia used significantly more CAM methods (2.7 +/- 1.4, p = 0.005). On patients' self-perceived efficacy scale of 1-10, the mean score of the whole group was 5.3 +/- 3.2. Acupuncture and homeopathy achieved significantly higher self-perceived efficacy scores in CAM users with spondylo-arthropathies and osteoarthritis, respectively, when compared to some of the other disease groups. Satisfaction was lowest among CAM users with rheumatoid arthritis, vasculitis and connective tissue diseases. CONCLUSION: In general, CAM users were less than moderately satisfied with self-perceived-efficacy of CAM therapies. However efficacy of specific CAM methods differed significantly among patients in different disease groups. 75 PMID- 16012063 AU - Burckhardt CS TI - Educating pts: self-management approaches. [FM] SO - Disabil Rehabil. 2005 Jun 17;27(12):703-9. IN - Oregon Health & Science U Portland, OR 97239, USA. burkhac@ohsu.edu AB - PURPOSE: To review and evaluate approaches to educating patients with fibromyalgia syndrome (FMS). METHODS: A narrative literature review was undertaken to summarize the published literature on patient education for FMS patients. RESULTS: A number of studies contain specific education strategies while others are combined with exercise or movement therapies or cognitive-behavioural therapy. CONCLUSIONS: Self-efficacy provides an effective theoretical model from which to understand how patients change as a result of education strategies that focus on self-management. Programmes that combine education with cognitive-behavioural techniques and exercise are most effective in enhancing self-efficacy and decreasing symptoms of FMS. 76 PMID- 15860132 AU - Burckhardt CS, Jones KD TI - Effects of chr widespread pain on the health status & quality of life of women after breast cancer surgery. [CF] SO - Health Qual Life Outcomes. 2005 Apr 28;3(1):30. IN - Primary Care, School o Nursing, Oregon Health & Science U, Portland, Oregon, USA. burckhac@ohsu.edu AB - BACKGROUND: Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. METHODS: A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered. RESULTS: There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance. CONCLUSION: This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain. 77 PMID- 15943960 AU - Burwinkle T, Robinson JP, Turk DC TI - Fear of movement: factor structure of the tampa scale of kinesiophobia in pts w FM syndrome. SO - J Pain. 2005 Jun;6(6):384-91. IN - D o Anesthesiology, U o Washington, Seattle, Washington 98195, USA. tburwinkle@aol.com AB - Chronic pain patients often report fears that movement will exacerbate their symptoms. The Tampa Scale of Kinesiophobia (TSK) was designed to assess fear of movement. Previous findings with the TSK showed inconsistent factor structures and varied measurement properties. The TSK was completed by a sample of 233 patients with fibromyalgia syndrome who were being evaluated for participation in a rehabilitation program. A principal components analysis initially derived a 5-factor solution. However, the factor structure accounted for less than 50% of the variance, and the internal consistency of the factors was below conventional standards (<0.70). A series of principal components analyses "forcing" different factor structures revealed that the best solution was a single factor solution that contained 4 of the original 17 TSK items, accounting for more than 50% of the variance with adequate internal consistency (alpha =0.71). Inspection of the content of these 4 items, however, suggests that this factor more likely represents catastrophic thinking, rather than fear of movement. Nevertheless, for patients with fibromyalgia syndrome, a 4-item TSK appears to retain the most acceptable factor solution while also maintaining adequate internal consistency. PERSPECTIVE: Although the TSK is one of the most commonly used measures of fear of movement, the present study using the TSK with a sample of patients with fibromyalgia syndrome suggests that the measurement properties of the TSK are problematic. Recommendations for use of the TSK are provided. 78 PMID- 15788956 AU - Buskila D, Neumann L, Press J TI - Genetic factors in neuromuscular pain. [FM] SO - CNS Spectr. 2005 Apr;10(4):281-4. IN - D o Internal Med, Faculty o Health Sciences, Ben Gurion U o the Negev, Beer Sheva 84101, Israel. dbuskila@bgumail.bgu.ac.il AB - Recent evidence suggests that fibromyalgia, a chronic widespread pain condition and related syndromes (chronic fatigue syndrome, irritable bowel syndrome, etc.) may share heritable pathophysiologic features. We review the recent literature on genetic and familial factors found to participate in the pathogenesis of these syndromes, specifically fibromyalgia, including evidence suggesting that serotonin- and dopamine-related genes may play a role in the pathogenesis of these illnesses. The importance of environmental factors triggering these conditions in predisposed individuals is also discussed. 79 PMID- 16157058 AU - Buskila D, Neumann L TI - Genetics of FM. SO - Curr Pain Headache Rep. 2005 Oct;9(5):313-5. IN - D o Med H, Soroka Med Ctr, P.O. Box 151, Beer Sheva 84101, Israel. dbuskila@bgumail.bgu.ac.il AB - The pathogenesis of fibromyalgia (FM) and related conditions is not entirely understood. Recent evidence suggests that these syndromes may share heritable pathophysiologic features. Familial studies suggest that genetic and familial factors may play a role in the etiopathogenesis of these conditions. There is evidence that polymorphisms of genes in the serotoninergic and catecholaminergic systems are linked to the pathophysiology of FM and related conditions and are associated with personality traits. The precise role of genetic factors in the etiopathology of FM remains unknown, but it is likely that several genes are operating together to initiate this syndrome. Larger longitudinal studies are needed to better clarify the role of genetics in the development of FM. 80 PMID- 15699087 AU - Cairns R, Hotopf M TI - A systematic review describing the prognosis of CFS. SO - Occup Med (Lond). 2005 Jan;55(1):20-31. IN - D o Psychological Med, Inst o Psychiatry, London, UK. AB - AIM: To perform a systematic review of studies describing the prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify occupational outcomes from such studies. METHOD: A literature search was used to identify all studies describing the clinical follow-up of patients following a diagnosis of CF or CFS. The prognosis is described in terms of the proportion of individuals improved during the period of follow-up. Return to work, other medical illnesses and death as outcomes are also considered, as are variables which may influence prognosis. RESULTS: Twenty-eight articles met the inclusion criteria and, for the 14 studies of subjects meeting operational criteria for CFS, the median full recovery rate was 5% (range 0-31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8-63%). Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. CONCLUSIONS: Full recovery from untreated CFS is rare. The prognosis for an improvement in symptoms is less gloomy. This review looks at the course of CF/CFS without systematic intervention. However, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given. 81 PMID- 15607706 AU - Casado B, Zanone C, Annovazzi L, Iadarola P, Whalen G, Baraniuk JN TI - Urinary electrophoretic profiles from CFS & CFS/FM pts: a pilot study for achieving their normalization. SO - J Chromatogr B Analyt Technol Biomed Life Sci. 2005 Jan 5;814(1):43-51. IN - D o Biochemistry A. Castellani, U o Pavia, V.le Taramelli 3/B, 27100 Pavia, Italy. bc48@georgetown.edu AB - Aim of our study was to determine if there were distinct, disease-related patterns of urinary analytes in chronic fatigue syndrome (CFS) and chronic fatigue syndrome/fibromyalgia (CFS/FM) compared to normal controls (NC). Urine was collected from these subjects for two consecutive 24 h periods and aliquots were submitted to micellar electrokinetic chromatography (MEKC). To compensate for the differences in peak migration times, these were normalized from the 35 min duration of run to a 100-point scale, and each peak was assigned its normalized time measure. Peak heights were also normalized by dividing the mAU by that of the internal standard (creatinine) and multiplying by 100. MEKC with normalization for peak height and migration time generated comparable results within each of the patient groups. CFS/FM and CFS had significant differences in peaks compared to NC that may be of significance as biomarkers of illnesses. 82 PMID- 16357732 AU - Castro I, Barrantes F, Tuna M, Cabrera G, Garcia C, Recinos M, Espinoza LR, Garcia-Kutzbach A TI - Prevalence of abuse in FM & other rheumatic disorders at a specialized clinic in rheumatic diseases in Guatemala City. SO - J Clin Rheumatol. 2005 Jun;11(3):140-5. IN - Louisiana St U Health Sciences Ctr, New Orleans, Louisiana, USA. AB - BACKGROUND: The importance of past adverse experiences is increasingly recognized in patients with rheumatic disease. OBJECTIVE: The objective of this study was to study the association of physical, verbal, and sexual abuse in patients with rheumatic disorders as compared with healthy volunteers. METHODS: In this case-control study, 500 new patients attending an outpatient rheumatic clinic were interviewed from September 1, 1999, to August 31, 2001. A total of 187 patients with 3 diagnoses were selected: 58 had fibromyalgia (FM), 74 rheumatoid arthritis (RA), and 55 patients with soft tissue rheumatic disease (STRD). All selected patients were asked to complete a questionnaire designed to obtain information regarding demographics and history of verbal, physical, and sexual abuse. A group of 187 healthy control subjects were also included, matched for sex and age. RESULTS: The prevalence of abuse was significantly more common in the rheumatic disease group than in the control group (48.1% versus 15%, P < 0.001). The prevalence of abuse among the groups was as follows: 70.7% of patients with FM reported abuse (24.3% verbal, 60.9% physical, and 14.8% sexual), 35.1% of patients with RA had a history of abuse (42.3% verbal, 30.7% physical, and 0% sexual), whereas 41.8% of patients with STRD reported abuse (43.4% verbal, 43.4% physical, and 0% sexual). When comparing the 3 groups, patients with FM showed a higher prevalence of abuse (P < 0.05). The abuse was usually longstanding (range, 1-10 years), and most abusers were close family members. CONCLUSION: Abuse, both physical and psychologic, was significantly increased in our rheumatic disease population, especially in patients with FM. Further studies are needed to fully establish its role. Questions about abuse may provide important information relative to care of our patients. 83 PMID- 16254097 AU - Chia JK TI - The role of enterovirus in CFS. SO - J Clin Pathol. 2005 Nov;58(11):1126-32. IN - CEI Research Ctr, Torrance, CA 90505, USA. Chiiasann@pol.net AB - Two and a half decades after coining of the term chronic fatigue syndrome (CFS), the diagnosis of this illness is still symptom based and the aetiology remains elusive. Enteroviruses are well known causes of acute respiratory and gastrointestinal infections, with tropism for the central nervous system, muscles, and heart. Initial reports of chronic enteroviral infections causing debilitating symptoms in patients with CFS were met with skeptism, and had been largely forgotten for the past decade. Observations from in vitro experiments and from animal models clearly established a state of chronic persistence through the formation of double stranded RNA, similar to findings reported in muscle biopsies of patients with CFS. Recent evidence not only confirmed the earlier studies, but also clarified the pathogenic role of viral RNA through antiviral treatment. This review summarises the available experimental and clinical evidence that supports the role of enterovirus in chronic fatigue syndrome. 84 PMID- 16518973 AU - Chiowchanwisawakit P, Koolvisoot A, Ratanasuwan W, Suwanagool S TI - Prevalence of rheumatic disease in HIV infected Thai pts. [FM] SO - J Med Assoc Thai. 2005 Dec;88(12):1775-81. IN - Division o Rheumatology, D o Med, Faculty o Medicine, Siriraj Hosp, Mahidol U, Bangkok 10700, Thailand. AB - OBJECTIVE: To determine the prevalence of rheumatic diseases in HIV-infected patients at Siriraj Hospital, Thailand. MATERIAL AND METHOD: 178 patients who attended the HIV-Clinic at Siriraj Hospital between November 2002 and February 2003 were examined for the presence of rheumatic diseases. Diagnosis of HIV infection was performed by ELISA and confirmed by partial agglutination testing. HIV-infected patients were classified according to the Centers for Disease Control (CDC) 1993 revised classification system. Standard criteria were used to classify the rheumatic diseases. RESULTS: 98 patients had rheumatic diseases. Seventy-seven patients were treated with antiretroviral drugs. Forty-nine patients had mechanical low back pain, twenty-four patients had arthralgia, nineteen patients had plantar fasciitis, eighteen patients had nonspecific myalgia, thirteen patients had fibromyalgia, and eleven patients had others. Arthralgia was associated significantly with Quadricept muscle wasting (p = 0.00001). Nonspecific myalgia was more likely to be associated with female (p = 0. 018) and less likely with use of antiretroviral therapy (p = 0.031). CONCLUSION: Rheumatic diseases were commonly found in HIV-infected patients. Arthralgia associated with wasting Quadricep muscle. Nonspecific myalgia was predominant in female and without antiretroviral drug treatment. 85 PMID- 16192099 AU - Christie D, Wilson C TI - CBT in paediatric & adolescent health settings: a review of practice-based evidence. [CFS] SO - Pediatr Rehabil. 2005 Oct-Dec;8(4):241-7. IN - U Coll & Middlesex Hopsitals, London, UK. deborah.christie@uclh.org AB - Cognitive Behavioural therapy (CBT) has strong theoretical underpinnings that facilitate the systematic evaluation of outcomes and process of change adults. CBT has been extensively adapted for use with children and young people with session content and method of delivery modified to acknowledge developmental stage and ability. Current approaches emphasise the psychological management of the impact of symptoms of particular types of physical health difficulties and prevention of the development of psychological difficulties, as well as in the alleviation of procedurally related stress. The need for collaboration with families and other parts of a child's network is particularly relevant in the paediatric setting. This review describes what we have found helpful in our work and provides a road map of where to go to find out more about how to do more. General CBT approaches are described as well as examples of how CBT has been used specifically for procedural distress, diabetes, sickle cell disease, chronic pain and chronic fatigue. 86 PMID- 16093743 AU - Ciccone DS, Elliott DK, Chandler HK, Nayak S, Raphael KG TI - Sexual & physical abuse in women w FM syndrome: a test of the trauma hypothesis. SO - Clin J Pain. 2005 Sep-Oct;21(5):378-86. IN - D o Psychiatry, UMDNJ-New Jersey MS, Newark, NJ 07103, USA. cicconds@umdnj.edu AB - OBJECTIVES: According to the trauma hypothesis, women with fibromyalgia syndrome (FMS) are more likely to report a history of sexual and/or physical abuse than women without FMS. In this study, we rely on a community sample to test this hypothesis and the related prediction that women with FMS are more likely to have posttraumatic stress disorder than women without FMS. METHODS: Eligibility for the present study was limited to an existing community sample in which FMS and major depressive disorder were prevalent. The unique composition of the original sample allowed us to recruit women with and without FMS from the community. A total of 52 female participants were enrolled in the present FMS group and 53 in the control (no FMS) group. Sexual and physical abuse were assessed retrospectively using a standardized telephone interview. RESULTS: Except for rape, sexual and physical abuse were reported equally often by women in the FMS and control groups. Women who reported rape were 3.1 times more likely to have FMS than women who did not report rape (P<0.05). There was no evidence of increased childhood abuse in the FMS group. Women with FMS were more likely to have posttraumatic stress disorder symptoms (intrusive thoughts and arousal) as well as posttraumatic stress disorder diagnosis (P<0.01). DISCUSSION: With the exception of rape, no self-reported sexual or physical abuse event was associated with FMS in this community sample. In accord with the trauma hypothesis, however, posttraumatic stress disorder was more prevalent in the FMS group. Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS. 87 PMID- 16338194 AU - Cimbiz A, Bayazit V, Hallaceli H, Cavlak U TI - The effect of combined therapy (spa & physical therapy) on pain in various chr diseases. [FM] SO - Complement Ther Med. 2005 Dec;13(4):244-50. Epub 2005 Oct 11. IN - Dumlupinar U, Health Institution o Higher Education, D o Physical Therapy & Rehabilitation, Tanvanly Yolu, 43100 Kutahya, Turkey. alicimbizphd@hotmail.com AB - OBJECTIVE: Spa therapy is commonly used in the treatment of daily chronic diseases practice, but its benefits are still the subjects of discussion. This study investigates possible effects of a combined spa and physical therapy program on pain and hemodynamic responses in various chronic diseases. METHODS: The pain intensity and hemodynamic responses of 472 patients involved in a spa and physical therapy program were studied retrospectively. Assessment criteria were pain [Visual Analog Scale (VAS)] and hemodynamic responses (heart rate, blood pressure, respiratory rate). Assessments took place before, immediately after treatment, and after completion of the spa program (before discharge). RESULTS: The patients with ankle arthrosis, fibromyalgia and cervical disc herniation reported the highest VAS score before treatment program (P < 0.05). After the therapy program, VAS scores were seen to decrease compared to before treatment (P < 0.05). The patients with osteoarthritis of the hip (1.3+/-1.2) and soft tissue rheumatism (1.3+/-1.2) had the lowest VAS score before discharge compared to patients with other pathologies (P < 0.05). No statistically significant differences were detected between both sexes in terms of pain improvement (P > 0.05). On discharge, all hemodynamic responses decreased significantly compared to before and immediately after initiation of the therapy program (P < 0.01). CONCLUSION: To decrease pain and high blood pressure without hemodynamic risk, a combined of spa and physical therapy program may help to decrease pain and improve hemodynamic response in patients with irreversible pathologies. 88 PMID- 15755409 AU - Clark GT, Minakuchi H, Lotaif AC TI - Orofacial pain & sensory disorders in the elderly. [FM] SO - Dent Clin North Am. 2005 Apr;49(2):343-62. IN - Division o Diagnostic Sciences, U o Southern California, School o Dentistry, 925 West 34th Street, Room B-14, Los Angeles, CA 90089-0641, USA. gtc@usc.edu AB - Many orofacial pain conditions occur in the elderly. Specifically,this article reviews the prevalence of general and orofacial-related pain in the elderly. The authors also describe and discuss the likely disorders and diseases that produce facial pain and burning pain in the mouth. They do not cover jaw joint pain, oral sores, or ulceration-induced pain, as these conditions are better discussed in the context of arthritis and oral pathologies of the mouth. The authors discuss oral motor disorders, myogenous pain, vascular pain, headaches, trigeminal neuralgia, trigeminal neuropathic dis-ease, postherpetic neuralgia, burning mouth syndrome, and occlusal dysesthesia. 89 PMID- 15691524 AU - Cleare AJ, Messa C, Rabiner EA, Grasby PM TI - Brain 5-HT1A receptor binding in CFS measured using positron emission tomography & [11C]WAY-100635. SO - Biol Psychiatry. 2005 Feb 1;57(3):239-46. IN - Section o Neurobiology o Mood Disorders, Div o Psychological Med, Inst o Psychiatry & Guy-s, King-s & St. Thomas- School o Medicine, London, United Kingdom. a.cleare@iop.kcl.ac.uk AB - BACKGROUND: Research from neuroendocrine challenge and other indirect studies has suggested increased central 5-HT function in chronic fatigue syndrome (CFS) and increased 5-HT1A receptor sensitivity. We assessed brain 5-HT1A receptor binding potential directly using the specific radioligand [11C]WAY-100635 and positron emission tomography (PET). METHODS: We selected 10 patients from a tertiary referral clinic who fulfilled the CDC consensus criteria for CFS. To assemble a homogenous group and avoid confounding effects, we enrolled only subjects who were completely medication-free and did not have current comorbid psychiatric illness. We also scanned 10 healthy control subjects. RESULTS: There was a widespread reduction in 5-HT1A receptor binding potential in CFS relative to control subjects. This was particularly marked in the hippocampus bilaterally, where a 23% reduction was observed. CONCLUSIONS: There is evidence of decreased 5-HT1A receptor number or affinity in CFS. This may be a primary feature of CFS, related to the underlying pathophysiology, or a finding secondary to other processes, such as previous depression, other biological changes or the behavioral consequences of CFS. 90 PMID- 16177595 AU - Cook DB, Nagelkirk PR, Peckerman A, Poluri A, Mores J, Natelson BH TI - Exercise & cognitive performance in CFS. SO - Med Sci Sports Exerc. 2005 Sep;37(9):1460-7. IN - U o Wisconsin-Madison, D o Kinesiology, USA. cookdb@njneuromed.org AB - PURPOSE: To determine the effect of submaximal steady-state exercise on cognitive performance in patients with chronic fatigue syndrome (CFS) alone, CFS with comorbid fibromyalgia FM (CFS + FM), and sedentary healthy controls (CON). METHODS: Twenty CFS-only patients, 19 CFS + FM, and 26 CON completed a battery of cognitive tests designed to assess speed of information processing, variability, and efficiency. Tests were performed at baseline, immediately before, and twice following 25 min of either cycle ergometry set at 40% of peak oxygen capacity or quiet rest. RESULTS: There were no group differences in average percentage of peak oxygen consumption during exercise (CFS = 45%; CFS + FM = 47%; Control = 43%: P = 0.2). There were no significant effects of acute exercise on cognitive performance for any group. At baseline, one-way ANOVA indicated that CFS patients displayed deficits in speed of processing, performance variability, and task efficiency during several cognitive tests compared with healthy controls. However, the CFS + FM patients were not different than controls. Repeated measures ANOVA indicated that across all tests (pre- and postexercise) CFS, but not CFS + FM, were significantly less consistent (F2,59 = 3.7, P = 0.03) and less efficient (F2,59 = 4.6, P = 0.01) than controls. CONCLUSION: CFS patients without comorbid FM exhibit subtle cognitive deficits in terms of speed, consistency, and efficiency that are not improved or exacerbated by light exercise. Importantly, our data suggest that CFS + FM patients do not exhibit cognitive deficits either pre- or postexercise. These results highlight the importance of disease heterogeneity in studies determining acute exercise and cognitive function in CFS. 91 PMID- 15818653 AU - Costa DD, Bernatsky S, Dritsa M, Clarke AE, Dasgupta K, Keshani A, Pineau C TI - Determinants of sleep quality in women w SLE. [FM] SO - Arthritis Rheum. 2005 Apr 15;53(2):272-8. IN - McGill U Health Centre, Montreal, Quebec, Canada. Deborah.DaCosta@mcgill.ca AB - OBJECTIVE: To characterize sleep complaints in women with systemic lupus erythematosus (SLE) and to identify correlates of sleep quality. METHODS: Sleep quality in 100 women with SLE was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants completed standardized questionnaires assessing depressed mood, leisure time physical activity, functional disability, and pain severity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled the American College of Rheumatology criteria for fibromyalgia. A series of hierarchical multiple regressions were computed. RESULTS: The mean +/- SD global PSQI score was 6.98 +/- 4.03, with moderate to severe sleep impairment reported by 56% of the sample. The first model testing the importance of demographic factors was not statistically significant. In the disease-related model, the use of prednisone and functional disability both contributed to poor sleep quality (P < 0.001). The addition of level of exercise participation to the demographic set significantly added to the model (P = 0.001). Depression significantly added to the demographic set, explaining 29% of the variance (P < 0.0001). When these variables, along with disease related variables, were simultaneously regressed on the PSQI Global Score, only depressed mood appeared as a significant independent determinant of global sleep quality (P < 0.001). However, the point estimates for the Beta coefficients were consistent with effects for lack of exercise and prednisone use. CONCLUSION: A significant proportion of women with SLE suffer from poor sleep quality. The findings suggest that depressed mood, prednisone use, and lack of exercise contribute to decreased overall sleep quality. 92 PMID- 16029148 AU - Covelli V, Passeri ME, Leogrande D, Jirillo E, Amati L TI - Drug targets in stress-related disorders. [CGS] SO - Curr Med Chem. 2005;12(15):1801-9. IN - Division o Neurology, Polyclinic Hosp, Bari Italy. AB - Nervous and immune systems mutually cooperate via release of mediators of both neurological and immunological derivation. Adrenocorticotropin hormone (ACTH) is a product of the hypothalamus-pituitary adrenal axis (HPAA) which stimulates secretion of corticosteroids from adrenals. In turn, corticosteroids modulate the immune response in virtue of their anti-inflammatory activity. On the other hand, catecholamines, products of the sympathetic nervous system (SNS), regulate immune function by acting on specific beta-adrenergic receptors. Conversely, cytokines released by monocytes/macrophages and lymphocytes, upon antigenic stimulation, are able to cross the blood-brain-barrier, thus modulating nervous functions (e.g., thermoregulation, sleep, and appetite). However, cytokines are locally produced in the brain, especially in the hypothalamus, thus contributing to the development of anorexic, pyrogenic, somnogenic and behavioural effects. Besides pathogens and/or their products, the so-called stressors are able to activate both HPAA and SNS, thus influencing immune responses. In this respect, many studies conducted in medical students taking exams have evidenced an array of stress-induced immune alterations. Phobic disorders and migraine without aura (MWA) represent examples of stress-related disorders in which phagocytic immune deficits, endotoxemia and exaggerated levels of proinflammatory cytokines [Tumor Necrosis Factor-alpha (TNF- alpha), and interleukin- 1 beta] have been detected. Quite interestingly, administration of a thymic hormone could ameliorate clinical symptoms in phobic patients. In MWA patients, a beta-blocker, propranolol, could mitigate migraine, whose cessation coincided with a drop of TNF-alpha serum concentration. In phobic disorders and in MWA, benzodiazepines are very often administered and, in this respect, some of them, such as diazepam, inhibit immune functions, while others, e.g., alprazolam, enhance immune responses. Alprazolam could improve clinical symptoms in MWA patients. Chronic Fatigue Syndrome (CFS) is a disorder whose etiology and pathogenesis are still unknown. In this syndrome both abnormalities of nervous and immune systems have been reported. Despite many immune parameters evaluated in CFS no specific biomarkers of disease have been found. Our own data are in agreement with current literature in that we found decreased levels of serum (IFN)-gamma in these patients, thus indicating a predominance of T helper (h)1 response in CFS. Also leptin, a hormone which regulates food intake, fluctuates within normal ranges in CFS individuals. Quite interestingly, in depressed patients, used as controls, leptinaemia was more elevated than in CFS. Finally, in a series of recent therapeutic trials several immunomodulating agents have been used, such as staphypan Berna, lactic acid bacteria, kuibitang and intravenous immunoglobulin. In conclusion, it seems that major drug targets in stress-related disorders are immune cells in terms of inhibition of proinflammatory cytokines and modulation of Th responses. In particular, according to recent evidences, antidepressants seem to exert beneficial effects in experimental autoimmune neuritis in rats by decreasing IFN- beta release or augmenting NK activity in depressed patients. 93 PMID- 16078360 AU - Crofford LJ TI - The relationship of FM to neuropathic pain syndromes. SO - J Rheumatol Suppl. 2005 Aug;75:41-5. IN - U o Kentucky, Lexington, Kentucky 40536, USA. lcrofford@uky.edu AB - The appropriateness and utility of considering fibromyalgia syndrome (FM) and other syndromes without anatomically localized pathology of the nervous system as neuropathic pain syndromes is uncertain. In this afterword, a synthesis of the information presented in these proceedings and opinion as to how FM relates to classical neuropathic pain syndromes is provided. 94 PMID- 15727017 AU - Crowhurst G TI - Supporting people w severe ME. [CFS] SO - Nurs Stand. 2005 Feb 2-8;19(21):38-43. IN - 25% Severe ME Group, Great Walsingham, Norfolk. gregcrowhurst@yahoo.co.uk AB - This article aims to raise nurses' awareness of myalgic encephalomyelitis (ME) also known as chronic fatigue syndrome (CFS). Key symptoms are presented along with possible service responses and treatment options. It emphasises that this condition is often misunderstood but that it can be serious and more research is needed to promote better understanding of the physical symptoms. 95 PMID- 16030079 AU - Da Costa D, Abrahamowicz M, Lowensteyn I, Bernatsky S, Dritsa M, Fitzcharles MA, Dobkin PL TI - A randomized clinical trial of an individualized home-based exercise programme for women w FM. SO - Rheumatology (Oxford). 2005 Nov;44(11):1422-7. Epub 2005 Jul 19. IN - Division o Clinical Epidemiology, McGill U Health Centre, Montreal, Quebec, H3G 1A4 Canada. Deborah.DaCosta@mcgill.ca AB - 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. 96 PMID- 16282040 AU - Dadabhoy D, Clauw DJ TI - FM: progress in Dx & Rx. SO - Curr Pain Headache Rep. 2005 Dec;9(6):399-404. IN - Division o Rheumatology, D o Med, Chronic Pain & Fatigue Research Ctr, The U o Michigan, 24 Frank Lloyd Wright Drive, Box 385, Ann Arbor, MI 48106, USA. dadabhoy@umich.edu AB - Fibromyalgia is a frequent cause of chronic widespread pain and affects up to 5% of the general population. Diagnosis and treatment have been especially challenging due to limited knowledge of etiology and poor response to conventional treatment of pain. Appreciation for the interactions of neurobiologic, psychologic, and behavioral factors in the disease pathogenesis has led to improved treatment options that can be effective in individual patients. Current evidence advocates a multifaceted program emphasizing patient education, medications for improving symptoms, and aggressive use of exercise and cognitive-behavioral approaches to retain or restore function. 97 PMID- 15802694 AU - Darbishire L, Seed P, Ridsdale L TI - Predictors of outcome following Rx for chr fatigue. [CF] SO - Br J Psychiatry. 2005 Apr;186:350-1. IN - D o General Practice & Primary Care, Guy's, King's & St Thomas' School ol o Med, 5 Lambeth Walk, London, SE11 6SP, UK. lucy.clark@kcl.ac.uk AB - We explored the role of baseline characteristics of 105 patients who presented with fatigue in primary care in determining outcome following either graded exercise or cognitive-behavioural therapy. Meeting the criteria for chronic fatigue syndrome was the most powerful predictor of poor outcome and this negative effect was enhanced by greater functional impairment or greater perceived negative consequences, but was not further enhanced by both. 98 PMID- 15955606 AU - Davidson J TI - Contesting stigma & contested emotions: personal experience & public perception of specific phobias. [CFS] SO - Soc Sci Med. 2005 Nov;61(10):2155-64. IN - D o Geography, Queen's U, Kingston, Ont., K7L 3N6, Canada. joyce.davidson@queensu.ca AB - This paper draws on interviews with members of the United Kingdom National Phobics Society to explore the implications of the contested nature of specific phobias for their experience and perception. In common with other chronic and contested conditions such as Chronic Fatigue Syndrome, phobias are stigmatised and subjected to widespread judgmental attitudes in both medical and lay populations. In contrast, however, phobic experience is rarely characterised by difficulty in describing symptoms and obtaining a diagnosis: core fearful reaction to and avoidance of particular objects is usually obvious and uncontested. The crucial difference is that phobias are constituted by emotions and behaviours considered irrational and inconsequential, and it is their (perceived absence of) significance that raises questions and eyebrows. In other words, what does it matter and who cares if you happen to be scared of snakes? Using phobics' own words as far as possible, the paper explores the processes through which phobic emotions are constructed as contested, and examines phobic means of managing experience and perception of these emotions. It reveals that many respondents are resourceful and resistant, continually renegotiating their positioning as irrational, incapable and emotionally weak. 99 PMID- 15955487 AU - de Lange FP, Kalkman JS, Bleijenberg G, Hagoort P, van der Meer JW, Toni I TI - Gray matter volume reduction in the CFS. SO - Neuroimage. 2005 Jul 1;26(3):777-81. Epub 2005 Apr 7. IN - F.C. Donders Centre for Cognitive Neuroimaging, Radboud U Nijmegen, NL-6500 HB Nijmegen, The Netherlands. floris.delange@fcdonders.ru.nl AB - The chronic fatigue syndrome (CFS) is a disabling disorder of unknown etiology. The symptomatology of CFS (central fatigue, impaired concentration, attention and memory) suggests that this disorder could be related to alterations at the level of the central nervous system. In this study, we have used an automated and unbiased morphometric technique to test whether CFS patients display structural cerebral abnormalities. We mapped structural cerebral morphology and volume in two cohorts of CFS patients (in total 28 patients) and healthy controls (in total 28 controls) from high-resolution structural magnetic resonance images, using voxel-based morphometry. Additionally, we recorded physical activity levels to explore the relation between severity of CFS symptoms and cerebral abnormalities. We observed significant reductions in global gray matter volume in both cohorts of CFS patients, as compared to matched control participants. Moreover, the decline in gray matter volume was linked to the reduction in physical activity, a core aspect of CFS. These findings suggest that the central nervous system plays a key role in the pathophysiology of CFS and point to a new objective and quantitative tool for clinical diagnosis of this disabling disorder. 100 PMID- 16084221 AU - Denko CW, Malemud CJ TI - Role of the growth hormone/insulin-like growth factor-1 paracrine axis in rheumatic diseases. [FM] SO - Semin Arthritis Rheum. 2005 Aug;35(1):24-34. IN - Case Western Reserve U School o Med, Cleveland, Ohio 44106, USA. AB - OBJECTIVES: Hypothalamic-pituitary axis abnormalities have been associated with systemic disturbances in several rheumatic diseases. Longitudinal analysis of erythrocyte, serum, urinary and synovial fluid growth hormone (GH), insulin-like growth factor-1 (IGF-1), and somatostatin levels could provide important surrogate measures of disease activity in rheumatic diseases. METHODS: The authors reviewed the population and longitudinal studies literature on GH, IGF-1, and somatostatin levels in rheumatic disorders using the PubMed and Medlines databases from the National Library of Medicine. In addition to the literature search, primary data were analyzed for basal somatostatin levels in patients with hand, knee, and spine osteoarthritis (OA) as well as primary and secondary hip OA. RESULTS: A review of the literature supports the view that hypothalamic-pituitary axis dysfunction accompanies clinical symptoms in many rheumatic diseases. In studies from our laboratory, serum GH levels were elevated in patients with OA, rheumatoid arthritis (RA), fibromyalgia, and diffuse idiopathic skeletal hyperostosis but not in patients with gout, pseudogout, or systemic lupus erythematosus. In OA and RA, synovial fluid GH levels exceeded serum GH levels. However, the literature remains controversial regarding the significance of changes in IGF-1 levels in rheumatic disorders. Many studies support an inverse relationship between age and IGF-1. Elevated serum GH levels in various rheumatic diseases were not coupled to changes in serum IGF-1 in diffuse idiopathic skeletal hyperostosis, RA, and fibromyalgia. In particular, serum IGF-1 levels in OA were shown to be lower or no different compared with age-matched normal subjects. Further, in OA, impaired articular chondrocyte response to IGF-1 was attributed, in part, to low synovial fluid IGF-1 that further compromised IGF-1 chondrocyte responses as a result of increased levels of synovial fluid IGF-1 binding proteins. Of note, serum somatostatin levels and "specific" somatostatin receptor levels were often lower in RA and systemic lupus erythematosus, but basal serum somatostatin levels were generally not altered in OA. CONCLUSIONS: The results of these analyses support the view that some rheumatic diseases such as OA and diffuse idiopathic skeletal hyperostosis, heretofore considered to be purely focal and degenerative, could be reclassified as systemic metabolic disturbances. We propose that serum GH, IGF-1, and somatostatin levels be monitored on a longitudinal basis during the course of medical therapy of rheumatic diseases to determine the extent to which changes in clinical symptoms (exemplified by reduced pain and inflammation and improved range of joint motion) are accompanied by changes in the basal concentration of these hypothalamic/pituitary-related hormones. 101 PMID- 15759159 AU - Denko CW, Malemud CJ TI - Serum growth hormone & insulin but not insulin-like growth factor-1 levels are elevated in pts w FM syndrome. SO - Rheumatol Int. 2005 Mar;25(2):146-51. Epub 2004 Jul 24. IN - D o Med, Div o Rheumatic Diseases, Case Western Reserve U School o Medicine, Cleveland, Ohio, USA. AB - Standard radioimmunoassay (RIA) was employed to quantify basal serum growth hormone (GH), insulin-like growth factor-I (IGF-1), and insulin levels in 32 normoglycemic patients with clinically active fibromyalgia and in 29 normoglycemic control subjects. The GH concentration was significantly higher (P < 0.001) in female fibromyalgia patients than age-matched, normal female subjects. In contrast, basal serum IGF-1 concentrations did not differ between these groups. A scatter plot generated from two-stage, least-squares analysis showed that serum GH lacked correlation with the serum IGF-1 concentrations of normal female subjects (P = 0.73) and female fibromyalgia patients (P = 0.19). In addition to the results from serum GH and IGF-1 RIA, we also found significantly higher fasting serum insulin levels (P = 0.03) in male fibromyalgia patients and a trend toward elevated fasting serum insulin levels in the female fibromyalgia population ( P = 0.07), with the mean fasting level in the male fibromyalgia group (35.7 microU/ml(-1)) exceeding the upper limit of normal serum insulin levels (i.e., 27 microU/ml(-1)). Based on these results, basal serum GH and fasting serum insulin levels appear to be valuable surrogate markers in clinically active, normoglycemic fibromyalgia patients. 102 PMID- 16056170 AU - DiNucci EM TI - Energy healing: a complementary Rx for orthopaedic & other conditions. SO - Orthop Nurs. 2005 Jul-Aug;24(4):259-69. IN - Stanford U, Stanford, CA, USA. AB - Complementary and alternative therapies continue to grow in popularity among healthcare consumers. Among those modalities is energy healing (EH) (Eisenberg et al., 1998). EH is an adjunctive treatment that is noninvasive and poses little downside risk to patients. Well more than 50 major hospitals and clinics throughout the United States offer EH to patients (DiNucci, research table on healthcare facilities that offer Reiki, unpublished data, 2002). The National Institutes of Health is funding numerous EH studies that are examining its effects on a variety of conditions, including temporomandibular joint disorders, wrist fractures, cardiovascular health, cancer, wound healing, neonatal stress, pain, fibromyalgia, and AIDS (National Institutes of Health, 2004a). Several well-designed studies to date show significant outcomes for such conditions as wound healing (Grad, 1965) and advanced AIDS (Sicher, Targ, Moore, & Smith, 1998), and positive results for pain and anxiety (Aetna IntelliHealth, 2003a; Wardell, Weymouth, 2004), among others (Gallob, 2003). It is also suggested that EH may have positive effects on various orthopaedic conditions, including fracture healing, arthritis, and muscle and connective tissue (Prestwood, 2003). Because negative outcomes risk is at or near zero throughout the literature, EH is a candidate for use on many medical conditions. 103 PMID- 16208640 AU - Dobkin PL, Abrahamowicz M, Fitzcharles MA, Dritsa M, da Costa D TI - Maintenance of exercise in women w FM. SO - Arthritis Rheum. 2005 Oct 15;53(5):724-31. IN - The McGill U Health Centre, McGill University, Montreal, Quebec, Canada. patricia.dobkin@mcgill.ca AB - OBJECTIVE: To identify predictors of maintenance of exercise for women with fibromyalgia (FM). METHODS: Women with FM who had been randomized to the exercise arm of a clinical trial were studied prospectively during and 3 months following treatment. Subjects completed exercise logs weekly and returned the data via postal mail. Outcome variables were duration of aerobic and stretching exercises. Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time. Pretreatment characteristics (self efficacy, pain, disability, stress, exercise barriers and benefits, and age) and changes during treatment (pain, disability, stress, and exercise barriers and benefits) were considered potential predictors of exercise maintenance. RESULTS: Stretching significantly decreased in the 3 months following treatment. High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching. Disability at baseline (measured with the Fibromyalgia Impact Questionnaire), an increase in barriers to exercise during treatment, and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment. CONCLUSION: The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability. 104 PMID- 16076658 AU - Doljansky JT, Kannety H, Dagan Y TI - Working under daylight intensity lamp: an occupational risk for developing circadian rhythm sleep disorder? [CFS] SO - Chronobiol Int. 2005;22(3):597-605. IN - The Inst for Sleep & Fatigue Med, Chaim Sheba Health Ctr, Tel-Hashomer, Israel. Julia.Tamir@Sheba.health.gov.il AB - A 47-yr-old male was admitted to the Institute for Fatigue and Sleep Medicine complaining of severe fatigue and daytime sleepiness. His medical history included diagnosis of depression and chronic fatigue syndrome. Antidepressant drugs failed to improve his condition. He described a gradual evolvement of an irregular sleep-wake pattern within the past 20 yrs, causing marked distress and severe impairment of daily functioning. He had to change to a part-time position 7 yrs ago, because he was unable to maintain a regular full-time job schedule. A 10-day actigraphic record revealed an irregular sleep-wake pattern with extensive day-to-day variability in sleep onset time and sleep duration, and a 36 h sampling of both melatonin level and oral temperature (12 samples, once every 3 h) showed abnormal patterns, with the melatonin peak around noon and oral temperature peak around dawn. Thus, the patient was diagnosed as suffering from irregular sleep-wake pattern. Treatment with melatonin (5 mg, 2 h before bedtime) did not improve his condition. A further investigation of the patient's daily habits and environmental conditions revealed two important facts. First, his occupation required work under a daylight intensity lamp (professional diamond-grading equipment of more than 8000 lux), and second, since the patient tended to work late, the exposure to bright light occurred mostly at night. To recover his circadian rhythmicity and stabilize his sleep-wake pattern, we recommended combined treatment consisting of evening melatonin ingestion combined with morning (09:00 h) bright light therapy (0800 lux for 1 h) plus the avoidance of bright light in the evening. Another 10-day actigraphic study done only 1 wk after initiating the combined treatment protocol revealed stabilization of the sleep-wake pattern with advancement of sleep phase. In addition, the patient reported profound improvement in maintaining wakefulness during the day. This case study shows that chronic exposure to bright light at the wrong biological time, during the nighttime, may have serious effects on the circadian sleep-wake patterns and circadian time structure. Therefore, night bright light exposure must be considered to be a risk factor of previously unrecognized occupational diseases of altered circadian time structure manifested as irregularity of the 24 h sleep-wake cycle and melancholy. 105 PMID- 15817039 AU - Driver C TI - An under-active or over-active internal world? An exploration of parallel dynamics within psyche & soma, & the difficulty of internal regulation, in pts w CFS & ME. SO - J Anal Psychol. 2005 Apr;50(2):155-73. AB - This paper explores the dynamics brought into analytic work when there is a symmetric fusion between psyche and soma within the patient. It will consider how such a fusion may emerge from reverberations between physical constitution and a lack of maternal attunement, containment and reflective function. I will describe the work with a patient, Jane, who was diagnosed with Myalgic Encephalomyelitis (ME) during the course of her analysis. The dynamic of her physical symptoms within the analytic work, and the impact of her internal affects and internal 'objects' within the transference and countertransference, indicated a difficulty in finding an homeostatic balance resulting in overactivity and underactivity at both somatic and psychological levels. Using the clinical work with Jane this paper will also examine the interrelationship between mother-infant attachment, an inadequate internalized maternal reflective function, affect dysregulation, unconscious fusion, the lack of psyche-soma differentiation and the impact of the latter in relation to internal regulation systems, or lack of, in patients with Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME). I will draw on similar work carried out by Holland (1997), Simpson (1997) and Simpson et al. (1997). The paper will also employ the concept of the reflective function (Fonagy 2001; Knox 2003), and consider Matte-Blanco's (1999) concepts of generalization and unconscious symmetry in relation to the patient's internal world. I go on to consider how analysis provides a point outside the 'fusion' that can enable the 'deadlock' to be broken. 106 PMID- 15945613 AU - Durlach J, Pages N, Bac P, Bara M, Guiet-Bara A TI - Magnesium depletion w hypo- or hyper- function of the biological clock may be involved in chronopathological forms of asthma. [FM] SO - Magnes Res. 2005 Mar;18(1):19-34. IN - SDRM, Universite Pierre et Marie Curie, 75252 Paris Cedex 05, France. jean.durlach@wanadoo.fr AB - Asthma is a chronic, inflammatory disorder of the airways leading to airflow limitation. Its worldwide rise, mainly in developed countries, is a matter of concern. Nocturnal asthma (NA) frequently occurs and concerns two thirds of asthmatics. But, it remains controversial whether NA is a distinct entity or is a manifestation of more severe asthma. Generally, it is considered as an exacerbation of the underlying pathology. The pathological mechanisms most likely involve endogenous circadian rhythms with pathological consequences on both respiratory inflammation and hyperresponsiveness. A decrease in blood and tissue magnesium levels is frequently reported in asthma and often testifies to a true magnesium depletion. The link with magnesium status and chronobiology are well established. The quality of magnesium status directly influences the Biological Clock (BC) function, represented by the suprachiasmatic nuclei and the pineal gland. Conversely, BC dysrythmias influence the magnesium status. Two types of magnesium deficits must be clearly distinguished: deficiency corresponding to an insufficient intake which can be corrected through mere nutritional Mg supplementation and depletion due to a dysregulation of the magnesium status which cannot be corrected through nutritional supplementation only, but requires the more or less specific correction of the dysregulation mechanisms. Both in clinical and in animal experiments, the dysregulation mechanisms of magnesium depletion associate a reduced magnesium intake with various types of stress including biological clock dysrhythmias. The differenciation between Mg depletion forms with hyperfunction of BC (HBC) and forms with hypofunction of BC (hBC) is seminal and the main biological marker is melatonin (MT) production alteration. We hypothesize that magnesium depletion with HBC or hBC may be involved in chronopathological forms of asthma. Nocturnal asthma would be linked to HBC, represented by an increase in MT levels. The corresponding clinical forms associate diverse expressions of nervous hypoexcitability such as depression, cluster headaches, dyssomnia, mainly advanced sleep phase syndrome, some clinical forms of chronic fatigue syndrome and of fibromyalgia. The main comorbidities are depression and/or asthenia. They take place during the night or the "bad" seasons (autumn and winter) when sunshine is at a minimum. The corresponding chronopathological therapy relies on bright light phototherapy sometimes with additional psychoanaleptics. Conversely, asthma forms linked to hBC are less frequently studied as a whole and present a decrease in MT levels. They associate various signs of nervous hyperexcitability such as anxiety, diurnal cephalalgia (mainly migraine), dyssomnia, mainly delayed sleep phase syndrome, and some clinical forms of chronic fatigue syndrome and of fibromyalgia. The treatment relies on diverse forms of "darkness therapy", possibly with the help of some psycholeptics. Finally, the treatment of asthma involves the maintenance of a standard dosing schedule of anti-asthma drugs, a balanced magnesium intake and the appropriate treatment of the chronopathological disorders. 107 PMID- 16314551 AU - Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR TI - Behavioral insomnia therapy for FM pts: a randomized clinical trial. SO - Arch IM. 2005 Nov 28;165(21):2527-35. IN - Psychology Service, Veterans Affairs Med Ctr, Durham, NC 27705, USA. jack.edinger@duke.edu AB - BACKGROUND: Insomnia is common and debilitating to fibromyalgia (FM) patients. Cognitive-behavioral therapy (CBT) is effective for many types of patients with insomnia, but has yet to be tested with FM patients. This study compared CBT with an alternate behavioral therapy and usual care for improving sleep and other FM symptoms. METHODS: This randomized clinical trial enrolled 47 FM patients with chronic insomnia complaints. The study compared CBT, sleep hygiene (SH) instructions, and usual FM care alone. Outcome measures were subjective (sleep logs) and objective (actigraphy) total sleep time, sleep efficiency, total wake time, sleep latency, wake time after sleep onset, and questionnaire measures of global insomnia symptoms, pain, mood, and quality of life. RESULTS: Forty-two patients completed baseline and continued into treatment. Sleep logs showed CBT-treated patients achieved nearly a 50% reduction in their nocturnal wake time by study completion, whereas SH therapy- and usual care-treated patients achieved only 20% and 3.5% reductions on this measure, respectively. In addition, 8 (57%) of 14 CBT recipients met strict subjective sleep improvement criteria by the end of treatment compared with 2 (17%) of 12 SH therapy recipients and 0% of the usual care group. Comparable findings were noted for similar actigraphic improvement criteria. The SH therapy patients showed favorable outcomes on measures of pain and mental well-being. This finding was most notable in an SH therapy subgroup that self-elected to implement selected CBT strategies. CONCLUSIONS: Cognitive-behavioral therapy represents a promising intervention for sleep disturbance in FM patients. Larger clinical trials of this intervention with FM patients seem warranted. 108 PMID- 16087910 AU - Edwards RR TI - Individual differences in endogenous pain modulation as a risk factor for chr pain. [FM] SO - Neurology. 2005 Aug 9;65(3):437-43. IN - D o Psychiatry & Behavioral Sciences, Johns Hopkins U School o Med, Baltimore, MD 21287, USA. redwar10@jhmi.edu AB - This review summarizes evidence, primarily from recent human studies, indirectly supporting a novel hypothesis: that the assessment of healthy individuals' responses to standardized noxious stimuli in a controlled laboratory environment has important implications for the later risk of developing a broad spectrum of chronically painful conditions. Descriptions of many chronic pain syndromes note that the disorder (e.g., fibromyalgia, headache, complex regional pain syndrome) is associated with hypersensitivity to pain and with reduced endogenous inhibition of pain, implying that an individual's processing of pain-related information changes with the onset of the syndrome. However, pain sensitivity and pain-inhibitory capacity are normally distributed along a wide continuum in the general population, and recent evidence suggests that heightened baseline pain sensitivity and reduced basal pain-inhibitory processing place individuals at greater risk for experiencing severe, acute, clinical pain (e.g., postoperative pain). More controversial is the hypothesis that such individual-difference characteristics confer risk for, or protection against, chronic pain; although only a single prospective study has been published, substantial indirect evidence supports the contention that greater basal pain sensitivity and reduced pain-inhibitory capacity may act as a diathesis for chronic pain. Long-term cohort studies are necessary to test this hypothesis; such research could yield insight into the nature of chronic pain and permit greater precision in selecting high-risk individuals for chronic pain prevention research. 109 PMID- 15941694 AU - Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R, Jackson LW, Alpern R, Parks BJ, Klimas N, Hall C, Pak HS, Hunter J, Karlinsky J, Battistone MJ, Lyons MJ TI - Gulf War veterans' health: medical evaluation of a U.S. cohort. SO - Ann Intern Med. 2005 Jun 7;142(11):881-90. IN - Veterans Affairs Med Ctr, Washington U School o Med, St. Louis, Missouri 63106, USA. seth.eisen@med.va.gov AB - BACKGROUND: United States military personnel reported various symptoms after deployment to the Persian Gulf during the 1991 Gulf War. However, the symptoms' long-term prevalence and association with deployment remain controversial. OBJECTIVE: To assess and compare the prevalence of selected medical conditions in a national cohort of deployed and nondeployed Gulf War veterans who were evaluated by direct medical and teledermatologic examinations. DESIGN: A cross-sectional prevalence study performed 10 years after the 1991 Gulf War. SETTING: Veterans were examined at 1 of 16 Veterans Affairs medical centers. PARTICIPANTS: Deployed (n = 1061) and nondeployed (n = 1128) veterans of the 1991 Gulf War. MEASUREMENTS: Primary outcome measures included fibromyalgia, the chronic fatigue syndrome, dermatologic conditions, dyspepsia, physical health-related quality of life (Short Form-36 [SF-36]), hypertension, obstructive lung disease, arthralgias, and peripheral neuropathy. RESULTS: Of 12 conditions, only 4 conditions were more prevalent among deployed than nondeployed veterans: fibromyalgia (deployed, 2.0%; nondeployed, 1.2%; odds ratio, 2.32 [95% CI, 1.02 to 5.27]); the chronic fatigue syndrome (deployed, 1.6%; nondeployed 0.1%; odds ratio, 40.6 [CI, 10.2 to 161]); dermatologic conditions (deployed, 34.6%; nondeployed, 26.8%; odds ratio, 1.38 [CI, 1.06 to 1.80]), and dyspepsia (deployed, 9.1%; nondeployed, 6.0%; odds ratio, 1.87 [CI, 1.16 to 2.99]). The mean physical component summary score of the SF-36 for deployed and nondeployed veterans was 49.3 and 50.8, respectively. LIMITATIONS: Relatively low participation rates introduce potential participation bias, and deployment-related illnesses that resolved before the research examination could not, by design, be detected. CONCLUSIONS: Ten years after the Gulf War, the physical health of deployed and nondeployed veterans is similar. However, Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36 physical component score. 110 PMID- 16238661 AU - Elena Garralda M, Chalder T TI - Practitioner review: CFS in childhood. SO - J Child Psychol Psychiatry. 2005 Nov;46(11):1143-51. IN - Imperial Coll, London, UK. egarralda@imperial.ac.uk AB - BACKGROUND: Chronic fatigue syndrome (CFS) is being increasingly recognized in children and adolescents. Yet comparatively little attention has been given in the literature to management. METHODS: Description of the main features of the disorder, precipitating and maintaining factors and diagnostic assessment. Outline of different views on the nature and treatment of CFS in childhood. Description of a rehabilitation program based on cognitive behavior therapy and graded activity. RESULTS: Using adult research criteria, CFS can be diagnosed in children and adolescents. In its severe form it is often triggered by infectious illness episodes. It is commonly associated with mood disorders in the child and with mental distress and high levels of emotional involvement in parents. A number of patient support groups hold the view that CFS is a medical disorder, contest a psychiatric contribution and advocate 'pacing' as an approach to rehabilitation which includes avoiding activities. To date there is no empirical evidence for the efficacy of this approach. Research in adults, open and clinical reports in children support the use of graded activity and family cognitive behavior therapy. The main aim is to enable children, with the help of their family, to carry out their own rehabilitation with some support and guidance from a health professional. Engaging the child and family in treatment and forming a therapeutic alliance is a continual process and a crucial aspect of management, as many families view the condition as a medical disorder and are initially ambivalent towards this approach. CONCLUSIONS: There is controversy about the nature and management of CFS in childhood but a rehabilitation program based on family cognitive behavior therapy can be implemented and seems to hold most promise in the management of children with CFS. Family engagement is a crucial aspect of management. 111 PMID- 16168154 AU - Evengard B, Jacks A, Pedersen NL, Sullivan PF TI - The epidemiology of chr fatigue in the Swedish Twin Registry. [CFS] SO - Psychol Med. 2005 Sep;35(9):1317-26. IN - D o Laboratory Med, Karolinska Institutet at Karolinska U Hosp Huddinge, Stockholm, Sweden. AB - BACKGROUND: Chronic fatigue syndrome (CFS) remains an idiopathic and controversial entity. METHOD: We screened 31405 individual members of the Swedish Twin Registry (aged 42-64 years) for the symptoms of fatiguing illness via a telephone questionnaire. We refined self-reported symptoms via data from several national registries and from physician review of all available medical records in order to approximate closely the dominant case definition of CFS. FINDINGS: The 6-month prevalence of CFS-like illness was 2.36% (95% CI 2.19-2.53) and was markedly higher in women than men, odds ratio 3.92 (95% CI 3.24-4.72) with no significant association with age or years of education. There was a highly significant association with occupation that disappeared after accounting for gender. INTERPRETATION: CFS-like illness may be more common that previously acknowledged. There is a marked increase in risk by gender. Previous reports that CFS is more prevalent in individuals in certain occupational categories were not confirmed and may have been due to confounding by gender. 112 PMID- 15996074 AU - Finckh A, Berner IC, Aubry-Rozier B, So AK TI - A randomized controlled trial of dehydroepiandrosterone in postmenopausal women w FM. SO - J Rheumatol. 2005 Jul;32(7):1336-40. IN - Rheumatology D, U Hosp o Vaud (CHUV), Lausanne, Switzerland. afinckh@post.harvard.edu AB - 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. 113 PMID- 16083460 AU - Fishbain DA, Lewis J, Cole B, Cutler B, Smets E, Rosomoff H, Rosomoff RS TI - Multidisciplinary pain facility Rx outcome for pain-associated fatigue. [FM] SO - Pain Med. 2005 Jul-Aug;6(4):299-304. IN - D o Psychiatry, U o Miami School o Med, Miami, FL 33136, USA. d.fishbain@miami.edu AB - OBJECTIVES: Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. DESIGN: A total of 85 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory on admission. In addition, an information tool was completed on each CPP by the senior author. This tool listed demographic information, primary and secondary pain diagnoses, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, type of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, worker compensation status, and whether, according to the clinical examination, the CPP had a neuropathic pain component. At completion of the multidisciplinary multimodal treatment, each CPP again completed the MFI. Student's t-test was utilized to test for statistical changes on the MFI five scales from pre- to post-treatment. Pearson and point-biserial correlations were utilized to determine which variables significantly correlated with MFI change scores. Variables found significant at less than or equal to 0.01 were utilized in a stepwise aggression analysis to find variables predictive of change in MFI scores. SETTING: Multidisciplinary pain facility. PATIENTS: Chronic LBP and chronic neck pain patients. RESULTS: Multidisciplinary multimodal treatment significantly improved CPP fatigue as measured by the MFI. The available variables utilized to predict fatigue best explained only a small percentage (28.9%) of the variance. Improvement in fatigue was related to NPS-10 scale scores (neuropathic pain) and a previous diagnosis of fibromyalgia. CONCLUSIONS: Multidisciplinary multimodal pain facility treatment improves chronic LBP- and neck pain-associated fatigue. At the present time we cannot predict this improvement with significant accuracy. 114 PMID- 16139179 AU - Flodgren GM, Crenshaw AG, Alfredson H, Fahlstrom M, Hellstrom FB, Bronemo L, Djupsjobacka M TI - Glutamate & prostaglandin E2 in the trapezius muscle of female subjects w chr muscle pain & controls determined by microdialysis. [FM] SO - Eur J Pain. 2005 Oct;9(5):511-5. Epub 2004 Dec 18. IN - Centre for Musculoskeletal Research, U o Gavle, P.O. Box 7629, S-907 12 Umea, Sweden. gerd.flodgren@hig.se AB - Much is still unknown concerning the mechanisms underlying the development of chronic muscle pain. The presence and magnitude of inflammatory substances and neurotransmitters in chronic painful conditions is not clear. The aims of the present study were to determine, with the use of microdialysis, the interstitial concentrations and the equilibration times for PGE2 and glutamate in the trapezius muscles of nine female subjects with chronic muscle pain, and nine pain-free age-matched controls. A microdialysis probe was implanted in the upper part of the trapezius muscle and perfused with Ringer-acetate solution at a flow rate of 0.3 microL/min. Samples were obtained every 30 min, during a 4-h rest period. At equilibration, the mean concentrations (+/-SE) of PGE2 were 0.71 (+/-0.11) ng/mL for the pain-group and 0.97 (+/-0.35) ng/mL for the controls. For glutamate the mean concentrations for the pain-group were 66.3 (+/-13.3) micromol/L and 60.6 (+/-22.9) micromol/L for the controls. For the pain group and the control group, respectively, equilibration for PGE2 was reached at 180 and 150 min, and for glutamate at 150 and 120 min. The present study showed no differences between groups in the concentrations of PGE2 and glutamate in the trapezius muscle. Further, it revealed that when using the slow-flow method, a period of at least 2.0-2.5 h is needed, after probe insertion, to reach steady state for glutamate and PGE2. 115 PMID- 16091130 AU - Fowler T, Duthie P, Thapar A, Farmer A TI - The definition of disabling fatigue in children & adolescents. [CF] SO - BMC Fam Pract. 2005 Aug 9;6:33. IN - D o Psychological Med, Wales Coll o Medicine, Cardiff U, UK. fowlerta@cardiff.ac.uk AB - BACKGROUND: Disabling fatigue is the main illness related reason for prolonged absence from school. Although there are accepted criteria for diagnosing chronic fatigue in adults, it remains uncertain as to how best to define disabling fatigue and Chronic Fatigue Syndrome (CFS) in children and adolescents. In this population-based study, the aim was to identify children who had experienced an episode of disabling fatigue and examine the clinical and demographic differences between those individuals who fulfilled a narrow definition of disabling fatigue and those who fulfilled broader definitions of disabling fatigue. METHODS: Participants (aged 8-17 years) were identified from a population-based twin register. Parent report was used to identify children who had ever experienced a period of disabling fatigue. Standardised telephone interviews were then conducted with the parents of these affected children. Data on clinical and demographic characteristics, including age of onset, gender, days per week affected, hours per day spent resting, absence from school, comorbidity with depression and a global measure of impairment due to the fatigue, were examined. A narrow definition was defined as a minimum of 6 months disabling fatigue plus at least 4 associated symptoms, which is comparable to the operational criteria for CFS in adults. Broader definitions included those with at least 3 months of disabling fatigue and 4 or more of the associated symptoms and those with simply a minimum of 3 months of disabling fatigue. Groups were mutually exclusive. RESULTS: Questionnaires were returned by 1468 families (65% response rate) and telephone interviews were completed on 99 of the 129 participants (77%) who had experienced fatigue. There were no significant differences in demographic and clinical characteristics or levels of impairment between those who fulfilled the narrower definition and those who fulfilled the broader definitions. The only exception was the reported number of days per week that the child was affected by the fatigue. All groups demonstrated evidence of substantial impairment associated with the fatigue. CONCLUSION: Children and adolescents who do not fulfil the current narrow definition of CFS but do suffer from disabling fatigue show comparable and substantial impairment. In primary care settings, a broader definition of disabling fatigue would improve the identification of impaired children and adolescents who require support. 116 PMID- 16039337 AU - Fox RI TI - SS [Sjogren's syndrome, FM] SO - Lancet. 2005 Jul 23-29;366(9482):321-31. IN - Rheumatology Clinic, Scripps Memorial Hosp & Research Foundation, La Jolla, CA 92037, USA. bobfox@adnc.com AB - Sjogren's syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. Dryness of the mouth and eyes results from involvement of the salivary and lacrimal glands. The accessibility of these glands to biopsy enables study of the molecular biology of a tissue-specific autoimmune process. The exocrinopathy can be encountered alone (primary Sjogren's syndrome) or in the presence of another autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. A new international consensus for diagnosis requires objective signs and symptoms of dryness including a characteristic appearance of a biopsy sample from a minor salivary gland or autoantibody such as anti-SS-A. Exclusions to the diagnosis include infections with HIV, human T-lymphotropic virus type I, or hepatitis C virus. Therapy includes topical agents to improve moisture and decrease inflammation. Systemic therapy includes steroidal and non-steroidal anti-inflammatory agents, disease-modifying agents, and cytotoxic agents to address the extraglandular manifestations involving skin, lung, heart, kidneys, and nervous system (peripheral and central) and haematological and lymphoproliferative disorders. The most difficult challenge in diagnosis and therapy is patients with symptoms of fibromyalgia (arthralgia, myalgia, fatigue) and oral and ocular dryness in the presence of circulating antinuclear antibodies. 117 PMID- 15924878 AU - Fremont M, El Bakkouri K, Vaeyens F, Herst CV, De Meirleir K, Englebienne P TI - 2',5'-Oligoadenylate size is critical to protect RNase L against proteolytic cleavage in CFS. SO - Exp Mol Pathol. 2005 Jun;78(3):239-46. Epub 2005 Mar 2. IN - RED Laboratories, Pontbeek 61, B-1731 Zellik, Belgium. AB - A dysregulation in the 2',5'-oligoadenylate (2-5A)-dependent RNase L antiviral pathway has been detected in peripheral blood mononuclear cells (PBMC) of chronic fatigue syndrome (CFS) patients, which is characterized by upregulated 2-5A synthetase and RNase L activities, as well as by the presence of a low molecular weight (LMW) 2-5A-binding protein of 37-kDa related to RNase L. This truncated protein has been shown to originate from proteolytic cleavage of the native 83-kDa RNase L by m-calpain and human leukocyte elastase (HLE). We investigated the possible role of 2-5A oligomers in the proteolytic action toward the endonuclease and show that incubation of CFS PBMC extracts with 2-5A trimer and tetramer, but not with the dimer, results in a significant protection of the native 83-kDa RNase L against cleavage by endogenous and purified proteases. Similar results are obtained with a purified recombinant RNase L. An analysis of the size of 2-5A oligomers produced by the catalytic activity of the 2-5A synthetase present in PBMC extracts further shows that samples containing the 37-kDa RNase L preferentially produce 2-5A dimers instead of higher oligomers. Taken together, our results indicate that homodimerization of RNase L by 2-5A oligomers higher than the dimer prevents its cleavage by proteolytic enzymes. The presence of the truncated 37-kDa RNase L in PBMC extracts is therefore likely to result, not only from the abnormal activation of inflammatory proteases, but also from a dysregulation in 2-5A synthetase induction or activation towards the preferential production of 2-5A dimers. 118 PMID- 16331774 AU - Friedberg F, Leung DW, Quick J TI - Do support groups help people w CFS & FM? A comparison of active & inactive members. SO - J Rheumatol. 2005 Dec;32(12):2416-20. IN - D o Psychiatry, Stony Brook U, Stony Brook, New York 11794-8790, USA. fred.friedberg@stonybrook.edu AB - OBJECTIVE: To examine the benefits and problems of a chronic fatigue syndrome (CFS) and fibromyalgia (FM) support organization as reported by its participants. METHODS: Active members (n = 32) and inactive members or dropouts (n = 135) of a regional support organization for people with CFS and FM completed a 26 item questionnaire by telephone interview or by self-completion and postal return. RESULTS: The most frequently endorsed benefits of membership were illness legitimization (67.8%), finding out helpful new information (66.4%), and feeling understood by others (62.2%). Lower frequency endorsements were given to: helped to find (35.0%) or deal with (38.5%) doctors, and helped to improve my illness (36.4%). The most frequently reported reasons for dropping out were inconvenient location (37.8%) or time (37.0%), too much negative talk or complaining (33.3%), too sick to attend (28.8%), and illness or coping improvement (29.6% each). The active-member group showed significantly higher (p < 0.04) symptom severity scores and less illness improvement (p < 0.01) in comparison to the inactive/dropout group. CONCLUSION: This cross-sectional study suggests that support groups for CFS are viewed as helpful by participants on a number of illness related issues. On the other hand, active members reported greater symptom severity and less illness improvement than inactive members or dropouts. 119 PMID- 15950390 AU - Fries E, Hesse J, Hellhammer J, Hellhammer DH TI - A new view on hypocortisolism. [CF] SO - Psychoneuroendocrinology. 2005 Nov;30(10):1010-6. IN - D for Psychobiology, U o Trier, Johanniterufer 15, 54290 Trier, Germany. AB - Low cortisol levels have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Data suggest that these disorders are characterized by a symptom triad of enhanced stress sensitivity, pain, and fatigue. This overview will present data on the development, mechanisms and consequences of hypocortisolism on different bodily systems. We propose that the phenomenon of hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress as illustrated in an animal model. Further evidence suggests that despite symptoms such as pain, fatigue and high stress sensitivity, hypocortisolism may also have beneficial effects on the organism. This assumption will be underlined by some studies suggesting protective effects of hypocortisolism for the individual. 120 PMID- 16042909 AU - Frissora CL, Koch KL TI - Symptom overlap & comorbidity of irritable bowel syndrome w other conditions. [FM/CFS] SO - Curr Gastroenterol Rep. 2005 Aug;7(4):264-71. IN - D o Med, The Weill Med Coll o Cornell U, 520 E. 70th Street, Suite J-314, New York, NY 10021, USA. cfrissor@med.cornell.edu AB - Irritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance), and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions. 121 PMID- 16253618 AU - Furberg H, Olarte M, Afari N, Goldberg J, Buchwald D, Sullivan PF TI - The prevalence of self-reported chr fatigue in a U.S. twin registry. [CF] SO - J Psychosom Res. 2005 Nov;59(5):283-90. IN - D o Genetics, U o North Carolina, Chapel Hill, NC, USA. AB - OBJECTIVE: To investigate the prevalence and correlates of various definitions of self-reported lifetime fatiguing illness in a U.S. twin registry. METHODS: Data from 4591 female and male twins from the population-based Mid-Atlantic Twin Registry were available for this study. Variables representing different definitions of lifetime fatiguing illness and personal characteristics were obtained through questionnaires. Odds ratios and 95% confidence intervals were calculated as measures of association between fatigue and gender. Kaplan-Meier curves were produced to examine the age at onset for lifetime fatiguing illnesses. RESULTS: Prevalences for different definitions of self-reported lifetime fatigue ranged from 36.7% for any fatigue to 2.7% for chronic fatigue syndrome-like illness. Females were two to three times more likely to report fatigue than males. Gender differences increased as fatigue definitions grew more restrictive. Ages at onset of chronic fatiguing illness were significantly earlier and the number of ancillary symptoms was greater for females than males. People with lifetime fatigue had significantly more compromised functional status than people without lifetime fatigue. CONCLUSION: The prevalence of self-reported lifetime fatiguing illness varied widely depending upon how it was defined. Given the debilitating consequences of fatiguing illnesses, the reasons for the female predominance and the earlier onset in women should receive increased research priority. 122 PMID- 16142879 AU - Furlan R, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, Porta A, Pace F, Malliani A, Sarzi-Puttini P TI - Abnormalities of cardiovascular neural control & reduced orthostatic tolerance in pts w primary FM. SO - J Rheumatol. 2005 Sep;32(9):1787-93. IN - D o Internal Med II, Ospedale L. Sacco, Universita degli Studi di Milano, Milano, Italy. raffaellof@fisiopat.sacco.unimi.it AB - OBJECTIVE: Fibromyalgia (FM) is a syndrome characterized by widespread musculoskeletal pain. Symptoms of orthostatic intolerance may also be present, suggesting underlying abnormalities of cardiovascular neural regulation. We tested the hypothesis that FM is characterized by sympathetic overactivity and alterations in cardiovascular autonomic response to gravitational stimulus. METHODS: Sixteen patients with primary FM and 16 healthy controls underwent electrocardiography examination, finger blood pressure, respiration, and muscle sympathetic nerve activity (MSNA) recordings at rest and during stepwise tilt test, up to 75 degrees . The autonomic profile was assessed by MSNA, plasma catecholamine, and spectral indices of cardiac sympathetic (LFRR in normalized units, NU) and vagal (HFRR both in absolute and NU) modulation and of sympathetic vasomotor control (LFSAP) computed by spectrum analysis of RR and systolic arterial pressure (SAP) variability. Arterial baroreflex function was evaluated by the SAP/RR spontaneous-sequences technique, the index a, and the gain of MSNA/diastolic pressure relationship during stepwise tilt test. RESULTS: At rest, patients showed higher values of heart rate, MSNA, LFRR NU, LF/HF, LFSAP, and reduced HFRR than controls. During tilt test, lack of increase of MSNA, less decrease of HFRR, and excessive rate (44%) of syncope were found in patients, suggesting reduced capability to enhance the sympathetic activity to vessels and withdraw the vagal modulation to sino-atrial node. Baroreflex function was similar in both groups. CONCLUSION: Patients with FM have an overall enhancement of cardiovascular sympathetic activity while recumbent. Lack of increased sympathetic discharge to vessels and decreased cardiac vagal activity characterize their autonomic profile during tilt test, and might account for the excessive rate of syncope. 123 PMID- 15471616 AU - Gaab J, Rohleder N, Heitz V, Engert V, Schad T, Schurmeyer TH, Ehlert U TI - Stress-induced changes in LPS-induced pro-inflammatory cytokine production in CFS. SO - Psychoneuroendocrinology. 2005 Feb;30(2):188-98. IN - Center for Psychobiological & Psychosomatic Research, U o Trier, Trier, Germany. j.gaab@psychology.unizh.ch AB - OBJECTIVE: It has been suggested that a hypofunctional hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome could result in an exaggerated release of pro-inflammatory cytokines during stress. As pro-inflammatory cytokines are involved in the induction of sickness behavior and thus constitute a potential physiological correlate of stress-induced symptom exacerbation in chronic fatigue syndrome, we set out to evaluate the LPS-induced production of pro-inflammatory cytokines during psychosocial stress in CFS and healthy controls. METHOD: Twenty-one CFS patients and 20 healthy controls matched for age and gender underwent a standardized psychosocial stress test (Trier social stress test, TSST). Adrenocorticotropine hormone (ACTH), salivary cortisol and plasma cortisol levels were measured before and repeatedly following exposure to the stressor. Lipopolysaccharide-stimulated production of interleukin-6 and tumor necrosis factor-alpha were assessed at baseline as well as 10 and 60 min after the stress test. RESULTS: CFS patients showed an inverse stress-induced response pattern of LPS-stimulated cytokines responses in comparison to healthy controls, i.e. stimulated cytokine production decreased shortly after stress in CFS patients, while it increased in controls. Fatigue scores and basal LPS-induced cytokine levels were significantly associated for TNF-alpha in controls and for both cytokines in CFS patients. Stress-induced changes in stimulated cytokine production were not associated with general fatigue scores in the control group, whereas in the CFS group, fatigue scores were significantly correlated with integrated levels of LPS-induced cytokines. However, partial correlations revealed that these results were due to the high correlations with basal LPS-induced cytokine levels. CONCLUSION: CFS patients do not show an exaggerated secretion of LPS-induced cytokines. Although cortisol responses to stress were normal, pro-inflammatory cytokine levels in CFS patients were significantly attenuated. Possible intracellular mechanisms, such as for example an enhanced sensitivity to inhibitory effects of glucocorticoids, a diminished responsivity to catecholaminergic stimulation, and a disruption of intracellular activation are discussed. Basal levels of stimulated pro-inflammatory Il-6 levels are generally related to fatigue scores. However, in CFS patients this association is of greater magnitude and can also be observed for TNF-alpha. 124 PMID- 15992572 AU - Gallagher AM, Coldrick AR, Hedge B, Weir WR, White PD TI - Is the CFS an exercise phobia? A case control study. SO - J Psychosom Res. 2005 Apr;58(4):367-73. IN - Centre for Psychiatry, Inst o Community Health Sciences, Queen Mary School o Med & Dentistry, St. Bartholomew's Hosp, EC1A 7BE London, UK. AB - OBJECTIVE: The aim of this study was to test whether patients with chronic fatigue syndrome (CFS) have an exercise phobia, by measuring anxiety-related physiological and psychological reactions to ordinary activity and exercise. METHODS: Patients and healthy but sedentary controls were assessed over 8 h of an ordinary day, and before, during and after an incremental exercise test on a motorised treadmill. To avoid confounding effects, those with a comorbid psychiatric disorder were excluded. Heart rate, galvanic skin resistance (GSR) and the amount of activity undertaken were measured, along with state and trait measures of anxiety. RESULTS: Patients with CFS were more fatigued and sleep disturbed than were the controls and noted greater effort during the exercise test. No statistically significant differences were found in either heart rate or GSR both during a normal day and before, during and after the exercise test. Patients with CFS were more symptomatically anxious at all times, but this did not increase with exercise. CONCLUSION: The data suggest that CFS patients without a comorbid psychiatric disorder do not have an exercise phobia. 125 PMID- 16012065 AU - Gard G TI - Body awareness therapy for pts w FM & chr pain. SO - Disabil Rehabil. 2005 Jun 17;27(12):725-8. IN - D o Health Sciences, Lulea U, Hedenbrovagen, 961 3b, Boden, Sweden. gunvord.gard@Hu.se AB - 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. 126 PMID- 16206355 AU - Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, Williams DA, Mease PJ, McLean SA, Clauw DJ TI - Efficacy of milnacipran in pts w FM. SO - J Rheumatol. 2005 Oct;32(10):1975-85. IN - Cypress Biosciences, 4350 Executive Drive, San Diego, CA 92121, USA. mgendreau1@cypressbio.com AB - 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. 127 PMID- 16259310 AU - Gerwin RD TI - A review of myofascial pain & FM--factors that promote their persistence. SO - Acupunct Med. 2005 Sep;23(3):121-34. IN - gerwin@painpoints.com AB - Chronic muscle pain (myalgia) is a common problem throughout the world. Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain. The two common muscle pain conditions are fibromyalgia and myofascial pain syndrome. Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis. Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle. The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying cause(s) of persistent or chronic muscle pain in order to develop a specific treatment plan. Chronic myalgia may not improve until the underlying precipitating or perpetuating factor(s) are themselves managed. Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypomobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency. Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition. 128 PMID- 15880832 AU - Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ TI - The relationship between depression, clinical pain, & experimental pain in a chr pain cohort. [FM] SO - Arthritis Rheum. 2005 May;52(5):1577-84. IN - U o Michigan, Ann Arbor, USA. AB - OBJECTIVE: Individuals with chronic pain frequently display comorbid depression, but the impact of symptoms of depression on pain processing is not completely understood. This study evaluated the effect of symptoms of depression and/or clinically diagnosed major depressive disorder (MDD) on pain processing in patients with fibromyalgia (FM). METHODS: Results of quantitative sensory testing and neural responses to equally painful pressure stimuli (measured by functional magnetic resonance imaging [fMRI]) were compared with the levels of symptoms of depression and comorbid MDD among patients with FM. RESULTS: Neither the level of symptoms of depression nor the presence of comorbid MDD was associated with the results of sensory testing or the magnitude of neuronal activation in brain areas associated with the sensory dimension of pain (primary and secondary somatosensory cortices). However, symptoms of depression and the presence of MDD were associated with the magnitude of pain-evoked neuronal activations in brain regions associated with affective pain processing (the amygdalae and contralateral anterior insula). Clinical pain intensity was associated with measures of both the sensory dimension of pain (results of sensory testing) and the affective dimension of pain (activations in the insula bilaterally, contralateral anterior cingulate cortex, and prefrontal cortex). CONCLUSION: In patients with FM, neither the extent of depression nor the presence of comorbid major depression modulates the sensory-discriminative aspects of pain processing (i.e., localizing pain and reporting its level of intensity), as measured by sensory testing or fMRI. However, depression is associated with the magnitude of neuronal activation in brain regions that process the affective-motivational dimension of pain. These data suggest that there are parallel, somewhat independent neural pain-processing networks for sensory and affective pain elements. The implication for treatment is that addressing an individual's depression (e.g., by prescribing an antidepressant medication that has no analgesic properties) will not necessarily have an impact on the sensory dimension of pain. 129 PMID- 15664781 AU - Glaser R, Padgett DA, Litsky ML, Baiocchi RA, Yang EV, Chen M, Yeh PE, Klimas NG, Marshall GD, Whiteside T, Herberman R, Kiecolt-Glaser J, Williams MV TI - Stress-associated changes in the steady-state expression of latent Epstein-Barr virus: implications for CFS & cancer. [CFS] SO - Brain Behav Immun. 2005 Mar;19(2):91-103. IN - D o Molecular Virology, Immunology & Med Genetics, The Ohio St U Med Ctr, 333 W. 10th Avenue, Columbus, OH 43210, USA. glaser.1@osu.edu AB - Antibodies to several Epstein-Barr virus (EBV)-encoded enzymes are observed in patients with different EBV-associated diseases. The reason for these antibody patterns and the role these proteins might play in the pathophysiology of disease, separate from their role in virus replication, is unknown. In this series of studies, we found that purified EBV deoxyuridine triphosphate nucleotidohydrolase (dUTPase) can inhibit the replication of human peripheral blood mononuclear cells in vitro and upregulate the production of TNF-alpha, IL-1beta, IL-6, IL-8, and IL-10. It also enhanced the ability of natural killer cells to lyse target cells. The EBV dUTPase also significantly inhibited the replication of mitogen-stimulated lymphocytes and the synthesis of IFN-gamma by cells isolated from lymph nodes and spleens obtained from mice inoculated with the protein. It also produced sickness behaviors known to be induced by some of the cytokines that were studied in the in vitro experiments. These symptoms include an increase in body temperature, a decrease in body mass and in physical activity. The data provide a new perspective on how an early nonstructural EBV-encoded protein can cause immune dysregulation and produce clinical symptoms observed in patients with chronic fatigue syndrome (CFS) separate from its role in virus replication and may serve as a new approach to help identify one of the etiological agents for CFS. The data also provide additional insight into the pathophysiology of EBV infection, inflammation, and cancer. 