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 Books, pamphlets, advocacy materials, unpublished conference proceedings, and nonmedical articles dealing with the politics and economics of CFS etc.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meritorious (i.e, published in peer-reviwed journals), whether or not they have subsequently been discredited or become outdated.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 and no interactions were significant. Our results concur with findings in community studies that employed women report better quality of life than those not employed, but only for the physical dimension of quality of life. The findings regarding MCS are intriguing in that women with FMS are not very different from controls and that employment has little effect on the mental health component of quality of life. 527 PMID- 15115468 AU - Reuter K, Harter M TI - The concepts of fatigue & depression in cancer. [CFS] SO - Eur J Cancer Care (Engl) 2004 May;13(2):127-34. IN - Freiburg U Med Ctr, D o Psychiatry & Psychotherapy, Freiburg, Germany. Katrin_Reuter@psyallg.ukl.uni-freiburg.de AB - A strong association between fatigue and depression in cancer patients has been reported repeatedly in clinical studies. The distinction remains difficult, mainly because of the similar phenomenology of fatigue and depression. It is the aim of this paper to work out similarities and differences in the conception of fatigue and depressive disorders. For that, a differentiation between depression as emotional distress and depression as clinical syndrome, according to the current classification systems, has to be made. Therefore, the classification of depressive disorders and their criteria is presented in the second section of this paper, especially in view of the diagnosis of depressive disorders in cancer patients. The comparison of the multidimensional fatigue construct and depression shows a strong overlap of symptoms. None of the fatigue symptoms are specific for fatigue, all being elements of depressive syndromes. It is in particular the psychological symptoms of depressive disorders that differentiate between the two concepts. To that end, the question is discussed whether fatigue in its current conceptualization can be defined as a diagnostic entity independent of depressive disorders. Additionally, research approaches are presented from the area of the chronic fatigue syndrome and neurasthenia, which could be adapted to cancer-related fatigue and help to clarify the clinical differences between fatigue and depression. In order to ensure better differential diagnostics in the future, criteria-orientated research in particular is needed. 528 PMID- 15468372 AU - Ribeiro LS, Proietti FA TI - Interrelations between FM, thyroid autoantibodies, & depression. SO - J Rheumatol. 2004 Oct;31(10):2036-40. IN - D o Rheumatology, Governador Israel Pinheiro Hosp, Belo Horizonte, Brazil. luizseveriano@brfree.com.br AB - OBJECTIVE: To detect and quantify the association between fibromyalgia (FM) and thyroid autoimmunity. METHODS: This cross-sectional study comprised 146 women with FM and 74 case-controls, all 18 years of age or older. FM was diagnosed according to the American College of Rheumatology 1990 classification criteria. The Mini-International Neuropsychiatric Interview (MINI) was applied for the diagnosis of depression, previously considered as an important confounding factor. Thyroid autoimmunity was defined as the occurrence of detectable antithyroid peroxidase antibodies and/or antithyroglobulin antibodies by the immunometric assay. Cases of diffuse connective tissue diseases and thyroid dysfunctions (hypo or hyperthyroidism) were excluded in both groups. RESULTS: Univariate analysis detected an association between FM and thyroid autoimmunity (odds ratio, OR = 3.87, 95% confidence interval, CI = 1.54-10.13), depression (OR = 3.94, 95% CI = 1.97-7.93), and age (OR = 1.04, 95% CI = 1.01-1.07). In the final logistic regression model, after adjustment for depression and age, the association between FM and thyroid autoimmunity was strengthened (OR = 4.52, 95% CI = 1.86-11.0). CONCLUSION: Our results suggest an association between FM and thyroid autoimmunity. 529 PMID- 14720312 AU - Richardson RD, Engel CC Jr TI - Evaluation & management of medically unexplained physical Sx. [CFS/FM/GWS] SO - Neurologist 2004 Jan;10(1):18-30. IN - VA Puget Sound Healthcare System, Seattle, WA, USA. AB - BACKGROUND: Medically unexplained physical symptoms (MUPS) and related syndromes are common in medical care and the general population, are associated with extensive morbidity, and have a large impact on functioning. Much of medical practice emphasizes specific pharmacological and surgical intervention for discrete disease states. Medical science, with its emphasis on identifying etiologically meaningful diseases comprised of homogeneous groups of patients, has split MUPS into a number of diagnostic entities or syndromes, each with its own hypothesized pathogenesis. However, research suggests these syndromes may be more similar than different, sharing extensive phenomenological overlap and similar risk factors, treatments, associated morbidities, and prognoses. Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.' REVIEW SUMMARY: This paper is a narrative review of the increasing body of evidence suggesting that MUPS and related syndromes are common, disabling, and costly. It emphasizes that MUPS occur along a continuum of symptom count, severity, and duration and may be divided into acute, subacute (or recurrent), and chronic types. Predisposing, precipitating, and perpetuating factors influence the natural history of MUPS. CONCLUSIONS: Effective symptom management involves collaborative doctor-patient approaches for identification of problems based on a combination of medical importance and patient readiness to initiate behavioral change, negotiated treatment goals and outcomes, gradual physical activation and exercise prescription. Additionally, efforts should be made to teach and support active rather than passive coping with the symptoms. 530 PMID- 14971625 AU - Ridsdale L, Darbishire L, Seed PT TI - Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care. SO - Psychol Med 2004 Jan;34(1):37-49. IN - D o Neurology, Guy's, King's & St Thomas's School o Med, Lo+ AB - +IN: ndon. BACKGROUND: Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet. METHOD: This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated. RESULTS: In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI) = -25 to -15), with no significant difference between groups (mean difference = -1.3; CI = -3.9 to 1.3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS. CONCLUSIONS: Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier 'to sell'. Low recovery in the CFS subgroup suggests that brief treatment is too short. 531 PMID- 15515407 AU - Riering K, Rewerts C, Zieglgansberger W TI - Analgesic effects of 5-HT3 receptor antagonists. [FM] SO - Scand J Rheumatol Suppl 2004;(119):19-23. IN - Max Planck Inst o Psychiatry, Munich, Germany. AB - Current research suggests an involvement of 5-HT3 receptors in peripheral and central perception and processing of pain as well as in inflammation. Tropisetron and other selective 5-HT3 receptor antagonists have been used successfully for pain reduction and treatment of related symptoms in patients diagnosed with fibromyalgia. This article proposes a concept of the underlying pathophysiology and mechanisms of action of 5-HT3 receptor antagonists in the context of the relevant clinical data on their application in patients with rheumatic disease. 532 PMID- 15162344 AU - Riley JL 3rd, Tomar SL, Gilbert GH TI - Smoking & smokeless tobacco: increased risk for oral pain. [FM] SO - J Pain 2004 May;5(4):218-25. IN - Division o Public Health Services & Research, Coll o Dentistry, U o Florida, Gainesville, Florida 32610-0404, USA. JRILEY@DENTAL.UFL.EDU AB - Tobacco has been linked with several pain conditions that include musculoskeletal pain, rheumatoid arthritis, and fibromyalgia. This study documented associations between smoking and smokeless tobacco use and measures of orofacial pain and oral pain impacts (activity reduction and trouble with sleep) assessed during a 48-month time period. These data were collected as part of the Florida Dental Care Study, a longitudinal study of oral health among 873 adults aged 45 years and older at baseline. Twenty-five percent of the study participants were current users of some form of tobacco, and 34% were former users. Separate models were tested for smoking and smokeless tobacco. Current tobacco users were at increased risk of experiencing a range of painful oral symptoms. We also found that behavioral impacts associated with oral pain are sensitive to differences in tobacco use status. Our data also support the supposition that once tobacco cessation occurs, the risk for pain associated with oral disease decreases significantly. No differences were found between former users and those never having used tobacco across any of the pain measures. Strengths of the current study include the longitudinal methodology, assessment of different pain symptoms with potentially differing etiology, and that several markers of tobacco use were used (prevalence, consumption, and duration). PERSPECTIVE: This study considers the harmful effects of tobacco use on oral health. Smokers were at significantly increased risk for oral pain and related limitation of daily activities. The data also suggest that the risk for oral pain associated with tobacco use decreases significantly if tobacco cessation occurs. 533 PMID- 15485007 AU - Rivera J, Gonzalez T TI - The FM Impact Questionnaire: a validated Spanish version to assess the health status in women w FM. SO - Clin Exp Rheumatol 2004 Sep-Oct;22(5):554-60. IN - Rheumatology Unit, Instituto Provincial de Rehabilitacion, Hosp Universitario Gregorio Maranon, Madrid, Spain. javierrivera@ser.es AB - OBJECTIVE: To translate, adapt, validate and assess the sensitivity to change of a Spanish version of the Fibromyalgia Impact Questionnaire (FIQ-S). METHODS: The FIQ-S was adapted following the translation and back-translation methodology. Female patients with fibromyalgia (FM) were invited to participate. Reliability was analyzed by the Spearman correlation coefficient between test and retest. Internal consistency was checked by the Cronbach's alpha coefficient. Construct validity was analyzed comparing FIQ-S with: HAQ, FHAQ, SF-36, SCL90-R, and the visual analogue scale for pain. Sensitivity to change was assessed in an 8-week randomized trial of exercise therapy. Feasibility was analyzed by the time taken in completing the FIQ-S and the proportion of patients able to complete the questionnaire. RESULTS: Translation was concordant. Adaptation affected at 4 sub-items of physical function. One-hundred and two FM patients completed the protocol. Mean age was 48.7 years with a mean of 9.2 years of evolution. Test-retest correlations were between 0.61-0.85 (p < 0.0001). Internal consistency showed alpha = 0.82 for all items and alpha = 0.86 for the sub-items of physical function. Significant correlations (p < 0.0001) were found between the FIQ-S items and HAQ, FHAQ, SF-36 and SCL90-R. For patients treated with the exercise program, the pre-treatment FIQ-S score was 52.0 +/- 11.5 and the post-treatment score was 40.8 +/- 13.7 (p < 0.003). Mean time for completing FIQ-S was 3.3 minutes. In 4% of the patients external help was needed. CONCLUSION: The FIQ-S is a reliable, valid and responsive to changes questionnaire for measuring health status and physical function in Spanish speaking FM patients. 534 PMID- 15170935 AU - Rizzi M, Sarzi-Puttini P, Atzeni F, Capsoni F, Andreoli A, Pecis M, Colombo S, Carrabba M, Sergi M TI - Cyclic alternating pattern: a new marker of sleep alteration in pts w FM? SO - J Rheumatol 2004 Jun;31(6):1193-9. IN - Center for Sleep & Respiratory Disorders, Rheumatology Unit, U Hosp L. Sacco, Milan, Italy. AB - OBJECTIVE: In the dynamic organization of sleep, cyclic alternating pattern (CAP) expresses a condition of instability of the level of vigilance that manifests the brain's fatigue in preserving and regulating the macrostructure of sleep. We evaluated the presence of CAP in patients with fibromyalgia (FM) compared to healthy controls. METHODS: Forty-five patients with FM (42 women) were studied and compared with 38 healthy subjects (36 women) matched for age, sex, and body mass index. Entry criteria were diagnosis of FM according to 1990 American College of Rheumatology criteria; willingness to participate in the study; and having no other diagnosis of autoimmune, neoplastic, or other possible causes of secondary diffuse musculoskeletal pain. Patients in the study underwent polysomnography recordings and a sleep questionnaire. Hypersomnolence was evaluated according to the Epworth Sleepiness Scale. RESULTS: FM patients had less sleep efficiency (sleep time/time in bed) than controls (79 +/- 10 vs 89 +/- 6; p < 0.01), a higher proportion of stage 1 non-rapid eye movement (non-REM) sleep (20 +/- 5 vs 12 +/- 5; p < 0.001), and twice as many arousals per hour of sleep (9.7 +/- 3.3 vs 4.1 +/- 1.9; p < 0.01). The CAP rate (total CAP time/non-REM sleep time) was significantly increased in FM patients compared to controls (68 +/- 6% vs 45 +/- 11%; p < 0.001). CAP rate seemed to correlate with the severity of clinical symptoms in FM patients (tender points index; p < 0.01) and with less efficiency of sleep (p < 0.01). CONCLUSION: The increase of CAP rate indicates a worse quality of sleep in patients with FM. These data are strongly correlated to the severity of symptoms. 535 PMID- 14754825 AU - Roberts AD, Wessely S, Chalder T, Papadopoulos A, Cleare AJ TI - Salivary cortisol response to awakening in CFS. SO - Br J Psychiatry 2004 Feb;184:136-41. IN - Section o General Hosp Psychiatry, Div o Psychological Medicine, Guy's, King's & St Thomas' School o Med & Dentistry, London, UK. AB - BACKGROUND: There is accumulating evidence of hypothalamic-pituitary-adrenal (HPA) axis disturbances in chronic fatigue syndrome (CFS). The salivary cortisol response to awakening has been described recently as a non-invasive test of the capacity of the HPA axis to respond to stress. The results of this test correlate closely with those of more invasive dynamic tests reported in the literature; furthermore, it can be undertaken in a naturalistic setting. AIMS: To assess the HPA axis using the salivary cortisol response to awakening in CFS. METHOD: We measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwards in 56 patients with CFS and 35 healthy volunteers. RESULTS: Patients had a lower cortisol response to awakening, measured by the area under the curve. CONCLUSIONS: This naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS. 536 PMID- 15290744 AU - Robinson RL, Birnbaum HG, Morley MA, Sisitsky T, Greenberg PE, Wolfe F TI - Depression & FM: Rx & cost when diagnosed separately or concurrently. SO - J Rheumatol 2004 Aug;31(8):1621-9. IN - Eli Lilly & Company, Indianapolis, Indiana 46285, USA. rlrobinson@lilly.com AB - OBJECTIVE: Depression and fibromyalgia (FM) are often coincident. Both syndromes share common symptoms and impose significant economic burdens. This study compared claims for treatment and costs of FM plus depression with those for FM or depression alone. METHODS: Administrative claims data from a national Fortune 100 manufacturer were used to identify 3 mutually exclusive patient cohorts based on claims with a diagnosis for: FM only, depression only, and FM plus depression. A fourth cohort comprised a random sample of 10% of the employer's overall beneficiary population. Cohorts were compared for demographics, comorbid conditions, and healthcare resources utilization. Mean direct (treatment) costs were calculated and indirect (work loss) costs imputed, and these were assessed using Student's t test and Bonferroni adjustments. RESULTS: Mean annual employer payments (direct plus indirect costs) per patient were 5,163 dollars for FM only, 8,073 dollars for depression only, 11,899 dollars for FM plus depression, and 2,486 dollars for the overall sample. Mean incremental employer payments (i.e., above those for the random sample) per patient with FM plus depression were 9,413 dollars, an amount more than the sum of incremental costs for those with FM or depression alone (8,264 dollars). These costs are consistent with costs of other chronic diseases. CONCLUSION: Patients with FM plus depression are high users of healthcare services. As in studies that established relationships between depression and other medical conditions, incremental costs for patients with FM plus depression were more than additive of costs for each condition alone. 537 PMID- 15171105 AU - Roelofs J, McCracken L, Peters ML, Crombez G, van Breukelen G, Vlaeyen JW TI - Psychometric evaluation of the Pain Anxiety Sx Scale (PASS) in chr pain pts. SO - J Behav Med 2004 Apr;27(2):167-83. IN - D o Med, Clinical & Experimental Psychology, Maastricht U, + AB - +IN: P.O. Box 616, 6200 MD Maastricht, The Netherlands. j.roelofs@dep.unimaas.nl This study examined psychometric properties of the Pain Anxiety Symptoms Scale (PASS), a measure of pain-related fear. A recently developed shortened version of the PASS, the PASS-20, was also investigated. Previously reported factor structures of the PASS were tested by means of confirmatory factor analysis. Results indicated that all models fitted adequately but that a five-factor solution fitted slightly better compared to the other models tested. The four-factor solution of the PASS-20 was tested by means of confirmatory factor analysis and results indicated adequate fit. Moreover, the four-factor solution of the PASS-20 was invariant among fibromyalgia and low-back pain patients. Convergent validity of the original PASS and the PASS-20 was good and internal consistency reliability adequate to excellent. The suitability of the original PASS and the PASS-20 are discussed and directions for future research are provided. 538 PMID- 15324781 AU - Roelofs J, Goubert L, Peters ML, Vlaeyen JW, Crombez G TI - The Tampa Scale for Kinesiophobia: further examination of psychometric properties in pts w chr low back pain & FM. SO - Eur J Pain 2004 Oct;8(5):495-502. IN - D o Med, Clinical & Experimental Psychology, Maastricht U, P.O. Box 616, 6200 MD Maastricht, The Netherlands. j.roelofs@dep.unimaas.nl AB - The present study attempted to replicate the robustness of a two-factor model of the Tampa Scale for Kinesiophobia (TSK) in chronic low back pain (CLBP) patients and fibromyalgia patients, by means of confirmatory factor analysis. Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two-factor model fitted best in both pain samples. These two factors were labelled somatic focus, which reflects the belief in underlying and serious medical problems, and activity avoidance, which reflects the belief that activity may result in (re)injury or increased pain. Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients. Implications of the results are discussed and directions for future research are provided. 539 PMID- 15159267 AU - Ross SD, Estok RP, Frame D, Stone LR, Ludensky V, Levine CB TI - Disability & CFS: a focus on function. SO - Arch IM 2004 May 24;164(10):1098-107. IN - MetaWorks Inc, 10 President's Landing, Medford, MA 02155, USA. AB - BACKGROUND: Evidence was sought in the published literature on how best to measure, monitor, and treat disability in patients with chronic fatigue syndrome (CFS). METHODS: A systematic review was performed of English-language literature published between January 1, 1988, and November 15, 2001. Interventional and observational studies of adults with CFS were eligible if they reported measures of disability and employment. A qualitative synthesis of results relating impairment measures to employment was performed. RESULTS: Of 3840 studies identified, 37 reported employment status and some measure of mental or physical impairment associated with disability. Most patients with CFS in these studies were unemployed. In 22 studies, the employment status of control subjects was also available. Only depression seemed to be associated with unemployment in patients with CFS. No other measurable impairment seemed to be consistently associated with disability or work outcomes. Only cognitive behavior therapy, rehabilitation, and exercise therapy interventions were associated with restoring the ability to work. No specific patient characteristics were identified as best predictors of positive employment outcomes. No quantitative syntheses of results were performed. CONCLUSIONS: For questions of disability and employment in CFS, the limitations inherent in the current literature are extensive. Methodologically rigorous, longitudinal, and interventional studies are needed to determine baseline characteristics that are associated with the inability to work and interventions that are effective in restoring the ability to work in the CFS population. Simple and consistent evaluations of functional capacity in patients with CFS are needed. 540 PMID- 14982142 AU - Roy-Byrne P, Smith WR, Goldberg J, Afari N, Buchwald D TI - Post-traumatic stress disorder among pts w chr pain & chr fatigue. SO - Psychol Med 2004 Feb;34(2):363-8. IN - D o Psychiatry & Behavioral Science, U o Washington, Seattl+ AB - +IN: e, WA, USA. BACKGROUND: Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD). METHOD: Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD. RESULTS: The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3.4, 95% CI 2.0-5.8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1.5-7.1); conversely, FM patients without MDD showed no increase in PTSD (OR=1.3, 95% CI 0.5-3.2). The components of the CFS criteria were not significantly associated with PTSD. CONCLUSION: Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM. 541 PMID- 15159679 AU - Russo EB TI - Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, FM, irritable bowel syndrome & other Rx-resistant conditions? [FM] SO - Neuro Endocrinol Lett 2004 Feb-Apr;25(1-2):31-9. IN - GW Pharmaceuticals, 2235 Wylie Avenue, Missoula, MT 59802, USA. erusso@montanadsl.net AB - OBJECTIVES: This study examines the concept of clinical endocannabinoid deficiency (CECD), and the prospect that it could underlie the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome, and other functional conditions alleviated by clinical cannabis. METHODS: Available literature was reviewed, and literature searches pursued via the National Library of Medicine database and other resources. RESULTS: Migraine has numerous relationships to endocannabinoid function. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects. AEA is tonically active in the periaqueductal gray matter, a migraine generator. THC modulates glutamatergic neurotransmission via NMDA receptors. Fibromyalgia is now conceived as a central sensitization state with secondary hyperalgesia. Cannabinoids have similarly demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders. The past and potential clinical utility of cannabis-based medicines in their treatment is discussed, as are further suggestions for experimental investigation of CECD via CSF examination and neuro-imaging. CONCLUSION: Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines. 542 PMID- 15193362 AU - Sackner MA, Gummels EM, Adams JA TI - Say NO to FM & CFS: an alternative & complementary therapy to aerobic exercise. SO - Med Hypotheses 2004;63(1):118-23. IN - Mt. Sinai Med Ctr o Greater Miami, Div o Pulmonary Disease & Critical Care Med, Miami Beach, FL 33140, USA. artchive@msn.com AB - Increased shear stress to the endothelium increases activity of endothelial nitric oxide synthase (eNOS) with subsequent release of small quantities (nMol) of nitric oxide (NO) into the circulation. It occurs during moderate aerobic exercise mostly as a result of laminar shear stress and with whole body, periodic acceleration as a result of pulsatile shear stress. The latter is administered by means of a new, non-invasive, passive exercise device. Moderate exercise has long been known to alleviate the symptoms of fibromyalgia and chronic fatigue syndrome and in the current study, whole body, periodic acceleration did as well. Since NO through action of eNOS has potent anti-inflammatory properties mainly by suppressing nuclear factor kappabeta activity, it is hypothesized that both diseases have chronic inflammation as their basis. Whole body periodic acceleration can be applied separately or supplementary to aerobic exercise in the treatment of fibromyalgia and chronic fatigue syndrome. 543 PMID- 14746418 AU - Sahin G, Ulubas B, Calikoglu M, Erdogan C TI - Handgrip strength, pulmonary function tests, & pulmonary muscle strength in FM syndrome: is there any relationship? SO - South Med J 2004 Jan;97(1):25-9. IN - D o Physical Med & Rehabilitation, Faculty o Medicine, Mers+ AB - +IN: in U, Mersin, Turkey. gunsahsahin@hotmail.com OBJECTIVE: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength as a determinant of peripheral muscle strength and pulmonary muscle strength in patients with FMS by comparing them with healthy controls. METHODS: Forty-one consecutive women with FMS (diagnosed according to the American College of Rheumatology 1990 criteria) were compared with 40 age- and body mass index-matched healthy female controls. Pulmonary function tests were assessed by spirometry. Maximal pulmonary pressures were evaluated using an oral pressure meter. A dyspnea score was obtained. Pain was scored according to visual analogue scale and chest pain was classified (0-9) in fibromyalgia patients. Chest expansion was also measured in the two groups. Tender points were also evaluated in FMS patients. Grip strength (Jamar handheld dynamometer) was also measured in the two groups. RESULTS: The difference in pulmonary function tests was not statistically significant between groups. Maximal respiratory pressures (maximum inspiratory pressure and maximum expiratory pressure) and endurance (maximum ventilatory volume) were significantly lower in patients with FMS than in controls. There was also a statistically significant difference between groups regarding grip strength. There was also significant correlation between maximal inspiratory pressure and maximal expiratory pressure values and handgrip strength in patients with FMS. CONCLUSION: These data indicate that handgrip strength may be a determinant of pulmonary muscle strength in fibromyalgia patients. 544 PMID- 15050199 AU - Sahin G, Ulubas B, Calikoglu M, Bolgen Cime O, Erdogan C TI - Is chest expansion a determinant of pulmonary muscle strength in primary FM? SO - Joint Bone Spine 2004 Mar;71(2):140-3. IN - D o Physical Med & Rehabilitation, School o Medicine, Mersin U, Mersin, Turkey. gunsahsahin@hotmail.com AB - OBJECTIVE: To examine the possible relationship between chest expansion and pulmonary muscle strength in patients with primary fibromyalgia (PFM). METHODS: Forty-one consecutive women with PFM were compared with age and body mass index matched 40 healthy women concerning pulmonary function tests, chest expansion, and maximum respiratory pressures indicating pulmonary muscle strength, and endurance (MVV). Pain was scored according to a visual analog scale (VAS). Chest pain was scored on a 10 point scale. RESULTS: There was no significant difference between the two groups regarding chest expansion (P > 0.05). Maximum inspiratory and expiratory pressures (MIP, MEP) were lower in fibromyalgia patients than controls (P < 0.05). However, chest expansion and dyspnea score were insignificant between groups (P > 0.05). CONCLUSION: Reduced maximum respiratory pressures (MIP, MEP) may result from isometric type pulmonary muscle dysfunction as a result of low physical performance in fibromyalgia patients, despite insignificant finding of chest expansion and dyspnea score according to controls. 545 PMID- 15631355 AU - Samborski W, Lezanska-Szpera M, Rybakowski JK TI - Effects of antidepressant mirtazapine on FM Sx. SO - Rocz Akad Med Bialymst. 2004;49:265-9. IN - D o Physiotherapy & Rheumatology, U o Med Sciences, Poznan, Poland. AB - PURPOSE: Fibromyalgia syndrome (FS) is a form of non-articular rheumatism. The main criteria are the widespread musculoskeletal pain and tender points at multiple characteristic sites which are associated with several vegetative and functional symptoms. Depression is the most frequent psychiatric concomitant of FS. Etiology is unknown, connection between disturbances of serotonin metabolism and pathogenesis is postulated. Pharmacological therapy with analgetic and nonsteroidal antiinflammatory drugs is not very effective. Positive effects were reported in some patients treated with antidepressant drugs, especially serotonergic agents. MATERIAL AND METHODS: In the study a novel antidepressant drug mirtazapine was used characterized by selective blockade of 5-HT2 and 5-HT3 receptors. In an open trial participated 29 patients with FS, who met 1990 ACR criteria for fibromyalgia. All were treated with mirtazapine for 6 weeks. Intensity of pain, sleep disturbances, fatigue and other symptoms were measured using visuale analogue scale, severity of depression was evaluated with HDRS and BDI. RESULTS: An open trial completed 26 patients, the majority of them experienced a clinical improvement at the end of the study as a consequence of > or = 40% reduced intensity of fibromyalgia symptoms as well as reduced severity of depression. The significant correlation between reduction in depression after 6 weeks of mirtazapine treatment with the reduction on all four main symptoms of FS suggests a common pathophysiology of depression and symptoms of fibromyalgia. The data thus far obtained indicate the blockade of 5-HT2 and 5-HT3 receptors with mirtazapine as an effective and promising method in FS. CONCLUSIONS: Further double-blind placebo-controlled study are required to confirm our results. 546 PMID- 15467973 AU - Samborski W, Lezanska-Szpera M, Rybakowski JK TI - Open trial of mirtazapine in pts w FM. SO - Pharmacopsychiatry 2004 Jul;37(4):168-70. IN - D o Rheumatology & Clinical Immunology, U o Med Sciences, Poznan, Poland. AB - BACKGROUND: Some positive therapeutic effects in fibromyalgia syndrome (FS) were reported with both tricyclic and new antidepressant drugs as well as serotonergic agents (5HT2 and 5HT3 receptor blockers). METHODS: In the present study, a novel antidepressant drug mirtazapine, 15-30 mg/day, has been used in 29 patients with FS in an open trial. RESULTS: Twenty-six patients completed the six-week study. Ten (38%) were considered responders on account of the reduction of > or =40% on pain, fatigue and sleep disturbances and remission of depressive symptoms at the end of study. Eighteen patients had at least moderate depression before mirtazapine treatment and 8 patients presented mild depressive symptoms. Reduction on main symptoms of FS after 6 weeks of mirtazapine treatment significantly correlated with the reduction in depression. However, the percentage of responders and patients with > or = 40% reduction on main symptoms of fibromyalgia was similar in high and low depression groups. CONCLUSIONS: The results obtained suggest that mirtazapine may be promising method of FS treatment. Further double-blind placebo-controlled studies are required to confirm these results. 547 PMID- 14987626 AU - Sandberg M, Lindberg LG, Gerdle B TI - Peripheral effects of needle stimulation (acupuncture) on skin & muscle blood flow in FM. SO - Eur J Pain 2004 Apr;8(2):163-71. IN - D o Rehabilitation Med, Faculty o Health Sciences, Linkoping U, Linkoping SE-581 85, Sweden. margareta.sandberg@lio.se AB - Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM. 548 PMID- 15016576 AU - Sansone RA, Levengood JV, Sellbom M TI - Psychological aspects of FM: research vs. clinician impressions. SO - J Psychosom Res 2004 Feb;56(2):185-8. IN - Departments o Psychiatry & Internal Med, Wright St U School o Medicine, Dayton, OH, USA. Randy.sansone@kmcnetwork.org AB - OBJECTIVE: This study was designed to compare the psychological features of patients with fibromyalgia, as described in the research literature, with physicians' clinical impressions. METHOD: Using a survey method, physicians (n=44) and physicians-in-training (n=54) were polled regarding their clinical impressions of 18 psychological features, culled from the research literature, which are attributed to fibromyalgia patients. RESULTS: Over 90% of respondents reported that fatigue, muscle tension, pain proneness, depression and anxiety were clinically associated with fibromyalgia patients "frequently" or "very frequently." The majority of respondents (52%) endorsed 10 of 18 items as occurring "frequently" or "very frequently." CONCLUSIONS: Physicians and physicians-in-training appear to observe in fibromyalgia patients over half of the psychological features identified in the research literature. For the remainder of items, we discuss possible explanations for the disparity. 549 PMID- 15377055 AU - Santaella ML, Font I, Disdier OM TI - Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for CFS. SO - P R Health Sci J 2004 Jun;23(2):89-93. IN - D o Med, U o Puerto Rico School o Medicine, Med Sciences Ca+ AB - +IN: mpus, San Juan, Puerto Rico. OBJECTIVE: To compare effectiveness of oral therapy with reduced nicotinamide adenine dinucleotide (NADH) to conventional modalities of treatment in patients with chronic fatigue syndrome (CFS). BACKGROUND: CFS is a potentially disabling condition of unknown etiology. Although its clinical presentation is associated to a myriad of symptoms, fatigue is a universal and essential finding for its diagnosis. No therapeutic regimen has proven effective for this condition. METHODS: A total of 31 patients fulfilling the Centers for Disease Control criteria for CFS, were randomly assigned to either NADH or nutritional supplements and psychological therapy for 24 months. A thorough medical history, physical examination and completion of a questionnaire on the severity of fatigue and other symptoms were performed each trimester of therapy. In addition, all of them underwent evaluation in terms of immunological parameters and viral antibody titers. Statistical analysis was applied to the demographic data, as well as to symptoms scores at baseline and at each trimester of therapy. RESULTS: The twelve patients who received NADH had a dramatic and statistically significant reduction of the mean symptom score in the first trimester (p < 0.001). However, symptom scores in the subsequent trimesters of therapy were similar in both treatment groups. Elevated IgG and Ig E antibody levels were found in a significant number of patients. CONCLUSIONS: Observed effectiveness of NADH over conventional treatment in the first trimester of the trial and the trend of improvement of that modality in the subsequent trimesters should be further assessed in a larger patient sample. 550 PMID- 15016581 AU - Sarzi-Puttini P, Atzeni F, Turiel M, Furlan R, Vulpio L, Carrabba M, Pace F TI - The Italian version of the Fibrofatigue Scale, a reliable tool for the evaluation of FM Sx. [FM] SO - J Psychosom Res 2004 Feb;56(2):213-6. IN - D o Rheumatology, U Hosp L. Sacco, Via GB Grassi, 20157 Milan, Italy. sarzi@tiscali.it AB - Objective: To validate a translated Italian version of the Fibrofatigue Scale (FFS). Methods: The Italian version of FFS was administered to 60 patients affected by fibromyalgia (FM) (57 patients were interviewed again 10 days later) together with the Italian version of the Fibromyalgia Impact Questionnaire (FIQ), the Stanford Health Assessment Questionnaire (HAQ) and the Medical Outcome Survey Short Form-36 (SF-36). All patients were asked about the severity of pain today (10-cm visual analogue scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FFS was evaluated by correlations among the FFS, the FIQ and the subscales of the SF-36. Results: Mean duration of symptoms was 7.6 years, and mean age of participants was 56.3 years. Test-retest reliability was between 0.70 and 0.95 for the single items as well as for the total FFS and other components. Internal consistency was 0.90 for the overall FFS. Significant correlations were obtained between the FFS items and the SF-36. Conclusions: The Italian FFS is a reliable and valid instrument for detecting and measuring functional disability and symptoms severity in Italian patients with FM. 551 PMID- 15243852 AU - Sayar K, Gulec H, Topbas M, Kalyoncu A TI - Affective distress & FM. SO - Swiss Med Wkly 2004 May 1;134(17-18):248-53. IN - Daradeniz Technical U MS, Trabzon, Turkey. mkemalsayar@superonline.com AB - PRINCIPLES: Elevated rates of lifetime and current psychiatric disorders, elevations of psychological self-report measures assessing depression, anxiety and hypochondriasis have been reported in fibromyalgia syndrome (FMS) patients as well as studies refuting these findings. Studies comparing FMS patients with rheumatoid arthritis (RA) patients provide discrepant data. The aim of this paper is to compare FMS patients with RA patients and healthy controls with respect to psychological measures in a case control design. METHODS: Fifty subjects with FMS, 20 with RA and 42 healthy controls were assessed with respect to anxiety, depression, pain intensity and disability. Three logistical regression models were performed to test whether higher levels of a psychological measure (disability, depression or anxiety) are associated with one disease rather than another, or with one disease rather than with healthy controls. For each regression model, the best exploratory covariates were determined using receiver operating characteristic (ROC) curves. RESULTS: In the logistic regression, anxiety scores were the most important covariate determining the likelihood of having FMS whereas depression scores increased the chances of being an RA patient. Age and disability scores did not differ between FMS and RA. CONCLUSIONS: Affective distress is not specific to FMS patients, but the manner in which affective distress is incorporated into the patient's life is worth studying. FMS.seems to be associated with anxiety rather than depression. 552 PMID- 15278756 AU - Sayar K, Gulec H, Topbas M TI - Alexithymia & anger in pts w FM. SO - Clin Rheumatol 2004 Oct;23(5):441-8. Epub 2004 Jun 30. IN - School o Med, Karadeniz Technical U, Trabzon, Turkey. mkemalsayar@superonline.com AB - Our objective was to delineate the relevance of the personality construct alexithymia and anger-in in patients with fibromyalgia syndrome. Fifty subjects with fibromyalgia syndrome were compared to 20 subjects with rheumatoid arthritis and 42 healthy controls on the measures of anxiety, depression, anger, alexithymia, pain intensity and disability. There was a significant difference on the measures of anxiety and anger between FMS and RA groups, and also between FMS patients and healthy controls. There was a significant difference between FMS patients and healthy controls on the measures of depression, difficulty in identifying feelings subscale of TAS (TAS-dif), and total alexithymia scores. When the severity of pain was controlled for, there was a significant difference on the measures of anger and alexithymia between the FMS and the RA groups. Fibromyalgia patients were more alexithymic than rheumatoid arthritis patients even when the level of depression was controlled for. Anger towards oneself, which is anger-in, was higher in patients with fibromyalgia patients than in the rheumatoid arthritis sample. A stepwise regression model showed that the anger-out scores and the anxiety scores predicted the level of pain severity, and this explained 32% of the variance in the fibromyalgia syndrome group. Although anger-in is consistently higher in fibromyalgia patients, it is the behavioral expression of anger, together with anxiety, that predicts the severity of the pain. The difficulty of identifying feelings, rather than other dimensions of alexithymia, seems to be associated with fibromyalgia. 553 PMID- 14980991 AU - Schacterle RS, Komaroff AL TI - A comparison of pregnancies that occur before & after the onset of CFS. SO - Arch IM 2004 Feb 23;164(4):401-4. IN - D o Med, Brigham & Women's Hosp, Harvard MS, Boston, Massachasetts 02115, USA. AB - BACKGROUND: Many women with chronic fatigue syndrome (CFS) fear that pregnancy will worsen their condition, increase the risks of maternal complications of pregnancy, or threaten the health of their offspring. Little empirical evidence, however, has been published on this matter. METHODS: A detailed questionnaire was administered to 86 women regarding 252 pregnancies that occurred before or after the onset of CFS and the outcomes of these pregnancies were observed. RESULTS: During pregnancy, there was no change in CFS symptoms in 29 (41%), an improvement of symptoms in 21 (30%), and a worsening of symptoms in 20 (29%) of 70 subjects. After pregnancy, there was no change in CFS symptoms in 21 (30%), an improvement of symptoms in 14 (20%), and a worsening of symptoms in 35 (20%) of the subjects. The rates of many complications were similar in pregnancies occurring before the onset and in those occurring after the onset of CFS. There was a higher frequency of spontaneous abortions in the pregnancies occurring after, vs before, the onset of CFS (22 [30%] of 73 pregnancies after vs 13 [8%] of 171 before; P<.001), but no differences in the rates of other complications. Developmental delays or learning disabilities were reported more often in the offspring of women who became pregnant after, vs before, the onset of CFS (9 [21%] of 43 children vs 11 [8%] of 139 children; P =.01). CONCLUSIONS: Pregnancy did not consistently worsen the symptoms of CFS. Most maternal and infant outcomes were not systematically worse in pregnancies occurring after the onset of CFS. The higher rates of spontaneous abortions and of developmental delays in offspring that we observed could be explained by maternal age or parity differences, and should be investigated by larger, prospective studies with control populations. 