130 PMID- 15865951 AU - Glass JM, Park DC, Minear M, Crofford LJ TI - Memory beliefs & function in FM pts. SO - J Psychosom Res. 2005 Mar;58(3):263-9. IN - Institute for Social Research, U o Michigan, 426 Thompson Street, Ann Arbor, MI 48106, United States. jglass@umich.edu AB - OBJECTIVE: The aim of this study was to investigate memory beliefs and their relationship to actual memory function in fibromyalgia (FM) patients. METHODS: Twenty-three FM patients, 23 age- and education-matched controls, and 22 older controls completed the Metamemory in Adulthood (MIA) questionnaire, which assessed beliefs about seven aspects of memory function. Group differences on the seven scales were assessed, and scores on the capacity scale were correlated with objective memory performance. RESULTS: FM patients reported lower memory capacity and more memory deterioration than did either control group. Patients reported lower control or self-efficacy over memory, higher achievement motivation, higher strategy use, and higher anxiety about memory than age-matched controls did. Among the patients, perceived capacity, achievement motivation, and self-efficacy were significantly correlated with objective memory performance on a recall task. CONCLUSION: FM patients' complaints about memory function have some accuracy. 131 PMID- 15599128 AU - Goossens ME, Vlaeyen JW, Hidding A, Kole-Snijders A, Evers SM TI - Treatment expectancy affects the outcome of cognitive-behavioral interventions in chr pain. SO - Clin J Pain. 2005 Jan-Feb;21(1):18-26; discussion 69-72. IN - D o Med, Clinical, & Experimental Psychology, Maastricht U, Maastricht, The Netherlands. m.goossens@dep.unimaas.nl AB - Patients' initial beliefs about the success of a given pain treatment are shown to have an important influence on the final treatment outcome. The aims of the paper are to assess determinants of patients' treatment expectancy and to examine the extent to which treatment expectancy predicts the short-term and long-term outcome of cognitive-behavioral treatment of chronic pain. This study employs the data of 2 pooled randomized clinical trials evaluating the effectiveness of cognitive-behavioral interventions for 171 patients with fibromyalgia and chronic low back pain. Pretreatment and posttreatment expectancy were measured by a short questionnaire, which was based on the procedure by Borkovec and Nau. Four composite outcome variables (pain coping and control, motoric behavior, negative affect, and quality of life) were measured before and after the intervention and at 12 months follow-up. Furthermore, several patient characteristics were taken into account. Patients with higher treatment expectancies significantly received less disability compensation and were less fearful. A regression model of 3 factors (better pain coping and control, active and positive interpretation of pain, and less disability compensation) significantly explained 10% of the variance in pretreatment expectancy. Pretreatment expectancy significantly predicted each of the 4 outcome measures immediately after treatment and at 12 months follow-up. This study corroborates the importance of treatment expectation before entering a cognitive-behavioral intervention in patients with chronic musculoskeletal pain. 132 PMID- 15710856 AU - Gottschalk M, Kumpfel T, Flachenecker P, Uhr M, Trenkwalder C, Holsboer F, Weber F TI - Fatigue & regulation of the hypothalamo-pituitary-adrenal axis in multiple sclerosis. [CF] SO - Arch Neurol. 2005 Feb;62(2):277-80. IN - Max Planck Inst o Psychiatry, Munich, Germany. AB - BACKGROUND: Fatigue is a common and disabling symptom in patients with multiple sclerosis (MS). Underlying mechanisms postulated so far have involved localization of brain lesions and abnormalities of the neuroendocrine system and cytokine regulation. OBJECTIVE: To investigate the relationship between fatigue and the hypothalamo-pituitary-adrenal (HPA) axis in patients with MS. DESIGN: A prospective survey. SETTING: Outpatient and inpatient study at the Max Planck Institute of Psychiatry, Munich, Germany. PATIENTS: Thirty-one patients with clinically definite MS, a relapsing-remitting disease course, and without MS-specific treatment. INTERVENTIONS: Assessment of fatigue with 3 questionnaires: the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), and the Visual Analog Scale. Assessment of HPA axis regulation with the combined dexamethasone-corticotropin releasing hormone (Dex-CRH) test. RESULTS: The FSS score was significantly correlated with the MFIS score. Patients with fatigue had significantly elevated adrenocorticotropin (ACTH) levels in the combined Dex-CRH test. CONCLUSIONS: In contrast to results for chronic fatigue syndrome, where a hyporeactivity of the HPA axis has been shown, MS patients with fatigue exhibited a higher activity of the HPA axis than those without fatigue, as evidenced by significantly increased ACTH concentrations. Proinflammatory cytokines, known to be elevated in patients with MS, may cause both HPA axis alterations and fatigue. 133 PMID- 16474286 AU - Guven AZ, Kul Panza E, Gunduz OH TI - Depression & psychosocial factors in Turkish women w FM syndrome. SO - Eura Medicophys. 2005 Dec;41(4):309-13. IN - D o Physical Med & Rehabilitation, Marmara U School o Medicine, Istanbul, Turkey. zoguven@tnn.net AB - AIM: The aim of this study was to evaluate the demographic qualifications, frequency of depression, degree of pain, and the correlations between these factors in Turkish women with fibromyalgia syndrome (FS). METHODS: Fifty-three women with FS and 54 healthy women were included in the study. The visual analogue scale (VAS) was applied to evaluate the degree of pain and Beck depression inventory (BDI) for depression. RESULTS: Mean age of the FS and the healthy women groups was 42.6+/-9.6 (21-63) and 39.4+/-13.2 (24-60) years respectively; which were statistically similar (P>0.05). Of the patients, 69.8% were married, and the mean years of education was 8.7+/-4.8 years. Marriage among relatives was found in 18.4% of the patients. The mean VAS score of the patients was 7.2+/-1.7 cm with the mean duration of pain 5+/-4.6 years. Mean BDI scores of FS patients and the healthy group were 15.7+/-8.7 and 10.2+/-5.5 respectively; the difference between the 2 groups was statistically significant (P<0.05). According to the BDI scores, 90% of FS patients were classified as depressed; among them, 50% had minor, 38% moderate, and 2% severe depression. FS patients who were married to a relative had higher scores of BDI (r=0.414, P=0.013). There was negative correlation between BDI score and patients' total year of education (r=-0.295, P=0.037); and the husband's education level (r=-0.367, P=0.030). According to BDI, the c2 test revealed significant depression in patients with sleep-disorders (P=0.009). CONCLUSIONS: We found a significant degree of depression in Turkish female FS patients. This situation is found to be correlated with the education level of both patient and husband; marital status, and sleep-disorder; it is suggested that these factors should be taken into consideration in the diagnosis, treatment and follow-up of FS patients. 134 PMID- 15781924 AU - Haines LC, Saidi G, Cooke RW TI - Prevalence of severe fatigue in primary care. [CF] SO - Arch Dis Child. 2005 Apr;90(4):367-8. IN - Royal Coll o Paediatrics & Child Health, 50 Hallam Street, London W1W 6DE, UK. Linda.haines@rcpch.ac.uk AB - A postal survey of 1024 UK GP practices showed the prevalence of medically unexplained severe fatigue over three months in 5-19 year olds to be 62/100,000. Cases were predominantly adolescent girls and were more likely to come from practices in less deprived areas, which could reflect consulting behaviours. 135 PMID- 15805126 AU - Hamilton WT, Gallagher AM, Thomas JM, White PD TI - The prognosis of different fatigue diagnostic labels: a longitudinal survey. [CFS] SO - Fam Pract. 2005 Aug;22(4):383-8. Epub 2005 Apr 1. IN - The Grange, Bristol BS8 1AU, UK. w.hamilton@bristol.ac.uk AB - BACKGROUND: Several different diagnostic labels exist for the fatigue syndromes, including chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME) and postviral fatigue syndrome (PVFS). An allied condition is fibromyalgia. No study has examined prognostic differences across these different labels. OBJECTIVE: To compare the prognoses of patients labelled with different fatigue syndromes in primary care. METHODS: We performed a longitudinal survey, using electronic records from the General Practice Research Database. All 18,122 patients diagnosed by their GP with a fatigue syndrome from 1988-2001 with a minimum of one year of records after diagnosis were collated into four groups: CFS, ME, PVFS and fibromyalgia. CFS and ME were combined for the main analysis as no code for CFS was available until 1995. The length of illness was calculated as the interval between the diagnosis and the last recorded fatigue symptom, expressed as days per year, to account for differing lengths of record after diagnosis. RESULTS: Patients with CFS/ME combined had a worse prognosis (median length of illness 80 days per year; interquartile range 0-242) than fibromyalgia (51; 0-244) or PVFS 0 (0-108), a significant difference, P < 0.001. In a subgroup analysis, ME had a worse prognosis (median length of illness in days per year 106; interquartile range 0-259) than CFS (33; 0-170), P < 0.001, in spite of a better course before diagnosis. Secondary outcome measures were consistent with these results. CONCLUSION: There were important differences in outcome between the various fatigue labels, with ME having the worst prognosis and PVFS the best. This could be an adverse effect of the label ME itself. Alternatively, patients who are destined to have a worse prognosis may preferentially attract the ME label. Our data support the first interpretation. 136 PMID- 15693098 AU - Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, Tahir M TI - Prevalence of rheumatic diseases & associated outcomes in rural & urban communities in Bangladesh: a COPCORD study. [FM] SO - J Rheumatol. 2005 Feb;32(2):348-53. IN - Rheumatology Wing, D o Med, Bangabandhu Sheikh Mujib Med U Shahbagh, Dhaka, Indonesia. sahaq@citech.net AB - OBJECTIVE: To estimate the burden of rheumatic disorders in adults (age >/= 15 yrs) in Bangladeshi rural and urban communities. METHODS: The survey was carried out in a rural community, an urban slum, and an affluent urban community with samples of 2635, 1317, and 1259 adults, respectively. Through door-to-door surveys, trained interviewers identified subjects with musculoskeletal pain. A socio-culturally adapted and validated Bengali version of the COPCORD (Community Oriented Program for Control of Rheumatic Disorders) questionnaire was used. Trained internists and rheumatologists examined the positive respondents using an English COPCORD examination sheet to identify respondents with definite rheumatic disorders and to reach a diagnosis. RESULTS: The overall point prevalence of musculoskeleletal pain was 26.3%. The point prevalence estimates of musculoskeletal pain in rural, urban slum, and affluent urban communities were 26.2% (women 31.3%, men 21.1%), 24.9% (women 27.5%, men 22.6%), and 27.9% (women 35.5%, men 18.6%), respectively. Most commonly affected sites were low back, knees, hips, and shoulders in all 3 communities. The point prevalence of definite rheumatic disorders was 24.0%. The commonest rheumatic disorders were osteoarthritis of the knees, nonspecific low back pain, lumbar spondylosis, fibromyalgia, and soft tissue rheumatism. Their prevalence estimates were 7.5%, 6.6%, 5.0%, 4.4%, and 2.7%, respectively, in the rural, 9.2%, 9.9%, 2.0%, 3.2%, and 2.5%, respectively, in the urban slum, and 10.6%, 9.2%, 2.3%, 3.3%, and 3.3% in the urban affluent community. The point prevalence of functional disability was 25.5%, 23.3%, and 24.8%, respectively, in the rural, urban slum, and urban affluent communities. Among the positive respondents, 22%, 52%, and 22% reported loss of work for durations of 49.3 +/- 47.5, 50.90 +/- 103.3, and 29.25 +/- 56.5 days, respectively, within the previous year. CONCLUSION: Rheumatic disorders are common causes of morbidity, disability, and work loss in rural and urban communities of Bangladesh. Women are affected more frequently than men. Mechanical disorders are more common than inflammatory arthropathies. 137 PMID- 16258905 AU - Harris RE, Williams DA, McLean SA, Sen A, Hufford M, Gendreau RM, Gracely RH, Clauw DJ TI - Characterization & consequences of pain variability in individuals w FM. SO - Arthritis Rheum. 2005 Nov;52(11):3670-4. IN - Chronic Pain & Fatigue Research Ctr, U o Michigan Med Center, 24 Frank Lloyd Wright Drive, PO Box 385, Ann Arbor, MI 48106, USA. reharris@med.umich.edu AB - OBJECTIVE: A growing body of evidence suggests that real-time electronic assessments of pain are preferable to traditional paper-and-pencil measures. We used electronic assessment data derived from a study of patients with fibromyalgia (FM) to examine variability of pain over time and to investigate the implications of pain fluctuation in the context of a clinical trial. METHODS: The study group comprised 125 patients with FM who were enrolled in a randomized, placebo-controlled trial of milnacipran. Pain intensity levels were captured in real time by participants using electronic diaries. Variability in pain was assessed as the standard deviation of pain entries over time (pain variability index [PVI]). RESULTS: Substantial between-subject differences in pain variability were observed (mean +/- SD PVI 1.61 +/- 0.656 [range 0.27-4.05]). The fluctuation in pain report was constant over time within individuals (r = 0.664, P < 0.001). Individuals with greater variability were more likely to be classified as responders in a drug trial (odds ratio 6.14, P = 0.006); however, this association was primarily attributable to a greater change in pain scores in individuals receiving placebo (r = 0.460, P = 0.02) rather than active drug (r = 0.09, P > 0.10). CONCLUSION: Among individuals with FM, there were large between-subject differences in real-time pain reports. Pain variability was relatively constant over time within individuals. Perhaps the most important finding is that individuals with larger pain fluctuations were more likely to respond to placebo. It is not clear whether these findings are applicable only to patients with FM or whether they may also be seen in patients with other chronic pain conditions. 138 PMID- 16131290 AU - Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, Groner KH, Biswas P, Gracely RH, Clauw DJ TI - Treatment of FM w formula acupuncture: investigation of needle placement, needle stimulation, & Rx frequency. SO - J Altern Complement Med. 2005 Aug;11(4):663-71. IN - D o Internal Med, Div o Rheumatology, U o Michigan, Ann Arbor, MI 48106, USA. reharris@med.umich.edu AB - 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 < or = 0.002). CONCLUSIONS: Although needle insertion led to analgesia and improvement in other somatic symptoms, correct needle location and stimulation were not crucial. 139 PMID- 16198192 AU - Henderson M, Tannock C TI - Use of depression rating scales in CFS. SO - J Psychosom Res. 2005 Sep;59(3):181-4. IN - Academic D o Psychological Medicine, GKT School o Med & Inst o Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom. AB - OBJECTIVE: The aim of this study was to examine the performance of three commonly used depression rating scales in a hospital sample of patients with chronic fatigue syndrome (CFS). METHODS: Sixty-one patients with CDC criteria for CFS completed the General Health Questionnaire (GHQ), the Hamilton Depression Scale (HAM-D) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). Current psychiatric status was assessed using the Structured Clinical Interview for DSM-III-R. DISORDERS: Patient version (SCID-P). Receiver operating curves were drawn for each of the depression rating scales. RESULTS: Thirty-one percent of the patients were depressed according to the SCID-P. Using the standard cut-offs, both GHQ and HAM-D overestimated the number of depressed patients, whilst the HADS-D underestimated the number. The receiver operating curves suggest that the optimum cut-offs for GHQ, HAM-D and HADS-D in this population are 7/8, 13/14 and 8/9, respectively. CONCLUSIONS: Standard cutoffs may not be appropriate when using depression rating scales in CFS patients in a tertiary care setting. 140 PMID- 16012061 AU - Henriksson CM, Liedberg GM, Gerdle B TI - Women w FM: work & rehabilitation. SO - Disabil Rehabil. 2005 Jun 17;27(12):685-94. IN - Section o Occupational Therapy, Linkoping U, Linkoping, Sweden. AB - PURPOSE: To explore disability in women with fibromyalgia with a focus on their work situation. METHOD: Review of literature on work status of women with fibromyalgia. RESULTS: Major differences exist between studies in reported disability and in the percentages of women working. Limitations caused by pain, fatigue, decreased muscle strength, and endurance influence work capacity. However, 34 - 77% of the women work. Individual adjustments in the work situation are reported. When the women find a level that matches their ability, they continue to work and find satisfaction in their work role. Many factors besides degree of impairment or disability influence whether clients with longstanding pain can remain in their work role or return to work after sickness leave. CONCLUSION: The total life situation, other commitments, type of work tasks, the ability to influence the work situation, and the physical and psychosocial work environment are important factors in determining whether a person can remain in a work role. More knowledge is needed about how to adjust work conditions for people with partial work ability to the benefit of society and the individual. 141 PMID- 15861265 AU - Hershfield NB TI - Nongastrointestinal Sx of irritable bowel syndrome: an office-based clinical survey. [FM] SO - Can J Gastroenterol. 2005 Apr;19(4):231-4. IN - Division o Gastroenterology, D o Med, U o Calgary, Calgary, Alberta. gutdoc1@shaw.ca AB - Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal problem faced by practicing gastroenterologists. For many years, nongastrointestinal symptoms have been documented in IBS patients, but the medical literature does not emphasize them. The present study explored how IBS and inflammatory bowel disease patients differ in their reporting of nongastrointestinal symptoms. Information from 200 consecutive patients with IBS and a similar number of patients with Crohn's disease (in a single gastroenterology practice) was obtained at the initial visit using a simple questionnaire. Comparison of the data revealed that IBS patients describe certain nongastrointestinal symptoms far more frequently than do those with inflammatory bowel disease. It is recommended that these symptoms be considered along with the generally accepted criteria for making a positive diagnosis of IBS. 142 PMID- 16171242 AU - Hindmarch I, Dawson J, Stanley N TI - A double-blind study in healthy volunteers to assess the effects on sleep of pregabalin compared w alprazolam & placebo. [FM] SO - Sleep. 2005 Feb 1;28(2):187-93. IN - HPRU Med Research Centre, U o Surrey, School o Biomedical & Molecular Sciences, Egerton Road, Guildford, UK. AB - STUDY OBJECTIVES: To assess the effects of pregabalin compared with alprazolam and placebo on aspects of sleep in healthy volunteers. DESIGN: Randomized, double-blind, placebo- and active-controlled, 3-way crossover. SETTING: Single research center. PARTICIPANTS AND INTERVENTIONS: Healthy adult (12 men) volunteers (N=24) received oral pregabalin 150 mg t.i.d., alprazolam 1 mg t.i.d., and placebo t.i.d. for 3 days. MEASUREMENTS AND RESULTS: Objective sleep was measured by an 8-channel polysomnograph; subjective sleep was measured using the Leeds Sleep Evaluation Questionnaire. Compared with placebo, pregabalin significantly increased slow-wave sleep both as a proportion of the total sleep period and the duration of stage 4 sleep. Alprazolam significantly reduced slow-wave sleep. Pregabalin and alprazolam produced modest, but significant, reductions in sleep-onset latency compared with placebo. Rapid eye movement sleep latency after pregabalin was no different than placebo but was significantly shorter than that found with alprazolam. Although there were no differences between the active treatments, both pregabalin and alprazolam reduced rapid eye movement sleep as a proportion of the total sleep period compared with placebo. Pregabalin also significantly reduced the number of awakenings of more than 1 minute in duration. Leeds Sleep Evaluation Questionnaire ratings of the ease of getting to sleep and the perceived quality of sleep were significantly improved following both active treatments, and ratings of behavior following awakening were significantly impaired by both drug treatments. CONCLUSIONS: Pregabalin appears to have an effect on sleep and sleep architecture that distinguishes it from benzodiazepines. Enhancement of slow-wave sleep is intriguing, since reductions in slow-wave sleep have frequently been reported in fibromyalgia and general anxiety disorder. 143 PMID- 16170166 AU - Hjermstad MJ, Fossa SD, Oldervoll L, Holte H, Jacobsen AB, Loge JH TI - Fatigue in long-term Hodgkin's Disease survivors: a follow-up study. [CF] SO - J Clin Oncol. 2005 Sep 20;23(27):6587-95. IN - D o Oncology, Ulleval U Hosp HF, KSLB, 0407 Oslo, Norway. m.j.hjermstad@basalmed.uio.no AB - PURPOSE: To describe total fatigue (TF) and chronic fatigue (CF) in 476 long-term Hodgkin's disease survivors (HDSs). The development in CF over time was explored in 280 of the patients who had also been assessed 8 years earlier. PATIENTS AND METHODS: In 2003, the Fatigue Questionnaire was mailed to 610 successfully treated HDSs at the Norwegian Radium Hospital from 1971 to 1997. Mean TF scores and occurrence of CF were compared with general population (GP) values. RESULTS: Four hundred seventy-six complete forms (81%) were received (median age, 46 years; 56% males, median follow-up time, 195 months). There was a positive association between age and TF (P < .05), whereas presence of B symptoms at diagnosis and treatment before 1980 were associated with CF. Mean TF scores were elevated in HDSs compared with the GP (mean TF score, 14.6; 95% CI, 14.1 to 15.7 v 12.1; 95% CI, 11.9 to 12.3, respectively; P < .001), as was the proportion of persons with CF (30% v 11%, respectively; odds ratio = 3.6; P < .001). The 70 patients with CF 8 years earlier still reported higher TF at follow-up than the 210 patients without CF at the previous assessment (mean TF score, 17.0; 95% CI, 15.6 to 18.3 v 13.1; 95% CI, 12.9 to 14.1, respectively; P < .001). Significantly more patients with persisting CF had B symptoms at diagnosis compared with patients who had recovered (P = .05). No significant association with treatment modality and intensity was found. CONCLUSION: Fatigue remains a major complaint in HDSs several years after treatment, but the association between treatment and fatigue still remains unclear. Many HDSs may recover from CF, particularly patients without B symptoms at diagnosis. 144 PMID- 16052595 AU - Holman AJ, Myers RR TI - A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in pts w FM receiving concomitant medications. SO - Arthritis Rheum. 2005 Aug;52(8):2495-505. IN - Pacific Rheumatology Associates, Renton, Washington 98055, USA. ajhseattle@aol.com AB - 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 > or =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. 145 PMID- 16076786 AU - Hutchings A, Raine R, Sanderson C, Black N TI - An experimental study of determinants of the extent of disagreement within clinical guideline development groups. [CFS] SO - Qual Saf Health Care. 2005 Aug;14(4):240-5. IN - Health Services Research Unit, London School o Hygiene & Tropical Med, London WC1E 7HT, UK. andrew.hutchings@lshtm.ac.uk AB - OBJECTIVE: To assess the effect of design features and clinical and social cues on the extent of disagreement among participants in a formal consensus development process. METHODS: Factorial design involving 16 groups consisting of 135 general practitioners (GPs) and 42 mental health professionals from England. The groups rated the appropriateness of four mental health interventions for three conditions (chronic back pain, irritable bowel syndrome, and chronic fatigue syndrome) in the context of various clinical and social cues. The groups differed in three design features: provision of a systematic literature review (versus not provided), group composition (mixed versus GP only), and assumptions about the healthcare resources available (realistic versus idealistic). Disagreement was measured using the mean absolute deviation from a group's median rating for a scenario. RESULTS: None of the design features significantly affected the extent of disagreement within groups (all p>0.3). Disagreement did differ between treatments (closer consensus for cognitive behavioural therapy and behavioural therapy than for brief psychodynamic intervention therapy and antidepressants) and cues (closer consensus for depressed patients and patients willing to try any treatment). CONCLUSION: In terms of the extent of disagreement in the groups in this study, formal consensus development was a robust technique in that the results were not dependent on the way it was conducted. 146 PMID- 15730417 AU - Inder WJ, Prickett TC, Mulder RT TI - Normal opioid tone & hypothalamic-pituitary-adrenal axis function in CFS despite marked functional impairment. SO - Clin Endocrinol (Oxf). 2005 Mar;62(3):343-8. IN - D o Endocrinology, Christchurch Hosp, & D o Psychological Med, Christchurch School o Medicine, Christchurch, New Zealand. winder@medstv.unimelb.edu.au AB - OBJECTIVE: To determine whether the functional impairment seen in chronic fatigue syndrome (CFS) is associated with reduced levels of central opioids and/or deficiency of the hypothalamic-pituitary-adrenal (HPA) axis. DESIGN: Single-blinded case-control study measuring functional and psychological status, basal hormonal parameters and ACTH/cortisol response to naloxone and ovine corticotrophin-releasing hormone (oCRH) vs. placebo in people with CFS and healthy controls. PATIENTS: Twelve people with CFS and 11 age-matched controls. MEASUREMENTS: Hormonal parameters: basal levels of 09:00 h plasma cortisol, dehydroepiandrosterone sulfate (DHEAS) and IGF-1. 24-h urinary free cortisol. Plasma ACTH and cortisol response to naloxone 125 microg/kg, oCRH 1 microg/kg and placebo (normal saline). Psychological parameters: SF-36, Hamilton Depression Score, Hospital Anxiety and Depression Scale and Fatigue Scale. RESULTS: There were highly significant differences between the CFS subjects and the controls with respect to the measures of fatigue and physical functioning. However, there were no differences in basal levels of 09:00 h cortisol (367 +/- 37 vs. 331 +/- 39 nmol/l, P = 0.51), DHEAS (4.2 +/- 0.6 vs. 4.0 +/- 0.5 micromol/l, P = 0.81), 24-h urinary free cortisol (182 +/- 27 vs. 178 +/- 21 nmol/24 h, P = 0.91) or IGF-1 (145 +/- 19 vs. 130 +/- 11 microg/l, P = 0.52) between the CFS group and controls, respectively. There was also no difference between the groups with respect to the ACTH and cortisol response to either oCRH or naloxone. CONCLUSIONS: Our data do not support an aetiological role for deficiency in central opioids or the HPA axis in the symptoms of CFS. 147 PMID- 16415546 AU - Iwakami E, Arashima Y, Kato K, Komiya T, Matsukawa Y, Ikeda T, Arakawa Y, Oshida S TI - Treatment of CFS w antibiotics: pilot study assessing the involvement of Coxiella burnetii infection. SO - Intern Med. 2005 Dec;44(12):1258-63. IN - D o Legal Med, Nihon U School o Medicine, Tokyo, Japan. AB - OBJECTIVE: To examine whether Coxiella burnetii (C. burnetii) is involved in chronic fatigue syndrome (CFS), we administered tetracycline antibiotics to subjects with CFS, and followed changes in clinical symptoms, PCR findings, and C. burnetii antibody titers. PATIENTS AND METHODS: The subjects were 8 patients with CFS and 213 with nonspecific complaints such as chronic fatigue and low-grade fever for several months or longer but not meeting the diagnostic criteria for CFS. All were examined for C. burnetii infection by nested PCR and the indirect immunofluorescence test (IF). RESULTS: Four CFS patients (the CFS group) and 54 controls [the post-Q fever fatigue syndrome (QFS) group] positive for C. burnetii were treated mainly with minocycline or doxycycline (100 mg/day) for 3 months. After treatment, all 58 patients tested negative for C. burnetii infection. In the CFS group, no significant difference was noted between the mean pre- and post-treatment temperatures or headache scores. Similarly, there was no significant improvement in performance status (PS) scores. In the QFS group, however, mean temperatures and headache scores were significantly decreased after treatment (p<0.001). PS scores were also improved. CONCLUSION: These results suggest the possibility of direct involvement of C. burnetii in the pathological state of CFS to be low, despite the C. burnetii infection rate being high in CFS patients. This is a pilot study and further larger investigations are necessary to confirm our preliminary results. 148 PMID- 15715687 AU - Jammes Y, Steinberg JG, Mambrini O, Bregeon F, Delliaux S TI - CFS: assessment of increased oxidative stress & altered muscle excitability in response to incremental exercise. SO - J Intern Med. 2005 Mar;257(3):299-310. IN - Laboratoire de Physiopathologie Respiratoire (UPRES EA 2201), Faculte de Medecine, Institut Federatif de Recherche Jean Roche, Marseille, France. jammes.y@jean-roche.univ-mrs.fr AB - OBJECTIVES: Because the muscle response to incremental exercise is not well documented in patients suffering from chronic fatigue syndrome (CFS), we combined electrophysiological (compound-evoked muscle action potential, M wave), and biochemical (lactic acid production, oxidative stress) measurements to assess any muscle dysfunction in response to a routine cycling exercise. DESIGN: This case-control study compared 15 CFS patients to a gender-, age- and weight-matched control group (n=11) of healthy subjects. INTERVENTIONS: All subjects performed an incremental cycling exercise continued until exhaustion. MAIN OUTCOME MEASURES: We measured the oxygen uptake (VO2), heart rate (HR), systemic blood pressure, percutaneous O2 saturation (SpO2), M-wave recording from vastus lateralis, and venous blood sampling allowing measurements of pH (pHv), PO2 (PvO2), lactic acid (LA), and three markers of the oxidative stress (thiobarbituric acid-reactive substances, TBARS, reduced glutathione, GSH, and ascorbic acid, RAA). RESULTS: Compared with control, in CFS patients (i) the slope of VO2 versus work load relationship did not differ from control subjects and there was a tendency for an accentuated PvO2 fall at the same exercise intensity, indicating an increased oxygen uptake by the exercising muscles; (ii) the HR and blood pressure responses to exercise did not vary; (iii) the anaerobic pathways were not accentuated; (iv) the exercise-induced oxidative stress was enhanced with early changes in TBARS and RAA and enhanced maximal RAA consumption; and (v) the M-wave duration markedly increased during the recovery period. CONCLUSIONS: The response of CFS patients to incremental exercise associates a lengthened and accentuated oxidative stress together with marked alterations of the muscle membrane excitability. These two objective signs of muscle dysfunction are sufficient to explain muscle pain and postexertional malaise reported by our patients. 149 PMID- 15929497 AU - Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C TI - CFS: the need for subtypes. SO - Neuropsychol Rev. 2005 Mar;15(1):29-58. IN - DePaul U, Chicago, Illinois 60614, USA. ljason@depaul.edu AB - Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains. 150 PMID- 15922454 AU - Jerjes WK, Cleare AJ, Wessely S, Wood PJ, Taylor NF TI - Diurnal patterns of salivary cortisol & cortisone output in CFS. SO - J Affect Disord. 2005 Aug;87(2-3):299-304. IN - D o Clinical Biochemistry, King's Coll Hosp, Denmark Hill, London SE5 9RX, United Kingdom. w_jerjes@yahoo.co.uk AB - BACKGROUND: The aim of the present study was to obtain a naturalistic measure of diurnal hypothalamic-pituitary-adrenal (HPA) axis output in CFS patients unaffected by medication or comorbid psychiatric disorder likely to influence the axis. METHOD: Cortisol and cortisone levels were measured in saliva samples collected from 0600 h to 2100 h at 3-h intervals in CFS patients and healthy controls. RESULTS: Mean cortisol and cortisone concentrations were significantly lower in patients than controls across the whole day, as were levels at each individual time point except 2100 h. Cosinor analysis showed a significant diurnal rhythm of cortisol and cortisone that was not phase-shifted in CFS compared to controls. However, there was a lower rhythm-adjusted mean and a lower amplitude in CFS patients. The cortisol/cortisone ratio showed no diurnal rhythm and did not differ between CFS subjects and controls. LIMITATIONS: The sample size was relatively small, and drawn from specialist referral patients who had been ill for some time; generalisation of these results to other populations is therefore unwarranted. CONCLUSION: The main findings of this study are to provide further evidence for reduced basal HPA axis function in at least some patients with CFS and to show for the first time that salivary cortisone is also reduced in CFS and has a diurnal rhythm similar to that of cortisol. We have also demonstrated that the cortisol/cortisone ratio remains unchanged in CFS, suggesting that increased conversion of cortisol to cortisone cannot account for the observed lowering of salivary cortisol. 151 PMID- 16378795 AU - Jones JF, Nicholson A, Nisenbaum R, Papanicolaou DA, Solomon L, Boneva R, Heim C, Reeves WC TI - Orthostatic instability in a population-based study of CFS. SO - AJM. 2005 Dec;118(12):1415. IN - Division o Viral & Rickettsial Diseases, Nat Ctr for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, Ga 30333, USA. jaj9@cdc.gov AB - PURPOSE: Autonomic nervous system dysfunction has been suggested as involved in the pathophysiology of chronic fatigue syndrome. This population-based case control study addressed the potential association between orthostatic instability (one sign of dysautonomia) and chronic fatigue syndrome. SUBJECTS AND METHODS: Fifty-eight subjects who fulfilled criteria of the 1994 chronic fatigue syndrome research case definition and 55 healthy controls participated in a 2-day inpatient evaluation. Subjects had been identified during a 4-year population-based chronic fatigue syndrome surveillance study in Wichita, Kan. The present study evaluated subjects' current medical and psychiatric status, reviewed past medical/psychiatric history and medication use, used a stand-up test to screen for orthostatic instability, and conducted a head-up tilt table test to diagnose orthostatic instability. RESULTS: No one manifested orthostatic instability in the stand-up test. The head-up tilt test elicited orthostatic instability in 30% of eligible chronic fatigue syndrome subjects (all with postural orthostatic tachycardia) and 48% of controls (50% with neurally mediated hypotension); intolerance was present in only nonfatigued (n=7) subjects. Neither fatigue nor illness severity were associated with outcome. CONCLUSIONS: Orthostatic instability was similar in persons with chronic fatigue syndrome and nonfatigued controls subjects recruited from the general Wichita population. Delayed responses to head-up tilt tests were common and may reflect hydration status. These findings suggest reappraisal of primary dysautonomia as a factor in the pathogenesis of chronic fatigue syndrome. 152 PMID- 15967423 AU - Jones MG, Goodwin CS, Amjad S, Chalmers RA TI - Plasma & urinary carnitine & acylcarnitines in CFS. SO - Clin Chim Acta. 2005 Oct;360(1-2):173-7. IN - St. George's Hosp MS, Cranmer Terrace, London, SW17 0RE, UK. AB - Contradictory reports have suggested that serum free carnitine and acylcarnitine concentrations are decreased in patients with chronic fatigue syndrome (CFS) and that this is a cause of the muscle fatigue observed in these patients. Others have shown normal serum free carnitine and acylcarnitines in similar patients. We report here studies on free, total and esterified (acyl) carnitines in urine and blood plasma from UK patients with CFS and three control groups. Plasma and timed urine samples were obtained from 31 patients with CFS, 31 healthy controls, 15 patients with depression and 22 patients with rheumatoid arthritis. Samples were analysed using an established radioenzymatic procedure for total, free and esterified (acyl) carnitine. There were no significant differences in plasma or urinary total, free or esterified (acyl) carnitine between UK patients with CFS and the control groups or in renal excretion rates of these compounds. The data presented here show that, in the CFS patients studied, there are no significant abnormalities of free or esterified (acyl) carnitine. It is thus unlikely that abnormalities in carnitine homeostasis have any significant role in the aetiology of their chronic fatigue. 153 PMID- 15992788 AU - Jones MG, Cooper E, Amjad S, Goodwin CS, Barron JL, Chalmers RA TI - Urinary & plasma organic acids & amino acids in CFS. SO - Clin Chim Acta. 2005 Nov;361(1-2):150-8. IN - St George's Hosp MS, Cranmer Terrace, London, SW17 0RE, UK. AB - Previous work by others have suggested the occurrence of one or more chemical or metabolic 'markers' for ME/CFS including specific amino acids and organic acids and a number of unidentified compounds (CFSUM1, CFSUM2). We have shown elsewhere that CFSUM1 is partially derivatised pyroglutamic acid and CFSUM2 partially derivatised serine and have suggested and demonstrated that the analytical methods used were unsuitable to identify or to accurately quantify urinary metabolites. We have now made a detailed analysis of plasma and urinary amino acids and of urinary organic acids from patients with ME/CFS and from three control groups. Fasting blood plasma and timed urine samples were obtained from 31 patients with CFS, 31 age and sex-matched healthy controls, 15 patients with depression and 22 patients with rheumatoid arthritis. Plasma and urinary amino acids and urinary organic acids were determined using established and validated methods and data compared by statistical analysis. None of the previously reported abnormalities in urinary amino acids or of organic acids could be confirmed. Results however provide some evidence in patients with ME/CFS for underlying inflammatory disease and for reduced intramuscular collagen with a lowered threshold for muscle micro-injury. These factors in combination may provide a basis for the fatigue and muscle pain that are the major symptoms in these patients. 154 PMID- 16119758 AU - Jowi JO, Gathua SN TI - Lyme disease: report of 2 cases. [FM] SO - East Afr Med J. 2005 May;82(5):267-9. IN - Kenyatta Nat Hosp, P.O. Box 19624-00202, Nairobi, Kenya. AB - Lyme disease is a tick-borne multisystem disease. It was first described in Lyme, Connecticut, USA in 1975. Cases have been reported in Canada, Switzerland, Austria, Australia and Great Britain. It is an inflammatory disease that has varied clinical manifestations ranging from skin rash (erythema migrans), arthritis, fibromyalgia, and regional lymphadenopathy, cardiac conduction defects to neurological manifestations of meningoencephalitis, Bell's palsy, peripheral neuropathy, and painful radiculoneuropathy. There has been no case record of Lyme disease in Kenya and indeed literature on Lyme disease in Africa is very scanty. We present two cases of Lyme disease with predominant neurological manifestations; outline their clinical presentation and management. 155 PMID- 15733656 AU - Julien N, Goffaux P, Arsenault P, Marchand S TI - Widespread pain in FM is related to a deficit of endogenous pain inhibition. SO - Pain. 2005 Mar;114(1-2):295-302. IN - Departement des Sciences de la Sante, Universite du Quebec en Abitibi-Temiscamingue, Rouyn-Noranda, Que., Canada. AB - A deficit of endogenous pain inhibitory systems has been suggested to contribute to some chronic pain conditions, one of them being fibromyalgia. The aim of the investigation was to test whether endogenous pain inhibitory systems were activated by a spatial summation procedure in 30 fibromyalgia, 30 chronic low back pain, and 30 healthy volunteers who participated in a cross-over trial (two sessions). Each session consisted of visual analog scale ratings of pain during the immersion of different surfaces of the arm in circulating noxious cold (12 degrees C) water. The arm was arbitrarily divided into eight segments from the fingertips to the shoulder. One session was ascending (from the fingertips to the shoulder) and the other was descending (from the shoulder to the fingertips); they included eight consecutive 2-min immersions separated by 5-min resting periods. For healthy and low back pain subjects, pain was perceived differently during the ascending and descending sessions (P=0.0001). The descending session resulted in lower pain intensity and unpleasantness. This lowering of the perception curve seems to be due to a full recruitment of inhibitory systems at the beginning of the descending session as opposed to a gradual recruitment during the ascending session. For fibromyalgia subjects, no significant differences were found between the increasing and decreasing sessions (P>0.05). These data support a deficit of endogenous pain inhibitory systems in fibromyalgia but not in chronic low back pain. The treatments proposed to fibromyalgia patients should aim at stimulating the activity of those endogenous systems. 156 PMID- 16009053 AU - Karmisholt K, Gotzsche PC TI - Physical activity for secondary prevention of disease. Systematic reviews of randomised clinical trials. [CFS] SO - Dan Med Bull. 2005 May;52(2):90-4. IN - Nordic Cochrane Centre, H:S Rigshospitalet, DK-2100 Kobenhavn O, Denmark. AB - BACKGROUND: Physical activity is recommended for secondary prevention of several diseases but it is not always clear how reliable the evidence is. METHODS: We searched MEDLINE and The Cochrane Library for systematic reviews of randomised clinical trials published 1998-2004. RESULTS: We identified 30 eligible systematic reviews and excluded 13 that contained trials covered in larger reviews or were older than other reviews on the same subject. Physical activity decreased all-cause mortality in patients with coronary heart disease, odds ratio 0.73 (95% confidence interval 0.54 to 0.98), increased maximum walking time in patients with intermittent claudication by 6.5 min (4.4 to 8.7), and decreased pain in patients with osteoarthritis of the knee, standardised mean difference 0.34 (0.24 to 0.44). There were positive effects also in heart failure, chronic obstructive lung disease, type 2 diabetes and fibromyalgia, but they need confirmation in high-quality trials. Exercise improved quality of life in several conditions and generally led to improved physical performance. An effect was not shown in stroke, asthma, rheumatoid arthritis, acute or chronic low back pain, chronic fatigue syndrome, depression, cystic fibrosis or HIV/AIDS. The occurrence of harms was generally not reported. CONCLUSION: Physical activity can have important, and even life-saving, effects as secondary prevention of disease, but more and better trials are needed to fully assess its benefits and harms, in particular trials that compare exercise with drugs. 157 PMID- 16078340 AU - Kashikar-Zuck S, Swain NF, Jones BA, Graham TB TI - Efficacy of cognitive-behavioral intervention for juvenile primary FM syndrome. SO - J Rheumatol. 2005 Aug;32(8):1594-602. IN - Cincinnati Children's Hosp Med Ctr, D o Pediatrics, U o Cincinnati Coll o Med, OH 45229, USA. Susmita.Kashikar-Zuck@cchmc.org AB - 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. 158 PMID- 16049284 AU - Kaushik N, Fear D, Richards SC, McDermott CR, Nuwaysir EF, Kellam P, Harrison TJ, Wilkinson RJ, Tyrrell DA, Holgate ST, Kerr JR TI - Gene expression in peripheral blood mononuclear cells from pts w CFS. SO - J Clin Pathol. 2005 Aug;58(8):826-32. IN - D o Paediatric Infectious Diseases, St Marys Campus, Imperial Coll, Norfolk Place, London W2 1PG, UK. AB - BACKGROUND: Chronic fatigue syndrome (CFS) is a multisystem disease, the pathogenesis of which remains undetermined. AIMS: To test the hypothesis that there are reproducible abnormalities of gene expression in patients with CFS compared with normal healthy persons. METHODS: To gain further insight into the pathogenesis of this disease, gene expression was analysed in peripheral blood mononuclear cells from 25 patients with CFS diagnosed according to the Centers for Disease Control criteria and 25 normal blood donors matched for age, sex, and geographical location, using a single colour microarray representing 9522 human genes. After normalisation, average difference values for each gene were compared between test and control groups using a cutoff fold difference of expression > or = 1.5 and a p value of 0.001. Genes showing differential expression were further analysed using Taqman real time polymerase chain reaction (PCR) in fresh samples. RESULTS: Analysis of microarray data revealed differential expression of 35 genes. Real time PCR confirmed differential expression in the same direction as array results for 16 of these genes, 15 of which were upregulated (ABCD4, PRKCL1, MRPL23, CD2BP2, GSN, NTE, POLR2G, PEX16, EIF2B4, EIF4G1, ANAPC11, PDCD2, KHSRP, BRMS1, and GABARAPL1) and one of which was downregulated (IL-10RA). This profile suggests T cell activation and perturbation of neuronal and mitochondrial function. Upregulation of neuropathy target esterase and eukaryotic translation initiation factor 4G1 may suggest links with organophosphate exposure and virus infection, respectively. CONCLUSION: These results suggest that patients with CFS have reproducible alterations in gene regulation. 159 PMID- 16085177 AU - Kennedy G, Spence VA, McLaren M, Hill A, Underwood C, Belch JJ TI - Oxidative stress levels are raised in CFS & are associated w clinical Sx. SO - Free Radic Biol Med. 2005 Sep 1;39(5):584-9. IN - Vascular Diseases Research Unit, The Inst o Cardiovascular Research, Ninewells Hosp & MS, Dundee, Scotland DD1 9SY, UK. g.y.kennedy@dundee.ac.uk AB - The aetiology of chronic fatigue syndrome (CFS) is unknown; however, recent evidence suggests excessive free radical (FR) generation may be involved. This study investigated for the first time levels of 8-iso-prostaglandin-F(2 alpha)-isoprostanes alongside other plasma markers of oxidative stress in CFS patients and control subjects. Forty-seven patients (18 males, 29 females, mean age 48 [19--63] years) who fulfilled the Centres for Disease Control classification for CFS and 34 healthy volunteers (13 males, 21 females, 46 [19--63] years) were enrolled in the study. The CFS patients were divided into two groups; one group had previously defined cardiovascular (CV) risk factors of obesity and hypertension (group 1) and the second were normotensive and nonobese (group 2). Patients had significantly increased levels of isoprostanes (group 1, P=0.007; group 2, P=0.03, unpaired t test compared to controls) and oxidised low-density lipoproteins (group 2, P=0.02) indicative of a FR attack on lipids. CFS patients also had significantly lower high-density lipoproteins (group 1, P=0.011; group 2, P=0.005). CFS symptoms correlated with isoprostane levels, but only in group 2 low CV risk CFS patients (isoprostanes correlated with; total symptom score P=0.005; joint pain P=0.002; postexertional malaise P=0.027, Pearson). This is the first time that raised levels of the gold standard measure of in vivo oxidative stress (isoprostanes) and their association with CFS symptoms have been reported. 160 PMID- 16316396 AU - Kerr JR TI - Pathogenesis of parvovirus B19 infection: host gene variability, & possible means & effects of virus persistence. [CFS] SO - J Vet Med B Infect Dis Vet Public Health. 2005 Sep-Oct;52(7-8):335-9. IN - D o Cellular & Molecular Med, St George's U o London, Cranmer Terrace, London SW17 0RE, UK. jkerr@sgul.ac.uk AB - Since conducting follow-up studies of patients with acute symptomatic parvovirus B19 infection which showed that a significant proportion of patients develop prolonged arthritis and chronic fatigue syndrome (CFS), we have become interested in the mechanisms of this phenomenon. We showed that these cases have high levels of pro-inflammatory cytokines in their circulation and that this correlates with the symptoms. However, the underlying mechanisms were not apparent, and we have used various approaches to begin studying this phenomenon. DNA polymorphisms were looked for and several were shown to be more common in these subjects compared with controls; these occur within genes of both the immune response [human leucocyte antigen (HLA)-DRB1, HLA-B, transforming growth factor (TGF)-beta1] and those involved in several other cellular functions (predominantly the cytoskeleton and cell adhesion). Interestingly, one particular single-nucleotide polymorphism (SNP) which is associated with symptomatic B19 infection occurs in the Ku80 gene which has recently been shown to be a B19 co-receptor. B19 persistence is probably the key to this phenomenon, and some new data are presented on short regions of sequence homology (17-26 bp) between human, mouse and rat parvoviruses and their respective hosts which occur in many host genes. This homology may provide a foothold for virus persistence and may also play a role in the genesis of disease through gene disruption. Finally, we used microarrays and TaqMan real-time polymerase chain reaction in 108 normal persons to study human gene expression in persons who are B19-seropositive versus B19-seronegative (age- and sex-matched) to examine the hypothesis that gene regulation may be altered in subjects harbouring the B19 virus DNA. Six genes were found to be differentially expressed with roles in the cytoskeleton (SKIP, MACF1, SPAG7, FLOT1), integrin signalling (FLOT1, RASSF5), HLA class III (c6orf48), and tumour suppression (RASSF5). These results have implications not only for B19 but also for other persistent viruses as well and confirmation is required. In conclusion, these disparate findings contribute to our understanding of the pathogenesis of B19 disease. We are using these studies as a starting point to study the phenomenon of chronic immune activation following B19 infection. 161 PMID- 16100439 AU - Kim CH, Shin HC, Won CW TI - Prevalence of chr fatigue & CFS in Korea: community-based primary care study. SO - J Korean Med Sci. 2005 Aug;20(4):529-34. IN - D o Family Med, Sungkyunkwan U School o Medicine, Korea. kchjp@hanafos.com AB - There have been many epidemiological and clinical researches on chronic fatigue (CF) and chronic fatigue syndrome (CFS) since the 1990s, but such studies have been quite limited in Korea. The aim of this study was to investigate the point prevalence of CF and CFS in patients who visited community-based eight primary care clinics in Korea. The study subjects were 1,648 patients aged 18 yr and over who visited one of eight primary care clinics in Korea between the 7th and 17th of May 2001. The physicians determined the status of the subjects through fatigue-related questionnaires, medical history, physical examination, and laboratory tests. The subjects were categorized into no fatigue, prolonged fatigue, CF and then CF were further classified to medically explained CF (Physical CF and Psychological CF) and medically unexplained CF (CFS and idiopathic chronic fatigue). The point prevalence of CF and CFS were 8.4% (95% CI 7.1-9.7%) and 0.6% (95% CI 0.2-1.0%). Medically explained CF was 80.5% of CF, of which 57.1% had psychological causes. The clinical characteristics of CFS were distinguished from explained CF. CF was common but CFS was rare in community-based primary care settings in Korea. 162 PMID- 15450690 AU - King C, Jason LA TI - Improving the diagnostic criteria & procedures for CFS. SO - Biol Psychol. 2005 Feb;68(2):87-106. IN - Spinal Cord Injury Service (128), Hines VA Hosp, P.O. Box 5000, Hines, IL 60141-5128, USA. cpking@rcn.com AB - Since the publication of the case definition for chronic fatigue syndrome (CFS) in 1988 the diagnostic criteria have been revised twice in the U.S. None of the case definitions were derived empirically. As a result, there is concern regarding the sensitivity, specificity, and reliability of the criteria. The goal of the present study was to identify methods for improving the diagnostic criteria for CFS. Three groups of 15 participants each were recruited: participants with (1) CFS, (2) major depressive disorder (MDD), and (3) healthy controls. Using statistical procedures, three methods for improving the diagnostic criteria were explored: identification of new diagnostic symptoms, the use of severity ratings for symptomatology, and the identification of standardized measures that differentiate cases of CFS from other conditions. Results of the present study suggest that these three methods hold promise for improving the sensitivity, specificity, and reliability of the diagnostic criteria for CFS. 163 PMID- 16181932 AU - Kingsley JD, Panton LB, Toole T, Sirithienthad P, Mathis R, McMillan V TI - The effects of a 12-week strength-training program on strength & functionality in women w FM. SO - Arch Phys Med Rehabil. 2005 Sep;86(9):1713-21. IN - D o Nutrition, Food & Exercise Sciences, Florida St U, Tallahassee, FL 32306, USA. AB - 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. 164 PMID- 15583836 AU - Kodama M, Kodama T TI - The clinical course of interstitial pneumonia alias CFS under the control of megadose vitamin C infusion system w dehydroepiandrosterone-cortisol annex. SO - Int J Mol Med. 2005 Jan;15(1):109-16. IN - Kodama Research Inst o Preventive Med, 50-5 Chikusaku, Chikusaku, Nagoya 464-0005, Japan. AB - The year 1995 marked the onset of interstitial pneumonia spread in Nagoya, Japan. For the last 9 years, we have been accumulating clinical experience with the disease control using the combination of prophylactic use of anti-biotics and regular practice of megadose vitamin C infusion with either dehydroepiandrosterone-annex or dehydroepiandrosterone-cortisol annex. The purpose of this study is to assess the usefulness of our new treatment system for the control of interstitial pneumonia alias chronic fatigue syndrome. The results obtained are given as follows: i) The long-term maintenance of the above treatment system was effective not only for decreasing the risk for recurrence of active form pneumonia, but also for prevention of malignancy emergence in aged patients with interstitial pneumonia. ii) Evidence is presented to indicate that interstitial pneumonia was associated with increased risk for depression of which the emergence is a candidate subject causally related to the long-term use of glucocorticoid. iii) A patient with both interstitial pneumonia and depression was found to be less responsive to our treatment system. It is suggested that the use of more dehydroepiandrosterone at the sacrifice of cortisol in the infusion annex may be a choice for the control of both interstitial pneumonia and depression. iv) The description of chronic fatigue syndrome as regards the endocrinological, epidemiological and psychiatric characteristics are in good agreement with our experience on patients having interstitial pneumonia, evidence in support of our proposal that there is no convincing reasoning to separate chronic fatigue syndrome from interstitial pneumonia. v) The long-term practice of our treatment system for the control of interstitial pneumonia (an autoimmune disease) was found to suppress the inflammatory process but not the fibrotic process in the long run. vi) A few innovations were made in our treatment system to reduce the risk of bleeding or thrombosis--vascular complications of pneumonia. vii) The merit of our treatment system is to create a new hormonal environment to improve the state of immunodeficiency by use of a non-steroid substance--vitamin C which encounters little resistance from the feedback mechanism of steroid metabolism in the in vivo system. 165 PMID- 15641057 AU - Kop WJ, Lyden A, Berlin AA, Ambrose K, Olsen C, Gracely RH, Williams DA, Clauw DJ TI - Ambulatory monitoring of physical activity & Sx in FM & CFS. SO - Arthritis Rheum. 2005 Jan;52(1):296-303. IN - D o Med & Clinical Psychology, Uniformed Services U o the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. wjkop@usuhs.mil AB - OBJECTIVE: Fibromyalgia (FM) and chronic fatigue syndrome (CFS) are associated with substantial physical disability. Determinants of self-reported physical disability are poorly understood. This investigation uses objective ambulatory activity monitoring to compare patients with FM and/or CFS with controls, and examines associations of ambulatory activity levels with both physical function and symptoms during activities of daily life. METHODS: Patients with FM and/or CFS (n = 38, mean +/- SD age 41.5 +/- 8.2 years, 74% women) completed a 5-day program of ambulatory monitoring of physical activity and symptoms (pain, fatigue, and distress) and results were compared with those in age-matched controls (n = 27, mean +/- SD age 38.0 +/- 8.6 years, 44% women). Activity levels were assessed continuously, ambulatory symptoms were determined using electronically time-stamped recordings at 5 time points during each day, and physical function was measured with the 36-item Short Form health survey at the end of the 5-day monitoring period. RESULTS: Patients had significantly lower peak activity levels than controls (mean +/- SEM 8,654 +/- 527 versus 12,913 +/- 1,462 units; P = 0.003) and spent less time in high-level activities when compared with controls (P = 0.001). In contrast, patients had similar average activity levels as those of controls (mean +/- SEM 1,525 +/- 63 versus 1,602 +/- 89; P = 0.47). Among patients, low activity levels were associated with worse self-reported physical function over the preceding month. Activity levels were inversely related to concurrent ambulatory pain (P = 0.031) and fatigue (P < 0.001). Pain and fatigue were associated with reduced subsequent ambulatory activity levels, whereas activity levels were not predictive of subsequent symptoms. CONCLUSION: Patients with FM and/or CFS engaged in less high-intensity physical activities than that recorded for sedentary control subjects. This reduced peak activity was correlated with measures of poor physical function. The observed associations may be relevant to the design of behavioral activation programs, because activity levels appear to be contingent on, rather than predictive of, symptoms. 166 PMID- 16145181 AU - Krell HV, Leuchter AF, Cook IA, Abrams M TI - Evaluation of reboxetine, a noradrenergic antidepressant, for the Rx of FM & chr low back pain. SO - Psychosomatics. 2005 Sep-Oct;46(5):379-84. IN - Laboratory o Behavioral Pharmacology, UCLA Neuropsychiatric Inst, 37-452 NPI, 760 Westwood Plaza, Los Angeles, CA 90024, USA. hkrell@mednet.ucla.edu AB - 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. 167 PMID- 16247056 AU - Kwan CL, Diamant NE, Pope G, Mikula K, Mikulis DJ, Davis KD TI - Abnormal forebrain activity in functional bowel disorder pts w chr pain. [FM] SO - Neurology. 2005 Oct 25;65(8):1268-77. IN - Institute o Med Science, U o Toronto, Ontario, Canada. AB - BACKGROUND: Abnormal cortical pain responses in patients with fibromyalgia and conversion disorder raise the possibility of a neurobiologic basis underlying so-called "functional" chronic pain. OBJECTIVE: To use percept-related fMRI to test the hypothesis that patients with a painful functional bowel disorder do not process visceral input or sensations normally or effectively at the cortical level. METHODS: Eleven healthy subjects and nine patients with irritable bowel syndrome (IBS) underwent fMRI during rectal distensions that elicited either a moderate level of urge to defecate or pain. Subjects continuously rated their rectal stimulus-evoked urge or pain sensations during fMRI acquisition. fMRI data were interrogated for activity related to stimulus presence and to specific sensations. RESULTS: In IBS, abnormal responses associated with rectal-evoked sensations were identified in five brain regions. In primary sensory cortex, there were urge-related responses in the IBS but not control group. In the medial thalamus and hippocampus, there were pain-related responses in the IBS but not control group. However, pronounced urge- and pain-related activations were present in the right anterior insula and the right anterior cingulate cortex in the control group but not the IBS group. CONCLUSIONS: Percept-related fMRI revealed abnormal urge- and pain-related forebrain activity during rectal distension in patients with irritable bowel syndrome (IBS). As visceral stimulation evokes pain and triggers unconscious processes related to homeostasis and reflexes, abnormal brain responses in IBS may reflect the sensory symptoms of rectal pain and hypersensitivity, visceromotor dysfunction, and abnormal interoceptive processing. 168 PMID- 16175250 AU - Lam DK, Sessle BJ, Cairns BE, Hu JW TI - Neural mechanisms of temporomandibular joint & masticatory muscle pain: a possible role for peripheral glutamate receptor mechanisms. [FM] SO - Pain Res Manag. 2005 Autumn;10(3):145-52. IN - Faculty o Dentistry, U o Toronto, Toronto, Ontario, Canada. AB - The purpose of the present review is to correlate recent knowledge of the role of peripheral ionotropic glutamate receptors in the temporomandibular joint and muscle pain from animal and human experimental pain models with findings in patients. Chronic pain is common, and many people suffer from chronic pain conditions involving deep craniofacial tissues such as temporomandibular disorders or fibromyalgia. Animal and human studies have indicated that the activation of peripheral ionotropic glutamate receptors in deep craniofacial tissues may contribute to muscle and temporomandibular joint pain and that sex differences in the activation of glutamate receptors may be involved in the female predominance in temporomandibular disorders and fibromyalgia. A peripheral mechanism involving autocrine and/or paracrine regulation of nociceptive neuronal excitability via injury or inflammation-induced release of glutamate into peripheral tissues that may contribute to the development of craniofacial pain is proposed. 169 PMID- 15907308 AU - Lange G, Steffener J, Cook DB, Bly BM, Christodoulou C, Liu WC, Deluca J, Natelson BH TI - Objective evidence of cognitive complaints in CFS: a BOLD fMRI study of verbal working memory. SO - Neuroimage. 2005 Jun;26(2):513-24. Epub 2005 Apr 7. IN - D o Radiology, U o Med & Dentistry o New Jersey-New Jersey MS, Newark, 07103, USA. lange@njneuromed.org AB - Individuals with Chronic Fatigue Syndrome (CFS) often have difficulties with complex auditory information processing. In a series of two Blood Oxygen Level Dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) studies, we compared BOLD signal changes between Controls and individuals with CFS who had documented difficulties in complex auditory information processing (Study 1) and those who did not (Study 2) in response to performance on a simple auditory monitoring and a complex auditory information processing task (mPASAT). We hypothesized that under conditions of cognitive challenge: (1) individuals with CFS who have auditory information processing difficulties will utilize frontal and parietal brain regions to a greater extent than Controls and (2) these differences will be maintained even when objective difficulties in this domain are controlled for. Using blocked design fMRI paradigms in both studies, we first presented the auditory monitoring task followed by the mPASAT. Within and between regions of interest (ROI), group analyses were performed for both studies with statistical parametric mapping (SPM99). Findings showed that individuals with CFS are able to process challenging auditory information as accurately as Controls but utilize more extensive regions of the network associated with the verbal WM system. Individuals with CFS appear to have to exert greater effort to process auditory information as effectively as demographically similar healthy adults. Our findings provide objective evidence for the subjective experience of cognitive difficulties in individuals with CFS. 170 PMID- 15862476 AU - Laursen BS, Bajaj P, Olesen AS, Delmar C, Arendt-Nielsen L TI - Health related quality of life & quantitative pain measurement in females w chr non-malignant pain. [FM] SO - Eur J Pain. 2005 Jun;9(3):267-75. IN - Clinical Nursing Research Unit, Aalborg Hosp Stengade 10, Denmark. AB - The aim of the present study was to assess, compare, and correlate the pain response to an experimental pain stimulus (hyperalgesia to pressure pain threshold (PPT) measured from different body sites), the pain intensity (VAS) of the habitual pain, and quality of life parameters (SF-36) in groups of females with chronic non-malignant pain syndromes. Forty female pain patients with fibromyalgia/whiplash (n = 10), endometriosis (n = 10), low back pain (n = 10), or rheumatoid arthritis (n = 10), as well as 41 age-matched healthy female controls participated in the study. The fibromyalgia/whiplash patients scored significantly higher (p < 0.04) VAS ratings (median rating = 7.0) than the endometriosis (6.0), low back pain (6.0), and rheumatoid arthritis (3.5) patients. All fours patient groups had significantly lower PPTs at all sites as compared with controls. The fibromyalgia/whiplash patients experienced the highest influence of pain on their overall health status, particularly vitality, social function, emotional problems, and mental health. A significant negative correlation was found between VAS rating and quality of life (p < 0.04). Significant correlation (p < 0.05) was found between pressure hyperalgesia measured at lowest PPT sites and the impairment of SF-36 physical function as well as mental health parameters. This study demonstrates significant generalised pressure hyperalgesia in four groups of chronic pain patients, correlations between degree of pressure hyperalgesia and impairment of some quality of life parameters, and increased pain intensity of the ongoing pain is associated with decreased quality of life. 171 PMID- 15779535 AU - Lavigne G, Woda A, Truelove E, Ship JA, Dao T, Goulet JP TI - Mechanisms associated w unusual orofacial pain. [FM] SO - J Orofac Pain. 2005 Winter;19(1):9-21. IN - Quebec Oral Health Research Network (FRSQ), Faculties o Dentistry & Med Universite de Montreal Montreal, Quebec, Canada. gilles.lavigne@umontreal.ca AB - This article presents an overview of possible mechanisms associated with pain perception, with a specific focus on understanding unusual manifestations of orofacial pain associated with nerve insult. It includes recent evidence concerning neurobiological changes that occur in the periphery at tissue and nerve sites, or within the central nervous system, and that may involve chemical and inflammatory responses, sensitization, or alterations of cellular function. Moreover, the contribution of the autonomic nervous system, changes in emotional reactivity and vigilance, the roles of high brain centers such as the basal ganglia (nigro-striatal) system, and the influence of aging and gender, are briefly described. 172 PMID- 16273759 AU - Lee SS, Yoon HJ, Chang HK, Park KS TI - FM in Behcet's disease is associated w anxiety & depression, & not w disease activity. SO - Clin Exp Rheumatol. 2005 Jul-Aug;23(4 Suppl 38):S15-9. IN - Division o Rheumatology, D o Internal Med, Chonnam Nat U MS, Gwangju, South Korea. shinseok@chonnam.ac.kr AB - OBJECTIVE: To determine the prevalence of fibromyalgia (FM) in Korean patients with Behcet's disease (BD) and to evaluate the association between FM and clinical and psychological variables. METHODS: Seventy patients with BD were examined for FM tender points and asked to complete a Korean version of the Fibromyalgia Impact Questionnaire (FIQ). Disease activity was measured using the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and a clinical activity score, which was calculated by summing the clinical manifestations. The State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) were used for psychometric scoring. RESULTS: Twenty-six BD patients (37.1%) met the American College of Rheumatology criteria for FM. The patients who met the criteria for FM were more frequently female, less frequently employed, and less well educated. Age, disease duration, clinical manifestations, medication, and measures of disease activity did not differ between BD patients with and without FM. Nevertheless, BD patients with FM had higher STAI and BDI scores than did patients without FM (all p < 0.05). FM tender points were significantly correlated with the STAI and BDI, and not with disease activity variables. The FIQ scores were also strongly correlated with the STAI and BDI scores, and not with disease activity. CONCLUSION: FM was very common among BD patients and was associated with the presence of anxiety and depression, and not with disease activity. 173 PMID- 15722810 AU - Lemstra M, Olszynski WP TI - The effectiveness of multidisciplinary rehabilitation in the Rx of FM: a randomized controlled trial. SO - Clin J Pain. 2005 Mar-Apr;21(2):166-74. IN - College o Med, U o Saskatchewan, Saskatoon, Canada. AB - OBJECTIVES: To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to standard medical care. METHODS: Seventy-nine men and women were randomly assigned to one of two groups. The intervention group consisted of a rheumatologist and physical therapist intake and discharge, 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard medical care with the patients' family physician. Outcome measures included self-perceived health status, pain-related disability, average pain intensity, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, and work status. Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up. RESULTS: Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups prior to intervention. Intention-to-treat analysis revealed that the intervention group, in comparison to the control group, experienced statistically significant changes at intervention completion in self-perceived health status, average pain intensity, pain related disability, depressed mood, days in pain, and hours in pain, but no significant differences in nonprescription drug use, prescription drug use, or work status. At 15 months, all health outcomes retained their significance except health status. Nonprescription and prescription drug use demonstrated significant reductions at 15 months. Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status. CONCLUSIONS: Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting. 174 PMID- 16078358 AU - Levine JD, Reichling DB TI - FM: the nerve of that disease. SO - J Rheumatol Suppl. 2005 Aug;75:29-37. IN - Division o Rheumatology, D o Med, U o California, San Francisco, California 94143-0440, USA. Levine@itsa.ucsf.edu AB - Fibromyalgia syndrome (FM) is a common, often debilitating and intractable, chronic, generalized pain condition. The development of effective therapies to treat FM has been hindered by a lack of understanding of fundamental mechanisms in the etiology of FM. In view of prominent characteristics that FM shares with other generalized pain conditions, we suggest that a key mechanism in such disorders may be that of altered activity in the subdiaphragmatic vagus nerve. Specifically, we propose that activity in vagal afferents, arising from the gastrointestinal tract, and sympathoadrenal function mediate a contribution of stress to FM and its strong association with irritable bowel syndrome. An important prediction of the proposed mechanism is that interventions that selectively modulate activity in specific populations of subdiaphragmatic afferents might be used to treat the symptoms of FM and other generalized pain syndromes. 175 PMID- 15737168 AU - Liedberg GM, Burckhardt CS, Henriksson CM TI - Validity & reliability testing of the Quality of Life Scale, Swedish version in women w FM -- statistical analyses. SO - Scand J Caring Sci. 2005 Mar;19(1):64-70. IN - D o Neuroscience & Locomotion, Sect o Occupational Therapy, Faculty o Health Sciences, Linkoping U, Linkoping, Sweden. gunilla.liedberg@inr.liu.se AB - One consequence of constant widespread pain is a low quality of life. The purpose of the study was to examine whether the Quality of Life Scale, Swedish version (QOLS-S), regarded as a generic quality-of-life instrument, is a reliable and valid instrument for use in women with fibromyalgia (FM). Women with FM (n = 113) contributed data on the QOLS-S and other standardized instrument at three points in time. Internal consistency reliability estimates ranged from 0.89 to 0.92. Convergent construct validity was indicated by moderate agreement with a global life satisfaction question. Discriminant construct validity was denoted by low correlations with the physical functioning subscale of the SF-36. In a factor analysis three factors emerged: 'personal and social well-being', 'relations with others' and 'active participation'. A few of the items have high cross-loadings, and the instrument could be improved by rewording those items to more closely reflect one specific factor. Overall, these results provide evidence that the QOLS-S has acceptable validity and reliability for use in women with FM. 176 PMID- 15970921 AU - Luedtke CA, Thompson JM, Postier JA, Neubauer BL, Drach S, Newell L TI - A description of a brief multidisciplinary Rx program for FM. SO - Pain Manag Nurs. 2005 Jun;6(2):76-80. IN - Fibromyalgia Treatment Program, Mayo Clinic, Rochester, Minnesota, USA. Luedtke.connie@Mayo.edu AB - The majority of fibromyalgia treatment programs are weeks or months in duration. This tertiary care center draws people worldwide for diagnostic purposes; however, most patients are unable to stay for extended treatment. It was deemed important to offer a brief multidisciplinary fibromyalgia treatment program that provided fundamental education and established a foundation for self-management strategies. This article describes the components of a brief multidisciplinary program for fibromyalgia. Initial results indicate improvement in patient outcomes and in patient and physician satisfaction. Patients who complete any fibromyalgia program need to maintain a relationship with their primary care providers for ongoing care. Some patients may need a more comprehensive program because of their level of functional impairment. 177 PMID- 16261517 AU - Lukaczer D, Darland G, Tripp M, Liska D, Lerman RH, Schiltz B, Bland JS TI - A pilot trial evaluating Meta050, a proprietary combination of reduced iso-alpha acids, rosemary extract & oleanolic acid in pts w arthritis & FM. SO - Phytother Res. 2005 Oct;19(10):864-9. IN - Clinical Research at the Functional Med Research Ctr, Gig Harbor, WA 98332, USA. DanLukaczer@metagenics.com AB - The aim of this open-label, 8-week observational trial was to investigate the efficacy of Meta050 (a proprietary, standardized combination of reduced iso-alpha-acids from hops, rosemary extract and oleanolic acid) on pain in patients with rheumatic disease. Osteoarthritis, rheumatoid arthritis and fibromyalgia patients were given 440 mg Meta050 three times a day for 4 weeks, which was changed to 880 mg twice a day for the subsequent 4 weeks in the majority of patients. Pain and condition-specific symptoms were assessed using a standard visual analog scale (VAS), an abridged arthritis impact measurement scale (AIMS2) and the fibromyalgia impact questionnaire. Fifty-four subjects with rheumatic disease completed the trial. Following treatment, a statistically significant decrease in pain of 50% and 40% was observed in arthritis subjects using the VAS (p < 0.0001; Wilcoxon-ranked sums) and AIMS2 (p < 0.0001), respectively. Fibromyalgia subject scores did not significantly improve. A decreasing trend of C-reactive protein, a marker for inflammation, was also observed in those subjects who presented with elevated C-reactive protein. No serious side effects were observed. These observations suggest that Meta050 at a dosage of 440 mg three times a day has a beneficial effect on pain in arthritis subjects. 178 PMID- 16174480 AU - Macfarlane GJ TI - Chronic widespread pain & FM: Should reports of increased mortality influence management? SO - Curr Rheumatol Rep. 2005 Oct;7(5):339-41. IN - Epidemiology Group, U o Aberdeen, D o Public Health, School o Med, Polwarth Building, Aberdeen, AB25 2ZD, Scotland, UK. g.j.macfarlane@abdn.ac.uk AB - There have been few studies examining whether persons with chronic widespread pain or fibromyalgia are at increased risk for dying prematurely. Among the studies conducted there is little consistency in results. If there is an increased mortality risk, it is of the order of a 30% excess and it may be related to the lifestyle of patients with these symptoms, including lack of exercise. Skilled judgment is required in determining whether reports of new symptoms are likely to indicate underlying new pathology. Studies are currently underway which will determine whether initial observations of an increased mortality risk can be replicated. 179 PMID- 16264414 AU - Maes M, Mihaylova I, De Ruyter M TI - Decreased dehydroepiandrosterone sulfate but normal insulin-like growth factor in CFS (CFS): relevance for the inflammatory response in CFS. SO - Neuro Endocrinol Lett. 2005 Oct;26(5):487-92. IN - M-Care4U outpatient Clinics, & the Clinical Research Ctr for Mental Health, Olmenlaan 9, 2610 Antwerp, Belgium. AB - There are a few reports that chronic fatigue syndrome (CFS) may be accompanied by changes in hormones, such as dehydroepiandrosterone (DHEA) and insulin-like growth factor (IGF1). This study examines the serum concentrations of DHEA-sulfate (DHEAS), IGF1 and IGF1 binding protein-3 (IGFBP3) in 20 patients with CFS and in 12 normal controls. The IGFBP3/IGF1 ratio was computed as an index for IGF1 availability. We found significantly lower serum DHEAS concentrations in CFS, but no significant differences either in IGF1 or the IGFBP3/IGF1 ratio between CFS patients and normal controls. The decrease in serum DHEAS was highly sensitive and specific for CFS. There were significant and positive correlations between serum DHEAS and serum zinc and the mitogen-induced expression of the CD69 molecule on CD3+CD8+ T cells (an indicator of early T cell activation). There was a significant and negative correlation between serum DHEAS and the increase in the serum alpha-2 protein fraction (an inflammatory marker). Serum IGF1, but not DHEAS, was significantly and inversely correlated to age. The results show that CFS is accompanied by lowered levels of DHEAS and that the latter may play a role in the immune (defect in the early activation of T cells) and the inflammatory pathophysiology of CFS. 180 PMID- 16297163 AU - Maher KJ, Klimas NG, Fletcher MA TI - CFS is associated w diminished intracellular perforin. SO - Clin Exp Immunol. 2005 Dec;142(3):505-11. IN - D o Med, U o Miami Miller School o Medicine, Miami, FL 33176, USA. AB - Chronic fatigue syndrome (CFS) is an illness characterized by unexplained and prolonged fatigue that is often accompanied by abnormalities of immune, endocrine and cognitive functions. Diminished natural killer cell cytotoxicity (NKCC) is a frequently reported finding. However, the molecular basis of this defect of in vitro cytotoxicy has not been described. Perforin is a protein found within intracellular granules of NK and cytotoxic T cells and is a key factor in the lytic processes mediated by these cells. Quantitative fluorescence flow cytometry was used to the intracellular perforin content in CFS subjects and healthy controls. A significant reduction in the NK cell associated perforin levels in samples from CFS patients, compared to healthy controls, was observed. There was also an indication of a reduced perforin level within the cytotoxic T cells of CFS subjects, providing the first evidence, to our knowledge, to suggest a T cell associated cytotoxic deficit in CFS. Because perforin is important in immune surveillance and homeostasis of the immune system, its deficiency may prove to be an important factor in the pathogenesis of CFS and its analysis may prove useful as a biomarker in the study of CFS. 181 PMID- 15712623 AU - Maizels M, McCarberg B TI - Antidepressants & antiepileptic drugs for chr non-cancer pain. [FM] SO - Am Fam Physician. 2005 Feb 1;71(3):483-90. IN - D o Family Practice, Kaiser Permanente, Woodland Hills, California 91365, USA. morris.maizels@kp.org AB - The development of newer classes of antidepressants and second-generation antiepileptic drugs has created unprecedented opportunities for the treatment of chronic pain. These drugs modulate pain transmission by interacting with specific neurotransmitters and ion channels. The actions of antidepressants and antiepileptic drugs differ in neuropathic and non-neuropathic pain, and agents within each medication class have varying degrees of efficacy. Tricyclic antidepressants (e.g., amitriptyline, nortriptyline, desipramine) and certain novel antidepressants (i.e., bupropion, venlafaxine, duloxetine) are effective in the treatment of neuropathic pain. The analgesic effect of these drugs is independent of their antidepressant effect and appears strongest in agents with mixed-receptor or predominantly noradrenergic activity, rather than serotoninergic activity. First-generation antiepileptic drugs (i.e., carbamazepine, phenytoin) and second-generation antiepileptic drugs (e.g., gabapentin, pregabalin) are effective in the treatment of neuropathic pain. The efficacy of antidepressants and antiepileptic drugs in the treatment of neuropathic pain is comparable; tolerability also is comparable, but safety and side effect profiles differ. Tricyclic antidepressants are the most cost-effective agents, but second-generation antiepileptic drugs are associated with fewer safety concerns in elderly patients. Tricyclic antidepressants have documented (although limited) efficacy in the treatment of fibromyalgia and chronic low back pain. Recent evidence suggests that duloxetine and pregabalin have modest efficacy in patients with fibromyalgia. 182 PMID- 15711234 AU - Mannerkorpi K TI - Exercise in FM. SO - Curr Opin Rheumatol. 2005 Mar;17(2):190-4. IN - D o Rheumatology & Inflammation Research, Sahlgrenska Academy, Goteborg U, Goteborg, Sweden. kaisa.mannerkorpi@rheuma.gu.se AB - PURPOSE OF REVIEW: Several studies have indicated that physical exercise is beneficial for patients with fibromyalgia. The aim of this article is to review the recent literature relating to exercise in fibromyalgia, specifically articles published between September 2003 and September 2004, to highlight developments in the field. RECENT FINDINGS: Previous studies indicate that aerobic exercise performed at adequate intensity for an individual can improve function, symptoms, and well-being. A recent study of aerobic exercise showed that training in sedentary women with fibromyalgia using short bouts of exercise produces improvements in health outcomes. A study of aerobic walking resulted in improvements in physical function, symptoms, and distress. Two studies of low-intensity pool exercise reported a positive impact on fibromyalgia symptoms and distress. Two studies of qigong movement therapy were reported, one indicating improvements in symptoms and the other in movement harmony, indicating that this mode of exercise needs to be evaluated further. SUMMARY: The recent studies support existing literature on the benefits of exercise for patients with fibromyalgia. The outcomes appear to be related to the program design and the characteristics of the populations studied. As the patients with fibromyalgia form a heterogeneous population, more research is required to identify the characteristics of patients who benefit from specific modes of exercise. Moreover, long-term planning is needed to motivate the patients to continue regular exercise. Informing patients about the benefits of exercise and adjusting the exercise intensity to individual limitations enhances adherence. The social support gained by exercising in groups also enhances adherence to exercise. 183 PMID- 16012062 AU - Mannerkorpi K, Hernelid C TI - Leisure Time Physical Activity Instrument & Physical Activity at Home & Work Instrument. Development, face validity, construct validity & test-retest reliability for subjects w FM. SO - Disabil Rehabil. 2005 Jun 17;27(12):695-701. IN - D o Rheumatology & Inflammation Research, Sahlgrenska Academy, Goteborg U, Goteborg. AB - PURPOSE: A new instrument measuring leisure time physical activity (LTPAI) in populations predominately engaging in low intensity activities and a new instrument measuring the Physical Activity at Home and Work (PAHWI) were designed. METHODS: Patients with long-lasting pain and expert physiotherapists participated in the development of the two instruments. Test-retest reliability was evaluated for the LTPAI and the PAHWI. Construct validity was evaluated for the LTPAI by comparing it with an instrument measuring physical activities for older people, six-minute walk test and aerobic capacity. POPULATION: 37 women with FM, with the mean age of 46 years (SD 8.4) and mean symptom duration of 11 years (SD 5.9) were recruited to the study. RESULTS: The mean time that the study population spent in physical activities during leisure time was 5.2 hours (SD 4.0) a week. Satisfactory test-retest reliability was found for the total score of LTPAI (ICC 0.86, CI 0.79 - 0.93) and for the PAHWI (ICC 0.91, CI 0.82 - 9.96). A significant association between the LTPAI and the six-minute walk test (rs 0.40, p = 0.02) and another physical activity instrument (rs 0.39, p = 0.02) was found. As expected, LTPAI did not have any association with aerobic capacity. CONCLUSIONS: Face validity of the instruments was ensured during the development process. Satisfactory test-retest reliability was found for the LTPAI and the PAHWI. Significant but low associations were found between the LTPAI and the six-minute walk test and an instrument designed for older people, respectively, while no association was found between the LTPAI and aerobic capacity. 184 PMID- 15902517 AU - Marcus DA, Bernstein C, Rudy TE TI - FM & headache: an epidemiological study supporting migraine as part of the FM syndrome. SO - Clin Rheumatol. 2005 Nov;24(6):595-601. Epub 2005 May 18. IN - D o Anesthesiology, U o Pittsburgh Med Ctr, PA, USA. AB - Fibromyalgia is defined by widespread body pain, tenderness to palpation of tender point areas, and constitutional symptoms. The literature reports headache in about half of fibromyalgia patients. The current epidemiological study was designed to determine the prevalence and characteristics of headache in fibromyalgia patients. Treatment-seeking fibromyalgia patients were evaluated with measures for fibromyalgia, chronic headache, quality of life, and psychological distress. Multivariate analysis of variance (MANOVA) and t-tests were used to identify significant differences, as appropriate. A total of 100 fibromyalgia patients were screened (24 fibromyalgia without headache and 76 fibromyalgia with headache). International Headache Society diagnoses included: migraine alone (n = 15 with aura, n = 17 without aura), tension-type alone (n = 18), combined migraine and tension-type (n = 16), post-traumatic (n = 4), and probable analgesic overuse headache (n = 6). Fibromyalgia tender point scores and counts and most measures of pain severity, sleep disruption, or psychological distress were not significantly different between fibromyalgia patients with and without headache. As expected, the fibromyalgia patients with headache scored higher on the Headache Impact Test (HIT-6) (62.1 +/- 0.9 vs 48.3 +/- 1.6, p < 0.001). HIT-6 scores were >60 in 80% of fibromyalgia plus headache patients, representing severe impact from headache, and 56-58 in 4%, representing substantial impact. In summary, chronic headache was endorsed by 76% of treatment-seeking fibromyalgia patients, with 84% reporting substantial or severe impact from their headaches. Migraine was diagnosed in 63% of fibromyalgia plus headache patients, with probable analgesic overuse headache in only 8%. General measures of pain, pain-related disability, sleep quality, and psychological distress were similar in fibromyalgia patients with and without headache. Therefore, fibromyalgia patients with headache do not appear to represent a significantly different subgroup compared to fibromyalgia patients without headache. The high prevalence and significant impact associated with chronic headache in fibromyalgia patients, however, warrants inclusion of a headache assessment as part of the routine evaluation of fibromyalgia patients. 185 PMID- 15616761 AU - Marques AP, Ferreira EA, Matsutani LA, Pereira CA, Assumpcao A TI - Quantifying pain threshold & quality of life of FM pts. SO - Clin Rheumatol. 2005 Jun;24(3):266-71. Epub 2004 Dec 23. IN - D o Physical, Speech, & Occupational Therapy, School o Med, U o Sao Paulo, Rua Cipotania 51, Cidade Universitaria, Sao Paulo, 05360-160, Brazil, pasqual@usp.br AB - The most typical symptom of fibromyalgia (FM) is diffuse pain, and pain at specific points-tender points-is crucial for its diagnosis. By comparing healthy individuals and FM patients, this study was aimed at assessing pain and quality of life of Brazilian females with FM, while seeking for a correlation between pain threshold and quality of life. A total of 178 women were evaluated: 124 were FM patients and 54 were healthy women. Pain threshold at tender points was quantified by dolorimetry, and diffuse pain by means of the visual analogue scale (VAS); the Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate quality of life. Statistical treatment of the data allowed for proposing two indexes: a pain threshold index (PT) and a quality of life one (QOL). PT is the lowest value among all pain thresholds measured at the 18 tender points; QOL is the mean of responses to the FIQ and VAS. Both indexes were tested and showed significant differences between the test and control groups. By pairing pain threshold values of each tender point in the test and control groups, it was found that the most sensitive points matched between the two groups, that is, the most sensitive anatomic spots in a healthy individual are also likely to be the most sensitive points in a person with FM. This suggests that a stimulus that provokes slight discomfort to a healthy person may produce more pain in FM patients--which may bear implications for FM clinical treatment. In this sample of Brazilian women, FM patients had both lower pain threshold and worse quality of life than healthy women. 186 PMID- 15992574 AU - Masuda A, Kihara T, Fukudome T, Shinsato T, Minagoe S, Tei C TI - The effects of repeated thermal therapy for 2 pts w CFS. SO - J Psychosom Res. 2005 Apr;58(4):383-7. IN - Respiratory & Stress Care Ctr, Kagoshima U Hosp, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. masudaak@m.kufm.kagoshima-u.ac.jp AB - OBJECTIVE: This paper describes the successful treatment of two patients with chronic fatigue syndrome (CFS) using repeated thermal therapy. METHODS: Two patients with CFS underwent treatment with prednisolone (PSL), with no satisfactory effect. They were subjected to thermal therapy that consisted of a far-infrared ray dry sauna at 60 degrees C and postsauna warming. The therapy was performed once a day, for a total of 35 sessions. After discharge, these subjects continued the therapy once or twice a week on an outpatient basis for 1 year. RESULTS: Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy. Although PSL administration was discontinued, the subjects showed no relapse or exacerbation of symptoms during the first year after discharge. The patients became socially rehabilitated 6 months after discharge. CONCLUSIONS: These results suggest that repeated thermal therapy might be a promising method for the treatment of CFS. 187 PMID- 16207340 AU - McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R, Dickens C, Gupta A, Macfarlane GJ TI - Hypothalamic-pituitary-adrenal stress axis function & the relationship w chr widespread pain & its antecedents. [FM] SO - Arthritis Res Ther. 2005;7(5):R992-R1000. Epub 2005 Jun 17. IN - Arthritis Research Campaign (ARC) Epidemiology Unit, School o Epidemiology & Health Sciences, U o Manchester, Manchester, United Kingdom. john.mcbeth@manchester.ac.uk AB - In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with saliva cortisol scores. Further, those in the chronic widespread pain (1.9 (0.8, 4.7)) and 'at risk' (1.6 (0.7, 3.6)) groups were also more likely to have the highest serum cortisol scores. High post-stress serum cortisol was related to high levels of psychological distress (p = 0.05, 95% CI (0.02, 0.08)). After adjusting for levels of psychological distress, the association between chronic widespread pain and post-stress cortisol scores remained, albeit slightly attenuated. This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group. Although some aspects of the altered function are related to the psychosocial factors measured, we conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress. 188 PMID- 16268331 AU - McCabe C, Lewis J, Shenker N, Hall J, Cohen H, Blake D TI - Don't look now! Pain & attention. [FM] SO - Clin Med. 2005 Sep-Oct;5(5):482-6. IN - Royal Nat Hosp for Rheumatic Diseases, Bath. candy.mccabe@rnhrd-tr.swest.nhs.uk AB - Attention and pain are linked inexorably. The manipulation of attention, via either distraction or focused attention, has been used as a therapeutic initiative for generations. Imaging evidence and clinical observations demonstrate that attention can be altered with associated changes at the cortical level and this may have positive or negative effects on the individual. New theories suggest that cortical remapping and visual attention may play key roles in a cortical model of pain specifically involving the motor control system. Within this system, the relationship between allocentric (external) and egocentric (internal) stimuli are managed; where conflict occurs, somaesthetic disturbances may be generated. If an individual pays too much attention to such sensory disturbances, then they may report the disturbances as abnormal symptoms, which may explain the diverse symptomatology of fibromyalgia. The use of a therapeutic optokinetic device to correct existing imbalances in the motor control system is also discussed. 189 PMID- 15750469 AU - McGhee SA, Kaska B, Liebhaber M, Stiehm ER TI - Persistent parvovirus-associated chr fatigue treated w high dose intravenous immunoglobulin. [CF] SO - Pediatr Infect Dis J. 2005 Mar;24(3):272-4. IN - D o Pediatrics, David Geffen School o Med at UCLA, Los Angeles, CA, USA. smcghee@mednet.ucla.edu AB - We report a 16-year-old boy with no evidence of immunodeficiency who had a 2-year history of chronic fatigue, low grade fever and slapped-cheek rash associated with chronic parvovirus B19 viremia. Prolonged intravenous immunoglobulin therapy resulted in resolution of his symptoms and viremia. Intravenous immunoglobulin may be useful in the resolution of parvovirus viremia regardless of immune status. 190 PMID- 16012058 AU - McLean SA, Clauw DJ TI - Biomedical models of FM. SO - Disabil Rehabil. 2005 Jun 17;27(12):659-65. IN - U o Michigan Chronic Pain & Fatigue Research Ctr, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA. samclean@umich.edu AB - PURPOSE: Fibromyalgia (FM) and chronic widespread pain (CWP) are common, but the etiology of these disorders remains poorly understood. A large body of data indicates a neurobiological basis for these disorders, but this information has not been effectively transmitted to many medical professionals. METHODS: Contemporary data on the epidemiologic characteristics of FM and CWP are reviewed, and evidence for a neurobiological basis for these disorders is presented. In addition, possible predisposing, triggering, and maintaining factors for the development of these disorders are discussed. RESULTS: Approximately 10% of the population have CWP, and approximately 4% have FM. The tender point criteria for FM have resulted in the common misconception among health care professionals that this spectrum of disorders is limited to women with high degrees of psychological distress. A hallmark of FM is the presence of non-nociceptive, central pain. There is evidence of centrally augmented pain processing, which can be detected both with sensory testing and by more objective measures (e.g., evoked potentials, functional neuroimaging). DISCUSSION: An appreciation of the neurobiological basis for these disorders, and an understanding of some of the abnormalities of pain processing present in patients with FM, will hopefully provide greater understanding of these patients. It may also serve to decrease the level of frustration and improve the care experience of both chronic pain patients and physicians. 191 PMID- 16019393 AU - McLean SA, Williams DA, Clauw DJ TI - FM after motor vehicle collision: evidence & implications. SO - Traffic Inj Prev. 2005 Jun;6(2):97-104. IN - D o Emergency Med & The Chronic Pain & Fatigue Research Ctr, U o Michigan Med Center, Ann Arbor, Michigan, USA. samclean@umich.edu AB - OBJECTIVE: Assess currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of fibromyalgia (FM). METHODS: Consensus standards developed by the American College of Rheumatology Environmental Disease Study Group were used to assess the ability of an MVC to trigger FM. RESULTS: Increasing evidence suggests that FM and related disorders are characterized by abnormalities in central nervous system function related to sensory processing, autonomic regulation, and neuroendocrine function. MVC trauma appears capable of triggering FM, but generally not through direct biomechanical injury. Instead, the evidence suggests that MVC trauma can act as a "stressor," which in concert with other factors, such as an individual's biologic vulnerability, psychosocial factors, cultural factors, and so on, may result in the development of chronic widespread pain and other somatic symptoms. MVC trauma is only one of many stressors which can trigger such disorders, and the environment within which the stressor is experienced (biological and psychosocial) may largely determine whether there is an adverse physiologic result or not. CONCLUSIONS: The evidence that MVC trauma may trigger FM meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders. 192 PMID- 16258904 AU - McLean SA, Williams DA, Harris RE, Kop WJ, Groner KH, Ambrose K, Lyden AK, Gracely RH, Crofford LJ, Geisser ME, Sen A, Biswas P, Clauw DJ TI - Momentary relationship between cortisol secretion & Sx in pts w FM. SO - Arthritis Rheum. 2005 Nov;52(11):3660-9. IN - Chronic Pain & Fatigue Research Ctr, U o Michigan Med Center, 24 Frank Lloyd Wright Drive, PO Box 385, Ann Arbor, MI 48106, USA. samclean@umich.edu AB - OBJECTIVE: To compare the momentary association between salivary cortisol levels and pain, fatigue, and stress symptoms in patients with fibromyalgia (FM), and to compare diurnal cycles of cortisol secretion in patients with FM and healthy control subjects in a naturalistic environment. METHODS: Twenty-eight patients with FM and 27 healthy control subjects completed assessments on salivary cortisol levels and pain, fatigue, and stress symptoms, 5 times a day for 2 consecutive days, while engaging in usual daily activities. Only those participants who adhered to the protocol (assessed via activity monitor) were included in the final analyses. RESULTS: Twenty FM patients and 16 healthy control subjects adhered to the protocol. There were no significant differences in cortisol levels or diurnal cortisol variation between FM patients and healthy controls. Among women with FM, a strong relationship between cortisol level and current pain symptoms was observed at the waking time point (t = 3.35, P = 0.008) and 1 hour after waking (t = 2.97, P = 0.011), but not at the later 3 time points. This association was not due to differences in age, number of symptoms of depression, or self-reported history of physical or sexual abuse. Cortisol levels alone explained 38% and 14% of the variation in pain at the waking and 1 hour time points, respectively. No relationship was observed between cortisol level and fatigue or stress symptoms at any of the 5 time points. CONCLUSION: Among women with FM, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis. 193 PMID- 16259313 AU - Mears T TI - Acupuncture in the Rx of post viral fatigue syndrome--a case report. [CFS] SO - Acupunct Med. 2005 Sep;23(3):141-5. IN - tim26@tesco.net AB - This case report concerns the treatment of post viral fatigue (chronic fatigue syndrome) with electroacupuncture. This condition is particularly difficult to treat whether using conventional or complementary therapy. Whilst the treatment did not cure the patient, it appears to have facilitated her return to work and markedly improved her symptoms. There are few publications on acupuncture treatment of this condition and the approach used here has not been reported previously. 194 PMID- 16265715 AU - Mease PJ, Clauw DJ, Arnold LM, Goldenberg DL, Witter J, Williams DA, Simon LS, Strand CV, Bramson C, Martin S, Wright TM, Littman B, Wernicke JF, Gendreau RM, Crofford LJ TI - FM syndrome. SO - J Rheumatol. 2005 Nov;32(11):2270-7. IN - Swedish Med Ctr, the U o Washington School o Med, Seattle, WA, USA. pmease@nwlink.com AB - The objectives of the first OMERACT Fibromyalgia Syndrome (FM) Workshop were to identify and prioritize symptom domains that should be consistently evaluated in FM clinical trials, and to identify aspects of domains and outcome measures that should be part of a concerted research agenda of FM researchers. Such an effort will help standardize and improve the quality of outcomes research in FM. A principal assumption in this workshop has been that there exists a clinical syndrome, generally known as FM, characterized by chronic widespread pain typically associated with fatigue, sleep disturbance, mood disturbance, and other symptoms and signs, and considered to be related to central neuromodulatory dysregulation. FM can be diagnosed using 1990 American College of Rheumatology criteria. In preparation for the workshop a Delphi exercise involving 23 FM researchers was conducted to establish a preliminary prioritization of domains of inquiry. At the OMERACT meeting, the workshop included presentation of the Delphi results; a review of placebo-controlled trials of FM treatment, with a focus on the outcome measures used and their performance; a panel discussion of the key issues in FM trials, from both an investigator and regulatory agency perspective; and a voting process by the workshop attendees. The results of the workshop were presented in the plenary session on the final day of the meeting. A prioritized list of domains of FM to be investigated was thus developed, key issues and controversies in the field were debated, and consensus on a research agenda on outcome measure development was reached. 195 PMID- 16078356 AU - Mease P TI - FM syndrome: review of clinical presentation, pathogenesis, outcome measures, & Rx. SO - J Rheumatol Suppl. 2005 Aug;75:6-21. IN - Seattle Rheumatology Associates, Washington 98104, USA. pmease@nwlink.com AB - 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. 196 PMID- 16100965 AU - Mercante JP, Peres MF, Guendler V, Zukerman E, Bernik MA TI - Depression in chr migraine: severity & clinical features. [FM] SO - Arq Neuropsiquiatr. 2005 Jun;63(2A):217-20. IN - Psicologa, pesquisadora do Instituto de Ensino e Pesquisa do Hosp Israelita Albert Einstein, Sao Paulo SP, Brasil. julianeperes@terra.com.br AB - INTRODUCTION: Chronic migraine (CM) is a common medical condition affecting 2.4% of the general population. Depression is one of the most frequent comorbid disorders in CM. METHOD: Seventy patients diagnosed with chronic migraine were studied. All patients evaluated filled out the Beck Depression Inventory (BDI). Depression severity was divided into none or minimal depression, mild, moderate, and severe. RESULTS: BDI ranged from 4 to 55, mean 21 +/- 10.7. Moderate or severe depression, were present in 58.7% of the patients. Some degree of depression appeared in 85.8% of patients. The BDI scores correlated with pain intensity (p = 0.02). Severe depression was more frequent in patients with comorbid fibromyalgia and in patients reporting fatigue. CONCLUSION: The BDI is an easy tool to access depression in CM patients. Suicide risk assessment is needed in CM patients. Patients with fibromyalgia and fatigue are at even higher risk for severe depression. 197 PMID- 16372904 AU - Michalsen A, Riegert M, Ludtke R, Backer M, Langhorst J, Schwickert M, Dobos GJ TI - Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion & clinical outcome in pts w RA & FM: an observational study. SO - BMC Complement Altern Med. 2005 Dec 22;5:22. IN - Kliniken Essen-Mitte, D o Internal & Integrative Med, U Duisburg-Essen, am Deimelsberg 34a, 45276 Essen, Germany. andreas.michalsen@uni-essen.de AB - BACKGROUND: Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA) or fibromyalgia (FM) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. METHODS: During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16) or FM (n = 35) were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y) or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y). Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA) were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. RESULTS: We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09). Clinical outcome was not related to alterations in the intestinal flora. CONCLUSION: Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal flora and sIgA levels in patients with RA and FM. The impact of dietary interventions on the human intestinal flora and the role of the fecal flora in rheumatic diseases have to be clarified with newer molecular analysis techniques. The potential benefit of fasting treatment in RA and FM should be further tested in randomised trials. 198 PMID- 16372029 AU - Mihrshahi R, Beirman R TI - Aetiology & pathogenesis of CFS: a review. SO - N Z Med J. 2005 Dec 16;118(1227):U1780. IN - D o Biological Sciences, Macquarie U, Sydney, NSW, Australia. rbeirman@els.mq.edu.au AB - Chronic fatigue syndrome (CFS) is a debilitating disease of uncertain aetiology that is characterised by unexplained, severe fatigue associated with a number of typical symptoms. This paper reviews the scientific literature related to current theories about the aetiology and pathogenesis of CFS by focussing on what appear to be the four most significant aspects in the development and perpetuation of this disease: the role of infectious agents as well as immunological, neuroendocrine, and psychiatric factors. A multifactorial model for the aetiology of CFS, which includes and draws together these four aspects, is proposed; and suggestions are offered regarding approaches to the diagnosis and treatment of this disease. 199 PMID- 16314601 AU - Montoya P, Sitges C, Garcia-Herrera M, Izquierdo R, Truyols M, Blay N, Collado D TI - Abnormal affective modulation of somatosensory brain processing among pts w FM. SO - Psychosom Med. 2005 Nov-Dec;67(6):957-63. IN - D o Psychology & Research Inst o Health Sciences (IUNICS), U o the Balearic Islands, Palma, Spain. pedro.montoya@uib.es AB - OBJECTIVE: It is well established that subjective pain perception can be modulated by negative mood states and that patients with chronic pain are characterized by high levels of depression and anxiety. Nevertheless, very little is known about the effects of negative mood induction on brain processing of somatosensory information in fibromyalgia. The objective of the present study was to examine the influence of two emotional states (pleasant and unpleasant) on brain activity of patients with fibromyalgia (FM; n = 27) and with musculoskeletal (MSK) pain resulting from identifiable somatic lesions (n = 16). METHODS: For this purpose, somatosensory-evoked potentials (SEPs) elicited by nonpainful pneumatic stimuli, delivered to the right and left hand following an oddball paradigm, were recorded when patients were viewing affective slides. RESULTS: As compared with patients with MSK pain, patients with FM displayed overall larger P50 amplitude to tactile stimuli. In addition, significantly larger P50 and smaller N80 amplitudes were found within patients with FM when they were viewing the unpleasant rather than the pleasant slides. CONCLUSION: Our data suggest an abnormal processing of nonpainful somatosensory information in FM, especially when somatic signals are arising from the body within an aversive stimulus context. These findings provide further support for the use of biopsychosocial models for understanding FM and other chronic pain states. 200 PMID- 15862479 AU - Montoya P, Pauli P, Batra A, Wiedemann G TI - Altered processing of pain-related information in pts w FM. SO - Eur J Pain. 2005 Jun;9(3):293-303. IN - D o Psychology & Research Inst on Health Sciences, U o the Balearic Islands, Palma, Spain. pedro.montoya@uib.es AB - Pressure pain thresholds (PPTs) and event-related potentials (ERPs) elicited by emotional words were analyzed in 12 patients with fibromyalgia (FM) and 12 matched healthy subjects. PPTs were assessed at the middle finger of both hands, before and after the experiment. Overall, FM patients and healthy subjects did not differ in PPT. Nevertheless, FM patients as compared with healthy controls were characterized by a significant enhancement of pain sensitivity from the beginning to the end of the experiment indicating a long lasting sensitization due to repeated stimulation. ERPs were recorded during a language decision task where subjects had to react to unpleasant pain-related and emotionally neutral words depending on syntactic or orthographic cues. An emotional category effect was observed on N400 and P300 components of the ERP, indicating that unpleasant words elicited more positive amplitudes than neutral words. A significant group effect was observed on P200 amplitudes, showing reduced amplitudes in FM patients as compared to healthy controls. Furthermore, unpleasant pain-related compared to neutral words triggered significantly enhanced late positive slow waves in healthy controls, while a comparable effect was not found in FM patients. The ERP and PPT data suggest that FM patients are characterized by an altered cognitive processing of pain-related information and by an abnormal adaptation to mechanical pain stimuli, respectively. 201 PMID- 15743467 AU - Morf S, Amann-Vesti B, Forster A, Franzeck UK, Koppensteiner R, Uebelhart D, Sprott H TI - Microcirculation abnormalities in pts w FM - measured by capillary microscopy & laser fluxmetry. SO - Arthritis Res Ther. 2005;7(2):R209-16. Epub 2004 Dec 10. IN - D o Rheumatology, Inst o Physical Med, U Hosp, Zurich, Switzerland. susanne.morf@gmx.ch AB - This unblinded preliminary case-control study was done to demonstrate functional and structural changes in the microcirculation of patients with primary fibromyalgia (FM). We studied 10 women (54.0 +/- 3.7 years of age) with FM diagnosed in accordance with the classification criteria of the American College of Rheumatology, and controls in three groups (n = 10 in each group) - age-matched women who were healthy or who had rheumatoid arthritis or systemic scleroderma (SSc). All 40 subjects were tested within a 5-week period by the same investigators, using two noninvasive methods, laser fluxmetry and capillary microscopy. The FM patients were compared with the healthy controls (negative controls) and with rheumatoid arthritis patients and SSc patients (positive controls). FM patients had fewer capillaries in the nail fold (P < 0.001) and significantly more capillary dilatations (P < 0.05) and irregular formations (P < 0.01) than the healthy controls. Interestingly, the peripheral blood flow in FM patients was much less (P < 0.001) than in healthy controls but did not differ from that of SSc patients (P = 0.73). The data suggest that functional disturbances of microcirculation are present in FM patients and that morphological abnormalities may also influence their microcirculation. 202 PMID- 15759948 AU - Morris CR, Bowen L, Morris AJ TI - Integrative therapy for FM: possible strategies for an individualized Rx program. SO - South Med J. 2005 Feb;98(2):177-84. IN - Arthritis Associates, Kingsport, TN, USA. arthritis@charter.net AB - One of the most complex patient treatment situations encountered by the clinician is the patient who presents with the cluster of signs and symptoms that lead to the diagnosis of fibromyalgia syndrome. While physicians focus primarily on pharmacologic treatment, a number of nonpharmacologic modalities have been shown to benefit patients as well. No one therapy is uniformly effective in every patient; treatment programs consisting of a combination of pharmacologic and nonpharmacologic therapies must be individualized to the patient, and the clinician may have to try several different modalities before reaching an optimal improvement in the patient's symptoms. 203 PMID- 15684437 AU - Moss J TI - Development of a functional ability scale for children & young people w myalgic encephalopathy (ME)/CFS (CFS). SO - J Child Health Care. 2005 Mar;9(1):20-30. IN - Association o Young People with ME, Milton Keynes MK2 2XD, UK. jill@ayme.org.uk AB - The numerous symptoms and unpredictable pattern of myalgic encephalopathy (ME) make it difficult to describe, especially for children. It was left to carers to guess what the child could achieve each day, often leading to over/underestimates. A functional ability scale was needed, which measured from 0 to 100 percent able and that children and young people themselves designed. A new scale was developed from the Moss Ability Scale using the critique of 251 children and young people from the Association of Young People with ME (AYME). Responding to the shift in emphasis towards patients taking an active role in their own care, it was felt these young people would know whether the scale measured what it had set out to measure, and were asked questions on the face and content validity of the scale. There was a 99 percent agreement between the young people that the final scale was 'workable' or better. 204 PMID- 15723894 AU - Moss-Morris R, Sharon C, Tobin R, Baldi JC TI - A randomized controlled graded exercise trial for CFS: outcomes & mechanisms of change. SO - J Health Psychol. 2005 Mar;10(2):245-59. IN - Health Psychology, The Faculty o Med & Health Sciences, The U o Auckland, Private Bag 92 019, Auckland, New Zealand. r.moss-morris@auckland.ac.nz AB - The aim of this study was to investigate the potential mechanisms underlying the efficacy of graded exercise therapy for chronic fatigue syndrome (CFS). Forty-nine CFS patients were randomized to a 12-week graded exercise programme or to standard medical care. At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group. A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect. Graded exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms. 205 PMID- 15940777 AU - Narvaez J, Nolla JM, Valverde-Garcia J TI - Lack of association of FM w hepatitis C virus infection. SO - J Rheumatol. 2005 Jun;32(6):1118-21. IN - D o Rheumatology, Hosp Universitario de Bellvitge-IDIBELL, Barcelona, Spain. 31577edd@comb.es AB - OBJECTIVE: An association between chronic hepatitis C virus (HCV) infection and fibromyalgia (FM) remains controversial, mainly because previous studies were based on prevalent case series or comparisons with less than optimal control groups. We investigated whether there might be an association between chronic HCV infection and FM. METHODS: We prospectively investigated the prevalence of HCV infection in a series of 115 patients with FM and compared it with the prevalence in the general population of our community reported in the same period. Anti-HCV antibodies were determined by ELISA. In positive cases, infection was confirmed by recombinant immunoblot assay and HCV-RNA was detected by PCR using sera samples. Differences between prevalence rates were assessed by chi-square test. RESULTS: HCV infection was confirmed in 3 of 115 patients with FM (2.6%). Two of these patients (1.74%) had active HCV infection shown by the presence of viral RNA in serum, whereas HCV RNA was undetectable in the third patient. In these cases, liver disease had previously been undiagnosed and HCV infection manifested itself by extrahepatic symptoms. Although the prevalence of HCV infection was slightly higher in patients with FM than in the general population in the age groups 25-44 and 45-64 years, when we compared prevalence rates in the total group and the different age groups, no statistically significant differences were found. CONCLUSION: From our results, it seems unlikely that HCV infection plays a pathogenic role in FM. 206 PMID- 15693096 AU - Naschitz JE, Rozenbaum M, Fields MC, Enis S, Manor H, Dreyfuss D, Peck S, Peck ER, Babich JP, Mintz EP, Sabo E, Slobodin G, Rosner I TI - Cardiovascular reactivity in FM: evidence for pathogenic heterogeneity. SO - J Rheumatol. 2005 Feb;32(2):335-9. IN - D o Internal Med A & Rheumatology, Bnai Zion Med Ctr & Bruce Rappaport Faculty o Medicine, Technion-Israel Inst o Technology, Haifa, Israel. Naschitz@tx.technion.ac.il AB - OBJECTIVE: To evaluate disease-specific cardiovascular reactivity patterns in patients with fibromyalgia (FM) using a recently described method called fractal and recurrence analysis score (FRAS). METHODS: The study group included 30 women with FM, average age 46.7 years (SD 7.03). An age matched group of 30 women with other rheumatic disorders or having a dysautonomic background [chronic fatigue syndrome (CFS), non-CFS fatigue, neurally mediated syncope, and psoriatic arthritis (PsA)] served as controls. Subjects were evaluated with a head-up tilt test with beat-to-beat recording of the heart rate (HR) and pulse transit time. A 10-minute supine phase was followed by 600 cardiac cycles recorded on tilt. Data were processed by recurrence plot and fractal analysis. Variables acting as independent predictors of the cardiovascular reactivity were identified in FM patients versus controls. RESULTS: No statistically significant differences were found between the groups by univariate analysis comparing 92 variables of cardiovascular reactivity in FM patients compared to controls. CONCLUSION: Study of cardiovascular reactivity utilizing a head-up tilt test and processing the data using the FRAS method did not reveal a specific FM-associated abnormality. Our data confirm studies that utilized other methodologies and reached similar conclusions. Patients with FM represent a heterogenous group with respect to their pattern of cardiovascular reactivity. 207 PMID- 15838538 AU - Naschitz JE, Mussafia-Priselac R, Peck ER, Peck S, Naftali N, Storch S, Slobodin G, Elias N, Rosner I TI - Hyperventilation & amplified blood pressure response: is there a link? [FM] SO - J Hum Hypertens. 2005 May;19(5):381-7. IN - D o Internal Med A, Bnai-Zion Med Ctr, Haifa, Israel. Naschitz@tx.technion.ac.il AB - Based on prior studies, the hypothesis that hyperventilation (HV) may have a pressor effect and play a causal role in hypertension has been suggested. The objective of this study was to correlate HV with blood pressure (BP)-change during a postural challenge. Consecutive subjects referred for evaluation of syncope, dizziness, chronic fatigue syndrome (CFS), fibromyalgia, or non-CFS fatigue were assessed with a 10-min supine 30-min head-up tilt test combined with capnography. We selected for analysis the records of patients aged 17-70 years, not taking vasoactive medications, having sitting systolic BP (SBP) < 140 mmHg, sitting diastolic BP (DBP) < 90 mmHg, and who completed 30 min of tilt. HV was diagnosed when end-tidal pressure of CO2 < 30 mmHg was recorded consecutively for > or = 10 min. Postural hypertension (PHT) was diagnosed when DBP on tilt > or = 90 mmHg was recorded consecutively for > or = 10 min. DBP-change was computed as (median DBP on tilt) -(median DBP supine). PHT and DBP-change were correlated with HV. A total of 320 patient charts were reviewed. PHT was present in 30 cases. The mean DBP-change in patients with PHT was +9.9 mmHg (s.d. 5.8), with three patients manifesting HV. Of the remaining 290 patients, 56 had HV, their mean DBP-change was -0.3 mmHg (s.d. 7.2). The other 234 patients without HV had a mean DBP-change +0.95 mmHg (s.d. 5.7), comparable to the DBP-change in patients with HV. In, conclusion, posturally induced HV was not associated with an increase in BP, nor was PHT associated with HV, except in a small minority of cases. 208 PMID- 15330754 AU - Naschitz JE, Rozenbaum M, Fields M, Isseroff H, Enis S, Babich JP, Peck S, Peck ER, Gaitini L, Naschitz S, Sabo E, Rosner I TI - Search for disease-specific cardiovascular reactivity patterns: developing the methodology. [CFS] SO - Clin Sci (Lond). 2005 Jan;108(1):37-46. IN - D o Internal Med A, Bnai Zion Med Ctr & Bruce Rappaport Faculty o Medicine, Technion-Israel Inst o Technology, Haifa, Israel. Naschitz@tx.technion.ac.il AB - Aberrations of CVR (cardiovascular reactivity), an expression of autonomic function, lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome has been observed. In the present study, we aimed to develop methodologies for assessing disease-specific CVR patterns. As a prototype, a population of 50 consecutive patients with FMF (familial Mediterranean fever) was studied and compared with control populations. A 10 min supine/30 min head-up tilt test with recording of the heart rate and blood pressure or the pulse transit time was performed. Five studies were conducted applying different methods. In each study, statistical analysis identified independent predictors of CVR in FMF. Based on regression coefficients of these predictors, a linear DS (discriminant score) was computed for every subject. Each study established an equation to assess CVR, calculate DS for FMF and determine the sensitivity and specificity of the DS cut-off. In each of the five studies, abnormal CVR was observed in FMF patients. The best accuracy (88% sensitivity and 90.1% specificity for FMF) was obtained by a method based on beat-to-beat heart rate and pulse transit time recordings. Data was processed by fractal and recurrence quantitative analysis with recordings in FMF patients compared with a mixed control population. Identification of disease-specific CVR patterns was possible with the methodologies described in the present study. In FMF, disease-specific CVR may be explained by the interplay between neuroendocrine loops specific to FMF with cardiovascular homoeostatic mechanisms. Recognition of disease-specific CVR patterns may advance the understanding of homoeostatic mechanisms and have implications in clinical practice. 209 PMID- 15642984 AU - Natelson BH, Weaver SA, Tseng CL, Ottenweller JE TI - Spinal fluid abnormalities in pts w CFS. SO - Clin Diagn Lab Immunol. 2005 Jan;12(1):52-5. IN - CFS Cooperative Research Ctr & D o Neurosciences, U o Med & Dentistry o New Jersey-New Jersey MS, Newark, New Jersey, USA. bhn@njneuromed.org AB - Arguments exist as to the cause of chronic fatigue syndrome (CFS). Some think that it is an example of symptom amplification indicative of functional or psychogenic illness, while our group thinks that some CFS patients may have brain dysfunction. To further pursue our encephalopathy hypothesis, we did spinal taps on 31 women and 13 men fulfilling the 1994 case definition for CFS and on 8 women and 5 men serving as healthy controls. Our outcome measures were white blood cell count, protein concentration in spinal fluid, and cytokines detectable in spinal fluid. We found that significantly more CFS patients had elevations in either protein levels or number of cells than healthy controls (30 versus 0%), and 13 CFS patients had protein levels and cell numbers that were higher than laboratory norms; patients with abnormal fluid had a lower rate of having comorbid depression than those with normal fluid. In addition, of the 11 cytokines detectable in spinal fluid, (i) levels of granulocyte-macrophage colony-stimulating factor were lower in patients than controls, (ii) levels of interleukin-8 (IL-8) were higher in patients with sudden, influenza-like onset than in patients with gradual onset or in controls, and (iii) IL-10 levels were higher in the patients with abnormal spinal fluids than in those with normal fluid or controls. The results support two hypotheses: that some CFS patients have a neurological abnormality that may contribute to the clinical picture of the illness and that immune dysregulation within the central nervous system may be involved in this process. 210 PMID- 16260962 AU - Nijs J, Meeus M, McGregor NR, Meeusen R, de Schutter G, van Hoof E, de Meirleir K TI - CFS: exercise performance related to immune dysfunction. SO - Med Sci Sports Exerc. 2005 Oct;37(10):1647-54. IN - D o Human Physiology, Faculty o Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. AB - PURPOSE: To date, the exact cause of abnormal exercise response in chronic fatigue syndrome (CFS) remains to be revealed, but evidence addressing intracellular immune deregulation in CFS is growing. Therefore, the aim of this cross-sectional study was to examine the interactions between several intracellular immune variables and exercise performance in CFS patients. METHODS: After venous blood sampling, subjects (16 CFS patients) performed a maximal exercise stress test on a bicycle ergometer with continuous monitoring of cardiorespiratory variables. The following immune variables were assessed: the ratio of 37 kDa Ribonuclease (RNase) L to the 83 kDa native RNase L (using a radiolabeled ligand/receptor assay), RNase L enzymatic activity (enzymatic assay), protein kinase R activity assay (comparison Western blot), elastase activity (enzymatic-colorimetric assay), the percent of monocytes, and nitric oxide determination (for monocytes and lymphocytes; flow cytometry, live cell assay). RESULTS: Forward stepwise multiple regression analysis revealed 1) that elastase activity was the only factor related to the reduction in oxygen uptake at a respiratory exchange ratio (RER) of 1.0 (regression model: R = 0.53, F (1,14) = 15.5, P < 0.002; elastase activity P < 0.002); 2) that the protein kinase R activity was the principle factor related to the reduction in workload at RER = 1.0; and 3) that elastase activity was the principle factor related to the reduction in percent of target heart rate achieved. CONCLUSION: These data provide evidence for an association between intracellular immune deregulation and exercise performance in patients with CFS. To establish a causal relationship, further study of these interactions using a prospective longitudinal design is required. 211 PMID- 16323389 AU - Nijs J, Van de Putte K, Louckx F, De Meirleir K TI - Employment status in CFS. A cross-sectional study examining the value of exercise testing & self-reported measures for the assessment of employment status. SO - Clin Rehabil. 2005 Dec;19(8):895-9. IN - D o Human Physiology, Faculty o Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium. Jo.Nijs@vub.ac.be AB - OBJECTIVE: To examine the value of exercise testing and self-reported disability for the assessment of employment status in patients with chronic fatigue syndrome. DESIGN: Cross-sectional observational study. SETTING: A university-based chronic fatigue clinic. SUBJECTS: Fifty-four consecutive, Flemish, employed (not self-employed) chronic fatigue syndrome patients (49/54 female). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were questioned about their current and premorbid employment status, filled in the Chronic Fatigue Syndrome Activities and Participation Questionnaire (CFS-APQ), the Medical Outcomes Short Form 36 Health Status Survey (SF-36), and performed a maximal exercise test on a bicycle ergometer with continuous monitoring of cardiorespiratory variables. RESULTS: A significant association was observed between the current employment rate and two SF-36 subscales (i.e., role limitations due to physical functioning and social functioning; rho = 0.39 and 0.35 respectively) (n = 54). Analysing only the female chronic fatigue syndrome patients (n = 49), the current employment rate correlated significantly with the peak workload (rho = 0.38). CONCLUSIONS: The associations between either exercise testing or self-reported disability and employment status are too weak to predict employment status. 212 PMID- 16277015 AU - Nijs J, De Meirleir K TI - Impairments of the 2-5A synthetase/RNase L pathway in CFS. SO - In Vivo. 2005 Nov-Dec;19(6):1013-21. IN - D o Human Physiology, Faculty o Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. Jo.Nijs@vub.ac.be AB - This paper provides an overview of the evidence addressing the impairments of the 2'-5' oligoadenylate (2-5 A) synthetase/RNase L pathway in Chronic Fatigue Syndrome (CFS) patients. The 2-5A synthetase/RNase L pathway in CFS patients appears to be both up-regulated (i.e. increased levels of bioactive 2-5A synthetase and increased activity of the RNase L enzyme) and deregulated (elastase and calpain initiate 83 kDa RNase L proteolysis, generating two major fragments with molecular masses of 37 and 30 kDa, respectively). The deregulation of the 2-5A synthetase/RNase L pathway in CFS accompanies decreased NK-function and deregulation of apoptotic pathways. Since various components of the pathway appear to be related to performance during a graded exercise stress test, some evidence supportive of the clinical importance of the impaired pathway in CFS patients has been provided. Studies addressing the treatment of the deregulation of the 2-5A synthetase/RNase L pathway in CFS are warranted. 213 PMID- 15617866 AU - Nijs J, Van de Velde B, De Meirleir K TI - Pain in pts w CFS: does nitric oxide trigger central sensitisation? SO - Med Hypotheses. 2005;64(3):558-62. IN - D o Human Physiology, Faculty o Physical Education & Physical Therapy, Vrije Universiteit Brussel (VUB), Belgium. jo.nijs@vub.ac.be AB - Previous studies have provided evidence supportive of the clinical importance of widespread pain in patients with chronic fatigue syndrome (CFS): pain severity may account for 26-34% of the variability in the CFS patient's activity limitations and participation restrictions. The etiology of widespread pain in CFS remains to be elucidated, but sensitisation of the central nervous system has been suggested to take part of CFS pathophysiology. It is hypothesised that a nitric oxide (NO)-dependent reduction in inhibitory activity of the central nervous system and consequent central sensitisation accounts for chronic widespread pain in CFS patients. In CFS patients, deregulation of the 2',5'-oligoadenylate synthetase/RNase L pathway is accompanied by activation of the protein kinase R enzyme. Activation of the protein kinase R and subsequent nuclear factor-kappaB activation might account for the increased production of NO, while infectious agents frequently associated with CFS (Coxsackie B virus, Epstein-Barr Virus, Mycoplasma) might initiate or accelerate this process. In addition, the evidence addressing behavioural changes in CFS patients fits the central sensitisation-hypothesis: catastrophizing, avoidance behaviour, and somatization may result in, or are initiated by sensitisation of the central nervous system. 214 PMID- 16136868 AU - Nijs J, Vaes P, De Meirleir K TI - The CFS Activities & Participation Questionnaire (CFS-APQ): an overview. SO - Occup Ther Int. 2005;12(2):107-21. IN - D o Physiology, Faculty o Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium. Jo.Nijs@vub.ac.be AB - Chronic fatigue syndrome (CFS) is characterized by severe fatigue and a reduction in activity levels. The purpose of this study was to provide an overview of design, reliability, and validity of the CFS Activities and Participation Questionnaire (CFS-APQ). The CFS-APQ was constructed based on a retrospective analysis of the Karnofsky Performance Status Questionnaire and the Activities of Daily Living Questionnaire (n = 141). In a reliability study of 34 participants the test-retest reliability coefficient of the CFS-APQ was 0.95. In two different studies, the Cronbach alpha coefficient for internal consistency varied between 0.87 (n = 88) and 0.94 (n = 47). The CFS-APQ was administered to 47 patients who listed 183 activities that had become difficult due to their chronic symptoms, and 157 (85.8%) answers matched the content of the CFS-APQ. The outcome of a cross-sectional study (n = 88) studying the correlations between the Medical Outcomes Short Form 36 Health Status Survey subscale scores and the CFS-APQ supported the validity of the CFS-APQ. The CFS-APQ scores correlated with a behavioural assessment of the patients' performance of activities encompassed by the questionnaire (r = 0.29-0.55; n = 63), and correlated with exercise capacity parameters (r = 0.26-0.39; n = 77) obtained during a maximal exercise capacity stress test. Finally, the CFS-APQ correlated with visual analogue scales for pain (r = 0.51) and fatigue (r = 0.50; n = 47). It is concluded that the CFS-APQ generates reliable and valid data, and can be used as a clinical measure of disease severity in patients with CFS. Future studies should aim at examining the sensitivity of the CFS-APQ. 215 PMID- 16191727 AU - Njoku MG, Jason LA, Torres-Harding SR TI - The relationships among coping styles & fatigue in an ethnically diverse sample. [CFS] SO - Ethn Health. 2005 Nov;10(4):263-78. IN - Center for Community Research, Chronic Fatigue Research Study, Chicago, IL 60614, USA. nmgloria@depaul.edu AB - The present study focused on coping strategies among African Americans, Latinos, and European Americans with chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). The coping strategies examined were measured by using the COPE Scales, which assess Seeking Emotional Social Support, Positive Reinterpretation and Growth, Acceptance, Denial, Turning to Religion, Behavioral Disengagement, and Focusing on and Venting Emotions. In addition, the four coping strategies specifically designed for people with CFS, including maintaining activity, accommodating to the illness, focusing on symptoms, and information-seeking, were used in this study. It was hypothesized that African Americans and Latinos in comparison to European Americans would be more likely to use religious coping, behavioral disengagement, and denial. As predicted, African Americans were significantly more likely to turn to religion than European Americans, and Latinos and African Americans used denial significantly more often than European Americans. An additional finding was that focusing on symptoms was associated with greater fatigue and more physical disability among African Americans. Within the Latino sample, acceptance was related to greater fatigue and less physical disability, and greater optimism predicted less mental disability. Among European American participants, maintaining activity was related to less mental disability, whereas accommodating to the illness predicted more physical disability. These results indicate that coping varies among various ethnic groups with CFS and ICF; however, denial is consistently related to less adaptive outcomes. Therefore, healthcare professionals should find ways to reduce patient use of denial and promote alternative strategies for managing life events. 216 PMID- 15902759 AU - Offenbaecher M, Ackenheil M TI - Current trends in neuropathic pain Rxs w special reference to FM. SO - CNS Spectr. 2005 Apr;10(4):285-97. IN - D o Med Psychology, U o Munich MS, Goethestrasse 31, 80336 Munchen, Germany. Martin.Offenbaecher@med.uni-muenchen.de AB - Neuropathic pain and fibromyalgia are prevalent diseases which have major consequences on healthcare resources and the individual. From the clinical point of view neuropathic pains represent a heterogeneous group of aetiologically different diseases ranging from cancer to diabetes. Patients with fibromyalgia also display clinical features common in neuropathic pain suggesting that there might be some overlap. The mechanisms responsible for symptoms and signs in both diseases are still unknown. Recently, there have been numerous reports of various pharmacological treatments of neuropathic pain and fibromyalgia with often disappointing results. Most of the studies were of short duration, had high attrition rates, and displayed other methodological problems. Some compounds had high rates of adverse effects which makes it often difficult for the patients to tolerate the treatment, especially in the long-term. At present, the best options for medication treatment are tricyclic antidepressants in lower dosage than usual in psychiatric disorders and a wide range of anticonvulsants. Opioids are sometimes recommended but have been found to have minor efficacy. Recently, there have been more controlled trials, which are reported here if they had been published between 2002 and 2004. Various compounds have been tested in different studies. Treatment of fibromyalgia, which has many features in common with depressive symptoms, became the focus of interest. New promising studies with dual serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipram) and a newer antiepileptic drug (pregabalin) are in progress. Future research will have to apply new approaches (e.g., using a mechanism-based classification of neuropathic pain and carrying out studies in populations with the same symptom but not necessarily the same disease) in order to find effective treatments for these common and often debilitating diseases. 217 PMID- 15856367 AU - Ofluoglu D, Berker N, Guven Z, Canbulat N, Yilmaz IT, Kayhan O TI - Quality of life in pts w FM syndrome & RA. SO - Clin Rheumatol. 2005 Sep;24(5):490-2. Epub 2005 Apr 23. IN - D o Physical Med & Rehabilitation, Marmara U School o Medicine, Istanbul, Turkey. AB - The objective of this study was to determine and compare the quality of life (QOL) of patients with fibromyalgia syndrome (FS) and rheumatoid arthritis (RA) and to assess patients' psychological and functional status in each group. This prospective study included 62 female FS patients and 60 female RA patients diagnosed by the American College of Rheumatology criteria. The Turkish translations of the Arthritis Impact Measurement Scale II (AIMS II) and Beck Depression Index (BDI) were given to all of the patients and they were asked to complete the two questionnaires. The scores of AIMS II, pain, and QOL were evaluated in the FS and RA groups. There were no statistically significant differences between the FS and RA groups (p>0.05) in terms of QOL. The affect subgroup scores of the AIMS II and BDI were highly correlated in the FS and RA groups (p<0.002, r=0.85 and p<0.05, r=0.80, respectively). The results show that the QOL is negatively but similarly affected in FS and RA groups. 218 PMID- 15642872 AU - Ohayon MM TI - Prevalence & correlates of nonrestorative sleep complaints. [CFS/Fm] SO - Arch IM. 2005 Jan 10;165(1):35-41. IN - Stanford Sleep Epidemiology Research Ctr, Stanford U School o Med, Stanford, Calif., USA. mohayon@stanford.edu AB - BACKGROUND: Nonrestorative sleep (NRS) has been little studied in the general population, even though this symptom has an important role in several medical conditions such as heart disease, fibromyalgia, and chronic fatigue syndrome, as well as various sleep disorders. METHODS: A total of 25,580 individuals (age range, 15-100 years) from the noninstitutionalized general population representative of 7 European countries (France, the United Kingdom, Germany, Italy, Portugal, Spain, and Finland) were interviewed by telephone using the Sleep-EVAL system. Nonrestorative sleep was analyzed in relationship to sociodemographic determinants, environmental factors, life habits, health, sleep-wake schedule, and psychological factors. RESULTS: The prevalence of NRS was 10.8% (95% confidence interval, 10.4%-11.2%) in the sample, was higher in women than in men (12.5% vs 9.0%; P<.001), and decreased with age. The United Kingdom (16.1%) and Germany (15.5%) had the highest prevalence of NRS and Spain (2.4%), the lowest. In multivariate analyses, several factors were positively associated with NRS. The most important were younger age, dissatisfaction with sleep, difficulty getting started in the morning, stressful life, presence of anxiety, bipolar or a depressive disorder, and having a physical disease. When compared with subjects who have difficulty initiating or maintaining sleep (without NRS), subjects with NRS reported more frequently a variety of daytime impairment (irritability, physical, and mental fatigue) and consulted a physician twice as frequently for their sleeping difficulties than did other subjects with insomnia. CONCLUSIONS: Nonrestorative sleep is a frequent symptom in the general population, but its prevalence largely varies between countries. It is often associated with mental disorders and characteristics of sleep deprivation (such as extra sleep time on weekends). Nonrestorative sleep affected more frequently the active classes of the population and caused greater daytime impairment than difficulty initiating or maintaining sleep. 219 PMID- 15677300 AU - Oliver K, Cronan TA TI - Correlates of physical activity among women w FM syndrome. SO - Ann Behav Med. 2005 Feb;29(1):44-53. IN - SDSU/UCSD Joint Doctoral Program in Clinical Psychology, U o California-San Diego, La Jolla, CA 92093, USA. AB - BACKGROUND: Fibromyalgia (FMS) is a chronic pain syndrome of unknown origin that lacks standardized treatment. However, participation in physical activity (PA) benefits people with FMS. Despite the psychosocial and health benefits that can be gained through PA, the correlates of PA among people with FMS remain poorly understood. PURPOSE: The purpose of this study was to identify and compare the effects of cross-sectional and longitudinal correlates of PA among women with FMS. METHODS: Participants were 187 female members of a HMO with a confirmed diagnosis of FMS. They were administered a battery of questionnaires assessing potential correlates of PA. These correlates were suggested by social cognitive theory and the transtheoretical model, and have been repeatedly associated with PA among the general population. RESULTS: Multivariate analyses indicated that self-efficacy for PA and the behavioral processes of change were the strongest discriminators among PA adopters, maintainers, quitters, and those who were sedentary. Enjoyment of PA, barriers to PA, the impact of FMS, and the environment also significantly discriminated among these groups. Longitudinally, changes in self-efficacy were significantly associated with changes in PA. CONCLUSIONS: These findings suggest that self-efficacy may play a critical role in both the present and long-term PA of women with FMS. They also lend additional support to the role of social cognitive and transtheoretical variables in discriminating among levels of PA. 220 PMID- 12961098 AU - Otero M, Nogueiras R, Lago F, Meijide J, Amarelo J, Mera A, Gomez-Reino J, Gualillo O TI - Ghrelin plasmatic levels in pts w FM. SO - Rheumatol Int. 2005 Jan;25(1):6-8. Epub 2003 Sep 5. IN - Research Area, Research Laboratory 4, Santiago U Clinical Hosp, Trav. Choupana sn, 15706 Santiago de Compostela, Spain. AB - Ghrelin is a recently discovered 28 amino acid peptide that regulates GH secretion and energy homeostasis. In fibromyalgia (FM) there are alterations in the pituitary-hypothalamic axis, particularly in the growth hormone (GH) secretion pattern. Whether this anomalous secretion of GH pertains to abnormal levels of ghrelin is still unknown. The purpose of this study was to investigate plasma ghrelin levels in patients with fibromyalgia (FM) compared with healthy controls. Plasmatic ghrelin concentrations were determined by a double antibody radioimmunoassay in 19 patients with FM and 14 healthy controls. Compared with controls, patients with FM did not show any significant differences of ghrelin plasmatic levels. In conclusion, FM is not associated with deviation in ghrelin concentrations. Existing alterations in FM with respect to GH are unlikely due to circulating ghrelin. 221 PMID- 16396694 AU - Pamuk ON, Cakir N TI - The variation in chr widespread pain & other Sx in FM pts. The effects of menses & menopause. SO - Clin Exp Rheumatol. 2005 Nov-Dec;23(6):778-82. IN - D o Rheumatology, Trakya Med Faculty, U o Trakya, Edirne, Turkey. omernpamuk@yahoo.com AB - OBJECTIVES: We determined the relationship between the menstrual cycle and fibromyalgia (FM) symptoms in premenopausal women. In addition, we compared the clinical features of FM patients diagnosed pre-and postmenopausally. METHODS: We included 80 premenopausal, and 72 postmenopausal patients with FM. All patients were questioned about the severity of their pain and symptoms of FM by using a visual analog scale (VAS). In addition, the patients were asked questions about symptoms of somatization, depression and anxiety. Postmenopausal subjects were asked about the change in their FM symptoms with the onset of menopause; and premenopausal subjects were asked whether their FM symptoms changed during the menses. In addition, 40 premenopausal patients were requested to fill in a diary about their FM symptoms using VAS throughout one menstrual cycle. RESULTS: Postmenopausal patients had more severe pain on VAS (p = 0.048). Of all the postmenopausal females, 25% said that their FM symptoms started with the onset of menopause and 26.4% said that the severity of their previous symptoms increased after menopause. Of all the premenopausal females, 45% admitted to higher pain severity and 57.5% to a higher fatigue severity during the menses. The patients who defined an increase in their symptoms during the menses were the ones with higher sleep disturbance scores, more somatization symptoms and more tender points (p values < 0.05). The results of the diaries revealed that the mean pain and fatigue scores in the menstrual and luteal phases were higher than the scores in the follicular and premenstrual phases (p values < 0.05). CONCLUSIONS: The menstrual cycle and the onset of menopause affect pain and the severity of other FM-related symptoms in approximately one half of the subjects. 222 PMID- 15790342 AU - Pasoto SG, Abrao MS, Viana VS, Bueno C, Leon EP, Bonfa E TI - Endometriosis & SLE: a comparative evaluation of clinical manifestations & serological autoimmune phenomena. [FM] SO - Am J Reprod Immunol. 2005 Feb;53(2):85-93. IN - Rheumatology Div, MS, U o Sao Paulo, Sao Paulo, Brazil. reumato@edu.usp.br AB - PROBLEM: In view of evidences suggesting association between endometriosis (EM) and systemic lupus erythematosus (SLE), we have performed a comparative evaluation of clinical and humoral immunologic abnormalities in both diseases. METHOD OF STUDY: Forty-five women (18-40 years) with histologically confirmed pelvic EM, 21 healthy-women and 15 female SLE-patients (18-40 years) without surgically confirmed EM were prospectively evaluated. Immunologic investigations were performed by blinded researchers. RESULTS: None of the EM-patients fulfilled criteria for SLE. However, EM-patients presented higher frequencies of arthralgia (62%) and generalized myalgia (18%) superior than normal-controls (24%, P = 0.004/0%, P = 0.048) but comparable with SLE-patients (33%, P = 0.052/27%, P = 0.5). Similarly to SLE (7%), 9% of EM-patients presented fibromyalgia. Antinuclear antibodies (ANA) were detected in 18% of EM-sera, as compared with healthy-women (0%, P = 0.014) and SLE-patients (93%, P = 0.0005). In contrast with SLE, antibodies to dsDNA, Sm and U1RNP were negative in EM-sera. Anti-Ro and anticardiolipin antibodies were more often in SLE (40%, 33%) than in EM-patients (2%, P < 0.001/9%, P = 0.04). Elevated immune-complexes and low total complement were more frequent in SLE (40%, 13%) compared with EM-sera (7%, P = 0.005/0%, P = 0.01). CONCLUSIONS: Our data indicate differences of ANA antigenic specificity and complement consumption between EM and SLE. The high prevalence of generalized musculoskeletal complaints in EM justifies a multidisciplinary approach. 223 PMID- 15898458 AU - Patten SB, Beck CA, Kassam A, Williams JV, Barbui C, Metz LM TI - Long-term medical conditions & major depression: strength of association for specific conditions in the general population. [CFS/FM] SO - Can J Psychiatry. 2005 Mar;50(4):195-202. IN - D o Community Health Sciences, U o Calgary, Alberta. patten@ucalgary.ca AB - BACKGROUND: The prevalence of major depression (MD) in persons with nonpsychiatric medical conditions is an indicator of clinical need in those groups, an indicator of the feasibility of screening and case-finding efforts, and a source of etiologic hypotheses. This analysis explores the prevalence of MD in the general population in relation to various long-term medical conditions. METHODS: We used a dataset from a large-scale Canadian national health survey, the Canadian Community Health Survey (CCHS). The sample consisted of 115 071 subjects aged 18 years and over, randomly sampled from the Canadian population. The survey interview recorded self-reported diagnoses of various long-term medical conditions and employed a brief predictive interview for MD, the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression was used to adjust estimates of association for age and sex. RESULTS: The conditions most strongly associated with MD were chronic fatigue syndrome (adjusted odds ratio [AOR] 7.2) and fibromyalgia (AOR 3.4). The conditions least strongly associated were hypertension (AOR 1.2), diabetes, heart disease, and thyroid disease (AOR 1.4 in each case). We found associations with various gastrointestinal, neurologic, and respiratory conditions. CONCLUSIONS: A diverse set of long-term medical conditions are associated with MD, although previous studies might have lacked power to detect some of these associations. The strength of association in prevalence data, however, varies across specific conditions. 224 PMID- 16155813 AU - Perez-Pareja J, Borras C, Sese A, Palmer A TI - Pain perception & FM. SO - Actas Esp Psiquiatr. 2005 Sep-Oct;33(5):303-10. IN - Departamento de Psicologia, Universidad de las Islas Baleares, Ctra. de Valldemossa, km. 7,5, 07122 Palma de Mallorca, Spain. AB - INTRODUCTION: Although psychological factors and self-regulation processes rarely cause pain they have enough importance to exacerbate pain and contribute to its maintenance. Nevertheless, pain perception and associated beliefs can influence its confrontation and the sensation of intensity. Pain perception in fibromyalgia acquires special relevance due to an abnormal sensitivity to digital pressure on the so-called "tender points". This constitutes the main factor for its differential diagnosis. METHOD: The aim of the present study is to determine differences in pain perception and associated beliefs that appear between a group of patients with fibromyalgia (n = 36), a control group with chronic pain with objectified non-inflammatory locomotion apparatus pathology (n = 44) and a control group with healthy subjects (n = 31). Pain perception and beliefs concerning pain were assessed using Spanish versions of the following self-reports: West Haven Yale Multidimensional Questionnaire (WHYWP) and Pain Perceptions and Beliefs Inventory (PBAPI). RESULTS: Results show that the difference between patients with chronic pain is not related to pain global perception, but rather to greater perception of pain as more incapacitating when carrying out every day activities in fibromyalgic patients. In this sense, these people use escape-avoidance strategies in their every day lives believing that pain incapacitates them and therefore that physical activity should be avoided. CONCLUSIONS: Measurement of pain perceptions and beliefs could be considered relevant for assessment and for intervention programs on pathologies associated with chronic pain. 225 PMID- 15862482 AU - Petzke F, Harris RE, Williams DA, Clauw DJ, Gracely RH TI - Differences in unpleasantness induced by experimental pressure pain between pts w FM & healthy controls. SO - Eur J Pain. 2005 Jun;9(3):325-35. IN - D o Anesthesiology o the U o Cologne, Germany. AB - Pain possesses both sensory and affective dimensions, which are highly correlated yet distinct. Comparison of these dimensions within experimental pain settings has resulted in the construct of relative unpleasantness. Relative unpleasantness is defined as the amount of affective unpleasantness elicited for a given sensory magnitude. The aim of this study was to determine the relationship between affective and sensory components of evoked pain in subjects with fibromyalgia (FM) and healthy controls. Here we show that patients with FM unexpectedly display less relative unpleasantness than healthy controls in response to random noxious pressure stimuli. Relative unpleasantness was not correlated with distress, anxiety, or depression, which were pronounced in the FM group. Clinical pain in patients with FM was perceived to be more unpleasant than the evoked pain stimuli. These results are consistent with the concept that chronic pain may reduce the relative unpleasantness of evoked pain sensations. 226 PMID- 16009690 AU - Piche T, Vanbiervliet G, Cherikh F, Antoun Z, Huet PM, Gelsi E, Demarquay JF, Caroli-Bosc FX, Benzaken S, Rigault MC, Renou C, Rampal P, Tran A TI - Effect of ondansetron, a 5-HT3 receptor antagonist, on fatigue in chr hepatitis C: a randomised, double blind, placebo controlled study. [CFS] SO - Gut. 2005 Aug;54(8):1169-73. IN - D o Hepatogastroenterology, Chu de Nice, France. tpiche@fc.horus-medical.fr AB - BACKGROUND AND AIMS: There are no available effective therapies for fatigue associated with chronic hepatitis C (CHC). The serotonin antagonist ondansetron has been shown to be effective in the chronic fatigue syndrome. In this randomised, placebo controlled, double blind trial, we investigated the effect of orally administered ondansetron on fatigue in CHC. METHODS: Thirty six patients with CHC were included if fatigue was their predominant symptom and they scored more than 4 on a visual analogue scale (0-10). During the study, fatigue and depression were measured on days 0, 15, 30, and 60 using a validated self report questionnaire (fatigue impact scale and Beck depression inventory). Patients were randomised to receive ondansetron tablets 4 mg twice daily or placebo for one month followed by an additional four weeks of observation. RESULTS: Fatigue score was 85.4 (28.2) and 98.2 (26.9) in the ondansetron and placebo groups, respectively (NS). Ondansetron significantly reduced the fatigue score with more than 30% improvement on day 15 (57.1 (38.9); p<0.01), day 30 (54.5 (37.6); p<0.01), and day 60 (60.8 (37.3); p<0.01) whereas placebo did not. Overall, the reduction in fatigue was significantly higher with ondansetron compared with placebo (ANOVA for repeated measurements) for the whole follow up period (p = 0.03) or for the treatment period only (p = 0.04). Ondansetron also significantly reduced depression scores. CONCLUSIONS: The 5-hydroxytryptamine receptor type 3 antagonist ondansetron had a significant positive effect on fatigue in CHC. These observations support the concept that fatigue involves serotoninergic pathways and may encourage further evaluations of the efficacy of ondansetron on fatigue in chronic liver diseases. 227 PMID- 16214660 AU - Pierrynowski MR, Tiidus PM, Galea V TI - Women w FM walk w an altered muscle synergy. SO - Gait Posture. 2005 Nov;22(3):210-8. Epub 2004 Nov 5. IN - Human Movement Laboratory, School o Rehabilitation Science, McMaster U, Hamilton, Ontario, Canada. pierryn@mcmaster.ca AB - Most individuals can use different movement and muscle recruitment patterns to perform a stated task but often only one pattern is selected which optimizes an unknown global objective given the individual's neuromusculoskeletal characteristics. Patients with fibromyalgia syndrome (FS), characterized by their chronic pain, reduced physical work capacity and muscular fatigue, could exhibit a different control signature compared to asymptomatic control volunteers (CV). To test this proposal, 22 women with FS, and 11 CV, were assessed in a gait analysis laboratory. Each subject walked repeatedly at self-selected slow, comfortable, and fast walking speeds. The gait analysis provided, for each walk, each subject's stride time, length, and velocity, and ground reaction force, and lower extremity joint kinematics, moments and powers. The data were then anthropometrically scaled and velocity normalized to reduce the influence of subject mass, leg length, and walking speed on the measured gait outcomes. Similarities and differences in the two groups' scaled and normalized gait patterns were then determined. Results show that FS and CV walk with externally similar stride lengths, times, and velocities, and joint angles and ground reaction forces but they use internally different muscle recruitment patterns. Specifically, FS preferentially power gait using their hip flexors instead of their ankle plantarflexors. Interestingly, CV use a similar muscle fatiguing recruitment pattern to walk fast which parallels the common complaint of fatigue reported by FS walking at comfortable speed. 228 PMID- 16078357 AU - Price DD, Staud R TI - Neurobiology of FM syndrome. SO - J Rheumatol Suppl. 2005 Aug;75:22-8. IN - D o Neuroscience, U o Florida, Gainesville, Florida, USA. Dprice@dental.ufl.edu AB - Accumulating evidence suggests that fibromyalgia syndrome (FM) pain is maintained by tonic impulse input from deep tissues, such as muscle and joints, in combination with central sensitization mechanisms. This nociceptive input may originate in peripheral tissues (trauma and infection) resulting in hyperalgesia/allodynia and/or central sensitization. Evidence for abnormal sensitization mechanisms in FM includes enhanced temporal summation of delayed pain in response to repeated heat taps and repeated muscle taps, as well as prolonged and enhanced painful after-sensations in FM patients but not control subjects. Moreover, magnitudes of enhanced after-sensations are predictive of FM patients' ongoing clinical pain. Such alterations of relevant pain mechanisms may lead to longterm neuroplastic changes that exceed the antinociceptive capabilities of affected individuals, resulting in ever-increasing pain sensitivity and dysfunction. Future research needs to address the important role of abnormal nociception and/or antinociception for chronic pain in FM. 229 PMID- 16055833 AU - Prins J, Bleijenberg G, Rouweler EK, van der Meer J TI - Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for CFS. SO - Br J Psychiatry. 2005 Aug;187:184-5. IN - D o Psychology, Radboud U Nijmegen Med Centre, Nijmegen, The Netherlands. j.prins@mps.umcn.nl AB - Psychiatric disorders have been associated with poor outcome in individuals with chronic fatigue syndrome (CFS). This study examines the impact of psychiatric disorders on outcome of cognitive-behavioural therapy (CBT). Psychiatric diagnoses were assessed with a structured psychiatric interview in a CBT trial of 270 people with CFS. Lifetime and current psychiatric disorders were found in 50 and 32% respectively. No significant differences in fatigue severity and functional impairment following treatment were found between participants with and without psychiatric diagnoses. 230 PMID- 15836975 AU - Pukall CF, Strigo IA, Binik YM, Amsel R, Khalife S, Bushnell MC TI - Neural correlates of painful genital touch in women w vulvar vestibulitis syndrome. [FM] SO - Pain. 2005 May;115(1-2):118-27. IN - D o Psychology, Queen's U, Humphrey Hall, 62 Arch Street, Kingston, Ont., Canada K7L 3N6. pukallc@post.queensu.ca AB - Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Recent evidence points to the importance of the sensory component in VVS, particularly the heightened processing of tactile and pain sensation in the vulvar vestibule. The goal of the present study was to examine the neural basis of heightened sensitivity to touch (i.e. allodynia) in women with VVS. Using functional magnetic resonance imaging, we compared regions of neural activity in 14 women with VVS and 14 age- and contraceptive-matched control women in response to the application of mild and moderate pressure to the posterior portion of the vulvar vestibule. Intensity and unpleasantness ratings were recorded after each scan; these ratings were significantly higher for women with VVS than controls. All women with VVS described moderate pressure as painful and unpleasant, and 6 of the 14 women with VVS described mild pressure as painful and unpleasant. In contrast, none of the stimuli was painful for control women. Correspondingly, women with VVS showed more significant activations during pressure levels that they found to be either painful or non-painful than did controls during comparable pressure levels. During pressure described as painful by women with VVS, they had significantly higher activation levels in the insular and frontal cortical regions than did control women. These results suggest that women with VVS exhibit an augmentation of genital sensory processing, which is similar to that observed for a variety of syndromes causing hypersensitivity, including fibromyalgia, idiopathic back pain, irritable bowel syndrome, and neuropathic pain. 231 PMID- 15789937 AU - Rakib A, White PD, Pinching AJ, Hedge B, Newbery N, Fakhoury WK, Priebe S TI - Subjective quality of life in pts w CFS. SO - Qual Life Res. 2005 Feb;14(1):11-9. IN - Queen Mary's School o Med & Dentistry, Newham Centre for Mental Health, London, UK. AB - The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest 'predictor' of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients. 232 PMID- 16272188 AU - Randall DC, Cafferty FH, Shneerson JM, Smith IE, Llewelyn MB, File SE TI - Chronic Rx w modafinil may not be beneficial in pts w CFS. SO - J Psychopharmacol. 2005 Nov;19(6):647-60. IN - Psychopharmacology Research Unit, Centre for Neuroscience Research, King's Coll London, London, UK. AB - Fourteen patients (7 male, 7 female, 22-63 years), classified as having chronic fatigue syndrome (CFS), but without concurrent major depression, significant sleepiness or use of psychoactive medication, completed a double-blind, placebo-controlled, crossover study of the effects of the selective wakefulness-promoting agent, modafinil (200 and 400mg/day). The treatment periods were each 20 days, with washout periods of 2 weeks. The primary aim was to determine effects on cognition and the secondary aim was to determine effects on self-ratings of fatigue, quality of life and mood. Modafinil had mixed effects in two cognitive tasks. In a test of sustained attention, treatment with 200mg reduced the latency to correctly detect sequences, but 400mg increased the number of missed targets. In a test of spatial planning, the 200mg dose resulted in a slower initial thinking time for the easiest part of the task, whereas 400mg reduced the initial thinking time for the hardest part of the test. Lastly, in a test of mental flexibility and one of motor speed, patients performed worse whilst on modafinil (400mg), compared with the placebo period. No effects were observed on the performance of other psychometric tests or on self-ratings of fatigue, quality of life or mood, but this may have been due to insufficient statistical power. It is discussed whether the limited and mixed cognitive effects that we observed could have occurred by chance, or whether a subgroup of CFS patients with daytime sleepiness would have shown greater benefits. 233 PMID- 15689728 AU - Rangel L, Garralda ME, Jeffs J, Rose G TI - Family health & characteristics in CFS, juvenile RA, & emotional disorders of childhood. SO - J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):150-8. IN - Academic Unit o Child & Adolescent Psychiatry, Imperial Coll, London, UK. AB - OBJECTIVE: To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. METHOD: Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. RESULTS: Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the child's illness in comparison with families of children with JRA. CONCLUSIONS: CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness. 234 PMID- 15699086 AU - Ranjith G TI - Epidemiology of CFS. SO - Occup Med (Lond). 2005 Jan;55(1):13-9. IN - D o Psychological Med, King's Coll Hosp, London, UK. g.ranjith@iop.kcl.ac.uk AB - BACKGROUND: Chronic fatigue syndrome (CFS) is a controversial disorder with different case definitions, aetiological models and proposed treatments. An epidemiological approach is likely to bring some clarity to the field. AIM: The aim of this article is to review the literature on the epidemiology of fatigue, chronic fatigue and CFS. METHOD: A literature search was conducted using the databases Medline and Pubmed as well as the reference lists of recent reviews to identify the relevant studies. The aim was not to do a systematic review but to review the key studies in the area to highlight the methodological issues. RESULTS: The review is organized according to the following areas: the prevalence of fatigue and chronic fatigue, the prevalence and incidence of CFS, epidemiological associations such as gender, social class and psychiatric co-morbidity and CFS in special groups such as those recovering from a viral infection, specific occupational groups and Gulf War veterans. CONCLUSION: While fatigue as a symptom is very common, CFS is relatively rare. Many of the epidemiological associations seen in specialist clinics are not found in community samples. It is unlikely that one specific causal factor can explain CFS. Future studies should go beyond estimating the prevalence to testing more complex aetiological models. 235 PMID- 16356178 AU - Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L, Papanicolaou DA, Unger ER, Vernon SD, Heim C TI - CFS--a clinically empirical approach to its definition & study. SO - BMC Med. 2005 Dec 15;3:19. IN - Division o Viral & Rickettsial Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA. wcr1@cdc.gov AB - BACKGROUND: The lack of standardized criteria for defining chronic fatigue syndrome (CFS) has constrained research. The objective of this study was to apply the 1994 CFS criteria by standardized reproducible criteria. METHODS: This population-based case control study enrolled 227 adults identified from the population of Wichita with: (1) CFS (n = 58); (2) non-fatigued controls matched to CFS on sex, race, age and body mass index (n = 55); (3) persons with medically unexplained fatigue not CFS, which we term ISF (n = 59); (4) CFS accompanied by melancholic depression (n = 27); and (5) ISF plus melancholic depression (n = 28). Participants were admitted to a hospital for two days and underwent medical history and physical examination, the Diagnostic Interview Schedule, and laboratory testing to identify medical and psychiatric conditions exclusionary for CFS. Illness classification at the time of the clinical study utilized two algorithms: (1) the same criteria as in the surveillance study; (2) a standardized clinically empirical algorithm based on quantitative assessment of the major domains of CFS (impairment, fatigue, and accompanying symptoms). RESULTS: One hundred and sixty-four participants had no exclusionary conditions at the time of this study. Clinically empirical classification identified 43 subjects as CFS, 57 as ISF, and 64 as not ill. There was minimal association between the empirical classification and classification by the surveillance criteria. Subjects empirically classified as CFS had significantly worse impairment (evaluated by the SF-36), more severe fatigue (documented by the multidimensional fatigue inventory), more frequent and severe accompanying symptoms than those with ISF, who in turn had significantly worse scores than the not ill; this was not true for classification by the surveillance algorithm. CONCLUSION: The empirical definition includes all aspects of CFS specified in the 1994 case definition and identifies persons with CFS in a precise manner that can be readily reproduced by both investigators and clinicians. 236 PMID- 15621381 AU - Reid GJ, McGrath PJ, Lang BA TI - Parent-child interactions among children w juvenile FM, arthritis, & healthy controls. SO - Pain. 2005 Jan;113(1-2):201-10. IN - Psychology, IWK Health Centre & Dalhousie U, Halifax, NS, Canada. greid@uwo.ca AB - Parent-child interactions during pain-inducing exercise tasks among children (11-17 years old) with fibromyalgia, juvenile rheumatoid arthritis, and pain-free controls were examined and the contribution of parent-child interactions to disability was tested. Fifteen children in each of the three diagnostic groups and their parents completed 5-min exercise tasks and completed questionnaire measures of disability (Functional Disability Inventory) and coping (Pain Coping Questionnaire). There were few group differences in parent-child interactions. After controlling for children's ratings of pain evoked by the exercise, group differences in interactions during exercise tasks were no longer significant. Sequential analyses, controlling for group and exercise task, revealed that when parents made statements discouraging coping following children's negative verbalizations about the task or pain, children were less likely to be on task, compared to when parents made statements encouraging coping or when parents made any other statements. Children's general pain coping strategies were not related to parent-child interactions. Parent-child interactions were generally not related to disability. Across the groups, more pain and less time on task during the exercises were related to Functional Disability Inventory scores and more school absences. Parent-child interaction patterns influence children's adaptation to pain during experimental tasks. Parents' discouragement of coping in response to their children's negative statements related to the pain or the pain-evoking task are counter productive to children's ability to maintain activity in a mildly painful situation. 237 PMID- 16372472 AU - Ribel-Madsen S, Gronemann ST, Bartels EM, Danneskiold-Samsoe B, Bliddal H TI - Collagen structure in skin from FM pts. SO - Int J Tissue React. 2005;27(3):75-82. IN - The Parker Inst, D o Rheumatology, Frederiksberg Hosp, H:S U Hospital, Denmark. soren.ribel.madsen@fh.hosp.dk AB - The distribution and amount of collagen in skin from a non-tender-point area from fibromyalgia patients was assessed by quantitative analysis of amino acids and by electron and light microscopy. Skin biopsies were obtained from the front of the thigh of 27 females who fulfilled the American College of Rheumatology criteria of fibromyalgia and from eight control subjects who were matched for gender, age and physical activity. Amino acids were determined by high-performance liquid chromatography. Electron and light microscopic investigations were carried out to examine tissue structure. Among the collagen-related amino acids, the mean number of hydroxyproline residues per 1,000 residues was 52.5 and 63.4 in fibromyalgia patients and control subjects, respectively (p = 0.050); proline residues were 81.7 and 110.0 (p = 0.006); and hydroxylysine residues were 14.7 and 10.1 (p = 0.002). The total amount of skin protein in proportion to dry tissue weight was 83.4% and 72.6% in fibromyalgia and controls, respectively (p = 0.037). The overall microscopic picture was normal. The lamellar structure of the perineurium and a deficiency in collagen packing in the endoneurium was observed more frequently and to a larger extent in fibromyalgia patients than in controls. In conclusion, there are some differences between the amino acid composition of skin proteins in fibromyalgia patients compared with controls. The amount of collagen may be lower in skin from fibromyalgia patients, and collagen packing in the endoneurium may be less dense. 238 PMID- 16220215 AU - Richards J, Turk J, White S TI - Children & adolescents w CFS in non-specialist settings: beliefs, functional impairment & psychiatric disturbance. SO - Eur Child Adolesc Psychiatry. 2005 Sep;14(6):310-8. IN - Child & Family Clinic, Unit 5 Des Roches Square, Witan Way, Witney, OX28 4BE, Oxfordshire, UK. AB - BACKGROUND: Adolescents with Chronic Fatigue Syndrome (CFS) seen in specialist centres have substantial psychological and functional impairment. Beliefs about activity levels may be important in the development of CFS. METHOD: The aim was to investigate psychological and functional impairment, and beliefs in children and adolescents with CFS recruited from non-specialist services. A total of 30 such individuals participated, and 30 young people with Inflammatory Bowel Disease (IBD) formed the comparison group. RESULTS: Emotional symptoms and disorder were high in both groups. In all, 50% of those with CFS and 30% with IBD reached the threshold for emotional disorder according to the Strengths and Difficulties Questionnaire (SDQ) parent report, although this difference did not reach statistical significance. Participants with CFS scored statistically significantly higher on measures of functional impairment, including school non-attendance, compared to those with IBD. According to questionnaire responses, those with CFS were statistically significantly more likely to favour rest rather than exercise compared to those with IBD. Comparison of parental beliefs did not show such a difference. CONCLUSIONS: These young people with CFS were at high risk of psychiatric disorder. They were substantially disabled when compared to individuals with a known chronic illness. Also, as a group, they were characterised by a preference for rest rather than exercise. 239 PMID- 15610961 AU - Rico-Villademoros F, Hidalgo J, Dominguez I, Garcia-Leiva JM, Calandre EP TI - Atypical antipsychotics in the Rx of FM: a case series w olanzapine. SO - Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jan;29(1):161-4. IN - Biometrica, Departamento Medico, Eloy Gonzalo 27, 28010 Madrid, Spain. AB - 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. 240 PMID- 15699088 AU - Rimes KA, Chalder T TI - Treatments for CFS. SO - Occup Med (Lond). 2005 Jan;55(1):32-9. IN - D o Psychological Med, Inst o Psychiatry, London, UK. k.rimes@iop.kcl.ac.uk AB - AIMS: To review studies evaluating the treatment of chronic fatigue and chronic fatigue syndrome, to describe predictors of response to treatment and to discuss the role of the occupational health physician. METHODS: A literature search was carried out using Medline and PsychInfo. RESULTS: Studies evaluating cognitive behaviour therapy, graded exercise therapy, pharmacological interventions (e.g. antidepressants and corticosteroids), immunological interventions and nutritional supplements were reviewed. The most promising results have been found with cognitive behaviour therapy and graded exercise therapy, and some predictors of outcome have been identified. Most of the other interventions were evaluated in just one or two studies and therefore evidence is insufficient to draw firm conclusions. CONCLUSIONS: By applying the models of fatigue that form the bases for cognitive behaviour therapy and graded exercise therapy, occupational health physicians may play an important role in helping the patients with chronic fatigue syndrome to reduce their symptoms, improve their functioning and return to work. 241 PMID- 15996197 AU - Robertson MJ, Schacterle RS, Mackin GA, Wilson SN, Bloomingdale KL, Ritz J, Komaroff AL TI - Lymphocyte subset differences in pts w CFS, multiple sclerosis & major depression. SO - Clin Exp Immunol. 2005 Aug;141(2):326-32. IN - Division o Hematologic Malignancies, Dana-Farber Cancer Inst, Harvard MS, Boston, MA, USA. mjrobert@iupui.edu AB - Chronic fatigue syndrome (CFS) is a heterogeneous disorder of unknown aetiology characterized by debilitating fatigue, along with other symptoms, for at least 6 months. Many studies demonstrate probable involvement of the central and autonomic nervous system, as well as a state of generalized immune activation and selective immune dysfunction in patients with CFS. The aim of this study was to compare the lymphocyte subsets of patients with chronic fatigue syndrome to those of patients with major depression and multiple sclerosis as well as those of healthy control subjects. No differences were found in total numbers of T cells, B cells or natural killer (NK) cells. However, differences were found in T, B and NK cell subsets. Patients with major depression had significantly fewer resting T (CD3(+)/CD25(-)) cells than the other groups. Patients with major depression also had significantly more CD20(+)/CD5(+) B cells, a subset associated with the production of autoantibodies. Compared to patients with multiple sclerosis, patients with CFS had greater numbers of CD16(+)/CD3(-) NK cells. Further study will be required to determine whether these alterations in lymphocyte subsets are directly involved in the pathophysiology of these disorders, or are secondary effects of the causal agent(s). 242 PMID- 16078359 AU - Rowbotham MC TI - Is FM a neuropathic pain syndrome? SO - J Rheumatol Suppl. 2005 Aug;75:38-40. IN - U o California San Francisco Pain Clinical Research Ctr, San Francisco, California 94115, USA. mcrwind@itsa.ucsf.edu AB - The fibromyalgia syndrome (FM) seems an unlikely candidate for classification as a neuropathic pain. The disorder is diagnosed based on a compatible history and the presence of multiple areas of musculoskeletal tenderness. A consistent pathology in either the peripheral or central nervous system (CNS) has not been demonstrated in patients with FM, and they are not at higher risk for diseases of the CNS such as multiple sclerosis or of the peripheral nervous system such as peripheral neuropathy. A large proportion of FM sufferers have accompanying symptoms and signs of uncertain etiology, such as chronic fatigue, sleep disturbance, and bowel/bladder irritability. With the exception of migraine headaches and possibly irritable bowel syndrome, the accompanying disorders are clearly not neurological in origin. The impetus to classify the FM as a neuropathic pain comes from multiple lines of research suggesting widespread pain and tenderness are associated with chronic sensitization of the CNS. An examination of how the term neuropathic pain is defined reveals a conceptual split into 2 partially overlapping groups of disorders: those with demonstrable pathology in the nervous system and those characterized primarily by enduring dysfunction in the nervous system. Requiring demonstrable pathology in the nervous system in the definition of neuropathic pain is the traditional approach. The expansion of the definition to require only enduring nervous system dysfunction is less palatable because it opens the classification to many disorders of uncertain etiology, including complex regional pain syndrome. As it is uncertain which of the many different chronic pain syndromes include an enduring component of central sensitization, restricting the term "neuropathic pain" to those disorders with a primary etiology clearly related to the peripheral or CNS is prudent and consistent with clinical practice. 