554 PMID- 15238752 AU - Schaefer KM TI - Breastfeeding in chr illness: the voices of women w FM. SO - MCN Am J Matern Child Nurs 2004 Jul-Aug;29(4):248-53. IN - Temple U, Coll o Health Professions, D o Nursing, Philadelphia, PA, USA. karen.schaefer@temple.edu AB - PURPOSE: To describe what it is like for women with fibromyalgia (FM) to breastfeed their infants. STUDY DESIGN AND METHODS: Nine women with FM who chose to breastfeed their infants were the sample for this qualitative study. van Manen's phenomenological method of reflection, writing, and rewriting was used to analyze the data collected through in-depth tape-recorded interviews and written stories. RESULTS: All nine women felt that they were not successful in their attempts to breastfeed, and felt frustrated. Themes included (a) muscle soreness, pain, and stiffness made it difficult to breastfeed the baby; (b) fatigue interfered with the breastfeeding process; (c) the need for medication, perceived insufficient milk supply, and sore nipples led to forced unplanned weaning; and (d) being forced to wean the infant when not ready to do so created sadness and a feeling of depression. CLINICAL IMPLICATIONS: Nurses who work with women with FM who choose to breastfeed need to be proactive in providing informational, emotional, and physical support to facilitate a successful breastfeeding experience for these women. Knowing that the pain, muscle soreness, stiffness, and fatigue of FM may affect breastfeeding can direct nurses to help women with FM plan for support after childbirth and learn techniques to control/reduce the muscle pain and stiffness. Nurses are encouraged to refer breastfeeding women with FM to lactation consultants and support groups for encouragement and validation regarding their concerns about breastfeeding. It is important that nurses continue to serve as advocates for breastfeeding women with FM and keep other healthcare providers informed about the issues related to breastfeeding for women with FM. 555 PMID- 15052746 AU - Schaefer KM TI - Caring for the patient w FM: the rehabilitation nurse's role. SO - Rehabil Nurs 2004 Mar-Apr;29(2):49-55. IN - D o Nursing, Coll o Health Professions, Temple U, Philadelp+ AB - +IN: hia, PA, USA. karen.schaefer@temple.edu Fibromyalgia (FM) is a chronic, potentially disabling, cluster of symptoms that manifests as pain for 3 months or more and pain with pressure on 11 of 18 tender points throughout the body. Because there is no known cause, and therefore, no cure, treatment focuses on the control or relief of symptoms. Many patients are referred to rehabilitation settings for physical or exercise therapy. While exercise is helpful in the control of the pain, stiffness, fatigue, sleep disorders, and mood changes, a holistic approach to treatment is more effective. Rehabilitation nurses provide major support for patients with FM. Validation of the patients' experiences is essential for achieving quality of life. Many patients have a history of being undertreated because of a lack of credibility and invisibility of the illness. This article provides background information about FM, summarizes the FM trajectory, reviews approaches to management, and discusses the role of rehabilitation nurses in a holistic approach to care of clients with FM. 556 PMID- 15465441 AU - Schillings ML, Kalkman JS, van der Werf SP, van Engelen BG, Bleijenberg G, Zwarts MJ TI - Diminished central activation during maximal voluntary contraction in CFS. SO - Clin Neurophysiol 2004 Nov;115(11):2518-24. IN - D o Clinical Neurophysiology, U Med Centre Nijmegen, Internal postal code 314, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. AB - OBJECTIVE: We have investigated whether central activation failure (CAF) is increased during local muscle fatigue in chronic fatigue syndrome (CFS). METHODS: Fourteen female CFS patients and 14 age-matched healthy female controls made a 2 min sustained maximal voluntary contraction (MVC) of the biceps brachii muscle. Before, during, and after sustained MVC, electrical endplate stimulation was applied. Force and 5 channel surface EMG (sEMG) were registered. RESULTS: Although force responses upon stimulation during rest did not differ between patients and controls, MVC was significantly lower in patients. Already at the beginning of sustained MVC, CFS patients showed significantly larger CAF than controls (36.5+/-17.0% and 12.9+/-13.3%, respectively). For all individual patients mean CAF over the first 45 s was higher than 30%, while it was below 30% for all controls. Less peripheral fatigue in patients was demonstrated by the changes in muscle fibre conduction velocity and the differences between force responses before and after contraction. CONCLUSIONS: Central activation is diminished in CFS patients. Possible causes include changed perception, impaired concentration, reduced effort and physiologically defined changes, e.g. in the corticospinal excitability or the concentration of neurotransmitters. As a consequence, demands on the muscle are lower, resulting in less peripheral fatigue. SIGNIFICANCE: CFS patients show reduced central activation during MVC. The underlying pathophysiological processes remain still to be determined. 557 PMID- 14994411 AU - Schlesinger N TI - Clues to pathogenesis of FM in pts w sickle cell disease. SO - J Rheumatol 2004 Mar;31(3):598-600. IN - D o Med, UMDNJ-Robert Wood Johnson MS, New Brunswick, New Jersey 08903-0019, USA. schlesna@umdnj.edu AB - OBJECTIVE: To investigate the association between sickle cell disease (SCD) and fibromyalgia (FM). METHODS: Nine patients with SCD for whom a rheumatology consult was requested were assessed for FM by retrospective chart review. Eleven inpatients with other forms of anemia referred for rheumatology consult were also assessed for FM. RESULTS: Eight of 9 patients with SCD fulfilled classification criteria for FM compared to one of 11 patients without SCD (p < 0.001). CONCLUSION: Awareness of the high frequency of FM in SCD can improve treatment of sickle cell crisis. Some pain that is labeled as sickle cell crisis pain may be due to FM, and may improve with tender point injections. 558 PMID- 15515411 AU - Schneider EM, Ma X, Stratz T, Muller W, Lorenz I, Seeling WD TI - Immunomodulatory function of the 5-HT3 receptor antagonist tropisetron. [FM] SO - Scand J Rheumatol Suppl 2004;(119):34-40. IN - Section o Experimental Anesthesiology, U Clinic Ulm, Ulm, Germany. marion.schneider@medizin.uni-ulm.de AB - OBJECTIVE: To characterize the immune modulatory effects of 5-HT3 receptor antagonist treatment in patients with fibromyalgia, autoimmune disorders, and chronic pain. METHODS: Multiplex-assisted cytokine measurements were performed before and during treatment. Whole blood stimulation with TNF-alpha was carried out to determine the proinflammatory response induced by exogenous TNF-alpha. RESULTS: Five of nine patients clinically responded to treatment, and two had a moderate response. All patients had significantly elevated levels of T-H1 cytokines more prominent than TNF-alpha, IL-1beta, and IL-6. Treatment resulted in transient effects on peripheral monocyte counts in all but one patient, a plasma IL-1beta increase in two responder patients, and decreased T-H1 cytokines in two responder patients. Ex vivo TNF-alpha stimulation was transiently reconstituted in three responder patients to a significant level. Three patients showed a marginal reconstitutive response. CONCLUSION: 5-HT3 receptor blockade transiently affects monocyte tissue infiltration, modulates T-H1 cytokines in clinical responders as well as MIP-1beta in moderate responders, and transiently affects the ex vivo response to exogenous TNF-alpha. 559 PMID- 15549528 AU - Schoenen J TI - Tension-type headache & FM: what's common, what's different? SO - Neurol Sci 2004 Oct;25 Suppl 3:S157-9. IN - Headache Research Unit, Departments o Neuroanatomy & Neurology, U o Liege CHR Citadelle, B-4000 Belgium. jschoenen@ulg.ac.be AB - Chronic tension-type headache and fibromyalgia have striking clinical and pathophysiologic similarities. They can be associated in patients. In both conditions there is evidence of altered processing of peripheral nociceptive information. Peripheral sensitisation of musculotendinous nociceptors may play a role and, at least in chronic tension-type headache, there are indications of central sensitisation. As for the clinical presentation, there also pathophysiological differences between the two disorders. A better understanding of both these differences and similarities may hopefully help in the future management of patients. 560 PMID- 15682879 AU - Schoofs N, Bambini D, Ronning P, Bielak E, Woehl J TI - Death of a lifestyle: the effects of social support & healthcare support on the quality of life of persons w FM and/or CFS. SO - Orthop Nurs. 2004 Nov-Dec;23(6):364-74. IN - Grand Valley St U, Grand Rapids, MI, USA. AB - PURPOSE: The purpose of this study was to investigate how social support and healthcare support affect the quality of life of persons with fibromyalgia and chronic fatigue syndrome. METHOD: A constant comparison method was used for the qualitative portion of the research and descriptive correlational methods were used for the quantitative portion. CONCLUSION: This mixed design research study suggested that social support, unlike healthcare support, is related to Quality of Life (QOL). It was also evident that subjects suffering from CFS and/or FMS do not experience high levels of social support. 561 PMID- 14994410 AU - Senna ER, De Barros AL, Silva EO, Costa IF, Pereira LV, Ciconelli RM, Ferraz MB TI - Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. [FM] SO - J Rheumatol 2004 Mar;31(3):594-7. IN - D o Med, U o Montes Claros -- UNIMONTES, Sao Paulo, Brazil. AB - OBJECTIVE: To estimate the prevalence of rheumatic diseases in residents of Montes Claros, Brazil, of both sexes, aged above 16 years, using the COPCORD questionnaire. METHODS: This was a cross-sectional study of 3038 people; the sample was probabilistic, by conglomerates, multiple stages, within homogeneous strata, the sampling unit being the domicile. The COPCORD questionnaire was used for all subjects, and a rheumatologist evaluated those patients who presented pain and/or functional disability. Laboratory tests and radiographs of small and large joints were done in some patients to confirm the diagnosis. Subjects were identified by socioeconomic level in quintiles A, B, C, D, and E, A being the highest. RESULTS: Two hundred nineteen patients were identified with rheumatic diseases, mean age 37 (SD 27) years, with female predominance. Seventy-seven (35.2%) were unemployed and socioeconomic level D was the most prevalent. Of all patients with rheumatic disease, osteoarthritis (OA) was observed in 126 (57.5%) patients, fibromyalgia (FM) in 76 (34.7%), rheumatoid arthritis (RA) in 14 (6.4%), and lupus in 3 (1.4%). Women were predominant in all diseases except OA. The mean (SD) age was 56 (12.7) years for OA, 43.2 (9.1) for FM, 53.4 (13.9) for RA, and 40 (14) for lupus. CONCLUSION: The prevalence of rheumatic diseases evaluated by the COPCORD questionnaire was 4.14% for OA, 2.5% for FM, 0.46% for RA, and 0.098% for lupus. 562 PMID- 14976272 AU - Severens JL, Prins JB, van der Wilt GJ, van der Meer JW, Bleijenberg G TI - Cost-effectiveness of cognitive behaviour therapy for pts w CFS. SO - QJM 2004 Mar;97(3):153-61. IN - D o Med Technology Assessment, U Med Centre Nijmegen, The Netherlands. h.severens@boez.unimaas.nl AB - BACKGROUND: There is some evidence that cognitive behaviour therapy (CBT) is efficacious in chronic fatigue syndrome (CFS), but little data on its cost-effectiveness. DESIGN: Prospective economic analysis alongside a randomized clinical trial. METHODS: CFS patients were randomly assigned to CBT, guided support groups (SG), or the 'natural course' (NC, no protocol-based interventions). Patients were treated for 8 months and followed-up for another 6 months. Costs per patient showing clinically significant improvement, based on the CIS fatigue scale, and costs per quality-adjusted life year, were determined for a time period of 14 months. RESULTS: Data were available for 171 patients at 8 months and for 128 at 14 months. At 8 and 14 months, the percentages of improved patients were 31% and 27% for CBT, 9% and 11% for SG, and 12% and 20% for NC. Mean QALYs gained at 14 months were, for CBT, SG and NC, respectively, 0.0737, -0.0018 and 0.0458. CBT and SG mean treatment costs were euro1490 and euro424. Other medical costs for CBT, SG, and NC, respectively, were euro324, euro623 and euro412 for the first period, and euro232, euro561 and euro378 for the second period. Non-medical costs for these periods for CBT, SG and NC were euro262, euro550, euro427 and euro226, euro439, euro287, respectively. Productivity costs were considerable, but not significantly different between groups. DISCUSSION: CBT was less costly and more effective than SG. Compared to NC, the baseline incremental cost-effectiveness of CBT was euro20 516 per CFS patient showing clinically significant improvement, and euro21 375 per QALY. The bootstrap ratios showed considerable uncertainty regarding the results. Future research should focus on productivity costs, and follow patients prospectively over a longer period. 563 PMID- 14983107 AU - Sewitch MJ, Dobkin PL, Bernatsky S, Baron M, Starr M, Cohen M, Fitzcharles MA TI - Medication non-adherence in women w FM. SO - Rheumatology (Oxford) 2004 May;43(5):648-54. Epub 2004 Feb 24. IN - D o Med, McGill U, Montreal, Quebec, Canada. maida.sewitch@mail.mcgill.ca AB - OBJECTIVE: To identify the determinants of medication non-adherence in women with fibromyalgia (FM). METHODS: Participants included 10 rheumatologists and 127 women recruited from tertiary care hospitals and the community. Demographic, clinical and psychosocial characteristics and patient-physician discordance were assessed at the baseline visit. Non-adherence was assessed 2 weeks later. Multivariable generalized estimating equations were used to identify determinants of non-adherence to medication. RESULTS: The average age of the women was 50.4 (s.d. 10.5) yr and the mean disability score was 60.3 (16.0) yr. Sixty (47.2%) women were non-adherent to medication; 20 (33.3%) of these were intentionally non-adherent, 24 (40.0%) were unintentionally non-adherent, and the remaining subjects were both. Overall non-adherence was predicted by higher patient-physician discordance. Unintentional non-adherence was predicted by community subjects, not being under a rheumatologist's care, less disease activity, less use of instrumental coping, and higher patient-physician discordance. Intentional non-adherence was predicted by shorter duration under a rheumatologist's care and higher patient-physician discordance. CONCLUSION: The therapeutic relationship, in addition to clinical and psychosocial characteristics, influenced non-adherence to medication. 564 PMID- 15016572 AU - Shapiro CM TI - Chronic fatigue--chronically confusing but growing information. SO - J Psychosom Res 2004 Feb;56(2):153-5. 565 PMID- 15062736 AU - Shaver JL TI - FM syndrome in women. SO - Nurs Clin North Am 2004 Mar;39(1):195-204, viii. IN - U o Illinois at Chicago, Coll o Nursing, M/C 802, 845 South Damen Avenue, Chicago, IL 60612-7350, USA. jshaver@uic.edu AB - Many more women than men experience the chronically fatiguing condition of fibromyalgia syndrome (FMS), a growing diagnosis in the United States. Estimates are that upwards of 2% to 6% of adults have been diagnosed with FMS, and at high societal costs. In this article, common manifestations are described to guide assessment and various lines of research are explored as a basis for under-standing contributing factors and potential treatments for FMS and other chronic disorders, such as chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and temporomandibular disorders (TMD), and the effectiveness of current treatment options. 566 PMID- 15013189 AU - Shin HY, An NH, Cha YJ, Shin EJ, Shin TY, Baek SH, Kim CH, Lyu YS, Lee EJ, Kim HM TI - Effect of Kuibitang on lipopolysaccharide-induced cytokine production in peripheral blood mononuclear cells of CFS pts. SO - J Ethnopharmacol 2004 Feb;90(2-3):253-9. IN - D o Pharmacology, Coll o Oriental Med, Kyung Hee U, Seoul, South Korea. AB - Kuibitang (KBT) is clinically used to treat patients suffering from chronic fatigue syndrome (CFS) in South Korea. However, its effect has not been investigated experimentally. Recent reports have shown that CFS patients display an altered cytokine production. We examined the effect of KBT on lipopolysaccharide (LPS)-induced various cytokines production in peripheral blood mononuclear cells (PBMC) of CFS patients and healthy controls. KBT (1 mg/ml) significantly inhibited LPS-induced tumor necrosis factor-alpha, interleukin-10, and transforming growth factor-beta1 production in PBMC of CFS patients. However, LPS-induced interferon-gamma production was significantly increased by KBT (0.01 mg/ml). These results provide evidence of a novel activity of the KBT that regulate cytokines production related with CFS. 567 PMID- 15266001 AU - Shookster L, Falke GI, Ducic I, Maloney CT Jr, Dellon AL TI - FM & Tinel's sign in the foot. SO - J Am Podiatr Med Assoc 2004 Jul-Aug;94(4):400-3. IN - Division o Rheumatology, New York Coll o Podiatric Med, New York, NY, USA. AB - In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel's sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of Rheumatology recognizes fibromyalgia as a condition characterized by multiple "tender points" on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel's sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia. 568 PMID- 15351380 AU - Siemionow V, Fang Y, Calabrese L, Sahgal V, Yue GH TI - Altered central nervous system signal during motor performance in CFS. SO - Clin Neurophysiol 2004 Oct;115(10):2372-81. IN - D o Biomedical Engineering, The Lerner Research Inst, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. AB - OBJECTIVE: The purpose of this study was to determine whether brain activity of chronic fatigue syndrome (CFS) patients during voluntary motor actions differs from that of healthy individuals. METHODS: Eight CFS patients and 8 age- and gender-matched healthy volunteers performed isometric handgrip contractions at 50% maximal voluntary contraction level. They first performed 50 contractions with a 10 s rest between adjacent trials--'Non-Fatigue' (NFT) task. Subsequently, the same number of contractions was performed with only a 5 s rest between trials--'Fatigue' (FT) task. Fifty-eight channels of surface EEG were recorded simultaneously from the scalp. Spectrum analysis was performed to estimate power of EEG frequency in different tasks. Motor activity-related cortical potential (MRCP) was derived by triggered averaging of EEG signals associated with the muscle contractions. RESULTS: Major findings include: (i) Motor performance of the CFS patients was poorer than the controls. (ii) Relative power of EEG theta frequency band (4-8 Hz) during performing the NFT and FT tasks was significantly greater in the CFS than control group (P < 0.05). (iii) The amplitude of MRCP negative potential (NP) for the combined NFT and FT tasks was higher in the CFS than control group (P < 0.05) (iv) Within the CFS group, the NP was greater for the FT than NFT task (P<0.01), whereas no such difference between the two tasks was found in the control group. CONCLUSIONS: These results clearly show that CFS involves altered central nervous system signals in controlling voluntary muscle activities, especially when the activities induce fatigue. SIGNIFICANCE: Physical activity-induced EEG signal changes may serve as physiological markers for more objective diagnosis of CFS. 569 PMID- 15608957 AU - Siqueira JT, Lin HC, Nasri C, Siqueira SR, Teixeira MJ, Heir G, Valle LB TI - Clinical study of pts w persistent orofacial pain. [FM] SO - Arq Neuropsiquiatr. 2004 Dec;62(4):988-96. Epub 2004 Dec 15. IN - Dentistry Div, Hosp das Clinicas, School o Med, U o Sao Paulo, Sao Paulo, SP, Brazil. jtts@uol.com.br AB - OBJETIVE: To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male). RESULTS: Patients were classified into three groups according to their presenting symptoms: a)Group I, eight patients (30.7%) with severe, diffuse pain at the face, teeth or head; b)Group II, eight patients (30.7%) with chronic non-myofascial pain and; c)Group III, ten patients with chronic myofascial pain (38.4%). We find 11 different diagnoses among the 26 patients: pulpitis(7), leukemia(1), oropharyngeal tumor(1), atypical odontalgia(1), Eagle's syndrome(1), trigeminal neuralgia(4), continuous neuralgia(1), temporomandibular disorders (9), fibromyalgia (2), tension-type headache(1), conversion hysteria(2). After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orofacial pain diagnosis (benign to life-threatening diseases) indicates the necessity to reevaluate patients presenting recurrent pain that is refractory to the usual treatments. 570 PMID- 15184691 AU - Skapinakis P, Lewis G, Mavreas V TI - Temporal relations between unexplained fatigue & depression: longitudinal data from an international study in primary care. [CFS] SO - Psychosom Med 2004 May-Jun;66(3):330-5. IN - D o Psychiatry, U o Ioannina, School o Med, Greece. pskapin@cc.uoi.gr AB - OBJECTIVE: Unexplained fatigue syndromes, such as chronic fatigue syndrome and neurasthenia, are strongly associated with depression, but the temporal nature of this association is not clear. METHODS: The authors examined this issue by using data from the World Health Organization collaborative study of psychological problems in general health care. Three thousand two hundred one subjects from 15 primary care centers in 14 countries were followed up for 12 months. The Composite International Diagnostic Interview was the main instrument used. Odds ratios and their 95% confidence intervals (CI) were calculated using logistic regression models adjusted for sociodemographic variables, physical morbidity and intercenter variability. RESULTS: Cases of depression were found to have an increased risk of developing a new episode of unexplained fatigue at follow-up with an adjusted odds ratio of 4.15 (95% CI = 2.64-6.54). Similarly, cases of unexplained fatigue were found to have an increased risk of developing a new episode of depression at follow-up with an adjusted odds ratio of 2.76 (95% CI = 1.32-5.78). Further adjustment for subthreshold symptoms at baseline weakened the reported associations, especially between fatigue and development of a new episode of depression, but these remained significant. CONCLUSIONS: The findings support the view that unexplained fatigue and depression might act as independent risk factors for each other. 571 PMID- 14738459 AU - Skowera A, Cleare A, Blair D, Bevis L, Wessely SC, Peakman M TI - High levels of type 2 cytokine-producing cells in CFS. SO - Clin Exp Immunol 2004 Feb;135(2):294-302. IN - D o Immunology, Guy's, King's & St Thomas's School o Med, King's Coll London, London, UK. AB - The aetiology of chronic fatigue syndrome (CFS) is not known. However, it has been suggested that CFS may be associated with underlying immune activation resulting in a Th2-type response. We measured intracellular production of interferon (IFN)-gamma and interleukin (IL)-2; type 1 cytokines), IL-4 (type 2) and IL-10 (regulatory) by both polyclonally stimulated and non-stimulated CD4 and CD8 lymphocytes from patients with CFS and control subjects by flow cytometry. After polyclonal activation we found evidence of a significant bias towards Th2- and Tc2-type immune responses in CFS compared to controls. In contrast, levels of IFN-gamma, IL-2 and IL-10-producing cells were similar in both study groups. Non-stimulated cultures revealed significantly higher levels of T cells producing IFN-gamma or IL-4 in CFS patients. Concluding, we show evidence for an effector memory cell bias towards type 2 responsiveness in patients with CFS, as well as ongoing type 0 immune activation in unstimulated cultures of peripheral blood cells. 572 PMID- 14993075 AU - Smith MS TI - Adolescent CFS. SO - [CON: Arch Pediatr Adolesc Med. 2004 Mar;158(3):225-9. PMID: 14993080]; Arch Pediatr Adolesc Med 2004 Mar;158(3):207-8. 573 PMID- 15760806 AU - Smith NL TI - Serotonin mechanisms in pain & functional syndromes: management implications in comorbid FM, headache, & irritable bowl syndrome - case study & discussion. SO - J Pain Palliat Care Pharmacother. 2004;18(4):31-45. IN - U o Utah, School o Med, USA. smithnlee@aol.com AB - A young woman presented with multiple central hypersensitivity disorders, including fibromyalgia, headache, pelvic pain and several smooth muscle spasm disorders, including irritable bowel syndrome, irritable bladder and Raynaud's phenomenon. She also had significant fatigue and sleep problems. Her case illustrates the importance and surprising frequency of atypical bipolar mood disorders in people with multiple central hypersensitivity pain disorders, especially with depression and anxiety resistant to antidepressant treatment. Considering neurological mechanisms common to her overlapping disorders was very helpful in guiding treatment choices. This experience illustrates the value of serotonin receptor type 2 (5HT2) inhibition with atypical neuroleptics, of neural cation channel and glutamate inhibition with anticonvulsants, and the potential usefulness of antidepressants after establishing 5HT2 control to enhance downward inhibitory tracts. Medications with combined usefulness for both bipolar mood and pain disorders were highly effective for her multiple hypersensitivity problems. 574 PMID- 15534161 AU - Solomon L, Reeves WC TI - Factors influencing the Dx of CFS. SO - Arch IM 2004 Nov 8;164(20):2241-5. IN - Division o Viral & Rickettsial Diseases, Nat Ctr for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, GA 30333, USA. AB - BACKGROUND: Most of what is believed about chronic fatigue syndrome (CFS) is based on clinic-based studies. These studies may not reflect CFS cases in the population. METHODS: We used data from a population-based study of CFS to identify factors associated with receiving a CFS diagnosis. Wichita, Kan, residents were screened by random-digit dialing. Eligible individuals completed a telephone interview. Respondents meeting CFS criteria were invited for a clinical evaluation to confirm CFS. We analyzed all persons with confirmed CFS. The main outcomes of this study, prevalence and incidence of CFS, are published elsewhere. Herein, we present an exploratory analysis with previous CFS diagnosis as the outcome, predicted by demographic and symptom characteristics. RESULTS: We confirmed CFS in 90 subjects; 14 (16%) had been previously diagnosed as having CFS. Persons in the middle- vs the higher-income group were more likely to have been diagnosed as having CFS (9 [29%] of 31 subjects vs 3 [8%] of 39 subjects; P = .03), as were those with sudden vs gradual fatigue onset (7 [41%] of 17 subjects vs 4 [6%] of 64 subjects; P < .01), those reporting tender lymph nodes (7 [33%] of 21 subjects vs 7 [10%] of 69 subjects; P = .02), and those reporting a sore throat (6 [35%] of 17 subjects vs 8 [11%] of 73 subjects; P = .02). Only 17 (21%) of 81 subjects had sudden fatigue onset, and tender lymph nodes (reported in 21 [23%] of 90 subjects) and a sore throat (reported in 17 [19%] of 90 subjects) were the least common symptoms. CONCLUSION: Most cases of CFS in the population are unrecognized by the medical community; persons diagnosed as having CFS may be different from persons with CFS in the general population. 575 PMID- 15370724 AU - Spath M, Stratz T, Neeck G, Kotter I, Hammel B, Amberger CC, Haus U, Farber L, Pongratz D, Muller W TI - Efficacy & tolerability of intravenous tropisetron in the Rx of FM. SO - Scand J Rheumatol 2004;33(4):267-70. IN - Friedrich-Baur-Institute, U o Munich, D-80336 Munchen, Germany. michael.spaeth@lrz.uni-muenchen.de AB - OBJECTIVE: To determine the efficacy of a serotonin receptor (5-HT(3)) antagonist in the treatment of fibromyalgia (FM) in a prospective, randomized, double-blind, placebo-controlled, multicentre trial. METHODS: Twenty-one female patients (age 21-63 years) with FM according to the American College of Rheumatology classification criteria for FM were assigned randomly to either a placebo group or to receive a daily intravenous bolus injection of 5 mg tropisetron for 5 days. RESULTS: In patients receiving tropisetron, the visual analogue scale (VAS) score for pain decreased by 28.9 compared with a decrease of 6.8 in the placebo group [probability (p)=0.063; effect size: 0.794]. Similar results were obtained using a body diagram pain score as a secondary efficacy parameter: mean pain reduction was 27.2 in the tropisetron group, versus 2.8 in the placebo group (p=0.038; effect size: 0.902). CONCLUSION: 5-HT(3) receptor antagonists provide significant pain relief for a group of FM patients. 576 PMID- 15515418 AU - Spath M, Stratz T, Farber L, Haus U, Pongratz D TI - Treatment of FM w tropisetron--dose & efficacy correlations. SO - Scand J Rheumatol Suppl 2004;(119):63-6. IN - Friedrich-Baur-Institute, U o Munich, Munich, Germany. michael.spaeth@lrz.uni-muenchen.de AB - Previous studies evaluating the efficacy and tolerance of tropisetron for the treatment of fibromyalgia (FM) used the drug either intravenously or orally, and at different dosage levels ranging from 2 mg to 15 mg daily. The shortest treatment was a single dose and the longest treatment period covered 28 days. A significant reduction of the pain intensity was achieved by using tropisetron 5 mg per day. Apart from the fact that treatment periods were different, the efficacy of oral and intravenous administration did not differ significantly. Tropisetron was well tolerated; but in the 15 mg group in one of the studies, the decrease in pain was less than in the placebo group, however, the frequency of constipation and other gastrointestinal symptoms increased. Furthermore, it was hypothesized that due to the impacts of CYP2D6 activities, a daily dose of tropisetron 2 mg may be efficacious in slow metabolizers only. Although tropisetron proved to be efficacious in a group of fibromyalgia patients, the dose-response curves cannot yet be explained in a fully satisfactory manner, which may encourage research focusing on possible subgroups of FM. 577 PMID- 15041034 AU - Spence VA, Khan F, Kennedy G, Abbot NC, Belch JJ TI - Acetylcholine mediated vasodilatation in the microcirculation of pts w CFS. SO - Prostaglandins Leukot Essent Fatty Acids. 2004 Apr;70(4):403-7. IN - Vascular Diseases Research Unit, U D o Med, Ninewells Hosp & MS, Dundee DD1 9SY, UK. AB - The aetiology of chronic fatigue syndrome (CFS) remains controversial and a number of hypotheses have been put forward to explain it. Research into the condition is hindered by the considerable heterogeneity seen across patients but several reports have highlighted disturbances to cholinergic mechanisms in terms of central nervous system activity, neuromuscular function and autoantibodies to muscarinic cholinergic receptors. This paper examines an altogether separate function for acetylcholine and that is its role as an important and generalized vasodilator. Most diseases are accompanied by a blunted response to acetylcholine but the opposite is true for CFS. Such sensitivity is normally associated with physical training so the finding in CFS is anomalous and may well be relevant to vascular symptoms that characterise many patients. There are several mechanisms that might lead to ACh endothelial sensitivity in CFS patients and various experiments have been designed to unravel the enigma. These are reported here. 578 PMID- 14962957 AU - Sprott H, Salemi S, Gay RE, Bradley LA, Alarcon GS, Oh SJ, Michel BA, Gay S TI - Increased DNA fragmentation & ultrastructural changes in fibromyalgic muscle fibres. [FM] SO - Ann Rheum Dis 2004 Mar;63(3):245-51. IN - WHO Collaborating Centre for Molecular Biology & Novel Therapeutic Strategies for Rheumatic Diseases, D o Rheumatology & Inst o Physical Med, U Hosp, Gloriastrasse 25, CH-8091 Zurich, Switzerland. haiko.sprott@usz.ch AB - OBJECTIVE: To determine whether there is evidence of increased DNA fragmentation and ultrastructural changes in muscle tissue of patients with fibromyalgia (FM) compared with healthy controls. METHODS: Muscle tissues from 10 community residents with FM and 10 age and sex matched healthy controls were examined "blindly" for the presence of DNA fragmentation by two different methods: terminal deoxynucleotidyl transferase (TdT) staining (TUNEL) and the FragEL-Klenow DNA fragmentation detection kit. Ultrastructural analysis of tissue was performed by electron microscopy. RESULTS: DNA fragmentation was detected by both methods in 55.4 (SEM 2.5)% of the nuclei in muscle tissue of patients with FM compared with 16.1 (4.1)% (p<0.001) of the nuclei in healthy controls. Contrary to expectation, no typical features of apoptosis could be detected by electron microscopy. The myofibres and actin filaments were disorganised and lipofuscin bodies were seen; glycogen and lipid accumulation were also found. The number of mitochondria was significantly lower in patients with FM than in controls and seemed to be morphologically altered. CONCLUSION: The ultrastructural changes described suggest that patients with FM are characterised by abnormalities in muscle tissue that include increased DNA fragmentation and changes in the number and size of mitochondria. These cellular changes are not signs of apoptosis. Persistent focal contractions in muscle may contribute to ultrastructural tissue abnormalities as well as to the induction and/or chronicity of nociceptive transmission from muscle to the central nervous system. 579 PMID- 15082083 AU - Staines DR TI - Is CFS an autoimmune disorder of endogenous neuropeptides, exogenous infection & molecular mimicry? SO - Med Hypotheses 2004;62(5):646-52. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport 4215, Qld, Australia. don_staines@health.qld.gov.au AB - Chronic fatigue syndrome is a disorder characterised by prolonged fatigue and debility and is mostly associated with post-infection sequelae although ongoing infection is unproven. Immunological aberration is likely and this may prove to be associated with an expanding group of vasoactive neuropeptides in the context of molecular mimicry and inappropriate immunological memory. Vasoactive neuropeptides including vasoactive intestinal peptide (VIP) and pituitary adenylate activating polypeptide (PACAP) belong to the secretin/glucagon superfamily and act as hormones, neurotransmitters, immune modulators and neurotrophes. They are readily catalysed to smaller peptide fragments by antibody hydrolysis. They and their binding sites are immunogenic and are known to be associated with a range of autoimmune conditions. Vasoactive neuropeptides are widely distributed in the body particularly in the central, autonomic and peripheral nervous systems and have been identified in the gut, adrenal gland, reproductive organs, vasculature, blood cells and other tissues. They have a vital role in maintaining vascular flow in organs, and in thermoregulation, memory and concentration. They are co-transmitters for acetylcholine, nitric oxide, endogenous opioids and insulin, are potent immune regulators with primarily anti-inflammatory activity, and have a significant role in protection of the nervous system to toxic assault, promotion of neural development and the maintenance of homeostasis. This paper describes a biologically plausible mechanism for the development of CFS based on loss of immunological tolerance to the vasoactive neuropeptides following infection, significant physical exercise or de novo. It is proposed that release of these substances is accompanied by a loss of tolerance either to them or their receptor binding sites in CFS. Such an occurrence would have predictably serious consequences resulting from compromised function of the key roles these substances perform. All documented symptoms of CFS are explained by vasoactive neuropeptide compromise, namely fatigue and nervous system dysfunction through impaired acetylcholine activity, myalgia through nitric oxide and endogenous opioid dysfunction, chemical sensitivity through peroxynitrite and adenosine dysfunction, and immunological disturbance through changes in immune modulation. Perverse immunological memory established against these substances or their receptors may be the reason for the protracted nature of this condition. The novel status of these substances together with their extremely small concentrations in blood and tissues means that clinical research into them is still in its infancy. A biologically plausible theory of CFS causation associated with vasoactive neuropeptide dysfunction would promote a coherent and systematic approach to research into this and other possibly associated disabling conditions. 580 PMID- 15082086 AU - Staines DR TI - Is FM an autoimmune disorder of endogenous vasoactive neuropeptides? SO - Med Hypotheses 2004;62(5):665-9. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport, Qld 4215, Australia. don_staines@health.qld.gov.au AB - Fibromyalgia (FM) is a disorder characterised by soft tissue pain, disturbance of function an often prolonged course and variable fatigue and debility. A clearly defined aetiology has not been described. This paper proposes that immunological aberration is likely and this may prove to be associated with an expanding group of novel vasoactive neuropeptides. Vasoactive neuropeptides act as hormones, neurotransmitters, immune modulators and neurotrophes. They are readily catalysed to small peptide fragments. They and their binding sites are immunogenic and are known to be associated with a range of autoimmune conditions. They have a vital role in maintaining vascular flow in organs, and in thermoregulation, memory and concentration. They are co-transmitters for acetylcholine, are potent immune regulators with primarily anti-inflammatory activity, and have a significant role in protection of the nervous system to toxic assault and the maintenance of homeostasis. Failure of these substances has adverse consequences for homeostasis. This paper describes a biologically plausible mechanism for the development of FM based on loss of immunological tolerance to the vasoactive neuropeptides. The proposed mechanism of action is that inflammatory cytokines are provoked by tissue injury from unaccustomed exercise or physical injury. This may trigger a response by certain vasoactive neuropeptides which then undergo autoimmune dysfunction as well as affecting their receptor binding sites. The condition may potentially arise de novo perhaps in genetically susceptible individuals. FM is postulated to be an autoimmune disorder and may include dysfunction of purine nucleotide metabolism and nociception. 581 PMID- 15082085 AU - Staines DR TI - Is Gulf War Syndrome an autoimmune disorder of endogenous neuropeptides, exogenous sandfly maxadilan & molecular mimicry? [GWS/CFS] SO - Med Hypotheses 2004;62(5):658-64. IN - Gold Coast Public Health Unit, 10-12 Young Street, Southport, Qld. 4215, Australia. don_staines@health.qld.gov.au AB - Gulf War Syndrome (GWS) remains a contentious diagnosis with conflicting laboratory investigation and lack of a biologically plausible aetiology. This paper discusses the potential role of maxadilan, a potent sandfly vasoactive peptide, in causing autoimmune responses in susceptible individuals through possible molecular mimicry with pituitary adenylate cyclase activating polypeptide (PACAP) and the PAC1R receptor. Gulf War Syndrome may share some causative pathology with Chronic Fatigue Syndrome (CFS), a disorder characterised by prolonged fatigue and debility mostly associated with post-infection sequelae although ongoing infection is unproven. Immunological aberration associated with an expanding group of vasoactive neuropeptides in the context of molecular mimicry and inappropriate immunological memory has been recently raised as possible cause of CFS. Vasoactive neuropeptides act as hormones, neurotransmitters, immune modulators and neurotrophes. They are readily catalysed to small peptide fragments. They and their binding sites are immunogenic and are known to be associated with a range of autoimmune conditions. Maxadilan, while not sharing substantial sequence homology with PACAP is a known agonist of the PACAP specific receptor (PAC1R) and therefore emulates these functions. Moreover a specific amino acid sequence peptide deletion within maxadilan converts it to a PACAP receptor antagonist raising the possibility of this substance provoking a CFS like response in humans exposed to it. This paper describes a biologically plausible mechanism for the development of a GWS-like chronic fatigue state based on loss of immunological tolerance to the vasoactive neuropeptide PACAP or its receptor following bites of the sandfly Phlebotomus papatasi and injection of the vasodilator peptide maxadilan. Exacerbation of this autoimmune response as a consequence of recent or simultaneous multiple vaccination exposures deserves further investigation. While the possible association between the relatively recently discovered vasoactive neuropeptides and chronic fatigue conditions has only recently been reported in the literature, this paper explores links for further research into GWS and CFS. 582 PMID- 15336638 AU - Staud R, Price DD, Robinson ME, Vierck CJ Jr TI - Body pain area & pain-related negative affect predict clinical pain intensity in pts w FM. SO - J Pain 2004 Aug;5(6):338-43. IN - D o Med, McKnight Brain Inst, U o Florida, Gainesville, Florida, USA. AB - Patients with fibromyalgia (FM) report widespread chronic musculoskeletal pain. Palpation of 9 paired tender points (TPs) is commonly used for the diagnosis of FM according to criteria specified by the American College of Rheumatology. Although TP palpation can be used to assess deep tissue hypersensitivity, it has failed as a reliable indicator of clinical pain intensity in FM. The sum of local areas of pain (SLAP) obtained from a body pain diagram represents a relevant measure of the spatial extent of clinical pain, a feature most likely important for FM pain. Because spatial summation of pain can be an important determinant of clinical pain intensity, we hypothesized that this measure would predict clinical pain intensity in FM patients. Because pain is strongly associated with negative emotions, we evaluated the relationship of pain-related negative affect (PRNA) with clinical pain intensity in FM. The independent contributions of SLAP, PRNA, and TP count to the variance of clinical pain intensity were assessed in 280 FM patients. Clinical pain intensity of 280 FM patients was measured by using a visual analogue scale. FM patients shaded all painful body areas on body pain diagrams. Dolorimetry was used for TP evaluations. PRNA was assessed with the Medical College of Virginia Pain Questionnaire. Hierarchical linear regression was used to test the association of SLAP, TPs, and PRNA with clinical pain intensity. FM patients' mean visual analogue scale rating (0 to 100) of usual clinical pain was 50.1. Mean SLAP, TP count, and PRNA were 11.4, 16.0, and 44.3, respectively. Hierarchical linear regression analysis identified SLAP, TP count, and PRNA as independent predictors of clinical pain that accounted for 45% of the variance in clinical pain intensity ratings in FM patients. Consistent with the literature, TP count predicted only a small part (4%) of this variance. Our statistical model of body pain areas and negative affect predicts a large portion of the variance of pain intensity in FM. This result suggests that the extent of pain areas and negative emotions are uniquely associated with clinical pain intensity in FM. PERSPECTIVE: The number of painful body areas obtained by body pain diagrams is a better predictor of clinical pain intensity than TPs in FM patients. The combination of painful body areas, TP counts, and PRNA predicts 45% of the clinical pain intensity of FM patients. This finding might be useful for clinical evaluations of FM patients. 