243 PMID- 16351031 AU - Rubin JJ TI - Psychosomatic pain: new insights & management strategies. [FM] SO - South Med J. 2005 Nov;98(11):1099-110; quiz 1111-2, 1138. IN - Neurological Associates, 2685 SW 32nd Place, Suite 100, Ocala, Florida 34474, USA. Jrubin352@aol.com AB - At least 40 to 60 percent of women and at least 20 percent of men with chronic pain disorders report a history of being abused during childhood and/or adulthood. This incidence of abuse is two to four times higher than in the general population. Patients with more severe or frequent abuse, usually during childhood and worse if sexual in nature. often develop specific syndromes or combinations of syndromes. These syndromes include posttraumatic stress disorder, fibromyalgia, and other conditions characterized by repression, somatization, and increased utilization of medical care. Psychosomatic symptoms and dysfunctional behaviors may emerge as these patients seek attention and validation of their suffering, while paradoxically repressing painful memories of trauma. Behavioral observations and key features of the physical examination may greatly help the clinician identify both the presence and severity of psychosomatic disease. In addition, it is very interesting that various studies document physiologic changes in the brains of patients with a history of abuse and in patients with a diagnosis of fibromyalgia. These studies suggest that abuse may physiologically and developmentally increase a person's susceptibility to pain and that some organic changes may be associated with psychogenic disease. Diagnosis and treatment of even the most challenging patients with chronic pain is much more effective if it includes (a) careful inquiry about any history of past or present abuse or other severe trauma, (b) empathy and constructive validation of disease and suffering, (c) recognition of dysfunctional pain behaviors and personality traits, (d) documentation of nonanatomic as well as anatomic features on examination, (e) multidisciplinary treatments including psychotherapy whenever indicated, and (f) noninvasive procedures and alternatives to potentially habit-forming medications whenever possible and appropriate. Furthermore, it has been shown that helping patients gain insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients. 244 PMID- 15889304 AU - Russell AS, Hui BK TI - The use of PRIME-MD questionnaire in a rheumatology clinic. [FM] SO - Rheumatol Int. 2005 May;25(4):292-5. Epub 2004 Dec 10. IN - 562 Heritage Med Research Centre, U o Alberta Hosp, Edmonton, Alberta, Canada T6G 2S2. asr@ualberta.ca AB - OBJECTIVE: To determine whether the Primary Care Evaluation of Mental Disorders 1-page Brief Patient Health Questionnaire (PRIME-MD 1-page PHQ) can serve as: (1) a diagnostic test for fibromyalgia syndrome (FM), or (2) a questionnaire through which internists can be alerted to otherwise hidden mental disorders in patients attending internal medicine clinics. METHOD: Two hundred and thirteen consecutive patients attending a rheumatology clinic were given the PRIME-MD 1-page PHQ and seen by a rheumatologist who was blind to the PRIME-MD diagnosis. RESULTS: The PRIME-MD 1-page PHQ pointed to Major Depressive Disorder in 33.3% of FM patients, Other Depressive Disorder in 33.3% of FM patients, and Panic Disorder in 22.2% of FM patients (all of whom also had Major Depressive Disorder), as compared to 13.1, 13.1, and 3.0% respectively in patients with other rheumatic disorders. However, when used as a diagnostic test for FM, the PRIME-MD 1-page PHQ did not have adequate diagnostic value. When all the PRIME-MD 1-page PHQ diagnoses were compiled, however, a trend was observed. Compared to the rates of mental disorders in both the normal population and in primary care practices, the rates found in this rheumatology clinic were higher. CONCLUSIONS: The PRIME-MD 1-page PHQ is not an adequate diagnostic test for FM. Because FM is primarily a somatization disorder that draws its symptoms from other current diseases, it may in fact be impossible to diagnose FM based on specific symptoms alone. However, the PRIME-MD 1-page PHQ proved to be a useful diagnostic tool in a rheumatology clinic. It helped to alert the physician to the possibility of an elevated frequency of mental disorders that would otherwise have gone unnoticed and untreated. 245 PMID- 16393769 AU - Ruster M, Franke S, Spath M, Pongratz DE, Stein G, Hein GE TI - Detection of elevated N epsilon-carboxymethyllysine levels in muscular tissue & in serum of pts w FM. SO - Scand J Rheumatol. 2005 Nov-Dec;34(6):460-3. IN - D o Internal Med III, Friedrich-Schiller-U o Jena, Germany. Michael.Ruester@med.uni-jena.de AB - OBJECTIVES: To compare levels of the advanced glycation end product (AGE) N(epsilon)-carboxymethyllysine (CML) present in the muscle tissue and in the serum of patients with fibromyalgia (FM) vs. healthy controls. METHODS: The serum levels of CML were measured in 41 patients with FM and 81 healthy controls. The presence of CML, nuclear factor kappa B (NF-kappaB), the AGE receptor (RAGE), collagen types I, II, VI, and CD68-positive monocytes/macrophages in muscle tissue of 14 patients with FM was investigated by immunohistochemistry. RESULTS: Patients with FM showed significantly increased serum levels of CML in comparison to healthy controls. The immunohistochemical investigation revealed a stronger staining for CML and NF-kappaB and more CD68-positive monocytes/macrophages in the muscle of FM patients. The collagens and CML were co-localized, suggesting that the AGE modifications were related to collagen. RAGE was absent in controls but a faint and patchy staining was seen in FM. CONCLUSIONS: In the interstitial connective tissue of fibromyalgic muscles we found a more intensive staining of the AGE CML, activated NF-kappaB, and also higher CML levels in the serum of these patients compared to the controls. RAGE was only present in FM muscle. AGE modification of proteins causes reduced solubility and high resistance to proteolytic digestion of the altered proteins (e.g. AGE-modified collagens). AGEs can stimulate different types of cells by activation of the transcription factor NF-kappaB, mediated by specific receptors of AGEs (e.g. RAGE) on the cell surface. Both mechanisms may contribute to the development, perpetuation, and spreading of pain characteristic in FM patients. 246 PMID- 16215337 AU - Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C TI - Age & the experience of chr pain: differences in health & quality of life among younger, middle-aged, & older adults. [FM] SO - Clin J Pain. 2005 Nov-Dec;21(6):513-23. IN - Faculty o Nursing, Oslo U Coll, Oslo, Norway. tone.rustoen@su.hio.no AB - OBJECTIVES: To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain. METHODS: A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables. RESULTS: Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain. CONCLUSION: This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain. 247 PMID- 16396700 AU - Salaffi F, De Angelis R, Grassi W TI - Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. [FM] SO - Clin Exp Rheumatol. 2005 Nov-Dec;23(6):819-28. IN - Dipartimento di Patologia Molecolare e Terapie Innovative, Cattedra di Reumatologia, Universita Politecnica delle Marche, Italy. fsalaff@tin.it AB - OBJECTIVE: The objective of the MAPPING study was to estimate the prevalence of musculoskeletal conditions in an Italian population sample. METHODS: Questionnaires were sent to a random sample of 3664 individuals aged 18 years and over, stratified for age and gender, selected from the practice lists of 16 general practices. Trained rheumatologists carried out structured visits in which subjects were asked about musculoskeletal symptoms and socio-demographic characteristics, and underwent a standardized physical examination. Cases were defined by previously validated criteria. RESULTS: A total of 2155 subjects participated in the study (response rate 58.8%). The overall prevalence of musculoskeletal conditions in the general adult population was 26.7% (95% CI 25.4-28.5), being significantly higher among women than men (p < 0.0001). Disease prevalence increased significantly with age (p < 0.0001). The most common disease group was symptomatic peripheral osteoarthritis (SPOA), with a prevalence of 8.95% (95% CI 6.81-10.7), followed by soft tissue disorders--STD (8.81%; 95% CI 7.16-10.29), low back pain--LBP (5.91%; 95% CI 4.89-6.89), and inflammatory rheumatic disease--IRD (3.06%; 95% CI 2.38-3.93). The estimated rates of disease prevalence were as follows: rheumatoid arthritis: 0.46% (95% CI 0.33-0.59); psoriatic arthritis: 0.42% (95% CI 0.31-0.61); ankylosing spondylitis: 0.37% (95% CI 0.23-0.49); polymyalgia rheumatica: 0.37% (95% CI 0.29-0.44); undifferentiated connective tissue disease: 0.14% (95% CI 0.09-0.21); crystal arthropathies, including gout 0.46% (95% CI 0.34-0.57) and chondrocalcinosis: 0.42% (95% CI 0.33-0.58); symptomatic knee osteoarthritis (OA): 5.39% (95% CI 3.41-7.99); hip-OA: 1.61% (95% CI 1.39-1.87); hand-OA: 1.95 (95% CI 1.22-2.48); fibromyalgia: 2.22% (95% CI 1.36-3.19); shoulder tendinitis/adhesive capsulitis: 3.06% (95% CI 2.11-4.09); carpal tunnel syndrome: 1.90% (95% CI 1.06-2.29), localized regional pain syndromes of the neck: 0.88% (95% CI 0.561.29), and lateral epicondylitis 0.74% (95% CI 0.47-1.33). CONCLUSIONS: The MAPPING study indicates that musculoskeletal conditions are common in the general adult population of Italy. These data are useful in planning the provision of healthcare. 248 PMID- 16056199 AU - Salek AK, Khan MM, Ahmed SM, Rashid MI, Emran MA, Mamun MA TI - Effect of aerobic exercise on pts w primary FM syndrome. SO - Mymensingh Med J. 2005 Jul;14(2):141-4. IN - D o Physical Med & Rehabilitation, Bangabandhu Sheikh Mujib Med U. akmsalek@bdonline.com AB - Sixty eight adult patients of fibromyalgia were included in this prospective study from the Outpatient Department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of January 2003 to June 2003. Study samples were assigned into two treatment groups: Group A (n = 38) with exercise by static bicycle and aerobic walking in addition to tricyclic antidepressant and analgesic and Group B (n = 30) was non exercise group, treated with tricyclic antidepressant and analgesic only. The total duration of treatment was 16 weeks. Pre-treatment (week 0) and post treatment (week 16) evaluation was performed in both groups. Evaluation parameters included pain grade, number of trigger points, occurrence of arousal at night, frequency of micturition and global evaluation by the physician. After 16 weeks, mean improvement of exercise group and non exercise group was 48% and 39% respectively but this difference was not statistically significant. Therefore, from this study it was observed that aerobic exercise showed no significant benefit to fibromyalgia patients. 249 PMID- 16139178 AU - Sandberg M, Larsson B, Lindberg LG, Gerdle B TI - Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects & pts w FM & work-related trapezius myalgia. SO - Eur J Pain. 2005 Oct;9(5):497-510. Epub 2004 Dec 18. IN - D o Rehabilitation Med, INR, Faculty o Health Sciences, SE-581 85 Linkoping, Sweden. margareta.sandberg@lio.se AB - Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions. 250 PMID- 16000677 AU - Sayar K, Barsky AJ, Gulec H TI - Does somatosensory amplification decrease w antidepressant Rx? SO - Psychosomatics. 2005 Jul-Aug;46(4):340-4. IN - Bakirkoy Mental Health Training & Research Hosp, Istanbul, Turkey. kemalsayar@hotmail.com AB - Somatosensory amplification refers to a tendency to experience somatic and visceral sensations as unusually intense, noxious, and disturbing. The authors wanted to determine whether somatosensory amplification is a stable construct or whether it might change with antidepressant therapy. Fifteen patients with fibromyalgia and 17 patients with major depressive disorder received antidepressant treatment and were assessed after 6 and 12 weeks of treatment. Amplification scores responded to antidepressant treatment in patients with major depression but not in patients with fibromyalgia, despite a decrease in the levels of depression in both groups. When change in depression and anxiety scores was partialled out from change in somatosensory amplification scores, the amplification scores did not change significantly in either the depressed or the fibromyalgia groups. Given the small numbers and the marginal significance of the results, the authors are unable to say definitely just how independent of depression somatosensory amplification is. Whether somatosensory amplification is a measure of depression per se should be tested in a more definitive and larger future study. 251 PMID- 15736726 AU - Schaefer KM TI - The lived experience of FM in African American women. SO - Holist Nurs Pract. 2005 Jan-Feb;19(1):17-25. IN - D o Nursing, Coll o Health Professions, Temple U, 3307 N Broad St, Philadelphia, PA 19140, USA. karen.schaefer@temple.edu AB - This study aimed to learn what it is like for African American women to live with fibromyalgia. Van Manen's phenomenological method of writing and rewriting guided the inquiry. The sample included 10 women, who were interviewed for 30 to 60 minutes each. Two agreed to second interviews, for a total of 12 interviews for data analysis. Data analysis revealed the following themes: (a) managing the symptoms, (b) becoming a self-advocate, (c) medications camouflage the pain, (d) coming to grips with the illness means making changes, (e) being accused of "taking a free ride" angers them, (f) support comes from self and spiritual connections, and (g) a certain amount of secrecy makes it easier to live with the illness. Recommendations focus on using a holistic approach to help African American women achieve or maintain their integrity. 252 PMID- 15947513 AU - Schleicher H, Alonso C, Shirtcliff EA, Muller D, Loevinger BL, Coe CL TI - In the face of pain: the relationship between psychological well-being & disability in women w FM. SO - Psychother Psychosom. 2005;74(4):231-9. IN - D o Psychology, U o Wisconsin-Madison, Madison, Wisc. 59812-1584, USA. hollys@uwalumni.com AB - BACKGROUND: Few studies have examined the potentially beneficial role of positive psychological functioning in individuals with chronic pain. This study examined the relationship of psychological well-being (PWB) to pain and disability in women with fibromyalgia (FM) as compared to women with rheumatoid arthritis (RA) and healthy controls (HC). We targeted several domains of PWB that have been associated with health, and also tested whether PWB was related to the women's social network. METHODS: PWB, pain, and disability were assessed in 125 women (57 with FM, 20 with RA, and 48 HC) on two occasions. RESULTS: Women with FM reported lower overall PWB than did RA and HC women. Further, greater PWB was associated with less disability and fatigue, but not pain in women with FM. Self-acceptance, environmental mastery, purpose in life, and positive relations with others emerged as four important constructs in the association between PWB and disability. In addition, PWB mediated the relationship between social network size and disability. CONCLUSIONS: This assessment of PWB provides insight into those psychological domains that should be emphasized in treatments aimed at reducing the disabling aspects of FM. 253 PMID- 15992573 AU - Schmaling KB, Fiedelak JI, Bader J, Buchwald D TI - A longitudinal study of physical activity & body mass index among persons w unexplained chr fatigue. [CF] SO - J Psychosom Res. 2005 Apr;58(4):375-81. IN - College o Health & Human Services, U o North Carolina, Charlotte, NC 28223, USA. kbschmal@email.uncc.edu AB - OBJECTIVE AND METHODS: A cohort of 100 patients with unexplained chronic fatigue (CF) was assessed longitudinally for 1.5 years to determine if physical activity (kcal expended), exercise capacity (VO(2)max), perceived exertion, and body mass index (BMI) changed over time and were associated with changes in CF-related clinical status. RESULTS: BMI increased significantly over time but did not predict changes in clinical status. Increasing energy expenditure was associated with increasing vitality and decreasing CF symptom severity over time, and decreasing perceived exertion was associated with increasing physical functioning. However, increasing perceived exertion was also associated with increasing CF symptoms. CONCLUSIONS: These data do not support models that posit associations between CF and deconditioning. 254 PMID- 15813608 AU - Segal TY, Hindmarsh PC, Viner RM TI - Disturbed adrenal function in adolescents w CFS. SO - J Pediatr Endocrinol Metab. 2005 Mar;18(3):295-301. IN - U Coll London Hospitals, UK. AB - OBJECTIVE: To investigate adrenal function in children and adolescents with chronic fatigue syndrome (CFS) compared with age-matched controls. METHODS: Case-control study of low dose (500 ng/m2) synacthen tests (LDST) in 23 adolescents with CFS and 17 age-matched controls. Serum cortisol concentrations were measured at 5-min intervals from 10 to 45 minutes. Peak serum cortisol concentration, time to peak, rise in cortisol and area under the curve (AUC) were derived. RESULTS: Patients with CFS had significantly lower mean cortisol levels during the LDST (p <0.001), lower peak cortisol (p <0.025), reduced cortisol AUC (p <0.005) and longer time to peak cortisol (p <0.05). Abnormalities were seen in both sexes but were more pronounced in females. Unstimulated adrenal androgen and 17-hydroxyprogesterone concentrations were normal. CONCLUSIONS: Adolescents with CFS have subtle alterations in adrenal function suggesting a reduction in central stimulation of the adrenal glands. The more pronounced effects in females may reflect differential central effects of stress on hypothalamic-pituitary-adrenal axis regulation between the sexes. 255 PMID- 16322133 AU - Seng JS, Graham-Bermann SA, Clark MK, McCarthy AM, Ronis DL TI - Posttraumatic stress disorder & physical comorbidity among female children & adolescents: results from service-use data. [FM/CFS] SO - Pediatrics. 2005 Dec;116(6):e767-76. IN - Institute for Research on Women & Gender, U o Michigan, Ann Arbor, MI 48109-1290, USA. jseng@umich.edu AB - OBJECTIVE: In adults, posttraumatic stress disorder (PTSD) is associated with adverse health outcomes and high medical utilization and cost. PTSD is twice as common in women and is associated with increased risk for a range of diseases, chronic conditions, and reproductive-health problems. Little is known about the health effects of PTSD in children. The purpose of this study was to explore patterns of physical comorbidity in female children and adolescents with PTSD by using population data. METHODS: This study was a cross-sectional, descriptive epidemiologic case-control analysis of a Midwestern state's Medicaid eligibility and paid-claims data for girls (0-8 years old) and teens (9-17 years old). Data were from 1994-1997. All those with the PTSD diagnostic code were compared with randomly selected controls in relation to 3 sets of outcomes: (1) International Classification of Diseases, Ninth Revision (ICD-9) categories of disease; (2) chronic conditions previously associated with sexual trauma and PTSD in women; and (3) reproductive-health problems. Analyses included bivariate odds ratios (OR) and logistic-regression models that control for the extent of insurance coverage and the independent associations of victimization and psychiatric comorbidity with the 3 sets of outcomes. The mental health covariate was categorical to allow consideration of a range of severity. There were 4 categories for the young girls: neither PTSD nor depression, PTSD without depression, depression without PTSD, and PTSD + depression. For the adolescent analysis, a fifth category reflecting a "complex PTSD" was added, defined as having PTSD complicated by a dissociative disorder or borderline personality disorder diagnosis. RESULTS: There were 647 girls and 1025 adolescents with the PTSD diagnosis. Overall, PTSD was associated with adverse health outcomes in both age strata. Victimization was sometimes independently associated with adverse health outcomes, but PTSD often was a mediator, especially in the adolescent age stratum. The importance of PTSD diagnosis as a predictor of the ICD-9 categories of disease or chronic conditions seemed to increase with age. In the younger age stratum, the increased bivariate ORs of significant associations with PTSD ranged from 1.4 for digestive disorders to 3.4 for circulatory disorders. Among younger girls, PTSD diagnosis was associated with significantly greater bivariate odds for 9 of the 12 ICD-9 categories of disease but not for neoplasms, blood disorders, or respiratory disorders and with threefold increased odds for chronic fatigue. They also had 1.8 times greater odds for sexually transmitted infections, some of which could be from congenital transmission in this age group, which includes infants. In the multivariate models for the young girls, the mental health variable seemed to mediate the relationship between victimization and increased odds of infectious and parasitic diseases, endocrine/metabolic/immune disorders, circulatory diseases, skin and cutaneous tissue disorders, and having any 1 of the 5 chronic conditions. The mental health categories that were significantly associated with health outcomes varied across the conditions. There were no health outcomes in which the depression-without-PTSD category was the only one significantly associated with the outcome condition. Circulatory and musculoskeletal disorders were significantly associated with all 3 of the mental health categories. Having any 1 of the 5 chronic conditions was significantly associated only with simple PTSD (PTSD without depression). Genitourinary disorders and signs/symptoms/ill-defined conditions were significantly associated with both simple and comorbid PTSD. PTSD with comorbid depression, the most severe of the mental health categories in this younger age group, was the only category associated with the endocrine/metabolic/immune disorders and skin disorders outcomes. In the adolescent age stratum, the bivariate ORs significantly associated with PTSD ranged from 2.1 for blood disorders to 5.2 for irritable bowel syndrome. Adolescents with PTSD were nearly twice as likely to have a sexually transmitted infection and 60% more likely to have cervical dysplasia. However, their rate of pregnancy was lower (23% vs 31%), a one-fourth decreased odds. In the adolescent group, only 4 outcomes (nervous system/sense organ, digestive, and genitourinary disorders and signs/symptoms/ill-defined conditions) remained statistically significantly associated with victimization after the mental health variable was added, suggesting an additive model of risk for these outcomes but a mediating role for PTSD in relation to the majority of the health outcomes. Among the adolescent girls, the range of ORs for the ICD-9 and chronic-condition diagnoses generally increased across the categories of the mental health variable in a dose-response pattern. Compared with adolescents with neither PTSD nor depression, those with PTSD without depression had statistically significant ORs from 1.5 to 3.6. Those with depression without PTSD had statistically significant ORs from 1.9 to 4.4. The significant ORs for those with PTSD comorbid with depression were from 2.3 to 6.6, and those in the complex-PTSD category had significant ORs of between 2.5 and 14.9. Only blood disorders seemed to be more strongly associated with depression alone than with the comorbid and complex forms of PTSD. The simple-PTSD category was not significantly associated with blood disorders, chronic pelvic pain, fibromyalgia, or dysmenorrhea. Depression without PTSD was not significantly associated with chronic pelvic pain or fibromyalgia. Fibromyalgia was only significantly associated with complex PTSD. CONCLUSIONS: In young girls who receive Medicaid benefits, PTSD was associated with increased odds of a range of adverse health conditions. The pattern and odds of physical comorbidity among adolescent recipients with PTSD was nearly as extensive as that seen in adult women. Overall, the pattern observed suggests that objective disease states (eg, circulatory problems, infections) may be associated with PTSD to an extent nearly as great as that of PTSD with more subjective somatic experience of loss of wellness. Using the concepts of allostatic load and allostatic support, professionals who work with children and adolescents may be able to decrease the toll that traumatic stress takes on health even if available interventions can only be thought of as supportive and fall short of completely preventing trauma exposure or completely healing posttraumatic stress. Clinical research to extend these exploratory findings is warranted. 256 PMID- 16253617 AU - Shapiro JR, Anderson DA, Danoff-Burg S TI - A pilot study of the effects of behavioral weight loss Rx on FM Sx. SO - J Psychosom Res. 2005 Nov;59(5):275-82. IN - D o Psychology, U at Albany, St U o New York, Albany, NY, USA. AB - 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. 257 PMID- 16230991 AU - Shephard RJ TI - CFS. A brief review of functional disturbances & potential therapy. SO - J Sports Med Phys Fitness. 2005 Sep;45(3):381-92. IN - Faculty o Physical Education & Health & , D o Public Health Sciences, Faculty o Med, U o Toronto, Toronto, ON, Canada. royjshep@mountain-inter.net AB - The chronic fatigue syndrome (CFS) is debilitating for both athletes and the general population. A review of etiology and mechanisms underlying functional disturbances is undertaken to provide a valid basis for therapeutic options. The review focuses on CFS as characterized by standard diagnostic criteria, building on previous reviews through use of articles identified by Medline search. Overtraining, a negative energy balance, excessive physical or environmental stress, disorders of personality and affect, dysfunction of the hypophyseal-pituitary adrenal axis, hormonal imbalance, nutritional deficits, immune suppression or activation and chronic infection have all been proposed as factors precipitating CFS, but none of these precipitants are observed consistently. Impairments of peak aerobic power and muscle strength, together with many functional disturbances, seem related to patient- or physician-imposed inactivity. Once CFS is established, treatment should aim at breaking the vicious cycle of effort avoidance, deterioration in physical condition and increasing fatigue through a combination of psychotherapy, general encouragement and a progressive exercise regimen. 258 PMID- 15844841 AU - Shin YI, Lee MS TI - Qi therapy (external qigong) for CFS: case studies. SO - Am J Chin Med. 2005;33(1):139-41. IN - D o Physical Med & Rehabilitation, Wonkwang U School o Medicine, Inst o Med Science, Wonkwang University, Iksan 570-749, Republic o Korea. AB - The aim of this study was to examine the effects of Qi therapy (QT) on the symptoms of chronic fatigue syndrome (CFS), including fatigue and complications. QT affected the experience of mental and emotional relaxation in the subjects of these case studies, who also gained strength to overcome their pain and fatigue. Although the results of these two case studies may not constitute conclusive evidence, they provide a foundation for the exploration of QT as a complementary therapy in the reduction of negative symptoms of chronic fatigue syndrome. 259 PMID- 16128688 AU - Siniscalchi M, Iovino P, Tortora R, Forestiero S, Somma A, Capuano L, Franzese MD, Sabbatini F, Ciacci C TI - Fatigue in adult coeliac disease. [CF] SO - Aliment Pharmacol Ther. 2005 Sep 1;22(5):489-94. IN - Gastrointestinal Unit, D o Clinical & Experimental Med, Federico II U o Naples, Italy. AB - BACKGROUND: Fatigue is reported by many adults at the moment of diagnosis of coeliac disease and during follow-up. AIM: To evaluate the prevalence, characteristics and associations of fatigue in adult coeliac disease patients. METHODS: The investigated sample comprised adults from Campania, Italy. A total of 130 coeliac disease patients were consecutively recruited in both treated (59 on gluten-free diet) and untreated conditions (71 on normal diet). The control group was made up of 80 healthy controls. Coeliac disease patients and healthy controls underwent laboratory tests, a set of questionnaires for studying fatigue: visual analogue scale for fatigue, chronic fatigue syndrome questionnaire, fatigue severity scale and a modified version of the Zung self-rating depression scale. RESULTS: Coeliac disease patients showed a significantly lower body mass index than controls (P = 0.0001), lower serum iron (P = 0.04). The entire cohort of coeliac disease patients reported greater modified version of the Zung self-rating depression scale score (P = 0.001), greater visual analogue scale for fatigue score (P = 0.0001) and greater chronic fatigue syndrome questionnaire score (P = 0.0001) compared with healthy controls. Coeliac disease patients on a gluten-free diet had a significantly higher modified version of the Zung self-rating depression scale score than coeliacs on a normal diet (P = 0.001). The prevalence of pathological modified version of the Zung self-rating depression scale score was 17% in all coeliac disease patients and 0% in healthy controls. A significant correlation was found between modified version of the Zung self-rating depression scale score and fatigue scale scores in coeliacs on a normal diet. Presence/absence of gastrointestinal symptoms did not show any significant correlation with modified version of the Zung self-rating depression scale score and fatigue scale scores. In coeliacs on a gluten-free diet, modified version of the Zung self-rating depression scale and fatigue scales scores did not significantly differ from coeliacs on a normal diet and were not related to dietetic compliance. CONCLUSION: In coeliacs, fatigue is a common finding, which ameliorates with the gluten-free diet and is strictly correlated to depression although coeliacs on a gluten-free diet showed more frequent and more severe depression symptoms than coeliacs on a normal diet. 260 PMID- 15895835 AU - Sipila K, Zitting P, Siira P, Niinimaa A, Raustia AM TI - Generalized pain & pain sensitivity in community subjects w facial pain: a case-control study. [FM] SO - J Orofac Pain. 2005 Spring;19(2):127-32. IN - D o Prosthetic Dentistry & Stomatognathic Physiology, Inst o Dentistry, U o Oulu, Finland. kirsi.sipila@oulu.fi AB - AIMS: To investigate the existence of pain outside the facial area as well as pain sensitivity in a population-based sample of 34-year-old subjects with facial pain. METHODS: Fifty-two facial pain cases (10 men, 42 women) and 52 pain-free controls (10 men, 42 women) included in the Northern Finland Birth Cohort of 1966 underwent a clinical musculoskeletal examination. Pain outside the facial area during the week prior to the examination was defined by means of a pain drawing. Eighteen fibromyalgia points were palpated in response to digital palpation with an algometer. Pressure pain thresholds were measured from the dorsal side of the wrist and from the highest points of the temporalis muscles. RESULTS: Compared to controls, pain cases reported significantly more pain in areas outside the face, with the exception of the shoulder and lower back. The number of painful fibromyalgia points was significantly higher in cases than in controls. Mean pressure pain thresholds were slightly lower in cases than in controls; the difference was significant in the left wrist. CONCLUSION: Subjects with facial pain reported more pain and had more mascular tenderness outside the facial area compared to controls. Pain symptoms outside the facial area should be assessed in patients seeking treatment for facial pain, and they should be taken into account when treatment is planned. 261 PMID- 16049290 AU - Smith J, Fritz EL, Kerr JR, Cleare AJ, Wessely S, Mattey DL TI - Association of CFS w human leucocyte antigen class II alleles. SO - J Clin Pathol. 2005 Aug;58(8):860-3. IN - Tissue Typing Laboratory, Harefield Hosp, Middlesex UB9 6JH, UK. AB - BACKGROUND: A genetic component to the development of chronic fatigue syndrome (CFS) has been proposed, and a possible association between human leucocyte antigen (HLA) class II antigens and chronic fatigue immune dysfunction has been shown in some, but not all, studies. AIMS: To investigate the role of HLA class II antigens in CFS. METHODS: Forty nine patients with CFS were genotyped for the HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles and the frequency of these alleles was compared with a control group comprising 102 normal individuals from the UK. All patients and controls were from the same region of England and, apart from two patients, were white. RESULTS: Analysis by 2 x 2 contingency tables revealed an increased frequency of HLA-DQA1*01 alleles in patients with CFS (51.0% v 35%; odds ratio (OR), 1.93; p = 0.008). HLA-DQB1*06 was also increased in the patients with CFS (30.2% v 20.0%; OR, 1.73, p = 0.052). Only the association between HLA-DQA1*01 and CFS was significant in logistic regression models containing HLA-DQA1*01 and HLA-DRQB1*06, and this was independent of HLA-DRB1 alleles. There was a decreased expression of HLA-DRB1*11 in CFS, although this association disappeared after correction for multiple comparisons. CONCLUSIONS: CFS may be associated with HLA-DQA1*01, although a role for other genes in linkage disequilibrium cannot be ruled out. 262 PMID- 15796202 AU - Snell CR, Vanness JM, Strayer DR, Stevens SR TI - Exercise capacity & immune function in male & female pts w CFS (CFS). SO - In Vivo. 2005 Mar-Apr;19(2):387-90. IN - U o the Pacific, D o Sport Sciences, Stockton, CA 95211-0197, USA. snells@juno.com AB - Hyperactivition of an unwanted cellular cascade by the immune-related protein RNase L has been linked to reduced exercise capacity in persons with chronic fatigue syndrome (CFS). This investigation compares exercise capacities of CFS patients with deregulation of the RNase L pathway and CFS patients with normal regulation, while controlling for potentially confounding gender effects. Thirty-five male and seventy-one female CFS patients performed graded exercise tests to voluntary exhaustion. Measures of peak VO2, peak heart rate, body mass index, perceived exertion, and respiratory quotient were entered into a two-way factorial analysis with gender and immune status as independent variables. A significant multivariate main effect was found for immune status (p < 0.01), with no gender effect or interaction. Follow-up analyses identified VO2(peak) as contributing most to the difference. These results implicate abnormal immune activity in the pathology of exercise intolerance in CFS and are consistent with a channelopathy involving oxidative stress and nitric oxide-related toxicity. 263 PMID- 16272074 AU - Soderlund A, Malterud K TI - Why did I get CFS? A qualitative interview study of causal attributions in women pts. SO - Scand J Prim Health Care. 2005 Dec;23(4):242-7. IN - Section for General Practice, D o Public Health & Primary Health Care, U o Bergen, Norway. mpkat@msn.com AB - OBJECTIVES: To explore causal attributions among women with chronic fatigue syndrome (CFS). DESIGN: Qualitative study where data from individual semi-structured interviews were analysed according to Malterud's systematic text condensation. SETTING: Bergen, Norway. SUBJECTS: A purposeful sample of eight women aged 25-55, recruited among members of a self-help organization. MAIN OUTCOME MEASURES: Accounts of causal attribution for CFS among the informants, focusing on gender. RESULTS: The participants agreed that their way of living could have increased the vulnerability of their resistance resources. Pressure they put upon themselves, workload burdens without subsequent relaxation, emotional conflicts, or preparing for assumed problem-solving were mentioned as gendered dimensions. They presented different explanations regarding potential triggers encountering their fragile immune systems, most often a virus infection. The participants thought women might have a weaker immune system than men, or that CFS was caused by a virus that women are more likely to catch. In their experience, their symptoms were activated when people put pressure on them, such that they might be nervous as to whether they could live up to the demands of their surroundings, and in the case of emotional strain related to family and work. CONCLUSION: More studies are needed exploring hypotheses concerning the complex interplay between molecular predispositions and more or less gendered lifestyle issues in CFS. Doctors need to challenge their strong beliefs regarding medically unexplained conditions, where facts still remain unresolved. Recognizing this, the doctor may provide realistic support and advice, and contribute to the establishment of common ground for understanding and managing the condition. 264 PMID- 15842962 AU - Staevska M, Baraniuk JN TI - Persistent nonallergic rhinosinusitis. [CFS] SO - Curr Allergy Asthma Rep. 2005 May;5(3):233-42. IN - Division o Rheumatology, Immunology & Allergy, Room B105, Georgetown U, Lower Level Kober-Cogan Building, 3800 Reservoir Road, NW, Washington, DC 20007-2197, USA. AB - Nonallergic rhinitis is a complex of syndromes that are united by the absence of atopic, T(H)2 lymphocyte, immunoglobulin E (IgE)-mediated mechanisms. We propose a classification system based on the presence or absence of inflammatory granulocytes. Eosinophilic nonallergic rhinosinusitis may also be called chronic eosinophilic sinusitis syndromes (CESS) to help classify these disorders in which diverse mechanisms of eosinophil chemoattraction and survival predominate. Allergic fungal sinusitis, eosinophilic nasal polyps, aspirin sensitivity, and related disorders would fit in this category. Accumulation of neutrophils occurs in chronic infectious rhinosinusitis, foreign body reactions, and immunodeficiencies. More complex and variable combinations of leukocytes are found in Wegner's granulomatosis and related syndromes, and during the evolution of viral infections. The noninflammatory disorders can be divided by mechanism into hormonal; sympathetic dysfunction (including antihypertensive adrenergic drug therapy); cholinergic rhinitis; and nociceptive syndromes with hyperalgesia and other features (eg, the nonallergic rhinitis of chronic fatigue syndrome). Therapy based on the most likely pathophysiologic mechanism is anticipated to have the most success, but requires acceptance of the wide differential diagnosis of nonallergic rhinitis and rejection of the obsolete term of "vasomotor rhinitis." 265 PMID- 15893112 AU - Staines D TI - Are vasoactive neuropeptide autoimmune fatigue-related disorders mediated via G protein-coupled receptors? [CFS] SO - Med Hypotheses. 2005;65(1):29-31. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Qld., Australia. don_staines@health.qld.gov.au AB - Vasoactive neuropeptides such as pituitary adenylate cyclase activating polypeptide (PACAP), calcitonin gene related peptide (CGRP) and vasoactive intestinal peptide (VIP) have been implicated in a number of fatigue-related conditions. Associations of these vasoactive neuropeptides with heat shock proteins (hsps) and cytosine-guanosine dinucleotide (CpG) DNA fragments in autoimmune phenomena have been postulated to interfere with receptor signal activation for adenylate cyclase and other vital cellular processes. However, a specific mechanism for receptor dysfunction has not been explored to date. G protein-coupled receptors (GPCRs) constitute a high proportion of biological receptor mechanisms and serve a wide range of substances including nucleosides, nucleotides, catecholamines, calcium, histamine, serotonin and prostaglandins. They are complex transmembrane hepta-helical serpentine structures with specific binding capabilities resulting in conformational changes that activate cognate cyclic GMP (G proteins). GPCRs adapt to certain stimuli through desensitisation and changes in phosphorylation and are subject to distortions of signalling processes. Hence, these vital signalling structures are susceptible to impairment of function through a range of mechanisms. One of their vital functions is signalling through adenylate cyclase, a vital step in cyclic AMP metabolism. This step involves ATP metabolism and therefore is a crucial mediator of cellular energy pathways. Some GPCRs act to inhibit adenylate cyclase (Gi proteins). Also vasoactive neuropeptides, such as PACAP display a number of receptor isotypes including null variants. Overexpression of Gi proteins and null variant receptors may account for major disruptions of signal transduction and ATP/cAMP metabolism. This paper examines the possible role of GPCR dysfunction in contributing to fatigue-related vasoactive neuropeptide autoimmune disorders which may include chronic fatigue syndrome (CFS), Gulf War syndrome (GWS) and even sudden infant death syndrome (SIDS). 266 PMID- 15922114 AU - Staines DR TI - Do cytosine guanine dinucleotide (CpG) fragments induce vasoactive neuropeptide mediated fatigue-related autoimmune disorders? [CFS] SO - Med Hypotheses. 2005;65(2):370-3. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Qld., Australia. don_staines@health.qld.gov.au AB - Autoimmune dysfunction of certain vasoactive neuropeptides (e.g., vasoactive intestinal peptide, pituitary adenylate cyclase activating polypeptide) may be implicated in a range of disorders associated with fatigue-like states (chronic fatigue syndrome, Gulf War syndrome) and even sudden infant death syndrome (SIDS). The important roles of these vasoactive neuropeptides make them a vulnerable target for autoimmune dysfunction. They are known to be associated with heat shock proteins for intracellular functioning with which they may form immunostimulating complexes. Cytosine guanine dinucleotide (CpG) fragments are potently immunogenic DNA fragments which serve as friend or foe recognition systems between bacterial (hypomethylated) and mammalian (methylated) DNA and are being assessed for suitability for use in human vaccines as adjuvants. Interactions between CpG fragments, heat shock proteins and vasoactive neuropeptides may be associated with fatigue-related autoimmune conditions. 267 PMID- 16004938 AU - Staines D TI - Do vasoactive neuropeptide autoimmune disorders explain pyridostigmine's association w Gulf War syndrome? [CFS] SO - Med Hypotheses. 2005;65(3):591-4. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Queensland, Australia. don_staines@health.qld.gov.au AB - Gulf War syndrome (GWS) is a perplexing multi-symptom condition comprising a constellation of signs and symptoms consistently described in the literature. These include muscle fatigue and tiredness, malaise, myalgia, impaired cognition, ataxia, diarrhoea, bladder dysfunction, sweating disturbances, headaches, fever, arthralgia, skin rashes, and gastrointestinal and sleep disturbances. Excessive chemical sensitivity and odour intolerance is reported. Epidemiological analysis suggests association with pyridostigmine bromide (PB) use as nerve gas prophylaxis, insect repellent, certain vaccination regimes, a variety of possible chemical exposures and physical and psychological stress. Pituitary adenylate cyclase-activating polypeptide (PACAP), calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP) are potent vasoactive (vasodilatory) neuropeptides (VNs) having pleiotropic functions as immunomodulators, neuroregulators and hormones. VNs also have neurotrophic and anti-apoptotic roles. VNs act on G protein-coupled receptors (GPCRs) to activate adenylate cyclase, an important step in cyclic AMP metabolism. Autoimmune dysfunction of these VNs or their receptors is postulated to give rise to fatigue-related conditions such as chronic fatigue syndrome (CFS). Complex mechanisms involving heat shock proteins (hsps) and cytosine-guanine dinucleotide (CpG) DNA fragments may also be associated with autoimmunity to VNs or their GPCRs in contributing to fatigue-related conditions. Dysfunction of certain VNs may be the missing link in explaining the nebulous nexus between PB and GWS. This paper explores a possible link between exposures to PB and other chemical, physical and psychological stressors in producing a fatigue-related illness possibly related to autoimmune dysfunction of certain VNs. Treatment options involving restoration of VN function are considered in the context of analogues with other neurotransmitter fatigue-related conditions such as myasthenia gravis (MG). While evidence associating these conditions is thin, vasoactive neuropeptide neurotransmitters of the VIP/PACAP family have acetylcholine co-transmission functions via specific GPCRs. Autoimmune reactions to these receptors may have parallels with muscarinic (e.g., Sjogren's syndrome) and nicotinic (e.g., MG) acetylcholine neurotransmission. Hence theoretically, treatment options such as thymectomy, corticosteroids, plasma exchange, anti-idiotype antibodies and receptor genomic expression reactivation/suppression may be considered. Paradoxically pyridostigmine may prove to have a role in therapy although VN treatment/replacement may be associated with tachyphylaxis. 268 PMID- 15617862 AU - Staines DR TI - Do vasoactive neuropeptides & heat shock proteins mediate fatigue-related autoimmune disorders? [CFS] SO - Med Hypotheses. 2005;64(3):539-42. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Qld, Australia. don_staines@health.qld.gov.au AB - Autoimmune dysfunction of certain vasoactive neuropeptides may be implicated in a range of disorders associated with fatigue like states (chronic fatigue syndrome, Gulf War syndrome) and even sudden infant death syndrome. These substances have neurotrophic, neuroregulatory, and neurotransmission functions, as well as that of immune modulators and hormones. They exert significant control over carbohydrate and lipid metabolism. The hypothesis is that because these substances have vital and indispensable roles in cellular processes, loss or compromise of these roles would lead to predictable and severe cellular and systemic effects. The important roles of certain VNs make them a vulnerable target for autoimmune dysfunction. They are known to be associated with heat shock proteins for intracellular functioning with which they may form immunostimulating complexes. While peptide-HSP complexes are a relatively new area for research, this paper asserts that attention could be focused on these substances and complexes in an effort to elucidate a number of perplexing fatigue-associated disorders. 269 PMID- 16042995 AU - Staines DR TI - Therapeutic & preventive interventions for postulated vasoactive neuropeptide autoimmune fatigue-related disorders. [CFS] SO - Med Hypotheses. 2005;65(4):797-803. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Queensland, Australia. don_staines@health.qld.gov.au AB - Major advances have been made in understanding the relatively novel group of vasoactive (vasodilatory) neuropeptides (VNs) in humans. VNs comprise a novel but expanding group of substances having immunoregulation, inflammation modulation, neurotransmitter, neurotrophic, hormonal and metabolic functions. These substances may control gene expression for mRNA for themselves and their receptors. They have complex relationships with gaseous and other neurotransmitters and xenobiotic substances. Theoretical arguments have implicated these substances in autoimmune phenomena resulting in fatigue-related conditions such as chronic fatigue syndrome (CFS), sudden infant death syndrome (SIDS), fibromyalgia (FM) and Gulf War syndrome (GWS) but remain unproven. As well as possibly spontaneous onset, the precipitating causes of VN autoimmune dysfunction are likely to be a combination of genetic predisposition, infection and xenobiotic substances. Therapeutic and preventive possibilities for postulated VN autoimmune conditions will be influenced by the complex patholophysiology underpinning them. Some speculative possibilities are VN substitution/replacement, preservation of biological effect, epigenetic DNA modifications, plasma exchange, anti-cholinesterases, e.g., pyridostigmine, corticosteroids and other drug treatments, thymectomy, intravenous immunoglobulin and anti-idiotype antibodies, and CpG/DNA vaccines. Prevention and treatment of possible VN autoimmune fatigue-related disorders may prove to be important areas for future research and development. 270 PMID- 15695669 AU - Stang A, Korn K, Wildner O, Uberla K TI - Characterization of virus isolates by particle-associated nucleic acid PCR. [CFS] SO - J Clin Microbiol. 2005 Feb;43(2):716-20. IN - D o Molecular & Med Virology, Ruhr U Bochum, D-44780 Bochum, Germany. AB - Diagnostic virus isolation is still frequently used, particularly from respiratory tract secretions. Testing positive virus cultures for all possible viruses is time-consuming, and unexpected or unknown viruses may escape detection. Therefore, a novel random PCR approach was developed that allows sequence-independent amplification of viral nucleic acids from virus isolation-positive cultures. Selectivity for viral sequences is obtained by preferential isolation of nucleic acids that are particle associated and resistant to nucleases. Using primers with a degenerated 3' end, the isolated nucleic acids are amplified and the randomly amplified PCR products are cloned and sequenced. As proof of the concept, the PAN-PCR approach was applied to supernatants of coxsackievirus B3 and murine adenovirus type 1-infected cells. Enterovirus and adenovirus sequences were obtained, demonstrating that the random PCR approach allows detection of RNA and DNA viruses. As a first application of this PAN-PCR approach, we characterized a virus isolate from mouth-washing material of a patient with chronic fatigue syndrome and high antibody titers to coxsackievirus B2. The virus isolate had tested negative for enteroviruses and respiratory viruses (influenza viruses A and B, parainfluenza virus types 1 to 3, respiratory syncytial virus, and adenovirus) by immunofluorescence and PCR. Particle-associated, nuclease-resistant RNA and DNA were prepared from the supernatant of infected cells. The DNA and the reverse-transcribed RNA were randomly amplified, and PCR products were cloned and sequenced. Of 25 sequences obtained from the DNA preparation, 24 contained herpes simplex virus type 1 (HSV-1) sequences from 14 different loci spread over the HSV-1 genome. This result was confirmed by using a standard diagnostic HSV-PCR, demonstrating that the PAN-PCR correctly identified the virus isolate. Although the identification of HSV-1 in mouth-washing material is not surprising in retrospect, it clearly demonstrates the applicability of the PAN-PCR approach. This method should be particularly useful for characterizing virus isolates that have tested negative for all expected viruses and for identifying unknown viruses. 271 PMID- 15890634 AU - Staud R, Vierck CJ, Robinson ME, Price DD TI - Effects of the N-methyl-D-aspartate receptor antagonist dextromethorphan on temporal summation of pain are similar in FM pts & normal control subjects. SO - J Pain. 2005 May;6(5):323-32. IN - D o Med, McKnight Brain Inst, U o Florida, Gainesville, Florida 326100-0221, USA. staudr@ufl.edu AB - Temporal summation of second pain at least partly reflects temporal summation of dorsal horn neuronal responses, and both have been termed windup (WU), a form of nociception-dependent central sensitization. Animal and human experiments have shown that both forms of WU depend on N-methyl-D-aspartate (NMDA) and substance P receptor systems. WU of second pain (WU(SP)) in patients with fibromyalgia (FM) is enhanced compared with normal control (NC) subjects and is followed by exaggerated WU(SP) aftersensations and prolonged WU(SP) maintenance at low stimulus frequencies. Because the enhanced WU(SP) of FM patients could be related to abnormal endogenous modulation of NDMA receptors, we tested the effects of the NMDA receptor antagonist dextromethorphan (DEX) on WU(SP) in FM and NC subjects in a double-blind, placebo-controlled, crossover study. WU(SP) was elicited by trains of 0.7-second duration thermal pulses applied to the glabrous surface of the hands or by 1-second mechanical stimuli to the adductor pollicis muscle of the hands at a frequency of 0.33 Hz. In comparison to baseline and placebo conditions, single oral doses of DEX 60 and 90 mg reduced thermal and mechanical WU(SP) in NC and FM subjects, with DEX 90 mg being most effective. These effects did not differ for male and female NC subjects. FM subjects required less thermal and mechanical stimulus intensity than NC to achieve maximal WU(SP), but the extent of WU(SP) reduction by DEX did not statistically differ between NC and FM subjects for all study conditions. Thus, central pain processing of FM subjects is not different from NC in at least one important aspect, namely their NMDA receptor system responsiveness to pharmacologic inhibition by DEX. PERSPECTIVE: Results of this study demonstrate that FM patients show abnormal WU(SP) during thermal and mechanical stimulation compared with NC. Because oral doses of the NMDA receptor antagonist DEX attenuated thermal and mechanical WU(SP) similarly in FM patients and NC, other mechanisms than WU(SP) need to be considered for the widespread pain of FM patients. These mechanisms might include tonic nociceptive input from peripheral tissues and/or enhanced descending facilitation. 272 PMID- 16157059 AU - Staud R TI - Predictors of clinical pain intensity in pts w FM syndrome. SO - Curr Pain Headache Rep. 2005 Oct;9(5):316-21. IN - Division o Rheumatology & Clinical Immunology, U o Florida, PO Box 100221, Gainesville, FL 32610, USA. staudr@ufl.edu AB - Central changes in pain processing have been previously reported in patients with fibromyalgia syndrome. These changes include decreased thresholds to mechanical and thermal stimuli (allodynia) and central sensitization, both of which are fundamental to the generation of clinical pain. Therefore, psychophysical measures of central pain processing may be useful predictors of clinical pain intensity of fibromyalgia syndrome patients. Previous studies of fibromyalgia syndrome patients have shown statistically significant correlations of psychophysical test results with clinical pain intensity. The tests used to characterize this important relationship were dependent on spinal cord pain mechanisms and included temporal summation of pain or wind-up and wind-up after-sensations. Particularly, the magnitude of wind-up after-sensations appeared to be one of the best predictors for clinical pain intensity of fibromyalgia syndrome patients (27%). Furthermore, the combination of tender point count, negative affect, and wind-up after-sensations accounted for approximately 50% of the variance in clinical pain intensity of fibromyalgia syndrome patients. Therefore, wind-up after-sensations, tender point count, and negative affect not only seem to represent relevant pain mechanisms but also strongly emphasize their importance for fibromyalgia syndrome pain. 273 PMID- 16214721 AU - Steihaug S TI - Can chr muscular pain be understood? [FM] SO - Scand J Public Health Suppl. 2005 Oct;(66):36-40. IN - SINTEF Helse, Oslo, Norway. sissel@steihaug.net AB - Chronic muscular pain is often regarded as incomprehensible or indefinable when the doctor "can't find anything" on examination. However, the physiotherapist often detects physical signs in these patients: changes in posture, holding breath, tense and hard musculature, and poor balance. The findings are dependent on what is being sought. The view of the body as ambiguous, as something a person has and is, can shed light on the way life has left its traces in the body, such as changes in posture and poor balance. In this article it will be argued that combining a physiotherapeutic, a phenomenological, and a biological perspective can make chronic muscular pain more comprehensible. Chronic muscular pain can be perceived not as a sign representing a symbol of underlying factors but rather as a sign understood as an expression of the bodily state. 274 PMID- 15585538 AU - Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G TI - Cognitive behaviour therapy for adolescents w CFS: randomised controlled trial. SO - BMJ. 2005 Jan 1;330(7481):14. Epub 2004 Dec 7. IN - Expert Centre Chronic Fatigue, U Med Centre Nijmegen, PO Box 9101, 6500 HB, Netherlands. AB - OBJECTIVE: To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10-17 years with chronic fatigue syndrome. DESIGN: Randomised controlled trial. SETTING: Department of child psychology. PARTICIPANTS: 71 consecutively referred patients with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy. INTERVENTION: 10 sessions of therapy over five months. Treatment protocols depended on the type of activity pattern (relatively active or passive). All participants were assessed again after five months. MAIN OUTCOME MEASURES: Fatigue severity (checklist individual strength), functional impairment (SF-36 physical functioning), and school attendance. RESULTS: 62 patients had complete data at five months (29 in the immediate therapy group and 33 on the waiting list). Patients in the therapy group reported significantly greater decrease in fatigue severity (difference in decrease on checklist individual strength was 14.5, 95% confidence interval 7.4 to 21.6) and functional impairment (difference in increase on SF-36 physical functioning was 17.3, 6.2 to 28.4) and their attendance at school increased significantly (difference in increase in percentage school attendance was 18.2, 0.8 to 35.5). They also reported a significant reduction in several accompanying symptoms. Self reported improvement was largest in the therapy group. CONCLUSION: Cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome in adolescents. 275 PMID- 16168156 AU - Sullivan PF, Pedersen NL, Jacks A, Evengard B TI - Chronic fatigue in a population sample: definitions & heterogeneity. [CFS] SO - Psychol Med. 2005 Sep;35(9):1337-48. IN - D o Genetics, U o North Carolina at Chapel Hill, NC 27599-7264, USA. pfsulliv@med.unc.edu AB - BACKGROUND: Numerous nosological decisions are made when moving from the common human symptom of unusual fatigue to the rare chronic fatigue syndrome (CFS). These decisions have infrequently been subjected to rigorous evaluation. METHOD: We obtained telephone interview data on fatiguing symptoms from 31406 individuals twins in the Swedish Twin Registry aged 42-64 years; 5330 subjects who endorsed fatigue and possessed no exclusionary condition formed the analytic group. We evaluated the definition and classification of CFS-like illness using graphical methods, regression models, and latent class analysis. RESULTS: Our results raise fundamental questions about the 1994 Centers for Disease Control criteria as (1) there was no empirical support for the requirement of four of eight cardinal CFS symptoms; (2) these eight symptoms were not equivalent in their capacity to predict fatigue; and (3) no combination of symptoms was markedly more heritable. Critically, latent class analysis identified a syndrome strongly resembling CFS-like illness. CONCLUSIONS: Our data are consistent with the 'existence' of CFS-like illness although the dominant nosological approach captures population-level variation poorly. We suggest that studying a more parsimonious case definition - impairing chronic fatigue not due to a known cause - would represent a way forward. 276 PMID- 16168155 AU - Sullivan PF, Evengard B, Jacks A, Pedersen NL TI - Twin analyses of chr fatigue in a Swedish national sample. [CFS] SO - Psychol Med. 2005 Sep;35(9):1327-36. IN - D o Genetics, U o North Carolina at Chapel Hill, NC 27599-7264, USA. pfsulliv@med.unc.edu AB - BACKGROUND: Chronic fatigue has infrequently been studied in twins. Data from twin studies can inform clinical and research approaches to the management and etiology of human complex traits. METHOD: The authors obtained telephone interview data on current chronic fatigue from 31406 individuals twins in the Swedish Twin Registry (aged 42-64 years, 75.68% response rate), from both members of 12407 pairs and from one member of 6592 pairs. Of the complete pairs, 3269 pairs were monozygotic, 9010 pairs dizygotic, and 128 pairs of unknown zygosity. Structural equation twin modeling was used to estimate the latent genetic architecture of varying definitions of fatiguing illness. RESULTS: Estimates of additive genetic effects, shared environmental effects, and individual-specific environmental effects were similar in males and females. No definition of current fatiguing illness (ranging from any fatigue to CFS-like illness) was strikingly distinctive. Individual-specific effects were the predominant source of variation, followed by modest genetic influences. We could not exclude a small but conceptually important contribution of shared environmental effects. CONCLUSIONS: Current fatiguing illness appears to be a complex trait resulting from both environmental and genetic sources of variation without pronounced differences by gender. 277 PMID- 16268016 AU - Taylor RR TI - Can the social model explain all of disability experience? Perspectives of persons w CFS. SO - Am J Occup Ther. 2005 Sep-Oct;59(5):497-506. IN - U o Illinois at Chicago, D o Occupational Therapy, 1919 West Taylor Street (MC 811), Chicago, Illinois 60612-7250, USA. rtaylor@uic.edu AB - OBJECTIVE: The social model of disability has had a major influence on the academic field of disability studies and on contemporary understandings of the causes and experience of disability. The purpose of this study was to examine the adequacy of the social model for explaining the disability experience of persons with chronic fatigue syndrome (CFS). METHODS: This qualitative study examined the experiences of 47 adults with CFS participating in a research project that aimed to evaluate a participant-designed rehabilitation program. Data were aggregated from focus group interviews, open-ended questionnaires, progress notes, and from a program evaluation questionnaire. Data analysis was based on a grounded theory approach and used triangulation of multiple data sources and member checks to assure dependability of findings. RESULTS: Four themes emerged from the analysis: (1) minimization and mistrust of the disability; (2) negative experiences of impairment; (3) lack of identification with the disability community; and (4) the focus on advocacy as a quest for legitimacy. These themes varied in the extent to which they conformed to the principles set forth by the social model. CONCLUSIONS: Although the social model has important contributions to lend to occupational therapy practice, it is important to recognize that it may not capture the full reality of disability. In particular, the social model has serious limitations in describing the disability experience of individuals with disabilities who do not have visibly obvious disabilities and whose impairments do not conform to the traditional viewpoint of disability. 278 PMID- 16038114 AU - Taylor-Gjevre RM, Gjevre JA TI - Anti-glutamic acid decarboxylase antibodies in a patient w SLE & FM Sx. SO - Lupus. 2005;14(6):486-8. IN - Division o Rheumatology, Royal U Hosp, U o Saskatchewan, Saskatoon, SK, Canada. r.gjevre@usask.ca AB - We report the case of a 29-year old female nurse with a five-year history of systemic lupus erythematosus (SLE) involving multiple systems and on chronic prednisone therapy. This patient has a coexisting diagnosis of fibromyalgia fulfilling ACR criteria. A recent deterioration in her level of functioning in addition to a flare of her inflammatory disease led to further evaluation. During the course of investigation an anti-glutamic acid decarboxylase antibody was found to be present and significantly elevated. A therapeutic trial of baclofen did result in improvement of her subjective myalgias. We raise the possibility of an autoimmune contribution to myalgic symptoms in a portion of SLE patients. 279 PMID- 15934120 AU - Thieme K, Spies C, Sinha P, Turk DC, Flor H TI - Predictors of pain behaviors in FM syndrome. SO - Arthritis Rheum. 2005 Jun 15;53(3):343-50. IN - D o Anesthesiology, U o Washington, Seattle 98195-6450, USA. thiemek@u.washington.edu AB - OBJECTIVE: To evaluate the contributions of physical, pain-related, cognitive, stress-related, affective, and spouse-related variables to differences in pain behaviors in subgroups of patients with fibromyalgia syndrome (FMS). METHODS: One hundred forty FMS patients underwent medical, physical, and psychological evaluation. Patients and 30 pain-free controls performed a routine physical activity (window-washing task) to elicit pain behaviors with or without the presence of their spouses. The behaviors and spouses' responses during this task were videotaped and subsequently rated. Patients were classified as dysfunctional (DYS), interpersonally distressed (ID), or adaptive copers (AC) based on responses to the Multidimensional Pain Inventory. Hierarchical regression analyses were used to identify predictors of pain behaviors for the total group and subgroups of patients. RESULTS: Patients classified as DYS demonstrated the highest number of pain behaviors compared with those classified as ID or AC. This difference was observable when the spouse was present. Spouse responses and physical variables were significantly related to pain behaviors in the DYS and ID groups with the model accounting for 77.1% and 41.9% of the variance, respectively. In contrast, for the AC group, stress factors were the most significant predictor of pain behaviors, accounting for 22.8% of the variance. CONCLUSION: The results indicate that different variables account for the presence of pain behaviors in different subgroups of patients. The data provide support for the heterogeneity of the diagnosis of FMS and have implications for treatment of subgroups of patients. 280 PMID- 16351714 AU - Thomas MA, Smith AP TI - Primary healthcare provision & CFS: a survey of pts' & General Practitioners' beliefs. SO - BMC Fam Pract. 2005 Dec 13;6:49. IN - Centre for Occupational & Health Psychology, School o Psychology, Cardiff U, 63 Park Place, Cardiff, UK. thomasma@cf.ac.uk AB - BACKGROUND: The current study was conducted as part of a research project into the evaluation and assessment of healthcare provision and education in Chronic Fatigue Syndrome (CFS). One aim of the study was the development of informative and educational literature for both General Practitioners (GP) and sufferers. Issues such as diagnosis, management and treatment of the syndrome should be included in information booklets written by healthcare professionals. It was important to begin the process by assessing the level of specialist knowledge that existed in typical GP surgeries. This data would then be compared to data from CFS patients. METHOD: 197 survey booklets were sent to CFS sufferers from an existing research panel. The patients approached for the purpose of the study had been recruited onto the panel following diagnosis of their illness at a specialised CFS outpatient clinic in South Wales. A further 120 booklets were sent to GP surgeries in the Gwent Health Authority region in Wales. RESULTS: Results from the study indicate that the level of specialist knowledge of CFS in primary care remains low. Only half the GP respondents believed that the condition actually exists. CONCLUSION: Steps are recommended to increase the knowledge base by compiling helpful and informative material for GPs and patient groups. 281 PMID- 15848988 AU - Thune PO TI - The prevalence of FM among pts w psoriasis. SO - Acta Derm Venereol. 2005;85(1):33-7. IN - Dermatology OMNIA Med Ctr, Strommen, Norway. per.thune@tiscali.no AB - The aim of the present study was to investigate the prevalence of fibromyalgia and allied symptoms in patients with psoriasis. During a 3-year period from 1997 until 2000, 1269 patients were consecutively diagnosed with psoriasis. All patients were questioned about musculoskeletal symptoms and those with such symptoms were further examined according to a standardized protocol. In total 335 of 1269 patients had musculoskeletal symptoms. More women than men had such complaints, 33% versus 18.5%, respectively. As many as 13% of the women fulfilled the American College of Rheumatology 1990 (ACR-90) criteria for fibromyalgia, while 14.1% had symptoms compatible with chronic widespread pain without meeting the fibromyalgia criteria. In total, 8.3% suffered from fibromyalgia and 9% from chronic widespread pain. The results indicate that fibromyalgia and allied symptoms are frequent in female patients with psoriasis and constitute important problems with regard to disability and health-related quality of life. Only 35 of 105 patients with fibromyalgia had previously been diagnosed with psoriasis and the diagnostic label of fibromyalgia was new to 51 of them. Female patients with symptoms of psoriasis and pain seem to constitute a subgroup which deserves further studies. 282 PMID- 16006924 AU - Tikiz C, Muezzinoglu T, Pirildar T, Taskn EO, Frat A, Tuzun C TI - Sexual dysfunction in female subjects w FM. SO - J Urol. 2005 Aug;174(2):620-3. IN - D o Physical Med & Rehabilitation, Faculty o Medicine, Celal Bayar U, Manisa, Turkey. canan.tikiz@bayar.edu.tr AB - PURPOSE: We investigated sexual function in females with fibromyalgia (FM) and evaluate whether coexistent major depression (MD) has an additional negative effect on sexual function. MATERIALS AND METHODS: A total of 100 female subjects were enrolled in the study, including 40 with FM only, 27 with FM plus MD and 33 healthy volunteers as a control group. The diagnosis of MD was made according to Structured Clinical Interview for Diagnostic and Statistical Manual-IV interview and the Hamilton Depression Rate Scale was used to grade depression. Widespread pain and quality of life were assessed with the Lattinen Pain Scale and Fibromyalgia Impact Questionnaire, respectively. The Female Sexual Function Index (FSFI) was used to assess sexual dysfunction. RESULTS: All subjects were comparable in age, occupation and education. Mean FSFI total score +/- SD was significantly decreased in the FM and FM plus MD groups compared with that in healthy controls (21.83 +/- 5.84 and 22.43 +/- 7.0 vs 28.10 +/- 6.52, respectively, p = 0.001). However, the FSFI score was not significantly different between patients with FM only and FM plus MD (p >0.05). Correlation analysis revealed a negative moderate correlation between total Lattinen pain score and FSFI score in the FM only and FM plus MD groups (r = -0.366, p = 0.047 and r = -0.403, p = 0.018, respectively). FSFI score did not correlate with FIQ and HDRS scores (p >0.05). CONCLUSIONS: This study demonstrates that female patients with FM have distinct sexual dysfunction compared with healthy controls and coexistent MD has no additional negative effect on sexual function. Thus, female subjects with FM should be evaluated in terms of sexual function to provide better quality of life. 283 PMID- 15808295 AU - Tomoda A, Joudoi T, Rabab el-M, Matsumoto T, Park TH, Miike T TI - Cytokine production & modulation: comparison of pts w CFS & normal controls. SO - Psychiatry Res. 2005 Mar 30;134(1):101-4. IN - D o Child Development, School o Med, Kumamoto U, Kumamoto, Japan. atomoda@mclean.harvard.edu AB - We studied cytokine production in 15 patients with chronic fatigue syndrome (CFS) and 23 controls. CFS patients' peripheral blood mononuclear cells were cultured with lipopolysaccharide or phytohemagglutinin. Enzymatic immunoassay indicated cytokine concentration in culture supernatants. CFS patients showed significantly lower mRNA levels and transforming growth factor-beta1 (TGF-beta1) production. Cytokine dysregulation affects CFS pathogenesis. TGF-beta1 may aid treatment because it affects CFS inflammatory characteristics. 284 PMID- 16095011 AU - Topbas M, Cakirbay H, Gulec H, Akgol E, Ak I, Can G TI - The prevalence of FM in women aged 20-64 in Turkey. SO - Scand J Rheumatol. 2005 Mar-Apr;34(2):140-4. IN - D o Public Health, Faculty o Med, Karadeniz Technical U, Trabzon, Turkey. mtopbas@meds.ktu.edu.tr AB - OBJECTIVE: The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) in women aged 20-64 in the city of Trabzon, Turkey, and to evaluate associated demographic variables. METHODS: A minimum of 1825 subjects eligible for the study was calculated, and 2000 subjects were eventually planned for inclusion. Of these, 1930 subjects participated in the screening phase (a participation rate of 96.5%). The screening protocol included several interview items that have been defined as components of FMS. Subjects were also asked questions concerning demographics. Individuals with positive screening results were invited to be examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS using the 1990 American College of Rheumatology (ACR) classification criteria. RESULTS: Seventy of the 1930 women were diagnosed with FMS. The prevalence of fibromyalgia was 3.6% (95% CI 2.8-4.4). The prevalence was highest in the 50-59 age group (10.1%, 95% CI 8.8-11.4), in the uneducated (10.7%, 95% CI 9.3-12.1), in the widowed (8.8%, 95% CI 7.5-10.1), and in subjects with an annual household income of < USD 2000 (7.3%, 95% CI 6.1-8.5). CONCLUSION: This cross-sectional study is the first report of the prevalence of FMS in Turkey. These data will assist decision-making in the health system. 285 PMID- 15599131 AU - Turk DC TI - The potential of Rx matching for subgroups of pts w chr pain: lumping versus splitting. [FM] SO - Clin J Pain. 2005 Jan-Feb;21(1):44-55; discussion 69-72. IN - D o Anesthesiology, U o Washington, Seattle, WA 98195, USA. turkdc@u.washington.edu AB - A large and diverse number of treatments have been shown to be effective in reducing pain and other symptoms for a minority but statistically significant number of patients in different chronic pain syndromes. The means by which such different treatments achieve similar outcomes is not well understood. In this paper, the importance of considering patient heterogeneity for those who may be diagnosed with the same medical syndrome is discussed. The author suggests that the lack of satisfactory treatment outcomes for the treatments of chronic pain syndromes may be accounted for by the patient homogeneity myth--the assumption that all patients with the same medical diagnosis are similar on all important variables. The importance of subdividing (splitting) patients into meaningful groups is described. Studies presenting data on the identification of patient subgroups based on psychosocial and behavioral characteristics and the reliability and validity of this approach are presented. Some initial attempts to demonstrate the potential for matching treatments to patient subgroups are described. 286 PMID- 16195165 AU - Valkeinen H, Hakkinen K, Pakarinen A, Hannonen P, Hakkinen A, Airaksinen O, Niemitukia L, Kraemer WJ, Alen M TI - Muscle hypertrophy, strength development, & serum hormones during strength training in elderly women w FM. SO - Scand J Rheumatol. 2005 Jul-Aug;34(4):309-14. IN - D o Health Sciences, U o Jyvaskyla, Jyvaskyla, FIN-40 014, Finland. heli.valkeinen@sport.jyu.fi AB - OBJECTIVE: To examine the effects of strength training on maximal force, cross-sectional area (CSA), and electromyographic (EMG) activity of muscles and serum hormone concentrations in elderly females with fibromyalgia (FM). METHODS: Twenty-six patients with FM were randomly assigned to a training (FMT; n = 13; mean age 60 years) or a control (FMC; n = 13; 59 years) group. FMT performed progressive strength training twice a week for 21 weeks. The measurements included maximal isometric and concentric leg extension forces, EMG activity of the vastus lateralis and medialis, CSA of the quadriceps femoris, and serum concentrations of testosterone (T), free testosterone (FT), growth hormone (GH), insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEAS), and cortisol. Subjectively perceived symptoms of FM were also assessed. RESULTS: All patients were able to complete the training. In FMT strength training led to increases of 36% (p<0.001) and 33% (p<0.001) in maximal isometric and concentric forces, respectively. The CSA increased by 5% (p<0.001) and the EMG activity in isometric action by 47% (p<0.001) and in concentric action by 57% (p<0.001). Basal serum hormone concentrations remained unaltered during strength training. The subjective perceived symptoms showed a minor decreasing tendency (ns). No statistically significant changes occurred in any of these parameters in FMC. CONCLUSION: Progressive strength training increases strength, CSA, and voluntary activation of the trained muscles in elderly women with FM, while the measured basal serum hormone concentrations remain unaltered. Strength training benefits the overall physical fitness of the patients without adverse effects or any exacerbation of symptoms and should be included in the rehabilitation programmes of elderly patients with FM. 287 PMID- 16049059 AU - van de Putte EM, Engelbert RH, Kuis W, Sinnema G, Kimpen JL, Uiterwaal CS TI - CFS & health control in adolescents & parents. SO - Arch Dis Child. 2005 Oct;90(10):1020-4. Epub 2005 Jul 27. IN - D o Paediatrics, Wilhelmina Children's Hosp, U Med Ctr, Utrecht, Netherlands. e.vandeputte@wkz.azu.nl AB - AIMS: To explore the locus of health control in adolescents with chronic fatigue syndrome (CFS) and their parents in comparison with healthy adolescents and their parents. METHODS: In this cross-sectional study 32 adolescents with CFS were compared with 167 healthy controls and their respective parents. The Multidimensional Health Locus of Control (MHLC) questionnaire was applied to all participants. RESULTS: There was significantly less internal health control in adolescents with CFS than in healthy controls. An increase of internal health control of one standard deviation was associated with a 61% reduced risk for CFS (OR = 0.39, 95% CI 0.25 to 0.61). Internal health control of the parents was also protective (OR fathers: 0.57 (95% CI 0.38 to 0.87); OR mothers: 0.74 (95% CI 0.50 to 1.09)). The external loci of health control were higher in adolescents with CFS and in their parents. Increased levels of fatigue (56%) were found in the mothers of the adolescents with CFS, in contrast with the fathers who reported a normal percentage of 13. CONCLUSIONS: In comparison with healthy adolescents, adolescents with CFS and their parents show less internal health control. They attribute their health more to external factors, such as chance and physicians. This outcome is of relevance for treatment strategies such as cognitive behaviour therapy, for which health behaviour is the main focus. 288 PMID- 15805343 AU - van de Putte EM, Uiterwaal CS, Bots ML, Kuis W, Kimpen JL, Engelbert RH TI - Is CFS a connective tissue disorder? A cross-sectional study in adolescents. SO - Pediatrics. 2005 Apr;115(4):e415-22. IN - D o Pediatric, Wilhelmina Children's Hosp, U Med Ctr Utrecht, Utrecht, Netherlands. e.vandeputte@wkz.azu.nl AB - OBJECTIVES: To investigate whether constitutional laxity of the connective tissues is more frequently present in adolescents with chronic fatigue syndrome (CFS) than in healthy controls. Increased joint hypermobility in patients with CFS has been previously described, as has lower blood pressure in fatigued individuals, which raises the question of whether constitutional laxity is a possible biological predisposing factor for CFS. DESIGN: Cross-sectional study. PARTICIPANTS: Thirty-two adolescents with CFS (according to the criteria of the Centers for Disease Control and Prevention) referred to a tertiary hospital and 167 healthy controls. METHODS: The 32 adolescents with CFS were examined extensively regarding collagen-related parameters: joint mobility, blood pressure, arterial stiffness and arterial wall thickness, skin extensibility, and degradation products of collagen metabolism. Possible confounding factors (age, gender, height, weight, physical activity, muscle strength, diet, alcohol consumption, and cigarette smoking) were also measured. The results were compared with findings in 167 healthy adolescents who underwent the same examinations. RESULTS: Joint mobility, Beighton score, and collagen biochemistry, all indicators of connective tissue abnormality, were equal for both groups. Systolic blood pressure, however, was remarkably lower in patients with CFS (117.3 vs. 129.7 mm Hg; adjusted difference: -13.5 mm Hg; 95% confidence interval [CI]: -19.1, -7.0). Skin extensibility was higher in adolescents with CFS (mean z score: 0.5 vs. 0.1 SD; adjusted difference: 0.3 SD; 95% CI: 0.1, 0.5). Arterial stiffness, expressed as common carotid distension, was lower in adolescents with CFS, indicating stiffer arteries (670 vs 820 mum; adjusted difference: -110 mum; 95% CI: -220, -10). All analyses were adjusted for age, gender, body mass index, and physical activity. Additionally, arterial stiffness was adjusted for lumen diameter and pulse pressure. CONCLUSIONS: These findings do not consistently point in the same direction of an abnormality in connective tissue. Patients with CFS did have lower blood pressure and more extensible skin but lacked the most important parameter indicating constitutional laxity, ie, joint hypermobility. Moreover, the collagen metabolism measured by crosslinks and hydroxyproline in urine, mainly reflecting bone resorption, was not different. The unexpected finding of stiffer arteries in patients with CFS warrants additional investigation. 289 PMID- 16174484 AU - Van Houdenhove B, Egle U, Luyten P TI - The role of life stress in FM. SO - Curr Rheumatol Rep. 2005 Oct;7(5):365-70. IN - U Hosp Gasthuisberg, D o Liaison Psychiatry, K.U.Leuven, Herestraat 49, B-3000 Leuven, Belgium. boudewijn.vanhoudenhove@uz.kuleuven e AB - This paper focuses on recent evidence of etiopathogenetic links between fibromyalgia and life stress. From an etiologic point of view, studies concerning the role of adverse life events, personality and lifestyle factors, post-traumatic stress, and negative childhood experiences are reviewed. From a pathogenetic point of view, neurobiologic links between stress and fibromyalgia symptoms, notably chronic pain and fatigue are highlighted. Finally, several methodologic issues with regard to stress research on fibromyalgia, as well as the clinical relevance of the stress concept for fibromyalgia are discussed. 290 PMID- 15870847 AU - Ventegodt S, Gringols M, Merrick J TI - Clinical holistic medicine: whiplash, FM, & chr fatigue. [CF] SO - ScientificWorldJournal. 2005 Apr 25;5:340-54. IN - The Quality o Life Research Ctr, Teglgardstraede 4-8, DK-1452 Copenhagen K, Denmark. ventegodt@livskvalitet.org AB - Holistic treatment of the highly complex, "new diseases" are often possible with the tools of consciousness-based medicine. The treatment is more complicated and the cure usually takes longer than for less-complex diseases. The problem with these patients is that they have less easily accessible resources than most patients, as they suffer from a combined socio-psycho-physical problem with depression, poor social standing, low confidence, and low self-esteem. Often, they have also already tried most of the specialist and alternative treatments on the market. To cure them, the most important thing is to coach them to improve their social life by changing their behavior to be of more value to others. Holding and processing must be especially careful and the contract with the patients must be extremely explicit in order to work on their personal development for 6-12 months. The new diseases can be cured with consciousness-based medicine if the patients are motivated and keep their appointments and agreements. Low responsibility, low personal energy, little joy of life, and limited insight into self and existence are some of the features of the new diseases that make them difficult to cure. The important thing is to keep a pace the patient can follow and give the patient a row of small successes and as few failures as possible. The new diseases are a challenge, a unique chance to improve communication, holding, and processing skills. 291 PMID- 16012059 AU - Vollestad NK, Mengshoel AM TI - Relationships between neuromuscular functioning, disability & pain in FM. SO - Disabil Rehabil. 2005 Jun 17;27(12):667-73. IN - Section for Health Science, Inst o Nursing & Health Sciences, U o Oslo, Norway. nina.vollestad@medisin.uio.no AB - PURPOSE: Fibromyalgia (FM) is associated with pain and alterations in neuromuscular properties and function. A common belief is that these neuromuscular changes are a major cause of limitations in activities or restrictions in participation. The paper aims at examining the basis for such an understanding. Another aim is to investigate how pain is modified or is a modifier of neuromuscular properties and functions. METHOD: Based on a simplified model to analyze the relationship between pain, neuromuscular properties and function, and activities/participation. RESULTS: It is argued that the changes in neuromuscular properties and functions seen in FM may simply be an adaptation to lowered physical activity level, rather than being a primary feature of the FM. Furthermore, it is shown that chronic pain and acute contraction-induced pain relates differently to functioning. CONCLUSION: The analyses indicates that in clinical work and research it is important to distinguish between chronic pain and pain induced by physical activity. Furthermore, the deviations reported for FM in muscular properties and functions such as endurance and strength, are probably not reflecting pathology. Hence, physical activity and improvement of muscular functions are hardly sufficient as treatment of FM. 292 PMID- 15667030 AU - Wahner-Roedler DL, Elkin PL, Vincent A, Thompson JM, Oh TH, Loehrer LL, Mandrekar JN, Bauer BA TI - Use of complementary & alternative medical therapies by pts referred to a FM Rx program at a tertiary care center. SO - Mayo Clin Proc. 2005 Jan;80(1):55-60. IN - D o Internal Med & Div o General Internal Medicine, Mayo Clinic Coll o Medicine, Rochester, Minn 55905, USA. wahnerroedler.dietlind@mayo.edu AB - OBJECTIVE: To evaluate the frequency and pattern of complementary and alternative medicine (CAM) use in patients referred to a fibromyalgia treatment program at a tertiary care center. PATIENTS AND METHODS: Patients referred to the Mayo Fibromyalgia Treatment Program between February 2003 and July 2003 were invited on their initial visit to participate in a survey regarding CAM use during the previous 6 months. An 85-question survey that addressed different CAM domains was used. RESULTS: Of the 304 patients invited to participate, 289 (95%) completed the survey (263 women and 26 men). Ninety-eight percent of the patients had used some type of CAM therapy during the previous 6 months. The 10 most frequently used CAM treatments were exercise for a specific medical problem (48%), spiritual healing (prayers) (45%), massage therapy (44%), chiropractic treatments (37%), vitamin C (35%), vitamin E (31%), magnesium (29%), vitamin B complex (25%), green tea (24%), and weight-loss programs (20%). CONCLUSION: CAM use is common in patients referred to a fibromyalgia treatment program. 293 PMID- 16392538 AU - Wallman KE, Morton AR, Goodman C, Grove R TI - Reliability of physiological, psychological, & cognitive variables in CFS. SO - Res Sports Med. 2005 Jul-Sep;13(3):231-41. IN - School o Human Movement & Exercise Science, The U o Western Australia, Crawely, Western Australia, Australia. kwallman@cyllene.uwa.edu.au AB - The purpose of this study was to assess the reliability of specific physiological, psychological, and cognitive variables in 31 chronic fatigue syndrome (CFS) subjects and 31 matched control subjects. All variables were assessed weekly over a 4-week period and reliability was determined using an intraclass correlation coefficient (ICC). Results ranged from moderately to highly reliable for all variables assessed, except for mental and physical fatigue, which were of questionable reliability in both groups (ICC = 0.61 and 0.65, respectively, for the CFS group; 0.62 and 0.52 for the control group). A Pearson product-moment correlation analysis that compared exercise performance with all psychological variables assessed, demonstrated a significant relationship between exercise performance and depression (r = .41, P = .02) in week 3 only, suggesting minimal association between objective performance and psychological responses. These correlation results support a central, as opposed to a peripheral, basis to the sensation of fatigue in CFS. 294 PMID- 15719700 AU - Werle E, Jakel HP, Muller A, Fischer H, Fiehn W, Eich W TI - Serum hyaluronic acid levels are elevated in arthritis pts, but normal & not associated w clinical data in pts w FM syndrome. SO - Clin Lab. 2005;51(1-2):11-9. IN - Institute o Laboratory Diagnostics, Microbiology & Transfusion Med, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany. WerleE@DBK-NB.de AB - BACKGROUND: Fibromyalgia syndrome (FM) is a disease with widespread chronic pain and many nonspecific symptoms. Hyaluronic acid (HA) is a disputed marker for the diagnosis of FM. The aim of the study is to clarify the discrepant results reported so far. METHODS: Serum concentrations of HA were measured with a radiometric assay (Pharmacia & Upjohn, Sweden) in 41 patients with FM (38 females), 48 with arthritis (35 females) and 31 control subjects (28 females). Correlations of HA levels with clinical parameters (duration of disease, age, gender, medication) and scores of disease severity (e.g. depression and pain) were calculated. If appropriate, partial correlations and analysis of covariance adjusted for confounding variables (e.g. age) were used. RESULTS: HA levels were confirmed to be age-related in the whole study group (r(s) = 0.54; P < 0.001) and each subgroup. Association between HA levels and gender, drug therapy, clinical or psychometric data could not be demonstrated in patients suffering from FM. Analyzing all study participants, HA levels were correlated with the pain disability index (PDI) (r(tau) = 0.27; P < 0.02) and, in arthritis patients only, with duration of disease (r(tau) = 0.82; P < 0.001). Moreover, analysis of covariance revealed that patients with FM had normal HA values as compared with control subjects and only patients with arthritis had significantly higher levels than both other groups. CONCLUSIONS: The present study with a quite large cohort including patients with arthritis and FM demonstrates that serum levels of HA in FM are neither elevated nor associated with any relevant clinical data of this disease and, therefore, have no diagnostic or prognostic value in Germans. 295 PMID- 15885924 AU - Wheatland R TI - Chronic ACTH autoantibodies are a sign. pathological factor in the disruption of the hypothalamic-pituitary-adrenal axis in CFS, anorexia nervosa & major depression. SO - Med Hypotheses. 2005;65(2):287-95. IN - The Endocrine Research Project, 574 Sims Road, Santa Cruz, CA 95060, USA. rwheatla@query.com AB - Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is a commonly recognized feature of many pathological conditions. Abnormal adrenal responses to experimental manipulation have been well documented in patients suffering from chronic fatigue syndrome, anorexia nervosa and major depression. Yet no defect of any single organ, gland or brain region has been identified as a cause of these abnormalities. The disruption of the HPA axis that occurs in these conditions can be understood if an interfering factor is present in these patients. Evidence indicates that this interfering factor is adrenocorticotropin hormone (ACTH) autoantibodies. Chronic high levels of ACTH autoantibodies will significantly disrupt the HPA axis and force the body to compensate for an impaired cortisol response. The resulting effect of chronic ACTH autoantibody interference is the manifestation of adrenocortical insufficient symptoms and psychological disturbances. Some symptoms of chronic fatigue syndrome, anorexia nervosa and major depression, such as anxiety, are the adverse effects of mechanisms compensating for less effective ACTH due to autoantibodies. Furthermore, these patients engage in extraordinary behaviors, such as self-injury, to increase their cortisol levels. When this compensation is inadequate, symptoms of adrenocortical insufficiency appear. Corticosteroid supplements have been demonstrated to be an effective treatment for chronic fatigue syndrome, anorexia nervosa and major depression. It allows the patients to have the corticosteroids they require for daily functioning and daily stressors. This therapy will relieve the patients of their symptoms of adrenocortical insufficiency and permit their cortisol-stimulating mechanisms to operate at levels that will not cause pathological problems. 296 PMID- 15790422 AU - Whistler T, Jones JF, Unger ER, Vernon SD TI - Exercise responsive genes measured in peripheral blood of women w CFS & matched control subjects. SO - BMC Physiol. 2005 Mar 24;5(1):5. IN - Viral Exanthems & Herpesvirus Branch, Centers for Disease Control & Prevention, Atlanta, GA 30333, USA. taw6@cdc.gov AB - BACKGROUND: Chronic fatigue syndrome (CFS) is defined by debilitating fatigue that is exacerbated by physical or mental exertion. To search for markers of CFS-associated post-exertional fatigue, we measured peripheral blood gene expression profiles of women with CFS and matched controls before and after exercise challenge. RESULTS: Women with CFS and healthy, age-matched, sedentary controls were exercised on a stationary bicycle at 70% of their predicted maximum workload. Blood was obtained before and after the challenge, total RNA was extracted from mononuclear cells, and signal intensity of the labeled cDNA hybridized to a 3800-gene oligonucleotide microarray was measured. We identified differences in gene expression among and between subject groups before and after exercise challenge and evaluated differences in terms of Gene Ontology categories. Exercise-responsive genes differed between CFS patients and controls. These were in genes classified in chromatin and nucleosome assembly, cytoplasmic vesicles, membrane transport, and G protein-coupled receptor ontologies. Differences in ion transport and ion channel activity were evident at baseline and were exaggerated after exercise, as evidenced by greater numbers of differentially expressed genes in these molecular functions. CONCLUSION: These results highlight the potential use of an exercise challenge combined with microarray gene expression analysis in identifying gene ontologies associated with CFS. 297 PMID- 16331775 AU - Wolfe F, Katz RS, Michaud K TI - Jaw pain: its prevalence & meaning in pts w RA, osteoarthritis, & FM. SO - J Rheumatol. 2005 Dec;32(12):2421-8. IN - National Data Bank for Rheumatic Diseases, U o Kansas School o Med, Wichita, Kansas 67214, USA. fwolfe@arthritis-research.org AB - OBJECTIVE. Jaw pain may occur in rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). We investigated the prevalence and correlates of jaw pain, and whether jaw pain is increased in RA, where intrinsic articular disease can be noted radiographically, or is a manifestation of a generalized pain problem. METHODS: We analyzed data from 22,720 patients participating in a longitudinal outcome study of rheumatic diseases, including 17,683 with RA, 4,011 with OA, and 1,026 with FM. Jaw pain was considered to be present if a patient indicated it in either the left or right jaw. In addition to standard rheumatic disease measures, we also obtained self-report assessments that included a count of painful nonarticular regions (the regional pain score, RPS), a joint count, and a count of symptoms. RESULTS: The age and sex adjusted rate of jaw pain was 18.7% in RA, 18.6% in OA, and 35.4% in FM. Jaw pain was best predicted by joint count, RPS, and a count of somatic symptoms in univariate analyses. In multivariate analyses jaw pain was predicted by joint count, RPS, symptom count, and fatigue. The ROC area under the curve for this model was 0.79, and 82.8% of patients were correctly classified. There was little difference in predictor variables for RA and OA patients. Covariate adjusted analyses controlling for age, sex, symptom count, fatigue, RPS, and joint count predicted jaw pain in 14.7% (95% CI 14.1 to 15.3) of RA and 11.6% (95% CI 10.6 to 12.7) of OA patients. This difference, 3.1%, may represent the increment in jaw pain attributable to RA. CONCLUSION: Jaw pain is present in about 19% of patients with RA and OA, and is primarily a marker for a general pain increase and symptom sensitivity problem. Patients who have jaw pain have worse outcomes manifested by decreased functional ability, lower household income, and decreased quality of life. Variables not usually formally measured in clinical practice best identify this problem: self-reported joint count, symptom count, count of painful regions (RPS), and a visual analog scale for fatigue. 298 PMID- 16219901 AU - Wood PB, Kablinger AS, Caldito GS TI - Open trial of pindolol in the Rx of FM. SO - Ann Pharmacother. 2005 Nov;39(11):1812-6. Epub 2005 Oct 11. IN - D o Family Med, Louisiana St U Health Science Center-Shreveport, LA 71103-3932, USA. pwood@lsuhsc.edu AB - 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. 299 PMID- 16173251 AU - Yilmaz M, Baysal E, Gunduz B, Aksu A, Ensari N, Meray J, Bayazit YA TI - Assessment of the ear & otoacoustic emission findings in FM syndrome. SO - Clin Exp Rheumatol. 2005 Sep-Oct;23(5):701-3. IN - D o Otolaryngology, Faculty o Med, Gazi U, Besevler, Ankara, Turkey. AB - OBJECTIVE: We aimed to assess otoacoustic emission (OAE) findings in fibromyalgia (FM) syndrome. METHODS: Thirty-two ears of 16 female patients with FM syndrome and 30 ears of 15 healthy female controls were also included in the study. Pure tone audiometry, speech discrimination testing, tympanometry and otoacoustic emission testing (both transiently evoked and distortion product) were performed. RESULTS: There was no significant difference between the pure tone hearing results of the patients and controls (p > 0.05). There was no significant difference between the distortion-product-otoacoustic emission results of the patients and controls. Audiologic findings of the patients with and without otologic symptoms were not significantly different than controls (p > 0.05). CONCLUSION: Although FM patients generally have subjective symptoms related to ear, clinical or laboratory assessments usually fail to find out any objective finding related to these subjective symptoms. The otologic functions seem spared in FM syndrome. 300 PMID- 16046505 AU - Yuceturk TE, Yucel AE, Yuceturk H, Kart-Koseoglu H, Unuvar R, Ozdemir FN, Akcaly Z TI - FM: its prevalence in haemodialysis pts & its relationships w clinical & laboratory parameters. SO - Nephrol Dial Transplant. 2005 Nov;20(11):2485-8. Epub 2005 Jul 26. IN - D o Rheumatology, Baskent U, Ankara, Turkey. tolgayuceturk@hotmail.com AB - OBJECTIVE: Our aim was to determine the prevalence of fibromyalgia syndrome (FS) in chronic haemodialysis (HD) patients and to identify possible links between FS and various clinical and laboratory parameters. METHODS: We studied 122 chronic HD patients and 89 healthy age- and sex-matched controls, classified according to the American College of Rheumatology (ACR) classification criteria for FS. Age, sex, causes of renal failure, length of time on dialysis and marital status were recorded, and questions were asked about symptoms related to FS. All subjects completed the Fibromyalgia Impact Questionnaire (FIQ). Laboratory data obtained in the preceding 6 months were re-evaluated. RESULTS: Nine (7.4%) of the 122 HD patients and four of the 89 control subjects (4.5%) fulfilled the ACR criteria for definite FS (P = 0.56). The mean ages of the subjects who had definite FS and those who did not were similar. Most of the subjects diagnosed with definite FS were female (11 out of 13). The HD patients had higher FIQ scores than the controls, regardless of FS diagnosis. Among the HD patients, those with definite FS had a significantly higher mean FIQ score than all the other HD patients combined. In the all HD patients group, fatigue, irritable bowel syndrome and personal histories of depression were correlated with FS, whereas duration of HD, aetiology of renal failure, laboratory parameters and hepatitis B or C virus infection were not. CONCLUSION: The prevalence of FS appeared to be similar in chronic HD patients and the general population; also, FS-related symptoms appear to be similar in HD patients and the general population who have FS. No laboratory parameter was correlated with frequency of FS. 301 PMID- 16234874 AU - Zareba G TI - Pregabalin: a new agent for the Rx of neuropathic pain. [FM] SO - Drugs Today (Barc). 2005 Aug;41(8):509-16. IN - D o Environmental Medicine, U o Rochester, School o Med & Dentistry, Rochester, New York 14642, USA. grazyna_zareba@urmc.rochester.edu AB - Pregabalin (Lyrica, Pfizer) is a GABA analog with similar structure and actions to gabapentin. It has antiepileptic, analgesic and anxiolytic activity. Pregabalin is indicated for the management of neuropathic pain associated with diabetic neuropathy and post-herpetic neuralgia. Peak plasma levels occur approximately 1 hour after oral doses and oral bioavailability is about 90%. Based on AUC data, food does not significantly affect the extent of absorption. Pregabalin is not protein-bound and exhibits a plasma half-life of about 6 hours, which is not dose-dependent. Hepatic metabolism is negligible, and most of the oral dose (95%) appears unchanged in the urine. Pregabalin is a safe and well-tolerated new treatment for neuropathic pain. Furthermore, pregabalin has proven efficacy in adjunctive therapy of refractory partial seizures and in the treatment of acute pain, generalized anxiety disorder and social phobia. 302 PMID- 15796628 AU - Zautra AJ, Johnson LM, Davis MC TI - Positive affect as a source of resilience for women in chr pain. [FM] SO - J Consult Clin Psychol. 2005 Apr;73(2):212-20. IN - D o Psychology, Arizona St U, Tempe, AZ 85287-1104, USA. alex.zautra@asu.edu AB - A sample of 124 women with osteoarthritis or fibromyalgia, or both, completed initial assessments for demographic data, health status, and personality traits and 10-12 weekly interviews regarding pain, stress, negative affect, and positive affect. Multilevel modeling analyses indicated that weekly elevations of pain and stress predicted increases in negative affect. Both higher weekly positive affect as well as greater positive affect on average resulted in lower negative affect both directly and in interaction with pain and stress. Finally, increases in weekly negative affect and higher average negative affect related to greater levels of pain in subsequent weeks. In contrast, higher levels of overall positive affect predicted lower levels of pain in subsequent weeks. 303 PMID- 16157057 AU - Zheng L, Faber K TI - Review of the Chinese medical approach to the management of FM. SO - Curr Pain Headache Rep. 2005 Oct;9(5):307-12. IN - The Oregon Coll o Oriental Med, Portland, OR 97216-2859, USA. lzheng@ocom.edu AB - Traditional Chinese medicine (TCM) has a long history of efficacy in treating chronic illness. TCM views fibromyalgia and related conditions as disorders in the movement of energy (Qi) and body fluids (including blood) in the body and gets excellent treatment results using acupuncture, herbal medicine, massage, diet, and exercise to restore the proper flow of Qi and fluids. This article briefly introduces the TCM model of human physiology and TCM diagnostics and describes the TCM pathophysiology and treatment models for fibromyalgia. 304 PMID- 15695301 AU - Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E, Zakraoui L, Rasker JJ TI - Spa Rx for primary FM syndrome: a combination of thalassotherapy, exercise & patient education improves Sx & quality of life. SO - Rheumatology (Oxford). 2005 Apr;44(4):539-46. Epub 2005 Feb 3. IN - D o Rheumatology, Medisch Spectrum Twente Hosp, Enschede, The Netherlands. t.r.zijlstra@worldonline.nl AB - OBJECTIVES: To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia. METHODS: Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2(1/2) weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment) or treatment as usual (control treatment). Primary outcome measure was health-related quality of life, measured with the RAND-36 questionnaire. Secondary measures included the Fibromyalgia Impact Questionnaire, the McGill Pain Questionnaire, the Beck Depression Inventory, tender point score and a 6-min treadmill walk test. RESULTS: Fifty-eight participants receiving the active treatment reported significant improvement on RAND-36 physical and mental component summary scales. For physical health, differences from the 76 controls were statistically significant after 3 months, but not after 6 and 12 months. A similar pattern of temporary improvement was seen in the self-reported secondary measures. Tender point scores and treadmill walk tests improved more after active treatment, but did not reach significant between-group differences, except for walk tests after 12 months. CONCLUSIONS: A combination of thalassotherapy, exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life. 305 PMID- 15557875 TI - L-carnitine. [CFS] SO - Med Lett Drugs Ther. 2004 Nov 22;46(1196):95-6. AB - Although advertised on the Internet for weight loss, prevention of aging and enhancement of athletic and sexual performance, levocarnitine has only one well-established indication, and that is for treatment of carnitine deficiency. In clinical trials, the drug also seems to have had modest effects in some other conditions, particularly intermittent claudication and recovery after myocardial infarction, but more studies are needed. 306 PMID- 14983979 TI - Pregabalin (Pfizer). SO - Curr Opin Investig Drugs 2004 Jan;5(1):82-9. IN - Axovan Ltd., Innovation Ctr, Gewerbestrasse 16, CH-4123 All+ AB - +IN: schwil, Switzerland. richard.huckle@axovan.com Pregabalin is a gamma-aminobutyric acid analog that is under development by Pfizer for the potential treatment of central nervous system disorders, including epilepsy, neuropathic pain, fibromyalgia and generalized anxiety disorder. By April 2003, Pfizer had filed for approval of pregabalin in Europe for neuropathic pain and as an adjunctive therapy for epilepsy, and in October 2003 an NDA was filed for these indications and generalized anxiety disorder. At this time, phase III trials in fibromyalgia were ongoing. 307 PMID- 15121037 AU - Aceves-Avila FJ, Ferrari R, Ramos-Remus C TI - New insights into culture driven disorders. [FM/CFS] SO - Best Pract Res Clin Rheumatol 2004 Apr;18(2):155-71. IN - Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Unidad de Investigacion en Enfermedades Cronico-Degenerativas SC, Guadalajara, Jalisco, Mexico. fjaceves@megared.net.mx AB - Rheumatologists frequently encounter patients whose illnesses lack face-value; that is, they lack the typical objective features of pathology that rheumatologists traditionally rely on for diagnosis and developing effective treatment approaches: namely fibromyalgia, chronic fatigue syndrome, Gulf War syndrome, chronic whiplash, chronic low back pain, etc. In this article, we examine this group of illnesses as culture-driven disorders to emphasize the central importance of various societal constraints in the ultimate presentation of patients with these illnesses. We will examine them by first understanding the purpose they serve, the underlying factors that compel societal institutions to sanctify these disorders as diseases, and how research is beginning to examine the behaviour that captures and packages these symptoms to produce their clinical presentation. With this research understanding, rheumatologists may be able to offer patients more useful action plans, but likely changes in societal approaches to the expressions of distress and changes in disability and compensation systems will also be required. 308 PMID- 15301122 AU - Adiguzel O, Kaptanoglu E, Turgut B, Nacitarhan V TI - The possible effect of clinical recovery on regional cerebral blood flow deficits in FM: a prospective study w semiquantitative SPECT. SO - South Med J 2004 Jul;97(7):651-5. IN - D o Rheumatology, Cumhuriyet U, Sivas, Turkey. AB - OBJECTIVES: Regional deficits in cerebral blood flow have been reported in a few studies of fibromyalgia; however, there is no information on the effects of treatment and clinical recovery on these abnormalities. We evaluated the effects of amitriptyline treatment and consequent clinical recovery on cerebral blood flow changes in fibromyalgia. METHODS: We assessed cerebral blood flow with a semiquantitative functional brain mapping technique of single-photon emission computed tomography in 14 patients with primary fibromyalgia before and after 3 months of amitriptyline treatment. Patients were followed by visual analog scale, tender point count, and Beck Depression Inventory for clinical improvement. RESULTS: There was statistically significant improvement in visual analog scale and tender point count after treatment. Beck Depression Inventory did not change significantly. Statistically significant blood flow increase in bilateral hemithalami and basal ganglia and decrease in bilateral temporal, left temporo-occipital, and right occipital lobes were observed on single-photon emission computed tomography after treatment. CONCLUSIONS: We speculate that these findings could indicate that deficits in cerebral blood flow in fibromyalgia improve parallel to clinical recovery. 309 PMID- 15243847 AU - Adler RH TI - CFS (cfs). SO - Swiss Med Wkly 2004 May 15;134(19-20):268-76. IN - U o Berne MS, Kehrsatz, Switzerland. rolf.adler@tele2.ch AB - The Chronic Fatigue Syndrome (CFS) is described based on the revision of Fukuda et al. The question "whether CFS can be discussed as a homogenous disorder?" has been reviewed and the answer is "no". Other overlapping syndromes are mentioned. Disorders with fatigue as a symptom are depression, somatisation, irritable bowel syndrome, effort-syndrome, hyperventilation, conservation-withdrawal. Among the pathogenetic factors of CFS immune systems disorders, neuroendocrine abnormalities, autonomic activity, neuroimaging, neuropsychological abnormalities, exercise capacity and muscle function and psychological processes (attribution, perception, symptom avoidance and neutralisation of conflicts) are discussed. Since CFS cannot be comprehended without knowledge of the ontogenetic development of the affect "fatigue", it is extensively described. Based on this knowledge, fatigue as an affect and the CFS are embedded in a context, which has as its basis the fight-flight reaction and the conservation-withdrawal reaction. Weighing the evidence, it is concluded that CFS in its varieties can best be understood as a manifestation of the activation of the two biological emergency reactions: fight-flight and conservation-withdrawal. The physician should interview and examine each individual patient according to the Harvey Cushing dictum: The physician should not only study the diseased organ, but the man with his diseased organ, and not only these. He should comprehend the man with his diseased organ in his environment. This leads to study of the biological, psychological and social factors contributing to each patient's illness. Work-up and therapy have to be based on this integrated approach. The latter encompasses conflict centred psychotherapy, stepwise increasing physical activation and antidepressive drugs. 310 PMID- 15052861 AU - Afram R TI - New diagnoses & the ADA: a case study of FM & multiple chemical sensitivity. SO - Yale J Health Policy Law Ethics 2004 Winter;4(1):85-121. IN - Yale Law School, USA. 311 PMID- 12879267 AU - Akkus S, Senol A, Ayvacioglu NB, Tunc E, Eren I, Isler M TI - Is female predominance in irritable bowel syndrome related to FM? SO - Rheumatol Int 2004 Mar;24(2):106-9. Epub 2003 Jul 16. IN - D o Physical Med & Rehabilitation, Suleyman Demirel U MS, Isparta, Turkey. selamiakkus@hotmail.com AB - Irritable bowel syndrome (IBS) and fibromyalgia (FM) are common functional diseases in adult women. The aim of this study was to investigate whether female predominance in IBS is related to FM. Fifty patients with IBS and 50 healthy controls were enrolled. All participants answered questionnaires including personal and medical history. In addition, psychiatric interviews were conducted. Patients were divided into two groups according to the coexistence of FM ( IBS+FM or IBS only). The data obtained from patients with or without FM and the control group were compared. There was a significant female predominance in patients with IBS+FM (83.4%, F:M=5:1), but IBS-only patients consisted mainly of males (59.4%, F:M=2:3) ( P<0.01). Comparison of IBS+FM and IBS-only patients showed no significant difference in depression and anxiety status. However, both anxiety and depression scores were found to be higher in female IBS patients than their male counterparts ( P<0.01 and P<0.05, respectively). Our findings suggest that the female predominance in IBS patients may result from coexisting FM. 312 PMID- 15884687 AU - Al-Izzi MK, Jabber AS TI - FM in Iraqi pts w Behcet's disease. SO - J Med Liban. 2004 Apr-Jun;52(2):86-90. IN - D o Med, Coll o Medicine, U o Baghdad, Iraq. musizi@hotmail.com AB - OBJECTIVE: To determine the prevalence of fibromyalgia syndrome (FMS) in Iraqi patients with Behcet's disease. METHODS: The two-stage classification process proposed by the 1990 American College of Rheumatology (ACR) multicenter criteria committee on fibromyalgia was applied after completion of a questionnaire about Behcet's disease clinical features. Stage I: A plain questionnaire to a sample of 90 (41 female and 49 male) patients with Behcet's disease, mean age 37.5 years. Stage II: All patients with wide spread pain were examined by a physician blinded to the diagnosis of Behcet's disease for 18 tender points and 4 control non-tender points. A sample of 40 (16 female and 24 male) healthy individuals were examined as controls. RESULTS: There were 53 (58.9%) patients with BD with widespread pain compared to 6 (15%) individuals in the control group, whereas only 8 (8.9%) (7 female and 1 male) patients with BD fulfilled the 1990 ACR criteria for classification of FMS, compared to one individual in the controls (2.5%). There were significantly more females with BD having FMS compared to male patients. Also the FMS associated features were more prevalent in BD group compared to control group. CONCLUSIONS: FMS and widespread pain are more prevalent in patients with BD than in the general population while it is less prevalent when compared with other connective tissue diseases. There is a trend for an increased frequency of FMS in females with BD. BD patients with FMS may benefit from psychological evaluation as a part of their treatment. 313 PMID- 15188335 AU - Alarcon GS, McGwin G Jr, Uribe A, Friedman AW, Roseman JM, Fessler BJ, Bastian HM, Baethge BA, Vila LM, Reveille JD TI - SLE in a multiethnic lupus cohort (LUMINA). XVII. Predictors of self-reported health-related quality of life early in the disease course. [FM] SO - Arthritis Rheum 2004 Jun 15;51(3):465-74. IN - The U o Alabama at Birmingham. AB - OBJECTIVE: To determine the baseline factors predictive of self-reported health-related quality of life (HRQOL) early in the course of systemic lupus erythematosus patients (SLE) from a multiethnic LUMINA (Lupus in Minorities: Nature versus nurture) cohort. METHODS: LUMINA patients with > or =2 visits were studied. Self-reported HRQOL was examined with the 8 subscales and 2 summary measures (the Physical Component Summary [PCS], and the Mental Component Summary [MCS]) of the Short Form 36 (SF-36). Bivariable and multivariable analyses were done with the PCS, MCS and 8 subscales as the dependent variables. The analyses were performed including and excluding the corresponding SF-36 measure from the independent variables. Age, sex, and ethnicity were included in all models. Time was modeled in all regressions. RESULTS: A total of 1,351 visits (346 patients [80 Hispanics-Texas, 34 Hispanics-Puerto Rico, 126 African Americans, and 106 Caucasians]) were included in these analyses. Mean +/- SD PCS and MCS scores were 36.7 +/- 12.0 and 46.6 +/- 11.5, respectively. The scores for the eight subscales of the SF-36 were also lower than those for the general population. Baseline SF-36 measures were highly predictive of subsequent HRQOL. In the same set of regressions, older age was found to consistently predict poor self-reported HRQOL whereas fibromyalgia, helplessness, fatigue, and abnormal illness-related behaviors were also predictive, but less consistently. Estimated adjusted variances in these regressions ranged from 23% (Role-Emotional [RE]) to 43% (Physical Functioning [PF]). CONCLUSION: In patients with SLE, poor baseline HRQOL was highly predictive of subsequent poor HRQOL. Other predictive variables of poor functioning were primarily psychological/behavioral and socioeconomic-demographic. 314 PMID- 15581648 AU - Alonso C, Loevinger BL, Muller D, Coe CL TI - Menstrual cycle influences on pain & emotion in women w FM. SO - J Psychosom Res. 2004 Nov;57(5):451-8. IN - D o Psychology, U o Wisconsin, 1202 West Johnson Street, Madison, WI 53706-1696, USA. calonso@wisc.edu AB - OBJECTIVE: This study examined the influence of the menstrual cycle on pain and emotion in women with fibromyalgia (FM) as compared with women with rheumatoid arthritis (RA) and to healthy controls. METHODS: One hundred and twenty-five premenopausal women (21-45 years old) participated in this study (57 with FM, 20 with RA, and 48 controls). Pain and emotion assessments were conducted during the follicular and the luteal phases of the menstrual cycle. RESULTS: Women with FM experienced more pain, menstrual symptoms, and negative affect than did women with RA and the controls. All women reported less positive affect during the luteal phase, although this pattern was more pronounced in women with FM and RA than in controls. CONCLUSION: Although FM pain did not vary across the menstrual cycle, these results point to the importance of considering the lower level and cyclical nature of positive affect when studying women with chronic pain. 315 PMID- 14508601 AU - Altan L, Bingol U, Aykac M, Koc Z, Yurtkuran M TI - Investigation of the effects of pool-based exercise on FM syndrome. SO - Rheumatol Int 2004 Sep;24(5):272-7. Epub 2003 Sep 24. IN - Rheumatic Disease & Hydrotherapy Sect, Uludag U Med Faculty, Ataturk Rehabilitation Ctr, Bursa, Turkey. lalealtan@uludag.edu.tr AB - OBJECTIVE: The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome (FMS) patients. METHODS: Fifty female patients diagnosed with FMS according to the American College of Rheumatism (ACR) criteria were randomly assigned to two groups: group 1 (n=25) with pool-based exercise, and in group 2 (n=25) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks. In both groups, pre- (week 0) and post-treatment (weeks 12 and 24) evaluation was performed by one of the authors, who was blind to the patient group. Evaluation parameters included pain, morning stiffness, sleep, tender points, global evaluation by the patient and the physician, fibromyalgia impact questionnaire, chair test, and Beck depression inventory. Statistical analysis was done on data collected from three evaluation stages. RESULTS: Twenty-four exercise and 22 balneotherapy patients completed the study. Pretreatment (week 0) measurements did not show any difference between the groups. In group 1, statistically significant improvement was observed in all parameters ( P<0.01) except for the chair test at both weeks 12 and 24. In group 2, week 12 measurements showed significant improvement in all parameters ( P<0.01) except for the chair test and Beck depression inventory. Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale (VAS), 5-point scale, number of tender points, algometric and myalgic scores, and patient and physician global evaluation (P<0.01 and P<0.05, respectively), while improvements were nonsignificant in morning stiffness, sleep, fibromyalgia impact questionnaire (FIQ), chair test, and Beck depression inventory parameters in this group. Comparison of the two groups based on the post-treatment (weeks 12 and 24) percent changes and difference scores relative to pretreatment (week 0) values failed to show a significant difference between the groups for any parameter except Beck depression inventory (P<0.01). CONCLUSION: The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms, but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise. While we believe that exercise is a gold standard in FMS treatment, we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS, and further research regarding the type and duration of the exercise programs is necessary. 316 PMID- 15016582 AU - Andersen MM, Permin H, Albrecht F TI - Illness & disability in Danish CFS pts at Dx & 5-year follow-up. SO - J Psychosom Res 2004 Feb;56(2):217-29. IN - D o Infectious Diseases M5132, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. AB - OBJECTIVE: Evaluation of the life impact of Chronic Fatigue Syndrome (CFS) over 5 years. METHODS: Thirty-three adult patients meeting 1988 and 1994 CDC case criteria answered identical questionnaires at diagnosis and 5 years later, when a retrospective questionnaire was also completed. RESULTS: Work disability was very high and increased further, social isolation remained high, emotional adjustment improved. There were increased problems with reading and with allergies. Two measures of improvement were used: The relation between these measures was weak. Length of illness, extent of disability and emotional adjustment were poorly related to measures of improvement. Average illness scores were unchanged, but most individuals improved in some ways while worsening or remaining the same in others. Only one participant (3%) neared recovery, one other was substantially better but still severely disabled. CONCLUSION: CFS patients exhibit severe, long-term functional impairment. Substantial improvement is uncommon, less than 6%. Allergies and aspects of cognition may worsen, emotional adjustment often improves. 317 PMID- 14964579 AU - Arashima Y, Kato K, Komiya T, Kumasaka K, Matsukawa Y, Murakami M, Takahashi K,+ TI - Improvement of chr nonspecific Sx by long-term minocycline Rx in Japanese pts w Coxiella burnetii infection considered to have post-Q fever fatigue s+ SO - Intern Med 2004 Jan;43(1):49-54. IN - D o Laboratory Med, Nihon U School o Medicine, Tokyo, AB - +TI: yndrome. +AU: Ikeda T, Arakawa Y OBJECTIVE: To address the presence of post-Q fever fatigue syndrome (post-QFS) in Japan, and to evaluate the efficacy of minocycline for this condition. PATIENTS AND METHODS: In 20 Coxiella burnetii (C. burnetii) seropositive patients with persistent nonspecific symptoms including general fatigue, low-grade fever, myalgia and arthralgia, changes in subjective symptoms, C. burnetii antibody titers and C. burnetii DNA were evaluated after antibiotic treatment. RESULTS: After treatment mainly with minocycline (100 mg/day for 3 months), the clinical picture improved in all 20 patients as evidenced by decreases in body temperature (13/17), general fatigue (20/20) and headache (9/12). The mean performance status (PS) score improved from 5.0 to 1.8 (p<0.01). All 7 who had been positive for C. burnetii DNA, became negative together with an improvement in subjective symptoms. Indirect immunofluorescence tests demonstrated 6 of the 20 patients to be positive for C. burnetii IgM antibody to phase II antigen (1:32), and 18 to be positive for IgG antibody (1:128, 1:256). Antibody titers of both IgM (6/6, 1:16) and IgG (18/18, 1:16) decreased markedly after treatment. CONCLUSION: These results of an open label study in Japan suggest that minocycline administration is useful for improving chronic nonspecific symptoms considered to be post-Q fever fatigue syndrome caused by C. burnetii infection. 318 PMID- 15457467 AU - Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, Goldstein DJ TI - A double-blind, multicenter trial comparing duloxetine w placebo in the Rx of FM pts w or without major depressive disorder. SO - Arthritis Rheum 2004 Sep;50(9):2974-84. IN - U o Cincinnati Coll o Med, Cincinnati, Ohio 45219, USA. Lesley.Arnold@uc.edu AB - OBJECTIVE: To assess the efficacy and safety of duloxetine, a serotonin and norepinephrine reuptake inhibitor, in subjects with primary fibromyalgia, with or without current major depressive disorder. METHODS: This study was a randomized, double-blind, placebo-controlled trial conducted in 18 outpatient research centers in the US. A total of 207 subjects meeting the American College of Rheumatology criteria for primary fibromyalgia were enrolled (89% female, 87% white, mean age 49 years, 38% with current major depressive disorder). After single-blind placebo treatment for 1 week, subjects were randomly assigned to receive duloxetine 60 mg twice a day (n = 104) or placebo (n = 103) for 12 weeks. Co-primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score (score range 0-80, with 0 indicating no impact) and FIQ pain score (score range 0-10). Secondary outcome measures included mean tender point pain threshold, number of tender points, FIQ fatigue, tiredness on awakening, and stiffness scores, Clinical Global Impression of Severity (CGI-Severity) scale, Patient Global Impression of Improvement (PGI-Improvement) scale, Brief Pain Inventory (short form), Medical Outcomes Study Short Form 36, Quality of Life in Depression Scale, and Sheehan Disability Scale. RESULTS: Compared with placebo-treated subjects, duloxetine-treated subjects improved significantly more (P = 0.027) on the FIQ total score, with a treatment difference of -5.53 (95% confidence interval -10.43, -0.63), but not significantly more on the FIQ pain score (P = 0.130). Compared with placebo-treated subjects, duloxetine-treated subjects had significantly greater reductions in Brief Pain Inventory average pain severity score (P = 0.008), Brief Pain Inventory average interference from pain score (P = 0.004), number of tender points (P = 0.002), and FIQ stiffness score (P = 0.048), and had significantly greater improvement in mean tender point pain threshold (P = 0.002), CGI-Severity (P = 0.048), PGI-Improvement (P = 0.033), and several quality-of-life measures. Duloxetine treatment improved fibromyalgia symptoms and pain severity regardless of baseline status of major depressive disorder. Compared with placebo-treated female subjects (n = 92), duloxetine-treated female subjects (n = 92) demonstrated significantly greater improvement on most efficacy measures, while duloxetine-treated male subjects (n = 12) failed to improve significantly on any efficacy measure. The treatment effect on significant pain reduction in female subjects was independent of the effect on mood or anxiety. Duloxetine was safely administered and well tolerated. CONCLUSION: In this randomized, controlled, 12-week trial (with a 1-week placebo lead-in phase), duloxetine was an effective and safe treatment for many of the symptoms associated with fibromyalgia in subjects with or without major depressive disorder, particularly for women, who had significant improvement across most outcome measures. 319 PMID- 15022338 AU - Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, Starck LO, Keck PE Jr TI - Family study of FM. SO - Arthritis Rheum 2004 Mar;50(3):944-52. IN - U o Cincinnati Coll o Med, Cincinnati, Ohio 45267-0559, USA. Lesley.Arnold@uc.edu AB - OBJECTIVE: To assess for familial aggregation of fibromyalgia (FM) and measures of tenderness and pain, and for familial coaggregation of FM and major mood disorder (major depressive disorder or bipolar disorder). METHODS: Probands meeting the American College of Rheumatology criteria for FM and control probands with rheumatoid arthritis (RA) and no lifetime diagnosis of FM were recruited from consecutive referrals to 2 community-based rheumatology practices. Probands were ages 40-55 years and had at least 1 first-degree relative age 18 years or older who was available for interview and examination. All probands and interviewed relatives underwent a dolorimeter tender point examination and a structured clinical interview. Interviewed relatives were asked about first-degree relatives who were not available for interview, using a structured family interview. Logistic and linear regression models, adjusting for the correlation of observation within families, were applied to study the aggregation and coaggregation effects. RESULTS: Information was collected for 533 relatives of 78 probands with FM and 272 relatives of 40 probands with RA. FM aggregated strongly in families: the odds ratio (OR) measuring the odds of FM in a relative of a proband with FM versus the odds of FM in a relative of a proband with RA was 8.5 (95% confidence interval [95% CI] 2.8-26, P = 0.0002). The number of tender points was significantly higher, and the total myalgic score was significantly lower in the relatives of probands with FM compared with the relatives of probands with RA. FM coaggregated significantly with major mood disorder: the OR measuring the odds of major mood disorder in a relative of a proband with FM versus the odds of major mood disorder in a relative of a proband with RA was 1.8 (95% CI 1.1-2.9, P = 0.013). CONCLUSION: FM and reduced pressure pain thresholds aggregate in families, and FM coaggregates with major mood disorder in families. These findings have important clinical and theoretical implications, including the possibility that genetic factors are involved in the etiology of FM and in pain sensitivity. In addition, mood disorders and FM may share some of these inherited factors. 320 PMID- 14768459 AU - Asbring P, Narvanen AL TI - Patient power & control: a study of women w uncertain illness trajectories. SO - Qual Health Res 2004 Feb;14(2):226-40. IN - Stockholm Ctr o Public Health, D o Public Health Sciences, + AB - +IN: Karolinska Institutet, Stockholm, Sweden. The authors interviewed 12 women diagnosed with chronic fatigue syndrome and 13 with fibromyalgia with the aim of determining the strategies they perceive themselves as using to gain control over their situation during the health care process. The results highlight various strategies that the women report applying to find a way of managing the illness and to influence caregivers. They describe, for example, how they try to gain control over their situation by acquiring knowledge about the illness. The women also describe various power strategies they use in their interaction with the caregivers to take command of their situation, namely exiting, noncompliance, confrontation, persuasion/insistence, making demands, and demonstrative distancing. 321 PMID- 15458750 AU - Audette JF, Ryan AH TI - The role of acupuncture in pain management. [FM] SO - Phys Med Rehabil Clin N Am 2004 Nov;15(4):749-72, v. IN - D o Physical Med & Rehabilitation, Harvard MS, Boston, MA, USA. jaudette@partners.org AB - This article reviews the theories and applications of acupuncture to musculoskeletal pain management. First, Chinese theories of acupuncture are discussed briefly. Next, current understanding of nociception and central pain modulation is discussed in detail,followed by discussion of the physiologic effect of acupuncture analgesia.Other theories of acupuncture analgesia are presented based on neuromodulation of the central nervous system. Finally,the efficacy of acupuncture for many musculoskeletal pain syndromes,including spine-related pain, soft tissue pain, neuropathic pain, arthritis of the knee, and upper extremity tendinitis, is reviewed.The article concludes with a discussion of methodologic issues related to conducting randomized, placebo-controlled trials of acupuncture and goals for future research in this area of pain management. 322 PMID- 15129895 AU - Bae SC, Lee JH TI - Cross-cultural adaptation & validation of the Korean FM impact questionnaire in women pts w FM for clinical research. SO - Qual Life Res 2004 May;13(4):857-61. IN - D o Internal Med, Div o Rheumatology, Hanyang U Coll o Medi+ AB - +IN: cine, The Hosp for Rheumatic Diseases, Seoul, Korea. scbae@hanyang.ac.kr Our aim was to translate and cross-culturally adapt the fibromyalgia impact questionnaire into Korean (KFIQ), and then evaluate its reliability and validity. The FIQ was translated into Korean by three translators and then independently translated back into English by three different translators. A total of 62 women patients with fibromyalgia (FM) were studied for the psychometric properties of the KFIQ. The mean age of the patients was 47.1 (25-73) years, and all were female. The mean KFIQ score was 48.3 (17-91), and the mean Korean health assessment questionnaire (KHAQ) score was 0.4 (0-1.7). The test-retest reliability of the KFIQ yielded an intraclass correlation coefficient of 0.85 (0.53-0.96). For the construct validity, the Spearman rank correlations of KFIQ with patient global assessments using visual analog scale (pain, 0.58; morning stiffness, 0.45; fatigue, 0.48; depression, 0.43; anxiety, 0.56; global well-being, 0.46; disease severity, 0.49; impact on life, 0.51), KHAQ (0.44), and tender points (0.60) were high and statistically significant. The KFIQ might be a reliable and valid instrument for measuring health status and physical functioning in Korean women patients with FM, but needs further study. 323 PMID- 15016580 AU - Ball N, Buchwald DS, Schmidt D, Goldberg J, Ashton S, Armitage R TI - Monozygotic twins discordant for CFS: objective measures of sleep. SO - J Psychosom Res 2004 Feb;56(2):207-12. IN - Virginia Mason Sleep Disorders Ctr, U o Washington, Seattle, WA, USA. AB - PURPOSE: Chronic fatigue syndrome (CFS) is characterized by profound fatigue accompanied by disturbances of sleep, cognition, mood, and other symptoms. Our objective was to describe sleep architecture in CFS-discordant twin pairs. METHODS: We conducted a co-twin control study of 22 pairs of monozygotic twins where one twin met criteria for CFS and the co-twin was healthy. Twins underwent two nights of polysomnography. RESULTS: The percentage of Stage 3 and REM sleep was greater among the CFS twins than their healthy co-twins (P< or = .05 for both), but no other differences in sleep architecture including sleep latency, REM latency, and total sleep time were observed. Compared to their co-twins, CFS twins had higher values for the apnea-hypopnea index and apnea-hypopnea arousal index (P< or =.05 for both). CONCLUSION: These results do not provide strong evidence for a major role for abnormalities in sleep architecture in CFS. Respiration appears impaired in CFS, but these clinical abnormalities cannot alone account for the prominence of sleep complaints in this illness. The co-twin control methodology highlights the importance of selecting well-matched control subjects. 324 PMID- 14715383 AU - Banic B, Petersen-Felix S, Andersen OK, Radanov BP, Villiger PM, Arendt-Nielsen L, Curatolo M TI - Evidence for spinal cord hypersensitivity in chr pain after whiplash injury & in FM. SO - Pain 2004 Jan;107(1-2):7-15. IN - Division o Pain Therapy, D o Anesthesiology, U Hosp o Bern, Inselspital, 3010 Bern, Switzerland. AB - Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage. 325 PMID- 15588296 AU - Baraniuk JN, Whalen G, Cunningham J, Clauw DJ TI - Cerebrospinal fluid levels of opioid peptides in FM & chr low back pain. SO - BMC Musculoskelet Disord. 2004 Dec 9;5(1):48. IN - Chronic Pain & Fatigue Research Ctr, Div o Rheumatology, Immunology & Allergy, Room B107, Lower Level Kober-Cogan Building, Georgetown U, 3800 Reservoir Road, N,W, Washington, DC 20007-2197, USA. baraniuj@georgetown.edu AB - BACKGROUND: The mechanism(s) of nociceptive dysfunction and potential roles of opioid neurotransmitters are unresolved in the chronic pain syndromes of fibromyalgia and chronic low back pain. METHODS: History and physical examinations, tender point examinations, and questionnaires were used to identify 14 fibromyalgia, 10 chronic low back pain and 6 normal control subjects. Lumbar punctures were performed. Met-enkephalin-Arg6-Phe7 (MEAP) and nociceptin immunoreactive materials were measured in the cerebrospinal fluid by radioimmunoassays. RESULTS: Fibromyalgia (117.6 pg/ml; 85.9 to 149.4; mean, 95% C.I.; p = 0.009) and low back pain (92.3 pg/ml; 56.9 to 127.7; p = 0.049) groups had significantly higher MEAP than the normal control group (35.7 pg/ml; 15.0 to 56.5). MEAP was inversely correlated to systemic pain thresholds. Nociceptin was not different between groups. Systemic Complaints questionnaire responses were significantly ranked as fibromyalgia > back pain > normal. SF-36 domains demonstrated severe disability for the low back pain group, intermediate results in fibromyalgia, and high function in the normal group. CONCLUSIONS: Fibromyalgia was distinguished by higher cerebrospinal fluid MEAP, systemic complaints, and manual tender points; intermediate SF-36 scores; and lower pain thresholds compared to the low back pain and normal groups. MEAP and systemic pain thresholds were inversely correlated in low back pain subjects. Central nervous system opioid dysfunction may contribute to pain in fibromyalgia. 326 PMID- 15527474 AU - Barlow JH, Ellard DR TI - Psycho-educational interventions for children w chr disease, parents & siblings: an overview of the research evidence base. SO - Child Care Health Dev. 2004 Nov;30(6):637-45. IN - Interdisciplinary Research Centre in Health, School o Health & Social Sciences, Coventry U, Coventry, UK. j.barlow@coventry.ac.uk AB - BACKGROUND: The role of psycho-educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho-educational interventions for children and adolescents with chronic disease, their parents and siblings. METHODS: Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. RESULTS: No reviews of psycho-educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive-behavioural techniques on variables such as self-efficacy, self-management of disease, family functioning, psychosocial well-being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost-effectiveness. CONCLUSION: This overview has highlighted the need to extend the evidence base for psycho-educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self-care for children, adolescents and their parents. 327 PMID- 15155698 AU - Bates MN, Fawcett J, Garrett N, Cutress T, Kjellstrom T TI - Health effects of dental amalgam exposure: a retrospective cohort study. [CFS] SO - Int J Epidemiol 2004 Aug;33(4):894-902. Epub 2004 May 20. IN - Institute o Environmental Science & Research Ltd. (ESR), PO Box 50-348, Porirua, New Zealand. m_bates@uclink.berkeley.edu AB - BACKGROUND: Whether dental amalgam fillings (containing mercury) are hazardous is a long-standing issue, with few epidemiological investigations. Allegations have particularly involved nervous system disorders, such as multiple sclerosis, Alzheimer's disease, and chronic fatigue syndrome. This retrospective cohort study, the largest of its kind, contained people in the New Zealand Defence Force (NZDF) between 1977 and 1997. The NZDF has its own dental service, providing all personnel with regular and consistent treatment. Comprehensive treatment records are maintained and archived. METHODS: Yearly dental treatment histories, including amalgam filling placements, were compiled from individual records. To minimize amalgam exposure misclassification the cohort was restricted to people who, at NZDF entry, were aged <26 years and had all their posterior teeth. The cohort was linked with morbidity records. Data were analysed with a proportional hazards model, using a time-varying exposure unit of 100 amalgam surface-years. RESULTS: The final cohort contained 20 000 people, 84% males. Associations with medical diagnostic categories, particularly disorders of the nervous system and kidney, were examined. Of conditions allegedly associated with amalgam, multiple sclerosis had an adjusted hazard ratio (HR) of 1.24 (95% CI: 0.99, 1.53, P = 0.06), but there was no association with chronic fatigue syndrome (HR = 0.98, 95% CI: 0.94, 1.03), or kidney diseases. There were insufficient cases for investigation of Alzheimer's or Parkinson's diseases. CONCLUSIONS: Results were generally reassuring, and provide only limited evidence of an association between amalgam and disease. Further follow-up of the cohort will permit investigation of diseases more common in the elderly. 328 PMID- 15471384 AU - Bazelmans E, Prins JB, Hoogveld S, Bleijenberg G TI - Manual-based cognitive behaviour therapy for CFS: therapists' adherence & perceptions. SO - Cogn Behav Ther 2004;33(3):143-50. IN - The Netherlands Fatigue Research Group Nijmegen, D o Med Psychology, U Med Ctr, Nijmegen, The Netherlands. E.Bazelmans@cukz.umcn.nl AB - Several randomized controlled trials have indicated that cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome. In 1 of these studies 13 therapists applied cognitive behaviour therapy for chronic fatigue syndrome in 83 chronic fatigue syndrome patients. In the present study therapists' adherence and perceptions of the manual are studied. Following completion of the study the therapists were asked to complete a questionnaire. Audiotaped sessions were conducted to verify the therapists' adherence. Analyses of the audiotapes showed that in 87% of the sessions this appeared to be the case. The questionnaire revealed that the therapists found it more difficult to treat patients with chronic fatigue syndrome than to treat patients with psychological or other physical problems. Treatment aspects posing the most problems were integrating individual problems into the standardized treatment, dealing with the patients' lack of confidence in the treatment and handling insufficient motivation. 329 PMID- 15370183 AU - Bell IR, Lewis DA 2nd, Lewis SE, Schwartz GE, Brooks AJ, Scott A, Baldwin CM TI - EEG alpha sensitization in individualized homeopathic Rx of FM. SO - Int J Neurosci 2004 Sep;114(9):1195-220. IN - Program in Integrative Med, D o Psychiatry, The Mel & Enid Zuckerman Arizona Coll o Public Health, U o Arizona, Tucson, Arizona, USA. ibell@u.arizona.edu AB - Fibromyalgia (FM) patients show evidence of sensitizability in pain pathways and electroencephalographic (EEG) alterations. One proposed mechanism for the claimed effects of homeopathy, a form of complementary medicine used for FM, is time-dependent sensitization (TDS, progressive amplification) of host responses. This study examined possible sensitization-related changes in EEG relative alpha magnitude during a clinical trial of homeopathy in FM. A 4-month randomized, placebo-controlled double-blind trial of daily orally administered individualized homeopathy in physician-confirmed FM, with an additional 2-month optional crossover phase, included three laboratory sessions, at baseline, 3 and 6 months (N = 48, age 49.2 +/- 9.8 years, 94% women). Nineteen leads of EEG relative alpha magnitude at rest and during olfactory administration of treatment and control solutions were evaluated in each session. After 3 months, the active treatment group significantly increased, while the placebo group decreased, in global alpha-1 and alpha-2 during bottle sniffs over sessions. At 6 months, the subset of active patients who stayed on active continued to increase, while the active-switch subgroup reversed direction in alpha magnitude. Groups did not differ in resting alpha. Consistent with the TDS hypothesis, sniff alpha-1 and alpha-2 increases at 6 months versus baseline correlated with total amount of time on active remedy over all subjects (r = 0.45, p = .003), not with dose changes or clinical outcomes in the active group. The findings suggest initiation of TDS in relative EEG alpha magnitude by daily oral administration of active homeopathic medicines versus placebo, with laboratory elicitation by temporolimbic olfactory stimulation or sniffing. 330 PMID- 15165409 AU - Bell IR, Lewis DA 2nd, Schwartz GE, Lewis SE, Caspi O, Scott A, Brooks AJ, Baldwin CM TI - Electroencephalographic cordance patterns distinguish exceptional clinical responders w FM to individualized homeopathic medicines. SO - J Altern Complement Med 2004 Apr;10(2):285-99. IN - D o Med, U o Arizona, Tucson, AZ, USA. ibell@u.arizona.edu AB - OBJECTIVES: To characterize initial central nervous system responses to olfactory administration of homeopathic remedies as biomarkers for subsequently exceptional, simillimum-like clinical outcomes at a systemic level (i.e., both locally and globally). DESIGN: Double-blinded, randomized, placebo-controlled clinical trial. SETTING: A private homeopathic clinic in Phoenix, AZ, and a university laboratory in Tucson, AZ. PATIENTS: Sixty-two (62) persons with physician-confirmed fibromyalgia (FM) (mean age, 49 years; 94% women) enrolled; 53 completed the 3-month assessment visit. Exceptional responders (n = 6, 23% of active treatment group; none on placebo) were those with improvements in the top one-third for both tender point pain and global health ratings after 3 months. INTERVENTION: Patients took daily oral doses of treatment solution in LM (1/50,000 dilution) potency (active group received individualized remedy; placebo group received plain solvent). Dependent measures: Baseline and 3-month difference scores for initial prefrontal electroencephalographic alpha frequency cordance (EEG-C, a correlate of functional brain activity) during 16 pairs of randomized, double-blinded bottle sniffs (treatment minus control solutions). RESULTS: Exceptional responders versus other patients exhibited significantly more negative initial EEG-C difference scores at prefrontal sites. Right prefrontal cordance findings correlated with subsequently reduced pain (r = 0.85, p = 0.03), better global health (r =-0.73, p = 0.10), and trait absorption (genetically determined ability to focus attention selectively and fully) (r = 0.91, p = 0.012). CONCLUSIONS: These observations suggest prefrontal EEG-C as an early biomarker of individualized homeopathic medicine effects in patients with FM who later exhibit exceptional outcomes. Prefrontal cortex controls executive function, including ability to redirect attention. Interactions between executive function, absorption, and the simillimum remedy could facilitate exceptional responses. 331 PMID- 14734789 AU - Bell IR, Lewis DA 2nd, Brooks AJ, Schwartz GE, Lewis SE, Walsh BT, Baldwin CM TI - Improved clinical status in FM pts treated w individualized homeopathic remedies versus placebo. SO - Rheumatology (Oxford) 2004 May;43(5):577-82. Epub 2004 Jan 20. IN - D o Psychiatry, Mel & Enid Zuckerman Arizona Coll o Public Health at the U o Arizona, Tucson, USA. IBELL@U.ARIZONA.EDU AB - OBJECTIVE: To assess the efficacy of individualized classical homeopathy in the treatment of fibromyalgia. METHODS: This study was a double-blind, randomized, parallel-group, placebo-controlled trial of homeopathy. Community-recruited persons (N = 62) with physician-confirmed fibromyalgia (mean age 49 yr, s.d. 10 yr, 94% women) were treated in a homeopathic private practice setting. Participants were randomized to receive oral daily liquid LM (1/50,000) potencies with an individually chosen homeopathic remedy or an indistinguishable placebo. Homeopathic visits involved joint interviews and concurrence on remedy selection by two experienced homeopaths, at baseline, 2 months and 4 months (prior to a subsequent optional crossover phase of the study which is reported elsewhere). Tender point count and tender point pain on examination by a medical assessor uninvolved in providing care, self-rating scales on fibromyalgia-related quality of life, pain, mood and global health at baseline and 3 months, were the primary clinical outcome measures for this report. RESULTS: Fifty-three people completed the treatment protocol. Participants on active treatment showed significantly greater improvements in tender point count and tender point pain, quality of life, global health and a trend toward less depression compared with those on placebo. CONCLUSIONS: This study replicates and extends a previous 1-month placebo-controlled crossover study in fibromyalgia that pre-screened for only one homeopathic remedy. Using a broad selection of remedies and the flexible LM dose (1/50,000 dilution factor) series, the present study demonstrated that individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia. 332 PMID- 15165408 AU - Bell IR, Lewis DA 2nd, Brooks AJ, Schwartz GE, Lewis SE, Caspi O, Cunningham V, Baldwin CM TI - Individual differences in response to randomly assigned active individualized homeopathic & placebo Rx in FM: implications of a double-blinded optional crossover design. SO - J Altern Complement Med 2004 Apr;10(2):269-83. IN - D o Med, U o Arizona, Tucson, AZ, USA. ibell@u.arizona.edu AB - OBJECTIVE: To assess individual difference characteristics of subgroups of patients with fibromyalgia (FM) patients with respect to the decision to stay in or switch from randomly-assigned verum or placebo treatment during an optional crossover phase of a double-blinded homeopathy study. DESIGN: Double-blinded, randomized, placebo-controlled, optional crossover clinical trial. PARTICIPANTS: Fifty-three (53) community-recruited patients with FM entered the optional crossover phase. INTERVENTION: Two homeopaths jointly selected an individualized homeopathic remedy for all patients. The pharmacy dispensed either verum LM remedy or indistinguishable placebo in accord with randomized assignment for 4 months and the patient's optional crossover decision for an additional 2 months. OUTCOME MEASURES: Patients completed a battery of baseline state/trait questionnaires, including mood, childhood neglect and abuse, and trait absorption. They rated global health (whole person-centered) and tender point pain on physical examination (disease-specific) at baseline, 3 months, and 6 months. RESULTS: Rates of optional crossover from verum to placebo or placebo to verum were comparable (p = 0.6; 31%, and 41%, respectively). The switch subgroups had greater baseline psychologic issues (emotional neglect in placebo-switch; depression and anger in verum-switch). The verum-stay subgroup scored highest on treatment helpfulness and included all six exceptional responders who fell, prior to crossover, into the top terciles for improvement in both global health and pain. Patients staying in their randomly assigned groups, active or placebo (n = 34), scored significantly higher in trait absorption than did those who switched groups (n = 19). CONCLUSION: Individual difference factors may predict better and poorer responders with FM to specific and nonspecific effects of homeopathic and placebo treatment. 333 PMID- 15025886 AU - Bell IR, Lewis DA 2nd, Lewis SE, Brooks AJ, Schwartz GE, Baldwin CM TI - Strength of vital force in classical homeopathy: bio-psycho-social-spiritual correlates within a complex systems context. [FM] SO - J Altern Complement Med 2004 Feb;10(1):123-31. IN - D o Med & Program in Integrative Medicine, U o Arizona, Tucson, 85724-5153, USA. ibell@u.arizona.edu AB - OBJECTIVE: To explore associations between a global rating for the classical homeopathic construct of vital force and clinician and patient ratings on previously validated bio-psycho-social-spiritual questionnaires. METHODS: Sixty-two (62) community-recruited patients with fibromyalgia (FM) were assessed at baseline prior to a clinical trial of individualized homeopathy. Two homeopaths jointly performed case-taking interviews. A conventional medical provider independently evaluated patients with a standardized history and physical examination. Homeopaths rated each patient's vital force (five-point Likert scale, with 1 = very weak to 5 = very strong). Homeopaths and the conventional medical provider rated their Clinical Global Impression (CGI) of the severity of illness (1 = normal; 7 = among the most extremely ill). Patients completed self-rating scales on pain, global health, mood, quality of life, coping style, health locus of control, multidimensional well-being, spirituality, sense of coherence, positive states of mind, and social desirability. RESULTS: Greater vital force ratings (mean 2.9 standard deviation [SD] 0.6) correlated moderately (p < or = 0.005) with less severe CGI illness ratings by the homeopaths (r =-0.59), decreased patient-rated mental confusion (r =-0.43), higher vigor (r = 0.38), and greater positive states of mind (r = 0.36). Vital force also showed correlations (p < 0.05) with lower CGI ratings by the conventional medical provider (r =-0.32), better selfrated quality of life (r = 0.33), lesser fatigue (r =-0.31), better global health (r = 0.29), greater sense of coherence (r = 0.28), powerful-others health locus of control (r = 0.27), increased emotional well-being (r = 0.27), and higher social desirability (r = 0.27), but not with age, pain, or illness duration. CONCLUSION: Homeopathic vital force ratings reflect better perceived mental function, energy, and positive dimensions of the individual, beyond absence of disease. 334 PMID- 14760811 AU - Bellamy N, Sothern RB, Campbell J TI - Aspects of diurnal rhythmicity in pain, stiffness, & fatigue in pts w FM. SO - J Rheumatol 2004 Feb;31(2):379-89. IN - Faculty o Health Sciences, The U o Queensland, Brisbane, Australia. AB - OBJECTIVE: To determine diurnal rhythm characteristics of pain, stiffness, and fatigue in self-ratings performed by patients with fibromyalgia (FM). METHODS: Twenty-one women with FM made self-measurements of pain, stiffness, and fatigue on 100 mm horizontal visual analog scales at 6 prespecified timepoints at home for 10 consecutive days. Linear and multiple regressions were performed on the original data and the 24-hour means vs FM classifiers (age, disease duration, tender points, dolorimetry score, Fibromyalgia Impact Questionnaire score), respectively. Data were analyzed for 24-hour and 7-day time-effects by ANOVA and for diurnal and weekly rhythms by the cosinor technique. RESULTS: Individual ratings for pain, stiffness, and fatigue correlated highly with each other throughout the day and over the days of the week. Of the FM classifiers, dolorimetry score was found to be inversely related to the pain, stiffness, and fatigue scores. For the group of subjects with a low dolorimetry score (< 2.25 kg), a significant diurnal rhythm was found in each self-rated variable, with greater pain, stiffness, and fatigue observed in the morning and least in the late afternoon. No rhythm in pain or stiffness was observed in those subjects with a higher threshold for pain (dolorimetry score > 2.25 kg), while fatigue showed the same significant diurnal pattern as in the first group. For the group as a whole, the possible presence of a weekly variation was found with ratings for pain, stiffness, and fatigue higher on Sunday and Monday and lower on Friday. CONCLUSION: Ratings of pain, stiffness, and fatigue in FM are significantly correlated, and show diurnal and possibly weekly rhythmicity, especially when pain threshold is low (dolorimetry score < 2.25 kg), and are thus predictive of each other over these time spans. This has important implications for scheduling activities of daily living, for measurement in clinical trials, and possibly for timing the administration of medications. 335 PMID- 15153065 AU - Benca RM, Ancoli-Israel S, Moldofsky H TI - Special considerations in insomnia Dx & management: depressed, elderly, & chr pain populations. [FM] SO - J Clin Psychiatry 2004;65 Suppl 8:26-35. IN - U o Wisconsin, Madison, USA. AB - Patients with insomnia who also have chronic pain or depression or who are elderly represent segments of the population that are particularly difficult to treat. These populations tend to be at higher risk for experiencing difficulty sleeping and are more likely to experience chronic insomnia, sleep maintenance problems, and/or nonrestorative sleep. Worsening insomnia may exacerbate other somatic and psychological symptoms and vice versa. Conversely, there is evidence that appropriate recognition and management of the sleep complaint may alleviate other symptoms related to the associated condition and help interrupt this vicious cycle. 336 PMID- 15361322 AU - Bennett R TI - FM: present to future. SO - Curr Pain Headache Rep 2004 Oct;8(5):379-84. IN - D o Med, Oregon Health & Science U, 3181 Sam Jackson Park Road, Portland, OR 97201, USA. bennetrob1@comcast.net AB - There has been a dramatic increase in our understanding of fibromyalgia throughout the past 14 years since the publication of the 1990 American College of Rheumatology classification criteria. Before 1990, and for most of the 20th century, fibromyalgia was considered to be predominantly a muscle disorder; now the critical abnormality is described as "central sensitization." However, central sensitization has to have an initial genesis and nociceptive stimuli from painful foci in muscle are increasingly recognized as being relevant to the development of fibromyalgia. Clinicians also recognize an association between the initiation of fibromyalgia and chronic psychologic stressors and inflammatory disorders. It has been more difficult to understand how two such apparently diverse events could affect central pain physiology. However, some clues are emerging from the role of diverse stimuli in activating glial cells and the role of disordered cytokine networks. Some predictions about future developments in fibromyalgia are ventured based on the current state of knowledge. 337 PMID- 15251074 AU - Bennett R TI - Growth hormone in musculoskeletal pain states. [FM] SO - Curr Rheumatol Rep. 2004 Aug;6(4):266-73. IN - Oregon Health & Science U, D o Med (OP09), 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA. bennetrob1@comcast.net AB - Growth hormone is essential for normal linear growth and the attainment of an adult mature height. It also plays an important role in cartilage growth and the attainment of normal bone mass. There is only one rheumatic disorder, namely acromegaly, in which abnormalities of growth hormone production play a major etiologic role. However, there is increasing appreciation that suboptimal growth hormone secretion, leading to a state of adult growth hormone deficiency, may occur in the setting of chronic inflammatory disease, chronic corticosteroid use, and fibromyalgia. Therefore, the evaluation and effective management of growth hormone oversecretion and undersecretion is relevant to practicing rheumatologists. 338 PMID- 15106126 AU - Berger A, Dukes EM, Oster G TI - Clinical characteristics & economic costs of pts w painful neuropathic disorders. [FM] SO - J Pain 2004 Apr;5(3):143-9. IN - Policy Analysis Inc., Brookline, Mass 02445, USA. AB - Using a large US health insurance claims database, we identified all persons aged 18 years or older with 2 or more medical encounters in calendar year 2000 for painful neuropathic disorders (PNDs). We also identified an age- and gender-matched group of patients without PNDs (matched control subjects). We then compared the clinical characteristics and economic costs of PND patients with those of matched control subjects. There were a total of 55,686 patients with PNDs in the study database. The most frequently noted PNDs were back and neck pain with neuropathic involvement (62.3% of PND patients), causalgia (12.1%), and diabetic neuropathy (10.8%). In comparison with matched control subjects, PND patients were more likely to have other pain-related conditions, including fibromyalgia (6.0% vs 0.6% for control subjects), osteoarthritis (13.6% vs 3.6%), and other chronic comorbidities, such as coronary heart disease (13.6% vs 6.5%) and depression (6.4% vs 2.3%). Total calendar year 2000 health care charges were 3-fold higher for PND patients than matched control subjects ($17,355 vs $5,715, respectively). Our results suggest that patients with PNDs are generally in poorer health and have higher health care costs than their peers without these conditions. PERSPECTIVE: Use of nonsteroidal anti-inflammatory agents and opioids was widespread in patients with PNDs, while relatively few received antiepileptic drugs and tricyclic antidepressants, both of which are often more effective against neuropathic pain. Our study raises questions about the optimality of PND treatment in clinical practice. 339 PMID- 15087211 AU - Berry RB, Harding SM TI - Sleep & medical disorders. SO - MedClNA 2004 May;88(3):679-703, ix. IN - Sleep Disorders Centers Shands at AGH, Malcom Randall Veterans Affairs Med Ctr, U o Florida, Box 100225 HSC, Gainesville, FL 32610, USA. sleep_doc@msn.com 340 PMID- 15512927 AU - Binder LM, Campbell KA TI - Medically unexplained Sx & neuropsychological assessment. [CFS/FM/GWS] SO - J Clin Exp Neuropsychol 2004 May;26(3):369-92. IN - Oregon Health & Sciences U, Portland, OR, USA. pdxlarry@aol.com AB - Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin. There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress. 341 PMID- 15253851 AU - Birch S, Hesselink JK, Jonkman FA, Hekker TA, Bos A TI - Clinical research on acupuncture. Part 1. What have reviews of the efficacy & safety of acupuncture told us so far? [FM] SO - J Altern Complement Med 2004 Jun;10(3):468-80. IN - Foundation for the Study o Traditional East Asian Med, Amsterdam, The Netherlands. 71524.3461@compuserve.com AB - 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. 342 PMID- 15353532 AU - Blacker CV, Greenwood DT, Wesnes KA, Wilson R, Woodward C, Howe I, Ali T TI - Effect of galantamine hydrobromide in CFS: a randomized controlled trial. SO - JAMA 2004 Sep 8;292(10):1195-204. IN - D o Health & Social Sciences, U o Exeter, Exeter, England. c.v.r.blacker@btinternet.com AB - CONTEXT: There is no established pharmacological treatment for the core symptoms of chronic fatigue syndrome (CFS). Galantamine hydrobromide, an acetyl cholesterone inhibitor, has pharmacological properties that might benefit patients with CFS. OBJECTIVE: To compare the efficacy and tolerability of galantamine hydrobromide in patients with CFS. DESIGN, SETTING, AND PATIENTS: Randomized, double-blind trial conducted June 1997 through July 1999 at 35 outpatient centers in the United Kingdom (n = 17), United States (n = 14), the Netherlands (n = 2), Sweden (n = 1), and Belgium (n = 1) involving 434 patients with a clinical diagnosis of CFS (modified US Centers for Disease Control and Prevention criteria). INTERVENTIONS: A total of 89 patients were randomly assigned to receive 2.5 mg of galantamine hydrobromide; 86 patients, 5.0 mg; 91 patients, 7.5 mg; and 86 patients, 10 mg (these patients received medicine in the tablet form 3 times per day); a total of 82 patients received matching placebo tablets 3 times per day. MAIN OUTCOME MEASURES: The primary efficacy variable was the global change on the Clinician Global Impression Scale after 4, 8, 12, and 16 weeks of treatment. Secondary outcomes were changes in core symptoms of CFS on the Chalder Fatigue Rating Scale, the Fibromyalgia Impact Questionnaire, and the Pittsburgh Sleep Quality Index; changes in quality of life on the Nottingham Health Profile; and assessment of plasma-free cortisol levels and cognitive performance on a computer-based battery of tests. RESULTS: After 16 weeks, there were no statistically significant differences between any of the galantamine or placebo groups in clinical condition on the Clinician Global Impression Scale, or for any of the secondary end points. Exploratory regression analysis failed to detect any consistent prognostic factor that might have influenced the primary or any secondary outcome measures. CONCLUSION: This trial did not demonstrate any benefit of galantamine over placebo in the treatment of patients with CFS. 343 PMID- 15468381 AU - Blanco I, Canto H, de Serres FJ, Fernandez-Bustillo E, Rodriguez MC TI - Alpha1-antitrypsin replacement therapy controls FM Sx in 2 pts w PI ZZ alpha1-antitrypsin deficiency. SO - J Rheumatol. 2004 Oct;31(10):2082-5. IN - D o Internal Med, Respiratory Diseases Branch, Hosp Valle del Nalon, Asturias, Spain. ignacio.blanco@sespa.princast.es AB - Two Spanish sisters with alpha1-antitrypsin (AAT) deficiency and fibromyalgia (FM) started AAT replacement therapy with commercial alpha1-antitrypsin infusions in 1992. They both experienced a rapid, progressive, and constant control of their FM symptoms during the next 6 years (1992-98). However, in 1998, treatment of both patients was affected by the worldwide commercial shortage of AAT replacement therapy; replacement therapy infusions were halted for about 4-6 consecutive months every year for 5 years. As a result, we observed a striking recurrence of FM symptoms. Equally striking was the total disappearance of these symptoms when AAT replacement therapy infusions were resumed. 344 PMID- 15677401 AU - Boscarino JA TI - Posttraumatic stress disorder & physical illness: results from clinical & epidemiologic studies. [FM/CFS] SO - Ann N Y Acad Sci. 2004 Dec;1032:141-53. IN - Division o Health & Science Policy, Room 552, The New York Academy o Med, 1216 Fifth Avenue, New York, NY 10029-5293, USA. jboscarino@nyam.org AB - Research indicates that exposure to traumatic stressors and psychological trauma is widespread. The association of such exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. However, epidemiologic research increasingly suggests that exposure to these events is related to increased health care utilization, adverse health outcomes, the onset of specific diseases, and premature death. To date, studies have linked traumatic stress exposures and PTSD to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, and other diseases. Evidence linking cardiovascular disease and exposure to psychological trauma is particularly strong and has been found consistently across different populations and stressor events. In addition, clinical studies have suggested the biological pathways through which stressor-induced diseases may be pathologically expressed. In particular, recent studies have implicated the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) stress axes as key in this pathogenic process, although genetic and behavioral/psychological risk factors cannot be ruled out. Recent findings, indicating that victims of PTSD have higher circulating T-cell lymphocytes and lower cortisol levels, are intriguing and suggest that chronic sufferers of PTSD may be at risk for autoimmune diseases. To test this hypothesis, we assessed the association between chronic PTSD in a national sample of 2,490 Vietnam veterans and the prevalence of common autoimmune diseases, including rheumatoid arthritis, psoriasis, insulin-dependent diabetes, and thyroid disease. Our analyses suggest that chronic PTSD, particularly comorbid PTSD or complex PTSD, is associated with all of these conditions. In addition, veterans with comorbid PTSD were more likely to have clinically higher T-cell counts, hyperreactive immune responses on standardized delayed cutaneous hypersensitivity tests, clinically higher immunoglobulin-M levels, and clinically lower dehydroepiandrosterone levels. The latter clinical evidence confirms the presence of biological markers consistent with a broad range of inflammatory disorders, including both cardiovascular and autoimmune diseases. 345 PMID- 15283455 AU - Bradley LA, Kersh BC, DeBerry JJ, Deutsch G, Alarcon GA, McLain DA TI - Lessons from FM: abnormal pain sensitivity in knee osteoarthritis. SO - Novartis Found Symp 2004;260:258-70; discussion 270-9. IN - Division o Clinical Immunology & Rheumatology, U o Alabama + AB - +IN: at Birmingham, 805 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA. Fibromyalgia (FM) is a disorder that is characterized by widespread, musculoskeletal pain and abnormal pain sensitivity at multiple anatomic sites. Laboratory studies involving psychophysical and neuroimaging methods suggest that central augmentation of low intensity stimulation may contribute to abnormal pain sensitivity in FM. Recently, several investigators, using similar laboratory methods, have shown that patients with knee or hip osteoarthritis (OA) exhibit abnormal pain sensitivity or abnormal pain inhibition at anatomic sites distal to affected joints. Consistent with animal models of central sensitization, differences between patients and healthy controls in pain processing and pain inhibition at these distal sites are eliminated after nociceptive input is eliminated following total joint replacement surgery. This paper reviews these findings from our laboratory and those of independent investigators. It also presents verbal, psychophysical and neuroimaging data concerning ethnic group differences in affective and cognitive pain responses among patients with knee OA. We suggest that central sensitization as well as centrally-mediated cognitive and affective factors influence the pain responses of patients with knee OA. In addition, ethnic group differences in pain cognition and affect may contribute to differences among these groups in preferences for healthcare interventions such as total joint replacement. 346 PMID- 15041086 AU - Broderick JE, Arnold D, Kudielka BM, Kirschbaum C TI - Salivary cortisol sampling compliance: comparison of pts & healthy volunteers. [FM] SO - Psychoneuroendocrinology 2004 Jun;29(5):636-50. IN - D o Psychiatry & Behavioral Science, Putnam Hall, Stony Brook U, Stony Brook, NY 11794-8790, USA. joan.broderick@stonybrook.edu AB - OBJECTIVE: Problems of compliance with in vivo data collection and treatment protocols have been identified. This study investigated compliance with salivary cortisol sampling in a 7-day protocol. Impact of non-compliance on cortisol data was evaluated. METHODS: Female fibromyalgia patients were matched with healthy female volunteers and randomized to Aware or Unaware conditions regarding objective monitoring of their sampling compliance. The protocol entailed collecting five saliva samples at prescribed times on each of 7 consecutive days. Participants self-reported time of each sample, and electronic monitor caps provided an objective date and time stamp of each sample. RESULTS: Objective compliance among participants unaware of monitoring was 71%, though their self-reported compliance was 93%. Aware participants' objective compliance was 90% which was consistent with self-reported compliance of 93%. Within-subject comparison of early morning rise and day slope of cortisol for compliant and non-compliant samples found significant differences with non-compliant samples resulting in flatter slopes. Patients were somewhat more compliant than healthy volunteers. Slight decrements in compliance were found for the afternoon sample (1600 h) and for the last 3 days of sampling. Compliance did not differ on weekdays versus weekends. CONCLUSIONS: Self-report of compliance in a salivary cortisol sampling protocol substantially overestimates actual compliance in the absence of objective monitoring. Non-compliance with the sampling protocol results in cortisol data that significantly differs from compliant data. Awareness of electronic monitoring of sampling results in satisfactory compliance. 347 PMID- 15082130 AU - Broderick JE, Junghaenel DU, Turk DC TI - Stability of patient adaptation classifications on the multidimensional pain inventory. SO - Pain 2004 May;109(1-2):94-102. IN - D o Psychiatry & Behavioral Science, Putnam Hall, Stony Brook U, Stony Brook, NY 11794-8790, USA. joan.broderick@stonybrook.edu AB - This study examined the adaptational classification stability of the multidimensional pain inventory (MPI) in two samples of female fibromyalgia syndrome patients. Retest resulted in one-third of patients being assigned to a different classification. Twenty patients had four repeated MPI assessments over a 10-month period; 85% of them changed classification at least once. Prediction of classification stability using demographic variables and measures of pain, depression, anxiety, impression management, and self-deception was unsuccessful. Examination of the MPI Variable Response Scale and an index of the goodness of fit of the cluster for each patient did not yield sufficient predictive power. The implication of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations. As such, caution must be applied when treatment is tailored to MPI clusters and when classification change is used as an outcome measure. 348 PMID- 15619332 AU - Burnet RB, Chatterton BE TI - Gastric emptying is slow in CFS. SO - BMC Gastroenterol. 2004 Dec 26;4(1):32. IN - D o Endocrinology & Metabolism, Royal Adelaide Hosp, North Terrace, Adelaide, South Australia 5000, Australia. rburnet@mail.rah.sa.gov.au AB - BACKGROUND: Gastrointestinal symptoms are common in patients with Chronic Fatigue Syndrome (CFS). The objective of this study was to determine the frequency of these symptoms and explore their relationship with objective (radionuclide) studies of upper GI function. METHODS: Thirty-two (32) patients with CFS and 45 control subjects completed a questionnaire on upper GI symptoms, and the 32 patients underwent oesophageal clearance, and simultaneous liquid and solid gastric emptying studies using radionuclide techniques compared with historical controls. RESULTS: The questionnaires showed a significant difference in gastric (p > 0.01) symptoms and swallowing difficulty. Nocturnal diarrhoea was a significant symptom not previously reported.5/32 CFS subjects showed slightly delayed oesophageal clearance, but overall there was no significant difference from the control subjects, nor correlation of oesophageal clearance with symptoms. 23/32 patients showed a delay in liquid gastric emptying, and 12/32 a delay in solid gastric emptying with the delay significantly correlated with the mean symptom score (for each p < 0.001). CONCLUSIONS: GI symptoms in patients with chronic fatigue syndrome are associated with objective changes of upper GI motility. 349 PMID- 15012848 AU - Busichio K, Tiersky LA, Deluca J, Natelson BH TI - Neuropsychological deficits in pts w CFS. SO - J Int Neuropsychol Soc 2004 Mar;10(2):278-85. IN - Chronic Fatigue Syndrome Ctr, Newark, New Jersey 07666, USA. AB - The degree of neuropsychological dysfunction across multiple domains was examined in individuals suffering from chronic fatigue syndrome (CFS). In this descriptive study, a similar series of neuropsychological tests was administered to a group of CFS patients and healthy participants. More specifically, CFS patients (n = 141) who met the 1994 Case Definition criteria were compared to 76 healthy control participants on tests of memory, attention (concentration), speed of information processing, motor speed, and executive functioning. On the 18 measures administered, CFS patients scored 1 standard deviation below the healthy mean on nine measures and scored 2 standard deviations below the healthy mean on four of the measures. Moreover, results indicated that CFS patients were more likely than healthy controls to fail (1.6 SD below the healthy mean) at least one test in each of the following domains: attention, speed of information processing, and motor speed, but not on measures of memory and executive functioning. Finally, CFS patients demonstrated a greater total number of tests failed across domains. 350 PMID- 15053242 AU - Calis M, Gokce C, Ates F, Ulker S, Izgi HB, Demir H, Kirnap M, Sofuoglu S, Dura+ TI - Investigation of the hypothalamo-pituitary-adrenal axis (HPA) by 1 microg ACTH test & metyrapone test in pts w primary FM syndrome. SO - J Endocrinol Invest 2004 Jan;27(1):42-6. IN - Division o Physical Med & Rehabilitation, D o Med Sciences,+ AB - +IN: U o Erciyes, Kayseri, Turkey. +AU: k AC, Tutus A, Kelestimur F Primary fibromyalgia syndrome (PFS) is characterized by widespread chronic pain that affects the musculoskeletal system, fatigue, anxiety, sleep disturbance, headache and postural hypotension. The pathophysiology of PFS is unknown. The hypothalamic-pituitary-adrenal (HPA) axis seems to play an important role in PFS. Both hyperactivity and hypoactivity of the HPA axis have been reported in patients with PFS. In this study we assessed the HPA axis by 1 microg ACTH stimulation test and metyrapone test in 22 patients with PFS and in 15 age-, sex-, and body mass index (BMI)- matched controls. Metyrapone (30 mg/kg) was administered orally at 23:00 h and blood was sampled at 08:30 h the following morning for 11-deoxycortisol. ACTH stimulation test was carried out by using 1 microg (iv) ACTH as a bolus injection after an overnight fast, and blood samples were drawn at 0, 30 and 60 min. Peak cortisol level (659.4 +/- 207.2 nmol/l) was lower in the patients with PFS than peak cortisol level (838.7 +/- 129.6 nmol/l) in the control subjects (p < 0.05). Ten patients (45%) with PFS had peak cortisol responses to 1 microg ACTH test lower than the lowest peak cortisol detected in healthy controls. After metyrapone test 11-deoxycortisol level was 123.7 +/- 26 nmol/l in patients with PFS and 184.2 +/- 17.3 nmol/l in the controls (p < 0.05). Ninety five percent of the patients with PFS had lower 11-deoxycortisol level after metyrapone than the lowest 11-deoxycortisol level after metyrapone detected in healthy controls. We also compared the adrenal size of the patients with that of the healthy subjects and we found that the adrenal size between the groups was similar. This study clearly shows that HPA axis is underactivated in PFS, rather than overactivated. 