583 PMID- 14770104 AU - Staud R TI - FM pain: do we know the source? SO - Curr Opin Rheumatol 2004 Mar;16(2):157-63. IN - Division o Rheumatology & Clinical Immunology, U o Florida, Gainesville 32610-0221, USA. staudr@ufl.edu AB - PURPOSE OF REVIEW: Fibromyalgia Syndrome (FMS) is a chronic pain condition of unknown origin. Multiple abnormalities have been described, including peripheral tissue and central nervous system changes. The relation of these mechanisms, however, is likely bidirectional. FMS pain clearly depends on peripheral nociceptive input as well as abnormal central pain processing. This review will focus on the role of peripheral nociceptive input for pain in FMS. RECENT FINDINGS: There is strong evidence for abnormal central pain processing in FMS. Sensitized spinal cord neurons in the dorsal horn are responsible for augmented pain processing of nociceptive signals from the periphery. In addition, glial activation, possibly by cytokines and excitatory amino acids may play a role in the initiation and perpetuation of this sensitized state. SUMMARY: Nociceptive input clearly plays an important role in FMS. Acute or repetitive tissue injury has been associated with FMS pain. Cytokines related to such injuries may be responsible for long-term activation of spinal cord glia and dorsal horn neurons, thus resulting in central sensitization. A better understanding of these important neuro-immune interactions may provide relevant insights into future effective therapies. 584 PMID- 15288410 AU - Staud R, Price DD, Robinson ME, Mauderli AP, Vierck CJ TI - Maintenance of windup of second pain requires less frequent stimulation in FM pts compared to normal controls. SO - Pain 2004 Aug;110(3):689-96. IN - D o Med, McKnight Brain Inst, U o Florida, Gainesville, FL 32610, USA. staudr@ufl.edu AB - Many chronic pain syndromes, including fibromyalgia (FM), show evidence of central nervous system hyperexcitability related to central sensitization. Windup (WU) of second pain reflects increased excitability of spinal cord neurons that is related to central sensitization. Psychophysical testing can help characterize this important central nervous system phenomenon because of the parallels between electrophysiological WU and WU of second pain. Animal experiments have shown that once WU has been established, only low frequency tonic nociceptive input is required to maintain the sensitized state of dorsal horn neurons (WU-maintenance or WU-M). The stimulus frequency necessary to maintain the hyperexcitability of spinal cord neurons can provide a measure of central sensitization. Because central sensitization plays an important role in many chronic pain syndromes including FM, we compared WU-M in 72 normal controls (NC) and 104 FM subjects. WU of second pain was produced by a train of 0.7 s duration thermal pulses applied to the glabrous surface of the hands at a frequency of 0.3 Hz. Enhanced second pain associated with WU could, thereafter, be maintained in FM but not NC subjects for up to 120 s by stimuli delivered at 0.16 and 0.08 Hz (WU-M stimuli). These two frequencies of stimulation do not produce WU when delivered alone. Thus, unlike NC subjects, FM subjects showed enhanced second pain during WU-M stimuli at very low stimulus frequencies, indicating central sensitization. Increased WU sensitivity, enhanced WU-M, and increased WU-related aftersensations help account for persistent pain conditions in FM subjects. In addition to WU, WU-M appears to be a useful tool to study mechanisms of pain in patients with characteristics of central sensitization. 585 PMID- 15251076 AU - Staud R TI - Predictors of clinical pain intensity in pts w FM syndrome. SO - Curr Rheumatol Rep. 2004 Aug;6(4):281-6. 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. 586 PMID- 15363878 AU - Staud R, Vierck CJ, Robinson ME, Price DD TI - Spatial summation of heat pain within & across dermatomes in FM pts & pain-free subjects. SO - Pain 2004 Oct;111(3):342-50. IN - D o Med, McKnight Brain Inst, U o Florida, Coll o Medicine, 1600 SW Archer Road, P.O. Box 100221, Gainesville, FL 32610-0221, USA. staudr@ufl.edu AB - The mechanisms of spatial summation of pain (SSP) include pain coding dependent on impulse frequency and the number of recruited central neurons. However, SSP may also be influenced by pain inhibitory mechanisms, such as diffuse noxious inhibitory controls. Abnormal interactions between pain inhibitory mechanisms and SSP may be relevant for chronic pain conditions such as fibromyalgia (FM) and may help explain why widespread pain is characteristic for this chronic pain syndrome. The present study was designed to determine the difference of thermal SSP in the upper extremities between FM and normal control (NC) subjects, particularly within and across dermatomes of the hand. Fourteen NC and 19 FM subjects were enrolled in this study. SSP testing sessions involved immersion of each individual fingertip as well as stepwise immersion of the fingers, hands, and forearms in a hot water bath (46 degrees Celsius) for 5s and 20s. In addition, immersion of several fingertips across dermatome C(7)-C(8) was compared to progressive immersion of the index finger (dermatome C(7)). These experiments demonstrated significant spatial summation of heat-induced pain in both FM and NC subjects. SSP was most extensive within the fingers, and became negligible as the stimulus area increased above the hand. Furthermore, SSP was more pronounced within one dermatome such as that of the index finger than across several dermatomes of the hand. These results were similar for both FM and NC subjects. Thus, mechanisms of SSP, including possible inhibitory factors that limit this relevant pain mechanism, appear to be similar for both FM and NC subjects. 587 PMID- 15478168 AU - Stein PK, Domitrovich PP, Ambrose K, Lyden A, Fine M, Gracely RH, Clauw DJ TI - Sex effects on heart rate variability in FM & Gulf War illness. SO - Arthritis Rheum 2004 Oct 15;51(5):700-8. IN - Washington U School o Med, St. Louis, MO 63108, USA. pstein@im.wustl.edu AB - OBJECTIVE: To investigate autonomic abnormalities in male and female fibromyalgia (FM) and Gulf War illness (GWI) patients by comparing heart rate variability (HRV) with that of age- and sex-matched healthy controls. METHODS: Subjects included 26 (19 women, 7 men) with FM, 11 (6 men, 5 women) with GWI, and 36 (18 men,18 women) healthy controls. HRV was determined from Holter recordings obtained in the Clinical Research Center. Analysis of variance compared 24-hour, daytime, and nighttime HRV by sex within groups and by group within sex. RESULTS: In women with FM or GWI, HRV was significantly lower than in men with FM or GWI. HRV was similar in male and female controls. When HRV was compared by group within sex, HRV was significantly decreased in women with FM or GWI and no significant differences were seen for men with these conditions. CONCLUSION: Decreased HRV in FM and GWI appears to be sex dependent. Results suggest that different mechanisms may be operative in symptom expression in men and women with this spectrum of illness. 588 PMID- 15490094 AU - Steinau M, Unger ER, Vernon SD, Jones JF, Rajeevan MS TI - Differential-display PCR of peripheral blood for biomarker discovery in CFS. SO - J Mol Med. 2004 Nov;82(11):750-5. Epub 2004 Oct 14. IN - Division o Viral & Rickettsial Diseases, Nat Ctr for Infectious Diseases, Centers for Disease Control & Prevention, 1600 Clifton Rd., MSG-41, Atlanta, GA 30333, USA. AB - We used differential-display PCR of peripheral blood mononuclear cells (PBMCs) to search for candidate biomarkers for chronic fatigue syndrome (CFS). PBMCs were collected from a subject with CFS and an age- and sex-matched control before and 24 h after exercise. RNA expression profiles were generated using 46 primer combinations, and the similarity between the individuals was striking. Differentially expressed bands were excised, reamplified, and sequenced, yielding 95 nonredundant sequences, of which 50 matched to known gene transcripts, 38 matched to genes with unknown functions, and 7 had no similarity to any database entry. Most (86%) of the differences between the two subjects were present at baseline. Differential expression of ten genes was verified by real-time reverse-transcription PCR: five (cystatin F, MHC class II, platelet factor 4, fetal brain expressed sequence tag, and perforin) were downregulated, and the remaining five genes (cathepsin B, DNA polymerase epsilon4, novel EST PBMC191MSt, heparanase precursor, and ORF2/L1 element) were upregulated in the subject with CFS. Many of these genes have known functions in defense and immunity, thus supporting prior suggestions of immune dysregulation in the pathogenesis of CFS. Differential-display PCR is a powerful tool for identification of candidate biomarkers. Investigation of these markers in samples from well-designed epidemiological studies of CFS will be required to determine the validity of these candidate biomarkers. The real-time reverse-transcription PCR assays that we developed for assay of these biomarkers will facilitate high-throughput testing of these additional samples. 589 PMID- 15515412 AU - Stratz T, Fiebich B, Haus U, Muller W TI - Influence of tropisetron on the serum substance P levels in FM pts. SO - Scand J Rheumatol Suppl 2004;(119):41-3. IN - Hochrhein Inst o Rehabilitation Research, D o Clinical Research, Bad Sackingen, Germany. AB - BACKGROUND: Substance P is found at an elevated level in the cerebrospinal fluid of fibromyalgia (FM) patients. Treatment with tropisetron leads in a subgroup of FM patients to pain reduction. The question arises of whether the substance P level in the serum can be changed by tropisetron treatment. METHOD: Twenty patients with FM diagnosed according to the ACR criteria were treated for 5 days with a 5 mg tropisetron intravenous (i.v.) bolus injection daily. Before the first injection, 3 h later, and before and 3 h after the last injection, the serum levels of substance P were determined. The determination of this substance was carried out by means of an immunoassay from Assay Design Biotrend, Cologne. To evaluate the success of the tropisetron treatment, patients made a global assessment as 'clearly better', 'better', 'unchanged', or 'poor'. Patients who answered 'clearly better' and 'better' were regarded as responders. RESULTS: Of the 20 patients, ten reported a good or very good influence on their pain (responders). In these responders, the means of the serum substance P levels were elevated in comparison with the non-responders, though the difference was not significant. In responders, the 5-HT3 receptor antagonist tropisetron produced a significant decrease in the serum substance P levels, while this did not occur in the non-responders. CONCLUSION: It is possible that the responders to tropisetron represent a subgroup of FM patients for whom substance P and 5-HT3 receptors play key roles in the development of the pain symptoms. 590 PMID- 15515417 AU - Stratz T, Muller W TI - Treatment of Systemic Sclerosis w the 5-HT3 receptor antagonist tropisetron. [FM] SO - Scand J Rheumatol Suppl 2004;(119):59-62. IN - Hochrhein Inst o Rehabilitation Research, D o Clinical Research, Bad Sackingen, Germany. AB - BACKGROUND: There is no known disease-modifying therapy for progressive systemic sclerosis. OBJECTIVES: It was shown that a patient with secondary fibromyalgia syndrome for whom the development of systemic sclerosis was suspected because of a Raynaud's phenomenon and the presence of SCL-70 antibodies in the serum had experienced a clear pain reduction under treatment with tropisteron, which is the reason why this drug was also used with established systemic sclerosis. METHOD: Two patients with progressive systemic sclerosis and positive SCL-70 antibodies were treated for 6 weeks with 5 mg tropisetron daily. Both patients had clear skin symptoms, functional impairments of the locomotor system, and a secondary fibromyalgia syndrome. The skin score and joint motion were checked before, during, and after treatment. In addition, the patients filled in the visual analog scale for pain at these times. At the end of the 6 weeks, the patients showed a clear improvement of the skin score and the movability of various joints as well as a clear reduction of pain. The medication was well-tolerated. Constipation developed in the patients; it could be controlled with laxatives. Follow-up questioning of the patients after 3 months showed that their condition had remained stable. CONCLUSION: Two patients with progressive systemic sclerosis showed an improvement of various symptoms under a blockade of the 5-HT3 receptors via tropisetron. The long-lasting effect pointed to immunomodulation. The two cases give cause for clarifying this by means of clinical studies, which should also investigate the question of dosage (possibly 5 mg tropisetron twice daily). 591 PMID- 15353538 AU - Straus SE TI - Pharmacotherapy of CFS: another gallant attempt. SO - [CON: JAMA. 2004 Sep 8;292(10):1195-204. PMID: 15353532]; JAMA 2004 Sep 8;292(10):1234-5. 592 PMID- 15035239 AU - Stuifbergen AK, Harrison TC, Becker H, Carter P TI - Adaptation of a wellness intervention for women w chr disabling conditions. SO - J Holist Nurs 2004 Mar;22(1):12-31. IN - U o Texas, Austin, School o Nursing, USA. AB - Women with chronic disabling conditions live with multiple symptoms that decrease their ability to function in society, and they may be at elevated risk for further morbidity with age. Despite research indicating that health-promoting behaviors decrease the risk for further morbidity, few interventions have been designed to help women with chronic disabling conditions promote their health. The purpose of this article is to present the results of a pilot study of a wellness intervention adapted for use with women with fibromyalgia syndrome (FMS). First, the development of the original wellness intervention for women with multiple sclerosis (MS) will be described. Next, the steps taken to adapt the intervention to the needs of women with FMS will be described. Finally, it wil be argued that commonalities in symptoms and social experiences and the universal need for health-promoting skills make this intervention adaptable to multiple groups of women with chronic disabling conditions. 593 PMID- 15072733 AU - Sverdrup B TI - Use less cosmetics--suffer less from FM? SO - J Womens Health (Larchmt) 2004 Mar;13(2):187-94. IN - D o Rheumatology, Malarsjukhuset, 631-88 Eskilstuna, Sweden. berit.sverdrup@mse.dll.se AB - BACKGROUND: Widespread muscular pain, tenderness, unrefreshing sleep, and fatigue all constitute the fibromyalgia syndrome (FMS), which is often seen in both general and rheumatology practice, primarily in women. The etiology is unknown. The FMS patient usually looks normal. The cardinal finding is the presence of focal areas of hyperalgesia, that is, tender points. My clinical impression was that FMS patients often complained of dry skin. My hypothesis was that overambitious cleaning, resulting in dry skin, and regular use of cosmetics as moisturizers could contribute to their symptoms. METHODS: A prospective, randomized, controlled trial of 48 women with FMS (some of whom had a rheumatic condition) who were regular users of cosmetics was carried out to investigate if a reduced use of cosmetics would reduce the symptoms. The intervention group received special instructions on skin care, with reinforcement when needed. RESULTS: After 2 years, there was significant improvement in pain (p < 0.02), sleep (p < 0.01), and stiffness (p < 0.02), together with better physical function (p < 0.01) and improved wellbeing (p < 0.01) in the experimental group, as measured by the Fibromyalgia Impact Questionnaire (FIQ). CONCLUSIONS: The results should motivate further studies on the possible adverse effects of cosmetic use in FMS and perhaps other conditions. 594 PMID- 14983104 AU - Tang S, Calkins H, Petri M TI - Neurally mediated hypotension in SLE pts w FM. SO - Rheumatology (Oxford) 2004 May;43(5):609-14. Epub 2004 Feb 24. IN - D o Med & Geriatrics, Princess Margaret Hosp, Hong Kong. AB - OBJECTIVE: Fibromyalgia (FM) is a major determinant of poor health status in systemic lupus erythematosus (SLE). FM has been shown to be associated with neurally mediated hypotension (NMH) in the general population, in which effective treatments exist. We explored whether NMH was more common in SLE patients with FM than those without. METHODS: Seventy-six SLE patients (4 male, 72 female; 1 ethnic Indian, 28 African American, 47 Caucasian; mean age 40.2 +/- 9.4 yr) were recruited and their FM status ascertained using American College of Rheumatology (ACR) classification criteria. Patients who were pregnant or deconditioned were excluded. A two-stage tilt-table test was used to detect NMH. All patients completed the SF-36 Heath Status Inventory (SF-36) and the Krupp Fatigue Severity Scale (KFSS) to evaluate their quality of life. Serological markers and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) were recorded. Medications that might interfere with testing were temporarily withheld before the tilt-table test. RESULTS: The prevalence of NMH (first stage) in SLE patients was 47.9%. Seven patients had both NMH and postural orthostatic tachycardia syndrome. Two patients had borderline results with symptoms reproduced but an inadequate drop in systolic blood pressure by definition (a drop of at least 25 mmHg defines an abnormal response). Eighteen (23.7%) SLE patients had FM and 51 (67.1%) had at least one tender point (TP). The frequency of NMH (first or second stage) in SLE with FM was 58.3% compared with 69.4% in SLE without FM (odds ratio 0.62, 95% CI 0.16-2.37). SF-36 and KFSS scores were not significantly different in SLE patients with and without NMH. However, both scores were found to be associated with FM status (P<0.001 and P = 0.014), reflecting poor health status in the FM group. No confounding variable was found to be significantly associated with both NMH and FM. CONCLUSION: NMH is common in SLE patients with a high prevalence rate. The large increase in NMH, a form of autonomic neuropathy, in SLE, has not been explained. However, NMH has no impact on quality of life above that determined by FM, and has no statistically significant association with FM status. Identification of NMH may be important in selected patients with SLE who have chronic fatigue, but NMH cannot explain the increased prevalence of FM in SLE. 595 PMID- 14763638 AU - Taylor RR, Braveman B, Hammel J TI - Developing & evaluating community-based services through participatory action research: 2 case examples. SO - Am J Occup Ther 2004 Jan-Feb;58(1):73-82. IN - D o Occupational Therapy (MC 811), Coll o Applied Health Sc+ AB - +IN: iences, U o Illinois at Chicago, 1919 West Taylor Street, 3rd Floor, Chicago, Illinois 60612-7250, USA. rtaylor@uic.edu Occupational therapy has a strong history of embracing concepts of client empowerment. However there is limited literature in the field on how to achieve empowerment, or on how to extend empowerment to the level of the community and social groups and services within it. This article discusses how concepts and strategies of participatory action research, an extension of empowerment theory, can be used to inform service development and evaluation in occupational therapy. The participatory action research approach is illustrated using two case examples of participatory action research programs for persons with chronic fatigue syndrome and individuals with autoimmune deficiency syndrome (AIDS). A critical analysis of the application of this approach to research and practice is provided. Finally, the paper identifies key principles of participatory action research that can be used to guide occupational therapy services and empower both individuals and communities. 596 PMID- 14763634 AU - Taylor RR TI - Quality of life & Sx severity for individuals w CFS: findings from a randomized clinical trial. SO - Am J Occup Ther 2004 Jan-Feb;58(1):35-43. IN - U o Illinois at Chicago, D o Occupational Therapy (MC 811),+ AB - +IN: Coll o Applied Health Sciences, 1919 West Taylor Street, 3rd Floor, Chicago, Illinois 60612-7250, USA. rtaylor@uic.edu OBJECTIVE: Chronic fatigue syndrome is a profoundly disabling condition characterized by severe, unrelenting fatigue and a number of other physical and cognitive symptoms. Currently, there is no cure or widely accepted treatment for chronic fatigue syndrome, and few rehabilitation programs exist to address quality of life issues in chronic fatigue syndrome. In the present randomized clinical trial, the effects of an integrative, consumer-driven rehabilitation program on quality of life and symptom severity for individuals with chronic fatigue syndrome were examined. METHOD: Forty-seven participants were randomly assigned to either an immediate program group (n = 23) or a delayed program control group (n = 24) and assessed with the Chronic Fatigue Syndrome Symptom Rating Scale and the Quality of Life Index before the program, after program participants completed the group phase, and after program participants completed the one-on-one phase. It was hypothesized that the program would lead to improvements in quality of life and an overall reduction in symptom severity. RESULTS: Linear growth models were estimated comparing program and control conditions over time using random-effects regression analyses. Significant condition by time interactions were observed for the main outcomes of symptom severity and overall quality of life. Effect sizes for these interactions involving symptom severity (Cohen's d = 0.71) and overall quality of life (Cohen's d = .66) were moderate. CONCLUSIONS: Findings indicate that consumer driven programs such as this one can have a positive impact on symptom severity and quality of life over time for individuals with chronic fatigue syndrome. 597 PMID- 15251034 AU - ter Borg PC, van Os E, van den Broek WW, Hansen BE, van Buuren HR TI - Fluvoxamine for fatigue in primary biliary cirrhosis & primary sclerosing cholangitis: a randomised controlled trial [ISRCTN88246634]. [FM] SO - BMC Gastroenterol. 2004 Jul 13;4:13. IN - D o Gastroenterology & Hepatology, Erasmus MC, Dr, Molewaterplein 40, Rotterdam, The Netherlands. pterborg@zonnet.nl AB - BACKGROUND: Fatigue is a major clinical problem in many patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). An effective treatment has not been defined. Recently, a large proportion of patients with these diseases was found to have symptoms of depression. Because fatigue is a frequent symptom of depression and there is some evidence that treatment with an antidepressant improves fatigue in patients with fibromyalgia, we hypothesised that the antidepressant fluvoxamine might improve fatigue related to PBC and PSC. METHODS: Fatigued patients were randomised to receive fluvoxamine (75 mg BID) or placebo for a six-week period. Fatigue and quality of life were quantified using a visual analogue scale, the Fisk Fatigue Severity Scale, the Multidimensional Fatigue Inventory and the SF-36. RESULTS: Seventeen and 16 patients were allocated to fluvoxamine and placebo, respectively. There was no statistically significant beneficial effect of fluvoxamine on fatigue or quality of life. The median VAS scores in the fluvoxamine and placebo groups were 7.40 and 7.45 at day 0, 6.9 and 7.15 at day 14, 7.45 and 7.65 at day 42 and 7.8 and 8.0 four weeks after treatment discontinuation. CONCLUSION: We found no evidence for a beneficial effect of fluvoxamine on fatigue in these patients with cholestatic liver disease and severe chronic fatigue. 598 PMID- 15564347 AU - Thieme K, Turk DC, Flor H TI - Comorbid depression & anxiety in FM syndrome: relationship to somatic & psychosocial variables. SO - Psychosom Med. 2004 Nov-Dec;66(6):837-44. IN - D o Anesthesiology at the U o Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195-6540, USA. thiemek@u.washington.edu AB - OBJECTIVE: The prevalence as well as predictors of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] axis I and II) in patients with fibromyalgia syndrome (FMS) was evaluated.METHOD: One-hundred fifteen patients with FMS participated in the Structured Clinical Interview for DSM-IV to assess current mental disorders. In addition, patients completed standardized questionnaires regarding pain, pain impact, anxiety, depression, posttraumatic stress disorder-like symptoms, and sexual and physical abuse. RESULTS: Patients were grouped into one of three psychosocial subgroups based on responses to the Multidimensional Pain Inventory (MPI)-Dysfunctional (DYS), Interpersonally Distressed (ID), and Adaptive Copers (AC). Axis I diagnoses were present in 74.8% of the participants overall with the DYS subgroup mainly reporting anxiety and the ID group mood disorders. The AC group showed little comorbidity. Axis II diagnoses were present in only 8.7% of the FMS sample.CONCLUSION: These results suggest that FMS is not a homogeneous diagnosis, but shows varying proportions of comorbid anxiety and depression dependent on psychosocial characteristics of the patients. The results demonstrate the importance of not treating patients with FMS as a homogeneous group. Assessment should not only examine the presence of widespread pain and the number of tender points, but also the presence of affective distress. Treatment should focus both on physical and emotional dysfunction. 599 PMID- 15324981 AU - Thorne SE, Harris SR, Mahoney K, Con A, McGuinness L TI - The context of health care communication in chr illness. [FM] SO - Patient Educ Couns 2004 Sep;54(3):299-306. IN - U o British Columbia School o Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. thorne@nursing.ubc.ca AB - Patient-professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct "disease worlds" among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions. 600 PMID- 15554427 AU - Tillmann HL TI - Hepatitis C virus infection & the brain. [CFS] SO - Metab Brain Dis 2004 Dec;19(3-4):351-6. IN - Medizinische Klinik und Poliklinik II, U Leipzig, Philipp-Rosenthal Str. 27, 04103 Leipzig, Germany. hans.tillmann@medizin.uni-leipzig.de AB - While HCV was initially believed to uniformly cause liver inflammation with the consequence of liver cirrhosis in most of the infected patients, prospective studies have shown a much lower than expected rate of cirrhosis in patients infected for more than 20 years. However, a new problem associated with hepatitis C virus infection is emerging. This is the development of sometimes disabling fatigue. While many other viruses of the flaviviridae cause encephalitis, the most closely related virus to HCV in humans, the GB Virus C seems not to be associated with fatigue. Thus the mechanism for the development of fatigue in HCV infection seems specific for HCV. Delineating the mechanism will be a first step to develop treatment option for this currently untreatable impairment. 601 PMID- 14872449 AU - Tofferi JK, Jackson JL, O'Malley PG TI - Treatment of FM w cyclobenzaprine: A meta-analysis. SO - Arthritis Rheum 2004 Feb 15;51(1):9-13. IN - Walter Reed Army Med Ctr, Washington, DC, USA. AB - OBJECTIVE: To systematically review the effectiveness of cyclobenzaprine in the treatment of fibromyalgia. METHODS: Articles describing randomized, placebo-controlled trials of cyclobenzaprine in people with fibromyalgia were obtained from Medline, EMBase, Psyclit, the Cochrane Library, and Federal Research in Progress Database. Unpublished literature and bibliographies were also reviewed. Outcomes, including global improvement, treatment effects on pain, fatigue, sleep, and tender points over time, were abstracted. RESULTS: Five randomized, placebo-controlled trials were identified. The odds ratio for global improvement with therapy was 3.0 (95% confidence interval [95% CI] 1.6-5.6) with a pooled risk difference of 0.21 (95% CI 0.09-0.34), which calculates to 4.8 (95% CI 3.0-11) individuals needing treatment for 1 patient to experience symptom improvement. Pain improved early on, but there was no improvement in fatigue or tender points at any time. CONCLUSION: Cyclobenzaprine-treated patients were 3 times as likely to report overall improvement and to report moderate reductions in individual symptoms, particularly sleep. 602 PMID- 15515420 AU - Tolk J, Kohnen R, Muller W TI - Intravenous Rx of FM w the 5-HT3 receptor antagonist tropisetron in a rheumatological practice. SO - Scand J Rheumatol Suppl 2004;(119):72-5. IN - Rheumatology practice, Kiel, Germany. JochenTolk@aol.com AB - In 223 fibromyalgia (FM) patients in a rheumatology practice, a follow-up postal survey was carried out 0.5-2 years after a 5-day intravenous (i.v.) treatment with 5 mg of the 5-HT3 receptor antagonist tropisetron daily on the effect of this treatment. 121 patients returned the completed questionnaire. After subtraction of 22 undeliverable questionnaires, this represented 60.2% of patients contacted for whom an assessment of the tropisetron treatment was possible. A good to very good effect of the treatment on the pain was reported by 45% of the patients, and only 25% reported an unsatisfactory effect. The effect of tropisetron IV lasted between one day and 12 weeks (mean 8.6 +/- 13.6 d). Sleep and general condition were also assessed as good or very good by almost half of the patients. The tolerance of tropisetron was generally good. In comparison with the current treatment and the best treatment with other drugs ever received, tropisetron was rated as more efficacious in almost half of the cases, though an unsatisfactory effect of tropisetron compared to other treatments was reported in 30% of the cases. Considered in comparison to less or at most equally efficacious alternatives, according to this open respective study, IV tropisetron treatment represents a promising option for the treatment of FM even though the study design incorporated many imponderables. Particularly the question of whether the success of treatment can be improved further with a longer lasting treatment or a selection of the patients still needs to be settled. 603 PMID- 14759641 AU - Tomassini V, Pozzilli C, Onesti E, Pasqualetti P, Marinelli F, Pisani A, Fieschi C TI - Comparison of the effects of acetyl L-carnitine & amantadine for the Rx of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial. [MS/CF] SO - J Neurol Sci 2004 Mar 15;218(1-2):103-8. IN - D o Neurological Sciences, U o Rome "La Sapienza", viale dell' Universita 30, Rome 00185, Italy. AB - Treatment with acetyl L-carnitine (ALCAR) has been shown to improve fatigue in patients with chronic fatigue syndrome, but there have been no trials on the effect of ALCAR for treating fatigue in multiple sclerosis (MS). To compare the efficacy of ALCAR with that of amantadine, one of the drugs most widely used to treat MS-related fatigue, 36 MS patients presenting fatigue were enrolled in a randomised, double-blind, crossover study. Patients were treated for 3 months with either amantadine (100 mg twice daily) or ALCAR (1 g twice daily). After a 3-month washout period, they crossed over to the alternative treatment for 3 months. Patients were rated at baseline and every 3 months according to the Fatigue Severity Scale (FSS), the primary endpoint of the study. Secondary outcome variables were: Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI) and Social Experience Checklist (SEC). Six patients withdrew from the study because of adverse reactions (five on amantadine and one on ALCAR). Statistical analysis showed significant effects of ALCAR compared with amantadine for the Fatigue Severity Scale (p = 0.039). There were no significant effects for any of the secondary outcome variables. The results of this study show that ALCAR is better tolerated and more effective than amantadine for the treatment of MS-related fatigue. 604 PMID- 15554358 AU - Torpy DJ, Bachmann AW, Gartside M, Grice JE, Harris JM, Clifton P, Easteal S, Jackson RV, Whitworth JA TI - Association between CFS & the corticosteroid-binding globulin gene ALA SER224 polymorphism. SO - Endocr Res. 2004 Aug;30(3):417-29. IN - U o Queensland D o Med, Greenslopes Hosp, Brisbane, Queensland, Australia. dtorpy@mail.rah.sa.gov.au AB - Chronic fatigue syndrome (CFS) is characterized by idiopathic fatigue of greater than 6 months' duration with postexertional exacerbation and many other symptoms. A trend toward relative hypocortisolism is described in CFS. Twin and family studies indicate a substantial genetic etiologic component to CFS. Recently, severe corticosteroid-binding globulin (CBG) gene mutations have been associated with CFS in isolated kindreds. Human leukocyte elastase, an enzyme important in CBG catabolism at inflammatory sites, is reported to be elevated in CFS. We hypothesized that CBG gene polymorphisms may act as a genetic risk factor for CFS. A total of 248 patients with CFS defined by Centers for Disease Control criteria, and 248 controls were recruited. Sequencing and restriction enzyme testing of the CBG gene coding region allowed detection of severe CBG gene mutations and a common exon 3 polymorphism (c.825G-->T, Ala-Ser224). Plasma CBG levels were measured in 125 CFS patients and 198 controls by radioimmunoassay. Total and free (calculated and measured) cortisol levels were ascertained in single samples between 8-10 a.m. The age of onset (mid 30s) and gender ratio (2.2:1, female:male) of the patients were similar to those reported in U.S. epidemiologic studies. A trend toward a preponderance of serine224 homozygosity among the CFS patients was noted, compared with controls (chi2 = 5.31, P = 0.07). Immunoreactive-CBG (IR-CBG) levels were higher in Serine/Alanine (Ser/Ala) than Ala/Ala subjects and higher again in Ser/Ser subjects, this effect was strongest in controls; Ser/Ser: 46.1+/-1.8 (n = 31, P = 0.03) vs. Ser/Ala: 42.4+/-1.0 (n = 56, P = 0.05) vs. Ala/Ala: 40.8+/-1.7 microg/mL (n = 21). Despite higher CBG levels, there was a nonsignificant trend toward lower total and free plasma cortisol in serine allele positive patients, total cortisol: Ser/Ser: 13.3+/-1.4 (n = 34) vs. Ser/Ala: 14.0+/-0.7 (n = 66) vs. Ala/Ala: 15.4+/-1.0 (n = 23). Homozygosity for the serine allele of the CBG gene may predispose to CFS, perhaps due to an effect on hypothalamic-pituitary-adrenal axis function related to altered CBG-cortisol transport function or immune-cortisol interactions. 605 PMID- 15088993 AU - Tritt K, Nickel M, Mitterlehner F, Nickel C, Forthuber P, Leiberich P, Rother W+ TI - Chronic fatigue & indicators of long-term employment disability in psychosomatic inpts. SO - Wien Klin Wochenschr 2004 Mar 31;116(5-6):182-9. IN - Section o Psychosomatic Med, U Clinic o the U Regensburg, R+ AB - +IN: egensburg, Germany. +AU: , Loew T The major goal of this study was to determine indictors of long-term disability for psychosomatic inpatients with chronic fatigue syndrome. To this end, a cross-sectional study was performed with a random sample of patients (n=1000, response rate: 83.9%) at a psychosomatic inpatient clinic. 51.1% of the patients (n=429) reported intensely persistent exhaustion that had no logical relation to actual exertion. 159 (37.1%) patients in this group were disabled from working and these comprised the main target group of this study. Significantly more patients in the target group worked part time, were disabled for a disproportionately long period of time (50.9% of all were disabled for more than 6 months in the previous year), and felt stressed because of conflicts with their superiors and/or colleagues (in each case, P<0.01). While more frequent psychological comorbidity was not found, they reported physical complaints more often. It was not the patients fit for work who felt more burdened with chronic fatigue, but rather the employment-disabled, who were actually exposed to fewer demands. These patients had, in comparison with those fit to work, a stronger fixation on somatic complaints, inadequate perception of physical and psychic sensations, difficulties getting along with other people and in coping with a regular job (in each case, P<0.01). Prospective examination of these indicators could help detect predictor variables for long-term disability in chronic fatigue. Such predictors could contribute to timely social-medical assessment and treatment. 606 PMID- 15451649 AU - Tryon WW, Jason L, Frankenberry E, Torres-Harding S TI - CFS impairs circadian rhythm of activity level. SO - Physiol Behav 2004 Oct 15;82(5):849-53. IN - D o Psychology, Fordham U, 441 East Fordham Road, Bronx, NY 10458-5198, USA. wtryon@fordham.edu AB - Some of the symptoms of chronic fatigue syndrome (CFS) are the same as for disrupted circadian rhythm. Activity level is frequently used to study circadian rhythm. Continuous waist activity measurements taken every minute 24 h/day for from 5 to 7 days in 10 controls and from 2 to 7 days in 8 patients with CFS yielded two primary findings: (a) lower daytime activity and (b) less regular activity-rest cycles in persons with CFS than in controls. 607 PMID- 15556826 AU - Turk DC, Robinson JP, Burwinkle T TI - Prevalence of fear of pain & activity in pts w FM syndrome. SO - J Pain 2004 Nov;5(9):483-90. IN - D o Anesthesiology, U o Washington, Seattle, Washington 98195, USA. turkdc@u.washington.edu AB - Patients with fibromyalgia syndrome (FMS) report pain, fatigue, emotional distress, activity avoidance, and disability. The role of fear of pain and activity in FMS patients has received only limited attention. FMS patients (N = 233) underwent examinations by a physician, physical therapist, and psychologist and completed measures of fear of pain and activity, disability, depressive mood, impact, and pain. Patients with high levels of fear of pain and activity (38.6%) reported greater disability (t = 4.02, P < .001), depressed mood (t = -4.14, P < .001), pain severity (t = -2.71, P < .01), and lower treadmill performance (t = -2.39, P < .05) than patients with low fear. Patients classified on the Multidimensional Pain Inventory as Dysfunctional reported greater fear than Interpersonally Distressed patients and Adaptive Copers (F = 8.13, P < .001). Only 50% of Dysfunctional patients, however, met the criterion of high fear, whereas 23.4% of Adaptive Copers met this criterion. Demographic factors, perceived disability, and Multidimensional Pain Inventory subgroup significantly predicted fear of pain and activity, accounting for 21.2% of the variance. Fear of pain and activity is prevalent among FMS patients. Treatment should address patient fears, because it might reduce disability and rates of nonadherence and attrition from outcome studies. PERSPECTIVE: Fear of movement is a significant concern for chronic pain sufferers because these behaviors maintain pain and increase disability. This study examined the role of fear in FMS, including associations between fear of pain/movement, pain severity, depressed mood, physical performance, and disability in FMS subgroups. 608 PMID- 14716715 AU - Turkington D, Hedwat D, Rider I, Young AH TI - Recovery from CFS w modafinil. SO - Hum Psychopharmacol 2004 Jan;19(1):63-4. IN - Royal Victoria Infirmary, Newcastle upon Tyne, UK. 609 PMID- 15164953 AU - Tuzun EH, Albayrak G, Eker L, Sozay S, Daskapan A TI - A comparison study of quality of life in women w FM & myofascial pain syndrome. SO - Disabil Rehabil 2004 Feb 18;26(4):198-202. IN - D o Physical Therapy & Rehabilitation, Faculty o Health Sci+ AB - +IN: ences, Baskent U, Baglica, Ankara, Turkey. htuzun@baskent.edu.tr PURPOSE: To compare the quality of life scores of fibromyalgia patients with myofascial pain syndrome patients. METHOD: Thirty-three fibromyalgia patients, 33 myofascial pain syndrome patients, and 33 age-matched controls completed Beck Depression Inventory and Short Form-36 questionnaires. RESULTS: Compared with myofascial pain syndrome patients, fibromyalgia patients reported significantly more often fatigue, numbness, tingling, gastrointestinal discomfort, and poor sleep. The mean scores on VAS and on Beck Depression Inventory were significantly higher in fibromyalgia patients than myofascial pain syndrome patients. Patients with fibromyalgia had significantly poorer health than the patients with myofascial pain syndrome in pain, general health, vitality, and role emotional subscales. CONCLUSIONS: The quality of life profile of fibromyalgia patients is quite different from those in the myosfascial pain syndrome group. Myofascial pain syndrome impacted mostly on physical health whereas fibromyalgia impacted on both physical and mental health. 610 PMID- 15096280 AU - Unger ER, Nisenbaum R, Moldofsky H, Cesta A, Sammut C, Reyes M, Reeves WC TI - Sleep assessment in a population-based study of CFS. SO - BMC Neurol 2004 Apr 19;4(1):6. IN - Division o Viral & Rickettsial Diseases, Nat Ctr for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia, USA. eru0@cdc.gov AB - BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling condition that affects approximately 800,000 adult Americans. The pathophysiology remains unknown and there are no diagnostic markers or characteristic physical signs or laboratory abnormalities. Most CFS patients complain of unrefreshing sleep and many of the postulated etiologies of CFS affect sleep. Conversely, many sleep disorders present similarly to CFS. Few studies characterizing sleep in unselected CFS subjects have been published and none have been performed in cases identified from population-based studies. METHODS: The study included 339 subjects (mean age 45.8 years, 77% female, 94.1% white) identified through telephone screen in a previously described population-based study of CFS in Wichita, Kansas. They completed questionnaires to assess fatigue and wellness and 2 self-administered sleep questionnaires. Scores for five of the six sleep factors (insomnia/hypersomnia, non-restorative sleep, excessive daytime somnolence, sleep apnea, and restlessness) in the Centre for Sleep and Chronobiology's Sleep Assessment Questionnaire (SAQ) were dichotomized based on threshold. The Epworth Sleepiness Scale score was used as a continuous variable. RESULTS: 81.4% of subjects had an abnormality in at least one SAQ sleep factor. Subjects with sleep factor abnormalities had significantly lower wellness scores but statistically unchanged fatigue severity scores compared to those without SAQ abnormality. CFS subjects had significantly increased risk of abnormal scores in the non-restorative (adjusted odds ratio [OR] = 28.1; 95% confidence interval [CI]= 7.4-107.0) and restlessness (OR = 16.0; 95% CI = 4.2-61.6) SAQ factors compared to non-fatigued, but not for factors of sleep apnea or excessive daytime somnolence. This is consistent with studies finding that, while fatigued, CFS subjects are not sleepy. A strong correlation (0.78) of Epworth score was found only for the excessive daytime somnolence factor. CONCLUSIONS: SAQ factors describe sleep abnormalities associated with CFS and provide more information than the Epworth score. Validation of these promising results will require formal polysomnographic sleep studies. 