351 PMID- 15256300 AU - Candy B, Chalder T, Cleare AJ, Wessely S, Hotopf M TI - A randomised controlled trial of a psycho-educational intervention to aid recovery in infectious mononucleosis. [CFS] SO - J Psychosom Res 2004 Jul;57(1):89-94. IN - D o Psychological Med, Guy's, King's & St. Thomas' School o Medicine, 103 Denmark Hill, London SE5 8AZ, UK. AB - OBJECTIVES: Glandular fever is associated with an approximate fivefold increase in fatigue at 6 months. Reduced levels of fitness and illness beliefs may be important predictors of fatigue following glandular fever. We therefore developed a brief psycho-educational intervention aimed at improving recovery from infectious mononucleosis, and piloted a randomised controlled trial to evaluate the intervention. METHODS: We performed a randomised-controlled trial in primary health care in Southeast London and Kent. Sixty-nine patients aged between 16 and 45 years who were diagnosed, serologically and clinically, with acute infectious mononucleosis between December 1999 and December 2000 were randomised. The control group received a standardised fact-sheet about infectious mononucleosis, which gave no advice on rehabilitation. Patients who were randomised to the intervention received an individual treatment session, two follow-up telephone calls, and an information booklet. Fatigue score 6 months after the onset of infectious mononucleosis was the main outcome measure. RESULTS: Sixty-nine out of 139 patients referred were recruited and randomised. Eighty-seven percent of those recruited completed the Fatigue Questionnaire at 6 months. The intervention was acceptable to all who received it. There were fewer fatigue cases in the intervention group than the control group at 6 months follow-up (odds ratio 0.31, 95% confidence interval 0.09-0.91). CONCLUSIONS: A brief intervention at the diagnosis of infectious mononucleosis is acceptable, and may help prevent the development of chronic fatigue. Definitive randomised controlled trials are required to test the intervention. 352 PMID- 14962965 AU - Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A, Allaz AF, Vischer TL TI - FM: a randomised, controlled trial of a Rx programme based on self management. SO - Ann Rheum Dis 2004 Mar;63(3):290-6. IN - Division o Rheumatology, Geneva U Hosp, 1211 Geneva, Switzerland. Christine.Cedraschi@hcuge.ch AB - 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. 353 PMID- 15549565 AU - Centonze V, Bassi A, Cassiano MA, Munno I, Dalfino L, Causarano V TI - Migraine, daily chr headache & FM in the same patient: an evolutive "continuum" of non organic chr pain? About 100 clinical cases. SO - Neurol Sci 2004 Oct;25 Suppl 3:S291-2. IN - Headache Unit, Internal Med P.O. F. Jaia, Conversano (BA), Italy. vincenzocentonze@inwind.it AB - Aim of this study is to evaluate if migraine, daily chronic headache and fibromyalgia in the same patient can be considered as an evolutive continuum of non organic chronic pain. Therefore, migraine, daily chronic headache and fibromyalgia should be considered the expression of chronic antinociceptive system alteration. 354 PMID- 15588275 AU - Cevik R, Gur A, Acar S, Nas K, Sarac AJ TI - Hypothalamic-pituitary-gonadal axis hormones & cortisol in both menstrual phases of women w CFS & effect of depressive mood on these hormones. SO - BMC Musculoskelet Disord. 2004 Dec 8;5(1):47. IN - Physical Med & Rehabilitation, School o Medicine, Dicle U, Diyarbakir, Turkey. ftremzi@dicle.edu.tr AB - BACKGROUND: Chronic fatigue syndrome (CFS) is a disease which defined as medically unexplained, disabling fatigue of 6 months or more duration and often accompanied by several of a long list of physical complaints. We aimed to investigate abnormalities of hypothalamic-pituitary-gonadal (HPG) axis hormones and cortisol concentrations in premenopausal women with CFS and find out effects of depression rate on these hormones. METHODS: We examined follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone and cortisol concentrations in 43 premenopausal women (mean age: 32.86 +/- 7.11) with CFS and compared matched 35 healthy controls (mean age: 31.14 +/- 6.19). Patients were divided according to menstrual cycle phases (follicular and luteal) and compared with matched phase controls. Depression rate was assessed by Beck Depression Inventory (BDI), and patients with high BDI scores were compared to patients with low BDI scores. RESULTS: There were no significant differences in FSH, LH, estradiol and progesterone levels in both of menstrual phases of patients versus controls. Cortisol levels were significantly lower in patients compared to controls. There were no significant differences in all hormone levels in patients with high depression scores versus patients with low depression scores. CONCLUSION: In spite of high depression rate, low cortisol concentration and normal HPG axis hormones of both menstrual phases are detected in premenopausal women with CFS. There is no differentiation between patients with high and low depression rate in all hormone levels. Depression condition of CFS may be different from classical depression and evaluation of HPG and HPA axis should be performed for understanding of pathophysiology of CFS and planning of treatment. 355 PMID- 15043967 AU - Chaudhuri A, Behan PO TI - Fatigue in neurological disorders. [CFS] SO - Lancet 2004 Mar 20;363(9413):978-88. IN - Division o Clinical Neurosciences, U o Glasgow, Glasgow G51 4TF, UK. ac54p@udcf.gla.ac.uk AB - Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome. Disorders of neuromuscular junction transmission and metabolic diseases cause muscle fatigability, which is characterised by failure to sustain the force of muscle contraction (peripheral fatigue). Fatigue is also seen in diseases that affect the central, peripheral, and autonomic nervous systems (central fatigue). Enhanced perception of effort and limited endurance of sustained physical and mental activities are the main characteristics of central fatigue. Metabolic and structural lesions that disrupt the usual process of activation in pathways interconnecting the basal ganglia, thalamus, limbic system, and higher cortical centre are implicated in the pathophysiological process of central fatigue. A state of pre-existing relative hypocortisolaemia might sensitise the hypothalamic-pituitary-adrenal axis to development of persistent central fatigue after stress. The contributions of physiological, cognitive, and affective changes underlying fatigue are variable, and treatment is largely symptomatic and rehabilitative. 356 PMID- 15253888 AU - Chaudhuri A, Behan PO TI - In vivo magnetic resonance spectroscopy in CFS. SO - Prostaglandins Leukot Essent Fatty Acids 2004 Sep;71(3):181-3. IN - Division o Clinical Neurosciences, Inst o Neurological Sciences, Southern General Hosp, U o Glasgow, 1345 Govan Road, Glasgow G51 4TF, UK. ac54p@udcf.gla.ac.uk AB - The pathogenic mechanisms of chronic fatigue syndrome (CFS) are not clearly known. Fatigue, poor short-term memory and muscle pain are the most disabling symptoms in CFS. Research data on magnetic resonance spectroscopy (MRS) of muscles and brain in CFS patients suggest a cellular metabolic abnormality in some cases. 31P MRS of skeletal muscles in a subset of patients indicate early intracellular acidosis in the exercising muscles. 1H MRS of the regional brain areas in CFS have shown increased peaks of choline derived from the cell membrane phospholipids. Cell membrane oxidative stress may offer a common explanation for the observed MRS changes in the muscles and brain of CFS patients and this may have important therapeutic implications. As a research tool, MRS may be used as an objective outcome measure in the intervention studies. In addition, regional brain 1H MRS has the potential for wider use to substantiate a clinical diagnosis of CFS from other disorders of unexplained chronic fatigue. 357 PMID- 15229969 AU - Christopoulos S, Marcus VA, Fitzcharles MA TI - Collagenous colitis w spondyloarthropathy presenting as FM syndrome. SO - J Rheumatol 2004 Jul;31(7):1455-6. IN - Division o Rheumatology & the McGill-MGH Pain Centre, Montreal General Hosp, McGill U, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. AB - Collagenous colitis is a newly recognized clinicopathologic entity that presents with diarrhea and weight loss. In some patients arthropathy may be a concomitant feature. We describe a patient whose initial presentation masqueraded as fibromyalgia with associated bowel symptoms, but who was finally diagnosed as having collagenous colitis and inflammatory spondyloarthropathy. 358 PMID- 15110921 AU - Cleare AJ, O'Keane V, Miell JP TI - Levels of DHEA & DHEAS & responses to CRH stimulation & hydrocortisone Rx in CFS. SO - Psychoneuroendocrinology 2004 Jul;29(6):724-32. IN - Division o Psychological Med, The Inst o Psychiatry & Guy's, King's & St Thomas' School o Medicine, London SE5 8AF, UK. a.cleare@iop.kcl.ac.uk AB - Background: An association between chronic fatigue syndrome (CFS) and abnormalities of the hypothalamo-pituitary-adrenal axis has been described, and other adrenal steroid abnormalities have been suggested. Dehydroepiandrostenedione (DHEA) and its sulphate (DHEA-S), apart from being a precursor of sex steroids, have other functions associated with memory, depression and sleep. It has been suggested that CFS may be associated with a state of relative DHEA(-S) deficiency. Therefore we investigated basal levels of DHEA(-S), the cortisol/DHEA molar ratio and the responsiveness of DHEA to stimulation by corticotrophin-releasing hormone (CRH). Recent studies have also suggested that low dose hydrocortisone may be effective at reducing fatigue in CFS. We therefore also assessed these parameters prior to and following treatment with low dose oral hydrocortisone. Methods: Basal levels of serum DHEA, DHEAS and cortisol were measured in 16 patients with CFS without depression and in 16 controls matched for age, gender, weight, body mass index and menstrual history. CRH tests (1 g/kg i.v.) were carried out on all subjects and DHEA measured at 0, +30 and +90 min. In the patient group, CRH tests were repeated on two further occasions following treatment with hydrocortisone (5 or 10 mg, p.o.) or placebo for 1 month each in a double-blind cross over study protocol. Results: Basal levels of DHEA were higher in the patient, compared to the control, group (14.1+/-2.2 vs. 9.0+/-0.90 ng/ml, P=0.04), while levels of DHEAS in patients (288.7+/-35.4 microg/dl) were not different from controls (293.7+/-53.8, P=NS). Higher DHEA levels were correlated with higher disability scores. Basal cortisol levels were higher in patients, and consequently the cortisol/DHEA molar ratio did not differ between patients and controls. Levels of DHEA (8.9+/-0.97 ng/ml, P=0.015) and DHEAS (233.4+/-41.6 microg/dl, P=0.03) were lower in patients following treatment with hydrocortisone. There was a rise in DHEA responsiveness to CRH in the patients after treatment but this did not attain significance (AUCc: 2.5+/-1.7 ng/ml h pre-treatment vs. 6.4+/-1.2 ng/ml h post-hydrocortisone, P=0.053). However, those patients who responded fully to hydrocortisone in terms of reduced fatigue scores did show a significantly increased DHEA responsiveness to CRH (AUCc: -1.4+/-2.5 ng/ml h at baseline, 5.0+/-1.2 ng/ml h after active treatment, P=0.029). Conclusions: DHEA levels are raised in CFS and correlate with the degree of self-reported disability. Hydrocortisone therapy leads to a reduction in these levels towards normal, and an increased DHEA response to CRH, most marked in those who show a clinical response to this therapy. 359 PMID- 15036250 AU - Cleare AJ TI - The HPA axis & the genesis of CFS. SO - Trends Endocrinol Metab 2004 Mar;15(2):55-9. IN - Section o Neurobiology o Mood Disorders, Div o Psychological Med, The Inst o Psychiatry, London, SE5 8AF, UK. a.cleare@iop.kcl.ac.uk AB - Many studies of patients with long-standing chronic fatigue syndrome (CFS) have found alterations to the hypothalamo-pituitary-adrenal (HPA) axis, including mild hypocortisolism, heightened negative feedback and blunted responses to challenge. However, recent prospective studies of high-risk cohorts suggest that there are no HPA axis changes present during the early stages of the genesis of fatiguing illnesses. Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance. Nevertheless, raising levels of cortisol pharmacologically can temporarily alleviate symptoms of fatigue. This article presents the case that there is no specific change to the HPA axis in CFS and that the observed changes are of multifactorial aetiology, with some factors occurring as a consequence of the illness. Nevertheless, the HPA axis might play a role in exacerbating or perpetuating symptoms late on in the course of the illness. 360 PMID- 15045622 AU - Colangelo N, Bertinotti L, Nacci F, Conforti ML, Beneforti E, Pignone A, Matucci-Cerinic M, Zoppi M TI - Dimensions of psychological dysfunction in pts w FM: development of an Italian questionnaire. SO - Clin Rheumatol 2004 Apr;23(2):102-8. Epub 2004 Jan 17. IN - D o Med, Div o Rheumatology, U o Florence, Villa Monna Tessa, Viale Pieraccini 18, 50139, Florence, Italy. AB - Our objective was to observe whether dysfunctional psychological dimensions of pain could be detected in fibromyalgia patients through the development of a new questionnaire. An original questionnaire composed of 51 items was given to 250 patients (185 females and 65 males, mean age 55+/-12.8 years) suffering from chronic fibromyalgia according to the criteria of the Multicenter Criteria Committee of the American College of Rheumatology. A Varimax computerized program of factorial analysis with orthogonal and oblique rotation of the axes was used to analyze the data. Five strong independent factors were identified: 1) catastrophizing and 2) external control beliefs (cognitive); 3) alexithymia (emotional); 4) restless behavior (behavioral); and 5) need for support (relational). Our questionnaire is a preliminary development of an Italian language psychological characterization of FM patients which may be a relevant and useful tool for the evaluation of the outcome of clinical/psychological treatment of FM. 361 PMID- 14760810 AU - Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH TI - Functional imaging of pain in pts w primary FM. SO - J Rheumatol 2004 Feb;31(2):364-78. IN - Chronic Fatigue Syndrome Cooperative Research Ctr, New Jersey MS, Newark, New Jersey 07018, USA. cookdb@njneuromed.org AB - OBJECTIVE: To examine the function of the nociceptive system in patients with fibromyalgia (FM) using functional magnetic resonance imaging (fMRI). METHODS: Two groups of women, 9 with FM and 9 pain-free, volunteered to participate. In Experiment 1, we assessed psychophysical responses to painful stimuli and prepared participants for fMRI testing. For Experiment 2, subjects underwent fMRI scanning while receiving painful and nonpainful heat stimuli. Conventional and functional MR images were acquired using a 1.5 T MR scanner. Scanning occurred over 5 conditions. Condition 1 served as a practice session (no stimuli). Conditions 2 and 5 consisted of nonpainful warm stimuli. Conditions 3 and 4 consisted of an absolute thermal pain stimulus (47 degrees C) and a perceptually equivalent pain stimulus delivered in counterbalanced order. RESULTS: Experiment 1 indicated that subjects with FM were significantly more sensitive to experimental heat pain than controls (p < 0.001). In Experiment 2, fMRI data indicated that the FM group exhibited greater activity than controls over multiple brain regions in response to both nonpainful and painful stimuli (p < 0.01). Specifically, in response to nonpainful warm stimuli, FM subjects had significantly greater activity than controls in prefrontal, supplemental motor, insular, and anterior cingulate cortices (p < 0.01). In response to painful stimuli, FM subjects had greater activity in the contralateral insular cortex (p < 0.01). Data from the practice session indicated brain activity in pain-relevant areas for the FM group but not for controls. CONCLUSION: Our results provide further evidence for a physiological explanation for FM pain. 362 PMID- 14965242 AU - Costall B, Naylor RJ TI - 5-HT3 receptors. [FM] SO - Curr Drug Targets CNS Neurol Disord 2004 Feb;3(1):27-37. IN - Bradford School o Pharmacy, U o Bradford, Bradford, West Yorkshire, BD7 1DP, UK. AB - 5-HT(3)-receptor antagonists are highly selective competitive inhibitors of the 5-HT(3)-receptor with negligible affinity for other receptors. They are potent, rapidly absorbed and easily penetrate the blood-brain barrier; metabolized by the cytochrome P450-system with half-life varying from 3-10 hours. The compounds investigated so far do not modify normal behaviour in animals or man and are well tolerated over wide dose ranges, the most common side effects being headache or constipation. Clinical efficacy was first established in chemotherapy-induced emesis (and then in radiotherapy-induced and post-operative emesis), where 5-HT(3)-receptor antagonists set a new standard of antiemetic efficacy and tolerability. The 5-HT(3) receptor antagonists, via a central and / or peripheral action, have been shown to reduce secretion and motility in the gut and possess clinical utility in irritable bowel syndrome, and possibly other visceral pain disorders. Their value in fibromyalgia is being evaluated. In preclinical behavioural assays they induce effects consistent with anxiolysis, improved cognition, anti-dopaminergic activity and use in drug abuse and withdrawal. There is some evidence that ondansetron may reduce alcohol consumption in moderate alcohol abusers but overall, 5-HT(3) receptor antagonists seem to be of limited use in psychiatric disorders: where effects have been seen, they seem to be unusually sensitive to dose and stage of disease. Nevertheless, their antiemetic potential has been of great benefit to cancer patients and the possible extension of their use to bowel disorders may yet fulfil their initial exciting promise. 363 PMID- 15041027 AU - Cox IJ, Puri BK TI - In vivo MR spectroscopy in Dx & research of neuropsychiatric disorders. [CFS] SO - Prostaglandins Leukot Essent Fatty Acids. 2004 Apr;70(4):357-60. IN - Faculty o Med, Imaging Sciences D, Imperial Coll London, Div o Clinical Sciences, Robert Steiner Magnetic Resonance Unit, Hammersmith Campus, Du Cane Road, London W12 0HS, UK. j.cox@imperial.ac.uk AB - Magnetic resonance spectroscopy is one of the most important tools for quantitative analysis of chemical composition and structure, and this non-invasive technique is now being applied in vivo to study biochemical processes in those neuropsychiatric disorders that are part of the phospholipid spectrum. Interpretation of a clinical magnetic resonance spectrum can provide information about membrane phospholipid turnover, cellular energetics, neuronal function, selected neurotransmitter activity and intracellular pH. Cerebral proton and phosphorus magnetic resonance spectroscopy findings are summarized in relation to schizophrenia, dyslexia and chronic fatigue syndrome. 364 PMID- 15157948 AU - Crofford LJ, Young EA, Engleberg NC, Korszun A, Brucksch CB, McClure LA, Brown MB, Demitrack MA TI - Basal circadian & pulsatile ACTH & cortisol secretion in pts w FM and/or CFS. SO - Brain Behav Immun 2004 Jul;18(4):314-25. IN - D o Internal Med, U o Michigan School o Medicine, Ann Arbor, MI, USA. crofford@umich.edu AB - The objective of this study was to evaluate and compare the basal circadian and pulsatile architecture of the HPA axis in groups of patients with FMS, CFS, or both syndromes with individually matched control groups. Forty patients with either FMS (n = 13), FMS and CFS (n = 12), or CFS (n = 15) were matched by age (18-65), sex, and menstrual status to healthy controls. Subjects were excluded if they met criteria for major Axis I psychiatric disorders by structured clinical interview (SCID). Subjects were admitted to the General Clinical Research Center where meals and activities were standardized. Blood was collected from an intravenous line every 10 min over 24 h for analysis of ACTH and cortisol. Samples were evaluable for ACTH in 36 subject pairs and for cortisol in 37 subject pairs. There was a significant delay in the rate of decline from acrophase to nadir for cortisol levels in patients with FMS (P <.01). Elevation of cortisol in the late evening quiescent period was evident in half of the FMS patients compared with their control group, while cortisol levels were numerically, but not significantly, lower in the overnight period in patients with CFS compared with their control group. Pulsatility analyses did not reveal statistically significant differences between patient and control groups. We conclude that the pattern of differences for basal circadian architecture of HPA axis hormones differs between patients with FMS and CFS compared to their matched control groups. The abnormalities in FMS patients are consistent with loss of HPA axis resiliency. 365 PMID- 15251075 AU - Crofford LJ TI - Pharmaceutical Rx options for FM. SO - Curr Rheumatol Rep. 2004 Aug;6(4):274-80. IN - Division o Rheumatology, U o Michigan, Room 5510, MSRB-I, 1150 W. Med Ctr Dr., Ann Arbor, MI 48109-0680, USA. crofford@umich.edu AB - Fibromyalgia syndrome (FMS) is a chronic multisymptom illness characterized by widespread pain and associated with neuropsychological symptoms including fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression. A discreet cause of FMS has not been identified. It is likely that multiple mechanisms give rise to symptom expression. Understanding specific etiologic factors and pathogenic mechanisms in individual patients will allow clinicians to determine treatments that are most effective for a given patient. Available evidence implicates the central nervous system as key in maintaining pain and other core symptoms of FMS. The approach to treatment of pain will typically address these central mechanisms. Nonpain symptoms may be treated by drugs affecting similar central neurochemicals. This paper will review the rationale for the different types of pharmaceutical treatments that may be useful for the treatment of FMS and issues regarding new drug development for this indication. 366 PMID- 14770049 AU - Crombez G, Eccleston C, Van den Broeck A, Goubert L, Van Houdenhove B TI - Hypervigilance to pain in FM: the mediating role of pain intensity & catastrophic thinking about pain. SO - Clin J Pain 2004 Mar-Apr;20(2):98-102. IN - D o Experimental-Clinical & Health Psychology, Ghent U, Belgium. geert.crombez@rug.ac.be AB - OBJECTIVE: To investigate the mediating role of pain intensity, catastrophic thinking about pain, and negative affectivity in explaining enhanced attention for pain in patients with fibromyalgia. METHODS: Sixty-four patients with fibromyalgia and 46 patients with chronic low back pain completed self-report instruments of vigilance to pain, negative affectivity, and catastrophic thinking about pain. These measures, along with diagnostic group and pain intensity, were entered into a partial correlational analysis to investigate which variables mediate the relationship between diagnostic group (fibromyalgia vs. chronic low back pain) and vigilance to pain. RESULTS: Fibromyalgia patients reported significantly greater vigilance to pain than patients with chronic low back pain. They also reported higher pain intensity, more negative affectivity, and more catastrophic thinking about pain than patients with chronic low back pain. Vigilance to pain was correlated significantly with pain intensity, negative affectivity, and catastrophic thinking about pain. Further analyses revealed that pain intensity and catastrophic thinking about pain, but not negative affectivity, mediated the relationship between diagnostic group and vigilance to pain. CONCLUSION: Fibromyalgia patients report a heightened vigilance to pain. This vigilance is not a unique characteristic of fibromyalgia but is related to the intensity of pain and catastrophic thinking about pain. 367 PMID- 15567212 AU - Dammen T, Arnesen H, Ekeberg O, Friis S TI - Psychological factors, pain attribution & medical morbidity in chest-pain pts w & without coronary artery disease. [FM] SO - Gen Hosp Psychiatry 2004 Nov-Dec;26(6):463-9. IN - D o Psychiatry, Ulleval U Hosp, N-0407 Oslo, Norway. toril.dammen@medisin.uio.no AB - This cross-sectional psychiatric and cardiological study compared patients with and without coronary artery disease (CAD) with respect to psychiatric morbidity, psychological factors, pain characteristics, medical morbidity and the prevalence of coronary risk factors. The 199 participants had been referred to cardiological outpatient clinics for the investigation of chest pain and had no history of heart disease. Current panic disorder occurred significantly more often in non-CAD patients (41% vs. 22%). No significant differences were found for other psychiatric disorders and psychological variables. Non-CAD patients reported significantly longer histories of pain and a higher prevalence of atypical chest pain. In other respects, there were surprisingly few differences between the groups. High morbidity of both psychiatric disease (pain disorder, 19%; any current psychiatric disorder, 72%) and somatic conditions (musculoskeletal disease, 33%; dyspepsia, 23%) was found with no significant differences between the groups. In these patients, multifactorial complaints may explain chest pain in both patient groups. The physicians should attend to psychiatric disorders in non-CAD as well as in CAD patients. 368 PMID- 15240435 AU - de Lange FP, Kalkman JS, Bleijenberg G, Hagoort P, van der Werf SP, van der Meer JW, Toni I TI - Neural correlates of the CFS--an fMRI study. SO - Brain 2004 Sep;127(Pt 9):1948-57. Epub 2004 Jul 7. IN - F.C. Donders Centre for Cognitive Neuroimaging, U o Nijmegen, NL-6500 HB Nijmegen, The Netherlands E-mail: floris.delange@fcdonders.kun.nl AB - Chronic fatigue syndrome (CFS) is characterized by a debilitating fatigue of unknown aetiology. Patients who suffer from CFS report a variety of physical complaints as well as neuropsychological complaints. Therefore, it is conceivable that the CNS plays a role in the pathophysiology of CFS. The purpose of this study was to investigate neural correlates of CFS, and specifically whether there exists a linkage between disturbances in the motor system and CFS. We measured behavioural performance and cerebral activity using rapid event-related functional MRI in 16 CFS patients and 16 matched healthy controls while they were engaged in a motor imagery task and a control visual imagery task. CFS patients were considerably slower on performance of both tasks, but the increase in reaction time with increasing task load was similar between the groups. Both groups used largely overlapping neural resources. However, during the motor imagery task, CFS patients evoked stronger responses in visually related structures. Furthermore, there was a marked between-groups difference during erroneous performance. In both groups, dorsal anterior cingulate cortex was specifically activated during error trials. Conversely, ventral anterior cingulate cortex was active when healthy controls made an error, but remained inactive when CFS patients made an error. Our results support the notion that CFS may be associated with dysfunctional motor planning. Furthermore, the between-groups differences observed during erroneous performance point to motivational disturbances as a crucial component of CFS. 369 PMID- 15242142 AU - Dedert EA, Studts JL, Weissbecker I, Salmon PG, Banis PL, Sephton SE TI - Religiosity may help preserve the cortisol rhythm in women w stress-related illness. SO - Int J Psychiatry Med 2004;34(1):61-77. IN - U o Louisville, Kentucky, USA. AB - OBJECTIVE: Fibromyalgia has been characterized as a basic disorder of endocrine stress responses in which psychological stress has been linked both with etiology and symptom severity. This study investigated associations of religiosity and spirituality with psychological and physiological (endocrine) measures of stress in a sample of women with fibromyalgia. METHOD: Ninety-one participants provided self-reports of religiosity and spirituality using the Duke University Religion Index (DUREL) and the Index of Core Spiritual Experiences (INSPIRIT). Psychological outcomes were measured with the Perceived Stress Scale (PSS), and diurnal salivary cortisol profiles were measured as an indicator of neuroendocrine regulation. RESULTS: Hierarchal regression analyses controlling for age and medications likely to affect cortisol levels revealed significant associations of nonorganizational religiosity and intrinsic religiosity with the diurnal cortisol rhythm. Patients reporting medium or high religiosity had rhythmic cortisol profiles characterized by high morning and low evening levels. In contrast, cortisol rhythms of those reporting low religiosity appeared flattened. The association between intrinsic religiosity and cortisol rhythm persisted after controlling for social support. No significant effects of religiosity or spirituality on perceived stress were observed. CONCLUSIONS: These data suggest that religiosity may have a protective effect on the physiological effects of stress among women with fibromyalgia. 370 PMID- 14690675 AU - Delorme T, Boureau F, Eymard B, Laforet P, Cottrel F TI - Clinical study of chr pain in hered. myopathies. [FM] SO - Eur J Pain 2004 Feb;8(1):55-61. IN - Centre d'Evaluation et de Traitement de la Douleur, Hopital Saint-Antoine, 184 rue du Faubourg, 75102 Saint Antoine, Paris, France. thierry.delorme@curie.net AB - In the field of neuromuscular diseases, pain and its management remain imperfectly understood and described. We study 68 unselected, consecutive adult patients attending a multidisciplinary consultation for hereditary myopathy. Forty-six (67%) were suffering from chronic pain. Pain was assessed with self report questionnaire and a standardized clinical evaluation. Mean duration of the pain was 7.2+/-8.9 years, and multiple body sites were involved in 91% of cases. Usual pain intensity (Visual Analogue Scale 0-100) was moderate (39.5+/-26.2). For 42 patients (91%) the principal cause of the pain was of muscular origin, with frequent features of myofascial pain syndromes (MPS, 50%) and fibromyalgia (FMS, 26%). Pain was the major complaint for 6.3% of the patients. Pain management was essentially based on physiotherapy. Only a minority of patients (38%) has an appropriate drug treatment. Common analgesics appeared to be very effective in these patients. 371 PMID- 14751012 AU - Deluca J, Christodoulou C, Diamond BJ, Rosenstein ED, Kramer N, Natelson BH TI - Working memory deficits in CFS: differentiating between speed & accuracy of information processing. SO - J Int Neuropsychol Soc 2004 Jan;10(1):101-9. IN - D o Physical Med & Rehabilitation, U o Med & Dentistry o New Jersey, New Jersey MS, Newark, New Jersey, USA. Jdeluca@kmrrec.org AB - To examine the relative influence of speed of information processing versus working memory ability, CFS participants with psychiatric comorbidity (CFS-Psych) and CFS without a psychiatric history (CFS-noPsych) were examined on tests of visual and auditory processing speed and visual and auditory working memory. Compared to healthy controls (HC) and a group of participants with rheumatoid arthritis (RA), the CFS-noPsych group displayed significantly reduced performance on tests of information processing speed, but not on tests of working memory. No significant differences were observed between the CFS-Psych group and any other group in the study. The implications of group heterogeneity on the understanding of cognitive impairment in CFS are discussed. 372 PMID- 15222602 AU - Denison B TI - Touch the pain away: new research on therapeutic touch & persons w FM syndrome. SO - Holist Nurs Pract 2004 May-Jun;18(3):142-51. IN - Wichita St U & the Kansas Heart Hosp, Wichita, KS, USA. bde+ AB - +IN: nison@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. 373 PMID- 15496230 AU - Denko CW, Malemud CJ TI - Age-related changes in serum growth hormone, insulin-like growth factor-1 & somatostatin in system lupus erythematosus. [FM] SO - BMC Musculoskelet Disord. 2004 Oct 20;5(1):37. IN - D o Medicine/Division o Rheumatic Diseases, Case Western Reserve U School o Med, Cleveland, OH 44106-5076, USA. cwd2@cwru.edu AB - BACKGROUND: Systemic lupus erythematosus is an age- and gender-associated autoimmune disorder. Previous studies suggested that defects in the hypothalamic/pituitary axis contributed to systemic lupus erythematosus disease progression which could also involve growth hormone, insulin-like growth factor-1 and somatostatin function. This study was designed to compare basal serum growth hormone, insulin-like growth factor-1 and somatostatin levels in female systemic lupus erythematosus patients to a group of normal female subjects. METHODS: Basal serum growth hormone, insulin-like growth factor-1 and somatostatin levels were measured by standard radioimmunoassay. RESULTS: Serum growth hormone levels failed to correlate with age (r2 = 3.03) in the entire group of normal subjects (i.e. 20 - 80 years). In contrast, serum insulin-like growth factor-1 levels were inversely correlated with age (adjusted r2 = 0.092). Of note, serum growth hormone was positively correlated with age (adjusted r2 = 0.269) in the 20 - 46 year range which overlapped with the age range of patients in the systemic lupus erythematosus group. In that regard, serum growth hormone levels were not significantly higher compared to either the entire group of normal subjects (20 - 80 yrs) or to normal subjects age-matched to the systemic lupus erythematosus patients. Serum insulin-like growth factor-1 levels were significantly elevated (p < 0.001) in systemic lupus erythematosus patients, but only when compared to the entire group of normal subjects. Serum somatostatin levels differed from normal subjects only in older (i.e. >55 yrs) systemic lupus erythematosus patients. CONCLUSIONS: These results indicated that systemic lupus erythematosus was not characterized by a modulation of the growth hormone/insulin-like growth factor-1 paracrine axis when serum samples from systemic lupus erythematosus patients were compared to age- matched normal female subjects. These results in systemic lupus erythematosus differ from those previously reported in other musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, fibromyalgia, diffuse idiopathic skeletal hyperostosis and hypermobility syndrome where significantly higher serum growth hormone levels were found. Somatostatin levels in elderly systemic lupus erythematosus patients may provide a clinical marker of disease activity in these patients. 374 PMID- 15325387 AU - Derbyshire SW, Whalley MG, Stenger VA, Oakley DA TI - Cerebral activation during hypnotically induced & imagined pain. [FM] SO - Neuroimage 2004 Sep;23(1):392-401. IN - D o Anesthesiology, U o Pittsburgh Med Ctr, Pittsburgh, PA 15213, USA. derbyshiresw@anes.upmc.edu AB - The continuing absence of an identifiable physical cause for disorders such as chronic low back pain, atypical facial pain, or fibromyalgia, is a source of ongoing controversy and frustration among pain physicians and researchers. Aberrant cerebral activity is widely believed to be involved in such disorders, but formal demonstration of the brain independently generating painful experiences is lacking. Here we identify brain areas directly involved in the generation of pain using hypnotic suggestion to create an experience of pain in the absence of any noxious stimulus. In contrast with imagined pain, functional magnetic resonance imaging (fMRI) revealed significant changes during this hypnotically induced (HI) pain experience within the thalamus and anterior cingulate (ACC), insula, prefrontal, and parietal cortices. These findings compare well with the activation patterns during pain from nociceptive sources and provide the first direct experimental evidence in humans linking specific neural activity with the immediate generation of a pain experience. 375 PMID- 15180033 AU - DeSouza RA, Cardenas RJ, Lindler TU, De la Fuente FA, Mayorquin FJ, Trochtenber+ TI - Mitochondrial encephalomyopathy w lactic acidosis & strokelike episodes (MELAS): a mitochondrial disorder presents as FM. SO - South Med J 2004 May;97(5):528-31. IN - Meharry Med Coll & Centennial Med Ctr, Nashville, TN 38208-+ AB - +IN: 3599, USA. +AU: g DS This case report describes a patient who presented with symptoms and signs of longstanding fibromyalgia. Routine laboratory tests revealed an elevated anion gap. Evaluation of the elevated anion gap demonstrated elevated lactate and pyruvate levels and a lactate-to-pyruvate ratio greater than 20:1. A muscle biopsy was performed, exhibiting red ragged fibers, pathognomonic for a mitochondrial disorder. The patient was diagnosed with mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS). This is the first report describing fibromyalgia as the initial presentation of MELAS. This article outlines the diagnostic process that can assist the physician in distinguishing mitochondrial disorders from other muscular diseases, particularly fibromyalgia. 376 PMID- 15301243 AU - DeWalt DA, Reed GW, Pincus T TI - Further clues to recognition of pts w FM from a simple 2-page patient multidimensional health assessment questionnaire (MDHAQ). SO - Clin Exp Rheumatol 2004 Jul-Aug;22(4):453-61. IN - U o North Carolina School o Med, Chapel Hill, North Carolin+ AB - +IN: a, USA. OBJECTIVE: To analyze quantitative scores for pain, fatigue, functional disability, and the number of symptoms on a review of systems on a multidimensional health assessment questionnaire (MDHAQ), including the ratios of scores for pain to physical function and fatigue to physical function, and to further study how these scores can help to identify patients with fibromyalgia. METHODS: All consecutive patients seen at a rheumatology clinic completed a 2-sided, 1-page MDHAQ at each visit to assess physical function, pain, fatigue, global status, helplessness and review of systems, and had their erythrocyte sedimentation rate (ESR) measured. Scores for these variables were analyzed in 78 consecutive patients with fibromyalgia over a two-year period, and in 149 patients with rheumatoid arthritis (RA) as a "control" group. A subset analysis was conducted in patients with RA who were classified independently according to clinical criteria as having or not having coexistent fibromyalgia. Descriptive statistics, logistic regression, and receiver-operating-characteristic curves were computed for patients with fibromyalgia and compared to patients with RA. RESULTS: Patients with fibromyalgia had high ratios of pain:physical function and fatigue:physical function scores, and a high number of reported symptoms. These quantitative data differed significantly from patients with RA. Patients with fibromyalgia also had a lower ESR than patients with RA, whose scores were similar whether or not there was coexistent fibromyalgia. Patients with fibromyalgia were distinguished equally well from patients with RA by patient questionnaire data as by the ESR. CONCLUSION: A simple 1-page, 2-sided patient questionnaire provides quantitative information which may contribute to identify patients with fibromyalgia, including patients with RA who may also have coexistent fibromyalgia. 377 PMID- 15229956 AU - Diaz-Lopez C, Geli C, Corominas H, Malat N, Diaz-Torner C, Llobet JM, De La Serna AR, Laiz A, Moreno M, Vazquez G TI - Are there clinical or serological differences between male & female pts w primary SS? [FM] SO - J Rheumatol 2004 Jul;31(7):1352-5. IN - Unitat de Reumatologia, Departament de Medicina Interna, Hosp de la Santa Creu i Sant Pau, Avenida San Antoni M. Claret 167, 08025 Barcelona, Catalonia, Spain. AB - OBJECTIVE: Sjogren's syndrome (SS) is a chronic inflammatory autoimmune disease. It can be primary (pSS) or secondary (sSS) and is observed 90% more in women than in men, mainly in the fourth and fifth decades of life. We investigated the prevalence of serological and clinical manifestations in male and female patients with primary SS. METHODS: We analyzed 521 female and 28 male patients with pSS between 1993 and 2001. All patients fulfilled > or = 4 of the 1993 European Community Study Group criteria. RESULTS: Men presented higher concentrations of IgA, rheumatoid factor, and antinuclear antibodies than women. A higher percentage of women than men reported fibromyalgia, thyroidal manifestations, and carpal tunnel syndrome. There were no statistical differences between the 2 groups in relation to the presence of Raynaud's phenomenon, arthritis, erosive osteoarthritis, liver disease, or other visceral manifestations. CONCLUSION: The pattern of SS in our cohort of patients reveals a difference between male and female patients, in contrast with earlier studies. 378 PMID- 15273492 AU - DiVasta AD, Alexander ME TI - Fainting freshmen & sinking sophomores: cardiovascular issues of the adolescent. [CFS] SO - Curr Opin Pediatr 2004 Aug;16(4):350-6. IN - Division o Adolescent & Young Adult Med, D o Cardiology, Children's Hosp Boston, Harvard MS, Boston, Mass 02115, USA. amy.divasta@childrens.harvard.edu AB - PURPOSE OF REVIEW: Syncope is a common symptom in adolescents. The vast majority of cases are the result of benign neurocardiogenic syncope, without associated risk of sudden death. This paper reviews the mainstays of diagnosis and treatment for syncopal episodes, differentiation of syncope from life-threatening arrhythmia and aborted sudden cardiac death, and the patient populations at highest risk for cardiac symptoms and cardiac disease. RECENT FINDINGS: A detailed history (including past medical history and family history that focus on cardiac disease) combined with dynamic physical examination and electrocardiogram identifies the vast majority of adolescents with significant heart disease. Further diagnostic modalities have limited utility. Reassurance and supportive measures remain the treatment of choice, although drug therapy can sometimes be helpful, even if data are limited. Divergent approaches to the screening of the young competitive athlete exist. Particular attention is required in adolescents and young adults with exercise-associated syncope, eating disorders, chronic fatigue syndrome, or history of congenital heart disease. Their symptoms may be either more serious or challenging to manage. SUMMARY: Syncope in the adolescent patient is very common; true cardiac disease is not. The traditional diagnostic screen of history and physical combined with an electrocardiogram will identify the overwhelming majority of patients with significant disease. Patients with abnormalities on this initial office evaluation, history of cardiac disease, or complicating medical illness may benefit from referral to a cardiologist. Even within this patient subset, many will prove to have benign disease. 379 PMID- 14980990 AU - Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA TI - Posttraumatic stress disorder in female veterans: association w self-reported health problems & functional impairment. [CFS] SO - Arch IM 2004 Feb 23;164(4):394-400. IN - Departments o Psychiatry & Behavioral Sciences, U o Washington School o Med, Seattle, WA, USA. djdobie@u.washington.edu AB - BACKGROUND: The purpose of this report is to identify self-reported health problems and functional impairment associated with screening positive for posttraumatic stress disorder (PTSD) in women seen for care at a Department of Veterans Affairs (VA) medical center. METHODS: A survey was mailed to all women (N = 1935) who received care at the VA Puget Sound Health Care System between October 1996 and January 1998. The survey inquired about health history and habits. It included the PTSD Checklist-Civilian Version (PCL-C) and validated screening measures for other psychiatric disorders. The veteran's version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36-V) was included to assess health-related quality of life. RESULTS: Of the 1259 eligible women who completed the survey, 266 women (21%) screened positive for current PTSD (PCL-C score >or= 50). In age-adjusted bivariate analyses, women who screened positive for PTSD reported more psychiatric problems, substance abuse, and lifetime exposure to domestic violence. They were significantly more likely to endorse physical health problems including obesity, smoking, irritable bowel syndrome, fibromyalgia, chronic pelvic pain, polycystic ovary disease, asthma, cervical cancer, and stroke. In fully adjusted multivariate models, a PCL-C score of 50 or greater was independently associated with scoring in the lowest quartile on SF-36-V subscales and composite scales. CONCLUSIONS: Symptoms of PTSD are common in women treated at VA facilities. In addition, PTSD is associated with self-reported mental and physical health problems and poor health-related quality of life in these patients. These findings have implications for the design of VA primary care services for the growing population of female veterans. 380 PMID- 15249530 AU - Doron Y, Peleg R, Peleg A, Neumann L, Buskila D TI - The clinical & economic burden of FM compared w diabetes mellitus & hypertension among Bedouin women in the Negev. SO - Fam Pract 2004 Aug;21(4):415-9. IN - D o Family Med, Soroka Med Ctr & Faculty o the Health Sciences, Ben-Gurion U o the Negev, Beer-Sheva, Israel. AB - BACKGROUND: Fibromyalgia (FM) is a common idiopathic chronic, widespread pain syndrome with tenderness in anatomically defined tender points. OBJECTIVES: The purpose of the present study was to describe and characterize the economic and daily work burden of FM compared with diabetes mellitus and hypertension. METHODS: A retrospective study was conducted in 2001 in a primary care clinic, the Kuseife clinic of the Clalit Health Services. Data for the three study groups were obtained from the computerized database of the Kuseife clinic and the Negev District, Israel. The study group included 102 FM patients. The control groups included 102 diabetes patients and 103 patients with hypertension. RESULTS: Hospitalization and hospital day care services were the main expenses incurred by patients in this study. There were no differences among the study groups in any cost parameter examined except for the cost of diagnostic tests (P < 0.01), which was less for FM patients. FM patients were referred to specialists and diagnostic procedures more frequently than the control groups. No statistical difference was found in the total number of clinic visits, but FM patients visited physicians more frequently and visited nurses less frequently than patients in the other two groups (P < 0.05). CONCLUSIONS: FM patients consume health care resources to a similar extent to patients with other chronic diseases such as diabetes mellitus and hypertension, but the latter usually receive much more attention from the health care system. Greater awareness of this disorder can improve management and facilitate planning of health care resources, thus improving quality of care. 381 PMID- 15266475 AU - Edmonds M, McGuire H, Price J TI - Exercise therapy for CFS. SO - Cochrane Database Syst Rev 2004;(3):CD003200. AB - BACKGROUND: Chronic fatigue syndrome (CFS) is an illness characterised by persistent medically unexplained fatigue. CFS is a serious health-care problem with a prevalence of up to 3%. Treatment strategies for CFS include psychological, physical and pharmacological interventions. OBJECTIVES: To investigate the relative effectiveness of exercise therapy and control treatments for CFS. SEARCH STRATEGY: CCDANCTR-Studies and CENTRAL were searched using "Chronic Fatigue" and Exercise. The Journal of Chronic Fatigue Syndrome and CFS conferences were handsearched. Experts in the field were contacted. Clinicaltrials.gov and controlled-trials.com were searched. SELECTION CRITERIA: Only Randomised Controlled Trials (RCT) including participants with a clinical diagnosis of CFS and of any age were included. DATA COLLECTION AND ANALYSIS: The full articles of studies identified were inspected by two reviewers (ME and HMG). Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals. One sensitivity analysis was undertaken to test the robustness of the results. MAIN RESULTS: Nine studies were identified for possible inclusion in this review, and five of those studies were included. At 12 weeks, those receiving exercise therapy were less fatigued than the control participants (SMD -0.77, 95% CIs -1.26 to -0.28). Physical functioning was significantly improved with exercise therapy group (SMD -0.64, CIs -0.96 to -0.33) but there were more dropouts with exercise therapy (RR 1.73, CIs 0.92 to 3.24). Depression was non-significantly improved in the exercise therapy group compared to the control group at 12 weeks (WMD -0.58, 95% CIs -2.08 to 0.92).Participants receiving exercise therapy were less fatigued than those receiving the antidepressant fluoxetine at 12 weeks (WMD -1.24, 95% CIs -5.31 to 2.83). Participants receiving the combination of the two interventions, exercise + fluoxetine, were less fatigued than those receiving exercise therapy alone at 12 weeks, although again the difference did not reach significance (WMD 3.74, 95% CIs -2.16 to 9.64).When exercise therapy was combined with patient education, those receiving the combination were less fatigued than those receiving exercise therapy alone at 12 weeks (WMD 0.70, 95% CIs -1.48 to 2.88). REVIEWERS' CONCLUSIONS: There is encouraging evidence that some patients may benefit from exercise therapy and no evidence that exercise therapy may worsen outcomes on average. However the treatment may be less acceptable to patients than other management approaches, such as rest or pacing. Patients with CFS who are similar to those in these trials should be offered exercise therapy, and their progress monitored Further high quality randomised studies are needed. 382 PMID- 15257510 AU - Engstrom JW TI - Myasthenia gravis: diagnostic mimics. [CFS] SO - Semin Neurol 2004 Jun;24(2):141-7. IN - Professor o Neurology, D o Neurology, U o California, San Francisco, California 94143-0114, USA. AB - The clinical hallmark of myasthenia gravis (MG) is fluctuating, painless weakness of muscles that most often affect extraocular, lower bulbar, or limb musculature. Predicting the probability of successful treatment for the patient assumes that the physician has made an accurate diagnosis. In this review, the practical differential diagnosis of MG is reviewed from the perspective of conditions (at presentation of symptoms and signs) that may mimic the disorder. The differential diagnosis includes disorders that limit eye movements (with or without associated diplopia), cause false-positive laboratory studies, and mimic MG but have normal eye movements. The differential diagnosis includes disorders that affect the upper brainstem, cranial nerves, neuromuscular junction, muscles, or local orbit anatomy. Nonneurological systemic diseases (i.e., encephalopathy, sepsis) can produce fluctuating ptosis or eye movements that can occasionally be confused with MG. Although MG is considered often in the differential diagnosis of weakness or fatigue symptoms that lack a correlate on neurological examination (subjective fatigue, breakaway weakness, chronic fatigue syndrome), MG is almost never found. 383 PMID- 15082096 AU - Eriksen W TI - Linking work factors to neck myalgia: the nitric oxide/oxygen ratio hypothesis. [FM] SO - Med Hypotheses 2004;62(5):721-6. IN - D o General Practice & Community Med, U o Oslo, P.O. Box 1130, Blindern, 0318 Oslo, Norway. w.b.eriksen@samfunnsmed.uio.no AB - The pathophysiological link between work-related exposures and neck myalgia remains a puzzle. According to the hypothesis presented here, neck myalgia is evoked when low-level contractions in the trapezius muscle are combined with sympathetic vasoconstriction due to psychological stress or prolonged head-down neck flexion at work. These ischemic contractions increase nitric oxide/oxygen concentration ratio in the muscle fibres, enhancing herewith the reversible inhibition of mitochondrial cytochrome oxidase by nitric oxide. The result is depletion of adenosine triphosphate, which elicits production/efflux of lactic acid, in turn activating and sensitising proton-sensitive nociceptive fibres in the connective tissue, causing myalgic pain and tenderness. High estrogen-level, which gives a high expression of nitric oxide synthase in the muscle, accentuates the situation. During episodes of sustained inhibition of cytochrome oxidase by nitric oxide, peroxynitrite may be produced and cause irreversible inactivation of several enzymes in the mitochondrial electron-carrier chain. With repeated episodes, an increasing part of the enzymatic capacity for cellular respiration is inactivated. Even if this process only takes place within a small portion of the muscle fibres, it may contribute to frequent exacerbations of pain. Effects of peroxinitrite may also explain the mitochondrial abnormalities found in the trapezius muscle of many neck myalgia patients. Adrenergic antagonists and nitric oxide synthase inhibitors could reduce symptoms. Ascorbic acid, alpha tocopherol, and flavonoids, which are safe and effective scavengers of peroxynitrite, could prevent chronicity. The most effective non-pharmacological measure may be to reduce exposure to prolonged head-down neck flexions and psychosocial stress at work. 384 PMID- 15094030 AU - Eriksen HR, Ursin H TI - Subjective health complaints, sensitization, & sustained cognitive activation (stress). [CFS] SO - J Psychosom Res 2004 Apr;56(4):445-8. IN - D o Biological & Med Psychology, U o Bergen, Jonas Lies vei 91, N-5009 Bergen, Norway. hege.eriksen@psych.uib.no AB - INTRODUCTION: This review argues that "subjective health complaints" is a better and neutral term for "unexplained medical symptoms." The most common complaints are musculoskeletal pain, gastrointestinal complaints and "pseudoneurology" (tiredness, sleep problems, fatigue, and mood changes). These complaints are common in the general population, but for some these complaints reach a level that requires care and assistance. THEORETICAL ASSUMPTIONS: We suggest that these complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not. Cases without somatic disease, or with minimal somatic findings, occur under diagnoses like burnout, epidemic fatigue, multiple chemical sensitivity, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness. CONCLUSION: The psychobiological mechanisms for this is suggested to be sensitization in neural loops maintained by sustained attention and arousal. 385 PMID- 15088299 AU - Eriksson P, Andersson C, Ekerfelt C, Ernerudh J, Skogh T TI - SS w myalgia is associated w subnormal secretion of cytokines by peripheral blood mononuclear cells. [FM] SO - J Rheumatol 2004 Apr;31(4):729-35. IN - Division o Rheumatology, D o Molecular & Clinical Med, Autoimmunity & Immunoregulation Unit, Faculty o Health Sciences, Linkoping U Hosp, Linkoping, Sweden. per.eriksson@lio.se AB - OBJECTIVE: To measure in vitro cytokine release from peripheral blood mononuclear cells (PBMC) and serum cytokines in patients with primary Sjogren's syndrome (SS) with and without myalgia, compared to patients with rheumatoid arthritis (RA) and healthy controls. METHODS: Sixteen women with SS (8 with myalgia, 8 without pain), 15 women with RA, and 14 healthy women were studied. PBMC were isolated and cultured. Secretion of interleukin 1 beta (IL-1 beta), IL-6, IL-10, and tumor necrosis factor-alpha (TNF-alpha) was measured in cell supernatants with or without stimulation with phytohemagglutinin, tetanus toxoid, or purified protein derivative (PPD). Enzyme-linked immunospot was used to enumerate interferon-gamma (IFN-gamma) and IL-4-secreting cells. Serum concentrations of IL-8 and IL-18 were analyzed by ELISA. RESULTS: PPD-stimulated PBMC from SS patients responded with less production of IL-10, TNF-alpha, and IFN-gamma compared to controls. Patients with SS and pain were hyporesponsive also with respect to IL-1 beta and IL-6. The generally subnormal cytokine release was statistically significant in myalgic patients with SS compared to healthy controls. Serum IL-18 was increased in both SS groups as well as in patients with RA, and the highest levels were found in myalgic patients with SS. Serum IL-8 was increased in RA but not in SS. CONCLUSION: Patients with SS, especially those with myalgia, had diminished PBMC cytokine release and increased serum IL-18. This finding suggests that impaired cytokine regulation may have pathogenetic importance for myalgia in SS. 386 PMID- 15301985 AU - Ernst E TI - Musculoskeletal conditions & complementary/alternative medicine. [CFS] SO - Best Pract Res Clin Rheumatol 2004 Aug;18(4):539-56. IN - Complementary Med, Peninsula MS, Universities o Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. edzard.ernst@pms.ac.uk AB - Complementary/alternative medicine (CAM) is immensely popular for musculoskeletal conditions. It is, therefore, essential to define CAM's value for such indications. This chapter summarises the trial data for or against CAM as a symptomatic treatment for back pain, fibromyalgia, neck pain, osteoarthritis and rheumatoid arthritis. Collectively the evidence demonstrates that some CAM modalities show significant promise, e.g. acupuncture, diets, herbal medicine, homoeopathy, massage, supplements. None of the treatments in question is totally devoid of risks. By and large the data are not compelling, not least due to their paucity and methodological limitations. It is, therefore, concluded that our research efforts must be directed towards defining which form of CAM generates more good than harm for which condition. 387 PMID- 15252208 AU - Faggioli P, Giani L, Chianese R, Cusa C, Mazzone A TI - Increase in peripheral benzodiazepine receptors on monocytes in FM. SO - Rheumatology (Oxford) 2004 Oct;43(10):1224-5. Epub 2004 Jul 13. IN - Internal Med & Rheumatology Unit, Legnano Hosp, Via Candiani 2, 20025 Legnano, Milan, Italy. medicina2legnano@ao-legnano.it AB - OBJECTIVE: The aim of this study is to evaluate the expression of Peripheral Benzodiazepine Receptors (PBRs) on leukocytes in patients affected by primary fibromyalgia and to argue their possible role in pain perception and in modulation of immunologic process. METHODS: The expression of PBRs has been evaluated by flow cytometry on monocytes, on lymphocytes and on granulocytes in twenty patients with primary fibromyalgia, with indirect immunofluorescence methods. RESULTS: Upregulation of leukocyte PBRs expression has been demonstrated in fibromyalgia. A statistically significant difference has been documented only in monocytes. The monocyte PBRs expression was 26.74 +/- 14.84 MIF in fibromyalgia versus 17.45 +/- 8.54 MIF in controls (P < 0.023). Upregulation of PBRs expression, although not statistically significant, was also observed in lymphocytes and granulocytes. CONCLUSIONS: The monocyte PBRs overincrease in fibromyalgia may be due to abnormalities in the regulation of pain or to inflammation. It might perhaps explicate the possible mechanisms of therapeutic response to benzodiazepine in fibromyalgia. 388 PMID- 15591010 AU - Famularo G, De Simone C, Trinchieri V, Mosca L TI - Carnitines & its congeners: a metabolic pathway to the regulation of immune response & inflamm. [FM] SO - Ann N Y Acad Sci 2004 Nov;1033:132-8. IN - D o Internal Med, San Camillo Hosp, Circonvallazione Gianicolense, 00152 Rome, Italy. gfamularo@scamilloforlanini.rm.it AB - Carnitine and its congeners may regulate the immune networks, and their influence on functions of immune cells predominantly or exclusively relies on carnitine-dependent energy production from fatty acids. A reduced pool of carnitines has been demonstrated in either serum or tissues, or both, from patients with a wide spectrum of disorders characterized by unregulated or impaired immune responses ranging from sepsis syndrome to systemic sclerosis, infection with human immunodeficiency virus, and chronic fatigue syndrome. Furthermore, experimental studies have consistently reported that the deranged immune responses and the less efficient inflammation towards infectious organisms associated with aging may be enhanced or modulated by treatment with carnitines. There is also evidence that carnitine deprivation could adversely affect the course of the sepsis syndrome, at least in experimental models, and preliminary studies suggest that carnitine deficiency is ultimately implicated in the pathophysiology of endotoxin-mediated multiple organ failure. Several data indicate that carnitine deficiency is a contributing factor to the progression of infection with human immunodeficiency virus, and carnitine therapy in those patients could counteract the unregulated process of lymphocyte apoptosis and improve CD4 counts. Some case reports have suggested the use of carnitine for the treatment of the severe lactic acidosis that complicates in some patients the use of reverse transcriptase inhibitors. 389 PMID- 15515404 AU - Farber L, Haus U, Spath M, Drechsler S TI - Physiology & pathophysiology of the 5-HT3 receptor. [FM] SO - Scand J Rheumatol Suppl 2004;(119):2-8. IN - D o Pharmacology, Regensburg MS, Regensburg, Germany. LFaerber@web.de AB - The 5-HT3 receptor is a ligand-gated cation channel located in the central and peripheral nervous system; it has also been detected on a variety of other cells. In the periphery, it is found on autonomic neurons and on neurons of the sensory and enteric nervous system. In the CNS, the 5-HT3 receptor has been localized in the area postrema, nucleus tractus solitarii, nucleus vaudatus, nucleus accumbens, amygdala, hippocampus, entorhinal, frontal, cingulate cortex, and in the dorsal horn ganglia. Further extraneuronal locations include among others lymphocytes, monocytes, and foetal tissue. 5-HT3 receptors modulate the release of neurotransmitters and neuropeptides like dopamine, cholecystokinin, acetylcholine, GABA, substance P, and serotonin itself. They have been demonstrated to be involved in sensory transmission, regulation of autonomic functions, integration of the vomiting reflex, pain processing and control of anxiety. While the physiologic functions of the 5-HT3 receptor are discrete and difficult to detect, it plays a key role in certain pathologic situations related to increased serotonin release. Clinical development of 5-HT3 receptor antagonists revealed a remarkable range of activities. 5-HT3 receptor antagonists do not modify any aspect of normal behaviour in animals or induce pronounced changes of physiological functions in healthy subjects. Clinical efficacy was shown for various forms of emesis like chemotherapy-induced, radiotherapy-induced, and postoperative emesis, diarrhoea-predominant irritable bowel syndrome, anxiety, chronic fatigue syndrome, alcohol abuse, and in pain syndromes such as fibromyalgia and migraine. Most recent data also suggest that 5-HT3 receptor antagonists are effective for the treatment of other rheumatic diseases such as rheumatoid arthritis, tendinopathies, periarthropathies, and myofascial pain. Other possible indications under discussion are chronic heart pain and bulimia. Unfortunately, experimental findings do not yet provide a homogenous conception of the significance of 5-HT3 receptors in all investigated fields; in nociception, for example, contradictory observations are still inadequately explained and complicated by bell-shaped dose-response curves. Further elucidation and better understanding of the serotonergic neuronal network remains a task for the next decade. 390 PMID- 15172940 AU - Farmer A, Fowler T, Scourfield J, Thapar A TI - Prevalence of chr disabling fatigue in children & adolescents. [CFS] SO - Br J Psychiatry 2004 Jun;184:477-81. IN - MRC Social, Genetic, Developmental Psychiatric Research Centre, Inst o Psychiatry, London, UK. spjuaef@iop.kcl.ac.uk. AB - BACKGROUND: The epidemiology of chronic fatiguing illnesses in young people is poorly understood. AIMS: To estimate the lifetime prevalence of different definitions of chronic fatigue in 8- to 17-year-olds. METHOD: Participants came from two population-based twin series. Parents completed self-report questionnaires that inquired whether either child had ever experienced more than a few days of disabling fatigue. Telephone interviews were undertaken for individuals who had experienced such an episode. RESULTS: Questionnaires were returned by 1468 families (65% response rate) and telephone interviews were undertaken regarding 99 of the 129 subjects (77%) who had experienced fatigue. The lifetime prevalence estimates ranged from 2.34% (95% CI 1.75-2.94) for disabling fatigue lasting 3 months to 1.29% (95% CI 0.87-1.71) for a disorder resembling adult operationally defined chronic fatigue syndrome. CONCLUSIONS: From the age of 11 years, young people have similar rates and types of chronic fatiguing illnesses to adults. 391 PMID- 15078735 AU - Farney RJ, Lugo A, Jensen RL, Walker JM, Cloward TV TI - Simultaneous use of antidepressant & antihypertensive medications increases likelihood of Dx of obstructive sleep apnea syndrome. SO - Chest 2004 Apr;125(4):1279-85. IN - Intermountain Sleep Disorders Ctr, LDS Hosp, Salt Lake City, UT 84143, USA. rjfmd@msn.com AB - BACKGROUND: Essential hypertension and symptoms of depression such as unexplained fatigue and tiredness are frequently encountered in primary medical care clinics. Although, exhaustive evaluation rarely detects unsuspected underlying disorders, obstructive sleep apnea (OSA) is commonly associated with each of these conditions. We tested the hypothesis that therapy with antihypertensive and antidepressant medications predicts the increased likelihood of OSA. METHODS: We analyzed the computer archive of 212,972 patients for prescriptions for antihypertensive medications, antidepressant medications, and International Classification of Diseases, Ninth Revision codes for OSA. Prevalence, prevalence odds ratio (POR), and confidence intervals (CIs) were calculated correcting for gender and age group. RESULTS: The prevalence rates of OSA were 0.8%, 2.8%, and 3.2% for men and 0.4%, 1.4%, and 1.8% for women aged 20 to 39 years, 40 to 59 years, and >or= 60 years, respectively. Compared to groups of corresponding age and gender who had not received prescriptions for either hypertension or depression, the highest PORs were found in patients receiving medications from both categories: 18.30 (95% CI, 10.69 to 25.66), 5.72 (95% CI, 4.10 to 6.70), and 4.47 (95% CI, 2.45 to 7.01) for men, and 17.43 (95% CI, 9.54 to 28.67), 7.29 (95% CI, 5.20 to 9.29), and 2.72 (95% CI, 1.48 to 4.73) for women. CONCLUSIONS: We found that the likelihood of having a diagnosis of OSA increases when either antihypertensive or antidepressant medications have been prescribed. The probability is highest in the young and middle-age groups receiving prescriptions for both medications. The possibility of OSA should be considered in any patient with hypertension and depression or unexplained fatigue who is receiving antihypertensive and antidepressant medications. 392 PMID- 15041925 AU - Fietta P TI - FM: state of the art. SO - Minerva Med 2004 Feb;95(1):35-47, 47-52. IN - Rheumatic Disease & Internal Med Unit, Osteo-Articular D, Hosp o Parma, Parma, Italy. farnese15@libero.it AB - Fibromyalgia (FM) is a common and complex condition, defined as long lasting, widespread musculoskeletal pain, in the presence of tender points (TPs) at specific anatomical sites. Dysautonomic and functional symptoms, such as orthostatic hypotension, tachycardia, effort intolerance, marked fatigue, sleep disorders, cognitive disturbances, psychological distress, paresthesias, headache, genitourinary manifestations, irritable bowel syndrome and bladder dyskinesia, frequently occur. The etiopathogenesis of FM is presently unknown, but nociceptor, autonomic and neuro-endocrine system dysfunctions have been found in patients. Since specific serological or instrumental markers of the syndrome are not yet identifiable, TP search is the only useful diagnostic hallmark. The development of an effective therapy of FM has hitherto been hampered by the incomplete knowledge of its pathogenic mechanisms. In this paper, the most recent information on FM is reviewed. 393 PMID- 15124260 AU - Finset A, Wigers SH, Gotestam KG TI - Depressed mood impedes pain Rx response in pts w FM. SO - J Rheumatol 2004 May;31(5):976-80. IN - D o Behavioural Sciences in Med, U o Oslo, Oslo, Norway. arnstein.finset@basalmed.uio.no AB - OBJECTIVE: To investigate prognostic factors in the course of the fibromyalgia syndrome (FM) from baseline to post-treatment. METHODS: Fifty-seven patients with FM were examined in a randomized intervention study. Pre-treatment variables were entered into linear regression analyses: gender, age, duration of disease, allocation to treatment, pain distribution (based on a patient-made drawing), fatigue, sleep disturbance, and depressed mood (based on visual analog scores), with pain distribution at treatment completion as the dependent variable. RESULTS: Depressed mood at baseline was a significant predictor of sustained widespread pain at treatment completion. CONCLUSION: The findings indicate a role for depressed mood as a predictive factor for treatment response. 394 PMID- 14760809 AU - Fitzcharles MA, Almahrezi A, Ware MA TI - Clinical profile of rheumatic disease pts referred to a multidisciplinary pain center. [FM] SO - J Rheumatol 2004 Feb;31(2):359-63. IN - Division o Rheumatology, McGill U, Montreal, Quebec, Canada. mary-ann.fitzcharles@muhc.mcgill.ca AB - OBJECTIVE: Good pain control is a prerequisite for success in the management of many rheumatological diseases. However, some rheumatology patients may present challenges in terms of pain management and be subsequently referred to a specialized pain clinic. We examined the characteristics and assessed the outcome of patients with rheumatic diseases who were referred to a tertiary care pain center. METHODS: All new patients with a primary rheumatological diagnosis referred over a 9 year period to the McGill University Pain Centre were studied. Patients were identified through a computer search according to both diagnoses and symptoms. Demographic information, clinical and pain characteristics, and subsequent management and final outcome were assessed. RESULTS: Out of a total of 1120 new patients, 60 (5%) had a primary rheumatologic diagnosis to account for pain and referral. The diagnoses were as follows: fibromyalgia in 26 (43%), inflammatory arthritis 17 (28%), degenerative arthritis 9 (15%), and soft tissue rheumatism 8 (13%). The median age at presentation was 52 years and 47 (78%) were female. The median duration of pain was 5 years. The mean pain scores according to the McGill Pain Questionnaire and the visual analog scale were 27 +/- 15 and 7 +/- 2, respectively. Patients were followed a mean duration of 10.6 +/- 15 months. Seventy-two percent were assessed by a psychologist and 52% by a physiotherapist or occupational therapist. New pharmacologic treatments were prescribed for 47 (78%) patients, with 47% receiving opioids, 37% antidepressants, 12% nonsteroidal antiinflammatory drugs, 8% tranquillizers, and 18% other medications. Final outcome was described as follows: improved in 55%, no change in 43%, and worsened in 2%. CONCLUSION: Although patients with a primary rheumatologic process to account for pain constituted a small proportion of patients evaluated, improvement was considerable in over half. Further study should address the selection of patients that are most likely to benefit from referral to multidisciplinary pain centers and the longterm outcome of such interventions. 395 PMID- 15669445 AU - Fossey M, Libman E, Bailes S, Baltzan M, Schondorf R, Amsel R, Fichten CS TI - Sleep quality & psychological adjustment in CFS. SO - J Behav Med. 2004 Dec;27(6):581-605. IN - S.M.B.D.-Jewish General Hosp, Montreal, Quebec, Canada. AB - Without specific etiology or effective treatment, chronic fatigue syndrome (CFS) remains a contentious diagnosis. Individuals with CFS complain of fatigue and poor sleep--symptoms that are often attributed to psychological disturbance. To assess the nature and prevalence of sleep disturbance in CFS and to investigate the widely presumed presence of psychological maladjustment we examined sleep quality, sleep disorders, physical health, daytime sleepiness, fatigue, and psychological adjustment in three samples. individuals with CFS; a healthy control group; and individuals with a definite medical diagnosis: narcolepsy. Outcome measures included physiological evaluation (polysomnography), medical diagnosis, structured interview, and self-report measures. Results indicate that the CFS sample had a very high incidence (58%) of previously undiagnosed primary sleep disorder such as sleep apnea/hypopnea syndrome and restless legs/periodic limb movement disorder. They also had very high rates of self-reported insomnia and nonrestorative sleep. Narcolepsy and CFS participants were very similar on psychological adjustment: both these groups had more psychological maladjustment than did control group participants. Our data suggest that primary sleep disorders in individuals with CFS are underdiagnosed in primary care settings and that the psychological disturbances seen in CFS may well be the result of living with a chronic illness that is poorly recognized or understood. 396 PMID- 15293096 AU - Frank B, Niesler B, Bondy B, Spath M, Pongratz DE, Ackenheil M, Fischer C, Rappold G TI - Mutational analysis of serotonin receptor genes: HTR3A & HTR3B in FM pts. SO - Clin Rheumatol 2004 Aug;23(4):338-44. Epub 2004 May 7. IN - Institute o Human Genetics, U o Heidelberg, Heidelberg, Germany. AB - The neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) has been implicated in numerous human disorders. Dysfunction of serotonergic neurotransmission is thought to play a major role in the pathophysiology of the fibromyalgia syndrome (FMS) which is characterised by non-restorative sleep and severe pain. In our study, both serotonin receptor subunit genes, HTR3A and HTR3B, have been investigated for sequence variations in FMS patients in order to reveal a possible involvement in the aetiology of FMS. We examined DNA samples from 48 patients with FMS representing sporadic cases by single-strand conformation polymorphism (SSCP) and denaturing high-performance liquid chromatography (dHPLC) analysis, sequenced samples with conspicuous patterns and performed statistical calculations. HTR3A mutational analysis revealed one novel as well as five known sequence variations. Investigating HTR3B, we detected seven formerly described mutations and one novel sequence variant. Statistical computation rated all variants as probably non-disease-related polymorphisms. Nevertheless, one might speculate about an effect of the respective sequence variants on the severity of the disease. Sequence variants of the serotonin receptor subunit genes HTR3A and HTR3B indicate no obvious significance in the aetiology of fibromyalgia, yet they represent the basis for future studies on their pharmacogenetic relevance. 397 PMID- 15641871 AU - Frankenburg FR, Zanarini MC TI - The association between borderline personality disorder & chr medical illnesses, poor health-related lifestyle choices, & costly forms of health care utilization. [FM/CF] SO - J Clin Psychiatry 2004 Dec;65(12):1660-5. IN - Laboratory for the Study o Adult Development, McLean Hosp, Belmont, & the D o Psychiatry, Harvard MS, Boston, MA 02478, USA. ffrankenburg@mclean.harvard.edu AB - OBJECTIVE: The physical health of patients with borderline personality disorder has not been well studied. The purpose of this study was to compare the physical health, lifestyle choices affecting physical health, and health care utilization of patients with remitted and nonremitted borderline personality disorder. METHOD: 200 patients who no longer met the Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for borderline personality disorder and 64 patients who still met study criteria for borderline personality disorder were interviewed from June 1992 through December 2001 concerning their physical health, lifestyle choices, and use of medical care 6 years after their initial participation in a larger study of the longitudinal course of borderline personality disorder. RESULTS: Remitted borderline patients were found to be significantly less likely than non-remitted borderline patients to have a history of a "syndrome-like" condition (i.e., chronic fatigue, fibromyalgia, or temporomandibular joint syndrome) (p = .049) or to have a history of obesity (p = .026), osteoarthritis (p = .025), diabetes (p = .001), hypertension (p = .028), back pain (p < .001), or urinary incontinence (p < .001). They were also found to be significantly less likely to report pack per day smoking (p = .002), daily consumption of alcohol (p = .003), lack of regular exercise (p = .006), daily use of sleep medications (p < .001), and sustained use of pain medications (p = .026). In addition, remitted borderline patients were significantly less likely than nonremitted borderline patients to have had at least 1 medically related emergency room visit (p < .001), 1 medical hospitalization (p = .003), or 1 of each (p< .001). CONCLUSIONS: The failure to remit from borderline personality disorder seems to be associated with a heightened risk of suffering from chronic physical conditions, making poor health-related lifestyle choices, and using costly forms of medical services. 398 PMID- 15361319 AU - Fricton JR TI - The relationship of temporomandibular disorders & FM: implications for Dx & Rx. SO - Curr Pain Headache Rep 2004 Oct;8(5):355-63. IN - D o Diagnostic & Surgical Sciences, U o Minnesota School o Dentistry, 6-320 Moos Tower, Minneapolis, MN 55455, USA. frict001@umn.edu AB - Although most cases of temporomandibular disorders (TMD) are mild and self-limiting, approximately 10% of patients develop severe disorders associated with chronic pain. It has been found that the widespread pain, depression, and sleep disorders associated with fibromyalgia (FM) may play a significant role in the chronicity of patients with TMD. This paper reviews the characteristics and relationship between TMD and FM and discusses how the similar mechanisms and diagnostic and treatment strategies for both disorders suggest that there is a close relationship between them. 399 PMID- 15519943 AU - Friedberg F TI - Eye movement desensitization in FM: a pilot study. SO - Complement Ther Nurs Midwifery 2004 Nov;10(4):245-9. IN - D o Psychiatry & Behavioral Science, St U o New York at Stony Brook, Putnam Hall/South Campus, Stony Brook, NY 11794-8790, USA. fred.friedberg@stonybrook.edu AB - The purpose of this study was to investigate the effectiveness of eye movement desensitization (EMD) for the relief of pain, fatigue and anxiety and depression in fibromyalgia patients. Six Caucasian female patients (mean age=43.2 yr) participated in two treatment sessions. Outcome assessments included the Fibromyalgia Impact Questionnaire, Fatigue Scale, Beck Anxiety Inventory, and Beck Depression Inventory. In-session process measures included thermal biofeedback monitoring and subjective units of discomfort ratings of pain, stress, and fatigue. Four out of six subjects were considered treatment responders. Thermal biofeedback monitoring revealed an average increase in hand temperature of 5.4 degrees indicating a relaxation effect. At treatment termination, average scores decreased on the measures of anxiety (28.6%), depression (29.9%), fibromyalgia impact (12.6%), and fatigue (11.5%). At the 3-month follow-up assessment, total reductions in average scores from pre-treatment baseline reflected further improvements on measures of anxiety (45.8%), depression (31.6%), fibromyalgia impact (19.2%), and fatigue (26.7%). Because EMD produced a somewhat automatic relaxation response with minimal patient participation, it may be especially useful when standard relaxation techniques fail. 400 PMID- 15094026 AU - Gaab J, Engert V, Heitz V, Schad T, Schurmeyer TH, Ehlert U TI - Associations between neuroendocrine responses to the Insulin Tolerance Test & patient characteristics in CFS. SO - J Psychosom Res 2004 Apr;56(4):419-24. IN - Center for Psychobiological & Psychosomatic Research, U o Trier, Germany. jgaab@psychologie.unizh.ch AB - OBJECTIVE: Subtle dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis have been proposed as an underlying pathophysiological mechanism in chronic fatigue syndrome (CFS). This study attempted to assess the relationship between patient characteristics and HPA axis functioning using a neuroendocrine challenge test. METHOD: A test battery designed to assess different dimensions of CFS was given to 18 CFS patients and 17 controls. To evaluate the integrity of the HPA axis, the Insulin Tolerance Test (ITT), a centrally acting neuroendocrine challenge test, was performed on patients and controls. ACTH, salivary free cortisol and total plasma cortisol levels were assessed as a measure of the HPA axis stress response. Correlations of patient characteristics were calculated with integrated responses for all endocrine parameters. RESULTS: CFS patients had a significantly reduced area under the ACTH response curve (AUC) in the ITT. The AUC was significantly associated with the duration of CFS symptoms (r = -.592, P = .005) and the severity of fatigue symptomatology (r = -.41, P = .045). In addition, duration of CFS was correlated with the severity of fatigue symptoms (r = .38, P = .045). Similar associations were not observed for cortisol parameters. CONCLUSION: It has been postulated that neuroendocrine dysregulations observed in CFS are of an acquired nature. The results of a strong association between the integrated ACTH response and the duration of CFS emphasizes the need to consider factors known to be risk factors for the chronicity of CFS symptoms, such as profound inactivity, deconditioning and sleep abnormalities, as possible candidates for secondary causes of neuroendocrine dysregulations in CFS. 401 PMID- 15574853 AU - Gallagher AM, Thomas JM, Hamilton WT, White PD TI - Incidence of fatigue Sx & diagnoses presenting in UK primary care from 1990 to 2001. SO - J R Soc Med 2004 Dec;97(12):571-5. IN - Centre for Psychiatry & D o Information Services, Queen Mary School o Med & Dentistry, St Bartholomew's Hosp, London EC1A 7BE. AB - Little is known about whether the incidence of symptoms of fatigue presented in primary care, and the consequent diagnoses made, change over time. The UK General Practice Research Database was used to investigate the annual incidence of both fatigue symptoms and diagnoses recorded in UK primary care from 1990 to 2001. The overall incidence of all fatigue diagnoses decreased from 87 per 100 000 patients in 1990 to 49 in 2001, a reduction of 44%, while postviral fatigue syndromes decreased from 81% of all fatigue diagnoses in 1990 to 60% in 2001. Chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) together increased from 9% to 26% of all fatigue diagnoses. The incidence of fibromyalgia increased from less than 1 per 100 000 to 35 per 100 000. In contrast, there was no consistent change in the incidence of all recorded symptoms of fatigue, with an average of 1503 per 100 000, equivalent to 1.5% per year. CFS/ME and fibromyalgia were rarely diagnosed in children and were uncommon in the elderly. All symptoms and diagnoses were more common in females than in males. The overall incidence of fatigue diagnoses in general has fallen, but the incidence rates of the specific diagnoses of CFS/ME and fibromyalgia have risen, against a background of little change in symptom reporting. This is likely to reflect fashions in diagnostic labelling rather than true changes in incidence. 402 PMID- 15055373 AU - Garralda ME, Rangel L TI - Impairment & coping in children & adolescents w CFS: a comparative study w other paediatric disorders. SO - J Child Psychol Psychiatry 2004 Mar;45(3):543-52. IN - Academic Unit o Child & Adolescent Psychiatry, Imperial Col+ AB - +IN: l, Faculty o Med, London, UK. e.garralda@imperial.ac.uk BACKGROUND: Functional impairment is a key feature of chronic fatigue syndrome (CFS) of childhood. AIM: To compare impairment, illness attitudes and coping mechanisms in childhood CFS and in other paediatric disorders. METHOD: Participants were 28 children and adolescents with CFS, 30 with juvenile idiopathic arthritis (JIA) and 27 with emotional disorders (ED). The measures used were interviews with children and parents, with detailed enquiry on impairment, including the Functional Disability Inventory (FDI), Illness Attitudes Scales (IAS), and Kidcope to measure coping styles in relation to common problems, illness and disability. RESULTS: Children with CFS reported significantly more illness impairment, especially in school attendance, than those with JIA and ED. They had higher 'worry about illness' scores on the IAS. On the Kidcope they named school issues (work, expectations, attendance) as illness- or disability-related problems more than the other two groups. Fewer CFS participants reported using problem solving as a strategy to cope with illness and disability than with other problems in their lives. More in the CFS than in the JIA group used emotional regulation to cope with illness and disability. Fewer in the CFS than in the ED groups used social withdrawal to cope with illness and self-criticism for disability, but more used resignation to cope with disability. CONCLUSION: Severe illness-related impairment, particularly through school non-attendance, and high levels of illness-related school concerns appear specific to CFS. CFS may also have characteristically high levels of generalised illness worry and particular styles of coping with illness and disability. 403 PMID- 15537568 AU - Gebhart B, Jorgenson JA TI - Benefit of ribose in a patient w FM. SO - Pharmacotherapy 2004 Nov;24(11):1646-8. IN - D o Pharmacy Services, U Hospitals & Clinics, Salt Lake City, Utah, USA. AB - Ribose was added to the existing treatment regimen of a woman with fibromyalgia, resulting in a decrease in symptoms. It has been postulated that patients with fibromyalgia may have an alteration in muscle adenine nucleotide metabolism, leading to depleted energy reserves and an imbalance in cellular adenosine 5'-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge. As a key component in adenine nucleotide synthesis, ribose supplementation may be useful in such patients. 404 PMID- 15088308 AU - Geenen R, Janssens EL, Jacobs JW, van Staveren W TI - Hypothesis - dietary glutamate will not affect pain in FM. SO - J Rheumatol 2004 Apr;31(4):785-7. IN - D o Health Psychology, Utrecht U, Utrecht, The Netherlands. R.Geegen@home.nl 405 PMID- 15017442 AU - Gelinas C, Fillion L TI - Factors related to persistent fatigue following completion of breast cancer Rx. [CF] SO - Oncol Nurs Forum. 2004 Mar-Apr;31(2):269-78. IN - Faculty o Nursing, Laval U, Quebec City, Canada. AB - PURPOSE/OBJECTIVES: To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue. DESIGN: Correlational. SETTING: Tertiary medical center in Quebec City, Canada. SAMPLE: A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded. METHODS: Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b. MAIN RESEARCH VARIABLES: Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables. FINDINGS: Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b. CONCLUSIONS: The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue. IMPLICATIONS FOR NURSING: Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended. 406 PMID- 15467349 AU - Gerrity TR, Papanicolaou DA, Amsterdam JD, Bingham S, Grossman A, Hedrick T, Herberman RB, Krueger G, Levine S, Mohagheghpour N, Moore RC, Oleske J, Snell CR TI - Immunologic aspects of CFS. Report on a Research Symposium convened by The CFIDS Association of America & co-sponsored by the US Centers for Disease Control & Prevention & the National Institutes of Health. SO - Neuroimmunomodulation 2004;11(6):351-7. IN - Worcester Polytechnic Inst, Worcester, Mass., USA. AB - Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800,000 Americans of all ages, races, socioeconomic groups and genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the immune system. A symposium was organized in October 2001 to explore the possibility of an association between immune dysfunction and CFS, with special emphasis on the interactions between immune dysfunction and other abnormalities noted in the neuroendocrine and autonomic nervous systems of individuals with CFS. This paper represents the consensus of the panel of experts who participated in this meeting. Data suggest that persons with CFS manifest changes in immune responses that fall outside normative ranges, but current research does not provide definitive evidence on whether these immune abnormalities are a cause or result of the illness. It has become clear that CFS cannot be understood based on single measurements of immune, endocrine, cardiovascular, or autonomic nervous system dysfunction. This panel encourages a new emphasis on multidisciplinary research into CFS. 407 PMID- 14872506 AU - Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, Clauw DJ TI - Evidence of augmented central pain processing in idiopathic chr low back pain. [FM] SO - Arthritis Rheum 2004 Feb;50(2):613-23. IN - U o Michigan, Ann Arbor, MI 48106, USA. AB - OBJECTIVE: For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n = 11), patients with widespread pain (fibromyalgia; n = 16), and healthy control subjects (n = 11). METHODS: Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site. RESULTS: Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P = 0.03) or the patients with fibromyalgia (3.5 kg) (P = 0.006). When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups. CONCLUSION: At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP. 408 PMID- 14993080 AU - Gill AC, Dosen A, Ziegler JB TI - CFS in adolescents: a follow-up study. SO - Arch Pediatr Adolesc Med 2004 Mar;158(3):225-9. IN - D o General Pediatrics, Sydney Children's Hosp, Sydney, Australia. AB - OBJECTIVES: To compare the frequency of persistent symptoms up to 8 years after illness onset in adolescents diagnosed as having chronic fatigue syndrome, idiopathic chronic fatigue, and unexplained fatigue for less than 6 months, and to determine if hospital admission is associated with outcome. DESIGN: A cohort study using questionnaire follow-up. SETTING: A tertiary referral hospital. PATIENTS: Consecutive adolescents referred for assessment of persistent fatigue were identified and retrospectively divided into 3 groups according to the diagnostic criteria for chronic fatigue syndrome and idiopathic chronic fatigue. INTERVENTION: A questionnaire was designed and administered by telephone at a mean of 4.57 years after the initial examination. MAIN OUTCOME MEASURE: The persistence of self-reported symptoms was compared with respect to patient group and admission. RESULTS: Outcome data were obtained for 34 (69%) of the 49 eligible subjects. Twenty-five percent of the chronic fatigue syndrome group showed near to complete improvement, 31% showed partial improvement, and 44% showed no improvement. The idiopathic chronic fatigue group had near to complete recovery in 50%, partial in 10%, and no improvement in 40%. Those with unexplained fatigue for less than 6 months had all recovered. There was no difference between the outcome of the subjects admitted to the hospital and those managed as outpatients. CONCLUSIONS: Adolescents with less than 6 months of fatigue have a good outcome. Unexplained fatigue lasting more than 6 months has a similar outcome regardless of the presence of minor criteria for chronic fatigue syndrome. 409 PMID- 15518675 AU - Glass JM, Lyden AK, Petzke F, Stein P, Whalen G, Ambrose K, Chrousos G, Clauw DJ TI - The effect of brief exercise cessation on pain, fatigue, & mood Sx development in healthy, fit individuals. [FM] SO - J Psychosom Res 2004 Oct;57(4):391-8. IN - D o Psychiatry & Inst for Social Research, U o Michigan, Ann Arbor, MI, USA. jglass@umich.edu AB - OBJECTIVE: Abnormalities of the biological stress response (hypothalamic-pituitary-adrenal axis and the autonomic nervous system) have been identified in both fibromyalgia (FM) and chronic fatigue syndrome (CFS). Although these changes have been considered to be partly responsible for symptom expression, we examine an alternative hypothesis that these HPA and autonomic changes can be found in subsets of healthy individuals in the general population who may be at risk of developing these conditions. Exposure to "stressors" (e.g., infections, trauma, etc.) may lead to symptom expression (pain, fatigue, and other somatic symptoms) in part by precipitating lifestyle changes. In particular, we focus on the effect of deprivation of routine aerobic exercise on the development of somatic symptoms. METHODS: Eighteen regularly exercising (>/=4 h/week) asymptomatic, healthy adults refrained from physical activity for 1 week. We predicted that a subset of these individuals would develop symptoms of FM/CFS with exercise deprivation, and this manuscript focuses on the baseline HPA axis, immune, and autonomic function measures that may predict the development of symptoms. RESULTS: Eight of the subjects reported a 10% increase in one or more symptoms (pain, fatigue, mood) after 1 week of exercise deprivation. These symptomatic subjects had lower HPA axis (baseline cortisol prior to VO2max testing), immune (NK cell responsiveness to venipuncture), and autonomic function (measured by heart rate variability) at baseline (prior to cessation of exercise) when compared to the subjects who did not develop symptoms. CONCLUSIONS: A subset of subjects developed symptoms of pain, fatigue, or mood changes after exercise deprivation. This cohort was different from the individuals who did not develop symptoms in baseline measures of HPA axis, immune, and autonomic function. We speculate that a subset of healthy individuals who have hypoactive function of the biological stress response systems unknowingly exercise regularly to augment the function of these systems and thus suppress symptoms. These individuals may be at risk for developing chronic multisymptom illnesses (CMIs) (e.g., FM or CFS among others) when a "stressor" leads to lifestyle changes that disrupt regular exercise. 410 PMID- 15589439 AU - Godfrin B, Zabraniecki L, Lamboley V, Bertrand-Latour F, Sans N, Fournie B TI - Spondyloarthropathy w entheseal pain. A prospective study in 33 pts. [FM] SO - Joint Bone Spine 2004 Nov;71(6):557-62. IN - Rheumatology D, Purpan Teaching Hosp, place du Docteur-Baylac, 31059 Toulouse 9, France. AB - OBJECTIVES: To identify objective features individualizing spondyloarthropathy with isolated entheseal pain and distinguishing this condition from fibromyalgia. PATIENTS AND METHODS: Thirty-three patients presenting with entheseal pain were studied prospectively. The diagnoses were psoriatic arthritis in six patients and ankylosing spondylitis in seven patients; among the 20 remaining patients, in whom entheseal pain was the only symptom, 11 responded to nonsteroidal antiinflammatory drugs (NSAIDs) and were diagnosed with entheseal spondyloarthropathy whereas the nine unresponsive patients were diagnosed with fibromyalgia. A physical examination, laboratory tests, plain radiographs, and radionuclide scan and resonance imaging (MRI) scan of a painful enthesis were done in each patient. RESULTS: Among the 11 patients with entheseal spondyloarthropathy, two experienced inflammatory joint symptoms during the 4-6-month follow-up and three patients had radionuclide scanning and MRI evidence of entheseal inflammation similar to that in nine patients with definite spondyloarthropathy (ankylosing spondylitis or psoriatic arthritis). The feature that best discriminated between entheseal spondyloarthropathy and fibromyalgia was responsiveness to NSAIDs. CONCLUSION: These preliminary data suggest that isolated entheseal pain may indicate spondyloarthropathy in some patients. The imaging methods used in this study lacked sensitivity for enthesitis, which may therefore have been missed in some patients. The development of bone and joint ultrasonography may provide additional insights into the entheseal abnormalities present in patients with isolated entheseal pain. 411 PMID- 15164899 AU - Gold AR, Dipalo F, Gold MS, Broderick J TI - Inspiratory airflow dynamics during sleep in women w FM. SO - Sleep 2004 May 1;27(3):459-66. IN - Division o Pulmonary/Critical Care Med & the Applied Behavi+ AB - +IN: oral Med Research Inst, Stony Brook U School o Medicine, Stony Brook, NY, USA. avram.gold@med.va.gov STUDY OBJECTIVES: To determine whether women with fibromyalgia have inspiratory airflow dynamics during sleep similar to those of women with upper-airway resistance syndrome (UARS). DESIGN: A descriptive study of consecutive female patients with fibromyalgia. SETTING: An academic sleep disorders center. PATIENTS OR PARTICIPANTS: Twenty-eight women with fibromyalgia diagnosed by rheumatologists using established criteria. Fourteen of the women gave a history of snoring, while 4 claimed to snore 'occasionally' and 10 denied snoring. The comparison group comprised 11 women with UARS matched for age and obesity. INTERVENTIONS: Eighteen of the 28 women with fibromyalgia and all of the women with UARS had a full-night polysomnogram. All participants had a nasal continuous positive airway pressure (CPAP) study with quantitative monitoring of inspiratory airflow and effort between atmospheric pressure and therapeutic CPAP. Fourteen patients with fibromyalgia and all patients with UARS had a successful determination of pharyngeal critical pressure. MEASUREMENTS AND RESULTS: Twenty-seven of 28 women with fibromyalgia had sleep-disordered breathing. One of the 27 had obstructive sleep apnea hypopnea while 26 had milder inspiratory airflow limitation with arousals. One patient had no apnea or hypopnea or inspiratory airflow limitation during sleep. While the patients were sleeping at atmospheric pressure, apnea-hypopnea index, arousal index, the prevalence of flow-limited breaths, and maximal inspiratory flow were similar between groups. The pharyngeal critical pressure of the patients with fibromyalgia was -6.5 +/- 3.5 cmH2O (mean +/- SD) compared to -5.8 +/- 3.5 cmH2O for patients with UARS (P = .62). Treatment of 14 consecutive patients with nasal CPAP resulted in an improvement in functional symptoms ranging from 23% to 47%, assessed by a validated questionnaire. CONCLUSION: Inspiratory airflow limitation is a common inspiratory airflow pattern during sleep in women with fibromyalgia. Our findings are compatible with the hypothesis that inspiratory flow limitation during sleep plays a role in the development of the functional somatic syndromes. 412 PMID- 15547167 AU - Goldenberg DL, Burckhardt C, Crofford L TI - Management of FM syndrome. SO - JAMA 2004 Nov 17;292(19):2388-95. IN - D o Rheumatology, Newton-Wellesley Hosp, Newton, Mass 02462, USA. dgoldenb@massmed.org AB - 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. 413 PMID- 14770050 AU - Goubert L, Crombez G, Van Damme S, Vlaeyen JW, Bijttebier P, Roelofs J TI - Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: invariant two-factor model across low back pain pts & FM pts. SO - Clin J Pain 2004 Mar-Apr;20(2):103-10. IN - Faculty o Psychology & Educational Sciences, Ghent U, Belgium. Liesbet.Goubert@rug.ac.be AB - OBJECTIVES: (1) To investigate the factor structure of the Tampa Scale for Kinesiophobia (TSK) in a Dutch-speaking sample of chronic low back pain (CLBP) patients using confirmatory factor analysis, (2) to examine whether the internal structure of the TSK extends to another group of fibromyalgia (FM) patients, and (3) to investigate the stability of the factor structure in both patient groups using multi-sample analysis. PATIENTS AND METHODS: TSK-data from 8 studies collected in Dutch and Flemish chronic pain patients were pooled. For 188 CLBP patients and 89 FM patients, complete data were available. Confirmatory factor analyses were performed to assess 4 models of kinesiophobia, and to examine which factor model provided the best fit. Furthermore, a multi-sample analysis was performed to investigate the stability of the factor structure in both patient groups. RESULTS: For both CLBP and FM patients, the 2-factor model containing the factors "activity avoidance" and "pathologic somatic focus" was superior as compared with the 4-factor model containing the factors "harm," "fear of (re)injury." "importance of exercise," and "avoidance of activity". Moreover, the 2-factor model was found to be invariant across CLBP and FM patients, indicating that this model is robust in both pain samples. DISCUSSION: As the 2-factor structure provided the best fit of the data in both patient samples, we recommend to use this version of the TSK and its 2 subscales in both clinical practice and research. Based on the content of the items, the subscales were labeled "Harm" and "Fear-avoidance." 414 PMID- 14770100 AU - Gowans SE, deHueck A TI - Effectiveness of exercise in management of FM. SO - Curr Opin Rheumatol 2004 Mar;16(2):138-42. IN - D o Rehabilitation Services, U Health Network, Joseph Brant Memorial Hosp, Toronto, Ontario, Canada. sue.gowans@uhn.on.ca AB - PURPOSE OF REVIEW: Exercise was established as an integral part of the nonpharmacological treatment of fibromyalgia approximately 20 years ago. Since then many studies have investigated the effects of exercise-either alone or in combination with other interventions. This review will discuss the benefits of exercise alone and provide practical suggestions on how patients can exercise without causing a long-term exacerbation of their pain. RECENT FINDINGS: Short-term exercise programs for individuals with fibromyalgia have consistently improved physical function, especially physical fitness, and reduced tenderpoint pain. Exercise has also produced improvements in self-efficacy. These effects can persist for periods of up to 2 years but may require participants to continue to exercise. Most exercise studies have examined the effects of moderately intense aerobic exercise. Only in the past 2 years have muscle-strengthening programs, in isolation, been evaluated. To be well tolerated, exercise programs must start at a level just below the capacity of the participants and then progress slowly. Even with these precautions, exercise may still produce tolerable, short-term increases in pain and fatigue that should abate within the first few weeks of exercising. SUMMARY: Future studies should investigate the possible benefits of low-intensity exercise and test strategies that may enhance long-term compliance with exercise. Individuals with fibromyalgia also need to be able to access community exercise programs that are appropriate for them. This may require community instructors to receive instruction on exercise prescription and progression for individuals with fibromyalgia. 415 PMID- 15593364 AU - Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE TI - Six-month & one-year f/u of 23 weeks of aerobic exercise for individuals w FM. SO - Arthritis Rheum 2004 Dec 15;51(6):890-8. IN - U Health Network & U o Toronto, Toronto, Ontario, Canada. AB - 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. 416 PMID- 14960499 AU - Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, Clauw DJ TI - Pain catastrophizing & neural responses to pain among persons w FM. SO - Brain 2004 Apr;127(Pt 4):835-43. Epub 2004 Feb 11. IN - D o Internal Med, Div o Rheumatology, Chronic Pain & Fatigue Research Ctr, U o Michigan, Ann Arbor, MI 48106, USA. AB - Pain catastrophizing, or characterizations of pain as awful, horrible and unbearable, is increasingly being recognized as an important factor in the experience of pain. The purpose of this investigation was to examine the association between catastrophizing, as measured by the Coping Strategies Questionnaire Catastrophizing Subscale, and brain responses to blunt pressure assessed by functional MRI among 29 subjects with fibromyalgia. Since catastrophizing has been suggested to augment pain perception through enhanced attention to painful stimuli, and heightened emotional responses to pain, we hypothesized that catastrophizing would be positively associated with activation in structures believed to be involved in these aspects of pain processing. As catastrophizing is also strongly associated with depression, the influence of depressive symptomatology was statistically removed. Residual scores of catastrophizing controlling for depressive symptomatology were significantly associated with increased activity in the ipsilateral claustrum (r = 0.51, P < 0.05), cerebellum (r = 0.43, P < 0.05), dorsolateral prefrontal cortex (r = 0.47, P < 0.05), and parietal cortex (r = 0.41, P < 0.05), and in the contralateral dorsal anterior cingulate gyrus (ACC; r = 0.43, P < 0.05), dorsolateral prefrontal cortex (r = 0.41, P < 0.05), medial frontal cortex (r = 0.40, P < 0.05) and lentiform nuclei (r = 0.40, P < 0.05). Analysis of subjects classified as high or low catastrophizers, based on a median split of residual catastrophizing scores, showed that both groups displayed significant increases in ipsilateral secondary somatosensory cortex (SII), although the magnitude of activation was twice as large among high catastrophizers. Both groups also had significant activations in contralateral insula, SII, primary somatosensory cortex (SI), inferior parietal lobule and thalamus. High catastrophizers displayed unique activation in the contralateral anterior ACC, and the contralateral and ipsilateral lentiform. Both groups also displayed significant ipsilateral activation in SI, anterior and posterior cerebellum, posterior cingulate gyrus, and superior and inferior frontal gyrus. These findings suggest that pain catastrophizing, independent of the influence of depression, is significantly associated with increased activity in brain areas related to anticipation of pain (medial frontal cortex, cerebellum), attention to pain (dorsal ACC, dorsolateral prefrontal cortex), emotional aspects of pain (claustrum, closely connected to amygdala) and motor control. These results support the hypothesis that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain. Activation associated with catastrophizing in motor areas of the brain may reflect expressive responses to pain that are associated with greater pain catastrophizing. 417 PMID- 15257972 AU - Grahmann PH, Jackson KC 2nd, Lipman AG TI - Clinician beliefs about opioid use & barriers in chr nonmalignant pain. [FM] SO - J Pain Palliat Care Pharmacother 2004;18(2):7-28. IN - Texas Tech U School o Pharmacy, International Pain Ctr, Texas Tech Med Center, 2319 81st Street, Lubbock, TX 79423, USA. AB - A survey of the medical directors of multidisciplinary pain clinics and multidisciplinary pain centers listed in the American Pain Society Pain Facilities Directory was conducted to define those pain specialists' beliefs about the role of opioid analgesia in 14 types of chronic nonmalignant pain. Respondents also reported their perceptions of barriers to their prescribing opioids for chronic nonmalignant pain and what they perceived as barriers to opioid prescribing for chronic nonmalignant pain by other, non-pain specialist clinicians in their communities. The respondents are characterized by demographics, disciplines, specialties, and time in practice. The percentage of time that a pharmacist was available in the pain programs also is reported. There is increasing acceptance of opioids for most of the listed types of chronic nonmalignant pain, but the acceptance varies by types of pain syndromes. Opioids were most consistently accepted for sickle cell disease pain and least commonly endorsed for headaches, myofascial pain, and fibromyalgia. Factors that may influence clinicians' perceptions about opioids are discussed. 418 PMID- 14767151 AU - Graugaard PK, Holgersen K, Finset A TI - Communicating w alexithymic & non-alexithymic pts: an experimental study of the effect of psychosocial communication & empathy on patient satisfaction. [FM] SO - Psychother Psychosom 2004 Mar-Apr;73(2):92-100. IN - D o Behavioural Sciences in Med, U o Oslo, Oslo, Norway. p.k.graugaard@basalmed.uio.no AB - BACKGROUND: Previous studies have shown that alexithymia is associated with a wide range of somatic and psychiatric conditions. The aim of this study was to investigate experimentally how psychosocial communication and empathic response from the physician affects satisfaction in alexithymic and non-alexithymic patients. METHOD: Seven physicians and 65 female patients from a fibromyalgia patient association participated in the study. The Toronto Alexithymia Scale (TAS-20) was used to categorise patients as alexithymic or non-alexithymic. Patients also completed questionnaires regarding trait anxiety and satisfaction with their consultation. Physicians were instructed to differentiate their communication in terms of both psychosocial matters and empathic response. The content of the consultation was analysed using the Roter Interactional Analysis System. RESULTS: Regression analyses revealed that alexithymic patients were significantly more satisfied when they received a greater empathic response from the physician. Non-alexithymic patients, however, were more satisfied when the consultation was of longer duration. Psychosocial communication did not have any statistically significant effect on satisfaction in either of the two subgroups. CONCLUSIONS: Verbalised empathic response from the physician may be crucial for the alexithymic patient's post-consultation satisfaction and may thereby become the basis for a solid treatment alliance. The validity of this hypothesis should be tested in different clinical settings and with different patient populations. Future research on alexithymic patients' response to psychosocial communication may benefit from determining to what extent this communication is concerned with general distress or more complex emotional phenomena. 419 PMID- 12867573 AU - Gronemann ST, Ribel-Madsen S, Bartels EM, Danneskiold-Samsoe B, Bliddal H TI - Collagen & muscle pathology in FM pts. SO - Rheumatology (Oxford) 2004 Jan;43(1):27-31. Epub 2003 Jul 16. IN - The Parker Inst, D o Rheumatology, Frederiksberg Hosp, H:S U Hospital, Copenhagen, Denmark. AB - OBJECTIVE: To measure collagen concentration and search for muscle pathology in muscle non-tender-point areas from fibromyalgia (FM) patients. METHODS: Muscle biopsies were obtained from m. vastus lateralis of 27 carefully selected, female fibromyalgia patients, and from eight age-matched female control subjects. Amino acids were determined by HPLC and electron microscopy was performed. RESULTS: The FM patients had lower hydroxyproline and lower total concentration of the major amino acids of collagen than the controls. No significant difference was seen in the concentration of the major amino acids of myosin or of total protein. Electron microscopy showed no significant differences between FM patients and controls although atrophied muscle fibrils occurred in FM patients only, but frequencies were not significantly different. CONCLUSION: Fibromyalgia patients had a significantly lower amount of intramuscular collagen. This may lower the threshold for muscle micro-injury and thereby result in non-specific signs of muscle pathology. 420 PMID- 15162896 AU - Grothe DR, Scheckner B, Albano D TI - Treatment of pain syndromes w venlafaxine. SO - Pharmacotherapy 2004 May;24(5):621-9. IN - Global Med Communications, Neuroscience, Wyeth Pharmaceutic+ AB - +IN: als, Collegeville, Penn 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. 421 PMID- 15142258 AU - Gupta A, Silman AJ TI - Psychological stress & FM: a review of the evidence suggesting a neuroendocrine link. SO - Arthritis Res Ther. 2004;6(3):98-106. Epub 2004 Apr 7. IN - ARC Epidemiology Unit, School o Epidemiology & Health Sciences, Manchester, UK. anindya.gupta@man.ac.uk AB - The present review attempts to reconcile the dichotomy that exists in the literature in relation to fibromyalgia, in that it is considered either a somatic response to psychological stress or a distinct organically based syndrome. Specifically, the hypothesis explored is that the link between chronic stress and the subsequent development of fibromyalgia can be explained by one or more abnormalities in neuroendocrine function. There are several such abnormalities recognised that both occur as a result of chronic stress and are observed in fibromyalgia. Whether such abnormalities have an aetiologic role remains uncertain but should be testable by well-designed prospective studies. 422 PMID- 15142269 AU - Gur A, Cevik R, Nas K, Colpan L, Sarac S TI - Cortisol & hypothalamic-pituitary-gonadal axis hormones in follicular-phase women w FM & CFS & effect of depressive Sx on these hormones. SO - Arthritis Res Ther. 2004;6(3):R232-8. Epub 2004 Mar 15. IN - D o Physical Med & Rehabilitation, School o Medicine, Dicle U, Diyarbakir, Turkey. alig@dicle.edu.tr AB - We investigated abnormalities of the hypothalamic-pituitary-gonadal axis and cortisol concentrations in women with fibromyalgia and chronic fatigue syndrome (CFS) who were in the follicular phase of their menstrual cycle, and whether their scores for depressive symptoms were related to levels of these hormones. A total of 176 subjects participated - 46 healthy volunteers, 68 patients with fibromyalgia, and 62 patients with CFS. We examined concentrations of follicle-stimulating hormone, luteinizing hormone (LH), estradiol, progesterone, prolactin, and cortisol. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Cortisol levels were significantly lower in patients with fibromyalgia or CFS than in healthy controls (P < 0.05); there were no significant differences in other hormone levels between the three groups.Fibromyalgia patients with high BDI scores had significantly lower cortisol levels than controls (P < 0.05), and so did CFS patients, regardless of their BDI scores (P < 0.05). Among patients without depressive symptoms, cortisol levels were lower in CFS than in fibromyalgia (P < 0.05). Our study suggests that in spite of low morning cortisol concentrations, the only abnormalities in hypothalamic-pituitary-gonadal axis hormones among follicular-phase women with fibromyalgia or CFS are those of LH levels in fibromyalgia patients with a low BDI score. Depression may lower cortisol and LH levels, or, alternatively, low morning cortisol may be a biological factor that contributes to depressive symptoms in fibromyalgia. These parameters therefore must be taken into account in future investigations. 423 PMID- 15479904 AU - Gur A, Cevik R, Sarac AJ, Colpan L, Em S TI - Hypothalamic-pituitary-gonadal axis & cortisol in young women w primary FM: the potential roles of depression, fatigue, & sleep disturbance in the occurrence of hypocortisolism. SO - Ann Rheum Dis 2004 Nov;63(11):1504-6. IN - Physical Med & Rehabilitation, Dicle U School o Medicine, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr AB - OBJECTIVES: To investigate abnormalities of the hypothalamic-pituitary-gonadal (HPG) axis and cortisol concentrations in young women with primary fibromyalgia (FM); and to determine whether depression, fatigue, and sleep disturbance affect these hormones. METHODS: Follicle stimulating hormone (FSH), luteinising hormone (LH), oestradiol, progesterone, prolactin, and cortisol concentrations in 63 women with FM were compared with those in 38 matched healthy controls; all subjects aged <35 years. The depression rate was assessed by the Beck Depression Inventory (BDI) and patients with high and low BDI scores were compared. Additionally, patients were divided according to sleep disturbance and fatigue and compared both with healthy controls and within the group. RESULTS: No significant differences in FSH, LH, oestradiol, prolactin, and progesterone levels were found between patients with FM and controls, but cortisol levels were significantly lower in patients than in controls (p<0.05). Cortisol levels in patients with high BDI scores, fatigue, and sleep disturbance were significantly lower than in controls (p<0.05). Correlation between cortisol levels and number of tender points in all patients was significant (r = -0.32, p<0.05). CONCLUSION: Despite low cortisol concentrations in young women with FM, there is no abnormality in HPG axis hormones. Because fatigue, depression rate, sleep disturbance, and mean age of patients affect cortisol levels, these variables should be taken into account in future investigations. 424 PMID- 15209451 AU - Gustafsson M, Ekholm J, Ohman A TI - From shame to respect: musculoskeletal pain pts' experience of a rehabilitation programme, a qualitative study. SO - J Rehabil Med 2004 May;36(3):97-103. IN - D o Public Health Sciences, Div o Rehabilitation Med, Karol+ AB - +IN: inska Institutet, Stockholm, Sweden. monika.gustafsson@ks.se OBJECTIVE: This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison. RESULTS: One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively. CONCLUSION: The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment. 425 PMID- 14994400 AU - Hannu T, Kauppi M, Tuomala M, Laaksonen I, Klemets P, Kuusi M TI - Reactive arthritis following an outbreak of Campylobacter jejuni infection. [FM] SO - J Rheumatol 2004 Mar;31(3):528-30. IN - D o Med, Helsinki U Central Hosp, Helsinki, Finland. Timo.Hannu@ttl.fi AB - OBJECTIVE: To study the occurrence and the clinical picture of musculoskeletal (MSK) complications including reactive arthritis (ReA) following an outbreak of Campylobacter jejuni. METHODS: An outbreak of C. jejuni infection occurred in 2000 in Asikkala, Finland, during which 350 exposed subjects contacted the Municipal Health Centre (MHC). All primary care physicians in the MHC were advised to refer patients with acute MSK complications to the Rheumatism Foundation Hospital (RFH) for a specialist clinical examination, which was performed or = 6 months with no identifiable cause. The mean change in a fatigue measure was compared for placebo and Siberian ginseng at 1 and 2 months. Comparisons were for all subjects and for subjects with characteristics previously identified in the literature as important for categorizing chronic fatigue. RESULTS: Ninety-six subjects were randomized to treatment groups, and 76 provided information at 2 months of follow-up. Fatigue among subjects assigned to either placebo or Siberian ginseng was substantially reduced during the study, but differences between treatment groups were not statistically significant in the full sample. Fatigue severity and duration had a statistically significant interaction with response to Siberian ginseng at the P < 0.05 level. Treatment was effective at 2 months for 45 subjects with less severe fatigue (P = 0.04 unadjusted for multiple comparisons) and for 41 subjects with fatigue for > or = 5 years (P = 0.09 unadjusted for multiple comparisons). CONCLUSION: Overall efficacy was not demonstrated. However, the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value. 427 PMID- 14994414 AU - Hashkes PJ, Friedland O, Jaber L, Cohen HA, Wolach B, Uziel Y TI - Decreased pain threshold in children w growing pains. [FM] SO - J Rheumatol 2004 Mar;31(3):610-3. IN - D o Rheumatic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA. AB - OBJECTIVE: To investigate whether children with recurrent musculoskeletal pain termed growing pains (GP) have lower pain thresholds than children without GP. METHODS: We measured the pain threshold of 44 children with GP and 46 controls. Pain thresholds were measured by use of a Fisher type dolorimeter with pressure applied to areas associated with increased tenderness in fibromyalgia (FM), control points, and anterior tibia, the usual region of pain in children with GP. Unpaired Student's t test and chi-square tests were used to compare the pain threshold and number of tender points in patients and controls. RESULTS: The pain threshold in characteristic tender points of FM, control points, and anterior tibia in the children with GP was significantly lower in children with GP (3.5 +/- 0.6 kg/cm2 in GP versus 4.0 +/- 0.7 in controls, p < 0.001, 3.8 +/- 0.7 versus 4.4 +/- 0.8, p = 0.005; 5.1 +/- 1.1 versus 5.9 +/- 1.5, p = 0.004). Children with GP had a significantly greater number of tender points in response to an applied pressure of 4 kg/cm2. CONCLUSION: Children with GP have more tender points and lower pain thresholds than children without GP indicating that GP may represent a variant of a noninflammatory pain syndrome in younger children. 428 PMID- 15132522 AU - Haugli L, Strand E, Finset A TI - How do pts w rheumatic disease experience their relationship w their doctors? A qualitative study of experiences of stress & support in the doctor-pa+ SO - Patient Educ Couns 2004 Feb;52(2):169-74. IN - Norwegian Resource Ctr in Rheumatological Rehabilitation, D+ AB - +TI: tient relationship. +IN: iakonhjemmet Hosp, Oslo, Norway. liv.haugli@alpharma.no This study is evaluated what patients with rheumatic disease perceive as important in their medical encounters. We interviewed two groups of patients: one with a well-defined inflammatory condition (rheumatoid arthritis (RA) or ankylosing spondylitis) (n = 12) and one with non-inflammatory widespread chronic pain such as fibromyalgia (n = 14). Both groups focused on their relationship to their doctor. Two central themes emerged as of importance: 'to be seen' and 'to be believed'. However, these themes had different connotations for the two groups. For the patients with inflammatory conditions, 'to be seen' implied being seen as an individual and not as a mere diagnosis, and 'to be believed' as far as pain and suffering were concerned. For patients with non-inflammatory chronic pain 'to be seen' and 'to be believed' primarily implied being able to obtain a useful somatic diagnosis. Practical implications of these findings are discussed. 429 PMID- 15515406 AU - Haus U, Spath M, Farber L TI - Spectrum of use & tolerability of 5-HT3 receptor antagonists. [FM] SO - Scand J Rheumatol Suppl. 2004;(119):12-8. IN - Novartis Pharma GmbH, Nuremberg, Germany. ulrike.haus@pharma.novartis.com AB - Several 5-HT3 receptor antagonists are available (tropisetron, ondansetron, granisetron, dolasetron, and palonsetron), and further compounds are in clinical development. These substances show only minor differences in the activity profile regarding their affinity for particular receptors. 5-HT3 receptor antagonists are primarily used and found effective in the prevention and treatment of chemotherapy-induced nausea and emesis, and in postoperative nausea and vomiting (PONV). Antagonism of the 5-HT3 receptors in the peripheral and central nervous system is a probable mechanism of action. The substances are suitable as first-line therapy (combined with a corticosteroid) for the prevention of acute nausea and vomiting in patients treated with moderately to severely emetogenic chemotherapeutic agents. This combination is also moderately effective in the prevention of delayed nausea and vomiting. 5-HT3 receptor antagonists are an important constituent in the prevention and treatment of emesis and nausea caused by radiation therapy, especially in patients receiving whole body or upper abdominal treatment. Alosetron was found clinically effective in diarrhoea-predominant irritable bowel syndrome, whereas tropisetron in fibromyalgia and related pain disorders. Further indications for such treatment include anxiety disorders, alcohol dependence, drug withdrawal, and psychosis related to treatment of Parkinson's disease. 5-HT3 receptor antagonists are well tolerated with the most frequently reported adverse effects being headache, constipation, dizziness, tiredness, and gastrointestinal disturbances such as abdominal pain or constipation. Intravenous administration of serotonin induces the Bezold-Jarisch reflex and causes small reversible changes in electrocardiogram (ECG) parameters. 430 PMID- 15083352 AU - Heffez DS, Ross RE, Shade-Zeldow Y, Kostas K, Shah S, Gottschalk R, Elias DA, Shepard A, Leurgans SE, Moore CG TI - Clinical evidence for cervical myelopathy due to Chiari malformation & spinal stenosis in a non-randomized group of pts w the Dx of FM. SO - Eur Spine J 2004 Oct;13(6):516-23. Epub 2004 Apr 9. IN - Heffez Neurosurgical Associates SC, 12th Floor, 2900 North Lake Shore Drive, IL 60657, Chicago, USA. dheffez@sbcglobal.net. AB - OBJECTIVE: While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine. We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy. METHODS: Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis. RESULTS: Patients were primarily women (87%), of mean age 44 years, who had been symptomatic for 8 years (standard deviation, 6.3 years). The predominant complaints were neck/back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%). Eighty-eight percent of patients reported worsening symptoms with neck extension. The neurological examination was consistent with cervical myelopathy: upper thoracic spinothalamic sensory level (83%), hyperreflexia (64%), inversion of the radial periosteal reflex (57%), positive Romberg sign (28%), ankle clonus (25%), positive Hoffman sign (26%), impaired tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%). MRI and contrast-enhanced CT imaging of the cervical spine revealed stenosis. The mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6, C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm respectively, (CT images). In 46% of patients, the AP spinal diameter at C5/6 measured 10 mm, or less, with the neck positioned in mild extension, i.e., clinically significant spinal canal stenosis. MRI of the brain revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1+/-1.8 mm), i.e., Chiari 1 malformation. CONCLUSION. Our findings indicate that some patients who carry the diagnosis of fibromyalgia have both signs and symptoms consistent with cervical myelopathy, most likely resulting from spinal cord compression. We recommend detailed neurological evaluation of patients with fibromyalgia in order to exclude cervical myelopathy, a potentially treatable condition. 431 PMID- 15385690 AU - Heim C, Bierl C, Nisenbaum R, Wagner D, Reeves WC TI - Regional prevalence of fatiguing illnesses in the United States before & after the terrorist attacks of September 11, 2001. [CFS] SO - Psychosom Med. 2004 Sep-Oct;66(5):672-8. IN - Division o Viral & Rickettsial Diseases, Viral Exanthems & Herpesvirus Branch, Nat Ctr for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia, USA. cmheim@emory.edu AB - OBJECTIVE: Stress or emotional traumas are considered risk factors for unexplained fatiguing illnesses. From July to December 2001, the Centers for Disease Control and Prevention conducted a multigeographical pilot study to test the feasibility of a survey to estimate the prevalence of fatiguing illnesses in the United States. We used data obtained during this survey to estimate the effect of the coincidentally occurring terrorist attacks of September 11, 2001, on the regional prevalence of fatiguing illnesses. METHODS: Identified by random-digit dialing, 2,728 households in eight regional strata were interviewed, and 7,317 respondents were screened for severe fatigue of at least 1 month duration. Identified fatigued people of age 18 to 69 years (N = 440) and a sample of nonfatigued people of the same age range (N = 444) were interviewed in detail concerning fatigue, other symptoms, and medical and psychiatric histories. RESULTS: Weighted prevalence estimates based on interviews performed after the attacks were significantly lower compared with estimates based on interviews performed before the attacks (prolonged fatigue: 5,450 vs. 1,530/100,000, p =.010; chronic fatigue: 18,510 vs. 10,070/100,000, p =.002; chronic fatigue syndrome-like illness: 2,510 vs. 960/100,000, p =.014).CONCLUSION: Our findings suggest decreased regional prevalence of fatiguing illnesses in the aftermath of the terrorist attacks. The causes of this effect are unknown but might involve acute psychological and physiological adaptations that modify the perception or manifestation of fatigue. Future studies should be specifically designed to scrutinize the relationship between stress and fatiguing illnesses and the mediating mechanisms of such a relationship. 432 PMID- 15016586 AU - Henderson M, Tannock C TI - Objective assessment of personality disorder in CFS. SO - J Psychosom Res 2004 Feb;56(2):251-4. IN - Academic D o Psychological Medicine, GKT School o Med & Inst o Psychiatry, Guys Kings & St. Thomas' Hosp, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. m.henderson@iop.kcl.ac.uk AB - OBJECTIVES: This study aims to objectively assess the prevalence and nature of personality disorders in depressed and nondepressed chronic fatigue syndrome (CFS) patients and compare this to depressed and healthy control groups. METHODS: Sixty-one patients attending a tertiary referral clinic with chronic fatigue syndrome, 40 psychiatric inpatients with depressive disorder and 45 healthy medical students completed the Structured Clinical Interview for DSM-III-R Diagnoses (SCID-II) in addition to providing routine clinical and demographic information. RESULTS: Thirty-nine percent of the CFS group, 73% of the depressed group and 4% of the healthy group were diagnosed with personality disorders. Cluster C disorders were the most common in both the CFS and depressed group. The depressed CFS patients had more Cluster B personality disorders than nondepressed CFS patients. Overall for CFS patients there was no association between mood state and personality disorder. CONCLUSIONS: High levels of personality disorder are found on objective assessment of CFS patients attending a teaching hospital clinic. This cannot be accounted for by comorbid depression. 433 PMID- 15626161 AU - Henriksson C, Carlberg U, Kjallman M, Lundberg G, Henriksson KG TI - Evaluation of 4 outpatient educational programmes for pts w longstanding FM. SO - J Rehabil Med 2004 Sep;36(5):211-9. IN - D o Neuroscience & Locomotion, Linkoping U, Linkoping, Sweden. chris.henriksson@inr.liu.se AB - OBJECTIVE: Four programmes based on educational and cognitive principles but with a variation in total length and number of staff/patient contact hours were compared in order to gain further insight into the importance of the format of the programme for the final outcome. DESIGN: A prospective non-randomized intervention study with 191 persons with fibromyalgia. Data were collected before, after and at 1-year follow-up. Participants served as their own controls. Results within and between the programmes were calculated. METHODS: Clinical investigations before and after intervention. Questionnaires were answered before, after and at 1-year follow-up. RESULTS: Most instruments showed no significant improvements after the programme. However, some improvements were found in important variables such as attitudes, self-efficacy, vitality and "days feeling well". Results were unchanged at the 1-year follow-up and 16 persons had started working. Seven had ceased working. Participants reported frequent use of coping strategies in everyday life. No major differences could be found between the programmes. CONCLUSIONS: More comprehensive programmes did not produce better results at group level. Also short and less costly interventions based on educational and cognitive principles were valuable for persons with longstanding fibromyalgia. More attention must be given to evaluating the clinical effect of programmes. 434 PMID- 15670444 AU - Herman CJ, Allen P, Hunt WC, Prasad A, Brady TJ TI - Use of complementary therapies among primary care clinic pts w arthritis. [FM] SO - Prev Chronic Dis. 2004 Oct;1(4):A12. Epub 2004 Sep 15. IN - Division o Geriatrics, D o Internal Med, School o Medicine, U o New Mexico Health Sciences Ctr, Albuquerque, NM 87131, USA. cherman@salud.unm.edu AB - INTRODUCTION: Use of complementary and alternative medicine (CAM) for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. METHODS: To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18-84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. RESULTS: Nearly half (44.6%) of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than 25,000 dollars. Most (90.2%) had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin) (34.1%), mind-body therapies (29.0%), and herbal topical ointments (25.1%). Fewer participants made current use of vitamins and minerals (16.6%), herbs taken orally (13.6%), a CAM therapist (12.7%), CAM movement therapies (10.6%), special diets (10.1%), or copper jewelry or magnets (9.2%). Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. CONCLUSION: Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning. 435 PMID- 15275772 AU - Heuts PH, Vlaeyen JW, Roelofs J, de Bie RA, Aretz K, van Weel C, van Schayck OC TI - Pain-related fear & daily functioning in pts w osteoarthritis. [FM] SO - Pain 2004 Jul;110(1-2):228-35. IN - Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands. p.heuts@srl.nl AB - There is growing evidence supporting the relationship between pain-related fear and functional disability in chronic musculoskeletal pain conditions. In osteoarthritis (OA) patients the role of pain-related fear and avoidance has received little research attention so far. The present study investigates the degree to which pain-related fear, measured with the Tampa Scale for Kinesiophobia (TSK), influences daily functioning in OA patients. The purpose of the present paper was twofold: (1) to investigate the factor structure of the TSK in a sample of OA patients by means of confirmatory factor analysis; and (2) to investigate the role of pain-related fear in OA compared to other factors, such as radiological findings and level of pain intensity. The results show that TSK consists of two factors, called 'activity avoidance' and 'somatic focus', which is in line with other studies in low back pain and fibromyalgia. Furthermore, pain-related fear occurred to a considerable extent in this sample of osteoarthritis patients and was negatively associated with daily functioning. Level of pain and level of pain-related fear were significantly associated with functional limitations. Radiological findings were not significant predictors and when compared to pain-related fear they were not significant. These findings underscore the importance of pain-related fear in daily functioning of OA patients. Therefore, treatment strategies aiming at reduction of pain-related fear in OA patients need to be developed and investigated. 436 PMID- 14985208 AU - Holick MF TI - Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, & osteoporosis. [FM] SO - Am J Clin Nutr 2004 Mar;79(3):362-71. IN - Vitamin D, Skin, & Bone Research Laboratory, Sect o Endocrinology, Diabetes, & Nutrition, D o Med, Boston U School o Medicine, Boston, MA 02118-2394, USA. AB - The purpose of this review is to put into perspective the many health benefits of vitamin D and the role of vitamin D deficiency in increasing the risk of many common and serious diseases, including some common cancers, type 1 diabetes, cardiovascular disease, and osteoporosis. Numerous epidemiologic studies suggest that exposure to sunlight, which enhances the production of vitamin D(3) in the skin, is important in preventing many chronic diseases. Because very few foods naturally contain vitamin D, sunlight supplies most of our vitamin D requirement. 25-Hydroxyvitamin D [25(OH)D] is the metabolite that should be measured in the blood to determine vitamin D status. Vitamin D deficiency is prevalent in infants who are solely breastfed and who do not receive vitamin D supplementation and in adults of all ages who have increased skin pigmentation or who always wear sun protection or limit their outdoor activities. Vitamin D deficiency is often misdiagnosed as fibromyalgia. A new dietary source of vitamin D is orange juice fortified with vitamin D. Studies in both human and animal models add strength to the hypothesis that the unrecognized epidemic of vitamin D deficiency worldwide is a contributing factor of many chronic debilitating diseases. Greater awareness of the insidious consequences of vitamin D deficiency is needed. Annual measurement of serum 25(OH)D is a reasonable approach to monitoring for vitamin D deficiency. The recommended adequate intakes for vitamin D are inadequate, and, in the absence of exposure to sunlight, a minimum of 1000 IU vitamin D/d is required to maintain a healthy concentration of 25(OH)D in the blood. 437 PMID- 15200760 AU - Horton-Salway M TI - The local production of knowledge: disease labels, identities & category entitlements in ME support group talk. [CFS] SO - Health (London) 2004 Jul;8(3):351-71. IN - D o Social Sciences, Open U, UK. mkhs2@tutor.open.ac.uk AB - This article uses discursive psychology to analyse how knowledge claims and entitlements are locally produced in an ME support group meeting and a research interview. The article demonstrates how 'expertise' and 'experience' associated with lay and professional membership are locally constituted in the activity of reasoning, arguing and claims making. The analysis shows how expertise and experiential claims are constructed, disclaimed, warranted and undermined in relationship to membership categorization and entitlements to knowledge that are co-constructed in the process of a discussion about disease labels and the nature of the illness as physical or psychological. In a discussion about the definition of contested disease categories, what is 'at stake' for the group members is the entitlement to speak from experience as members who can 'know' their own minds. 438 PMID- 15576066 AU - Hudson JI, Arnold LM, Keck PE Jr, Auchenbach MB, Pope HG Jr TI - Family study of FM & affective spectrum disorder. SO - Biol Psychiatry 2004 Dec 1;56(11):884-91. IN - Biological Psychiatry Laboratory, McLean Hosp D o Psychiatry, Harvard MS, Belmont, MA 02478, USA. jhudson@mclean.harvard.edu AB - BACKGROUND: Fibromyalgia is one member of a proposed group of psychiatric and medical disorders, collectively termed affective spectrum disorder (ASD), hypothesized to share possibly heritable pathophysiologic features. Two predictions of the ASD hypothesis were tested: ASD, taken as a single entity, aggregates in families; and fibromyalgia coaggregates with other forms of ASD in families. METHODS: Probands with and without fibromyalgia, together with their first-degree relatives, were administered structured diagnostic interviews. Noninterviewed relatives were diagnosed according to information provided by interviewed relatives. Aggregation and coaggregation of disorders were analyzed with proband predictive logistic and linear regression models. RESULTS: In 533 relatives of 78 probands with fibromyalgia and 272 relatives of 40 probands without fibromyalgia, the estimated odds ratio (OR) (95% confidence interval) for the familial aggregation of ASD was 1.8 (.97, 3.2), p = .065, and the increase in number of forms of ASD in a relative for each additional form of ASD in a proband was .076 (.027, .1240), p = .002. The OR for the coaggregation of fibromyalgia with other forms of ASD was 2.0 (1.2, 3.2), p = .004; this remained significant even after excluding all mood-disorder diagnoses: 1.8 (1.1, 3.0), p = .012. CONCLUSIONS: These findings support familial aggregation of ASD collectively and familial coaggregation of fibromyalgia with other forms of ASD. 439 PMID- 15365116 AU - Huibers MJ, Kant IJ, Knottnerus JA, Bleijenberg G, Swaen GM, Kasl SV TI - Development of the CFS in severely fatigued employees: predictors of outcome in the Maastricht cohort study. SO - J Epidemiol Community Health 2004 Oct;58(10):877-82. IN - D o Epidemiology, Maastricht U, PO Box 616, 6200 MD Maastricht, Netherlands. m.huibers@dmkep.unimaas.nl AB - STUDY OBJECTIVE: To identify risk factors of the development of the chronic fatigue syndrome (CFS), the persistence or recurrence of fatigue, or recovery from fatigue in a large sample of fatigued employees. DESIGN: Analyses were based on the Maastricht cohort study (MCS), a prospective population based cohort study among more than 12 000 employees. Multiple regression models were used to identify predictors of CFS-like caseness (meeting research criteria for CFS), non-CFS fatigue caseness, or no fatigue caseness. SETTING: The working population in the Netherlands. PARTICIPANTS: 1143 employees with medically unexplained fatigue were followed up prospectively for 44 months. MAIN RESULTS: At 44 month follow up, 8% of the employees were CFS-like cases (none of who reported to have received a CFS diagnosis), 40% were non-CFS fatigue cases, and 52% were no longer fatigue cases. Factors that predicted CFS-like caseness compared with non-CFS fatigue caseness were high age, exhaustion, female sex, low education, and visits to the general practitioner. Factors that predicted CFS-like caseness compared with no fatigue caseness were fatigue, exhaustion, low education, visits to the GP and occupational physician, and bad self rated health. Factors that predicted non-CFS fatigue caseness compared with no fatigue caseness were fatigue, low self perceived activity, exhaustion, anxious mood, and bad self rated health. CONCLUSIONS: Unexplained fatigue among employees in some instances is a precursor of the development of CFS. The prognostic role of self rated health suggests that prevention and treatment of chronic fatigue should be aimed at changing the perception of health or illness. Less clear is the role of health care seeking or receiving a CFS diagnosis. 440 PMID- 14990522 AU - Huibers MJ, Beurskens AJ, Van Schayck CP, Bazelmans E, Metsemakers JF, Knottnerus JA, Bleijenberg G TI - Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial. [CFS] SO - Br J Psychiatry 2004 Mar;184:240-6. IN - D o Epidemiology, Maastricht U, The Netherlands. m.huibers@dmkep.unimaas.nl AB - BACKGROUND: Fatigue is a common complaint that may lead to long-term sick leave and work disability. AIMS: To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue among employees. METHOD: A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive-behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity, self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months. RESULTS: At baseline, 44% of the patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point. CONCLUSIONS: Cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so. 441 PMID- 15602178 AU - Huibers MJ, Bultmann U, Kasl SV, Kant I, van Amelsvoort LG, van Schayck CP, Swaen GM TI - Predicting the two-year course of unexplained fatigue & the onset of long-term sickness absence in fatigued employees: results from the Maastricht Cohort Study. [CFS] SO - J Occup Environ Med 2004 Oct;46(10):1041-7. IN - D o Med, Clinical & Experimental Psychology, Maastricht U, The Netherlands. m.huibers@dmkep.unimaas.nl AB - Because of the serious adverse consequences of unexplained fatigue, it is important to identify factors that determine the prognosis of unexplained fatigue and the onset of long-term sickness absence in fatigued employees. Analyses were based on the Maastricht Cohort Study, a prospective population-based cohort study among more than 12,000 employees. Severely fatigued employees who were not on sick leave (n = 2108) were selected at baseline and followed up at six time points during the course of 2 years. Point prevalences of severe fatigue (59% to 63%) and long-term sickness absence (1.8% to 3.1%) among participants were fairly stable at all consecutive time points. Lower levels of fatigue severity, work-related exhaustion and anxious mood, absence of conflicts with colleagues, and good self-rated health at baseline were predictors of the onset of recovery from fatigue in survival analyses. Older age, low decision authority, female sex, working in nightshift, a physical attribution of fatigue, and a history of absenteeism were predictors of the onset of long-term absenteeism. The course of unexplained fatigue in employees is characterized by remission and relapse in time while the absolute risk of long-term absenteeism is small. Given the broad range of predictors, it appears that fatigue and long-term sickness absence entangle different underlying processes. Our findings underscore the notion that prevention and treatment of fatigue should be aimed at health perception and emotional well-being. 442 PMID- 15581647 AU - Huibers MJ, Bleijenberg G, van Amelsvoort LG, Beurskens AJ, van Schayck CP, Bazelmans E, Knottnerus JA TI - Predictors of outcome in fatigued employees on sick leave: results from a randomised trial. [CFS] SO - J Psychosom Res. 2004 Nov;57(5):443-9. IN - D o Epidemiology, Maastricht U, P.O. Box 616, Maastricht 6200 MD, The Netherlands. m.huibers@dmkep.unimaas.nl AB - OBJECTIVE: The main objective of this study was to identify predictors of fatigue caseness, work resumption and chronic fatigue syndrome (CFS)-like caseness in a sample of fatigued employees on sick leave. METHODS: For 12 months, 151 fatigued employees on sick leave, 44% of whom met research criteria for CFS at baseline, were followed. Measures included fatigue, health aspects, psychological problems, burnout, causal attributions and self-efficacy. Logistic regression analysis was used to determine associations between predictor variables at baseline and outcome at follow-up. RESULTS: After 12 months, 43% of the patients were no longer fatigue cases, and 62% had resumed work. Recovery from fatigue caseness was predicted by stronger psychological attributions and other perception-related factors, whereas work resumption was predicted by lower age, male sex, CFS-like caseness and less cognitive difficulties. Lower physical functioning scores were predictive of (the development of) CFS-like caseness. CONCLUSION: Recovering from persistent fatigue and work resumption seem to result from different underlying processes and do not necessarily fall together. As many factors associated with outcome in fatigue reflect illness perception, the prevention of persistent fatigue and CFS may partly be achieved by the modification of perception. 443 PMID- 15090670 AU - Huibers MJ, Kant IJ, Swaen GM, Kasl SV TI - Prevalence of CFS-like caseness in the working population: results from the Maastricht cohort study. SO - Occup Environ Med 2004 May;61(5):464-6. IN - D o Med, Clinical & Experimental Psychology, Maastricht U, Netherlands. marcus.huibers@hag.unimaas.nl AB - AIM: To determine the prevalence of chronic fatigue syndrome (CFS)-like caseness in the working population. METHODS: Using data from the prospective Maastricht Cohort Study on Fatigue at Work, the prevalence and incidence of CFS-like cases (employees meeting research criteria for CFS) were determined among 5499 employees who responded to the follow up assessment 3 years and 8 months after baseline. RESULTS: Of the 5499 employees, 199 (3.6%) were identified as CFS-like cases. By deleting possible CFS-like cases at baseline, the annual incidence of CFS-like caseness was estimated to be 85 per 10 000. Twenty employees (0.36%) reported having been diagnosed with CFS by a physician. CONCLUSIONS: The prevalence of CFS-like cases (3.6%) was considerably higher than the prevalence of CFS reported in previous studies (0.006-3%). These findings suggest that the CFS-like caseness may be underdetected in the working population and perhaps in other populations as well. 444 PMID- 15253480 AU - Huttunen P, Kokko L, Ylijukuri V TI - Winter swimming improves general well-being. SO - Int J Circumpolar Health 2004 May;63(2):140-4. IN - D o Forensic Med, U o Oulu, Oulu, Finland. pirkko.huttunen@+ AB - +IN: oulu.fi OBJECTIVES: This study deals with the effects of regular winter swimming on the mood of the swimmers. METHODS: Profile of Mood State (POMS) and OIRE questionnaires were completed before (October) and after (January) the four-month winter swimming period. RESULTS: In the beginning, there were no significant differences in the mood states and subjective feelings between the swimmers and the controls. The swimmers had more diseases (about 50%) diagnosed by a physician. Tension, fatigue, memory and mood negative state points in the swimmers significantly decreased with the duration of the swimming period. After four months, the swimmers felt themselves to be more energetic, active and brisk than the controls. Vigour-activity scores were significantly greater (p < 0.05). All swimmers who suffered from rheumatism, fibromyalgia, or asthma, reported that winter swimming had relieved pains. CONCLUSION: Improvement of general well-being is thus a benefit induced by regular winter swimming. 445 PMID- 15207518 AU - Huuhka MJ, Haanpaa ML, Leinonen EV TI - Electroconvulsive therapy in pts w depression & FM. SO - Eur J Pain 2004 Aug;8(4):371-6. IN - D o Psychogeriatrics, Tampere U Hosp, Pitkaniemi Fin-33380, Finland. martti.huuhka@pshp.fi AB - 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. 446 PMID- 15083892 AU - Jensen B, Wittrup IH, Wiik A, Bliddal H, Friis AS, McLaughlin JK, Danneskiold-S+ TI - Antipolymer antibodies in Danish FM pts. SO - Clin Exp Rheumatol 2004 Mar-Apr;22(2):227-9. IN - Parker Inst, Frederiksberg Hosp, Frederiksberg, Denmark. bj+ AB - +IN: ensen@aab11.dk +AU: amsoe B, Olsen JH OBJECTIVE: To use a new immunologic assay to investigate antipolymer antibody (APA) levels in women with fibromyalgia (FM). METHODS: The study population consisted of 35 patients with FM and 129 controls. The controls were selected based on a prior history of breast surgery and the presence or absence of a prior hospital diagnosis of soft tissue rheumatism. Study subjects underwent blood sampling, including tests for antinuclear antibodies (ANA) and APA, a clinical examination, and an interview focusing on rheumatic complaints and self-reported disability. The severity of rheumatic symptoms/signs was scored from 1 (= none) to 5 (= severe) based on the clinical examination and the interview. RESULTS: FM patients in this study represented a broad spectrum of disease severity, with the majority having mild symptoms. FM patients had a higher symptom severity and myalgic scores than controls (p < 0.001 for both variables). Adjusting for symptom severity, a weak positive association between APA levels and FM was observed (p = 0.08). The APA level was inversely associated with age, i.e., decreasing APA levels were seen with increasing age (p = 0.008). CONCLUSION: FM patients tended to have slightly higher APA levels than controls when adjusted for symptom severity. APA levels declined with age, a finding that has not been reported previously. The APA test and its clinical relevance should be evaluated in future studies. 447 PMID- 15099185 AU - Jensen B, Wittrup IH, Wiik A, Friis S, Bliddal H, Thomsen B, McLaughlin JK, Danneskiold-Samsoe B, Olsen JH TI - Antipolymer antibodies in Danish women w silicone breast implants. [FM] SO - J Long Term Eff Med Implants 2004;14(2):73-80. IN - Parker Inst, Frederiksberg Hosp, P.G. Ramms Alle 1,3th, 2000 Frederiksberg, Denmark. bjensen@aab11.dk AB - OBJECTIVE: To use a new immunologic assay to evaluate antipolymer antibody (APA) levels among women with silicone breast implants (SBIs). METHODS: Women (n = 186) were identified through Danish population-based registers and categorized into six groups defined by prior breast surgery (silicone breast implantation/breast reduction/no breast surgery) and by the presence or absence of a prior hospital diagnosis of soft-tissue rheumatism (muscular rheumatism, ICD-8 codes 717.90 and 717.99). The women underwent blood tests, including an APA test, a clinical examination, and an interview focusing on rheumatic complaints. Blood samples were tested blindly. The severity of rheumatic symptoms/signs was scored from 1 (none) to 5 (severe) based on the clinical examination and interview. RESULTS: Women with SBIs did not have higher levels of APA than women without SBIs. The majority of women with SBIs had mild rheumatic complaints, and the severity of their symptoms was not related to APA levels. Among women who had previously been hospitalized because of soft-tissue rheumatism, there were more fibromyalgia cases, and their symptoms were more severe compared with those women without prior soft-tissue rheumatism; however, APA levels were not higher among these women. There was a significant difference in APA measurements resulting from between-kit variation (p less 0.01). CONCLUSIONS: Our data did not demonstrate higher APA levels among women with SBIs compared with controls. The large variation observed between the individual plates in the APA test should be evaluated in future studies. 448 PMID- 15327812 AU - Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML TI - Changes in readiness to self-manage pain are associated w improvement in multidisciplinary pain Rx & pain coping. [FM] SO - Pain 2004 Sep;111(1-2):84-95. IN - D o Rehabilitation Med, U o Washington School o Medicine, Box 356490, Seattle, WA 98195-6490, USA. mjensen@u.washington.edu AB - A patient's readiness to adopt a self-management approach to pain has been hypothesized to increase during multidisciplinary pain treatment and to impact pain coping responses. The Pain Stages of Change Questionnaire (PSOCQ; [J Pain (1997) 227]) was designed to assess four components of readiness to self-manage pain: pre-contemplation, contemplation, action, and maintenance. We tested three hypotheses concerning this construct in two different samples of patients with chronic pain: (1) readiness to self-manage pain, as assessed by the PSOCQ, would increase from pre-multidisciplinary pain treatment to post-treatment and follow-up; (2) changes in readiness to self-manage pain measured pre-treatment to post-treatment and follow-up would be associated with changes in the use of pain coping strategies; and (3) increases in readiness to self-manage pain would be associated with improvement in multidisciplinary pain treatment. The findings supported all three hypotheses. We discuss the implications of the findings for understanding motivational issues in the self-management of pain. 449 PMID- 15193572 AU - Jones JF, Nisenbaum R, Solomon L, Reyes M, Reeves WC TI - CFS & other fatiguing illnesses in adolescents: a population-based study. SO - J Adolesc Health 2004 Jul;35(1):34-40. IN - National Jewish Med & Research Ctr, Denver, Colorado, USA. AB - PURPOSE: To estimate the prevalence of chronic fatigue syndrome (CFS) and describe characteristics of other fatiguing illnesses in adolescents (aged 12 through 17 years). METHODS: We conducted a random digit dialing survey of the residents of Wichita, Kansas. Adults identified fatigued adolescents in the household and answered questions relating to the child's health. Selected adolescents were invited to attend a clinic with a parent/guardian. After clinical evaluation they were classified as CFS or another fatigue state as defined in the 1994 CFS definition. Annual telephone interviews and clinical evaluations monitored subjects' fatigue status. Data were analyzed using the Kruskal-Wallis test, the Mantel-Haenszel test, and the exact McNemar test. RESULTS: The survey contacted 34,018 households with 90,316 residents. Of 8586 adolescents, 138 had fatigue for > or =1 month and most (107 or 78%) had chronic fatigue (> or =6 months) at some point during the 3-year follow-up. Twenty-eight had exclusionary diagnoses. Thirty-one were considered to have a CFS-like illness and were invited for clinical evaluation. Eleven agreed to participate and none met the CFS case definition. The baseline weighted prevalence of CFS-like illness was 338 per 100,000. Significant differences existed between parental and adolescents' descriptions of illness. CONCLUSIONS: The prevalence of CFS among adolescents was considerably lower than among adults. Evaluation of CFS in adolescents must consider both parent and patient perception of fatigue and other illnesses that might explain the symptom complex. 450 PMID- 15067429 AU - Kargili A, Bavbek N, Kaya A, Kosar A, Karaaslan Y TI - Eosinophilia in rheumatologic diseases: a prospective study of 1000 cases. [FM] SO - Rheumatol Int. 2004 Nov;24(6):321-4. Epub 2004 Apr 6. IN - D o Internal Med, Fatih U MS, Ankara, Turkey. AB - The role of eosinophilia in connective tissue diseases and the relationship between symptoms of rheumatic disease and eosinophilia have not been clearly established. The purpose of the present study was to explore the prevalence of eosinophilia in rheumatologic disease and determine its relationship to the symptoms. One thousand patients who applied to our rheumatology outpatient clinic between 2001 and 2002 were prospectively studied. The upper limit of normal blood eosinophil numbers was determined as 500 cells/microl of blood. A detailed history was obtained from all patients and careful physical examination was done. A negative correlation was observed between eosinophilia and dryness of the mouth, vitiligo, and fatigue (P < 0.05). Nonsteroidal anti-inflammatory drug usage correlated positively with eosinophilia, which was also statistically meaningful (P < 0.05). Twenty-six of our patients with fibromyalgia (n = 293), three of our subjects with rheumatoid arthritis who were using methotrexate (n = 182), 15 of whom who were not on methotrexate therapy, and one of the 26 with vasculitis had eosinophilia, which was not statistically significant (P > 0.05). None of the patients with scleroderma (n = 12) had eosinophilia. Eleven of the patients with gout had eosinophilia, and only one of them was using allopurinol. We conclude that eosinophilia can be seen in various rheumatologic conditions but, as corticosteroids are one of the most common medications used in collagen tissue diseases, the eosinophil numbers found may be lower than expected and eosinophilia may be more frequent than reported. 451 PMID- 15362477 AU - Kasman NM, Badley EM TI - Beyond access: who reports that health care is not being received when needed in a publicly-funded health care system? SO - Can J Public Health 2004 Jul-Aug;95(4):304-8. IN - Arthritis Community Research & Evaluation Unit, D o Outcome+ AB - +IN: s & Population Health, Toronto Western Hosp Research Inst & the U Health Network, Ontario. OBJECTIVES: To examine the relationship between reporting that health care was not received when needed in Canada's publicly-funded health care system and contact with the health care system, and to explore whether there is a differential impact of specific chronic conditions. METHODS: Analyses were carried out on the 2000/2001 Canadian Community Health Survey. The proportion of survey respondents who reported that they had not received health care when it was needed was determined overall, and for individuals with selected socio-demographic, health status, and health care utilization characteristics, as well as stratified by various chronic conditions. Multivariate logistic regression was then employed to examine possible predictors of having reported that health care was not received when it was needed during the previous year. RESULTS: Approximately 13% of Canadians reported that health care was not received when they felt it was needed during the previous year. These individuals reported higher rates of health care utilization, worse health status, were more likely to have chronic health conditions (particularly conditions such as fibromyalgia, Crohn's disease, and chronic bronchitis for which there is no effective treatment), and were more likely to be female, younger, white, have higher education and lower income. CONCLUSION: Reporting that health care was not received when it was needed may not be related to accessibility but rather to a perceived failure of the system to meet the individual's needs. 452 PMID- 15088307 AU - Kendall SA, Schaadt ML, Graff LB, Wittrup I, Malmskov H, Krogsgaard K, Bartels EM, Bliddal H, Danneskiold-Samsoe B TI - No effect of antiviral (valacyclovir) Rx in FM: a double blind, randomized study. SO - J Rheumatol 2004 Apr;31(4):783-4. IN - Parker Inst, D o Rheumatology, Frederiksberg Hosp, Frederiksberg, Denmark. AB - 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. 453 PMID- 15115515 AU - Kendall SN TI - Remission of rosacea induced by reduction of gut transit time. [FM] SO - Clin Exp Dermatol 2004 May;29(3):297-9. IN - Mathematics Inst, U o Warwick, Coventry, UK. skendall@boltblue.net AB - Rosacea is a chronic disorder characterized by hypersensitivity of the facial vasculature, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistently found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones. The possible relevance of this hypothesis to other conditions featuring afferent hypersensitivity, such as fibromyalgia, is considered. 454 PMID- 15280416 AU - Kennedy G, Spence V, Underwood C, Belch JJ TI - Increased neutrophil apoptosis in CFS. SO - J Clin Pathol 2004 Aug;57(8):891-3. IN - Vascular Diseases Research Unit, U D o Med, Ninewells Hosp & MS, Dundee DD1 9SY, UK. g.kirk@dundee.ac.uk AB - BACKGROUND/AIMS: Many patients with chronic fatigue syndrome (CFS) have symptoms that are consistent with an underlying viral or toxic illness. Because increased neutrophil apoptosis occurs in patients with infection, this study examined whether this phenomenon also occurs in patients with CFS. METHODS: Apoptosis was assessed in patients with CFS in conjunction with concentrations of the anti-inflammatory cytokine, transforming growth factor beta1 (TGFbeta1). RESULTS: The 47 patients with CFS had higher numbers of apoptotic neutrophils, lower numbers of viable neutrophils, increased annexin V binding, and increased expression of the death receptor, tumour necrosis factor receptor-I, on their neutrophils than did the 34 healthy controls. Patients with CFS also had raised concentrations of active TGFbeta1 (p < 0.005). CONCLUSIONS: These findings provide new evidence that patients with CFS have an underlying detectable abnormality in their immune cells. 455 PMID- 15018881 AU - Kennedy G, Abbot NC, Spence V, Underwood C, Belch JJ TI - The specificity of the CDC-1994 criteria for CFS: comparison of health status in 3 groups of pts who fulfill the criteria. SO - Ann Epidemiol 2004 Feb;14(2):95-100. IN - Vascular Diseases Research Unit, U D o Med, Ninewells Hosp & MS, Dundee, UK. g.kirk@dundee.ac.uk AB - PURPOSE: The Centers for Disease Control (CDC)-1994 definition of chronic fatigue syndrome (CFS) is very broad, and there have been suggestions that it lacks specificity. To test this, we have compared three groups of patients, all of whom fulfill the criteria but self-report different etiologies. METHODS: Patients with self-reported symptoms which developed sporadically (sCFS, n=48); after Gulf War service (GW, n=24); and following exposure to organophosphate insecticides (OP, n=25) underwent a clinical examination, completed the MOS SF-36 quality of life and Hospital Anxiety and Depression scales, and were assessed for major and minor criteria for CDC-1994 CFS. RESULTS: Significant differences in simple clinical measures and outcome measures were observed between groups. The GW group had significantly more severe physical symptoms-fatigue, muscle and multi-joint pain-than OP or sCFS, and the sCFS group was significantly less impaired than the other two groups in terms of role emotional and mental health. In all three groups, a majority of patients exhibited muscle weakness in the lower limbs, and significant numbers of patients had absent or abnormal reflexes. CONCLUSIONS: Differences in simple, easily performed clinical outcome measurements can be observed between groups of patients, all of whom fulfill the CDC-1994 criteria for CFS. It is likely that their response to treatment may also vary. The specificity of the CFS case definition should be improved to define more homogeneous groups of patients for the purposes of treatment and research. 456 PMID- 14503920 AU - Khan F, Kennedy G, Spence VA, Newton DJ, Belch JJ TI - Peripheral cholinergic function in humans w CFS, Gulf War syndrome & w illness following organophosphate exposure. SO - Clin Sci (Lond) 2004 Feb;106(2):183-9. IN - Vascular Diseases Research Unit, U D o Med, Ninewells Hosp & MS, Dundee DD1 9SY, Scotland, U.K. f.khan@dundee.ac.uk AB - In the present study, we have investigated whether the peripheral cholinergic abnormalities that we have reported previously [Spence, Khan and Belch (2000) Am. J. Med. 108, 736-739] in patients with chronic fatigue syndrome (CFS) are also present in those with Gulf War syndrome (GWS) and agricultural workers exposed to organophosphate pesticides, where cholinesterase inhibition is specifically implicated. We also looked at whether these abnormalities might be due to a reduction in the activity of cholinesterase expressed on the vascular endothelium. We used laser Doppler imaging to measure the forearm skin blood flow responses to iontophoresis of acetylcholine and of methacholine (which is resistant to breakdown by cholinesterase) in patients with CFS, GWS and those with a history of ill health after definite organophosphate exposure, as well as in matched healthy controls. The response to acetylcholine was significantly higher in patients with CFS than in controls ( P =0.029, repeated-measures ANOVA), but was normal in those with GWS and those exposed to organophosphates. The methacholine response was higher than the acetylcholine response in all patient groups except for those with CFS, where there was no difference between the responses. Although there are many clinical similarities between these three illnesses, our results indicate peripheral cholinergic abnormalities in the vascular endothelium of only patients with CFS, suggesting that this syndrome has a different aetiology, which might involve inhibition of vascular cholinesterase. 457 PMID- 15581643 AU - Kivimaki M, Leino-Arjas P, Virtanen M, Elovainio M, Keltikangas-Jarvinen L, Puttonen S, Vartia M, Brunner E, Vahtera J TI - Work stress & incidence of newly diagnosed FM: prospective cohort study. SO - J Psychosom Res. 2004 Nov;57(5):417-22. IN - D o Psychology, U o Helsinki, P.O. Box 9, FIN-00014, Helsinki, Finland. mika.kivimaki@ttl.fi AB - OBJECTIVES: We examined the prospective association between occupational stress and incidence of newly diagnosed fibromyalgia. METHODS: Cohort study with questionnaire surveys in 1998 and 2000 completed by 4791 hospital employees (4250 women and 541 men). Stress, as indicated by high workload, low decision latitude, and being a victim of workplace bullying, was assessed in the first survey. Incident cases (n=47) were employees reporting physician-diagnosed fibromyalgia in 2000 but not in 1998. Covariates were sex, age, income, obesity, and smoking. RESULTS: After adjustment for covariates, the odds ratio of incident diagnosed fibromyalgia for workplace bullying was 4.1 (95% CI 2.0-9.6). The corresponding odds ratios for high workload and low decision latitude were 2.1 (1.2-3.9) and 2.1 (1.1-4.0), respectively. CONCLUSION: Stress seems to be a contributing factor in the development of fibromyalgia, but further research is needed to examine whether stress perceptions are affected by undiagnosed fibromyalgia. 458 PMID- 15515408 AU - Koeppe C, Schneider C, Thieme K, Mense S, Stratz T, Muller W, Flor H TI - The influence of the 5-HT3 receptor antagonist tropisetron on pain in FM: a functional magnetic resonance imaging pilot study. SO - Scand J Rheumatol Suppl 2004;(119):24-7. IN - D o Neuropsychology, U o Heidelberg, Central Inst o Mental Health, Mannheim, Germany. AB - OBJECTIVE: Central pain processing is altered in patients with fibromyalgia syndrome (FMS). The serotonin metabolism, especially the 5-HT3 receptor, seems to play an important role. METHODS: We investigated the effect of the local injection of the 5-HT3 receptor antagonist tropisetron on the perception and central processing of pain in FMS patients using painful mechanical stimulation and functional magnetic resonance imaging (fMRI) within the framework of a pre-/posttreatment double-blind design. RESULTS: In the contralateral primary somatosensory cortex, contralateral posterior insula, and anterior cingulate cortex, we found that the activation was significantly reduced after treatment. On average, patients rated the stimulation-induced pain intensity as stronger in the session after treatment compared to before treatment, although the individual data revealed a heterogeneous pattern. All patients showed sensitisation during the painful stimulation, which was not influenced by the treatment. CONCLUSIONS: Both the sensory-discriminative and motivational-affective components of pain as measured by fMRI were altered by tropisetron. 459 PMID- 15515419 AU - Kohnen R, Farber L, Spath M TI - The assessment of vegetative & functional Sx in FM pts: the tropisetron experience. SO - Scand J Rheumatol Suppl 2004;(119):67-71. IN - IMEREM Inst for Med Research Management & Biometrics Ltd., Germany. kohnen@imerem.de AB - Vegetative and functional symptoms are, besides pain and tenderness of tender points, considered as additional information for the diagnosis of fibromyalgia (FM). In clinical trials, vegetative and functional symptoms have been included for selection of patients (e.g. sleep disturbances) and as secondary outcome parameters. Despite the relevance of these symptoms, no validated method is currently available but symptom lists are ad hoc developed by investigators. In this manuscript, data from a published double blind, randomised study are reanalysed which compared oral therapy over 10 days with 5 mg, 10 mg, and 15 mg to placebo in FM patients. This study applied a list of 17 vegetative and functional symptoms, which had to be scored by the patients by use of a 4-point severity scale (0 = none to 3 = severe). Factor analysis of the baseline data from 195 patients suggested to separate 6 sub-scales: Cardiovascular, gastrointestinal, psychiatric (sleep disturbance), nervous, autonomic system, and general disorders. Sleep disturbances, general symptoms (morning stiffness, fatigue) and autonomic symptoms (cold extremities, hyperhidrosis) were most severe in intensity. Analysis of sensitivity for treatment effects made use of differences between placebo and 5 mg tropisetron in changes between baseline and final assessment of the tropisetron trial. While, on the item level, differences in favour of tropisetron could only be demonstrated for sleep disorders, on the sub-scale level, also favourable effects of tropisetron could be shown for cardiovascular and nervous system complaints and, as a tendency, for general symptoms. On the other side, the sub-scale score of gastrointestinal symptoms worsened under tropisetron whilst it improved under placebo which effect was due to side effects of the active treatment. It is concluded that symptom clusters like sub-scales of a list of vegetative and functional symptoms will be more suitable for diagnostic purposes and evaluation of treatment outcome of clinical trials. Further research is urgently required which addresses the development of a FM-specific scale to assess vegetative and functional symptoms. 460 PMID- 15283010 AU - Landis CA, Lentz MJ, Rothermel J, Buchwald D, Shaver JL TI - Decreased sleep spindles & spindle activity in midlife women w FM & pain. SO - Sleep 2004 Jun 15;27(4):741-50. IN - D o Biobehavioral Nursing & Health Systems, U o Washington,+ AB - +IN: Seattle 98195-7266, USA. calandis@u.washington.edu OBJECTIVES: To compare sleep-spindle incidence (number of spindles per minute of non-rapid eye movement [NREM] stage 2 sleep) and duration, spindle wave time (seconds per epoch in NREM stage 2 sleep), spindle frequency activity, and pain measures (pressure pain threshold, number of tender points, skinfold tenderness) between midlife women with fibromyalgia (FM) and moderate to high pain to a control group of sedentary women without pain. A second goal was to explore the extent to which pain pressure thresholds, age, and depression explain the variance in spindle incidence. DESIGN: A cross-sectional descriptive study. SETTING: A university-based sleep research laboratory and a referral clinic for chronic fatigue and pain. PARTICIPANTS: Thirty-seven medication-free women with FM (mean age, 44.9 +/- 8 years) and 30 women with self-reported good sleep and no pain (mean age, 44.1 +/- 7.7 years) completed a psychiatric interview and the Beck Depression Inventory prior to 2 consecutive nights of polysomnography, with pain measures obtained in the morning. Time domain analysis of spindle incidence and spectral analysis of spindle frequency activity were conducted on night 2 of polysomnography recordings. Interventions: NA. RESULTS: Women with FM had fewer mean spindles per minute of NREM stage 2 sleep and lower mean spindle time per epoch of NREM stage 2 sleep (both P values < .02), but mean spindle duration, although slightly shorter, was not statistically significantly different (P < .06) compared to control women. Women with FM had a lower mean pressure pain threshold, a higher average number of positive tender points, and higher skinfold tenderness compared to control women (all P values < .001). Group differences in spindle frequency activity were found after controlling for age, depression, and psychiatric diagnosis in a general linear model (P < .02). One-way analysis of variance revealed significantly lower spindle activity in the 3 frequency bins (12-12.5 Hz, 13-13.5 Hz, 14-14.5 Hz) at C3 (all P values < .04), Fz (all P values < .02), and Cz (all P values < .02). Finally, after controlling for age and depression, pain pressure threshold significantly predicted spindles per minute and spindle time per epoch of NREM stage 2 sleep (r2 = .26; P < .001). CONCLUSIONS: Women with FM and pain have fewer sleep spindles and reduced electroencephalogram power in spindle frequency activity compared to control women of similar age. These data imply that some aspect of thalamocortical mechanisms of spindle generation might be impaired in FM. 461 PMID- 15157947 AU - Landis CA, Lentz MJ, Tsuji J, Buchwald D, Shaver JL TI - Pain, psychological variables, sleep quality, & natural killer cell activity in midlife women w & without FM. SO - Brain Behav Immun 2004 Jul;18(4):304-13. IN - D o Biobehavioral Nursing & Health Systems, U o Washington, Seattle, WA 98195-7266, USA. calandis@u.washington.edu AB - In women with fibromyalgia (FM), central nervous system (CNS) dysfunction in pain, mood, and sleep processes could be associated with changes in immune system indicators. The primary purpose of this study was to compare pain, psychological variables, subjective and objective sleep quality, lymphocyte phenotypes and activation markers, and natural killer activity (NKA) in midlife women with and without FM. A secondary purpose was to explore relationships among these variables in a step-wise regression. Subjects had pain pressure tender points assessed, completed a psychiatric interview and questionnaires (Beck Depression Inventory, SCL-90, Profile of Mood States, subjective sleep), and underwent polysomnograhic assessment for two consecutive nights. Lymphocyte phenotypes, activation markers, and NKA were assessed from blood drawn the morning after sleep laboratory night 2. Compared to controls, women with FM had lower pain thresholds, more psychological distress, higher depression scores, and reduced subjective and objective sleep quality. They also had fewer NK cells (p <.009) and more NK cells that expressed the IL-2 receptor (p <.04), but these differences were not statistically significant after correction for multiple comparisons. NKA was not statistically significantly lower in the women with FM compared to controls. In a multiple regression of age, tender point threshold, depression, psychological distress, and sleep efficiency, only the effect of group was significant (F = 5.479, p <.03) on NKA. In conclusion, we found little evidence to support the hypothesis that pain, mood, and sleep symptoms are associated with changes in the enumeration of peripheral lymphocytes or function in FM. 462 PMID- 15252215 AU - Leeb BF, Andel I, Sautner J, Nothnagl T, Rintelen B TI - The DAS28 in RA & FM pts. SO - Rheumatology (Oxford) 2004 Dec;43(12):1504-7. Epub 2004 Jul 13. IN - Second D o Med, HUMANIS Klinikum Lower Austria, Lower Austrian Ctr for Rheumatology, A-2000 Stockerau, Landstrasse 18, Austria. leeb.khstockerau@aon.at AB - OBJECTIVE: To compare the DAS28 (Disease Activity Score including a 28-joint count) values of rheumatoid arthritis (RA) and fibromyalgia (FM) patients, and to establish whether high pain levels and impaired mood influence DAS28 values. METHODS: DAS28 values were calculated in 62 consecutive patients with RA and in 26 patients suffering from FM. Values for DAS28 scores as well as for the single items of the patient cohorts were compared using Student's t-tests. To evaluate the item weighting and internal consistency of the total score factor analysis was performed and Cronbach's alpha calculated. RESULTS: RA patients showed a mean DAS28 score of 4.23 (+/-1.2; range 0.77-7.46) and in FM patients the mean DAS28 came to 4.04 (+/-1.13; range 1.19-6.28). DAS28 values of RA and FM patients were not significantly different statistically. Comparing the single components of the score, however, highly significant differences (P<0.0005) occurred between RA and FM patients. Cronbach's alpha for the DAS28 in RA patients amounted to 0.7329, indicating high internal consistency, whereas in FM patients it was 0.4832. CONCLUSION: The DAS28, as expected, proved to be inappropriate to express disease activity in FM patients. DAS28 values for expressing disease activity in RA patients may be flawed by coexisting FM and should therefore be regarded with caution as high pain levels more than impaired mood may lead to higher total scores. 463 PMID- 15113035 AU - Lerner AM, Beqaj SH, Deeter RG, Fitzgerald JT TI - IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of pts w the CFS. SO - In Vivo 2004 Mar-Apr;18(2):101-6. IN - D o Med, William Beaumont Hosp & Wayne St U School o Medici+ AB - +IN: ne, Royal Oak, Michigan, USA. lerner@cdimed.com BACKGROUND: A unique subset of patients with chronic fatigue syndrome (CFS) and IgM serum antibodies to cytomegalovirus (HCMV) non-structural gene products p52 and CM2 (UL 44 and UL 57) has been described. PATIENTS AND METHODS: Fifty-eight CFS patients and 68 non-CFS matched controls were studied. Serum antibodies to EBV viral capsid antigen (VCA) IgM and EBV Early Antigen, diffuse (EA, D) as well HVCMV(V), IgM and IgG; VP (sucrose, density purified V); p52 and CM2 IgM serum antibodies were assayed. RESULTS: Mean age of CFS patients was 44 years (75% women). Control patients were 9 years older (73% women). Serum EBV VCA IgM positive antibody titers were identified in 33 CFS patients (Group A subset EBV VCA IgM 62.3+/-8.3, neg. <20), but were not present in other CFS patients, (Group B subset EBV VCA IgM 6.8+/-0.7) controls (p<0.0001). EBV VCA IgM titers remained positive in CFS patients from Group A for 24-42 months. CONCLUSION: Serum antibody to EBV VCA IgM may be a specific diagnostic test for a second subset of CFS patients. 