611 PMID- 14870911 AU - Valencia-Flores M, Cardiel MH, Santiago V, Resendiz M, Castano VA, Negrete O, R+ TI - Prevalence & factors associated w FM in Mexican pts w SLE. SO - Lupus 2004;13(1):4-10. IN - Departamento de Neurologia y Psiquiatra, Instituto Nacional+ AB - +IN: de Ciencias Medicas y Nutricion Salvador Zubiran, Delegacion Tlalpan, Mexico 14000, DF, Mexico. valflor@servidor.unam.mx +AU: osenberg C, Garcia-Ramos G, Alcocer J, Alarcon-Segovia D In total, 189 consecutive women diagnosed with SLE were evaluated using the ACR 1990 criteria for fibromyalgia. Patients were classified into three subgroups. The fibromyalgia group (FM) included patients experiencing pain on palpation in at least 11 of the 18 tender points examined, as well as having a history of widespread pain for at least three months. Patients who were noted to have pain in fewer than four quadrants with less than 11 of 18 tender points were considered to have regional pain (RP). All patients who did not meet criteria for either FM or RP were classified as having no pain (NP). Measurement of SLE disease activity, sleep complaints, depression, fatigue severity and health status were performed. Only 18 of the SLE patients (9.5%) (95% CI 5.3-14%) fulfilled the ACR criteria for the classification of FM. Of the patients, 106 (56.1%) fulfilled criteria for RP and had a number of tender points of 5.4 +/- 3.4, and the rest of the patients (34.4%) had no tenderness at specific tender point sites. Age, body mass index, educational level and disease duration were comparable between the groups. FM and RP groups had different patterns of symptoms prevalence, with dysmenorrhea being more distinctive for FM. Sleep disturbances were more severe in the FM than in the RP group. Daytime complaints such as sleepiness, fatigue and depression were similar for RP and FM groups, but patients with FM reported more disability. Fibromyalgia is not common in Mexican patients with SLE and has a different pattern of symptoms in RP and NP patients. These data add evidence that ethnicity can play an important role in FM manifestations. 612 PMID- 13130154 AU - Valkeinen H, Alen M, Hannonen P, Hakkinen A, Airaksinen O, Hakkinen K TI - Changes in knee extension & flexion force, EMG & functional capacity during strength training in older females w FM & healthy controls. SO - Rheumatology (Oxford) 2004 Feb;43(2):225-8. Epub 2003 Sep 16. IN - D o Health Sciences, U o Jyvaskla, Jyvaskla, Finland. hevalkei@sport.jyu.fi AB - OBJECTIVE: To investigate the effects of strength training on neuromuscular functions in elderly females with fibromyalgia (FM). METHODS: Thirteen females with fibromyalgia [group FMt; mean age (s.d.) 60.2 (2.5) years] and 11 healthy controls [group HCt; 64.2 (2.7) yr] carried out supervised strength training twice a week for 21 weeks. Thirteen FM patients [group FMc; 59.1 (3.5) yr] served as non-training controls. Maximal isometric force and electromyographic (EMG) activity of the right quadriceps femoris in knee extension and flexion actions, maximal 10-m walking speed, and 10-step stair-climbing time were measured. Tender points were assessed by palpation, subjectively perceived symptoms with a visual analogue scale, and the self-reported physical function capacity by Health Assessment Questionnaire (HAQ). RESULTS: The mean (s.d.) increases in maximal extension force during the training period in groups FMt and in HCt were 32 (33)% (P < 0.001) and 24 (12)% (P < 0.001) respectively and those of flexion were 13 (20)% (P < 0.05) and 24 (17)% (P < 0.01). Explosive force of the extensors increased in both FMt and in HCt. The integrated EMGs of the vastus lateralis and medialis muscles increased in both FMt and HCt. Muscle forces and EMGs in group FMc remained at the basal level. Walking speed, stair-climbing time and the HAQ index improved in group FMt. The changes in the number of tender points and in perceived symptoms were in favour of the training group FMt. CONCLUSIONS: The data support the hypothesis that elderly female FM patients have normal neuromuscular function. Supervised strength training also suits elderly FM patients, has positive effects on perceived symptoms and improves functional capacity without complications. 613 PMID- 15292624 AU - Van Houdenhove B, Egle UT TI - FM: a stress disorder? Piecing the biopsychosocial puzzle together. SO - Psychother Psychosom 2004 Sep-Oct;73(5):267-75. IN - Faculty o Med, K.U.Leuven, Leuven, Belgium. boudewijn.vanhoudenhove@uz.kuleuven.ac.be AB - Fibromyalgia (FM) is a controversial syndrome, characterised by persistent widespread pain, abnormal pain sensitivity and additional symptoms such as fatigue and sleep disturbance. The syndrome largely overlaps with other functional somatic disorders, particularly chronic fatigue syndrome (CFS). Although the exact aetiology and pathogenesis of FM are still unknown, it has been suggested that stress may play a key role in the syndrome. This article first reviews the function of the stress response system, placing special emphasis on the relationships between adverse life experiences, stress regulation and pain-processing mechanisms, and summarising the evidence for a possible aetiopathogenetic role of stress in FM. Finally, an integrative biopsychosocial model that conceptualizes FM as a stress disorder is proposed, and the clinical and research implications of the model are discussed. 614 PMID- 15570657 AU - Varni JW, Burwinkle TM, Szer IS TI - The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability & validity. [CF] SO - J Rheumatol 2004 Dec;31(12):2494-500. IN - D o Landscape Architecture & Urban Planning, Coll o Architecture, Texas A&M U, 3137 TAMU, Coll Station, TX 77843-3137, USA. jvarni@archone.tamu.edu AB - OBJECTIVE:. The PedsQL (Pediatric Quality of Life Inventory) is a modular instrument designed to measure health related quality of life (HRQOL) in children and adolescents ages 2-18 years. The recently developed 18-item PedsQL Multidimensional Fatigue Scale was designed to measure fatigue in pediatric patients and comprises the General Fatigue Scale (6 items), Sleep/Rest Fatigue Scale (6 items), and Cognitive Fatigue Scale (6 items). The PedsQL 4.0 Generic Core Scales were developed as the generic core measure to be integrated with the PedsQL Disease-Specific Modules. The PedsQL 3.0 Rheumatology Module was designed to measure pediatric rheumatology-specific HRQOL. Methods. The PedsQL Multidimensional Fatigue Scale, Generic Core Scales, and Rheumatology Module were administered to 163 children and 154 parents (183 families accrued overall) recruited from a pediatric rheumatology clinic. Results. Internal consistency reliability for the PedsQL Multidimensional Fatigue Scale Total Score (a = 0.95 child, 0.95 parent report), General Fatigue Scale (a = 0.93 child, 0.92 parent), Sleep/Rest Fatigue Scale (a = 0.88 child, 0.90 parent), and Cognitive Fatigue Scale (a = 0.93 child, 0.96 parent) were excellent for group and individual comparisons. The validity of the PedsQL Multidimensional Fatigue Scale was confirmed through hypothesized intercorrelations with dimensions of generic and rheumatology-specific HRQOL. The PedsQL Multidimensional Fatigue Scale distinguished between healthy children and children with rheumatic diseases as a group, and was associated with greater disease severity. Children with fibromyalgia manifested greater fatigue than children with other rheumatic diseases. CONCLUSION: The results confirm the initial reliability and validity of the PedsQL Multidimensional Fatigue Scale in pediatric rheumatology. 615 PMID- 15016578 AU - Vermeulen RC, Scholte HR TI - CFS & sexual dysfunction. SO - J Psychosom Res 2004 Feb;56(2):199-201. IN - CFS Research Centre Amsterdam, Waalstraat 25-31, 1078 BR Amsterdam, The Netherlands. rcwvermeulen@cfscentrumamsterdam.nl AB - OBJECTIVE: The study was undertaken to determine if ambulant female patients with the chronic fatigue syndrome (CFS) report problems with their sexual functioning. METHODS: We studied 35 female CFS patients and 36 healthy female controls. The severity of CFS was measured with a fatigue questionnaire and the presence and severity of sexual dysfunction with a questionnaire about sexual functioning. RESULTS: The mean fatigue score was 24.8 in the CFS patients and 11.9 in the controls (P=.000). No increase in sexual dysfunction was found in the CFS group. The control group showed negative correlations between the score of the fatigue questionnaire and the frequency of "sexual fantasies," "(desire for) sexual contact" and "satisfaction with sex life." Such correlations were absent in the CFS group. CONCLUSION: The satisfaction with sex life was similar in patients and controls. The results suggest that patients and controls have a different perception of fatigue. 616 PMID- 15039515 AU - Vermeulen RC, Scholte HR TI - Exploratory open label, randomized study of acetyl- & propionylcarnitine in CFS. SO - Psychosom Med 2004 Mar-Apr;66(2):276-82. IN - Research Ctr Amsterdam, Amsterdam, Netherlands. info@cfscentrumamsterdam.nl AB - OBJECTIVES: We compared the effects of acetylcarnitine, propionylcarnitine and both compounds on the symptoms of chronic fatigue syndrome (CFS). METHODS: In an open, randomized fashion we compared 2 g/d acetyl-L-carnitine, 2 g/d propionyl-L-carnitine, and its combination in 3 groups of 30 CFS patients during 24 weeks. Effects were rated by clinical global impression of change. Secondary endpoints were the Multidimensional Fatigue Inventory, McGill Pain Questionnaire, and the Stroop attention concentration test. Scores were assessed 8 weeks before treatment; at randomization; after 8, 16, and 24 weeks of treatment; and 2 weeks later. RESULTS: Clinical global impression of change after treatment showed considerable improvement in 59% of the patients in the acetylcarnitine group and 63% in the propionylcarnitine group, but less in the acetylcarnitine plus propionylcarnitine group (37%). Acetylcarnitine significantly improved mental fatigue (p =.015) and propionylcarnitine improved general fatigue (p =.004). Attention concentration improved in all groups, whereas pain complaints did not decrease in any group. Two weeks after treatment, worsening of fatigue was experienced by 52%, 50%, and 37% in the acetylcarnitine, propionylcarnitine, and combined group, respectively. In the acetylcarnitine group, but not in the other groups, the changes in plasma carnitine levels correlated with clinical improvement. CONCLUSIONS: Acetylcarnitine and propionylcarnitine showed beneficial effect on fatigue and attention concentration. Less improvement was found by the combined treatment. Acetylcarnitine had main effect on mental fatigue and propionylcarnitine on general fatigue. 617 PMID- 15469945 AU - Viner R, Hotopf M TI - Childhood predictors of self reported CFS/ME in adults: national birth cohort study. SO - BMJ 2004 Oct 23;329(7472):941. Epub 2004 Oct 6. IN - D o Paediatrics, Royal Free & U Coll MS, Middlesex Hosp, London W1T 3AA. R.Viner@ich.ucl.ac.uk AB - OBJECTIVE: To study childhood risk factors for chronic fatigue syndrome in adult life. DESIGN: Examination of data from the 1970 British birth cohort. PARTICIPANTS: 16,567 babies born 5-11 April 1970, followed up at 5, 10, 16, and 29-30 years. MAIN OUTCOME MEASURES: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) identified by self report at age 30 years. Data from childhood from questionnaires given to parents and teachers. Maternal mental health assessed with the malaise inventory. RESULTS: 93 (0.8%, 95% confidence interval 0.7 to 1.0) of 11 261 participants reported ever having CFS/ME, and 48 (0.4%, 0.3 to 0.6) had the condition currently. Higher risk of CFS/ME was associated with having a limiting longstanding condition in childhood (odds ratio 2.3, 1.4 to 3.9), female sex (2.3, 1.4 to 2.6), and high social class in childhood (2.2, 1.4 to 3.5). Higher levels of exercise in childhood were associated with lower risk (0.5, 0.2 to 0.9). Maternal psychological disorder, psychological problems in childhood, birth weight, birth order, atopy, obesity, school absence, academic ability, and parental illness were not associated with risk of CFS/ME. CONCLUSIONS: We identified no association between maternal or child psychological distress, academic ability, parental illness, atopy, or birth order and increasing risk of lifetime CFS/ME. Sedentary behaviour increased the risk. 618 PMID- 15210489 AU - Viner R, Gregorowski A, Wine C, Bladen M, Fisher D, Miller M, El Neil S TI - Outpatient rehabilitative Rx of CFS (CFS/ME). SO - Arch Dis Child 2004 Jul;89(7):615-9. IN - D o Adolescent Med, Great Ormond Street Hosp for Children & U Coll London Hospitals, London, UK. R.Viner@ich.ucl.ac.uk AB - AIMS: To assess the outcome of outpatient multidisciplinary rehabilitative treatment (graded activities/exercise programme, family sessions, and supportive care) compared with supportive care alone for children and adolescents with chronic fatigue syndrome (CFS/ME). METHODS: Fifty six young people (aged 9-17 years) with CFS/ME by standard criteria were followed up for 3-24 months. All subjects received supportive care. Families additionally opted to either enter the rehabilitation programme (supportive care plus graded activities/exercise programme and family sessions) or have no additional treatment. RESULTS: Twenty two (39%) subjects had supportive care alone and 26 (46%) entered the programme. Treatment groups were comparable at baseline in terms of age, severity and duration of illness, Wellness score, and school attendance. At end of follow up, those in the programme group had significantly higher Wellness score and school attendance than those having supportive care alone. The programme significantly reduced the overall severity of illness: after the programme, 43% had complete resolution of CFS/ME compared to only 4.5% of those having supportive care alone. The presence of depressed mood and family beliefs about the aetiology of CFS/ME were not significantly associated with outcomes. CONCLUSIONS: Outpatient rehabilitative treatment offers significant potential to improve the prognosis of CFS/ME in childhood and adolescence. 619 PMID- 15378666 AU - Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG TI - A double-blind placebo-controlled trial of milnacipran in the Rx of FM. SO - Hum Psychopharmacol 2004 Oct;19 Suppl 1:S27-35. IN - Cypress Bioscience, San Diego, CA 9212, USA. ovitton@cypressbio.com AB - Fibromyalgia syndrome is a systemic disorder of widespread pain which is thought to result from abnormal pain processing within the central nervous system. There are no currently approved treatments for this indication. Antidepressants appear, however, to be effective, especially those with an action on noradrenergic neurotransmission. The objective of the present study was to test the efficacy of the dual action noradrenaline and serotonin reuptake inhibitor antidepressant, milnacipran, in the treatment of fibromyalgia. The 125 patients, who were enrolled in a double-blind, placebo-controlled, flexible dose escalation trial, were randomized to receive placebo or milnacipran for 4 weeks of dose escalation (up to 200 mg/day), followed by 8 weeks at a constant dose. The study evaluated the efficacy and safety of milnacipran for the treatment of pain and associated symptoms such as fatigue, depressed mood and sleep. 75% of milnacipran-treated patients reported overall improvement, compared with 38% in the placebo group (p < 0.01). Furthermore, 37% of twice daily milnacipran-treated patients reported at least 50% reduction in pain intensity, compared with 14% of placebo-treated patients (p < 0.05). 84% of all milnacipran patients escalated to the highest dose (200 mg/day) with no tolerability issues. Most adverse events were mild to moderate in intensity, and transient in duration. These results suggest that milnacipran may have the potential to relieve not only pain but several of the other symptoms associated with fibromyalgia. 620 PMID- 15221876 AU - Vladutiu GD, Natelson BH TI - Association of medically unexplained fatigue w ACE insertion/deletion polymorphism in Gulf War veterans. [CFS/GWS] SO - Muscle Nerve 2004 Jul;30(1):38-43. IN - D o Pediatrics, School o Med & Biomedical Sciences, St U o New York at Buffalo, Buffalo, New York, USA. gdv@buffalo.edu AB - Genes associated with muscle metabolism and physical endurance were evaluated for variants that may contribute to the etiology of medically unexplained severe and chronic fatigue. Subjects included 49 Gulf War veterans and 61 nonveterans with chronic fatigue syndrome (CFS) or idiopathic chronic fatigue (ICF) and 30 veterans and 45 nonveterans who served as healthy controls. Increased risk for CFS/ICF was associated with alterations of the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene within the Gulf War veteran sample only. The I allele frequency was decreased in affected versus unaffected veterans (0.15 versus 0.48; odds ratio [OR], 5.08; 95% confidence interval [CI], 1.97-13.35; P < 0.0001). Correspondingly, the II genotype was decreased fourfold in affected veterans (0.08 versus 0.35; OR = 5.87; 95% CI: 1.21-28.36; P = 0.02), and the DD genotype was increased twofold (0.78 versus 0.39; OR, 5.4; 95% CI, 1.6-18.4; P = 0.007). Veterans with the DD genotype were eight times more likely to develop CFS/ICF than were those with the II genotype (OR, 8.30; 95% CI, 1.50-56.09; P = 0.009). 621 PMID- 15175170 AU - Vojdani A, Thrasher JD TI - Cellular & humoral immune abnormalities in Gulf War veterans. [CFS/GWS] SO - Environ Health Perspect 2004 Jun;112(8):840-6. IN - Section o Neuroimmunology, Immunosciences Lab Inc., 8693 Wilshire Boulevard, Suite 200, Beverly Hills, CA 90211, USA. drari@msn.com AB - We examined 100 symptomatic Gulf War veterans (patients) and 100 controls for immunologic assays. The veterans and controls were compared for the percentage of T cells (CD3); B cells (CD19); helper:suppressor (CD4:CD8) ratio; natural killer (NK) cell activity; mitogenic response to phytohemagglutin (PHA) and pokeweed mitogen (PWM); level of immune complexes; myelin basic protein (MBP) and striated and smooth muscle autoantibodies; and antibodies against Epstein-Barr virus, cytomegalovirus, herpes simplex virus type 1 (HSV-1), HSV-2, human herpes Type 6 (HHV-6), and Varicella zoster virus (VZV). The percentage of T cells in patients versus controls was not significantly different, whereas a significantly higher proportion of patients had elevated T cells compared with controls. The percentage of B cells was significantly elevated in the patients versus the controls. The NK cell (NK) activity was significantly decreased in the patients (24.8 +/- 16.5 lytic units) versus the controls (37.3 +/- 26.4 lytic units). The percentage of patients with lower than normal response to PHA and PWM was significantly different from controls. Immune complexes were significantly increased in the patients (53.1 +/- 18.6, mean +/- SD) versus controls (34.6 +/- 14.3). Autoantibody titers directed against MBP and striated or smooth muscle were significantly greater in patients versus controls. Finally, the patients had significantly greater titers of antibodies to the viruses compared with the controls (p < 0.001). These immune alterations were detected 2-8 years after participation in the Gulf War. The immune alterations are consistent with exposure to different environmental factors. We conclude that Gulf War syndrome is a multifaceted illness with immune function alterations that may be induced by various factors and are probably associated with chronic fatigue syndrome. 622 PMID- 15082811 AU - Vos R, Willems D, Houtepen R TI - Coordinating the norms & values of medical research, medical practice & patient worlds-the ethics of evidence based medicine in orphaned fields of medicine. [CFS] SO - J Med Ethics 2004 Apr;30(2):166-70. IN - Health Ethics & Philosophy, D o Health Care Studies, U o Maastricht, Maastricht, The Netherlands. Rein.Vos@ZW.unimaas.nl AB - Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. 623 PMID- 15361320 AU - Wallace DJ, Hallegua DS TI - FM: the gastrointestinal link. SO - Curr Pain Headache Rep 2004 Oct;8(5):364-8. IN - Cedars-Sinai/UCLA School o Med, 8737 Beverly Blvd., Suite 203, Los Angeles, CA 90048, USA. dwallace@ucla.edu AB - Patients with fibromyalgia (FM) frequently have gastrointestinal symptoms and signs. This article critically reviews the available literature and concludes the following: evidence that inflammatory bowel disease is associated with FM is contradictory, but should be looked for in patients taking concomitant steroids; patients diagnosed with celiac disease often have a history of FM or irritable bowel syndrome (IBS) that may or may not be present; reflux, nonulcer dyspepsia, and noncardiac chest pain are common in FM patients; medications used to manage pain, inflammation, and gastrointestinal complaints confound the management of FM; and IBS affects smooth muscles and the parasympathetic nervous system, while FM patients have complaints of striated muscles and dysfunction of the sympathetic nervous system. Of those patients with FM, 30% to 70% have concurrent IBS. Small intestinal bacterial overgrowth is associated with hyperalgesia and IBS-like complaints, is common in FM, and responds transiently to antimicrobial therapy. 624 PMID- 15595287 AU - Wallman KE, Morton AR, Goodman C, Grove R TI - Physiological responses during a submaximal cycle test in CFS. SO - Med Sci Sports Exerc 2004 Oct;36(10):1682-8. IN - School o Human Movement & Exercise Science, The U o Western Australia, Crawely, Western Australia, Australia. kwallman@cyllene.uwa.edu.au AB - INTRODUCTION/PURPOSE: Numerous studies have assessed physical function in individuals suffering from chronic fatigue syndrome (CFS) but neglected to match control subjects according to current activity levels, consequently casting doubt on reported results. The purpose of this study was to include current activity levels as one criterion for matching CFS subjects with healthy control subjects in order to more accurately assess physical function in these subjects. METHODS: Thirty-one healthy control subjects were matched to CFS subjects according to age, gender, body mass, height, and current activity levels. Physiological function was assessed weekly over a 4-wk period using a submaximal cycle test. RESULTS: Comparison of absolute physiological results recorded at the end of each incremental work level of the exercise test showed that ratings of perceived effort (RPE) was the only variable that was significantly different between the two groups. Scores for RPE were significantly higher in CFS subjects for each incremental work level assessed. Conversely, results recorded on completion of the exercise test showed that the control group was capable of a greater power output than the CFS group as reflected by significantly higher scores for watts per kilogram (P < 0.0005), net lactate production (P = 0.003), oxygen uptake (mL x kg(-1) x min(-1); P < 0.0005), respiratory exchange ratio (P = 0.021), and HR values as a percentage of age predicted HR(max) (P = 0.001). End-point RPE scores were again significantly higher in the CFS group (P < 0.0005). CONCLUSION: It is proposed that the reduced exercise tolerance in CFS is due to impairment in the mechanisms that constitute effort sense and/or to avoidance behaviors that result in a reluctance by these subject to exercise to full capacity. 625 PMID- 15115421 AU - Wallman KE, Morton AR, Goodman C, Grove R, Guilfoyle AM TI - Randomised controlled trial of graded exercise in CFS. SO - Med J Aust 2004 May 3;180(9):444-8. IN - School o Human Movement & Exercise Science, U o Western Australia, Stirling Highway, Nedlands, WA 6009, Australia. kwallman@cyllene.uwa.edu.au AB - OBJECTIVE: To investigate whether 12 weeks of graded exercise with pacing would improve specific physiological, psychological and cognitive functions in people with chronic fatigue syndrome (CFS). DESIGN: Randomised controlled trial. SETTING: Human performance laboratory at the University of Western Australia. PARTICIPANTS: 61 patients aged between 16 and 74 years diagnosed with CFS. INTERVENTIONS: Either graded exercise with pacing (32 patients) or relaxation/flexibility therapy (29 patients) performed twice a day over 12 weeks. MAIN OUTCOME MEASURES: Changes in any of the physiological, psychological or cognitive variables assessed. RESULTS: Following the graded exercise intervention, scores were improved for resting systolic blood pressure (P = 0.018), work capacity (W.kg(-1)) (P = 0.019), net blood lactate production (P = 0.036), depression (P = 0.027) and performance on a modified Stroop Colour Word test (P = 0.029). Rating of perceived exertion scores, associated with an exercise test, was lower after graded exercise (P = 0.013). No such changes were observed in the relaxation/flexibility condition, which served as an attention-placebo control. CONCLUSIONS: Graded exercise was associated with improvements in physical work capacity, as well as in specific psychological and cognitive variables. Improvements may be associated with the abandonment of avoidance behaviours. 626 PMID- 14964570 AU - Watanabe A TI - Various clinical types of Q-fever disease. SO - Intern Med. 2004 Jan;43(1):49-54. PMID: 14964579; Intern Me+ AB - +SO: d 2004 Jan;43(1):1-2. 627 PMID- 15453557 AU - Watson NF, Jacobsen C, Goldberg J, Kapur V, Buchwald D TI - Subjective & objective sleepiness in monozygotic twins discordant for CFS. SO - Sleep 2004 Aug 1;27(5):973-7. IN - D o Neurology, U o Washington, Seattle 98104-2499, USA. nwatson@u.washington.edu AB - STUDY OBJECTIVE: To examine the association of chronic fatigue syndrome (CFS) with measures of objective and subjective sleepiness. DESIGN: Monozygotic co-twin control study. SETTING: Academic medical center. PATIENTS AND PARTICIPANTS: Twenty monozygotic twin pairs discordant for CFS. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: All twins completed an Epworth Sleepiness Scale (ESS), 4 Stanford Sleepiness Scales (SSS), and underwent a standard 4-nap multiple sleep latency test. We compared the ESS scores, average SSS scores, and average sleep latency in CFS and healthy twins. The CFS twins reported more sleepiness as measured by mean scores on the ESS (10.9 vs 8.2; 95% confidence interval [CI] = 0.3-5.5; P = .03) and the SSS (3.4 versus 2.1; 95% CI = 0.7-1.9; P < .001). The mean sleep latency on the Multiple Sleep Latency Test was not significantly different between the CFS and healthy twins (8.9 vs 10.0 minutes; 95% CI -4.4-1.7; P = .33). Mean SSS scores increased among the CFS twins and decreased among healthy twins from nap 1 to nap 4 (P < .001). The individual ESS scores and mean sleep latencies on the Multiple Sleep Latency Test were negatively correlated for all the twins (Pearson's r = - 0.40; P = .01), with a slightly stronger association among the healthy twins (Pearson's r = -0.42, P = .07) than the CFS twins (Pearson's r = -0.36, P = .15). CONCLUSIONS: CFS twins reported significantly more subjective sleepiness than their healthy co-twins despite similar nonpathologic mean sleep latencies on the Multiple Sleep Latency Test. Patients with CFS may mistake their chronic disabling fatigue for sleepiness. 628 PMID- 15016577 AU - Weatherley-Jones E, Nicholl JP, Thomas KJ, Parry GJ, McKendrick MW, Green ST, Stanley PJ, Lynch SP TI - A randomised, controlled, triple-blind trial of the efficacy of homeopathic Rx for CFS. SO - J Psychosom Res 2004 Feb;56(2):189-97. IN - Medical Care Research Unit, School o Health & Related Research, U o Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. e.weatherley-jones@sheffield.ac.uk AB - OBJECTIVE: There is no management regime for chronic fatigue syndrome (CFS) that has been found to be universally beneficial and no treatment can be considered a "cure". Patients with CFS may use complementary and alternative medicine (CAM). Our aim was to evaluate homeopathic treatment in reducing subjective symptoms of CFS. METHOD: Using a triple-blind design (patient and homeopath blind to group assignment and data analyst blind to group until after initial analyses to reduce the possibility of bias due to data analyst), we randomly assigned patients to homeopathic medicine or identical placebo. One hundred and three patients meeting the Oxford criteria for CFS were recruited from two specialist hospital out patient departments. Patients had monthly consultations with a professional homeopath for 6 months. Main outcome measures were scores on the subscales of the Multidimensional Fatigue Inventory (MFI) and proportions of each group attaining clinically significant improvements on each subscale. Secondary outcome measures were the Fatigue Impact Scale (FIS) and the Functional Limitations Profile (FLP). Ninety-two patients completed treatment in the trial (47 homeopathic treatment, 45 placebo). Eighty-six patients returned fully or partially completed posttreatment outcome measures (41 homeopathic treatment group who completed treatment, 2 homeopathic treatment group who did not complete treatment, 38 placebo group who completed treatment, and 5 placebo group who did not complete treatment). RESULTS: Seventeen of 103 patients withdrew from treatment or were lost to follow-up. Patients in the homeopathic medicine group showed significantly more improvement on the MFI general fatigue subscale (one of the primary outcome measures) and the FLP physical subscale but not on other subscales. Although group differences were not statistically significant on four out of the five MFI subscales (the primary outcome measures), more people in the homeopathic medicine group showed clinically significant improvement. More people in the homeopathic medicine group showed clinical improvement on all primary outcomes (relative risk=2.75, P=.09). CONCLUSIONS: There is weak but equivocal evidence that the effects of homeopathic medicine are superior to placebo. Results also suggest that there may be nonspecific benefits from the homeopathic consultation. Further studies are needed to determine whether these differences hold in larger samples. 629 PMID- 15371077 AU - Wentz KA, Lindberg C, Hallberg LR TI - Psychological functioning in women w FM: a grounded theory study. SO - Health Care Women Int 2004 Sep;25(8):702-29. IN - Pain Clinic o Sahlgrenska U Hosp, Molndal, Sweden. kerstin.wentz@psy.gu.se AB - The aim of this study was to elucidate psychological functioning and psychological processes in women with fibromyalgia. Twenty-one females with fibromyalgia (aged 26-72 years) were interviewed in-depth. The interviews were analysed in line with grounded theory. A core concept, "unprotected self," mirroring childhood conditions and adult psychological functioning, was identified. Intense activity or hypomanic helpfulness often was used as self-regulation in adult life. Later an increased exposure to mental load is accompanied by reduction of cognitive functioning and generalised pain. The phase of persistence of fibromyalgia is marked by reduction of cognitive functions, unprotected psychological functioning, and increased mental load as from crisis and somatic symptoms. 630 PMID- 15259835 AU - White PD, Thomas JM, Sullivan PF, Buchwald D TI - The nosology of sub-acute & CFSs that follow infectious mononucleosis. SO - Psychol Med 2004 Apr;34(3):499-507. IN - D o Psychological Medicine, Barts, London & Queen Mary Scho+ AB - +IN: ol o Med & Dentistry, U o London. p.d.white@qmul.ac.uk BACKGROUND: A previous principal components analysis of symptoms occurring after infectious mononucleosis suggested that a discrete fatigue syndrome occurs, which is independent of psychiatric disorder. This work has not been replicated and no latent class analysis of subjects has been published. METHOD: We prospectively examined a cohort of 150 American primary care patients 2 and 6 months after the onset of corroborated infectious mononucleosis. A subset of 50 subjects was studied 4 years after onset. We performed principal components analyses of both psychological and somatic symptoms and latent class analyses of subjects. RESULTS: Principal components analyses consistently delineated two fatigue factors at 2 and 6 months and one fatigue factor at 4 years. These factors were separate from a mixed anxiety and depressive factor. A four-class solution for the latent class analyses consisted of most subjects with few symptoms, a few with many symptoms, a group with predominantly mood symptoms and some subjects with fatigue symptoms. CONCLUSIONS: The symptoms of the principal factors with fatigue were similar to those previously described. Both the factors and classes were independent of an equally delineated mood factor and class. These results support the existence of two discrete chronic fatigue syndromes after infectious mononucleosis, one of which is still demonstrable 4 years after onset. 631 PMID- 15009354 AU - Whitehead L TI - Enhancing the quality of hermeneutic research: decision trail. [CFS] SO - J Adv Nurs 2004 Mar;45(5):512-8. IN - D o Nursing & Midwifery, U o Stirling, Stirling, UK. lisa.whitehead@stir.ac.uk AB - BACKGROUND: Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research. AIM: This paper discusses the development of trustworthiness in hermeneutic phenomenological research. DISCUSSION: Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study. CONCLUSION: The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny. 632 PMID- 15157711 AU - Whiteside A, Hansen S, Chaudhuri A TI - Exercise lowers pain threshold in CFS. SO - Pain 2004 Jun;109(3):497-9. IN - Departments o Clinical Physics, Inst o Neurological Sciences, South Glasgow U Hospitals NHS Trust, Glasgow, UK. AB - Post-exertional muscle pain is an important reason for disability in patients who are diagnosed to have Chronic Fatigue Syndrome (CFS). We compared changes in pain threshold in five CFS patients with five age and sex matched controls following graded exercise. Pain thresholds, measured in the skin web between thumb and index finger, increased in control subjects with exercise while it decreased in the CFS subjects. Increased perception of pain and/or fatigue after exercise may be indicative of a dysfunction of the central anti-nociceptive mechanism in CFS patients. 633 PMID- 15322442 AU - Williams DA, Gendreau M, Hufford MR, Groner K, Gracely RH, Clauw DJ TI - Pain assessment in pts w FM syndrome: a consideration of methods for clinical trials. SO - Clin J Pain 2004 Sep-Oct;20(5):348-56. IN - D o Med, Div o Rheumatology, U o Michigan, Ann Arbor 48106, USA. daveawms@umich.edu AB - OBJECTIVE: This study was designed to compare 3 commonly used methodologies for assessing clinical pain during trials involving patients diagnosed with fibromyalgia syndrome. Baseline characteristics, characteristics over time, and compliance were evaluated for each of the methods. METHODS: Fourteen patients diagnosed with fibromyalgia syndrome were asked to monitor their symptoms of pain using 3 different strategies over a 12-week period: 1) real-time pain reports were collected on an electronic diary using randomly-scheduled audible prompts; 2) end-of-week reports asked patients to rate their mean pain over the past week on the electronic diary; and 3) monthly in-clinic reports asked patients to rate their mean pain for the week using a traditional paper and pencil diary. RESULTS: Significantly different baseline values were obtained for the 3 methods. Paper and pencil produced the highest values, and real-time pain reports produced the lowest baseline values. Pain ratings were more likely to reflect decreases in the 2 methods relying on recall than the real-time strategy. The average adherence with pain monitoring using the electronic diary was 85%, which was superior to the adherence for the recall measures completed during the clinic visits. CONCLUSION: Pain assessment methods relying on recall might contribute to an apparent improvement in clinical trials in the absence of an intervention; such an effect has been considered a "placebo response." Future clinical trials might consider using a real-time approach to pain assessment, which in this study appeared to mitigate against seeing improvement in the absence of an intervention and demonstrated higher levels of patient adherence. 634 PMID- 15016575 AU - Winkler AS, Blair D, Marsden JT, Peters TJ, Wessely S, Cleare AJ TI - Autonomic function & serum erythropoietin levels in CFS. SO - J Psychosom Res 2004 Feb;56(2):179-83. IN - D o Med, Div o Psychological Medicine, GKT School o Medicine, Inst o Psychiatry, De Crespigny Park, London SE5 9RJ, UK. AB - OBJECTIVE: Given previous findings, we wished to investigate whether there was evidence of autonomic dysfunction in patients with chronic fatigue syndrome, and whether this could be related to reduced erythropoietin levels and altered red blood cell indices. METHODS: We assessed autonomic function and analysed blood parameters (including erythropoietin) in 22 patients with chronic fatigue syndrome who were medication-free and without comorbid depression or anxiety. Results were compared to 23 iron-deficiency anaemia patients and 18 healthy individuals. RESULTS: Autonomic testing in patients with chronic fatigue syndrome yielded a significantly greater increase in heart rate together with a more pronounced systolic blood pressure fall on standing compared to healthy individuals. Heart rate beat-to-beat variation on deep breathing and responses to the Valsalva manoeuvre were normal. Two of 22 patients with chronic fatigue had mild normochromic normocytic anaemia with normal ferritin, vitamin B12 and folate levels. Serum erythropoietin levels were within reference range. CONCLUSION: Some autonomic dysfunction is present in chronic fatigue syndrome (CFS) patients; the explanation remains uncertain, but could relate to cardiovascular deconditioning. There were no major haematological, biochemical or immunological abnormalities in these patients. 635 PMID- 15196898 AU - Woldehiwet Z TI - Q fever (coxiellosis): epidemiology & pathogenesis. [CFS] SO - Res Vet Sci 2004 Oct;77(2):93-100. IN - D o Veterinary Pathology, U o Liverpool, Veterinary Teaching Hosp, Leahurst, Neston, Wirral CH64 7TE, UK. zerai@liverpool.ac.uk AB - Q fever is a widespread zoonosis caused by the Gram-negative bacterium Coxiella burnetii. Aborting domestic ruminants are the main sources of human infection but the reservoir of infection is extremely wide. In humans, Q fever may occur as acute pneumonia, hepatitis or flu-like illness or may take a severe chronic form, characterized by endocarditis, chronic hepatitis and chronic fatigue syndrome. In animals, the main clinical manifestation is late abortion. Infection with C. burnetii can be diagnosed using cultural, serological and genetic methods but because the organism is potentially dangerous and requires specialized skills only specialist laboratories are capable of undertaking diagnostic tests. This paper provides a brief overview of the epidemiology and pathogenesis of Q fever (coxiellosis). 636 PMID- 14760808 AU - Wolfe F, Michaud K, Burke TA, Zhao SZ TI - Longer use of COX-2-specific inhibitors compared to nonspecific nonsteroidal antiinflammatory drugs: a longitudinal study of 3639 pts in community practice. [FM] SO - J Rheumatol 2004 Feb;31(2):355-8. IN - National Data Bank for Rheumatic Diseases-Arthritis Research Ctr Foundation, Wichita, Kansas 67214, USA. fwolfe@arthritis-research.org AB - OBJECTIVE: To compare COX-2-specific inhibitor therapy with conventional nonspecific nonsteroidal antiinflammatory drugs (NS NSAID), and investigate the effect of demographic and disease factors on NSAID duration of use. METHODS: A total of 3639 patients with rheumatoid arthritis (RA), osteoarthritis, and fibromyalgia starting therapy of celecoxib, rofecoxib, naproxen, or ibuprofen were surveyed at 6-month intervals for up to 2.5 years. Detailed demographic and disease severity variables were also measured. Time to discontinuation, discontinuation rates, and effect of covariates were determined by Weibull parametric survival analyses, controlling for a wide variety of demographic and disease severity factors. RESULTS: The median duration of use for celecoxib, rofecoxib, naproxen, and ibuprofen was 15, 13, 10, and 10 months, respectively. Duration of use of celecoxib and rofecoxib, as measured by survival times, was significantly longer than those of naproxen and ibuprofen. The celecoxib survival time was significantly longer than the rofecoxib survival time (p = 0.005). Disease severity was not associated with survival times, but survival was related to younger age and male sex. In addition, ulcer diagnosis was a strong predictor of early termination. After adjustment for severity, survival times for RA and non-RA patients were the same. CONCLUSION: COX-2-specific inhibitors have a longer duration of use than NS NSAID. Among the COX-2-specific inhibitors, celecoxib has a longer survival time than rofecoxib. In addition, COX-2-specific inhibitors also have longer survival times than noted in the literature of NS NSAID in RA community practice. Duration of use can be an indicator of treatment effectiveness and/or drug acceptability, and provides additional interpretation beyond the results of clinical trials. 