464 PMID- 15369178 AU - Lerner AM, Dworkin HJ, Sayyed T, Chang CH, Fitzgerald JT, Beqaj S, Deeter RG, G+ TI - Prevalence of abnormal cardiac wall motion in the cardiomyopathy associated w incomplete multiplication of Epstein-barr Virus and/or cytomegalovirus + SO - In Vivo 2004 Jul-Aug;18(4):417-24. IN - D o Med, William Beaumont Hosp, Royal Oak, Michigan, USA. l+ AB - +TI: in pts w CFS. +IN: erner@cdimed.com +AU: oldstein J, Gottipolu P, O'Neill W We reported unique incomplete herpesvirus (Epstein-Barr Virus (EBV) and/or nonstructural (HCMV) cytomegalovirus) multiplication in 2 distinct subsets of CFS patients. The CFS subsets were identified by: a) presence of IgM serum antibodies to HCMV nonstructural gene products p52 and CM2 (UL44 and UL57), and/or b) IgM serum antibodies to Epstein-Barr virus viral capsid antigen (EBV, VCA IgM). Diagnostic IgM serum antibodies were found in two independent blinded studies involving 49 CFS patients, but the same antibodies were absent in 170 control patients (p<0.05). Abnormal 24 Hr-electrocardiographic monitoring, tachycardias at rest and, in severe chronic cases, abnormal cardiac wall motion (ACWM) were seen in these same CFS patients. We now report a prospective consecutive case control study from 1987--1999 of cardiac dynamics as measured by radionuclide ventriculography in 98 CFS patients from 1987--1999. Controls were patients with various malignancies who were evaluated in protocols requiring radionuclide ventriculography before initiation of cardiotoxic chemotherapeutic agents. The prevalence of abnormal cardiac wall motion (ACWM) at rest in CFS patients was 10 out of 87 patients (11.5%). With stress exercise, 21 patients (24.1%) demonstrated ACWM. Cardiac biopsies in 3 of these CFS patients with ACWM showed a cardiomyopathy. Among the controls, ACWM at rest was present in 4 out of 191 patients (2%) (p=0.0018). A progressive cardiomyopathy caused by incomplete virus multiplication of EBV and/or HCMV in CFS patients is present. 465 PMID- 15316000 AU - Lin HC TI - Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. [FM] SO - JAMA 2004 Aug 18;292(7):852-8. IN - Division o Gastrointestinal & Liver Diseases, D o Med, Keck School o Medicine, U o Southern California, Los Angeles 90033, USA. henry.c.lin@usc.edu AB - CONTEXT: Irritable bowel syndrome (IBS), which affects 11% to 14% of the population, is a puzzling condition with multiple models of pathophysiology including altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. Although no conceptual framework accounts for all the symptoms and observations in IBS, a unifying explanation may exist since 92% of these patients share the symptom of bloating regardless of their predominant complaint. EVIDENCE ACQUISITION: Ovid MEDLINE was searched through May 2004 for relevant English-language articles beginning with those related to bloating, gas, and IBS. Bibliographies of pertinent articles and books were also scanned for additional suitable citations. EVIDENCE SYNTHESIS: The possibility that small intestinal bacterial overgrowth (SIBO) may explain bloating in IBS is supported by greater total hydrogen excretion after lactulose ingestion, a correlation between the pattern of bowel movement and the type of excreted gas, a prevalence of abnormal lactulose breath test in 84% of IBS patients, and a 75% improvement of IBS symptoms after eradication of SIBO. Altered gastrointestinal motility and sensation, changed activity of the central nervous system, and increased sympathetic drive and immune activation may be understood as consequences of the host response to SIBO. CONCLUSIONS: The gastrointestinal and immune effects of SIBO provide a possible unifying framework for understanding frequent observations in IBS, including postprandial bloating and distension, altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. 466 PMID- 15156983 AU - Lipworth L, Tarone RE, McLaughlin JK TI - Breast implants & FM: a review of the epidemiologic evidence. SO - Ann Plast Surg 2004 Mar;52(3):284-7. IN - International Epidemiology Inst, 1455 Research Boulevard, R+ AB - +IN: ockville, MD 20850, USA. Although the collective epidemiologic literature does not support an association between silicone breast implants and any well-defined or atypical connective tissue disease, a recent study raised concern regarding an increased risk for fibromyalgia among women with extracapsular ruptured implants. In this review, we examine the results of 6 epidemiologic studies which have evaluated the occurrence of fibromyalgia among women with breast implants. Two large nationwide follow-up studies of women with breast implants in Sweden and Denmark reported relative risks for fibromyalgia of 1.0 (95% confidence interval [CI] 0.3 to 3.0) and for unspecified rheumatism (including fibromyalgia and myalgia) of 1.2 (95% CI 0.9 to 1.5), respectively. Similarly, both a case-control and a cross-sectional study conducted within rheumatic disease clinics reported no association between silicone breast implants and the subsequent development of fibromyalgia. The single positive finding, that of a greater than 2-fold excess of self-reported fibromyalgia among women with magnetic resonance imaging-diagnosed extra-capsular ruptures in one study, can be explained by selection bias and the use of an inappropriate reference group in the analyses. In the most recent study of indefinite connective tissue disease (including fibromyalgia) by rupture status, no association was found among unselected Danish women with ruptured implants (relative risk 1.0; 95% CI 0.3 to 3.0), and none of the women with extracapsular rupture reported fibromyalgia. Thus, the weight of the epidemiologic evidence is remarkably consistent and reassuring in failing to support an association between breast implants and subsequent fibromyalgia. 467 PMID- 15115418 AU - Lloyd AR TI - To exercise or not to exercise in CFS? No longer a question. SO - [CON: Med J Aust. 2004 May 3;180(9):444-8. PMID: 15115421]; Med J Aust 2004 May 3;180(9):437-8. 468 PMID- 15518673 AU - Looper KJ, Kirmayer LJ TI - Perceived stigma in functional somatic syndromes & comparable medical conditions. [CFS/FM] SO - J Psychosom Res 2004 Oct;57(4):373-8. IN - D o Psychiatry, Sir Mortimer B. Davis-Jewish General Hosp, 3755 Chemin de la Cote-Ste-Catherine, Montreal, PQ, Canada. karl.looper@mail.mcgill.ca AB - OBJECTIVE: To determine if patients with functional somatic syndromes (FSS) perceive greater levels of stigma than patients with comparable medical conditions that have a clear medical pathology. METHODS: Patients with chronic fatigue syndrome (CFS), fibromyalgia (FM), or irritable bowel syndrome (IBS) were compared to multiple sclerosis (MS), rheumatoid arthritis (RA), and inflammatory bowel disease (IBS), respectively. RESULTS: There were greater levels of perceived stigma in the combined group of FSS compared to the medical control group. When each FSS was compared to its matched control group, only CFS had a higher level of perceived stigma. These results remained when controlling for other variables relevant to stigma. CONCLUSIONS: The higher level of perceived stigma in CFS may be due to the ambiguity of its status as a medical condition. The absence of this effect in FM and IBS is consistent with a greater level of acceptance of these disorders as medical illnesses. 469 PMID- 15239640 AU - Lopatin M TI - I knew she was trouble. SO - Med Econ 2004 Jun 4;81(11):39-41. 470 PMID- 15047091 AU - Luthra A, Wessely S TI - Unloading the trunk: NA, CFS & race. SO - Soc Sci Med 2004 Jun;58(11):2363-9. IN - King's Coll School o Med, Inst o Psychiatry, 103 Denmark Hill, London SE5 8AZ, UK. AB - The aetiologies of both chronic fatigue syndrome (CFS) and its predecessor neurasthenia, have been linked to technological advances in 'developed' countries. This paper discusses how this has led to a form of race thinking within discussions about fatigue which has persisted for more than a century. We review the historical development of this race thinking from neurasthenia to CFS and describe how it is manifested in both the lay- and medical literature. We also review the epidemiological literature on CFS and ethnicity to better understand the relatively low percentage of non-white patients seen in tertiary referral clinics for CFS. The aim of this paper is to act as a starting point for a debate on race and CFS. 471 PMID- 15099145 AU - Mahurin RK, Claypoole KH, Goldberg JH, Arguelles L, Ashton S, Buchwald D TI - Cognitive processing in monozygotic twins discordant for CFS. SO - Neuropsychology 2004 Apr;18(2):232-9. IN - D o Radiology, U o Washington, Seattle, WA 98195-6465, USA. mahurin@u.washington.edu AB - Twenty-one pairs of monozygotic twins discordant for chronic fatigue syndrome (CFS) and 21 matched healthy control (HC) subjects were assessed with 5 untimed tests and 5 timed tests from the computer-based NeuroCognitive Assessment Battery (R. K. Mahurin, 1993). Random effects regression showed no difference between CFS and healthy twins on any of the cognitive tests. Further, the twin groups did not differ from the HC group on any content-dependent measure. In contrast, both sets of twins performed worse than the HC group on all speed-dependent tests except Finger Tapping. Self-rated fatigue and dysphoric mood were only weakly correlated with cognitive performance. These data point toward a shared genetic trait related to information processing that is manifest in the CFS context. The findings have implications for differentiating genetic and acquired vulnerability in the symptomatic expression of the disorder. ((c) 2004 APA, all rights reserved) 472 PMID- 15894939 AU - Manfredini D, Tognini F, Montagnani G, Bazzichi L, Bombardieri S, Bosco M TI - Comparison of masticatory dysfunction in temporomandibular disorders & FM. SO - Minerva Stomatol. 2004 Nov-Dec;53(11-12):641-50. IN - Section o Prosthetic Dentistry, D o Neurosciences, U o Pisa, Pisa, Italy. daniele.manfredini@tin.it AB - AIM: Many theories have been proposed as to the relationship between fibromyalgia (FM) and temporomandibular disorders (TMD). The aim of this study was to investigate the clinical features of the involvement of the stomatognathic system in patients with fibromyalgia, and to compare signs and symptoms of masticatory dysfunction between TMD and FM patients. METHODS: The study sample consisted of 30 subjects with fibromyalgia recruited at the Rheumatology Disease Department, University of Pisa, Italy, and of 30 with temporomandibular disorders at the Section of Prosthetic Dentistry, Department of Neurosciences, University of Pisa, Italy. Masticatory dysfunction has been compared between the 2 groups by means of a clinical assessment conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients of the TMD group underwent a rheumatologic examination to investigate for the presence of previously undiagnosed fibromyalgia. RESULTS: As regards specific clinical variables and RDC/TMD diagnoses, differences between the 2 groups appear to be not relevant, with the exception of the values of mouth opening, both voluntary and passive, and the presence of trigger points. FM patients showed a decrease in both maximum voluntary and passive mouth opening which was about 2 mm worse than that recorded in TMD patients. FM patients also showed a significantly higher number of trigger points, even though muscle palpation evoked tenderness in the same number of sites in the 2 groups. CONCLUSIONS: This study showed that most patients with fibromyalgia (86.7%) report signs and symptoms localized at the stomatognathic system; by contrast, only a minority of patients with temporomandibular disorders (10%) are actually affected by fibromyalgia. 473 PMID- 15841606 AU - Mannerkorpi K, Arndorw M TI - Efficacy & feasibility of a combination of body awareness therapy & qigong in pts w FM: a pilot study. SO - J Rehabil Med. 2004 Nov;36(6):279-81. IN - D o Rheumatology & Inflammation Research, Sahlgrenska Academy, Goteborg U, Goteborg, Sweden. kaisa.mannerkorpi@rheuma.gu.se AB - OBJECTIVE: To evaluate the effects of body awareness therapy combined with qigong for patients with fibromyalgia. DESIGN: A controlled randomized pilot study. SUBJECTS: Thirty-six female patients with fibromyalgia were randomized to either qigong plus body awareness therapy (n = 19) or a control group (n = 17). METHODS: The programme was conducted once a week over a period of 3 months. The outcome measures were an observational method called the Body Awareness Rating Scale, the Fibromyalgia Impact Questionnaire and 2 tests of physical function. An interview was conducted with the patients in the treatment group. RESULTS: Seven patients in each group (39%) were lost to the post-test examination. The inter-group analysis revealed a significant improvement in movement harmony for the treatment group (p = 0.03), while no differences were found in the Fibromyalgia Impact Questionnaire or the functional tests. The intra-group analysis revealed an improvement in movement harmony for the treatment group (p = 0.01), while the total score of the Fibromyalgia Impact Questionnaire deteriorated (p = 0.04) in the control group. The interviews indicated that several patients had experienced exacerbation of symptoms while standing still, and/or difficulty in concentrating on the movements. CONCLUSIONS: Although improvement in movement harmony occurred in the patients completing the treatment programme, no improvement was found for fibromyalgia symptoms or physical function. 474 PMID- 14987620 AU - Maquet D, Croisier JL, Demoulin C, Crielaard JM TI - Pressure pain thresholds of tender point sites in pts w FM & in healthy controls. SO - Eur J Pain 2004 Apr;8(2):111-7. IN - D o Physical Med & Rehabilitation, U o Liege, Liege, Belgium. adepaifve@ulg.ac.be AB - Pressure pain threshold (PPT) is defined as the minimum force applied which induces pain. This measure has proven to be commonly useful in evaluating tenderness symptom. Our aim was to study the intra-examiner reproducibility of PPT measurement, define cutoffs in normal groups, and compare these results with patients with fibromyalgia (FM). Fifty healthy females, 50 healthy males, and 20 patients with FM participated in the study. PPTs were assessed for 18 specific tender point sites by a dolorimeter. The intra-individual coefficient of variation determined by a test-retest PPT measurement procedure with 3-days interval reached, respectively, 17% and 13% in healthy females and males, versus 24% in patients with FM. PPTs were significantly lower in healthy females than in healthy males (p<0.01). Statistical analysis failed to show any differences between the dominant and nondominant side for both normal groups. PPTs were lower over all examined areas in patients with FM than those obtained in healthy females (p<0.000). Lower cutoff levels were calculated from normal values for all specific tender point sites. On average, 14 tender point sites in patients with FM were under the established lower cutoffs. In conclusion, pressure pain sensitivity was influenced by the anatomical localization of tender point and gender differences. Lowest PPTs were localized in trapezius, occiput, anterior cervical, and second rib. The reduction of total tender point score in patients with FM averaged 60% comparatively with normal values. PPT reproducibility and discrimination between the two groups were optimal for the gluteal and knee sites. 475 PMID- 15088301 AU - Marquez J, Restrepo CS, Candia L, Berman A, Espinoza LR TI - Human immunodeficiency virus-associated rheumatic disorders in the HAART era. [FM] SO - J Rheumatol 2004 Apr;31(4):741-6. IN - Rheumatology Sect, D o Med, LSU Health Sciences Ctr, New Orleans, Louisiana 70112, USA. AB - OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic. METHODS: A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 +/- 4.5 years (range 21-58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, cellulitis, osteomyelitis, diskitis, and pyomyositis. Fibromyalgia was present in 13 (17%), seronegative symmetric polyarthritis in 4, oligoarthritis in 4, psoriatic arthritis in 2, carpal tunnel syndrome in 2, and enthesitis in 2. Mutifocal bone non-Hodgkin's lymphoma was present in 7 (9.3%) and Kaposis's sarcoma of bone in 2 (2.6%) patients. Hypertrophic osteoarthropathy in 3 (4%) and aseptic bone necrosis of multiple bones was seen in 3 (4%) patients. Ten patients exhibited only arthralgias. Most patients had moderately elevated erythrocyte sedimentation rate and C-reactive protein. Mean CD4 cell count was 250 mm3 (range 20-450), and mean HIV viral load was 5210 (range 0-75,300) copies/ml. CONCLUSION: Rheumatic manifestations were highly frequent in HIV patients receiving HAART referred to a rheumatology clinic, although the clinical spectrum differed from the pre-HAART era with septic and malignant complications being the most common manifestations seen. 476 PMID- 15361323 AU - Martinez-Lavin M TI - FM as a sympathetically maintained pain syndrome. SO - Curr Pain Headache Rep 2004 Oct;8(5):385-9. IN - Rheumatology D, Instituto Nacional de Cardiologia, Juan Badiano 1, 14080 Mexico DF, Mexico. mmlavin@infosel.net.mx AB - Abnormal activity of the sympathetic nervous system may be involved in the pathogenesis of chronic pain syndromes. This article reviews the animal studies of sympathetically induced pain behavior, the controversy of sympathetically maintained pain in clinical practice, and the dysautonomic nature of fibromyalgia (FM). FM has neuropathic pain features (stimuli-independent pain state accompanied by allodynia and paresthesias). The proposal of FM as a sympathetically maintained pain syndrome is based on the controlled studies showing that patients with FM display signs of relentless sympathetic hyperactivity and that the pain is submissive to sympathetic blockade and is rekindled by norepinephrine injections. Dysautonomia also may explain the multisystem features of FM. 477 PMID- 15540638 AU - Martinez S, Guilleminault C TI - Periodic leg movements in prepubertal children w sleep disturbance. [CFS] SO - Dev Med Child Neurol 2004 Nov;46(11):765-70. IN - Stanford U Sleep Disorders Clinic, Stanford, California 94305, USA. AB - This study's aims were to determine: (1) prevalence of periodic leg movements (PLMs) in walking prepubertal children consulting a sleep clinic for any sleep disorder; (2) associations between PLMs and other sleep and medical disorders; and (3) the response of other sleep disorders to treatment with the dopamine agonist pramipexol. Clinical evaluation and polysomnography were carried out for a period of 12 months on 252 consecutively seen, prepubertal children with sleep disorders (156 males, 96 females; aged 15mo to 11y, mean 7y 1mo, SD3y 10mo). Sleep disorders unrelated to PLMs were treated, and six children received pramipexol for PLMs. Follow-up included clinical evaluation and polysomnography. Twenty-three per cent of children were diagnosed with PLMs on the basis of polysomnography. The presence of PLMs had usually been unrecognized clinically. The only clinical symptom that could be related to periodic limb movement disorder was a report of leg pains at morning awakening. Only two of 58 children had PLMs without other clinical or polysomnographic findings. Comorbidity seen with PLMs included neuropsychiatric syndromes (n=20), isolated sleep disordered breathing (SDB; n=29), and several other comorbid conditions (n=7). Seven of 11 children seen with attention-deficit-hyperactivity disorder also had PLMs. Surgery for SDB was associated with subsequent cessation of PLMs in 15 of 29 children. Five out of six children with PLMs who received pramipexol were able to tolerate the drug and experienced a complete disappearance of their PLMs. Presence of chronic fatigue, sleepiness, disrupted nocturnal sleep, and difficulties in falling asleep should lead to a systematic search for PLMs that is independent of associated syndromes. Isolated treatment of SDB might help eliminate some, but not all, PLMs. 478 PMID- 15283449 AU - McCabe CS, Haigh RC, Shenker NG, Lewis J, Blake DR TI - Phantoms in rheumatology. SO - Novartis Found Symp 2004;260:154-74; discussion 174-8, 277-+ IN - The Royal Nat Hosp for Rheumatic Diseases, Upper Borough Wa+ AB - +SO: 9. +IN: lls, UK. This paper examines rheumatology pain and how it may relate to amputee phantom limb pain (PLP), specifically as experienced in rheumatoid arthritis, fibromyalgia and complex regional pain syndrome (CRPS). Clinical findings, which suggest cortical sensory reorganization, are discussed and illustrated for each condition. It is proposed that this sensory reorganization generates pain and altered body image in rheumatology patients in the same manner as has previously been hypothesized for amputees with PLP; that is via a motor/sensory conflict. The correction of this conflict through the provision of appropriate visual sensory input, using a mirror, is tested in a population of patients with CRPS. Its analgesic efficacy is assessed in those with acute, intermediate and chronic disease. Finally, the hypothesis is taken to its natural conclusion whereby motor/sensory conflict is artificially generated in healthy volunteers and chronic pain patients to establish whether sensory disturbances can be created where no pain symptoms exists and exacerbated when it is already present. The findings of our studies support the hypothesis that a mismatch between motor output and sensory input creates sensory disturbances, including pain, in rheumatology patients and healthy volunteers. We propose the term 'ominory' to describe the central monitoring mechanism and the resultant sensory disturbances as a dissensory state. 479 PMID- 15554570 AU - McCrone P, Ridsdale L, Darbishire L, Seed P TI - Cost-effectiveness of cognitive behavioural therapy, graded exercise & usual care for pts w chr fatigue in primary care. [CF] SO - Psychol Med 2004 Aug;34(6):991-9. IN - Centre for the Economics o Mental Health, Health Services Research D, Inst o Psychiatry, King's Coll, London, UK. p.mccrone@iop.kcl.ac.uk AB - BACKGROUND: Chronic fatigue is a common condition, frequently presenting in primary care. The aim of this study was to compare the cost-effectiveness of cognitive behavioural therapy (CBT) and graded exercise therapy (GET), and to compare therapy with usual care plus a self-help booklet (BUC). METHOD: Patients drawn from general practices in South East England were randomized to CBT or GET. The therapy groups were then compared to a group receiving BUC recruited after the randomized phase. The main outcome measure was clinically significant improvements in fatigue. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. RESULTS: Costs were available for 132 patients, and cost-effectiveness results for 130. Costs were dominated by informal care. There were no significant outcome or cost differences between the therapy groups. The combined therapy group had significantly better outcomes than the standard care group, and costs that were on average 149 pounds higher (a non-significant difference). Therapy would have an 81.9% chance of being cost-effective if society were willing to attach a value of around 500 pounds to each four-point improvement in fatigue. CONCLUSION: The cost-effectiveness of cognitive behavioural therapy and graded exercise were similar unless higher values were placed on outcomes, in which case CBT showed improved cost-effectiveness. The cost of providing therapy is higher than usual GP care plus a self-help booklet, but the outcome is better. The strength of this evidence is limited by the use of a non-randomized comparison. The cost-effectiveness of therapy depends on how much society values reductions in fatigue. 480 PMID- 14578362 AU - McCully KK, Smith S, Rajaei S, Leigh JS Jr, Natelson BH TI - Muscle metabolism w blood flow restriction in CFS. SO - J Appl Physiol 2004 Mar;96(3):871-8. Epub 2003 Oct 24. IN - D o Exercise Science, U o Georgia, Athens, GA 30602, USA. kmccully@coe.uga.edu AB - The purpose of this study was to determine whether chronic fatigue syndrome (CFS) is associated with reduced blood flow and muscle oxidative metabolism. Patients with CFS according to Centers for Disease Control criteria (n = 19) were compared with normal sedentary subjects (n = 11). Muscle blood flow was measured in the femoral artery with Doppler ultrasound after exercise. Muscle metabolism was measured in the medial gastrocnemius muscle with (31)P-magnetic resonance spectroscopy. Muscle oxygen saturation and blood volume were measured using near-infrared spectroscopy. CFS and controls were not different in hyperemic blood flow or phosphocreatine recovery rate. Cuff pressures of 50, 60, 70, 80, and 90 mmHg were used to partially restrict blood flow during recovery. All pressures reduced blood flow and oxidative metabolism, with 90 mmHg reducing blood flow by 46% and oxidative metabolism by 30.7% in CFS patients. Hyperemic blood flow during partial cuff occlusion was significantly reduced in CFS patients (P < 0.01), and recovery of oxygen saturation was slower (P < 0.05). No differences were seen in the amount of reduction in metabolism with partially reduced blood flow. In conclusion, CFS patients showed evidence of reduced hyperemic flow and reduced oxygen delivery but no evidence that this impaired muscle metabolism. Thus CFS patients might have altered control of blood flow, but this is unlikely to influence muscle metabolism. Furthermore, abnormalities in muscle metabolism do not appear to be responsible for the CFS symptoms. 481 PMID- 15581533 AU - Mears CJ, Taylor RR, Jordan KM, Binns HJ TI - Sociodemographic & Sx correlates of fatigue in an adolescent primary care sample. [CFS] SO - J Adolesc Health 2004 Dec;35(6):528e.21-6. IN - D o Pediatrics, Feinberg School o Med, Northwestern U, Chicago, Illinois, USA. AB - PURPOSE: To describe the prevalence of prolonged fatigue, chronic fatigue syndrome (CFS)-like illness, and associated symptom patterns in adolescents attending primary care. METHODS: The design was cross-sectional. A questionnaire designed by the authors assessing fatigue and associated symptoms was administered to 901 adolescents (aged 11-18 years) attending 12 primary care clinics in the Chicago area. Prevalence rates for prolonged fatigue and CFS-like illness were calculated. Univariate comparisons involving sociodemographic data and fatigue severity were made between adolescents with and without prolonged fatigue, and sociodemographic and symptom predictors of prolonged fatigue were identified using logistic regression analysis. RESULTS: Prolonged fatigue (> or = 1 month) occurred at a rate of 8.0% and CFS-like illness occurred at a rate of 4.4%. Adolescents with prolonged fatigue were significantly older and also reported greater fatigue severity than those without fatigue. Findings from logistic regression indicated that, in addition to increasing age, headaches, muscle pains, fever, and fatigue made worse by exercise were significantly associated with prolonged fatigue. CONCLUSIONS: Abnormal fatigue is a disabling and prevalent condition in adolescents in primary care. It is associated with a number of additional symptoms, many of which may have viral origins. 482 PMID- 14660198 AU - Mengshoel AM, Heggen K TI - Recovery from FM - previous pts' own experiences. SO - Disabil Rehabil 2004 Jan 7;26(1):46-53. IN - Section o Health Science, Med Faculty, U o Oslo, Norway. a.m.mengshoel@helsefag.uio.no AB - PURPOSE: To explore what patients that had completely recovered from fibromyalgia (FM) experienced as being important for their recovery. METHODS: Five women, aged between 37 and 49 were interviewed individually. The interviews were aimed at finding out about the recovery process and the women's daily lives at the time of the interview and before and after their diagnosis, with a special emphasis on social relationships and obligations. The interviews were analysed by qualitative thematic content analysis. RESULTS: These five women reported that they recovered irrespective of specific treatment. The study shows that resistance to the unpleasantness of the sick role and the stigmatization associated with the uncertain nature of the FM diagnosis promoted recovery. Instead of adapting their activities to pain, they used pain as a warning signal of too much stress in life. This significantly developed their ability to alter their life goals and everyday obligations. At the same time they managed to maintain a social role they considered to be consistent with their self-image. CONCLUSIONS: Patients can recover from FM. The information from these informants suggests that to struggle against a role of chronic patient and keep up with their social obligations and goals were of great importance. 483 PMID- 15351079 AU - Miike T, Tomoda A, Jhodoi T, Iwatani N, Mabe H TI - Learning & memorization impairment in childhood CFS manifesting as school phobia in Japan. SO - Brain Dev 2004 Oct;26(7):442-7. IN - D o Child Development, Faculty o Med & Pharmaceutical Sciences, Kumamoto U Graduate School, 1-1-1 Honjo, Kumamoto 860-8556, Kumamoto, Japan. miketeru@kaiju.medic.kumamoto-u.ac.jp AB - For the last 15 years, we have tried to understand the pathophysiology of childhood chronic fatigue syndrome (CCFS) in Japan. In this condition, two major symptoms are important: easy fatigability and disturbed learning and memorization. In CCFS patients we clinically evaluated autonomic nervous system function, circadian rhythm of hormonal secretion (melatonin, cortisol and 3-endorphin), core body temperature, and sleep-wake pattern. Most patients showed autonomic nervous system dysfunction and circadian rhythm disturbances, similar to those observed in jet lag. Radiological imaging studies (SPECT, Xe-CT, and MRS) revealed decreased blood flow in the frontal and thalamic areas, and accumulation of choline in the frontal lobe. We analyzed the relationship between the laboratory data and clinical symptoms in CCFS. 484 PMID- 15349514 AU - Mo F, Choi BC, Li FC, Merrick J TI - Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals w chr diseases. [FM] SO - ScientificWorldJournal 2004 Aug 27;4:746-57. IN - Centre for Chronic Disease Prevention & Control, Population & Public Health Branch, Health Canada, 120 Colonnade Road, Ottawa, Ontario, Canada K1A 0K9. Frank_Mo@hc-sc.gc.ca AB - Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases.This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases. 485 PMID- 15593181 AU - Montoya P, Larbig W, Braun C, Preissl H, Birbaumer N TI - Influence of social support & emotional context on pain processing & magnetic brain responses in FM. SO - Arthritis Rheum 2004 Dec;50(12):4035-44. IN - U o the Balearic Islands, Palma, Spain. pedro.montoya@uib.es AB - OBJECTIVE: To examine the effects of social support provided by the presence of patient's significant other on pain ratings, pain thresholds, and brain activity associated with tactile stimulation in 18 fibromyalgia (FM) patients and 18 migraine patients (controls), and to assess the influence of emotional context on thermal pain perception and processing of non-pain-related information. METHODS: Thermal pain thresholds and somatosensory brain magnetic responses elicited by tactile stimulation at the elbow (a painful tender point in the FM group) and at the finger (nonpainful site) were evaluated under 2 experimental conditions of social support: patient alone and patient's significant other present. Brain activity was recorded using a 151-channel whole-head magnetoencephalography system. Additionally, the emotional context during presentation of tactile stimuli was manipulated by presenting aversive, pain-related pictures and neutral pictures and asking the patients to imagine that they were experiencing the situations depicted. RESULTS: Thermal pain thresholds indicated greater sensitivity in FM patients than in migraine patients, as well as enhanced sensitivity at the elbow than at the fingers. Specifically, in FM patients, there were significant reductions in pain sensitivity and subjective pain ratings when patients were stimulated at the painful tender point in the presence of their significant others as compared with the ratings when the patients were alone. Brain activity elicited by elbow stimulation was also significantly reduced in FM patients when a significant other was present as compared with the activity when the patient was alone. These effects were not observed in the migraine patients. CONCLUSION: When the significant other was present, FM patients reported less pain and thermal pain sensitivity and showed diminished brain activity elicited upon tactile stimulation of a tender point compared with these levels when the patients were alone. These findings are consistent with the hypothesis that social support through the presence of a significant other can influence pain processing at the subjective-behavioral level as well as the central nervous system level. 486 PMID- 15515413 AU - Muller W, Stratz T TI - Local Rx of tendinopathies & myofascial pain syndromes w the 5-HT3 receptor antagonist tropisetron. [FM] SO - Scand J Rheumatol Suppl 2004;(119):44-8. IN - Hochrhein Inst o Rehabilitation Research, Bad Sackingen, Germany. mehrer@hri.de AB - The use of local tropisetron injections improved the treatment of tendinopathies considerably, with the effect being comparable to the topical application of local anaesthetics combined with depot corticosteroids. On the other hand, local injection of prilocaine alone exerted a shorter and weaker effect on the condition. OBJECTIVES: After it had been proven that systemic application of the 5-HT3 receptor antagonist tropisetron exerts an analgesic effect on musculoskeletal pain in fibromyalgia, we investigated the efficacy of the substance in tendinopathies and myofascial pain syndromes. RESULTS: Local injections of tropisetron as a treatment for trigger points in myofascial pain syndrome also brought about rapid and prolonged relief in the majority of cases. The analgesic effect was far superior to the action of local anaesthetics. CONCLUSION: The present findings indicate that the analgesic action of the 5-HT3 receptor antagonist tropisetron sets in rapidly and lasts for a long time. Various mechanisms are under discussion to explain the long duration of the effect. Tropisetron not only has an analgesic but probably also an antiphlogistic effect which can be attributed to the inhibited release of substance P and other neuropeptides from the nociceptors and the blocked release of phlogistic substances from macrophages, monocytes etc. 487 PMID- 14604604 AU - Murphy BE, Abbott FV, Allison CM, Watts C, Ghadirian AM TI - Elevated levels of some neuroactive progesterone metabolites, particularly isopregnanolone, in women w CFS. SO - Psychoneuroendocrinology 2004 Feb;29(2):245-68. IN - D o Psychiatry, McGill U, 1033 Pine Avenue West, Montreal, + AB - +IN: Canada H3A 1A1. bev.murphy@mcgill.ca Chronic fatigue syndrome (CFS) is a controversial entity whose cause is unknown. In this study we have explored the possibility that progesterone metabolites may be involved. Plasma levels of the progesterone precursor pregnenolone, progesterone itself, and five ring A-reduced metabolites of progesterone were measured in 20 women with CFS and in 13 age-matched controls. To minimize the contribution of the ovary, women were either post-menopausal or in the follicular phase of the menstrual cycle (day 4-8), and progesterone levels were all well within the expected range (< or = 3.5 nmol/l). Mean values for progesterone and all of its metabolites were higher in CFS patients, the most marked being a 2.3-fold elevation in isopregnanolone (3beta,5alpha-tetrahydroprogesterone; p < or = 0.001). Progesterone levels were correlated with those of its metabolites, but even after controlling for progesterone by ANCOVA, isopregnanolone levels were still elevated (p < or = 0.001). These elevated levels of isopregnanolone could not be attributed to medications (antidepressants and anxiolytics). When the CFS patients were divided into two groups according to their Hamilton depression scale ratings, mean (+/-SD) isopregnanolone levels were higher (274+/-160 vs 197+/-119 pmol/l) in the less depressed group (ratings 2-14) than in the more depressed group (ratings 17-28), although this difference did not reach significance. Progesterone levels were negatively correlated with Hamilton depression rating scores (r=-0.56; p<0.01). These results suggest that increases in ring A-reduced progesterone metabolites, particularly isopregnanolone, are associated with CFS, and that the pathophysiology of CFS is unlikely to be due to depression. 488 PMID- 15623268 AU - Nampiaparampil DE, Shmerling RH TI - A review of FM. SO - Am J Manag Care 2004 Nov;10(11 Pt 1):794-800. IN - Spaulding Rehabilitation Hosp, Harvard MS, Boston, MA 02114, USA. dnampiaparampil@partners.org AB - 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. 489 PMID- 14962627 AU - Naschitz JE, Yeshurun D, Rosner I TI - Dysautonomia in CFS: facts, hypotheses, implications. SO - Med Hypotheses 2004;62(2):203-6. IN - D o Internal Med A, Bnai Zion Med Ctr & Bruce Rappaport Faculty o Medicine, Technion - Israel Inst o Technology, PO Box 4940, Haifa 31048, Israel. naschitz@tx.technion.ac.il AB - The diagnosis of chronic fatigue syndrome (CFS) is based on patient history and treatment on cognitive behavior therapy and graded exercise. There is increasing evidence that dysautonomia occurs in CFS manifest primarily as disordered regulation of cardiovascular responses to stress. We impart our experience relating to diagnosis, monitoring, and treatment of CFS based on identification and management of dysautonomia. Recently proposed methods for assessment of the cardiovascular reactivity, the 'hemodynamic instability score' (HIS) and the 'Fractal and Recurrence Analysis-based Score' (FRAS), served for this purpose. On HUTT, a particular dysautonomia is revealed in CFS patients that differ from dysautonomia in several other disorders. This distinct abnormality in CFS can be identified by HIS >-0.98 (sensitivity 84.5% and specificity 85.1%) and FRAS > +0.22 (sensitivity 70% and specificity 88%). Therefore, the HIS and FRAS may be used, in the appropriate clinical context, to support the diagnosis of CFS, which until now, could only be subjectively inferred. A pilot study suggested that midodrine treatment, directed at the autonomic nervous system in CFS, results first in correction of dysautonomia followed by improvement of fatigue. This finding implies that dysautonomia is pivotal in the pathophysiology CFS, at least in a large part of the patients, and that manipulating the autonomic nervous system may be effective in the treatment of CFS. 490 PMID- 15082846 AU - Naschitz J, Dreyfuss D, Yeshurun D, Rosner I TI - Midodrine Rx for CFS. SO - Postgrad Med J 2004 Apr;80(942):230-2. IN - D o Internal Med A, Bnai Zion Med Ctr & Bruce Rappaport Faculty o Medicine, Technion-Israel Inst o Technology, Haifa, Israel. Naschitz@tx.technion.ac.il AB - The long term results of midodrine treatment in a patient having debilitating chronic fatigue syndrome (CFS) are reported. Midodrine treatment, directed at the autonomic nervous system, resulted in correction of the dysautonomia followed by improvement of fatigue. This finding is consistent with the hypothesis that dysautonomia plays a major part in the pathophysiology of CFS and that therapies directed at the autonomic nervous system may be effective in the treatment of CFS. 491 PMID- 14976271 AU - Naschitz JE, Rosner I, Rozenbaum M, Fields M, Isseroff H, Babich JP, Zuckerman E, Elias N, Yeshurun D, Naschitz S, Sabo E TI - Patterns of cardiovascular reactivity in disease Dx. [CFS] SO - QJM 2004 Mar;97(3):141-51. IN - Departments o Internal Med A & Rheumatology, Bnai Zion Med Ctr & Bruce Rappaport Faculty o Medicine, Technion-Israel Inst o Technology, Haifa, Israel. naschitz@tx.technion.ac.il AB - BACKGROUND: Aberrations of cardiovascular reactivity (CVR), an expression of autonomic function, occur in a number of clinical conditions, but lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome was observed. Aim: To assess whether specific CVR patterns can be described for other clinical conditions. METHODS: Six groups of patients, matched for age and gender, were evaluated with a shortened head-up tilt test: patients with chronic fatigue syndrome (CFS) (n = 20), non-CFS fatigue (F) (n = 15), neurally-mediated syncope (SY) (n = 21), familial Mediterranean fever (FMF) (n = 17), psoriatic arthritis (PSOR) (n = 19) and healthy subjects (H) (n = 20). A 10-min supine phase was followed by recording 600 cardiac cycles on tilt (5-10 min). Beat-to-beat heart rate (HR) and pulse transit time (PTT) were measured. Results were analysed using conventional statistics, recurrence plot analysis and fractal analysis. RESULTS: Multivariate analysis evaluated independent predictors of the CVR in each patient group vs. all other groups. Based on these predictors, equations were determined for a linear discriminant score (DS) for each group. The best sensitivities and specificities of the DS, consistent with disease-related phenotypes of CVR, were noted in the following groups: CFS, 90.0% and 60%; SY, 93.3% and 62.5%; FMF, 90.1% and 75.4%, respectively. DISCUSSION: Pathological disturbances may alter cardiovascular reactivity. Our data support the existence of disease-related CVR phenotypes, with implications for pathogenesis and differential diagnosis. 492 PMID- 15369197 AU - Naschitz JE, Rozenbaum M, Shaviv N, Fields MC, Enis S, Babich JP, Manor H, Yesh+ TI - The feeling of fatigue--fatigue severity by unidimensional versus composite questionnaires. SO - Behav Med 2004 Winter;29(4):167-72. IN - D o internal med, Haifa, Isreal. Naschitz@techunix.techion.+ AB - +IN: ac.il +AU: urun D, Sabo E, Rosner I The authors' purpose in this study was to compare the perception of fatigue severity as measured by different fatigue questionnaires. The authors evaluated 3 groups of patients in a cross-sectional study: chronic fatigue syndrome (CFS, n = 20), non-CFS fatigue (n = 20), and familial Mediterranean fever (FMF n = 25). In addition, the authors tracked 7 patients with CFS longitudinally for severity of fatigue. The severity of fatigue-related symptoms was assessed with 2 questionnaires: the unidimensional Chalder's Fatigue Severity Scale (CH) and the composite Fatigue Impact Scale (FI) which has 3 subscales--cognitive, physical, and social--and a total score. In the cross-sectional study, correlations between CH and FI cognitive scores were r = .78 (p < .0001), CH versus FI physical scores r = .603 (p < .0001), CH versus FI social scores r = .66 (p < .0001), and CH versus FI total scores r = .74 (p < .0001). In the longitudinal survey of CFS patients, the authors compared 30 questionnaires revealing correlations of CH versus FI cognitive scores r = .64 (p = .0004), CH versus FI physical r = .68 (p = .0001), CH versus FI social r = .87 (p < .0001), and CH versus FI total r = .90 (p < .0001). Fatigue severity as assessed by the unidimensional CH scale and the composite FI scale is comparable. The simple CH scale may be adequate for the assessment of the feeling of fatigue, in general, and for monitoring the severity of fatigue in CFS, in particular. 493 PMID- 15616178 AU - Ng BY, Lim CC, Yeoh A, Lee WL TI - Neuropsychiatric sequelae of Nipah virus encephalitis. [CFS] SO - J Neuropsychiatry Clin Neurosci 2004 Fall;16(4):500-4. IN - D o Behavioral Med, Singapore General Hosp, Republic o Singapore. gdmnby@sgh.com.sg AB - The authors followed nine patients with Nipah virus encephalitis over the course of 24 months. Eight of the nine developed psychiatric features assigned to the encephalitis. Three patients developed major depressive disorder immediately after recovering from the encephalitis, and two developed depression approximately 1 year after the outbreak. Two patients developed personality changes, and two suffered chronic fatigue syndrome. Neuropsychological testing was accomplished in eight of the nine patients. Deficits in attention, verbal, and/or visual memory were substantial in seven of the eight patients tested. Verbal memory was more impaired than visual memory in these patients. Comparison between psychiatric and cognitive impairment and total number of brain lesions showed no discernible trends. 494 PMID- 15157683 AU - Nielson WR, Jensen MP TI - Relationship between changes in coping & Rx outcome in pts w FM Syndrome. SO - Pain 2004 Jun;109(3):233-41. IN - D o Med (Division o Rhematolody), U o Western Ontario, London, Ont. Canada. warren.nielson@sjhc.london.on.ca AB - 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. 495 PMID- 15082102 AU - Nijs J, De Meirleir K, Meeus M, McGregor NR, Englebienne P TI - CFS: intracellular immune deregulations as a possible etiology for abnormal exercise response. SO - Med Hypotheses 2004;62(5):759-65. IN - D o Human Physiology, Faculty o Physical Education & Physical Therapy Science, Vrije Universiteit Brussel, Brussel 1090, Belgium. jo.nijs@vub.ac.be AB - The exacerbation of symptoms after exercise differentiates Chronic fatigue syndrome (CFS) from several other fatigue-associated disorders. Research data point to an abnormal response to exercise in patients with CFS compared to healthy sedentary controls, and to an increasing amount of evidence pointing to severe intracellular immune deregulations in CFS patients. This manuscript explores the hypothetical interactions between these two separately reported observations. First, it is explained that the deregulation of the 2-5A synthetase/RNase L pathway may be related to a channelopathy, capable of initiating both intracellular hypomagnesaemia in skeletal muscles and transient hypoglycemia. This might explain muscle weakness and the reduction of maximal oxygen uptake, as typically seen in CFS patients. Second, the activation of the protein kinase R enzyme, a characteristic feature in atleast subsets of CFS patients, might account for the observed excessive nitric oxide (NO) production in patients with CFS. Elevated NO is known to induce vasidilation, which may limit CFS patients to increase blood flow during exercise, and may even cause and enhanced postexercise hypotension. Finally, it is explored how several types of infections, frequently identified in CFS patients, fit into these hypothetical pathophysiological interactions. 496 PMID- 15283620 AU - Nijs J, Vanherberghen K, Duquet W, De Meirleir K TI - CFS: lack of association between pain-related fear of movement & exercise capacity & disability. SO - Phys Ther 2004 Aug;84(8):696-705. IN - D o Human Physiology, Faculty o Physical Education & Physical Therapy Science, Vrije Universiteit Brussel, Brussels, Belgium. Jo.Nijs@vub.ac.be AB - BACKGROUND AND PURPOSE: Patients who experience pain, a symptom of chronic fatigue syndrome (CFS), often exhibit kinesiophobia (irrational fear of movement). The purpose of this study was to examine whether pain-related fear of movement is associated with exercise capacity, activity limitations, or participation restrictions in patients with CFS who experience widespread pain. SUBJECTS AND METHODS: Sixty-four subjects met the inclusion criteria. All subjects fulfilled the 1994 Centers for Disease Control and Prevention case definition for CFS and experienced widespread myalgias or arthralgias. The subjects completed the Tampa Scale for Kinesiophobia-Dutch Version (TSK-DV) and the Dutch Chronic Fatigue Syndrome-Activities and Participation Questionnaire (CFS-APQ). They then performed a maximal exercise test on a bicycle ergometer. Heart rate was monitored continuously by use of an electrocardiograph. Ventilatory factors were measured through spirometry. Correlations between the TSK-DV scores and both the exercise capacity data and the CFS-APQ scores were assessed using the Spearman rank correlation coefficient. Using the Mann-Whitney U test, the TSK-DV scores were compared between subjects who performed a maximal exercise stress test and those who did not perform the test. RESULTS: Forty-seven subjects (73.4%) attained a total score of greater than 37 on the TSK-DV, indicating high fear of movement. Neither the exercise capacity data nor the CFS-APQ scores indicated a correlation with the TSK-DV scores (n=64). Subjects who did not perform a maximal exercise capacity test had more fear of movement (median TSK-DV score=43.0, interquartile range=10.3) compared with those who did perform a maximal exercise capacity test (median TSK-DV score=38.0, interquartile range=13.2; Mann-Whitney U-test score=322.5, z=-1.974, P=.048), but the correlation analysis was unable to reveal an association between exercise capacity and kinesiophobia in either subgroup. DISCUSSION AND CONCLUSION: These results indicate a lack of correlation between kinesiophobia and exercise capacity, activity limitations, or participation restrictions, at least in patients with CFS who are experiencing widespread muscle or joint pain. 497 PMID- 15053122 AU - Nijs J, De Meirleir K, Wolfs S, Duquet W TI - Disability evaluation in CFS: associations between exercise capacity & activity limitations/participation restrictions. SO - Clin Rehabil 2004 Mar;18(2):139-48. IN - D o Human Physiology, Faculty o Physical Education & Physic+ AB - +IN: al Therapy & Chronic Fatigue Clinic, Vrije Universiteit Brussel (VUB), Belgium. Jo.Nijs@vub.ac.be OBJECTIVE: In an attempt to examine whether impairments in cardiorespiratory fitness are associated with daily functioning in patients with chronic fatigue syndrome (CFS), this study addresses the correlations between exercise capacity and activity limitations/participation restrictions. DESIGN: Prospective observational study. SETTING: An outpatient tertiary care, chronic fatigue clinic at the Vrije Universiteit Brussel (VUB), Belgium. SUBJECTS: Seventy-seven patients fulfilling the 1994 Centers for Disease Control and Prevention (CDC) case definition for CFS. INTERVENTIONS: All patients filled in the Chronic Fatigue Syndrome Activities and Participation Questionnaire (CFS-APQ) and performed a maximal exercise stress test on a bicycle ergometer. Heart rate was monitored continuously by use of an electrocardiograph. Metabolic and ventilatory parameters were measured through spirometry. RESULTS: A statistically significant correlation between the score obtained with the CFS-APQ and the body weight-adjusted peak oxygen uptake (Spearman rho = -0.32; p = 0.005), functional aerobic impairment (rho = 0.33; p = 0.004), workload/body weight (rho = -0.30; p = 0.009), exercise duration (rho = -0.30; p = 0.008), and the percentage of target heart rate achieved (rho = -0.33; p = 0.004) was observed. The correlations between the remaining exercise capacity parameters and the scores obtained with the CFS-APQ all indicated a trend towards association (0.01 AB - BACKGROUND: Fatigue is a crucial sensation that triggers rest, yet its underlying neuronal mechanisms remain unclear. Intense long-term fatigue is a symptom of chronic fatigue syndrome, which is used as a model to study the mechanisms underlying fatigue. METHODS: Using magnetic resonance imaging, we conducted voxel-based morphometry of 16 patients and 49 age-matched healthy control subjects. RESULTS: We found that patients with chronic fatigue syndrome had reduced gray-matter volume in the bilateral prefrontal cortex. Within these areas, the volume reduction in the right prefrontal cortex paralleled the severity of the fatigue of the subjects. CONCLUSION: These results are consistent with previous reports of an abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex. Thus, the prefrontal cortex might be an important element of the neural system that regulates sensations of fatigue. 504 PMID- 15692719 AU - Pagano T, Matsutani LA, Ferreira EA, Marques AP, Pereira CA TI - Assessment of anxiety & quality of life in FM pts. SO - Sao Paulo Med J. 2004 Nov 4;122(6):252-8. Epub 2005 Feb 2. IN - Rheumatology clinic, Hosp das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. tathipag@yahoo.com.br AB - CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE OF STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clinicas (Medical School, Universidade de Sao Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety. 505 PMID- 14758052 AU - Papanicolaou DA, Amsterdam JD, Levine S, McCann SM, Moore RC, Newbrand CH, Allen G, Nisenbaum R, Pfaff DW, Tsokos GC, Vgontzas AN, Kales A TI - Neuroendocrine aspects of CFS. SO - Neuroimmunomodulation 2004;11(2):65-74. IN - D o Medicine/Endocrinology, Emory U, Atlanta, GA, USA. AB - Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800000 Americans of all ages, races, socioeconomic groups and genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the neuroendocrine system. A symposium was organized in March 2001 to explore the possibility of an association between neuroendocrine dysfunction and CFS, with special emphasis on the interactions between neuroendocrine dysfunction and other abnormalities noted in the immune and autonomic nervous systems of individuals with CFS. This paper represents the consensus of the panel of experts who participated in this meeting. 506 PMID- 15246671 AU - Pazderka-Robinson H, Morrison JW, Flor-Henry P TI - Electrodermal dissociation of chr fatigue & depression: evidence for distinct physiological mechanisms. [CFS] SO - Int J Psychophysiol 2004 Aug;53(3):171-82. IN - Clinical Diagnostics & Research Centre, Alberta Hosp Edmonton, Box 307, 17480 Fort Road, Edmonton, Alberta, Canada T5J 2J7. hannah@ualberta.ca AB - Chronic fatigue syndrome (CFS) has an estimated prevalence between 0.5% and 3%, yet its diagnosis remains contentious. CFS is characterized by subjective symptoms that can be difficult to verify; moreover, depression is a commonly reported CFS complaint, whereas fatigue is a common symptom of depression. Our primary goal was dissociation of these disorders using psychophysiological methods. As previous research has implicated the autonomic nervous system in CFS, we conducted what we believe to be the first analysis of bilateral electrodermal and skin temperature responses of dextral females in a cross-modal orienting task, to investigate differences between these two patient groups and controls. A multivariate analysis of variance (MANOVA) examining three measures of electrodermal activity revealed prestimulus tonic skin conductance levels (SCLs) were markedly lower for the CFS group, with no difference between controls and depressives. Concurrent skin temperature levels were higher for the CFS group than the other two groups. These findings indicate that, despite overtly similar cognitive and symptom profiles, depression and CFS patients can be differentiated with psychophysiological measures. This study adds to the growing body of evidence demonstrating that CFS and depression have distinct neurobiological profiles, consistent with unique aetiologies. 507 PMID- 15256826 AU - Pearce JM TI - Myofascial pain, FM or fibrositis? SO - Eur Neurol 2004;52(2):67-72. Epub 2004 Jul 13. AB - The terms myofascial pain, fibromyalgia and fibrositis are critically examined. They constitute diagnostic labels for non-specific musculoskeletal aches and pains. Analysis of the evidence shows that none of these labels is substantiated by hard physical signs or by laboratory evidence of consistent pathological or biochemical abnormality. What is the objective evidence for disorder(s) of muscle, fascia or fibrous tissues, so clearly indicated by these diagnostic names? Alternative terms such as 'regional pain syndrome' or 'chronic pain syndrome' merely redefine the clinical problem without providing a mechanism or basis for diagnosis. Despite different diagnostic criteria, these conditions, along with chronic fatigue syndrome, have many demographic and clinical similarities, most notably tender trigger points. Indeed, the terms are often used interchangeably. There are few differences in the symptoms, physical findings, laboratory tests, functional status, psychosocial features and psychiatric disorders. This paper seeks not to deny the existence of aches and pains, but to critically examine the utility of these terms. The only claimed physical sign is the presence of tender trigger points over muscles or muscle attachments. Research suggests that tender points are a measure of general distress related to pain complaints but separately associated with fatigue and depression. They are present in some normal subjects and are variable in occurrence in time in the same individual. They reflect no demonstrable pathology. It is therefore argued that none of these commonly used diagnoses represent distinct disease entities. A possible but unproven alternative hypothesis is that such symptoms relate to neural pain with both peripheral and central components, and in some instances psychological or wilful embellishment. 508 PMID- 15229962 AU - Penrod JR, Bernatsky S, Adam V, Baron M, Dayan N, Dobkin PL TI - Health services costs & their determinants in women w FM. SO - J Rheumatol 2004 Jul;31(7):1391-8. IN - Division o Clinical Epidemiology, D o Med, McGill U Health Centre, Quebec, Canada. AB - OBJECTIVE: Patients with fibromyalgia (FM) use health services extensively. Knowledge about costs of FM is limited because of non-inclusiveness in assessing direct costs, because attempts to assess indirect costs are largely absent, and because determinants of costs have yet to be identified. We investigated the 6-month costs (direct and indirect) in women with primary FM, and we identified determinants of direct costs. METHODS: Subjects (n = 180 women) completed a health resource questionnaire as well as measures of pain, psychological distress, comorbidity, and disability. Unit costs for resources were obtained from government, hospital, laboratory, and professional association sources. Regression modeling for 6-month direct cost included age, disability, comorbidity, pain intensity, psychological distress, education, and work status. RESULTS: The average 6-month direct cost was $CDN 2298 (SD 2303). The largest components were medications ($CDN 758; SD 654), complementary and alternative medicine (CAM; $CDN 398; SD 776), and diagnostic tests ($CDN 356; SD 580). Our most conservative estimate of average 6-month indirect cost was $CDN 5035 (SD 7439). Comorbidity and FM disability were statistically significant contributors to direct costs in the multivariate analysis. Costs increased by approximately 20% with each additional comorbid condition. CONCLUSION: Women with FM are high consumers of both conventional and CAM services. Our estimates of costs exceed those from most other studies; this may be due to our inclusion of a broader set of health services, medications, and indirect costs. Although in univariate analyses the number of comorbidities and indices of the effect of FM, psychological distress, and pain intensity were associated with higher direct cost, in a multiple regression analysis, only the measure of FM disability and the number of comorbidities were significant direct-cost determinants. FM also imposes important indirect costs, which were nearly 70% of the economic burden. 509 PMID- 15315529 AU - Peres MF, Zukerman E, Senne Soares CA, Alonso EO, Santos BF, Faulhaber MH TI - Cerebrospinal fluid glutamate levels in chr migraine. [FM] SO - Cephalalgia 2004 Sep;24(9):735-9. IN - Hospital Israelita Albert Einstein, Instituto de Ensino e Pesquisa, Sao Paulo, Brazil. AB - Both preclinical and clinical data link glutamate to the migraine pathophisiology. Altered plasma, platelets and cerebrospinal (CSF) glutamate levels have been reported in migraine patients. Chronic migraine is comorbid with several conditions. It has been recently shown chronic migraine comorbidity with fibromyalgia. The objective of this study was to study cerebrospinal fluid glutamate levels in chronic migraine patients with and without fibromyalgia. We studied 20 chronic migraine patients, with and without fibromyalgia, compared to age-sex matched controls. CSF glutamate levels were measured by HPLC. CSF glutamate demonstrated significantly higher levels in patients with fibromyalgia compared to those without fibromyalgia. Patients overall had higher CSF glutamate levels than controls. Mean pain score correlated with glutamate levels in chronic migraine patients. Tender points, the hallmark of fibromyalgia, can be considered as pressure allodynia, and is probably mediated by central sensitization, with increase in CSF glutamate levels. We postulate chronic migraine patients with fibromyalgia, in addition to have more disabling headaches, suffer from a more severe central sensitization process. This subtype of patients may respond to medications modulating glutamate receptors. Headache intensity correlate with glutamate levels in chronic migraine patients. 510 PMID- 15140781 AU - Picavet HS, Hoeymans N TI - Health related quality of life in multiple musculoskeletal diseases: SF-36 & EQ-5D in the DMC3 study. SO - Ann Rheum Dis 2004 Jun;63(6):723-9. IN - D for Prevention & Health Services Research (PZO, pb 101), Nat Inst o Public Health & the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands. susan.picavet@rivm.nl AB - OBJECTIVE: To examine the health related quality of life of persons with one or more self reported musculoskeletal diseases, as measured by the short form 36 item health status survey (SF-36) and the Euroqol questionnaire (EQ-5D). METHODS: A sample of Dutch inhabitants aged 25 years or more (n = 3664) participated in a questionnaire survey. Twelve lay descriptions of common musculoskeletal diseases were presented and the subjects were asked whether they had ever been told by a physician that they had any of these. Their responses were used to assess the prevalence of these conditions. Commonly used scores of SF-36 and descriptive scores from EQ-5D are presented, along with standardised differences between disease groups and the general population. RESULTS: SUBJECTS: with musculoskeletal diseases had significantly lower scores on all SF-36 dimensions than those without musculoskeletal disease, especially for physical functioning (SF-36 score (SE), 75.2 (0.5) v 87.8 (0.5)); role limitations caused by physical problems (67.1 (0.9) v 85.8 (0.8)); and bodily pain (68.5 (0.5) v 84.1 (0.5)). The worst health related quality of life patterns were found for osteoarthritis of the hip, osteoporosis, rheumatoid arthritis, and fibromyalgia. Those with multiple musculoskeletal diseases had the poorest health related quality of life. Similar results were found for EQ-5D. CONCLUSIONS: All musculoskeletal diseases involve pain and reduced physical function. The coexistence of musculoskeletal diseases should be taken into account in research and clinical practice because of its high prevalence and its substantial impact on health related quality of life. 511 PMID- 15020342 AU - Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, Lin HC TI - A link between irritable bowel syndrome & FM may be related to findings on lactulose breath testing. SO - Ann Rheum Dis 2004 Apr;63(4):450-2. IN - GI Motility Program, Divisions o Gastroenterology & Rheumatology, D o Med, Cedars-Sinai Med Ctr, CSMC Burns & Allen Research Inst, Los Angeles, California 90048, USA. AB - BACKGROUND: An association between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) has been found. OBJECTIVE: To compare the prevalence and test results for bacterial overgrowth between IBS and fibromyalgia. METHODS: Subjects with independent fibromyalgia and IBS were compared with controls in a double blind study. Participants completed a questionnaire, and a lactulose hydrogen breath test was used to determine the presence of SIBO. The prevalence of an abnormal breath test was compared between study participants. Hydrogen production on the breath test was compared between subjects with IBS and fibromyalgia. The somatic pain visual analogue score of subjects with fibromyalgia was compared with their degree of hydrogen production. RESULTS: 3/15 (20%) controls had an abnormal breath test compared with 93/111 (84%) subjects with IBS (p<0.01) and 42/42 (100%) with fibromyalgia (p<0.0001 v controls, p<0.05 v IBS). Subjects with fibromyalgia had higher hydrogen profiles (p<0.01), peak hydrogen (p<0.0001), and area under the curve (p<0.01) than subjects with IBS. This was not dependent on the higher prevalence of an abnormal breath test. The degree of somatic pain in fibromyalgia correlated significantly with the hydrogen level seen on the breath test (r = 0.42, p<0.01). CONCLUSIONS: An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain. 512 PMID- 14760796 AU - Pope JE, Krizova A, Ouimet JM, Goodwin JL, Lankin M TI - Close association of herpes zoster reactivation & SLE (SLE) Dx: case-control study of pts w SLE or noninflammatory nusculoskeletal disorders. [FM] SO - J Rheumatol 2004 Feb;31(2):274-9. IN - Division o Rheumatology, D o Med, The U o Western Ontario, London, Ontario, Canada. janet.pope@sjhc.london.on.ca AB - OBJECTIVE: To investigate the prevalence of infections, particularly the frequency of shingles and the timing of varicella zoster virus (VZV) reactivation, and antibiotic use, vaccinations, and joint trauma prior to and at diagnosis of systemic lupus erythematosus (SLE). METHODS: We sent questionnaires to patients with SLE (n = 93) and controls with noninflammatory musculoskeletal disorders (MSK; n = 353) including osteoarthritis, fibromyalgia, and tendonitis. We matched SLE patients to controls for sex (up to 1:3). RESULTS: The response rate in SLE was 66% and in controls 69% (p < 0.53). Four of 61 SLE patients and 12 of 173 controls were men. The mean disease duration in the SLE group was 8 +/- 1 years compared to 10 +/- 1 years in controls (p < 0.23). SLE patients were significantly younger than controls (mean age of SLE patients 49 +/- 2 vs 57 +/- 1 years for controls; p < 0.0004), and results were adjusted for age. A significantly higher proportion of SLE participants had a history of VZV (shingles) (19% vs 7%, respectively; OR 2.98, p < 0.003), whereas rubella was reported less in SLE (23% vs 42%; OR 0.43, p < 0.03). VZV infections were clustered just prior to or after diagnosis in SLE but were more widely spaced temporally in the controls (1 +/- 4.5 years after the diagnosis of SLE vs -14.7 +/- 4 years before the diagnosis of noninflammatory MSK disorder; p < 0.003). Diagnosis of shingles was observed in 6 of 11 SLE patients within +/- 2 years of SLE diagnosis, whereas only 2 of 15 controls had shingles within +/- 2 years of diagnosis (OR 7.2, p < 0.03). Only 2 patients with SLE were taking immunosuppressive drugs or steroids at time of shingles, so immunosuppressive therapy was not usually concomitant at time of VZV reactivation. Common infections (respiratory, urinary tract, ear, and eye) in the SLE group exceeded controls, but not significantly (23% vs 9%; OR 2.98, p < 0.06) and SLE patients were more likely to have been vaccinated since 18 years of age with any type of vaccine (69% vs 51%; OR 2.21, p < 0.04). SLE patients were less likely than controls to report joint trauma within one year prior to their diagnosis (25% vs 40%; OR 0.49, p < 0.04). There were no differences with respect to streptococcal throat infection (p < 0.96), diarrhea/vomiting (p < 0.84), rash with fever (p < 0.07), parvovirus infection (p < 0.16), infection after surgery (p < 0.58), respiratory tract infection (p < 0.71), or ear (p < 0.09) and eye infection (p < 0.68) one year prior to diagnosis. A higher proportion of SLE patients had a history of urinary tract infections (46% vs 25%), but this was not significant (p < 0.17), nor was it significant one year prior to diagnosis (p < 0.63). Overall, the likelihood of having any infection one year prior to diagnosis was not significantly higher in the SLE group (p < 0.56). There were no differences one year prior to diagnosis in travel history (p < 0.69), hospitalizations (p < 0.47), use of antibiotics (p < 0.54), history of rheumatic fever, positive TB skin test, or hepatitis A, B or C infection. CONCLUSION: Varicella reactivation as shingles is increased in patients with SLE and clusters around diagnosis. Vaccinations are increased in those with SLE compared to controls. Common infections are not significantly increased in SLE patients prior to onset of symptoms. We cannot determine if VZV infections are causally associated with SLE in some people, are from an abnormal immune system response due to the lupus itself or from the use of steroids or other immunosuppressive drugs to control the disease, or are spurious. 513 PMID- 14754826 AU - Powell P, Bentall RP, Nye FJ, Edwards RH TI - Patient education to encourage graded exercise in CFS. 2-year follow-up of randomised controlled trial. SO - Br J Psychiatry 2004 Feb;184:142-6. IN - D o Psychology, U o Manchester, UK. AB - BACKGROUND: An earlier trial demonstrated good outcomes after 1 year for patients with chronic fatigue syndrome (CFS) who received an educational intervention designed to encourage graded activity. AIMS: To determine 2-year outcomes for the same treated patients and the response to treatment of patients formerly in the control condition. METHOD: Patients in the treatment groups (n=114) were followed up at 2 years; 32 patients from the control group were offered the intervention after 1 year and were assessed 1 year later. Assessments were the self-rated measures used in the original trial. RESULTS: At 2 years 63 of the treated patients (55%) no longer fulfilled trial criteria for CFS compared with 64 patients (56%) at 1 year. Fourteen of 30 crossover patients (47%) achieved a good outcome at 1 year and seven (23%) no longer fulfilled criteria for CFS. CONCLUSIONS: Benefits of the intervention were maintained at 2 years. Delaying treatment is associated with reduced efficacy and required more intensive therapy. 514 PMID- 15023475 AU - Price JS, Gardner R Jr, Erickson M TI - Can depression, anxiety & somatization be understood as appeasement displays? SO - J Affect Disord 2004 Apr;79(1-3):1-11. IN - Odintune Place, Plumpton, East Sussex BN7 3AN, UK. john.price@lycosmail.com AB - BACKGROUND: No satisfactory basis in normal function characterizes major depression and its co-morbid disorders. Yet these may represent maladaptive expression of adaptive communicational states exhibited normally in many species. METHODS: We examined the signal value of depressive and anxious mood states, fatigue syndrome and somatoform disorders and found them to resemble appeasement or submission to conspecifics (members of a same species) as studied in other animals. Moreover, applying game theory formulations of conflict resolution and the triune brain theory of MacLean supported the hypothesis. LIMITATIONS: Direct experimental evidence must still test hypotheses that emanate from the presented framework. Conclusions: Implications for this approach include improved understanding and treatment of depression, improved research strategies, and a potential future pathogenesis-focused nosology. 515 PMID- 15031590 AU - Prins JB, Bos E, Huibers MJ, Servaes P, van der Werf SP, van der Meer JW, Bleijenberg G TI - Social support & the persistence of complaints in CFS. SO - Psychother Psychosom 2004 May-Jun;73(3):174-82. IN - D o Med Psychology, U Med Centre Nijmegen, Nijmegen, The Netherlands. j.prins@cukz.umcn.nl AB - BACKGROUND: Several studies suggested that the surroundings of chronic fatigue syndrome (CFS) patients are of importance in the persistence of complaints. Contrary to what was expected, participation in support groups has not led to clinical improvement. The purpose of the present study was to describe social support in CFS patients as compared with other fatigued and non-fatigued groups. Further, changes in social support and the influence of social support on the course of CFS over a period of more than 1 year were studied in patients with and without treatment. METHODS: Baseline data were assessed in 270 CFS patients, 150 disease-free breast cancer patients, 151 fatigued employees on sick-leave and 108 healthy subjects using the Social Support List and Significant Others Scale. CFS patients were followed in cognitive behaviour therapy (CBT), guided support groups and natural course at 8 and 14 months. RESULTS: CFS patients and fatigued employees reported more negative interactions and insufficiency of supporting interactions than cancer patients and healthy controls. No differences in frequency of supporting interactions were found. Negative interactions decreased significantly after treatment with CBT, but did not change in support groups or natural course. In the natural course, higher fatigue severity at 8 months was predicted by more negative interactions at baseline. CONCLUSIONS: In CFS patients and fatigued employees, social support is worse than in disease-free cancer patients and healthy controls. Lack of social support was identified as a new factor in the model of perpetuating factors of fatigue severity and functional impairment in CFS. 516 PMID- 15117099 AU - Puri BK, Holmes J, Hamilton G TI - Eicosapentaenoic acid-rich essential fatty acid supplementation in CFS associated w Sx remission & structural brain changes. SO - Int J Clin Pract 2004 Mar;58(3):297-9. IN - MRI Unit, Imaging Sciences D, MRC Clinical Sciences Centre,+ AB - +IN: Imperial Coll School o Med, Hammersmith Hosp, London, UK. Lateral ventricular enlargement has been reported in chronic fatigue syndrome, while cerebral neurospectroscopy has recently indicated that essential fatty acid treatment may be of value in this condition. An essential fatty acid supplement rich in eicosapentaenoic acid (EPA) was therefore given daily to a female patient with a 6-year history of unremitting symptoms of chronic fatigue syndrome. Cerebral magnetic resonance scanning was carried out at baseline and 16 weeks later. The EPA-rich essential fatty acid supplementation led to a marked clinical improvement in her symptoms of chronic fatigue syndrome, starting within 6-8 weeks. Accurate quantification of the lateral ventricular volumes in the baseline and 16-week follow-up registered images of high-resolution magnetic resonance imaging structural scans showed that the treatment was accompanied by a marked reduction in the lateral ventricular volume during this period, from 28,940-23,660 mm3. 517 PMID- 15041033 AU - Puri BK TI - The use of eicosapentaenoic acid in the Rx of CFS. SO - Prostaglandins Leukot Essent Fatty Acids. 2004 Apr;70(4):399-401. IN - MRI Unit, Imaging Sciences D, MRC Clinical Sciences Centre, Imperial Coll School o Med, Hammersmith Hosp, Du Cane Road, London W12 0HS, England, UK. basant.puri@csc.mrc.ac.uk AB - There is evidence that there is an association between chronic fatigue syndrome, a condition of unknown aetiology, and essential fatty acids. This evidence is based on the actions of essential fatty acids, the results of proton neurospectroscopy studies, and essential fatty acid trial data. A series of patients with chronic fatigue syndrome were treated solely with a high-eicosapentaenoic acid-containing essential fatty acid supplement. All showed improvement in their symptomatology within eight to 12 weeks. These results, which are consistent with a recent detailed report of cerebral and clinical changes associated with a high intake of eicosapentaenoic acid, suggest that this n-3 highly unsaturated fatty acid may offer the hope of effective treatment for at least some patients with chronic fatigue syndrome. 518 PMID- 15068773 AU - Quisel A, Gill J, Walters D TI - Exercise & antidepressants improve FM. SO - J Fam Pract 2004 Apr;53(4):280-91. IN - D o Family & Community Med, Christiana Care Health Systems, 1401 Foulk Road, Wilmington, DE 19803, USA. bretandanna@comcast.net 519 PMID- 15288741 AU - Raine R, Sanderson C, Hutchings A, Carter S, Larkin K, Black N TI - An experimental study of determinants of group judgments in clinical guideline development. [CFS] SO - Lancet 2004 Jul 31;364(9432):429-37. IN - Health Services Research Unit, London School o Hygiene & Tropical Med, Keppel Street, London WC1E 7HT, UK. rosalind.raine@lshtm.ac.uk AB - BACKGROUND: Clinical guidelines for improving the quality of care are a familiar part of clinical practice. Formal consensus methods such as the nominal group technique are often used as part of guideline development, but little is known about factors that affect the statements produced by nominal groups, and on their consistency with the research evidence. METHODS: Cognitive behavioural therapy, behavioural therapy, brief psychodynamic interpersonal therapy, and antidepressants for irritable bowel syndrome, chronic fatigue syndrome, and chronic back pain were selected for study. 16 nominal groups in a factorial design allowed comparison of GP-only with mixed groups of GPs and specialists, provision of a literature review with no provision, and ratings made in the context of realistic or ideal levels of health-care resources. Participants rated appropriateness independently, and again after a facilitated meeting. Audiotapes of four group discussions were analysed. FINDINGS: There was agreement with the research evidence for 51% of 192 scenarios. Agreement was more likely if the group was GP-only, if a literature review was provided, or if the evidence was in accordance with clinicians' beliefs. Assumptions about the level of resources available had no impact. Clinical and social cues had mixed effects, irrespective of the research evidence. Qualitative analysis showed the modifying effect of clinical experience and beliefs about research evidence. INTERPRETATION: Guidelines cannot be based on data alone; judgment is unavoidable. The nominal group technique is a method of eliciting and aggregating judgments in a transparent and structured way. It can provide important information on levels of agreement between experts. However, conclusions can be at odds with the published literature. If they are, reasons need to be explicit. 520 PMID- 15169743 AU - Raine R, Carter S, Sensky T, Black N TI - General practitioners' perceptions of CFS & beliefs about its management, compared w irritable bowel syndrome: qualitative study. SO - BMJ 2004 Jun 5;328(7452):1354-7. Epub 2004 May 28. IN - D o Public Health & Policy, London School o Hygiene & Tropical Med, London WC1E 7HT. rosalind.raine@lshtm.ac.uk AB - OBJECTIVES: To compare general practitioners' perceptions of chronic fatigue syndrome and irritable bowel syndrome and to consider the implications of their perceptions for treatment. DESIGN: Qualitative analysis of transcripts of group discussions. PARTICIPANTS AND SETTING: A randomly selected sample of 46 general practitioners in England. RESULTS: The participants tended to stereotype patients with chronic fatigue syndrome as having certain undesirable traits. This stereotyping was due to the lack of a precise bodily location; the reclassification of the syndrome over time; transgression of social roles, with patients seen as failing to conform to the work ethic and "sick role" and conflict between doctor and patient over causes and management. These factors led to difficulties for many general practitioners in managing patients with chronic fatigue syndrome. For both conditions many participants would not consider referral for mental health interventions, even though the doctors recognised social and psychological factors, because they were not familiar with the interventions or thought them unavailable or unnecessary. CONCLUSIONS: Barriers to the effective clinical management of patients with irritable bowel syndrome and chronic fatigue syndrome are partly due to doctors' beliefs, which result in negative stereotyping of patients with chronic fatigue syndrome and the use of management strategies for both syndromes that may not take into account the best available evidence. 521 PMID- 14770096 AU - Rao JK, Hootman JM TI - Prevention research & rheumatic disease. [FM] SO - Curr Opin Rheumatol 2004 Mar;16(2):119-24. IN - Health Care & Aging Studies Branch, Centers for Disease Control & Prevention, Atlanta, Georgia 30341, USA. jrao@cdc.gov AB - PURPOSE OF REVIEW: Prevention may occur in clinical, community, or population settings and is often classified into primary, secondary, and tertiary types. To provide a context for this review, we define the three types and provide general and arthritis-specific examples of prevention strategies. Next, we highlight recently published longitudinal cohort and intervention studies that focus on arthritis prevention in the following topic areas: cognitive and behavioral strategies, obesity, exercise, and occupational injury prevention. RECENT FINDINGS: Few studies examined primary prevention strategies. In one study, an educational intervention significantly changed tick-related knowledge and behaviors among a population at risk of Lyme disease. Another population-based study used a mailed, stage-based educational program to successfully increase physical activity levels; this intervention may have practical application as a primary or tertiary prevention strategy for arthritis. Tertiary prevention research received much attention: Recent studies extend the benefits of exercise and cognitive-behavioral interventions to persons with different rheumatic conditions (eg, neck pain, low back pain, systemic lupus erythematosus, fibromyalgia). Longitudinal cohort studies improve our understanding of the relationships between computer use and carpal tunnel syndrome among office workers, birth weight and hand osteoarthritis, and baseline balance and functional declines among older adults with knee pain. SUMMARY: Prevention of arthritis and its complications is an active focus of investigation. Primary prevention research remains a challenge because of the prolonged time frame for disease expression. Scientific evidence continues to provide support for tertiary prevention strategies among people with documented rheumatic disease. 522 PMID- 15349132 AU - Rao SG, Clauw DJ TI - The management of FM. SO - Drugs Today (Barc) 2004 Jun;40(6):539-54. IN - Cypress Bioscience, San Diego, California 92121, USA. srao@cypressbio.com AB - Fibromyalgia is one of a number of overlapping "functional somatic syndromes", including irritable bowel syndrome, tension headache, chronic idiopathic lower back pain, chronic fatigue syndrome and others. These conditions affect females more frequently than males and probably share common underlying neurobiological mechanisms, as well as frequent psychological, cognitive and behavioral comorbidities. Since the pain in these conditions is most likely "central" in origin, classes of drugs such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids, which are quite effective for "peripheral" pain, are relatively ineffective for the pain seen in these syndromes. Instead, tricyclic and other classes of antidepressants, antiseizure drugs and a number of other neuroactive compounds seem to be more effective. In addition, nonpharmacological therapies such as aerobic exercise and cognitive behavioral therapy are quite effective and frequently underutilized in clinical practice. 523 PMID- 14996235 AU - Raphael KG, Janal MN, Nayak S TI - Comorbidity of FM & posttraumatic stress disorder Sx in a community sample of women. SO - Pain Med 2004 Mar;5(1):33-41. IN - U o Med & Dentistry o New Jersey, Newark, New Jersey 07103, USA. raphaekg@umdnj.edu AB - OBJECTIVE: To test alternative explanations for the comorbidity between fibromyalgia (FM), a medically unexplained syndrome involving widespread pain, and posttraumatic stress disorder (PTSD). In contrast to a default "risk factor" hypothesis, tested hypotheses were that: A) The association is due to a sampling bias introduced by the study of care-seeking individuals; B) FM is an additive burden that strains coping resources when confronting life stress; and C) Arousal symptoms of PTSD and FM are confounded. DESIGN: Community-dwelling women in the New York/New Jersey metropolitan area (N=1,312) completed a telephone survey regarding FM-like symptoms prior to September 11, 2001. Approximately 6 months after the World Trade Center terrorist attacks, they again completed the survey, to which questions regarding PTSD symptoms were added. RESULTS: The odds of probable PTSD were more than three times greater in women with FM-like symptoms, both assessed after 9/11. The odds ratio was not reduced by controlling for FM-like symptoms before 9/11 or for the potentially confounded symptoms of PTSD specifically related to arousal. CONCLUSIONS: These findings lead us to reject alternate explanations for the comorbidity between FM and PTSD. Speculations that FM and PTSD share psychobiological risk factors remain plausible. 524 PMID- 15275798 AU - Raphael KG, Janal MN, Nayak S, Schwartz JE, Gallagher RM TI - Familial aggregation of depression in FM: a community-based test of alternate hypotheses. SO - Pain 2004 Jul;110(1-2):449-60. IN - D o Psychiatry, New Jersey MS, U o Med & Dentistry o New Jersey, BHSB F1512, 183 S. Orange Avenue, Newark, NJ 07103, USA. raphaekg@umdnj.edu AB - Numerous studies report that fibromyalgia (FM), a syndrome characterized by widespread pain and generalized tender points, is comorbid with major depressive disorder (MDD). The current study tests two alternate explanations for their comorbidity using a family study methodology. The first is that FM is a depression spectrum disorder. The second is that depression is a consequence of living with FM. We recruited potential probands by initially screening by telephone for FM and MDD among women in the NY/NJ metropolitan area, randomly selecting telephone numbers from a list of households with women. Eligible women were invited for second stage physical examinations for FM diagnosis and psychiatric interviews for MDD diagnosis. All available adult, first-degree relatives received psychiatric interviews. Relatives of probands were divided into four groups on the basis of the probands' FM and MDD diagnoses (FM+/MDD+ (n = 156), FM+/MDD- (n = 51), FM-/MDD+ (n = 351) and FM-/MDD- (n = 101)). Results indicated that rates of MDD in the relatives of probands with FM but without personal histories of MDD were virtually identical to rates of MDD in relatives of probands with MDD themselves. This outcome is consistent with the hypothesis that FM is a depression spectrum disorder, in which FM and MDD are characterized by shared, familially mediated risk factors. The implications of these findings for a stress-vulnerability model of FM are discussed. 525 PMID- 15077258 AU - Redondo JR, Justo CM, Moraleda FV, Velayos YG, Puche JJ, Zubero JR, Hernandez TG, Ortells LC, Pareja MA TI - Long-term efficacy of therapy in pts w FM: a physical exercise-based program & a cognitive-behavioral approach. SO - Arthritis Rheum 2004 Apr 15;51(2):184-92. IN - Instituto Provincial de Rehabilitacion, Hosp Universitario Gregorio Maranon, Madrid, Spain. javierrivera@ser.es AB - 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. 526 PMID- 15691082 AU - Reisine S, Fifield J, Walsh S, Dauser D TI - Employment & quality of life outcomes among women w FM compared to healthy controls. SO - Women Health 2004;39(4):1-19. IN - D o Behavioral Sciences & Community Health, U o Connecticut, School o Dental Med, Farmington, CT 06030-3910, USA. reisine@nso1.uchc.edu AB - The purpose of this study was to assess the effects of paid employment on health related quality of life among women with fibromyalgia compared to a group of women who were otherwise healthy. Participants were recruited from 118 rheumatology practices randomly sampled from the membership of the American College of Rheumatology. Three hundred and sixty-five patients were referred to the study and 287 completed a telephone interview. At the end of each interview, participants were asked to nominate 2 individuals to serve as control subjects. Because of lagging enrollment of control subjects, we initiated an additional method of asking control subjects to nominate controls. Of 381 control subjects nominated for the study, 286 or 75% completed the initial interview. As with patients, controls completed a computer assisted phone interview with a trained interviewer similar to that of the patient. The mean age of women with FMS was 47 years, most were married (59.6%), 87.8% were of white race and non-Hispanic ethnicity, 47.7% were employed, had an average of 14 years of education and household annual incomes generally exceeded $20,000, with 40.4% having incomes in excess of $50,000. There we no significant differences between women with FMS and those without FMS on these characteristics. Women with FMS had significantly worse physical and mental health related quality of life measured by SF-12 Physical (PCS) and Mental (MCS) Component Summary Scores; those who were not employed had significantly worse PCS scores but there were no differences by employment for MCS. Ordinal regression analysis adjusting for demographic characteristics showed that there were significant main effects for condition and employment on PCS in that those with FMS and those who were not employed had worse PCS scores. Initially, we also found an interaction effect between condition and employment in that the beneficial effects of employment was restricted to the FMS cases. However, when adjustments were made for the double nesting design, the interaction effect was no longer significant. For MCS, FMS cases had significantly worse health related quality of life, but there were no main effects for employment a