637 PMID- 15088293 AU - Wolfe F, Michaud K TI - Severe RA (RA), worse outcomes, comorbid illness, & sociodemographic disadvantage characterize ra pts w FM. SO - J Rheumatol 2004 Apr;31(4):695-700. IN - National Data Bank for Rheumatic Diseases, Arthritis Research Ctr Foundation, U o Kansas School o Med, Wichita, Kansas 67214, USA. fwolfe@arthritis-research.org AB - OBJECTIVE: Fibromyalgia (FM) is a controversial construct. Recently suggested survey criteria identify persons with FM characteristics without physical examination or clinical diagnosis, thereby obviating many of the objections to FM. Little is known about FM among patients with rheumatoid arthritis (RAF). We used the survey definition to characterize persons with RAF and to obtain insight into possible pathogenic mechanisms. METHODS: A total of 11,866 patients with RA completed the Regional Pain Scale (RPS) and a 0-10 visual analog scale (VAS) for fatigue. FM was diagnosed in patients with an RPS score > or = 8 and a VAS fatigue score > or = 6. RESULTS: Altogether 1731 (17.1%) patients with RA fulfilled the criteria. Fewer RAF patients were married (64.9% vs 69.8%) and more were divorced (14.8% vs 10.4%); fewer were college graduates (19.7% vs 28.1%) and more did not finish high school (15.0% vs 8.9%). We found 35.8% of patients with FM but only 21.5% of those without FM had incomes less than 185% of the US poverty guidelines. Patients with RAF had higher validated hospitalization rates for major comorbid conditions and received treatment for comorbid conditions more often (expressed as odds ratios and 95% confidence interval): hypertension (1.5, 1.4-1.7), cardiovascular (1.8, 1.6-2.0), diabetes (1.9, 1.6-2.3), and depression (2.7, 1.8-4.2). RAF were 3.3 (3.0-3.7) times more likely to have been work-disabled (54.5% vs 26.4%) or to have total joint replacement (14.0% vs 11.2%; OR 1.3, 1.1-1.5), and incurred greater direct 6-month medical costs (6477 vs 4687 US dollars). RAF patients had more severe symptoms across all scales, including the Health Assessment Questionnaire (1.8 vs 1.0), pain (6.7 vs 3.4), Medical Outcomes Study Short Form-36 (SF-36) physical component score (23.5 vs 33.5), SF-36 mental component score (29.5 vs 46.1), and quality of life assessed by EuroQol mapped utilities (0.33 vs 0.65). CONCLUSION: FM exists in a substantial number of patients with RA (17.1%), who have more severe RA by subjective and objective measures, greater medical costs, worse outcomes, more comorbidities, sociodemographic disadvantage, and substantially worse quality of life. We hypothesize that illness severity and sociodemographic disadvantage both play a role in producing the clinical picture of FM. 638 PMID- 14975515 AU - Wood PB TI - Stress & dopamine: implications for the pathophysiology of chr widespread pain. [FM] SO - Med Hypotheses 2004;62(3):420-4. IN - D o Family Med, LSU Health Science Ctr - Shreveport, 1501 Kings Highway Shreveport, LA 71103, USA. pwood@lsuhsc.edu AB - Fibromyalgia has been called a "stress-related disorder" due to the onset and exacerbation of symptoms in the context of stressful events. Evidence suggests that inhibition of tonic pain is mediated by activation of mesolimbic dopamine neurons, arising from the cell bodies of the ventral tegmental area and projecting to the nucleus accumbens. This pain-suppression system is activated by acute stress, via the release of endogenous opioids and substance P within the ventral tegmental area. However, prolonged exposure to unavoidable stress produces both reduction of dopamine output in the nucleus accumbens and development of persistent hyperalgesia. It is proposed that a stress-related reduction of dopaminergic tone within the nucleus accumbens contributes to the development of hyperalgesia in the context of chronic stress and thus plays a role in the pathogenesis of fibromyalgia. A stress-related dysfunction of mesolimbic dopaminergic activity might serve as the basis for other fibromyalgia-associated phenomena as well. 639 PMID- 15016579 AU - Woolley J, Allen R, Wessely S TI - Alcohol use in CFS. SO - J Psychosom Res 2004 Feb;56(2):203-6. IN - Academic D o Psychological Medicine, Guy's, King's & St Thomas's School o Med & Inst o Psychiatry, 103 Denmark Hill, London SE5 8AF, UK. AB - OBJECTIVE: To examine the anecdotal observation that patients with chronic fatigue syndrome develop alcohol intolerance. METHODS: A consecutive case series of 114 patients fulfilling UK criteria for chronic fatigue syndrome referred to a specialist clinic. Self-reported alcohol use pre- and postdiagnosis, fatigue symptoms and comorbidity measures were collected. RESULTS: Two-thirds reduced alcohol intake. The most common reasons were increased tiredness after drinking (67%), increased nausea (33%), exacerbated hangovers (23%) and sleep disturbance (24%). One-third of the subjects also stopped drinking because "it seemed sensible." Some had been advised to avoid alcohol, but the majority (66%) did so on the basis of personal experience. CONCLUSION: Our data supports the anecdotal belief that chronic fatigue syndrome patients reduce or cease alcohol intake. This is associated with greater impairment in employment, leisure and social domains of function, and may hint at psycho-pathophysiological processes in common with other conditions that result in alcohol intolerance. 640 PMID- 15570154 AU - Yamamoto S, Ouchi Y, Onoe H, Yoshikawa E, Tsukada H, Takahashi H, Iwase M, Yamaguti K, Kuratsune H, Watanabe Y TI - Reduction of serotonin transporters of pts w CFS. SO - Neuroreport. 2004 Dec 3;15(17):2571-4. IN - D o Physiology, Osaka City U Graduate School o Med, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. AB - To assess the involvement of serotonin in the symptoms of chronic fatigue syndrome, we investigated the serotonergic neurotransmitter system of chronic fatigue syndrome patients by the positron emission tomography (PET). Here we show that the density of serotonin transporters (5-HTTs) in the brain, as determined by using a radiotracer, [C](+)McN5652, was significantly reduced in the rostral subdivision of the anterior cingulate as compared with that in normal volunteers. This subdivision is different from that in the dorsal anterior cingulate in which binding potential values of individual patient showed a weak negative correlation with self-reported pain score of the patients. Therefore, an alteration of serotonergic system in the rostral anterior cingulate plays a key role in pathophysiology of chronic fatigue syndrome. 641 PMID- 15174219 AU - Yildiz S, Kiralp MZ, Akin A, Keskin I, Ay H, Dursun H, Cimsit M TI - A new Rx modality for FM syndrome: hyperbaric oxygen therapy. SO - J Int Med Res 2004 May-Jun;32(3):263-7. IN - GATA Haydarpasa Military Hosp, Istanbul, Turkey. senolyildi+ AB - +IN: z@hotmail.com Fibromyalgia syndrome (FMS) is characterized by longstanding multifocal pain with generalized allodynia/hyperalgesia. There are several treatment methods but none has been specifically approved for this application. We conducted a randomized controlled study to evaluate the effect of hyperbaric oxygen (HBO) therapy in FMS (HBO group: n = 26; control group: n = 24). Tender points and pain threshold were assessed before, and after the first and fifteenth sessions of therapy. Pain was also scored on a visual analogue scale (VAS). There was a significant reduction in tender points and VAS scores and a significant increase in pain threshold of the HBO group after the first and fifteenth therapy sessions. There was also a significant difference between the HBO and control groups for all parameters except the VAS scores after the first session. We conclude that HBO therapy has an important role in managing FMS. 642 PMID- 15296795 AU - Yoshiuchi K, Quigley KS, Ohashi K, Yamamoto Y, Natelson BH TI - Use of time-frequency analysis to investigate temporal patterns of cardiac autonomic response during head-up tilt in CFS. SO - Auton Neurosci 2004 Jun 30;113(1-2):55-62. IN - D o Neurosciences, U o Med & Dentistry o New Jersey, New Jersey MS, East Orange, NJ 07018, USA. AB - Although a number of studies have reported alterations in cardiac autonomic nervous system function in chronic fatigue syndrome (CFS), the results are not consistent across studies. Reasons for these discrepancies include (1) the use of a heterogeneous patient sample that included those with orthostatic postural tachycardia (POTS), a condition with an autonomic changes, and (2) the use of frequency domain techniques which require a stationary signal and averaging data across relatively long epochs. To deal with these shortcomings, we used the smoothed pseudo-Wigner-Ville transform (SPWVT) to analyze heart rate variability (HRV) and blood pressure variability (BPV) during head-up tilt (HUT) by separating CFS patients into those with and without POTS. SPWVT has the advantage of providing instantaneous information about autonomic function under nonstable physiological conditions. We studied 18 CFS patients without POTS, eight CFS patients with POTS and 25 sedentary healthy controls during supine rest and during the first 10 min after HUT. While we found significant effects of postural change in both groups for all autonomic variables, there were significant group x time interactions between CFS without POTS and controls for only instant center frequency (ICF) within the low frequency region both from HRV (p=0.02) and from BPV (p=0.01). Although the physiological meaning of ICF still remains unknown, the data suggest that even CFS patients without POTS may have a subtle underlying disturbance in autonomic function. 643 PMID- 15570652 AU - Yunus MB, Celiker R, Aldag JC TI - FM in men: comparison of psychological features w women. SO - J Rheumatol 2004 Dec;31(12):2464-7. IN - D o Medicine, U o Illinois Coll o Med at Peoria, One Illinois Drive, Peoria, IL 61605, USA. yunus@uic.edu AB - OBJECTIVE: To describe possible differences in psychological factors in men compared to women with fibromyalgia syndrome (FM). METHODS: Forty men and 160 women with FM were evaluated for anxiety, stress, and depression measured by ordinal scales and validated psychological instruments. Clinical and psychological variables were evaluated by a protocol. RESULTS: Both men and women scored high in the psychological variables measured but the results were not significantly different between them. CONCLUSION: There was no significant difference between men and women with FM in their psychological status. 644 PMID- 15334421 AU - Yunus MB, Young CS, Saeed SA, Mountz JM, Aldag JC TI - Positron emission tomography in pts w FM syndrome & healthy controls. SO - Arthritis Rheum 2004 Aug 15;51(4):513-8. IN - U o Illinois Coll o Med at Peoria, IL 61656, USA. Yunus@uic.edu AB - OBJECTIVE: Abnormal brain findings have previously been described in fibromyalgia syndrome (FMS) by single-photon-emission computed tomography. Our goal was to investigate change in regional cerebral glucose metabolism in people with FMS by positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG). METHODS: Twelve patients with FMS and no comorbid psychiatric diagnosis and 7 healthy pain-free controls were studied with FDG-PET in a blinded manner. Those with a psychiatric diagnosis were excluded. Brain scans were obtained using a PET scanner. Semiquantitative analysis of regional 18F-FDG uptake was performed in both cortical and subcortical brain structures. RESULTS: In the resting state, there were no significant differences in 18F-FDG uptake between patients and controls for all brain structures measured. CONCLUSION: FDG-PET scan findings in FMS were not significantly different from healthy controls. Normal results in our study may be explained by discordance between regional cerebral blood flow and regional cerebral glucose metabolism. 645 PMID- 14735403 AU - Zachrisson O, Colque-Navarro P, Gottfries CG, Regland B, Mollby R TI - Immune modulation w a staphylococcal preparation in FM/CFS: relation between antibody levels & clinical improvement. SO - Eur J Clin Microbiol Infect Dis 2004 Feb;23(2):98-105. Epub 2004 Jan 20. IN - Institute o Clinical Neuroscience, SU/Molndal, 43180 Molndal, Sweden. olof.zachrisson@neuro.gu.se AB - The aims of this study were to evaluate the serological response to treatment with staphylococcal vaccine in fibromyalgia/chronic fatigue syndrome patients and to explore the relationship between serological response and clinical effect. Twenty-eight patients, half of whom served as controls, were recruited from a 6-month randomised trial in which repeated administration of the staphylococcal toxoid vaccine Staphypan Berna (Berna Biotech, Switzerland) was tested against placebo. Antibody status against extracellular toxins/enzymes, cell-wall components, and enterotoxins was evaluated at baseline and at endpoint. The clinical response to treatment was recorded in rating scales. In the group receiving active treatment, significant serological changes were recorded, whereas no significant changes were found in controls. Treatment led to a significantly increased capacity of serum to neutralise alpha-toxin and a significant increase in serum IgG to alpha-toxin and lipase. Furthermore, the increase in these parameters combined paralleled the improvement in clinical outcome. Thus, the greater the serological response, the greater was the clinical effect. In conclusion, this explorative study has shown that repeated administration of the Staphypan Berna vaccine in patients with fibromyalgia/chronic fatigue syndrome causes a serological response to several staphylococcal antigens, particularly to certain extracellular toxins and enzymes. The results further show that this response is related to the clinical outcome of treatment. 646 PMID- 14572929 AU - Zavestoski S, Brown P, McCormick S, Mayer B, D'Ottavi M, Lucove JC TI - Patient activism & the struggle for Dx: Gulf War illnesses & other medically unexplained physical Sx in the US. SO - Soc Sci Med 2004 Jan;58(1):161-75. IN - D o Sociology, U o San Francisco, 2130 Fulton Street, San F+ AB - +IN: rancisco, CA 94117-1080, USA. smzavestoski@usfca.edu We examine Gulf War illnesses--which include the fatigue, joint pain, dermatitis, headaches, memory loss, blurred vision, diarrhea, and other symptoms reported by Gulf War veterans--in relation to other medically unexplained physical symptoms such as multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. Our intent is to examine the diagnosis negotiations involved in these mysterious diseases, by showing the different forms of legitimacy involved in such interactions. Factors involved in diagnostic legitimacy are: diagnostic legitimacy in the medical community, lay acceptance of the diagnosis, uncertainty in looking for causes, and social mobilization. We conclude by noting that research may not be able to find any cause for these diseases/conditions; hence, it may be necessary to embrace medical uncertainty, and also to accept patient experience in order to facilitate diagnosis, treatment, and recovery process. Such a change can alter patients' expectations and taken-for-granted assumptions about medicine, and perhaps in turn reduce the frequency with which dissatisfied individuals form illness groups that mobilize to challenge what they see as an unresponsive medical system. 647 PMID- 15570653 AU - Zih FS, Da Costa D, Fitzcharles MA TI - Is there benefit in referring pts w FM to a specialist clinic? SO - J Rheumatol 2004 Dec;31(12):2468-71. IN - Division o Rheumatology & McGill Pain Centre, D o Med, Montreal General Hosp, McGill U Health Centre, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. AB - OBJECTIVE: To examine the benefit of specialist rheumatology consultation and followup for the first 238 patients referred to a tertiary care fibromyalgia (FM) clinic with emphasis on final diagnosis and outcome. METHODS: A retrospective chart review was performed for the first 238 patients attending a rheumatology subspecialty FM clinic. The main variables of interest were management received at the clinic, final diagnosis, and outcome. RESULTS: The final diagnosis was FM in 68%, and some other condition in the remaining 32%. Specialist contact was identified as useful in 73% of the total patient group, 96 with FM and 74 with non-FM. In the patients with FM who received followup in the clinic, outcome was judged favorable in 54%, whereas 46% showed no change or decline in health status. CONCLUSION: An important value of specialist rheumatology contact for patients with a symptom suggestive of diffuse musculoskeletal pain is to ensure that some other potentially treatable condition is not overlooked, rather than the provision of ongoing care for those with FM. Continued followup in a specialist clinic for patients with a primary diagnosis of FM is of questionable benefit. 648 PMID- 15580980 AU - Zoma A TI - Musculoskeletal involvement in SLE. [FM] SO - Lupus 2004;13(11):851-3. IN - Lanarkshire Centre for Rheumatology, Scotland, UK. a.zoma@ntlworld.com AB - Involvement of the musculoskeletal system is common if not universal in the clinical course of systemic lupus erythematosus (SLE). Joint involvement on the whole does not cause major erosive disease, however, recent developments in musculoskeletal imaging show clearly the presence of significant bony and soft tissue involvement. It might well explain the frequently observed discordance between the clinical signs and the articular symptoms assuming that fibromyalgia has been excluded. The clear demonstration of tendon involvement in SLE by MRI would merit considering tendonitis and tenosynovitis as candidates for inclusion in the diagnostic criteria. 649 PMID- 12849712 AU - Aaron LA, Buchwald D TI - Chronic diffuse musculoskeletal pain, FM & co-morbid unexplained clinical conditions. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):563-74. IN - D o Oral Med, U o Washington, 1959 NE Pacific Street, B316,+ AB - +IN: P.O. Box 356370, Seattle, WA 98195-6370, USA. laaron@u.washington.edu This chapter reviews our current knowledge on the presence of overlapping syndromes in one form of chronic diffuse pain, fibromyalgia. Patients with fibromyalgia often present with signs and symptoms of other unexplained clinical conditions, including chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorders, and multiple chemical sensitivities. The high prevalence, impact on function and opportunities for treatment underscore the need for clinicians and researchers to screen routinely for co-morbid unexplained clinical conditions among persons with fibromyalgia. We, therefore, describe a simple approach to screening for such conditions in accordance with published criteria. Interventions should directly address both fibromyalgia symptoms and co-morbid unexplained clinical conditions, as well as the multiple factors that propagate pain, fatigue and limitations in function. 650 PMID- 12562565 AU - Afari N, Buchwald D TI - CFS: a review. SO - Am J Psychiatry 2003 Feb;160(2):221-36 AB - OBJECTIVE: Chronic fatigue syndrome is an illness characterized by disabling fatigue of at least 6 months, accompanied by several other symptoms. This review summarizes the current state of knowledge about chronic fatigue syndrome. METHOD: The case definition, prevalence, clinical presentation, evaluation, and prognosis of chronic fatigue syndrome are discussed. Research on the pathophysiology and treatment of chronic fatigue syndrome is reviewed. RESULTS: Chronic fatigue syndrome is diagnosed on the basis of symptoms. Patients with chronic fatigue syndrome experience significant functional impairment. Pathophysiological abnormalities exist across many domains, suggesting that chronic fatigue syndrome is a heterogeneous condition of complex and multifactorial etiology. Evidence also is beginning to emerge that chronic fatigue syndrome may be familial. Although chronic fatigue syndrome has significant symptom overlap and comorbidity with psychiatric disorders, several lines of research suggest that the illness may be distinct from psychiatric disorders. Patients' perceptions, attributions, and coping skills, however, may help perpetuate the illness. Treatment for chronic fatigue syndrome is symptom-based and includes pharmacological and behavioral strategies. Cognitive behavior therapy and graded exercise can be effective in treating the fatigue and associated symptoms and disability. CONCLUSIONS: Chronic fatigue syndrome is unlikely to be caused or maintained by a single agent. Findings to date suggest that physiological and psychological factors work together to predispose an individual to the illness and to precipitate and perpetuate the illness. The assessment and treatment of chronic fatigue syndrome should be multidimensional and tailored to the needs of the individual patient. 651 PMID- 14689748 AU - Aktan NM TI - CFS. An overview of current concepts. SO - Adv Nurse Pract 2003 Dec;11(12):64-6. IN - CFS Cooperative Research Ctr, New Jersey MS, Newark, USA. 652 PMID- 12810939 AU - Al-Allaf AW, Mole PA, Paterson CR, Pullar T TI - Bone health in pts w FM. SO - Rheumatology (Oxford) 2003 Oct;42(10):1202-6. Epub 2003 Jun+ IN - U D o Med, Ninewells Hosp & MS, Dundee, UK. AB - +SO: 16. OBJECTIVES: To determine whether women with fibromyalgia are at increased risk of developing osteoporosis or osteomalacia. METHODS: Forty premenopausal women with fibromyalgia and 37 age-matched female controls were studied. Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were measured at the calcaneum and bone mineral density was measured at the forearm and lumbar spine using dual-energy X-ray absorptiometry. Serum calcium, alkaline phosphatase, gamma-glutamyl transferase, 25-hydroxyvitamin D and plasma viscosity were measured in all subjects and parathyroid hormone was measured in subjects recruited in the latter part of the study. RESULTS: Seventeen patients with fibromyalgia syndrome and seven controls had 25-hydroxyvitamin D concentrations <20 nmol/l (P < 0.015) and in three FMS patients serum parathyroid hormone was raised. Bone density in fibromyalgia patients was slightly lower at the mid-distal forearm but comparable to that in controls at other sites. CONCLUSIONS: There is no reason to recommend routine bone densitometry in fibromyalgia patients. However, vitamin D subnutrition is common in these patients and this should be sought. 653 PMID- 12927639 AU - Almeida TF, Roizenblatt S, Benedito-Silva AA, Tufik S TI - The effect of combined therapy (ultrasound & interferential current) on pain & sleep in FM. SO - Pain 2003 Aug;104(3):665-72. IN - D o Psychobiology, Universidade Federal de Sao Paulo, Rua N+ AB - +IN: apoleao de Barros 925, Vila Clementino, 04024-002 Sao Paulo, SP, Brazil. pra.c@terra.com.br Multidisciplinary treatment has proven to be the best therapeutic option to fibromyalgia (FM) and physiotherapy has an important role in this approach. Considering the controversial results of electrotherapy in this condition, the aim of this study was to assess the effects of combined therapy with pulsed ultrasound and interferential current (CTPI) on pain and sleep in FM. Seventeen patients fulfilling FM criteria were divided into two groups, CTPI and SHAM, and submitted to pain and sleep evaluations. Pain was evaluated by body map (BM) of the painful areas; quantification of pain intensity by visual analog scale (VAS); tender point (TP) count and tenderness threshold (TT). Sleep was assessed by inventory and polysomnography (PSG). After 12 sessions of CTPI or SHAM procedure, patients were evaluated by the same initial protocol. After treatment, CTPI group showed, before and after sleep, subjective improvement of pain in terms of number (BM) and intensity (VAS) of painful areas (P<0.001, both); as well as objective improvement, with decrease in TP count and increase in TT (P<0.001, both). Subjective sleep improvements observed after CTPI treatment included decrease in morning fatigue and in non-refreshing sleep complaint (P<0.001, both). Objectively, PSG in this group showed decrease in sleep latency (P<0.001) and in the percentage of stage 1 (P<0.001), increase in the percentage of slow wave sleep (P<0.001) and in sleep cycle count (P<0.001). Decrease in arousal index (P<0.001), number of sleep stage changes (P<0.05) and wake time after sleep onset (P<0.05), were also observed and no difference regarding pain or sleep parameters were verified after SHAM procedure. This study shows that CTPI can be an effective therapeutic approach for pain and sleep manifestations in FM. 654 PMID- 12913184 AU - Amato AA, Griggs RC TI - Unicorns, dragons, polymyositis, & other mythological beasts. SO - Neurology. 2003 Aug 12;61(3):316-21. PMID: 12913190; Neurol+ AB - +SO: ogy. 2003 Aug 12;61(3):384-6. PMID: 12913203; Neurology 2003 Aug 12;61(3):288-9. 655 PMID- 12699429 AU - Amel Kashipaz MR, Swinden D, Todd I, Powell RJ TI - Normal production of inflammatory cytokines in chr fatigue & FM syndromes determined by intracellular cytokine staining in short-term cultured blood + SO - Clin Exp Immunol 2003 May;132(2):360-5. IN - Division o Molecular & Clinical Immunology, School o Clinic+ AB - +TI: mononuclear cells. +IN: al Laboratory Sciences, U o Nottingham, Queen's Med Centre, Nottingham, UK. It has been proposed that cytokines play a role in the pathogenesis of chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS). However, different studies have reported conflicting results using enzyme-linked immunosorbent assay or polymerase chain reaction to detect cytokines in these conditions. In the present study, for the first time, the production of inflammatory [interleukin (IL)-1alpha, IL-6, and TNF-alpha] and anti-inflammatory (IL-10) cytokines by CD14+ and CD14- peripheral blood mononuclear cells (PBMC) from chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) patients and sex- and age-matched normal subjects was investigated at the level of individual cells using the technique of intracellular cytokine staining and flow cytometry. Cultures were carried out in the presence of polymyxin B to inhibit the effect of endotoxins on cytokine production by monocytes. The mean intensity of fluorescence (MIF) and percentage of CD14+ (monocytes) and CD14- (lymphocytes) cytokine-producing mononuclear cells were comparable in patients and controls in either unstimulated or IFN-gamma-stimulated conditions. Our study indicates that dysregulation of cytokine production by circulating monocytes or non-monocytic cells (lymphocytes) is not a dominant factor in the pathogenesis of CFS/FMS. 656 PMID- 14625399 AU - Anyanwu E, Campbell AW, Jones J, Ehiri JE, Akpan AI TI - The neurological significance of abnormal natural killer cell activity in chr toxigenic mold exposures. SO - ScientificWorldJournal 2003 Nov 13;3:1128-37. IN - Neurosciences Research, Cahers Inc., Conroe, TX, USA. ebere+ AB - +IN: anyanwu@msn.com Toxigenic mold activities produce metabolites that are either broad-spectrum antibiotics or mycotoxins that are cytotoxic. Indoor environmental exposure to these toxigenic molds leads to adverse health conditions with the main outcome measure of frequent neuroimmunologic and behavioral consequences. One of the immune system disorders found in patients presenting with toxigenic mold exposure is an abnormal natural killer cell activity. This paper presents an overview of the neurological significance of abnormal natural killer cell (NKC) activity in chronic toxigenic mold exposure. A comprehensive review of the literature was carried out to evaluate and assess the conditions under which the immune system could be dysfunctionally interfered with leading to abnormal NKC activity and the involvement of mycotoxins in these processes. The functions, mechanism, the factors that influence NKC activities, and the roles of mycotoxins in NKCs were cited wherever necessary. The major presentations are headache, general debilitating pains, nose bleeding, fevers with body temperatures up to 40 degrees C (104 degrees F), cough, memory loss, depression, mood swings, sleep disturbances, anxiety, chronic fatigue, vertigo/dizziness, and in some cases, seizures. Although sleep is commonly considered a restorative process that is important for the proper functioning of the immune system, it could be disturbed by mycotoxins. Most likely, mycotoxins exert some rigorous effects on the circadian rhythmic processes resulting in sleep deprivation to which an acute and transient increase in NKC activity is observed. Depression, psychological stress, tissue injuries, malignancies, carcinogenesis, chronic fatigue syndrome, and experimental allergic encephalomyelitis could be induced at very low physiological concentrations by mycotoxin-induced NKC activity. In the light of this review, it is concluded that chronic exposures to toxigenic mold could lead to abnormal NKC activity with a wide range of neurological consequences, some of which were headache, general debilitating pains, fever, cough, memory loss, depression, mood swings, sleep disturbances, anxiety, chronic fatigue, and seizures. 657 PMID- 12802844 AU - Arcari R, Crombie HD TI - Mark Twain & his family's health: Livy Clemens' NA in the gilded age & CFS of today. SO - Conn Med 2003 May;67(5):293-6. IN - D o Community Med & Healthcare, U o Connecticut School o Me+ AB - +IN: dicine, Farmington, USA. Our purpose is to compare and contrast the 19th century diagnosis and disease neurasthenia with the contemporary illness known as Chronic Fatigue Syndrome. The health of Mark Twain's wife, Olivia (Livy) Clemens, will then be discussed and evaluated with respect to these two medical conditions. 658 PMID- 12821018 AU - Asbring P, Narvanen AL TI - Ideal versus reality: physicians perspectives on pts w CFS (CFS) & FM. SO - Soc Sci Med 2003 Aug;57(4):711-20. IN - D o Public Health Sciences, Karolinska Institutet, Norrback+ AB - +IN: a, plan 2/7, 171 76, Stockholm, Sweden. pia.asbring@smd.sll.se Encountering patients with chronic fatigue syndrome (CFS) or fibromyalgia can cause dilemmas for physicians due to the uncertainty inherent in these illnesses. The aim of this study was to investigate: (1). How physicians in a Swedish sample describe and categorize patients with CFS and fibromyalgia; (2). What the character of CFS and fibromyalgia, with regard to diagnosing, treatment and medical knowledge/aetiology, mean to the physicians in encounters with patients; and (3). Which strategies physicians describe that they use in the encounter with these patients. Semi-structured interviews were carried out with 26 physicians, specialists in various fields who all had some experience of either CFS or fibromyalgia. The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients. This may lead to the professional role being questioned. Different strategies are developed to handle the encounters with these patients. The results also illuminate the physician's interpretations of patients in moralising terms. Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status. Scepticism was expressed regarding especially CFS, but also fibromyalgia. Moreover, it is shown how the patients are characterised by the physicians as ambitious, active, illness focused, demanding and medicalising. The patient groups in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases. 659 PMID- 12603367 AU - Ashina M, Stallknecht B, Bendtsen L, Pedersen JF, Schifter S, Galbo H, Olesen J TI - Tender points are not sites of ongoing inflamm. -in vivo evidence in pts w chr tension-type headache. SO - Cephalalgia 2003 Mar;23(2):109-16. IN - D o Neurology & Danish Headache Centre, Glostrup Hosp, U o + AB - +IN: Copenhagen, Denmark. ashina@dadlnet.dk Increased muscle tenderness is the most prominent finding in patients with tension-type headache, and it has recently been shown that muscle blood flow is diminished in response to static exercise in tender points in these patients. Although tenderness has been ascribed to local inflammation and release of inflammatory mediators, the interstitial concentration of inflammatory mediators has not previously been studied in tender muscles of patients with tension-type headache. The aim of the present study was to investigate in vivo concentrations of prostaglandin E2 (PGE2), adenosine 5'-triphosphate (ATP), glutamate, bradykinin and other metabolites in a tender point of patients with chronic tension-type headache, in the resting state as well as in response to static exercise, and to compare findings with measurements in a matched non-tender point of healthy controls. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle and dialysates were collected at rest, 15 and 30 min after start of static exercise (10% of maximal force) and 15 and 30 min after end of exercise. All samples were coded and analysed blindly. There was no difference in resting concentration of any inflammatory mediators or metabolites between tender patients and non-tender controls (P > 0.05). We also found no difference in change in interstitial concentration of ATP, PGE2, glutamate, glucose, pyruvate and urea from baseline to exercise and post-exercise periods between patients and controls (P > 0.05). The present study provides in vivo evidence of normal interstitial levels of inflammatory mediators and metabolites in tender trapezius muscle in patients with chronic tension-type headache during both rest and static exercise. Thus, our data suggest that tender points in these patients are not sites of ongoing inflammation. 660 PMID- 12672203 AU - Assefi NP, Coy TV, Uslan D, Smith WR, Buchwald D TI - Financial, occupational, & personal consequences of disability in pts w CFS & FM compared to other fatiguing conditions. SO - J Rheumatol 2003 Apr;30(4):804-8. IN - D o Med, U o Washington, Seattle, Washington, USA. nassefi@+ AB - +IN: u.washington.edu OBJECTIVE: To examine the nature and degree of self-reported disability in patients with chronic fatigue syndrome (CFS) and its associated conditions, fibromyalgia (FM) and subsyndromal fatigue (CF), compared with a chronically fatiguing but unrelated medical condition (MED). METHODS: Six hundred and thirty patients evaluated at the University of Washington Chronic Fatigue Clinic were sent questionnaires asking them to identify the financial, occupational, and personal consequences of their fatiguing illness. Thorough medical evaluations had previously applied accepted criteria for defining CFS, FM, and CF. RESULTS: The FM groups (those with and without CFS) were among the least employed. Likewise, the FM and CFS groups, more frequently than the other groups, endorsed loss of material possessions (such as car), loss of job, and loss of support by friends and family, as well as recreational activities as a result of their fatiguing illness. There were no reliable differences between groups in use of disability benefits. CONCLUSION: There is substantial illness-related disability among those evaluated at a specialized chronic fatigue clinic. Those reporting the most pervasive disability met criteria for FM either alone or in conjunction with CFS. Employers and personal relations of patients with chronic fatigue should make a greater effort to accommodate the illness-related limitations of these conditions, especially for those with FM and CFS. 661 PMID- 14528526 AU - Astin JA, Berman BM, Bausell B, Lee WL, Hochberg M, Forys KL TI - The efficacy of mindfulness meditation plus Qigong movement therapy in the Rx of FM: a randomized controlled trial. SO - J Rheumatol 2003 Oct;30(10):2257-62. IN - California Pacific Med Ctr Research Inst, 2300 California S+ AB - +IN: treet, Room 207, San Francisco, CA 94115, USA. jastin@cooper.cpmc.org OBJECTIVE: To test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome (FM). METHODS: A total of 128 individuals with FM were randomly assigned to the mind-body training program or an education support group that served as the control. Outcome measures were pain, disability (Fibromyalgia Impact Questionnaire), depression, myalgic score (number and severity of tender points), 6 minute walk time, and coping strategies, which were assessed at baseline and at 8, 16, and 24 weeks. RESULTS: Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Questionnaire, Total Myalgic Score, Pain, and Depression, and no improvement in the number of feet traversed in the 6 minute walk. However, there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group. Salutary changes occurring by the eighth week (which corresponded to the end of the mind-body and education control group sessions) were largely maintained by both groups throughout the 6 month followup period. CONCLUSION: While both groups showed improvement on a number of outcome variables, there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option. Additional randomized controlled trials are needed before interventions of this kind can be recommended for treatment of FM. 662 PMID- 12811674 AU - Ataoglu S, Ozcetin A, Yildiz O, Ataoglu A TI - Evaluation of dexamethasone suppression test in FM pts w or without depression. SO - Swiss Med Wkly 2003 Apr 19;133(15-16):241-4. IN - D o Physical Med & Rehabilitation, Duzce Faculty o Medicine+ AB - +IN: , Abant Izzet Baysal Univerity, Turkey. OBJECTIVE: While in most healthy persons dexamethasone administration suppresses cortisol synthesis from the adrenal cortex, such suppression is not usually observed in patients with depression. We set out to investigate whether the dexamethasone suppression test (DST) reveals any neurobiological relationship between fibromyalgia (FM) and depression related to the hypothalamic-pituitary-adrenal (HPA) axis. METHOD: To discover a relationship between depression and FM we performed the DST in 20 FM patients with depression, 26 FM patients without depression and 20 healthy subjects serving as a control group. RESULTS: Compared with the control group the cortisol level was found to be significantly higher in response to the DST in FM patients with depression (p = 0.03; z: -2.165), but not in those without depression (p = 0.153; z: -1.429). The cortisol level was not found to be statistically significant when patients with FM without depression were compared with the control group (p = 0.249; z: -1.152). In 7 FM patients with depression the DST failed to suppress cortisol; this was statistically significant compared with FM patients without depression (p = 0.014) and the control group(p = 0.008). Among FM patients without depression cortisol was not suppressed in one case. Cortisol was suppressed in all the controls. There was no statistically significant difference in cortisol suppression between FM patients without depression and the control group (p = 1.00). CONCLUSION: Our findings show that the DST reveals no neurobiological relationship between FM and depression related to the HPA axis. 663 PMID- 12571868 AU - Authier FJ, Sauvat S, Champey J, Drogou I, Coquet M, Gherardi RK TI - CFS in pts w macrophagic myofasciitis. SO - Arthritis Rheum 2003 Feb;48(2):569-70. IN - INSERM E 0011, Faculte de Medecine de Creteil-Paris XII, Cr+ AB - +IN: eteil, France. 664 PMID- 12772385 AU - Aylett E, Fawcett TN TI - CFS: the nurse's role. SO - Nurs Stand 2003 May 14-20;17(35):33-7. IN - School o Nursing Studies, U o Edinburgh. lizzie@aylett.co.uk AB - BACKGROUND: Chronic fatigue syndrome (CFS), a disorder of no proven cause, is characterised by extended periods of extreme, debilitating fatigue and related symptoms. This article discusses this distressing disorder and identifies the needs of those who have it. The authors suggest that the nurse could fulfil the role of key professional carer, interacting with the individual with CFS to co-ordinate care and form the pivotal therapeutic relationship. CONCLUSION: CFS remains a chronic illness of uncertain cause and prognosis. For those with CFS, care priorities involve validation, information and advocacy, a therapeutic relationship and co-ordinated care. The particular philosophy of care held by nurses makes them potentially ideal co-ordinators of care for those with CFS. 665 PMID- 12584556 AU - Baschetti R TI - CFS & Addison's disease. SO - J Pediatr 2003 Feb;142(2):217 IN - Retired Med Inspector, Italian St Railways, CP 671, 60001-9+ AB - +IN: 70 Fortaleza (CE), Brazil. 666 PMID- 14636284 AU - Baschetti R TI - CFS: an endocrine disease off limits for endocrinologists? SO - Eur J Clin Invest 2003 Dec;33(12):1029-31. IN - Retired Med Inspector o the Italian St Railways, Fortaleza,+ AB - +IN: Brazil. baschetti@baydenet.com.br Endocrinologists were not included in the multidisciplinary working groups that prepared two recent reports on chronic fatigue syndrome, despite its unequalled clinical overlap with Addison's disease, which is a classic endocrine disorder. The failure to include at least one endocrinologist in those panels may explain why in their extensive reports there is not a single word about the 42 clinical features that chronic fatigue syndrome shares with Addison's disease, including all the signs and symptoms listed in the case definition of this syndrome. 667 PMID- 12753877 AU - Bennett RM, Kamin M, Karim R, Rosenthal N TI - Tramadol & acetaminophen combination tablets in the Rx of FM pain: a double-blind, randomized, placebo-controlled study. SO - AJM 2003 May;114(7):537-45. IN - D o Med, Oregon Health & Science U, Portland 97201, USA. be+ AB - +IN: nnetro@ohsu.edu PURPOSE: To evaluate the efficacy and safety of a combination analgesic tablet (37.5 mg tramadol/325 mg acetaminophen) for the treatment of fibromyalgia pain. METHODS: This 91-day, multicenter, double-blind, randomized, placebo-controlled study compared tramadol/acetaminophen combination tablets with placebo. The primary outcome variable was cumulative time to discontinuation (Kaplan-Meier analysis). Secondary measures at the end of the study included pain, pain relief, total tender points, myalgia, health status, and Fibromyalgia Impact Questionnaire scores. RESULTS: Of the 315 subjects who were enrolled in the study, 313 (294 women [94%], mean [+/- SD] age, 50 +/- 10 years) completed at least one postrandomization efficacy assessment (tramadol/acetaminophen: n = 156; placebo: n = 157). Discontinuation of treatment for any reason was less common in those treated with tramadol/acetaminophen compared with placebo (48% vs. 62%, P = 0.004). Tramadol/acetaminophen-treated subjects also had significantly less pain at the end of the study (53 +/- 32 vs. 65 +/- 29 on a visual analog scale of 0 to 100, P <0.001), and better pain relief (1.7 +/- 1.4 vs. 0.8 +/- 1.3 on a scale of -1 to 4, P <0.001) and Fibromyalgia Impact Questionnaire scores (P = 0.008). Indexes of physical functioning, role-physical, body pain, health transition, and physical component summary all improved significantly in the tramadol/acetaminophen-treated subjects. Discontinuation due to adverse events occurred in 19% (n = 29) of tramadol/acetaminophen-treated subjects and 12% (n = 18) of placebo-treated subjects (P = 0.09). The mean dose of tramadol/acetaminophen was 4.0 +/- 1.8 tablets per day. CONCLUSION: A tramadol/acetaminophen combination tablet was effective for the treatment of fibromyalgia pain without any serious adverse effects. 668 PMID- 12821402 AU - Berglund B, Harju EL TI - Master scaling of perceived intensity of touch, cold & warmth. SO - Eur J Pain 2003;7(4):323-34. IN - Institute o Environmental Med, Karolinska Institutet & D o + AB - +IN: Psychology, Stockholm U, SE-106 91 Stockholm, Sweden. birber@mbox.ki.se A new approach is presented for scaling perceived intensity of touch, cold and warmth based on magnitude estimation. In this method named master scaling thenar is utilized as common reference area for scaling and calibrating perceived intensity. The master scaling is particularly well suited for clinical applications in which the stimulation in pain-affected body areas creates a complex perception (e.g., paradoxical heat for cold stimulation) and/or aberrant psychophysical functions for perceived intensity. The results from three different experiments showed that: (a) All patients and healthy subjects were able to scale adequately the perceived intensity of touch, cold, and warmth at unaffected body areas. (b) Thenar stimulations were shown to be adequate common references in the joint scaling of perceived intensity of other body areas in pain patients as well as healthy persons. (c) Individual thenar psychophysical functions can be used for screening patients and healthy persons with regard to their ability to scale perceived intensity of touch, cold and warmth. (d) Master scaled perceived intensity scales can be used for determining if various pain-unaffected body areas are normal or abnormal in patients and in healthy persons. (e) The interindividual variation in perceived intensity is considerably reduced after master scaling and approaches that of intraindividual variation as found in olfaction and hearing. Finally, empirically based thenar Master Functions of perceived intensity for touch, cold and warmth are proposed to be used in future sensory testing of patients, as well as of healthy persons. 669 PMID- 12829200 AU - Blockmans D, Persoons P, Van Houdenhove B, Lejeune M, Bobbaers H TI - Combination therapy w hydrocortisone & fludrocortisone does not improve Sx in CFS: a randomized, placebo-controlled, double-blind, crossover study. SO - AJM 2003 Jun 15;114(9):736-41. IN - D o General Internal Med, U Hosp Gasthuisberg, Leuven, Belg+ AB - +IN: ium. Daniel.Blackmans@uz.kuleuven.ac.be PURPOSE: Chronic fatigue syndrome has been associated with decreased function of the hypothalamic-pituitary-adrenal axis. Although neurally mediated hypotension occurs more frequently in patients with chronic fatigue syndrome than in controls, attempts to alleviate symptoms by administration of hydrocortisone or fludrocortisone have not been successful. The purpose of this study was to investigate the effect of combination therapy (5 mg/d of hydrocortisone and 50 microg/d of 9-alfa-fludrocortisone) on fatigue and well-being in chronic fatigue syndrome. METHODS: We performed a 6-month, randomized, placebo-controlled, double-blind, crossover study in 100 patients who fulfilled the 1994 Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. Between-group differences (placebo minus treatment) were calculated on a 10-point visual analog scale. RESULTS: Eighty patients completed the 3 months of placebo and 3 months of active treatment in a double-blind fashion. There were no differences between treatment and placebo in patient-reported fatigue (mean difference, 0.1; 95% confidence interval [CI]: -0.3 to 0.6) or well-being (mean difference, -0.4; 95% CI: -1.0 to 0.1). There were also no between-group differences in fatigue measured with the Abbreviated Fatigue Questionnaire, the Short Form-36 Mental or Physical Factor scores, or in the Hospital Anxiety and Depression Scale. CONCLUSION: Low-dose combination therapy of hydrocortisone and fludrocortisone was not effective in patients with chronic fatigue syndrome. 670 PMID- 14650573 AU - Bonadonna R TI - Meditation's impact on chr illness. SO - Holist Nurs Pract 2003 Nov-Dec;17(6):309-19. IN - College o Nursing, Med U o South Carolina, Charleston, SC, + AB - +IN: USA. holisticnursing@bellsouth.net Meditation is becoming widely popular as an adjunct to conventional medical therapies. This article reviews the literature regarding the experience of chronic illness, theories about meditation, and clinical effects of this self-care practice. Eastern theories of meditation include Buddhist psychology. The word Buddha means the awakened one, and Buddhist meditators have been called the first scientists, alluding to more than 2500 years of precise, detailed observation of inner experience. The knowledge that comprises Buddhist psychology was derived inductively from the historical figure's (Prince Siddhartha Gautama) diligent self-inquiry. Western theories of meditation include Jungian, Benson's relaxation response, and transpersonal psychology. Clinical effects of meditation impact a broad spectrum of physical and psychological symptoms and syndromes, including reduced anxiety, pain, and depression, enhanced mood and self-esteem, and decreased stress. Meditation has been studied in populations with fibromyalgia, cancer, hypertension, and psoriasis. While earlier studies were small and lacked experimental controls, the quality and quantity of valid research is growing. Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy. Health professionals demonstrate commitment to holistic practice by asking patients about use of meditation, and can encourage this self-care activity. Simple techniques for mindfulness can be taught in the clinical setting. Living mindfully with chronic illness is a fruitful area for research, and it can be predicted that evidence will grow to support the role of consciousness in the human experience of disease. 671 PMID- 12564667 AU - Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML TI - Intervention programs for arthritis & other rheumatic diseases. SO - Health Educ Behav 2003 Feb;30(1):44-63. IN - Division o Adult & Community Health, Centers for Disease Co+ AB - +IN: ntrol & Prevention, Atlanta, Georgia 30341-3724, USA. tob9@cdc.gov Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exerciselphysical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs met study criteria). Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively. 672 PMID- 12861471 AU - Briley M, Moret C TI - FM syndrome: an overview of potential drug targets. SO - IDrugs 2003 Jul;6(7):668-73. IN - NeuroBiz Consulting & Communications, Les Grezes, La Verdar+ AB - +IN: ie, 81100 Castres, France. mike.briley@neurobiz.com Fibromyalgia syndrome (FMS) is a chronic disease of widespread and debilitating pain. The cause of FMS is unknown and its risk factors are poorly understood. It occurs frequently in the general population where it is often co-morbid with other rheumatoid and pain disorders, and psychiatric disorders such as anxiety and depression, making diagnosis particularly difficult. Several types of drugs are used to treat FMS, but none are specifically approved for this indication. FMS appears to be strongly associated with depression or at least with some symptoms of depression, and antidepressants appear to be effective in the treatment of this disorder. The advent of new classes of antidepressants with fewer side effects than older drugs has suggested new avenues of therapy for patients diagnosed with FMS. 673 PMID- 14689761 AU - Buskila D TI - FM: a biopsychosocial syndrome. SO - Isr Med Assoc J 2003 Dec;5(12):887-8. IN - Rheumatic Disease Unit, Soroka U Med Ctr, Faculty o Health + AB - +IN: Sciences, Ben-Gurion U o the Negev, Beer Sheva, Israel. dbuskila@bgumail.bgu.ac.il 674 PMID- 12767784 AU - Bynum B TI - Neurasthenia. SO - Lancet 2003 May 17;361(9370):1753. IN - w.bynum@ucl.ac.uk 675 PMID- 14689686 AU - Carothers B, Schmidt L, Puri V TI - Case reports & review of Postural Orthostatic Tachycardia syndrome (POTS). SO - J Ky Med Assoc 2003 Dec;101(12):549-52. AB - Postural Orthostatic Tachycardia Syndrome (POTS) is a type of orthostatic intolerance that is characterized by excessive tachycardia and decreased cerebral blood flow in the upright position. This can result in significant symptoms of dizziness and light-headedness that can eventually lead to syncope. In this review, we describe two patients with POTS that varied in their degree of symptoms and treatment. One patient was able to be treated as an outpatient, while the other required hospitalization and extensive medical therapy. We would like to emphasize with this review that POTS is probably more common than it is diagnosed and is often confused with other conditions, such as chronic fatigue syndrome or functional syncope. It is important to make the correct diagnosis in order to allow appropriate treatment and to improve the quality of life for these patients. 676 PMID- 14500438 AU - Chalder T, Goodman R, Wessely S, Hotopf M, Meltzer H TI - Epidemiology of CFS & self reported ME in 5-15 year olds: cross sectional study. SO - BMJ 2003 Sep 20;327(7416):654-5. IN - D o Psychological Med, Guy's, King's, & St Thomas's School + AB - +IN: o Medicine, London SE5 8AZ. sphatrc@iop.kcl.ac.uk 677 PMID- 12622306 AU - Chalder T, Godfrey E, Ridsdale L, King M, Wessely S TI - Predictors of outcome in a fatigued population in primary care following a randomized controlled trial. [CF] SO - Psychol Med 2003 Feb;33(2):283-7. IN - D o Psychological Med, Guy's, King's & St Thomas's School o+ AB - +IN: Medicine, London. BACKGROUND: The objective of this study was to examine factors that predicted outcome in a chronically fatigued group of patients who were randomized to cognitive behaviour therapy or counselling in primary care. METHOD: Illness perceptions, attributions, fatigue, disability and demographic variables were recorded at assessment and levels of fatigue and disability were measured at 6 months post randomization. Logistic regression was used to examine associations. RESULTS: Factors that predicted a poor outcome (four or more on the fatigue questionnaire) were: poor social adjustment at assessment; the patients self-report that they had never seen the GP for an emotional reason; a physical illness attribution; and, a long perceived future illness duration. CONCLUSIONS: Patients who are more psychologically minded are more likely to improve with psychological treatments in primary care. General practitioners need to assess this before referring to an appropriate therapist. 678 PMID- 12818281 AU - Chang L, Berman S, Mayer EA, Suyenobu B, Derbyshire S, Naliboff B, Vogt B, Fitz+ TI - Brain responses to visceral & somatic stimuli in pts w irritable bowel syndrome w & without FM. SO - Am J Gastroenterol 2003 Jun;98(6):1354-61. IN - C.N.S. Ctr for Neurovisceral Sciences & Women's Health, D o+ AB - +IN: Medicine, David Geffen School o Med at UCLA, Los Angeles, California, USA. +AU: Gerald L, Mandelkern MA OBJECTIVE: Symptoms of irritable bowel syndrome (IBS) and fibromyalgia (FM) commonly coexist. We hypothesized that one of the mechanisms underlying this comorbidity is increased activation of brain regions concerned with the processing and modulation of visceral and somatic afferent information, in particular subregions of the anterior cingulate cortex (ACC). METHODS: Regional cerebral blood flow (rCBF) was assessed in age-matched female IBS (n = 10) and IBS + FM (n = 10) subjects using H(2)(15)O positron emission tomography during noxious visceral (rectal) and somatic pressure stimuli. RESULTS: GI symptom severity was significantly higher in the IBS patients compared with the IBS + FM patients (p < 0.05). In addition, IBS + FM patients rated somatic pain as more intense than their abdominal pain (p < 0.05). Whereas the somatic stimulus was less unpleasant than the visceral stimulus for IBS patients without FM, the somatic and visceral stimuli were equally unpleasant in the IBS + FM group. Group differences in regional brain activation were entirely within the middle subregion of the ACC. There was a greater rCBF increase in response to noxious visceral stimuli in IBS patients and to somatic stimuli in IBS + FM patients. CONCLUSION: Chronic stimulus-specific enhancement of ACC responses to sensory stimuli in both syndromes may be associated with cognitive enhancement of either visceral (IBS) or somatic (IBS + FM) sensory input and may play a key pathophysiologic role in these chronic pain syndromes. 679 PMID- 15168991 AU - Chatterjee T TI - CFS or ME in children & adolescents. SO - J Indian Med Assoc 2003 Sep;101(9):544, 547. IN - Northern Lincolnshire & Goole Hospitals NHS Trust, Diana Pr+ AB - +IN: incess o Wales Hosp, UK. Chronic fatigue syndrome or myalgic encephalomyelitis in children and adolescents is still poorly understood. The provisional diagnostic criteria and the concept are depicted here. The treatment modalities and prognosis for the disease are yet inconsistent. 680 PMID- 12598734 AU - Chaudhuri A, Condon BR, Gow JW, Brennan D, Hadley DM TI - Proton magnetic resonance spectroscopy of basal ganglia in CFS. SO - Neuroreport 2003 Feb 10;14(2):225-8. IN - D o Neurology, U o Glasgow, South Glasgow U Hospitals NHS T+ AB - +IN: rust, UK. ac54p@udcf.gla.ac.uk Fatigue is a common symptom of neurological diseases that affect basal ganglia function. We used proton magnetic resonance spectroscopy ((1)H MRS) to study the metabolic functions of the basal ganglia in chronic fatigue syndrome (CFS) to test the hypothesis that fatigue in CFS may have a neurogenic component. (1)H MRS of left basal ganglia was carried out in eight non-psychiatric patients with CFS and their results were compared to age- and sex-matched healthy asymptomatic healthy controls. A highly significant increase in the spectra from choline-containing compounds was seen in the CFS patient group (p < 0.001). In the absence of regional structural or inflammatory pathology, increased choline resonance in CFS may be an indicator of higher cell membrane turnover due to gliosis or altered intramembrane signalling. 681 PMID- 12912720 AU - Chester AC TI - Symptoms of rhinosinusitis in pts w unexplained chr fatigue or bodily pain: a pilot study. SO - Arch IM 2003 Aug 11-25;163(15):1832-6. IN - D o Med, Georgetown U Med Ctr, Washington, DC 20016, USA. a+ AB - +IN: chester@foxhallinternists.com BACKGROUND: Recent otolaryngologic studies document significant fatigue and bodily pain (BP) in patients with chronic rhinosinusitis. Studies of general medical patients are lacking. METHODS: A case-control study of 297 consecutive general medical outpatients. RESULTS: Sixty-five patients noted unexplained chronic fatigue (UCF), 33 reported BP, and 26 had both. Compared with 232 patients without UCF, patients with UCF more frequently had the following rhinosinusitis symptoms: facial pressure (odds ratio [OR], 9.7; 95% confidence interval [CI], 5.2-18.2), heavy-headedness (OR, 21.9; 95% CI, 10.9-44.0), nasal obstruction (OR, 4.3; 95% CI, 2.3-7.9), frontal headache (OR, 13.6; 95% CI, 6.5-28.5), postnasal drip (OR, 2.8; 95% CI, 1.6-5.0), sore throat (OR, 3.1; 95% CI, 1.5-6.6), and tender cervical lymph nodes (OR, 9.2; 95% CI, 4.3-19.7). A similar predominance of rhinosinusitis symptoms was noted in patients with BP and in 15 patients with UCF who had chronic fatigue syndrome. No increased prevalence of pollen allergy was noted in association with UCF, BP, or chronic fatigue syndrome. Gastrointestinal, sleep, and psychiatric problems were similar between patients with UCF and 38 patients with explained fatigue. Rhinosinusitis symptoms, however, were more common in UCF. CONCLUSIONS: There is an increased prevalence of rhinosinusitis symptoms but not pollen allergy among general medical outpatients with UCF, BP, or both. Rhinosinusitis symptoms are at least as common as gastrointestinal complaints, sleep disturbance, and psychiatric problems (previously well documented complaints associated with UCF and BP). Rhinosinusitis symptoms, furthermore, are more common in UCF than in fatigue explained by a physical or mental illness. 682 PMID- 12594650 AU - Chia JK, Chia A TI - Diverse etiologies for CFS. SO - Clin Infect Dis 2003 Mar 1;36(5):671-2 IN - I D Med, Torrance, CA, 90505, USA. Chiasann@pol.net 683 PMID- 12911103 AU - Chiaravalloti ND, Christodoulou C, Demaree HA, DeLuca J TI - Differentiating simple versus complex processing speed: influence on new learning & memory performance. SO - J Clin Exp Neuropsychol 2003 Jun;25(4):489-501. IN - Kessler Med Rehabilitation Research & Education Corporation+ AB - +IN: , West Orange, NJ 07052, USA. The current study was designed to examine how the construct of human information processing speed is conceptualized and measured, while also examining the influence of information processing speed on higher cognitive processes (i.e., learning). A mixed medical sample of 92 subjects participated in this study. Subjects underwent a broad-based neuropsychological evaluation, including measures of verbal and visuospatial new learning, spatial and verbal working memory, simple reaction time, choice reaction time, and information processing speed. Principal components factor analysis with varimax rotation resulted in a three-factor solution, comprised of: (1) simple speed/reaction time, (2) complex information processing and new learning, and (3) working memory. Notably, this factor solution identified 2 distinct forms of processing speed--simple and complex information processing speeds. In contrast to the abundance of literature grouping these two constructs together under one term (i.e., processing speed), these results indicate simple and complex speed to be distinct constructs assessed with different neuropsychological instruments. While the expected relationship between complex information processing capacities and working memory abilities was evident in this study, information processing speed also showed a significant relationship with new learning ability. The implications of this intriguing relationship are discussed. 684 PMID- 12651994 AU - Ciccone DS, Natelson BH TI - Comorbid illness in women w CFS: a test of the single syndrome hypothesis. SO - Psychosom Med 2003 Mar-Apr;65(2):268-75. IN - D o Psychiatry, U o Med & Dentistry o New Jersey-New Jersey+ AB - +IN: MS, Newark, New Jersey, USA. cicconds@umdnj.edu OBJECTIVE: Evidence of comorbidity among unexplained illness syndromes raises the possibility that all are variants of a single functional disorder, leading some to suggest that separate case definitions for chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivity (MCS) may be unnecessary. Our objective was to determine whether discrete diagnostic labels provide useful information about physical functioning, symptom severity, and risk of psychiatric illness. METHODS: The sample consisted of 163 consecutive female referrals with CFS enrolled at a tertiary clinic. Each participant was retrospectively assigned to one of four groups: CFS only, CFS/FM, CFS/MCS, and CFS/FM/MCS. At enrollment, participants gave their history, underwent a physical examination and a standardized psychiatric interview (Diagnostic Interview Schedule), and answered self-report questionnaires. RESULTS: Additional unexplained syndromes were prevalent: 37% met criteria for FM, and 33% met criteria for MCS. With the exception of FM-related pain and disability, there were few differences between the CFS only and CFS with comorbid illness groups. Patients with additional illness were more likely to have major depression and a higher risk of psychiatric morbidity compared with patients in the CFS only group (p <.01). Rates of lifetime depression increased from 27.4% in the CFS only group to 52.3% in the CFS/FM group, 45.2% in the CFS/MCS group, and 69.2% in the CFS/FM/MCS group. CONCLUSIONS: The prevalence of comorbid illness in the present CFS sample and the failure to find widespread differences in symptom severity can be seen as support for the single syndrome hypothesis. On the other hand, the existence of discrete syndromes could not be ruled out because of reliable differences between CFS and CFS/FM. Increasing comorbidity was associated with a corresponding increase in risk of major depression. 685 PMID- 12927469 AU - Clarke JN, James S TI - The radicalized self: the impact on the self of the contested nature of the Dx of CFS. SO - Soc Sci Med 2003 Oct;57(8):1387-95. IN - D o Sociology & Anthropology, Wilfrid Laurier U, Waterloo, + AB - +IN: N2L 3C5 ON, Canada. jclarke@wlu.ca Chronic fatigue syndrome (CFS) is a relatively new disease that is difficult to diagnose. It is also a contested disease immersed in dispute about whether it is a physical or psychiatric reality. Sufferers often claim to experience not only the physical challenges of the disease, and these can be extensive, but also, initially, the anomie of suffering from a condition whose very reality is debated both in the medical and in the wider communities. Theories of self in illness emphasize how people who are diagnosed as chronically ill work hard as they seek to maintain previous, or to develop supernormal, selves. Such goals are cast in a critical light by Foucault's notion of the technologies of self in the context of circulating neo-liberal discourses. As people with CFS, lacking an uncontested medical diagnosis, search for meaningful self-identities, they resist previously available discourses to take up an alternative discourse, one that we call radicalized selves. This paper raises questions about the constraints and liberties, power and powerlessness associated with a clear and undisputed medical diagnosis. It suggests a model of the self in chronic illness that considers not only changes in body and biography but also the availability of an uncontested diagnosis. 686 PMID- 12849719 AU - Clauw DJ, Crofford LJ TI - Chronic widespread pain & FM: what we know, & what we need to know. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):685-701. IN - Division o Rheumatology, D o Med, U o Michigan MS, 101 Simp+ AB - +IN: son, Ann Arbor, MI 48109-0723, USA. dclauw@umich.edu Fibromyalgia (FM) is currently defined as the presence of both chronic widespread pain (CWP) and the finding of 11/18 tender points on examination. Only about 20% of individuals in the population with CWP also have 11/18 tender points; these individuals are considerably more likely to be female, and have higher levels of psychological distress. There is no clear clinical diagnosis for the other 80% of individuals with less than 11/18 tender points, but it is likely that these persons, like FM patients, also have pain that is 'central' (i.e. not due to inflammation or damage of structures) rather than peripheral in nature. Research into FM has taught us a great deal about the confluence of neurobiological, psychological and behavioural factors that can cause chronic central pain. These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioural therapy. In contrast to drugs that work for peripheral pain due to damage or inflammation (e.g. NSAIDs, corticosteroids), neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain. 687 PMID- 14528498 AU - Clauw DJ TI - Clinical research into alternative & complementary therapies: how do we tell if the glass is half empty or half full? SO - J Rheumatol. 2003 Oct;30(10):2257-62. PMID: 14528526; J Rhe+ AB - +SO: umatol 2003 Oct;30(10):2088-9. 688 PMID- 12700181 AU - Cleare AJ TI - The neuroendocrinology of CFS. SO - Endocr Rev 2003 Apr;24(2):236-52. IN - Section o Neurobiology o Mood Disorders, Div o Psychologica+ AB - +IN: l Med, The Inst o Psychiatry, London SE5 8AZ, United Kingdom. a.cleare@iop.kcl.ac.uk Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear. There has been a wealth of interest in the endocrinology of this condition, which will be reviewed in this article. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. There is evidence for heightened negative feedback and glucocorticoid receptor function and for impaired ACTH and cortisol responses to a variety of challenges. However, there is no evidence for a specific or uniform dysfunction of the HPA axis. Given the many factors that may impinge on the HPA axis in CFS, such as inactivity, sleep disturbance, psychiatric comorbidity, medication, and ongoing stress, it seems likely that HPA axis disturbance is heterogeneous and of multifactorial etiology in CFS. Studies assessing GH, dehydroepiandrostenedione and its sulfate, melatonin, leptin, and neuroendocrine-monoamine interactions are also reviewed. There is some evidence from these studies to suggest alterations of dehydroepiandrostenedione sulfate function and abnormal serotonin function in CFS, but whether these changes are of functional importance remains unclear. To obtain a clearer assessment of the etiological and pathophysiological relevance of endocrine changes in CFS, it is suggested that more prospective cohort studies be undertaken in groups at high risk for CFS, that patients with CFS are followed up into recovery, and that multidimensional assessments are undertaken to unravel the influence of the various confounding factors on the observed endocrine changes in CFS. 689 PMID- 14558099 AU - Conte PM, Walco GA, Kimura Y TI - Temperament & stress response in children w juvenile primary FM syndrome. SO - Arthritis Rheum 2003 Oct;48(10):2923-30. IN - Hackensack U Med Ctr, Hackensack, New Jersey 07601, USA. pc+ AB - +IN: onte@humed.com OBJECTIVE: To examine temperament, stress response, child psychological adjustment, family environment, pain sensitivity, and stress response differences between children and adolescents with juvenile primary fibromyalgia syndrome (JPFMS), children with arthritis, and healthy controls. Parental psychological adjustment was also measured. METHODS: Subjects included 16 children with JPFMS, 16 children with arthritis, and 16 healthy controls. Participants completed the Dimensions of Temperament Survey-Revised (DOTS-R), State-Trait Anxiety Inventory, Children's Depression Inventory, Family Environment Scale (FES), Sensitivity Temperament Inventory for Pain (STIP), and Youth Self-Report. Responsiveness to an acute stressor was assessed by measuring salivary cortisol levels before and after venipuncture. Parents were asked to complete the parent versions of the DOTS-R, FES, STIP, Child Behavior Checklist, and Symptom Checklist-90-Revised. RESULTS: Children and adolescents with JPFMS demonstrated more temperamental instability, increased levels of depression and anxiety, less family cohesion, and higher pain sensitivity compared with the other 2 groups. Parents of children with JPFMS, in rating themselves, also reported higher levels of anxiety and depression, and lower overall psychological adjustment compared with parents of children in the other groups. CONCLUSION: These results suggest that a psychobiologic perspective may contribute to an increased understanding of JPFMS in children and adolescents, facilitating an approach to investigating the interaction of factors that appear to place a child at risk for development of a pain syndrome. Because temperamental instability, sensitivity to pain, vulnerability to stress, psychological adjustment, family context, and parental psychopathology are individual risk factors, the interaction of these factors may explain the breadth of symptoms associated with this pain syndrome, as well as its severity. 690 PMID- 12675983 AU - Creswell C, Chalder T TI - The relationship between illness attributions & attributional style in CFS. SO - Br J Clin Psychol 2003 Mar;42(Pt 1):101-4. IN - Sub-D o Clinical Health Psychology, U Coll London, UK. c.cr+ AB - +IN: eswell@ucl.ac.uk OBJECTIVE: To examine the relationship between illness attributions and general attributional style in Chronic Fatigue Syndrome (CFS). METHOD: Participants with CFS answered questions on their explanation for their illness and completed the Attributional Style Questionnaire (parallel form). RESULTS: Of the participants, 58.3% attributed their illness to predominantly physical factors. A significant relationship was found between the presence of a self-serving attributional style and illness attributions. CONCLUSION: Illness attributions were associated with an individual's general attributional style. It is suggested that illness attributions may be less important with regards prognosis than, for example, other variables which influence a person's general view of the world. 691 PMID- 12759467 AU - Croft P TI - Symptoms without pathology: should we try a little tenderness? SO - Rheumatology (Oxford). 2003 Jul;42(7):829-35. PMID: 1273053+ AB - +SO: 1; Rheumatology (Oxford) 2003 Jul;42(7):815-7. Epub 2003 May 16. 692 PMID- 14558051 AU - Currey SS, Rao JK, Winfield JB, Callahan LF TI - Performance of a generic health-related quality of life measure in a clinic population w rheumatic disease. SO - Arthritis Rheum 2003 Oct 15;49(5):658-64. IN - Thurston Arthritis Research Ctr, U o North Carolina at Chap+ AB - +IN: el Hill, USA. OBJECTIVE: To assess the performance of a generic health-related quality of life (HRQOL) measure in a rheumatology clinic population. METHODS: Participants (n = 619) with fibromyalgia, rheumatoid arthritis, or osteoarthritis receiving care from rheumatologists completed mailed questionnaires that included the Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measure and condition-specific measures assessing disability, pain, fatigue, and helplessness. The BRFSS assesses global health and number of days in the past 30 of poor physical or mental health or activity limitation. The overall sample was described, followed by comparison of adjusted scores on all HRQOL measures by diagnosis. RESULTS: Participants reported mild difficulty with activities of daily living, marked pain and fatigue, and moderate helplessness. Participants reported a mean of 8 or more days out of 30 of poor physical and mental health and activity limitations; more than 40% reported poor or fair health. Participants with fibromyalgia reported more ill health on condition-specific measures and the BRFSS HRQOL measures than did participants with osteoarthritis or rheumatoid arthritis. CONCLUSION: The BRFSS HRQOL measure is a brief, easily administered, generic health indicator that shows differences among rheumatic disease diagnoses. 693 PMID- 12749618 AU - Cymet TC TI - A practical approach to FM. SO - J Natl Med Assoc 2003 Apr;95(4):278-85. IN - Johns Hopkins School o Med, Sect Head, Family Medicine, Sin+ AB - +IN: ai Hosp o Baltimore, Maryland 21215, USA. Fibromyalgia is the name given to a collection of symptoms with no clear physiologic cause, The constellation of symptoms are clearly recognizable as a distinct pathologic entity. The diagnosis is made through clinical observations made by the examiner. Differential diagnosis must include other somatic syndromes as well as disease entities like hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalance, multiple sclerosis, and cancer. Diagnostic criteria are given as guidelines for the diagnosis, not as absolute requirements. Treatment of this condition remains individualized and relies heavily on having a therapeutic relationship with a provider. Treatment of this syndrome needs to be looked at as an ongoing process. Goal oriented treatment aimed at maintaining specific functions can be directed at helping a patient get restorative sleep, alleviating the somatic pains that ail the patient, keeping a person productive, regulating schedules or through goal oriented agreements made with the patient. Since this syndrome is chronic and may effect all areas of a persons functioning the family and social support system of the person being treated need to be evaluated. Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy. Treatment must involve more than just the symptoms presented and the patient can only be treated successfully if they are willing to work at changing their own perceptions, and ways of relating to stressors in their world. 694 PMID- 14570825 AU - Dalakas MC TI - Enteroviruses in CFS: "now you see them, now you don't". SO - JNeurNSPsy. 2003 Oct;74(10):1382-6. PMID: 14570830; J Neuro+ AB - +SO: l Neurosurg Psychiatry 2003 Oct;74(10):1361-2. 695 PMID- 12939888 AU - Darbishire L, Ridsdale L, Seed PT TI - Distinguishing pts w chr fatigue from those w CFS: a diagnostic study in UK primary care. SO - Br J Gen Pract 2003 Jun;53(491):441-5. IN - D o General Practice, Guy's, King's Coll & St Thomas's Scho+ AB - +IN: ol o Med, London. lucy.darbishire.ac.uk BACKGROUND: Chronic fatigue syndrome (CFS) has been defined, but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS. General practitioners (GPs) do not generally use the CFS diagnosis, and have some doubt about the validity of CFS as an illness. AIM: To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS, and to describe the social, psychological, and physical differences between patients with CFS and those with non-CFS chronic fatigue in primary care. DESIGN OF STUDY: Baseline data from a trial of complex interventions for fatigue in primary care. SETTING: Twenty-two general practices located in London and the South Thames region of the United Kingdom recruited patients to the study between 1999 and 2001. METHOD: One hundred and forty-one patients who presented to their GP with unexplained fatigue lasting six months or more as a main symptom were recruited, and the Centers for Disease Control (CDC) case definition was applied to classify CFS. RESULTS: Approximately two-thirds (69%) of patients had chronic fatigue and not CFS. The duration of fatigue (32 months) and perceived control over fatigue were similar between groups; however, fatigue, functioning, associated symptoms, and psychological distress were more severe in the patients in the CFS group, who also consulted their GP significantly more frequently, were twice as likely to be depressed, and more than twice as likely to be unemployed. About half (CFS = 50%; chronic fatigue = 55%) in each group attributed their fatigue to mainly psychological causes. CONCLUSIONS: In primary care, CFS is a more severe illness than chronic fatigue, but non-CFS chronic fatigue is associated with significant fatigue and is reported at least twice as often. That half of patients, irrespective of CFS status, attribute their fatigue to psychological causes, more than is observed in secondary care, indicates an openness to the psychological therapies provided in that setting. More evidence on the natural history of chronic fatigue and CFS in primary care is required, as are trials of complex interventions. The results may help determine the usefulness of differentiating between chronic fatigue and CFS. 696 PMID- 12800454 AU - Davey NJ, Puri BK, Catley M, Main J, Nowicky AV, Zaman R TI - Deficit in motor performance correlates w changed corticospinal excitability in pts w CFS. SO - Int J Clin Pract 2003 May;57(4):262-4. IN - D o Sensorimotor Systems, Div o Neuroscience & Psychologica+ AB - +IN: l Med, Imperial Coll Faculty o Medicine, Charing Cross Hosp, London W6 8RF, UK. Chronic fatigue syndrome (CFS) is characterised by fatigue and musculosketetal pain, the severity of which is variable. Simple reaction times (SRTs) and movement times (SMTs) are slowed in CFS. Our objective is to correlate the day-to-day changes in symptomatology with any change in SRT, SMT or corticospinal excitability. Ten CFS patients were tested on two occasions up to two years apart. Motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) of the motor cortex were recorded from the thenar muscles. Threshold TMS strength to evoke MEPs was measured to index corticospinal excitability. SRTs and SMTs were measured. The percentage change in both SRTs and SMTs between the two test sessions correlated with the percentage change in corticospinal excitability assessed according to threshold TMS intensity required to produce MEPs. This study provides evidence that changing motor deficits in CFS have a neurophysiological basis. The slowness of SRTs supports the notion of a deficit in motor preparatory areas of the brain. 697 PMID- 12784896 AU - Davis GC TI - Improved sleep may reduce arthritis pain. [FM] SO - Holist Nurs Pract 2003 May-Jun;17(3):128-35. IN - College o Nursing, Texas Woman's U, Denton, Tex 76204, USA.+ AB - +IN: gdavis@twu.edu Studies indicate that pain interferes with sleep and, in turn, sleep disturbances increase pain. Statistics show that up to 60% of those with arthritis experience pain during the night. But despite these findings, sleep is not generally addressed as a major treatment concern among this population. This article reviews the relationship between pain and sleep; sleep issues as they relate to 3 common types of arthritis--osteoarthritis, rheumatoid arthritis, and fibromyalgia; and holistic approaches that may be used by the patient in the self-management of pain and sleep. 698 PMID- 12855321 AU - de Gier M, Peters ML, Vlaeyen JW TI - Fear of pain, physical performance, & attentional processes in pts w FM. SO - Pain 2003 Jul;104(1-2):121-30. IN - D o Med, Clinical & Experimental Psychology, Maastricht U, + AB - +IN: P.O. Box 616, 6200 MD Maastricht, The Netherlands. Patients with fibromyalgia often present with increased levels of disability and physical functioning, for which the determinants are still unclear. In patients with other musculoskeletal pain syndromes, such as chronic low back pain, physical performance and disability levels are shown to be strongly associated with pain-related fear, and even stronger than pain severity. The present study was aimed at examining the role of pain-related fear and attentional processes on tolerance for physical activity in fibromyalgia patients. High and low fearful fibromyalgia patients (N=81) were requested to perform a physical task, a cognitive (reaction time) task, and a dual task in which the physical and cognitive tasks were combined. It was hypothesized that high fearful patients would terminate the physical performance task sooner than low fearful patients, and would show a greater disruption on the cognitive task. In addition, it was expected that when distracted in the dual task, high fearful patients would show improved performance on the physical task after a fear reduction instruction. The results showed that pain itself was a greater predictor of activity tolerance than pain-related fear, but that pain-related fear was the stronger predictor of reaction times on the cognitive task. Also, all groups showed equal improvement in physical performance in the dual task. The findings suggest that baseline pain acts as an occasion setter which determines the level of physical activity the patient is willing to perform, regardless of pain increase and threat-reducing instructions. 699 PMID- 12746916 AU - Desmeules JA, Cedraschi C, Rapiti E, Baumgartner E, Finckh A, Cohen P, Dayer P,+ TI - Neurophysiologic evidence for a central sensitization in pts w FM. SO - Arthritis Rheum 2003 May;48(5):1420-9. IN - Geneva U Hosp, Geneva, Switzerland. Jules.Desmeules@hcuge.ch AB - +AU: Vischer TL OBJECTIVE: To determine whether abnormalities of peripheral and central nociceptive sensory input processing exist outside areas of spontaneous pain in patients with fibromyalgia (FM) as compared with controls, by using quantitative sensory testing (QST) and a neurophysiologic paradigm independent from subjective reports. METHODS: A total of 164 outpatients with FM who were attending a self-management program were invited to participate in the study. Data for 85 patients were available and were compared with those for 40 non-FM controls matched for age and sex. QST was performed using thermal, mechanical, and electrical stimuli at locations of nonspontaneous pain. Pain assessment was 2-fold and included use of subjective scales and the spinal nociceptive flexion reflex (NFR), a specific physiologic correlate for the objective evaluation of central nociceptive pathways. Questionnaires regarding quality of life and the impact of FM were available. RESULTS: Participants were mainly middle-aged women, with a mean disease duration of 8 years. Between-group differences were significant for neurophysiologic, clinical, and quality of life measures. In patients with FM, peripheral QST showed significantly altered cold and heat pain thresholds, and tolerance to cold pain was radically reduced. The median NFR threshold in patients with FM (22.7 mA [range 17.5-31.7]) was significantly decreased compared with that in controls (33 mA [range 28.1-41]). A cutoff value of <27.6 mA for NFR provided sensitivity of 73% and specificity of 80% for detecting central allodynia in the setting of FM. CONCLUSION: Our results strongly, although indirectly, point to a state of central hyperexcitability of the nociceptive system in patients with FM. The NFR can be used to assess central allodynia in FM. It may also help discriminate patients who may benefit from use of centrally acting analgesics. 700 PMID- 12810928 AU - Dobkin PL, De Civita M, Bernatsky S, Kang H, Baron M TI - Does psychological vulnerability determine health-care utilization in FM? SO - Rheumatology (Oxford) 2003 Nov;42(11):1324-31. Epub 2003 Ju+ IN - Montreal General Hosp, Canada. patricia.dobkin@mcgill.ca AB - +SO: n 16. OBJECTIVES: Patients with fibromyalgia (FM) undergo multiple testing and referral to specialists, and often use complementary/alternative medicine (CAM) services. The objectives of the study were: (i) to document health service utilization, and (ii) to examine whether psychological vulnerability was associated with visits to physicians and CAM providers. METHODS: Women (N = 178) with a diagnosis of primary FM completed a psychosocial test measuring pain, perceived stress, global psychological distress, sexual abuse history, co-morbidity and disability due to FM. Subjects also completed a health services questionnaire, documenting visits to physicians and CAM providers during the previous 6 months. Psychological vulnerability was operationalized as obtaining high scores on psychological distress, perceived stress and reporting at least one abusive event. RESULTS: The average number of visits was 7.2 to physicians and 11.3 to CAM providers. CONCLUSIONS: The number of physician visits was significantly associated with more co-morbidity. Psychologically vulnerable subjects were more likely to use CAM services than those not so classified. 701 PMID- 12784410 AU - Dobkin PL, De Civita M, Abrahamowicz M, Bernatsky S, Schulz J, Sewitch M, Baron+ TI - Patient-physician discordance in FM. SO - J Rheumatol 2003 Jun;30(6):1326-34. IN - Division o Clinical Epidemiology, McGill U Health Centre, M+ AB - +IN: ontreal, Quebec, Canada. patricia.dobkin@mcgill.ca +AU: M OBJECTIVE: Discordance between patients' and physicians' health perceptions and satisfaction with the office visit in fibromyalgia (FM) has not been examined. We investigated this phenomenon to identify demographic, clinical, and psychosocial factors associated with patient-physician discordance on physical functioning, well being, and satisfaction with the office visit. METHODS: A sample of 182 women were examined by a rheumatologist to confirm the FM diagnosis. Patients and physicians independently completed the Patient-Physician Discordance Scale to assess perceptions of health and satisfaction with the office visit. Patients also completed questionnaires pertaining to sociodemographics, social support, disability, perceived stress, and psychological distress following the office visit. Separate generalized estimating equations with forward selection, controlling for the possible dependence of outcomes among patients of same physician, were modeled for each measure of discordance. RESULTS: The highest discordance score was on satisfaction with the office visit; physicians systematically underestimated patients' level of satisfaction. Higher levels of satisfaction with social support (p < 0.02) and more psychological distress (p < 0.03) were marginally associated with greater discordance on physical functioning. Higher levels of satisfaction with social support (p < 0.003), younger age (p < 0.02), and lower disability (p < 0.03) were associated with greater discordance on well being. More sexual abuse (p < 0.01) was significantly associated with more discordance on satisfaction with the office visit. CONCLUSION: There is a gap between what patients with FM and rheumatologists examining them experience during the office visit. Psychosocial factors contribute to our understanding of discordance on physical functioning, well being, and satisfaction. 702 PMID- 14556267 AU - Douche-Aourik F, Berlier W, Feasson L, Bourlet T, Harrath R, Omar S, Grattard F+ TI - Detection of enterovirus in human skeletal muscle from pts w chr inflammatory muscle disease or FM & healthy subjects. SO - J Med Virol 2003 Dec;71(4):540-7. IN - Laboratory o Bacteriology-Virology (GIMAP), Faculte de Mede+ AB - +IN: cine Jacques Lisfranc, Saint-Etienne, France. +AU: , Denis C, Pozzetto B Enterovirus RNA has been found previously in specimens of muscle biopsy from patients with idiopathic dilated cardiomyopathy, chronic inflammatory muscle diseases, and fibromyalgia or chronic fatigue syndrome (fibromyalgia/chronic fatigue syndrome). These results suggest that skeletal muscle may host enteroviral persistent infection. To test this hypothesis, we investigated by reverse transcription-polymerase chain reaction (RT-PCR) assay the presence of enterovirus in skeletal muscle of patients with chronic inflammatory muscle diseases or fibromyalgia/chronic fatigue syndrome, and also of healthy subjects. Three of 15 (20%) patients with chronic inflammatory muscle diseases, 4 of 30 (13%) patients with fibromyalgia/chronic fatigue syndrome, and none of 29 healthy subjects was found positive. The presence of VP-1 enteroviral capsid protein was assessed by an immunostaining technique using the 5-D8/1 monoclonal antibody; no biopsy muscle from any patient or healthy subject was found positive. The presence of viral RNA in some muscle biopsies from patients exhibiting muscle disease, together with the absence of VP-1 protein, is in favor of a persistent infection involving defective viral replication. 703 PMID- 12904102 AU - Duclos P TI - Safety of immunisation & adverse events following vaccination against hepatitis B. SO - Expert Opin Drug Saf 2003 May;2(3):225-31. IN - D o Vaccines & Biologicals, Health Technology & Pharmaceuti+ AB - +IN: cals, World Health Organization, Geneva, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. duclosp@who.int Hepatitis B vaccines (HBVs) are composed of highly purified preparations of hepatitis B virus surface antigen (HBsAg). An adjuvant, either aluminium phosphate or aluminium hydroxide, is added to the vaccines, which are sometimes preserved with thiomersal. In placebo-controlled studies, common side effects other than local reactions were reported no more frequently among vaccine recipients than among individuals receiving a placebo. A number of controversial adverse events have, however, been purported to be associated with HBVs, including rheumatoid arthritis (RA), diabetes, demyelinating diseases (e.g., multiple sclerosis [MS]), chronic fatigue syndrome, and more recently, lymphoblastic leukaemia. In addition, the safety of the thiomersal and aluminium contained in the vaccine has also been under close scrutiny. These issues have been reviewed by a number of country-specific or international independent review committees such as that of the US Institute of Medicine (IOM) and the World Health Organization's (WHO) Global Advisory Committee on Vaccine Safety (GACVS). Upon review of the scientific evidence, none of the serious allegations have so far been confirmed. On the contrary, scientific evidence has accumulated to disprove many of the allegations. In particular, the IOM committee has concluded that the evidence favoured rejection of a causal relationship between HBV administered to adults and incident MS or MS relapse. Whilst it is important to continue monitoring some of the safety issues, there is no evidence to suggest that the WHO should consider altering its recommendation that all countries should have universal infant and/or adolescent immunisation programmes. The risks of hepatitis B vaccination are only theoretical in comparison with clear benefits in terms of cirrhosis and cancer prevention, and the HBV remains one with an excellent safety profile. 704 PMID- 12926648 AU - Ehrlich GE TI - Back pain. SO - J Rheumatol Suppl 2003 Aug;67:26-31. IN - U o Penn School o Med, Philadelphia, Pennsylvania, USA. AB - Back pain is ubiquitous and probably plagues almost everyone in all cultures and ethnic groups at some time (around 20% annually), and in up to 50% of these at least once a year. The WHO-COPCORD epidemiologic investigations have established its prevalence even in countries that had been unaware of its frequency in their populace, and factors involving type of work and training probably accounted for this misperception. Medical journals are replete with articles addressing diagnosis and treatment, but the majority fail to meet the standards needed for metaanalysis or comparison. A task force of the Agency for Health Care Policy and Research of the United States Department of Health and Human Services screened more than 10,000 abstracts, eliminated the majority of these studies and papers, and still was unable to recommend the best approach even to acute back pain; the problem of subacute and chronic back pain is even more formidable. Yet back pain has been identified as perhaps the major cause of disability and absenteeism from the workplace worldwide. WHO chiefly addressed subacute back pain, as most acute back pain is self-limited and ends spontaneously, almost regardless of the treatment. Subacute pain is the intermediate stage toward chronic pain, which defies most treatments. Specific causes for back pain, such as infections, tumors, osteoporosis, spondyloarthropathies, and trauma, actually represent a minority of such pain syndromes, qualifying for specific therapeutic approaches. A major problem in defining the burden of disease for back pain has been a dearth of agreed-upon outcome measures by which to judge the various interventions, and this was the task that the WHO Low Back Pain Initiative took upon itself. Among measures recommended to be included in all studies, so that valid comparisons could be made, were measurement of pain by visual analog scales, somatic perception, the Oswestry disability and modified Zung questionnaires, and a modified Schober test of spinal mobility. These measures are needed for studies, not for diagnosis or treatment of individual patients. They have been translated into various major languages and validated by back-translations, and applied in comparative studies in various cultures to medical, chiropractic, and other common interventions. The importance of such scientifically sound studies cannot be overemphasized, as the costs of health care are mounting everywhere and it therefore becomes imperative to develop cost-effective approaches. All the more so as conversion of acute back pain to chronic back pain is often iatrogenic, with strong psychosocial factors as well, so that not only what to do but also what not to do become important public health issues. The general lack of attention to back pain by governments and organizations probably results from the fact that it is perceived as a syndromic presentation with myriad causes rather than as a specific disease entity. Even if the "disease" names classify like presentations but are not necessarily etiologically discrete, syndromic diagnoses that subsume a variety of causes receive less attention; international rankings of common disabilities and public health problems tend to emphasize the named disorders rather than the grouped disorders. Moreover, back pain is often self-treated with nonprescription medications or alternative therapies, and by nonmedical practitioners or treatments in many parts of the world. Validation of outcomes therefore not only reduces invalidism and direct costs but also reduces the indirect costs of absenteeism and medical care. 705 PMID- 12605310 AU - Ehrlich GE TI - FM, a virtual disease. SO - Clin Rheumatol 2003 Feb;22(1):8-11. 706 PMID- 14710509 AU - Ehrlich GE TI - Low back pain. SO - Bull World Health Organ 2003;81(9):671-6. IN - g2e@mindspring.com AB - Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. 707 PMID- 12913918 AU - Ehrlich GE TI - Pain is real; FM isn't. SO - J Rheumatol. 2003 Aug;30(8):1835-40. PMID: 12913943; J Rheu+ AB - +SO: matol 2003 Aug;30(8):1666-7. 708 PMID- 12699708 AU - Eidelman D TI - CFS - medical fact or artifact. SO - Med Hypotheses 2003 Jun;60(6):840-2. IN - Ramat Hasharon, Israel. daveid@netvision.net.il AB - Despite extensive investigation, the enigma of Chronic Fatigue Syndrome (CFS) continues to confound medical researchers. It is suggested that this may be due to two impediments inherent in their overall approach to the problem. Firstly, although fatigue is central to CFS, medical scientists appear not to understand what fatigue itself really is, nor what is its purpose or mode of function. A functional definition of fatigue is suggested to help resolve this. Secondly, physicians and other researchers - psychologists and alternative medicine practitioners - fail to observe an elementary and fundamental procedure of clinical medicine, namely, that of properly examining their patients before making a diagnosis or providing treatment. The notion of the 'black hole' of medicine is introduced. Recognizing the existence of these impediments is considered a self-evident precondition for further significant progress being made in this field. 709 PMID- 12606231 AU - Englebienne P, Verhas M, Herst CV, De Meirleir K TI - Type I interferons induce proteins susceptible to act as thyroid receptor (TR) corepressors & to signal the TR for destruction by the proteasome: pos+ SO - Med Hypotheses 2003 Feb;60(2):175-80. IN - U o Brussels (ULB/VUB), N.V., Brussels, Belgium. penglebi@u+ AB - +TI: sible etiology for unexplained chr fatigue. +IN: lb.ac.be In some patients complaining of chronic fatigue such as those suffering from the chronic fatigue syndrome (CFS), no underlying physical cause can be clearly identified and they typically present a normal thyroid function. Several studies indicate a dysregulation in the type I interferons (IFN-alpha/beta) pathway in CFS resulting in a sustained upregulation of 2('),5(')-oligoadenylate synthetases (2-5OAS). Likewise, patients treated with IFN-alpha/beta usually complain of severe fatigue as a limiting side effect. Beside the 2-5OAS, IFN-alpha/beta induce also the expression of three closely related proteins of unknown function termed the 2-5OAS-like (2-5OASL) proteins. The amino acid sequences of the 2-5OASL proteins display 96% identity with the partial sequence of the thyroid receptor interacting protein (TRIP) 14, further contain two typical thyroid hormone receptor (TR) coregulator domains and feature two ubiquitin C-terminal domains. From these observations, we raise the hypothesis that the 2-5OASL proteins are TRIPs capable of, respectively, repressing TR transactivation and/or signaling the receptor for destruction by the proteasome. Such molecular mechanisms could explain the development of a clinical hypothyroid state in presence of a normal thyroid function. 710 PMID- 12583870 AU - Ernberg M, Lundeberg T, Kopp S TI - Effects on muscle pain by intramuscular injection of granisetron in pts w FM. SO - Pain 2003 Feb;101(3):275-82 IN - D o Clinical Oral Physiology, Inst o Odontology, Karolinska+ AB - +IN: Institutet, Box 4064, SE-141 04, Huddinge, Sweden We have previously reported that the level of 5-HT in the masseter muscle is increased in patients with fibromyalgia as compared with healthy subjects and that high intramuscular level of 5-HT is associated with muscle pain. We have also reported that injection of the 5-HT(3) receptor antagonist granisetron (GRA) into the masseter muscle of healthy subjects reduced pain induced by 5-HT and abolished allodynia/hyperalgesia. The aim of this study was to investigate whether GRA can influence pain and allodynia/hyperalgesia of the masseter muscle in patients with fibromyalgia. Eighteen female patients who met the criteria of fibromyalgia according to the American College of Rheumatology participated in the study. They were examined regarding pain intensity and pressure pain threshold (PPT) over the masseter muscle. One milliliter of GRA (1mg/ml) was injected into the masseter muscle on one side and 1ml of isotonic saline on the other side in a randomized and double-blind manner. After the injections, the pain intensity and PPT were recorded during 30min. The pain intensity increased after injection of saline and to a lower degree after injection of GRA. The PPT increased after injection of GRA, while no such change was observed after saline. The difference between GRA and saline was, however, not significant. Eight of the patients responded to the GRA injection by an increase of PPT during the experimental period that differed from saline. They also showed a tendency to a lower increase of pain intensity after injection of GRA when compared to saline. In conclusion, the results of this study do not prove that injection of the 5-HT(3)-antagonist GRA into the masseter muscle influences local pain and allodynia/hyperalgesia in patients with fibromyalgia. 711 PMID- 14513080 AU - Ernst E TI - Chiropractic manipulation for non-spinal pain--a systematic review. SO - N Z Med J 2003 Aug 8;116(1179):U539. IN - Complementary Med, Peninsula MS, Universities o Exeter & Pl+ AB - +IN: ymouth, Exeter, United Kingdom. Edzard.Ernst@pms.ac.uk AIMS: Chiropractic manipulation is mostly used for spinal problems but, in an increasing number of cases, also for non-spinal conditions. This systematic review is aimed at critically evaluating the evidence for or against the effectiveness of this approach. METHODS: Five electronic databases were searched for all randomised clinical trials of chiropractic manipulation as a treatment of non-spinal pain. They were evaluated according to standardised criteria. RESULTS: Eight such studies were identified. They related to the following conditions: fibromyalgia, carpal tunnel syndrome, infantile colic, otitis media, dysmenorrhoea and chronic pelvic pain. Their methodological quality ranged from mostly poor to excellent. Their findings do not demonstrate that chiropractic manipulation is an effective therapy for any of these conditions. CONCLUSIONS: Only very few randomised clinical trials of chiropractic manipulation as a treatment of non-spinal conditions exist. The claim that this approach is effective for such conditions is not based on data from rigorous clinical trials. 712 PMID- 12598804 AU - Ernst E TI - Complementary medicine. SO - Curr Opin Rheumatol 2003 Mar;15(2):151-5. IN - Complementary Med, Peninsula MS, Universities o Exeter & Pl+ AB - +IN: ymouth, United Kingdom. Edzard.Ernst@pms.ac.uk Complementary medicine has become an important subject for rheumatologists, not least because many patients try complementary treatments. Recent clinical trials yield promising results. In particular, evidence suggests that several herbal medicines and dietary supplements can alleviate the pain of osteoarthritis and rheumatoid arthritis. Clearly, rigorous testing of complementary treatments is possible, and considering their popularity, should be encouraged. 713 PMID- 12856141 AU - Ersoz M TI - Nerve conduction tests in pts w FM: comparison w normal controls. SO - Rheumatol Int 2003 Jul;23(4):166-70. Epub 2003 Jan 4. IN - Ankara Physical Med & Rehabilitation Education & Research H+ AB - +IN: osp, Ministry o Health, Ankara, Turkey. mersoz@tr.net The purpose of this study was to evaluate nerve conduction in fibromyalgia (FM) patients and normal subjects. Testing of F waves and motor, sensory, and mixed nerve conduction was performed in 33 consecutive female FM patients complaining of paresthesias in the extremities and in 17 age- and sex-matched healthy volunteers. The nerve conduction results in FM patients were no different from those of normal subjects except for prolonged peroneal distal motor latency ( P=0.048) and decreased peroneal motor conduction velocity ( P=0.030). Five of the 33 patients (15%) showed abnormalities in peroneal nerve conduction, five (15%) had carpal tunnel syndrome (CTS), and overall nine (27%) had electrophysiologic findings of focal entrapment, which indicated that focal neuropathies were common in this patient group. There was no evidence of generalized polyneuropathy in the FM patients. 714 PMID- 12839515 AU - Evengard B, Jonzon E, Sandberg A, Theorell T, Lindh G TI - Differences between pts w CFS & w chr fatigue at an infectious disease clinic in Stockholm, Sweden. SO - Psychiatry Clin Neurosci 2003 Aug;57(4):361-8. IN - D o Laboratory Med, Karolinska Inst at Huddinge U Hosp, Sto+ AB - +IN: ckholm, Sweden. birgitta.evengard@labmed.ki.se Background data were collected from patients presenting with fatigue at the clinic of infectious diseases at Huddinge University Hospital, Stockholm. The main purpose was to look for differences as to demographic and functional status for patients fulfilling criteria for chronic fatigue syndrome (CFS) and chronic fatigue (CF). A cross-sectional questionnaire survey was performed using a variety of instruments. A thorough medical investigation was performed. No difference was found as to social situation, occupation and illness attributions for patients in the two categories. Patients with CFS reported in general a higher degree of 'sickness' with more self-reported somatic symptoms, more self-reported functional impairment and more absence from work. A higher degree of psychiatric comorbidity was observed in CF than in CFS patients. A majority of CFS patients (80%) had an acute infectious onset compared to 43% in the CF group. Presently used criteria might, according to findings presented here, define two different patient categories in a population characterized by severe, prolonged fatigue. Because CFS patients (compared to patients with CF) have more somatic symptoms, more often report an infectious, sudden onset and have less psychiatric comorbidity, and CF patients seem to have more of an emotional, burn-out-like component one could speculate about the existence of different pathogenetic backgrounds behind the two diagnoses. 715 PMID- 12661788 AU - Fasih T, Pickin M, Cuschieri RJ TI - Non-vascular claudication: a clinical conundrum. SO - Int J Clin Pract 2003 Mar;57(2):87-9. IN - D o Vascular Surgery & Orthopaedic Med, Doncaster Royal Inf+ AB - +IN: irmary, Doncaster, Yorkshire. This is a prospective study of patients referred to our department with symptoms of claudication unlikely to be of vascular origin. After clinical assessment these patients were referred to an orthopaedic physician. Of 1070 patients referred, 33 patients were diagnosed with a non-vascular problem. Of these, 21 were cases of spinal stenosis with or without nerve root irritation, seven had a combination of spinal pathology and peripheral vascular disease, and five were diagnosed with intervertebral disc prolapse (n=3), diabetic neuropathy (n=1) and chronic fatigue syndrome (n=1). The prognosis for patients with non-vascular claudication in respect of the development of premature vascular events is likely to be different from vascular claudicants and they should be counselled appropriately. Furthermore, the potentially less favourable outcome following reconstruction must be clearly explained to patients with a non-vascular contribution to their symptoms before any therapeutic vascular intervention. Failure to do this is likely to have significant medicolegal implications. 716 PMID- 14586283 AU - Ferrari R, Shorter E TI - From railway spine to whiplash--the recycling of nervous irritation. SO - Med Sci Monit 2003 Nov;9(11):HY27-37. IN - History o Med D, U o Toronto, Toronto, Ontario, Canada. rfe+ AB - +IN: rrari@shaw.ca The search for a specific structural basis for chronic whiplash and other chronic pain and fatigue syndromes has been in progress for decades, and yet currently there remains no "structural" solution to these enigmata. In light of the failure of research to identify the chronic "damage" or pathology as lying in a muscular, bony, or "connective tissue" sites for many chronic pain syndromes like whiplash, fibromyalgia, et cetera, more recent attention has been paid to nervous system structures. Nerve irritation has been implicated as the basis for the pain and other symptoms that are common to many chronic disability syndromes. We postulate here, however, that the concept of nervous irritation has been prostituted for centuries whenever more concrete structural explanations for chronic pain and other controversial illness have been untenable. We suggest that, after each cycle of nervous irritation as a disease, and subsequent dismissal of the notion, the doctrine of irritation as a disease was too good to go away. First, with the hypersthenic and asthenic diseases of the nineteenth century, then railway spine, whiplash, thoracic outlet syndrome, and now brachial plexus irritation, we detect the same pattern: patients with symptoms, but no objective evidence of nerve disease. Nervous irritation has repeatedly served this purpose for the last 200 years. It is our intent that bringing an understanding of this trend will encourage current clinicians and researchers to appreciate the need to abandon this form of speculation without historical insight when dealing with today's controversial syndromes. 717 PMID- 14527698 AU - Fillingim RB TI - Hyperalgesia versus response bias in FM. SO - Pain 2003 Oct;105(3):385-6. 718 PMID- 12508406 AU - Fitzcharles MA, Costa DD, Poyhia R TI - A study of standard care in FM syndrome: a favorable outcome. SO - J Rheumatol 2003 Jan;30(1):154-9 IN - Division o Rheumatology, Montreal General Hosp, Montreal, Q+ AB - +IN: uebec, Canada. OBJECTIVE: A longitudinal prospective study was undertaken to examine the outcome of fibromyalgia (FM) with standard medical care, as well as factors that might either predict or influence this outcome. METHODS: Eighty-two women with clinical FM were evaluated at baseline and 70 were followed for a mean of 40 months. Patients continued their usual management for FM as prescribed by their own physicians. The primary outcome variable was patient's overall status compared to baseline on a 7 point Likert scale (range 1 = much worse, 7 = much better). Secondary outcome measures included measurements for pain, fatigue, and patient and physician global assessment on a visual analog scale. Additional functional measures were the disease-specific Fibromyalgia Impact Questionnaire (FIQ), and the generic Health Assessment Questionnaire (HAQ). RESULTS: Of 70 (85%) patients who were followed up at 3 years, 33 (47%) reported overall moderate to marked improvement, and the remaining 53% reported either slight improvement, no change, or deterioration. The improved group (n = 33) compared to those that remained the same or worsened (n = 37) showed significant differences for change of score from baseline for tender point count, patient global assessment, sleep disturbance, fatigue, pain, FIQ and HAQ, and were younger, 46 versus 51 years. No other baseline demographic or disease variables discriminated between the 2 groups. The only baseline predictors for a favorable outcome were younger age and less sleep disturbance. CONCLUSION: The overall outcome in this group was favorable, with almost half the sample reporting clinically meaningful improvement in overall FM status. These findings are discussed in terms of their implications regarding current theory on the pathogenesis of FM. 719 PMID- 12595620 AU - Fitzcharles MA, Boulos P TI - Inaccuracy in the Dx of FM syndrome: analysis of referrals. SO - Rheumatology (Oxford) 2003 Feb;42(2):263-7 IN - Division o Rheumatology & McGill Pain Centre, D o Med, Mont+ AB - +IN: real General Hosp, McGill U Health Centre and. Div o Rheumatology, D o Medicine, St. Joseph's Hospital, McMaster University, Canada. OBJECTIVE: To examine prospectively the accuracy of an initial diagnosis for fibromyalgia (FM). METHODS: All patients newly referred for rheumatology consultation in a 6-month period were evaluated prospectively for either a preceding, current or subsequent diagnosis of FM. Clinical characteristics, previous and subsequent management and health care utilization were assessed. The final diagnosis at 6 months was verified and accuracy regarding the diagnosis of FM was assessed. RESULTS: Seventy six (12%) of all new patients were either referred with a question of FM or finally diagnosed with FM. At the final evaluation the accuracy of the diagnosis regarding FM by either the referring physician or by the rheumatologist at the time of the initial visit was correct in 34% of patients. The FM group in comparison with those with some other rheumatological diagnosis had more tender points (12.5 vs 4) and were more fatigued. In contrast, prolonged early morning stiffness and limitation of lumbar spinal mobility in more than one plane was more common in the non-FM group. CONCLUSION: There is a disturbing inaccuracy, mostly observed to be overdiagnosis, in the diagnosis of FM by referring physicians. This finding may help explain the current high reported rates of FM and caution physicians to consider other diagnostic possibilities when addressing diffuse musculoskeletal pain. 720 PMID- 12817660 AU - Flor H TI - Cortical reorganisation & chr pain: implications for rehabilitation. SO - J Rehabil Med 2003 May;(41 Suppl):66-72. IN - D o Clinical & Cognitive Neuroscience, U o Heidelberg, Cent+ AB - +IN: ral Inst o Mental Health, Mannheim, Germany. flor@zi-mannheim.de Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in such areas as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. Functional reorganisation in both the somatosensory and the motor system was observed in neuropathic and musculoskeletal pain. In patients with chronic low back pain and fibromyalgia the amount of reorganisational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes cortical reorganisation is correlated with the amount of pain. These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the somatosensory system as well as its effects on the motor system. Cortical plasticity related to chronic pain can be modified by behavioural interventions that provide feedback to the brain areas that were altered by somatosensory pain memories or by pharmacological agents that prevent or reverse maladaptive memory formation. 721 PMID- 12579593 AU - Freburger JK, Callahan LF, Currey SS, Anderson LA TI - Use of the trust in physician scale in pts w rheumatic disease: Psychometric properties & correlates of trust in the rheumatologist. [FM] SO - Arthritis Rheum 2003 Feb;49(1):51-8 IN - U o North Carolina at Chapel Hill, North Carolina. AB - OBJECTIVES: To assess the psychometric properties of the Trust in Physician Scale and to identify variables associated with patients' trust in their rheumatologist. METHODS: Analyses of self reported data from 713 patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia. Study variables included the Trust in Physician Scale, a decision-making question, a medical skepticism measure, and demographic and health-related measures. Internal consistency and construct validity were assessed using correlational analyses and factor analysis. A regression analysis was conducted to identify factors associated with trust in the rheumatologist. RESULTS: Internal consistency of the scale was high (Cronbach's alpha = 0.87). Scale items also loaded on a single factor. Construct validity was supported by inverse correlations between higher trust scores and both skepticism and independent decision making. Decreased trust was associated with older age, minority status, higher education, diagnosis of fibromyalgia or osteoarthritis, and poorer health. CONCLUSION: The Trust in Physician Scale is appropriate for patients with rheumatic disease. Several patient characteristics appear to be associated with lower trust in the rheumatologist. 722 PMID- 12729050 AU - Friedman AW, Tewi MB, Ahn C, McGwin G Jr, Fessler BJ, Bastian HM, Baethge BA, R+ TI - SLE in 3 ethnic groups: XV. Prevalence & correlates of FM. SO - Lupus 2003;12(4):274-9. IN - U o Texas-Houston Health Science Ctr, Houston, TX 77030, US+ AB - +IN: A. +AU: eveille JD, Alarcon GS The purpose of this study was to determine the prevalence and correlates of fibromyalgia (FM) in a prospective, multiethnic systemic lupus (SLE) cohort. A total of 266 SLE patients with disease duration of < or = 5 years at study entry were evaluated longitudinally for the presence of FM (per ACR criteria). Sociodemographic factors, behavioral/psychological variables, clinical features, serologic factors (autoantibodies), and self-reported functioning (MOS SF-36) were ascertained in all patients. Subjects were evaluated at study entry and annually thereafter. The prevalence of FM was then calculated, as was the prevalence of FM-like manifestations (widespread pain with at least 6, but fewer than 11/18 tender points). Variables were evaluated for association with FM or FM-like manifestations by univariate and stepwise logistic regression analyses. FM was present in 14 patients (5%; 9/92 Caucasians (C), 4/109 African Americans (AA), 1/65 Hispanics (H)) and FM/FM-like manifestations in 35 (13%; 16 C, 9 AA, 10 H). There was no difference noted between those with and without FM with respect to gender, education level, income below poverty level, disease activity or damage. By stepwise logistic regression analyses, the strongest association with both FM and FM/FM-like manifestations was a self-reported history of anxiety or affective disorder (P = 0.0237, OR = 4.6 and P = 0.0068, OR = 3.4, respectively). Caucasian ethnicity was strongly associated with FM (P = 0.0066, OR = 7.5) and African American ethnicity was negatively associated with FM/FM-like (P = 0.0204, OR = 0.3). Poorer self-reported physical functioning was associated with FM/FM-like (P = 0.0443, OR = 0.96). FM and FM-like manifestations correlate best with the presence of Caucasian ethnicity, concomitant anxiety or affective disorder, and to a lesser extent with poorer self-reported physical functioning. African American ethnicity is negatively associated with the combination of FM and FM-like manifestations. Clinical measures of disease activity, disease damage, specific organ dysfunction, sociodemographic factors and serologic features are not correlated with FM in this early SLE cohort. 723 PMID- 14763244 AU - Frieri M TI - Identification of masqueraders of autoimmune disease in the office. SO - Allergy Asthma Proc 2003 Nov-Dec;24(6):421-9. IN - D o Med, Pediatrics & Pathology, Nassau U Med Ctr, 2201 Hem+ AB - +IN: pstead Turnpike, East Meadow, NY 11554, USA. There are several rheumatologic and autoimmune disorders that can masquerade as allergic disease. Identification of these conditions in an office setting can be a challenge for the practicing allergist-immunologist. These conditions include rheumatoid and juvenile arthritis, Sjogren's syndrome, systemic lupus erythematosus, Behcet's and antiphospholipid syndromes, systemic sclerosis, vasculitis, sarcoidosis, chronic fatigue syndrome, and fibromyalgia. The article will address these topics and include clinical uses of immunologic tests for diagnosis. 724 PMID- 12899875 AU - Fulle S, Belia S, Vecchiet J, Morabito C, Vecchiet L, Fano G TI - Modification of the functional capacity of sarcoplasmic reticulum membranes in pts suffering from CFS. SO - Neuromuscul Disord 2003 Aug;13(6):479-84. IN - Laboratorio Interuniversitario di Miologia, Universita 'G. + AB - +IN: d'Annunzio', Nuovo Polo Didattico, 66013 Chieti Scalo, Italy. s.fulle@unich.it In chronic fatigue syndrome, several reported alterations may be related to specific oxidative modifications in muscle. Since sarcoplasmic reticulum membranes are the basic structures involved in excitation-contraction coupling and the thiol groups of Ca(2+) channels of SR terminal cisternae are specific targets for reactive oxygen species, it is possible that excitation-contraction coupling is involved in this pathology. We investigated the possibility that abnormalities in this compartment are involved in the pathogenesis of chronic fatigue syndrome and consequently responsible for characteristic fatigue. The data presented here support this hypothesis and indicate that the sarcolemmal conduction system and some aspects of Ca(2+) transport are negatively influenced in chronic fatigue syndrome. In fact, both deregulation of pump activities (Na(+)/K(+) and Ca(2+)-ATPase) and alteration in the opening status of ryanodine channels may result from increased membrane fluidity involving sarcoplasmic reticulum membranes. 725 PMID- 12618533 AU - Gaab J, Huster D, Peisen R, Engert V, Heitz V, Schad T, Schurmeyer T, Ehlert U TI - Assessment of cortisol response w low-dose & high-dose ACTH in pts w CFS & healthy comparison subjects. SO - Psychosomatics 2003 Mar-Apr;44(2):113-9. IN - Center for Psychobiological & Psychosomatic Research, U o T+ AB - +IN: rier, Germany. jgaab@klipsy.unizh.ch A reduced secretion of cortisol has been proposed as a possible explanation of the symptoms in chronic fatigue syndrome. However, the evidence of hypocortisolism in chronic fatigue syndrome is conflicting. In order to simultaneously assess possible alterations in adrenocortical sensitivity and secretory adrenal reserve, the authors administered both low-dose and high-dose ACTH to a group of 18 chronic fatigue syndrome patients and 18 age- and gender-matched healthy comparison subjects. No response differences for salivary and plasma cortisol were detectable after administration of either low-dose or high-dose ACTH, indicating that primary adrenal insufficiency is unlikely to play a significant role in the etiology of chronic fatigue syndrome. 726 PMID- 12888300 AU - Garrison RL, Breeding PC TI - A metabolic basis for FM & its related disorders: the possible role of resistance to thyroid hormone. SO - Med Hypotheses 2003 Aug;61(2):182-9. IN - 3306 Montavesta Drive, Lexington, KY 40502, USA. AB - It has long been recognized that the symptom complex of fibromyalgia can be seen with hypothyroidism. Hypothyroidism may been categorized, like diabetes, into type I (hormone deficient) and type II (hormone resistant). Most cases of fibromyalgia fall into the latter category. The syndrome is reversible with treatment, and is usually of late onset. It is likely more often acquired than due to mutated receptors. Now that there is evidence to support the hypothesis that fibromyalgia may be due to thyroid hormone resistance, four major questions appear addressable. First, can a simple biomarker be found to help diagnose it? Second, what other syndromes similar to Fibromyalgia may share a thyroid-resistant nature? Third, in non-genetic cases, how is resistance acquired? Fourth, what other methods of treatment become available through this new understanding? Preliminary evidence suggests that serum hyaluronic acid is a simple, inexpensive, sensitive, and specific test that identifies fibromyalgia. Overlapping symptom complexes suggest that chronic fatigue syndrome, Gulf war syndrome, premenstrual syndrome, post traumatic stress disorder, breast implant silicone sensitivity syndrome, bipolar affective disorder, systemic candidiasis, myofascial pain syndrome, and idiopathic environmental intolerance are similar enough to fibromyalgia to merit investigation for possible thyroid resistance. Acquired resistance may be due most often to a recently recognized chronic consumptive coagulopathy, which itself may be most often associated with chronic infections with mycoplasmids and related microbes or parasites. Other precipitants of thyroid resistance may use this or other paths as well. In addition to experimentally proven treatment with supraphysiologic doses of thyroid hormone, the thyroid-resistant disorders might be treatable with anti-hypercoagulant, anti-infective, insulin-sensitizing, and hyaluronolytic strategies. 727 PMID- 12670665 AU - Geisser ME, Casey KL, Brucksch CB, Ribbens CM, Appleton BB, Crofford LJ TI - Perception of noxious & innocuous heat stimulation among healthy women & women w FM: association w mood, somatic focus, & catastrophizing. SO - Pain 2003 Apr;102(3):243-50. IN - D o Physical Med & Rehabilitation, U o Michigan Health Syst+ AB - +IN: em, Ann Arbor, MI 48109, USA. mgeisser@umich.edu Recent studies have demonstrated that persons with fibromyalgia display abnormal processing of different types of painful stimulation, suggesting the disorder is characterized by a central pain-processing deficit not limited specifically to muscle pain. In the present study, 20 women with fibromyalgia and 20 normal, healthy women were compared on measures of pressure pain stimulation and response to contact thermal heat at both noxious and innocuous intensities. Women with fibromyalgia displayed significantly lower pressure pain thresholds at 18 tender point locations as defined by the American College of Rheumatology criteria, as well as lower pressure pain thresholds at five control sites. Women with fibromyalgia had significantly lower heat pain thresholds and tolerances when stimulated on the volar surface of the left forearm. When examining visual analog ratings of intensity and unpleasantness to constant stimuli, a multivariate analysis of variance performed on these ratings indicated that there were significant main effects of level of stimulation and group. Individual analysis of variances at each temperature revealed significant differences between the groups in pain intensity and unpleasantness ratings at both noxious and innocuous temperatures. Multiple regression analyses indicated that greater pain catastrophizing and diagnosis of fibromyalgia were associated with decreased pain thresholds and tolerances in the entire sample, whereas, self-report of depressive symptoms was associated with increased thresholds and tolerances. Self-report of somatic symptoms was not associated with these measures. These findings indicate that persons with fibromyalgia display altered perception of both pressure and thermal stimulation, even at innocuous levels. They also suggest that catastrophic thoughts about pain may play a role in increased pain perception in this population. 728 PMID- 12950117 AU - Genc H, Saracoglu M, Duyur B, Erdem HR TI - The role of tendinitis in FM syndrome. SO - Yonsei Med J 2003 Aug 30;44(4):619-22. IN - S.B. Ankara Egitim ve Arastirma Hastanesi 2. Fizik Tedavi v+ AB - +IN: e Rehabilitasyon Klinigi, 06340 Cebeci, Ankara, Turkey. hakangenc06@hotmail.com Fibromyalgia Syndrome (FS) is a common disease characterized by diffuse, widespread pain and multiple tender points. The syndrome has been subclassified as primary (PFS) and secondary (SFS) fibromyalgia. The aim of this study was to evaluate the role of common tendinitis (rotator cuff tendinitis, bicipital tendinitis, lateral epicondylitis, De-Quervain's tendinitis and pes anserinus tendinitis) in FS. Twenty female patients with PFS, 20 with SFS and 20 female controls, matched by age and body mass index, participated in the study. Existence of common tendinitis was evaluated with specific examination methods. Right and left rotator cuff tendinitis, pes anserinus tendinitis and left lateral epicondylitis were significantly more common in patients with PFS and SFS than in control subjects. As a result, considering the central hyperexcitability present in the fibromyalgia patients, concomitant pathologies such as tendinitis which lead to shoulder, arm, and leg pain must be evaluated. Follow up and therapy for the disease must be planned according to these factors which are not only probable symptoms of FS, but also leading causes for the occurrence and continuity of the pain in this disease. 729 PMID- 12708966 AU - Georgiades E, Behan WM, Kilduff LP, Hadjicharalambous M, Mackie EE, Wilson J, W+ TI - CFS: new evidence for a central fatigue disorder. SO - Clin Sci (Lond) 2003 Aug;105(2):213-8. IN - Centre for Exercise Science & Med, Inst o Biomedical & Life+ AB - +IN: Sciences, U o Glasgow, Glasgow G12 8QQ, Scotland, UK. +AU: ard SA, Pitsiladis YP Considerable evidence points towards a prominent role for central nervous system (CNS) mechanisms in the pathogenesis of chronic fatigue syndrome (CFS), a disorder characterized chiefly by persistent, often debilitating, fatigue. We wished to characterize circulating profiles of putative amino acid modulators of CNS 5-hydroxytryptamine (5-HT; serotoninergic) and dopaminergic function in CFS patients at rest, as well as during symptom-limited exercise and subsequent recovery. Groups of 12 CFS patients and 11 age- and sex-matched sedentary controls, with similar physical activity histories, underwent ramp-incremental exercise to the limit of tolerance. Plasma amino acid concentrations, oxygen uptake and ratings of perceived exertion were measured at rest, and during exercise and recovery. Peak oxygen uptake was significantly lower in the CFS patients compared with controls. Rating of perceived exertion in the patients was higher at all time points measured, including at rest, relative to controls. Levels of free tryptophan (free Trp), the rate-limiting 5-HT precursor, were significantly higher in CFS patients at exhaustion and during recovery, whereas concentrations of branched-chain amino acids (BCAA) and large neutral amino acids (LNAA) were lower in CFS patients at exhaustion, and for LNAA also during recovery. Consequently, the [free Trp]/[BCAA] and [free Trp]/[LNAA] ratios were significantly higher in CFS patients, except at rest. On the other hand, levels of tyrosine, the rate-limiting dopaminergic precursor, were significantly lower at all time points in the CFS patients. The significant differences observed in a number of key putative CNS 5-HT and dopaminergic modulators, coupled with the exacerbated perception of effort, provide further evidence for a potentially significant role for CNS mechanisms in the pathogenesis of CFS. 730 PMID- 14753387 AU - Gherardi RK, Authier FJ TI - Aluminum inclusion macrophagic myofasciitis: a recently identified condition. SO - Immunol Allergy Clin North Am 2003 Nov;23(4):699-712. IN - Muscle & Nerve Group, Henri Mondor U Hosp, Creteil, France.+ AB - +IN: lauret@univ-paris12.fr The authors conclude that the persistence of aluminum hydroxide at the site of intramuscular injection is a novel finding which has an exact significance that remains to be established fully. It seems mandatory to evaluate possible long-term adverse effects induced by this compound, because this issue has not been addressed (in the past, aluminum hydroxide was believed to be cleared quickly from the body). If safety concerns about the long-term effects of aluminum hydroxide are confirmed, novel and alternative vaccine adjuvants to rescue vaccine-based strategies should be proposed to ensure the enormous benefit for public health that these vaccines provide worldwide. 731 PMID- 14558098 AU - Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clau+ TI - Subgrouping of FM pts on the basis of pressure-pain thresholds & psychological factors. SO - Arthritis Rheum 2003 Oct;48(10):2916-22. IN - U o Michigan, Ann Arbor, USA. AB - +AU: w DJ OBJECTIVE: Although the American College of Rheumatology (ACR) criteria for fibromyalgia are used to identify individuals with both widespread pain and tenderness, individuals who meet these criteria are not a homogeneous group. Patients differ in their accompanying clinical symptoms, as well as in the relative contributions of biologic, psychological, and cognitive factors to their symptom expression. Therefore, it seems useful to identify subsets of fibromyalgia patients on the basis of which of these factors are present. Previous attempts at identifying subsets have been based solely on psychological and cognitive features. In this study, we attempt to identify patient subsets by incorporating these features as well as the degree of hyperalgesia/tenderness, which is a key neurobiologic feature of this illness. METHODS: Ninety-seven individuals meeting the ACR criteria for fibromyalgia finished the same battery of self-report and evoked-pain testing. Analyzed variables were obtained from several domains, consisting of 1) mood (evaluated by the Center for Epidemiologic Studies Depression Scale [for depression] and the State-Trait Personality Inventory [for symptoms of trait-related anxiety]), 2) cognition (by the catastrophizing and control of pain subscales of the Coping Strategies Questionnaire), and 3) hyperalgesia/tenderness (by dolorimetry and random pressure-pain applied at suprathreshold values). Cluster analytic procedures were used to distinguish subgroups of fibromyalgia patients based on these domains. RESULTS: Three clusters best fit the data. Multivariate analysis of variance (ANOVA) confirmed that each variable was differentiated by the cluster solution (Wilks' lambda [degrees of freedom 6,89] = 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.05). One subgroup of patients (n = 50) was characterized by moderate mood ratings, moderate levels of catastrophizing and perceived control over pain, and low levels of tenderness. A second subgroup (n = 31) displayed significantly elevated values on the mood assessments, the highest values on the catastrophizing subscale, the lowest values for perceived control over pain, and high levels of tenderness. The third group (n = 16) had normal mood ratings, very low levels of catastrophizing, and the highest level of perceived control over pain, but these subjects showed extreme tenderness on evoked-pain testing. CONCLUSION: These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood, and a group in whom mood and cognitive factors may be significantly influencing the symptom report. 732 PMID- 12508405 AU - Goldenberg D, Smith N TI - FM, rheumatologists, & the medical literature: a shaky alliance. SO - J Rheumatol 2003 Jan;30(1):151-3 IN - D o Med & Div o Rheumatology, Newton-Wellesley Hosp, Newton+ AB - +IN: , Mass, USA. 733 PMID- 15088284 AU - Goldenberg DL TI - FM: to diagnose or not. Is that still the question? SO - [CON: J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918]; [CON: J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919]; [CON: J Rheumatol. 2003 Aug;30(8):1671-2. PMID: 12913920]; J Rheumatol 2004 Apr;31(4):633-5. 734 PMID- 12735088 AU - Gordon AS, Panahian-Jand M, Mccomb F, Melegari C, Sharp S TI - Characteristics of women w vulvar pain disorders: responses to a Web-based survey. [FM] SO - J Sex Marital Ther 2003;29 Suppl 1:45-58. IN - Wasser Pain Management Centre, Mount Sinai Hosp, 600 U Ave.+ AB - +IN: #1170, Toronto, Ontario, M5G 1X5 Canada. This article presents data contributed by 428 highly educated, internet-savvy women who frequented various vulvar pain discussion lists. The age range was in the reproductive years and older and over 90% were Caucasians. No country of origin was given. They had a number of distressing symptoms, including vulvar pain at rest and with contact, burning, itching, redness, and inflammation. Most felt that they had either vulvar vestibulitis, vulvodynia, or both, although they had other vulvar conditions as well. Many felt that yeast infections, stress, antibiotics, infections, and chemicals played a contributing role. There were a number of comorbidities, including irritable bowel syndrome, fibromyalgia, and interstitial cystitis. Sexual abuse was not a major issue. The vulvar pain destroyed or altered then sex lives, lowered their self-esteem, and affected their relationships. Often, they relied upon understanding partners, support groups, and hobbies but not the medical profession for comfort. 735 PMID- 12913917 AU - Gordon DA TI - FM--real or imagined? SO - J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919; J Rheu+ AB - +SO: matol. 2003 Aug;30(8):1671-2. PMID: 12913920; J Rheumatol. 2003 Aug;30(8):1835-40. PMID: 12913943; J Rheumatol 2003 Aug;30(8):1665. 736 PMID- 12849714 AU - Gracely RH, Grant MA, Giesecke T TI - Evoked pain measures in FM. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):593-609. IN - D o Med, U o Michigan Health System, Ann Arbor VAMC, Ann Ar+ AB - +IN: bor, MI 48109-0483, USA. rgracely@umich.edu Fibromyalgia is defined by widespread pain and tenderness at a minimum of 11 of 18 defined tender points. Current evidence indicates that tender points are not unique to fibromyalgia and are simply regions in the body where all people are more tender. Tenderness (i.e. sensitivity to pressure) is widespread in fibromyalgia rather than being confined to tender points, and patients are also more sensitive to heat, cold and electrical stimulation. Using the number of painful tender points as a measure of tenderness is clinically expedient but is theoretically vulnerable to bias and is influenced by subjective distress. Other means of assessing tenderness (e.g. pressure dolorimeter devices, or more elaborate psychophysical methods) demonstrate the same increased pain sensitivity in fibromyalgia that is noted with tender point assessments, but these measures are relatively independent of biasing factors or distress. Fibromyalgia is one of only a few syndromes defined by the presence of both spontaneous (i.e. clinical) and evoked (i.e. experimental) pain. While the issues associated with the evaluation of spontaneous pain are shared with all chronic pain syndromes, the issues associated with the evaluation of evoked pain sensitivity are specific to fibromyalgia and related musculoskeletal disorders. This chapter focuses on the evaluation of altered pain sensitivity in fibromyalgia. It describes current measurement methodology, briefly reviews studies of sensitivity to experimentally evoked painful and non-painful sensations, analyses the factors assessed by different measurement methodologies, and concludes with recommendations for future diagnostic criteria and measurement methods. 737 PMID- 12849711 AU - Gran JT TI - The epidemiology of chr generalized musculoskeletal pain. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):547-61. IN - D o Rheumatology, Nat Hosp Rikshospitalet, Sognsvannsveien,+ AB - +IN: Oslo, Norway. jan.tore.gran@rikshospitalet.no Chronic widespread musculoskeletal pain has been subjected to several epidemiological studies during the last decade. According to these, approximately 10% of the general population report such complaints, clearly indicating chronic widespread musculoskeletal pain as a major health problem in the Western world. Almost unanimously, all studies found higher rates of such complaints among women compared with men, but the mechanisms responsible for the skewed gender ratio remain unknown.Chronic widespread musculoskeletal pain is the clinical hallmark of fibromyalgia and has been the subject of numerous epidemiological studies. The prevalence of fibromyalgia is reportedly 3-5%, again with a significant female predominance. Although the aetiopathogenesis of both fibromyalgia and chronic widespread musculoskeletal pain without other features of fibromyalgia remains an enigma, there is a body of evidence suggesting psychological and sociocultural factors as important for contracting such pain syndromes. 738 PMID- 12755648 AU - Greenberg PE, Leong SA, Birnbaum HG, Robinson RL TI - The economic burden of depression w painful Sx. [FM] SO - J Clin Psychiatry 2003;64 Suppl 7:17-23. IN - Analysis Group/Economics, Inc., Boston, MA 02199, USA. pgre+ AB - +IN: enberg@analysisgroup.com The economic burden of depression is substantial. The condition is highly prevalent, with both psychiatric and physical symptoms that often inflict pain. The chronic and often debilitating nature of depression results in costly medical therapies, as well as impaired workplace productivity. As a result, the overall economic burden of depression is comparable to that of serious physical illnesses, such as cancer and heart disease. This article presents an overview of the economic burden of depression and provides background on the relationship between depression and pain in this context. Research findings are also presented on the economic burden associated with a particular manifestation of pain among depressed patients, fibromyalgia. When painful physical symptoms accompany the already debilitating psychiatric and behavioral symptoms of depression, the economic burden that ensues for patients and their employers increases considerably. On purely economic grounds, more aggressive outreach may be warranted for patients with depression and comorbid pain to initiate treatment before symptoms are allowed to persist. However, more research is needed to assess the comprehensive economic impact that depression with painful physical symptoms can have on society. 739 PMID- 14689759 AU - Gur H TI - FM: a distinct entity or a biopsychosocial syndrome? SO - Isr Med Assoc J. 2003 Dec;5(12):885-6. PMID: 14689760; Isr + IN - Dept. o Med B, Tel Aviv Sourasky Med Ctr, 6 Weizmann Street+ AB - +SO: Med Assoc J. 2003 Dec;5(12):887-8. PMID: 14689761; Isr Med Assoc J 2003 Dec;5(12):885. +IN: , Tel Aviv 64239, Israel. hanang@tasmc.health.gov.il 740 PMID- 12739038 AU - Gursoy S, Erdal E, Herken H, Madenci E, Alasehirli B, Erdal N TI - Significance of catechol-O-methyltransferase gene polymorphism in FM syndrome. SO - Rheumatol Int 2003 May;23(3):104-7. Epub 2002 Oct 22. IN - D o Physical Med & Rehabilitation, Gaziantep U Med Hosp, 27+ AB - +IN: 00 Kolejtepe Gaziantep, Turkey. savasgursoy@operamail.com Fibromyalgia syndrome (FS) is associated with a neuroendocrinal disorder characterized by abnormal function of the hypothalamic-pituitary-adrenal (HPA) axis, including hyperactive adrenocorticotropic hormone (ACTH) release and adrenal hyporesponsiveness. Catechol-O-methyltransferase (COMT) enzyme inactivates catecholamines and catecholamine-containing drugs. Polymorphism in the gene encodes for the COMT enzyme. For this study, the significance of COMT polymorphism was assessed in FS. There were three polymorphisms of the COMT gene: LL, LH, and HH. The analysis of COMT polymorphism was performed using polymerase chain reaction (PCR). Sixty-one patients with FS and 61 healthy volunteers were included in the study. Although no significant difference was found between LL and LH separately, the LL and LH genotypes together were more highly represented in patients than controls ( P=0.024). In addition, HH genotypes in patients were significantly lower than in the control groups ( P=0.04). There was no significant difference between COMT polymorphism and psychiatric status of the patients as assessed by several psychiatric tests ( P>0.05). In conclusion, COMT polymorphism is of potential pharmacological importance regarding individual differences in the metabolism of catechol drugs and may also be involved in the pathogenesis and treatment of FS through adrenergic mechanisms as well as genetic predisposition to FS. 741 PMID- 12913919 AU - Hadler NM TI - "FM" & the medicalization of misery. SO - J Rheumatol. 2003 Aug;30(8):1835-40. PMID: 12913943; J Rheu+ AB - +SO: matol 2003 Aug;30(8):1668-70. 742 PMID- 14534442 AU - Hadler NM, Ehrlich GE TI - FM & the conundrum of disability determination. SO - J Occup Environ Med 2003 Oct;45(10):1030-3. 743 PMID- 12852256 AU - Hanley NR, Van de Kar LD TI - Serotonin & the neuroendocrine regulation of the hypothalamic--pituitary-adrenal axis in health & disease. SO - Vitam Horm 2003;66:189-255. IN - D o Pharmacology, Ctr for Serotonin Disorders Research, Loy+ AB - +IN: ola U o Chicago, Stritch School o Med, Maywood, Illinois 60153, USA. Serotonin (5-hydroxytryptamine, 5-HT)-containing neurons in the midbrain directly innervate corticotropin-releasing hormone (CRH)-containing cells located in paraventricular nucleus of the hypothalamus. Serotonergic inputs into the paraventricular nucleus mediate the release of CRH, leading to the release of adrenocorticotropin, which triggers glucocorticoid secretion from the adrenal cortex. 5-HT1A and 5-HT2A receptors are the main receptors mediating the serotonergic stimulation of the hypothalamic-pituitary-adrenal axis. In turn, both CRH and glucocorticoids have multiple and complex effects on the serotonergic neurons. Therefore, these two systems are interwoven and communicate closely. The intimate relationship between serotonin and the hypothalamic-pituitary-adrenal axis is of great importance in normal physiology such as circadian rhythm and stress, as well as pathophysiological disorders such as depression, anxiety, eating disorders, and chronic fatigue. 744 PMID- 12927008 AU - Hartz AJ, Bentler SE, Brake KA, Kelly MW TI - The effectiveness of citalopram for idiopathic chr fatigue. SO - J Clin Psychiatry 2003 Aug;64(8):927-35. IN - D o Family Med, U o Iowa Coll o Medicine, Iowa City 52242-1+ AB - +IN: 097, USA. arthur-hartz@uiowa.edu BACKGROUND: Chronic fatigue greatly affects quality of life and is a common reason for physician visits. Patients with chronic fatigue are often treated with antidepressants. METHOD: Prior to enrollment, all subjects had substantial fatigue for 6 months or more that was not explained by depression, organic illness, or lifestyle behaviors. Patients already taking an antidepressant were excluded from the study. Two designs were used. (1) Thirty-one subjects were given placebo for 1 week and then citalopram, 20 to 40 mg/day, for 2 months. Statistical testing evaluated whether fatigue (measured with the Rand Vitality Index) was reduced after citalopram was started. (2) Fatigue changes for subjects taking citalopram were compared with fatigue changes after 1 month and 2 months for 76 similar subjects taking an ineffective treatment. RESULTS: In design 1, fatigue for subjects taking citalopram was significantly and substantially reduced when subjects were switched from placebo to citalopram, p <.05. Benefits at 2 months were greatest for subjects who had fatigue less than 5 years, p <.01, and women, p <.01. In design 2, fatigue scores for subjects taking citalopram were not significantly better than the comparison group for all subjects but were significantly better at 2 months for subjects with less severe fatigue at baseline, p =.005, and for women, p =.08. Depression scores were not significantly better for citalopram subjects overall (p >.10) but were for certain subgroups. For all subjects, citalopram was associated with greater decrease in headaches and muscle aches at 1 month, p <.01. CONCLUSION: Citalopram may improve fatigue and symptoms associated with fatigue for some patients. 745 PMID- 14580073 AU - Hatcher S, House A TI - Life events, difficulties & dilemmas in the onset of CFS: a case-control study. SO - Psychol Med 2003 Oct;33(7):1185-92. IN - Academic Unit o Psychiatry & Behavioural Sciences, School o+ AB - +IN: Med, U o Leeds. BACKGROUND: The role of stress in the onset of chronic fatigue syndrome is unclear. Our objectives in this study were first, to determine the relation between the onset of chronic fatigue syndrome and stressful life events and difficulties. Secondly, we examined the role of a particular type of problem, dilemmas, in the onset of chronic fatigue syndrome. METHOD: We used a case-control design with 64 consecutive referrals from an Infectious Diseases/ Liaison Psychiatry Fatigue clinic and 64 age- and sex-matched controls from a general practice population control group in Leeds. We had two main outcome measures; the odds ratios of the risk of developing chronic fatigue syndrome after experiencing a severe life event, severe difficulties or both in the year and 3 months preceding onset; and the proportion of subjects in each group who experienced a dilemma prior to onset. RESULTS: Patients with chronic fatigue syndrome were more likely to experience severe events and difficulties in the 3 months (OR = 9, 95% CI 3.2 to 25.1) and year (OR = 4.3, 95% CI 1.8 to 10.2) prior to onset of their illness than population controls. In the 3 months prior to onset 19 of the 64 patients (30%) experienced a dilemma compared to none of the controls. CONCLUSIONS: Chronic fatigue syndrome is associated with stressful events and difficulties prior to onset. Those events and difficulties characterized as being dilemmas seem to be particularly important. 746 PMID- 12825734 AU - Hatchette TF, Hayes M, Merry H, Schlech WF, Marrie TJ TI - The effect of C. burnetii infection on the quality of life of pts following an outbreak of Q fever. SO - Epidemiol Infect 2003 Jun;130(3):491-5. IN - Queen Elizabeth II Health Sciences Centre, Dalhousie U, Hal+ AB - +IN: ifax, Nova Scotia, Canada. Sixty-six cases of Q fever were diagnosed in people affiliated with a goat-farming co-operative in rural Newfoundland in the spring of 1999. Follow-up studies which included administration of the Short Form 36 Health Survey (SF-36) were conducted 3 and 27 months after the initial outbreak to prospectively follow the effects of acute Q fever on the quality of life of the participants. Twenty-seven months after the outbreak 51% of those who had Q fever reported persistent symptoms including seven participants whose symptoms had initially resolved 3 months after the outbreak. Individuals with Q fever had significantly lower scores on five of the eight scales in the SF-36 and lower scores in the mental and physical summary scales compared to uninfected controls. Although this supports the hypothesis of a 'post Q fever fatigue syndrome' (QFFS), further study is warranted. 747 PMID- 12649396 AU - Hazemeijer I, Rasker JJ TI - FM & the therapeutic domain. A philosophical study on the origins of FM in a specific social setting. SO - Rheumatology (Oxford) 2003 Apr;42(4):507-15. IN - D o Military Forensic & Social Psychiatry, PO Box 3003, 380+ AB - +IN: 0 DA Amersfoort, The Netherlands. OBJECTIVES: Fibromyalgia has always attracted controversy. Wolfe states that fibromyalgia will always exist regardless of the name given to the syndrome. Hadler describes fibromyalgia as a form of illness behaviour escalated by labelling. However, we believe that fibromyalgia, as other functional somatic syndromes, is not waiting below the surface until it becomes manifest by labelling. METHODS: We developed our hypothesis on the relationship between a specific social setting (called the therapeutic domain) and fibromyalgia using empirical philosophical arguments based on Foucault and Hacking. A therapeutic domain is a real and heterogeneous medical domain in which people, their thoughts and practices, and medical technology in any form coexist and communicate. In this domain blood is aspirated, radiographs are taken and classification criteria are made and applied. It is a domain where patient and therapist have initiated a relationship, which is influenced by the media and political pressure. This results in a looping effect where classification criteria and images give structure to perceptions and form the description for human behaviour; the person thus diagnosed (!) constantly has to grow into the conformity of these classification criteria, which also have to be constantly revised. The fibromyalgia concept becomes manifest in an individual as non-specific aches and pains along with other features. RESULTS: In other times and settings this resulted in analogue syndromes like railway spine, telegraph wrists, neurocirculatory asthenia or perhaps repetitive strain injury. In the application of American College of Rheumatology fibromyalgia classification criteria, labels and medical technology it is possible that invisible experiences manifest themselves in a therapeutic domain. It is not only a phenotype induced by the physician, but in this domain a certain power creates reality making the 'disease' become manifest. CONCLUSION: The only certainty in fibromyalgia is that it is still being diagnosed. For prevention and treatment of fibromyalgia, doctors as well as politicians and media have to start by fundamentally changing the therapeutic domain. In such a renewed setting, fibromyalgia cannot become manifest in an individual and thus fibromyalgia syndrome can no longer exist. A firm public message that symptoms can be psychological in origin to prevent their spread, as Wessely recently stated in the comparable case of mass psychogenic illness, is only a part of the answer. 748 PMID- 12595908 AU - Helbig KJ, Heatley SL, Harris RJ, Mullighan CG, Bardy PG, Marmion BP TI - Variation in immune response genes & chr Q fever. Concepts: preliminary test w post-Q fever fatigue syndrome. [CFS] SO - Genes Immun 2003 Jan;4(1):82-5 AB - Acute primary Q fever is followed by various chronic sequelae. These include subacute Q fever endocarditis, granulomatous reactions in various organs or a prolonged debilitating post-infection fatigue syndrome (QFS). The causative organism, Coxiella burnetii, persists after an initial infection. The differing chronic outcomes may reflect variations within cytokine and accessory immune control genes which affect regulation of the level of persistence. As a preliminary test of the concept we have genotyped QFS patients and controls for gene variants spanning 15 genes and also examined HLA-B and DR frequencies. QFS patients exhibited a significantly increased frequency of HLA-DR-11 compared with controls and also significant differences in allelic variant frequencies within the NRAMP, and IFNgamma genes. These results indicate a possible genetic role in the expression of overt chronic Q fever. Further studies will be undertaken to increase sample sizes, to survey other forms of chronic Q fever and to examine Q fever patients who have recovered without sequelae.Genes and Immunity (2003) 4, 82-85. doi:10.1038/sj.gene.6363912 749 PMID- 12890830 AU - Helliwell PS, Bennett RM, Littlejohn G, Muirden KD, Wigley RD TI - Towards epidemiological criteria for soft-tissue disorders of the arm. SO - Occup Med (Lond) 2003 Aug;53(5):313-9. IN - U o Leeds, Leeds, UK. rr6psh@south-01.novell.leeds.ac.uk AB - BACKGROUND: The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. OBJECTIVES: To establish core variables for classification of the commonest disorders seen in population samples. METHODS: Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. RESULTS: A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. CONCLUSIONS: This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets. 750 PMID- 12883101 AU - Henningsen P, Zimmermann T, Sattel H TI - Medically unexplained physical Sx, anxiety, & depression: a meta-analytic review. SO - Psychosom Med 2003 Jul-Aug;65(4):528-33. IN - D o Psychosomatic Med, U o Heidelberg, Heidelberg, Germany.+ AB - +IN: Peter_henningsen@med.uni-heidelberg.de OBJECTIVE: Our objective was to review and compare, with meta-analytic methods, observational studies on the association of medically unexplained physical symptoms, anxiety, and depression with special emphasis on healthy and organically ill control groups and on different types of symptoms, measures, and illness behavior. METHODS: A search of MEDLINE and PsycLIT/PsycINFO for abstracts from 1980 to April 2001 was performed; principal investigators in the field were contacted and article reference lists were used to retrieve additional relevant articles. Two hundred forty-four studies were included on the basis of consensus ratings if they fulfilled seven of eight inclusion criteria pertaining to diagnostic accuracy and statistical appropriateness. Five hundred twenty-two studies were deferred or excluded. We focused specifically on the four functional somatic syndromes for which there were sufficient numbers for meta-analytic integration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia (FM), and chronic fatigue syndrome (CFS). Data were extracted independently by two authors according to a prespecified coding manual with up to 70 parameters per study. RESULTS: Effect sizes for the association of the four functional somatic syndromes with depression and anxiety were of moderate magnitude but were highly significant statistically when compared with healthy persons and controls with medical disorders of known organic pathology. Moreover, this association was significant whether depression was measured with or without somatic items. Chronic fatigue syndrome is characterized by higher scores of depression, fibromyalgia by lower scores of anxiety than irritable bowel syndrome. Consulting behavior and severity of somatization is related to higher levels of anxiety and depression. CONCLUSIONS: Meta-analytic integration confirms that the four functional somatic syndromes (IBS, NUD, FM, CFS) are related to (but not fully dependent on) depression and anxiety. At present, there is only limited meta-analytic evidence for the same sort of association for medically unexplained physical symptoms in general. In view of the relative independence from depression and anxiety, classification and treatment of these symptoms and syndromes as "common mental disorders" does not seem fully appropriate. 751 PMID- 12817664 AU - Henriksson KG TI - FM--from syndrome to disease. Overview of pathogenetic mechanisms. SO - J Rehabil Med 2003 May;(41 Suppl):89-94. IN - D o Neuroscience & Locomotion Sect o Med Rehabilitation, Fa+ AB - +IN: culty o Health Sciences, Linkoping U, Sweden. karl-g@telia.com According to the classification criteria proposed by the American College of Rheumatology, fibromyalgia is a long-standing multifocal pain condition combined with generalised allodynia/hyperalgesia. It is the generalised allodynia/hyperalgesia that distinguishes fibromyalgia from other conditions with chronic musculoskeletal pain. Central sensitisation of nociceptive neurons in the dorsal horn due to activation of N-methyl-D-aspartic acid receptors and disinhibition of pain due to deficient function of the descending inhibitory system are probable pathogenic factors for allodynia/hyperalgesia. Furthermore, chronic pain is a chronic emotional and physical stressor. Chronic stress and chronic sleep disturbance are not specific for fibromyalgia but could be the causes of symptoms like fatigue, cognitive difficulties and other stress-related symptoms. They may also cause neuroendocrinological and immunological aberrations. 752 PMID- 14604501 AU - Henriksson KG TI - Hypersensitivity in muscle pain syndromes. SO - Curr Pain Headache Rep 2003 Dec;7(6):426-32. IN - D o Rehabilitation Med, Faculty o Health Sciences, Linkopin+ AB - +IN: g University, Pain Clinic, U Hosp, Linkoping, SE-581 85, Sweden. karl-g@telia.com The aim of this review is to present research that has a bearing on the pathogenesis of hypersensitivity in muscle pain syndromes. Allodynia and hyperalgesia in these syndromes can be segmental or generalized and temporary or permanent. Hypersensitivity in muscle pain conditions in the clinic is best diagnosed by determining the pressure pain threshold. In a disorder such as fibromyalgia, decreased pain thresholds also are found at sites where there is no tenderness. Pathogenetic mechanisms for allodynia and hyperalgesia can be identified at several levels of the nociceptive system, from the nociceptors in the muscle to the cortex. Central sensitization of nociceptive neurons in the dorsal horn and a disturbed balance between inhibitory and facilitatory impulses in the descending tracts from the brain stem to the dorsal horn are the main mechanisms for pain hypersensitivity. Changes in function, biochemical make-up, and synaptic connections in the nociceptive neurons in the dorsal horn are considered to be caused by neuronal plasticity. 753 PMID- 12692775 AU - Herpfer I, Lieb K TI - Substance P & Substance P receptor antagonists in the pathogenesis & Rx of affective disorders. SO - World J Biol Psychiatry 2003 Apr;4(2):56-63. IN - D o Psychiatry & Psychotherapy, U o Freiburg, Germany. AB - Substance P (SP) is a neuropeptide which is widely distributed in the periphery and the central nervous system (CNS), where it is co-localised with other neurotransmitters such as serotonin or dopamine and where it acts as a neuromodulator. SP has been proposed to play a role in the aetiopathology of asthma, inflammatory bowel disease, emesis, psoriasis, as well as neuropsychiatric disorders including pain syndromes (e.g. migraine and fibromyalgia) and affective disorders, anxiety disorders, schizophrenia and Alzheimer's disease. This review focuses on the role of SP in the pathogenesis of affective disorders. It summarises the current knowledge on measurements of SP in the CSF and serum in patients with depressive disorders or fibromyalgia, effects of SP-application in humans, SP-receptor expression in postmortem brains and the modulation of SP levels in the course of antidepressant treatment. It also discusses the promise of substance P-receptor antagonists (SPA) for the treatment of affective disorders and their proposed mechanism of action. In summary, much more research is needed to elucidate the role of SP in the pathogenesis of depression. SPA are promising as future drugs for the treatment of affective disorders, but current clinical trials have yet to be completed to draw a firm conclusion. Key words: substance P, neurokinin1-receptor, affective disorders, depression, review. 754 PMID- 12843242 AU - Hoeger-Bement MK, Sluka KA TI - Phosphorylation of CREB & mechanical hyperalgesia is reversed by blockade of the cAMP pathway in a time-dependent manner after repeated intramuscular+ SO - J Neurosci 2003 Jul 2;23(13):5437-45. IN - Graduate Program in Physical Therapy & Rehabilitation Scien+ AB - +TI: acid injections. +IN: ce, Neuroscience Graduate Program, Pain Research Program, U o Iowa, Iowa City, Iowa 52242, USA. Spinal activation of the cAMP pathway produces mechanical hyperalgesia, sensitizes nociceptive spinal neurons, and phosphorylates the transcription factor cAMP-responsive element binding protein (CREB), which initiates gene transcription. This study examined the role of the cAMP pathway in a model of chronic muscle pain by assessing associated behavioral changes and phosphorylation of CREB. Bilateral mechanical hyperalgesia of the paw was induced by administering two injections of acidic saline, 5 d apart, into the gastrocnemius muscle of male Sprague Dawley rats. Interestingly, the increases in immunoreactivity for CREB and phosphorylated CREB (p-CREB) in the spinal dorsal horn occur 24 hr, but not 1 week, after the second injection of acidic saline compared with pH 7.2 intramuscular injections. Spinal blockade of adenylate cyclase prevents the expected increase in p-CREB that occurs after intramuscular acid injection. The reversal of mechanical hyperalgesia by adenylate cyclase or protein kinase A inhibitors spinally follows a similar pattern with reversal at 24 hr, but not 1 week, compared with the vehicle controls. The p-CREB immunoreactivity in the superficial dorsal horn correlates with the mechanical withdrawal threshold such that increases in p-CREB are associated with decreases in threshold. Therefore, activation of the cAMP pathway in the spinal cord phosphorylates CREB and produces mechanical hyperalgesia associated with intramuscular acid injections. The mechanical hyperalgesia and phosphorylation of CREB depend on early activation of the cAMP pathway during the first 24 hr but are independent of the cAMP pathway by 1 week after intramuscular injection of acid. 755 PMID- 12784262 AU - Hokama Y, Uto GA, Palafox NA, Enlander D, Jordan E, Cocchetto A TI - Chronic phase lipids in sera of CFS (CFS), chr ciguatera fish poisoning (CCFP), hepatitis B, & cancer w antigenic epitope resembling ciguatoxin, as a+ SO - J Clin Lab Anal 2003;17(4):132-9. IN - D o Pathology, U o Hawaii-Manoa, Honolulu, Hawaii 96822, US+ AB - +TI: ssessed w MAb-CTX. +IN: A. yoshitsu@hawaii.edu Clinical reports and descriptions of chronic fatigue syndrome (CFS) and chronic ciguatera fish poisoning (CCFP) show great similarities in clinical symptomology. These similarities in the literature suggested the exploration of lipids in sera of CFS, CCFP, and other diseases with the membrane immunobead assay (MIA), which is typically used for screening ciguateric ocean fish. Sera from patients with other diseases, including hepatitis B, cancer, and diabetes, were included to assess the degree of specificity involved. Sera were treated with acetone in a ratio of 1 part serum to 4 parts acetone. The suspension was centrifuged, and the acetone layer was evaporated. The residue was weighed and redissolved in 1.0 mL methanol and tested by the MIA, undiluted and titered to 1:160. The undiluted acetone fraction of the 37 normal showed +/- activity to +activity with 16 no titer, 15 with 1:5 titer and two with 1:10 titer, and four with > or =1:40 titers. One hundred fifteen CFS sera showed 1 with 1+ and 114 with 2+ activity in the undiluted samples, 1 with 1:10 titer, 3 with 1:20 titer, 31 with 1:40 titer, 50 with 1:80 titer, and 30 with 160 titer. Thus 95.6% of the samples had > or =1:40 titer. Eight hepatitis B sera samples had > or =1:40 titers. Four CCFP samples had > or =1:40 titers. Three of 16 cancer samples had 1:40 titer. These data are summarized in Fig. 1. As shown in Table 1, a significant increase (P<0.001) in the chronic phase lipids (CPLs) was shown relative to the normal group. A preliminary chemical study in C18 octadecylsilyl columns showed all fractions (100% chloroform, 9:1 chloroform : methanol, 1:1 chloroform : methanol, and 100% methanol) to contain lipids reactive to MAb-CTX with different intensities. Prostaglandins were shown in 100% methanol fraction. Competitive MIA with crude fish ciguatoxin and CFS with synthetic JKLM ciguatoxin epitope suggested similarities in structure with ciguatoxin. This was compatible with the neuroblastoma assay demonstrated in the C(18) column fractions 9:1 and 1:1, chloroform : methanol solvents. 756 PMID- 12849718 AU - Holdcraft LC, Assefi N, Buchwald D TI - Complementary & alternative medicine in FM & related syndromes. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):667-83. IN - D o Psychiatry & Behavioral Sciences, Harborview Med Ctr, U+ AB - +IN: o Washington School o Med, Box 359797, 325 Ninth Ave, Seattle, WA 98104-2499, USA. holdcraf@u.washington.edu Complementary and alternative medicine (CAM) has gained increasing popularity, particularly among individuals with fibromyalgia syndrome (FMS) for which traditional medicine has generally been ineffective. A systematic review of randomized controlled trials (RCTs) and non-RCTs on CAM studies for FMS was conducted to evaluate the empirical evidence for their effectiveness. Few RCTs achieved high scores on the CONSORT, a standardized evaluation of the quality of methodology reporting. Acupuncture, some herbal and nutritional supplements (magnesium, SAMe) and massage therapy have the best evidence for effectiveness with FMS. Other CAM therapies have either been evaluated in only one RCT with positive results (Chlorella, biofeedback, relaxation), in multiple RCTs with mixed results (magnet therapies), or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins, dietary modifications). Lastly, other CAM therapies have neither well-designed studies nor positive results and are not currently recommended for FMS treatment (chiropractic care). 757 PMID- 12560693 AU - Holmich LR, Kjoller K, Fryzek JP, Hoier-Madsen M, Vejborg I, Conrad C, Sletting+ TI - Self-Reported Diseases & Sx by Rupture Status among Unselected Danish Women w Cosmetic Silicone Breast Implants. [FM] SO - Plast Reconstr Surg 2003 Feb;111(2):723-32 AB - +AU: S, McLaughlin JK, Breiting V, Friis S Epidemiologic evidence does not support an association between silicone breast implants and connective tissue or other rheumatic diseases. However, a recent study has suggested that women with ruptured implants may be at increased risk of developing fibromyalgia. An analysis of adverse health outcomes according to breast implant rupture status was conducted in 238 unselected Danish women with cosmetic silicone breast implants. Ninety-two of the women had definite implant rupture, and 146 had intact implants as determined by magnetic resonance imaging. Before undergoing imaging, the women provided blood samples and completed a self-administered questionnaire. Women with ruptured implants overall, and the subgroup with extracapsular ruptures ( = 23), were compared with women with intact implants regarding a number of self-reported diseases and symptoms and the presence of specific autoantibodies, such as antinuclear antibodies, rheumatoid factor, and cardiolipin immunoglobulin G and M antibodies. Overall, there were no differences in the occurrence of self-reported diseases or symptoms or in the presence of autoantibodies between women with intact implants and women with ruptured implants, including extracapsular rupture. The only exception was capsular contracture, which was reported six times more frequently by women with extracapsular ruptures than by women with intact implants (OR, 6.3; 95 percent CI, 1.7 to 23.5). In conclusion, this study of unselected women with silicone breast implants could establish no association between silicone implant rupture and specific diseases or symptoms related to connective tissue disease or other rheumatic conditions, except for an excess of capsular contracture among women with extracapsular rupture. 758 PMID- 12919460 AU - Horwitz EB, Theorell T, Anderberg UM TI - FM pts' own experiences of video self-interpretation: a phenomenological-hermeneutic study. SO - Scand J Caring Sci 2003 Sep;17(3):257-64. IN - D o Public Health & Caring Sciences, Ctr for Environmental + AB - +IN: ill health & Stress, Uppsala U & U Hosp, Uppsala, Sweden. eva.bojner@stockholm.mail.telia.com Fibromyalgia syndrome (FMS) is a disorder with musculoskeletal pain as well as many other psychological and physical symptoms. Up-to-date treatment strategies for this disorder often have only limited effects. In order to develop more effective and adequate treatment tools, a phenomenological-hermeneutic study inspired by Paul Ricoeur was used. FMS patients viewed themselves on videotapes. After the video sessions the FMS patients were interviewed about thoughts that were triggered when they saw themselves on videotape. Video interpretation in combination with interviews facilitated a communication and understanding between the patient and therapist about the patients' body and self-image. The results showed that with the help of video interpretation, the patients' body and self-awareness could be improved, which in turn may help therapists to find better treatment tools for a more directed and individually adapted treatment. This is of importance as this method can be useful to FMS patients for early identification of maladaptive movement patterns and for a better integration their body and self-image. By allowing the FMS patients to interpret themselves from videotape, the FMS patients become more aware of both body and self-signals, which make it easier for the clinician/therapist to know where to start to work with each patients' specific rehabilitation programme. 759 PMID- 12941061 AU - Hossain JL, Reinish LW, Kayumov L, Bhuiya P, Shapiro CM TI - Underlying sleep pathology may cause chr high fatigue in shift-workers. SO - J Sleep Res 2003 Sep;12(3):223-30. IN - Sleep Research Laboratory, Toronto Western Hosp, U Health N+ AB - +IN: etwork, Toronto, Ontario, Canada. jamil.hossain@utoronto.ca About 20-25% of the population in primary healthcare settings complains of chronic fatigue but this symptom has been under-emphasized compared with sleepiness in clinical practice. Shift-workers are particularly vulnerable because of various fatigue-related personal and public morbidity and mortality. The goal of this cross-sectional study was to explore if fatigue severity could be used as an independent predictive tool to identify underlying sleep pathology. The 21 most-fatigued (study group) and 23 least-fatigued (control) miners were selected on the basis of the Fatigue Severity Scale (FSS), which was administered to 195 subjects in an underground mine in Timmins, a town in northern Ontario. The two groups were matched for age, gender, and body mass index (BMI). Mean FSS score for the most-fatigued subjects was 4.9 +/- 0.5 and the least-fatigued was 2.2 +/- 0.5 (P < 0.0001). The subjects from each group were studied polysomnographically to identify sleep disorders. The polysomnographic data in 15 of 21 (71.4%) of the most-fatigued subjects displayed significant sleep pathology compared with only three of 23 (13.0%) in the least-fatigued subjects. Based on Fisher's exact test, the difference between the two groups was highly significant (P < 0.0001). Also, in the total subject pool (n = 195), the correlation between subjective fatigue and sleepiness was not very strong (Pearson's r = 0.45), suggesting that these two symptoms can be independent phenomena. It is concluded that chronic high fatigue can be an independent manifestation of underlying sleep pathology, which warrants independent subjective and objective assessment. 760 PMID- 12578434 AU - Hudson JI, Mangweth B, Pope HG Jr, De Col C, Hausmann A, Gutweniger S, Laird NM+ TI - Family study of affective spectrum disorder. [FM] SO - Arch Gen Psychiatry 2003 Feb;60(2):170-7 IN - McLean Hosp, 115 Mill St, Belmont, MA 02478. jhudson@mclean+ AB - +IN: .harvard.edu +AU: , Biebl W, Tsuang MT BACKGROUND: Affective spectrum disorder (ASD) represents a group of psychiatric and medical conditions, each known to respond to several chemical families of antidepressant medications and hence possibly linked by common heritable abnormalities. Forms of ASD include major depressive disorder (MDD), attention-deficit/hyperactivity disorder, bulimia nervosa, cataplexy, dysthymic disorder, fibromyalgia, generalized anxiety disorder, irritable bowel syndrome, migraine, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and social phobia. Two predictions of the ASD hypothesis were tested: that ASD, taken as a single entity, would aggregate in families and that MDD would coaggregate with other forms of ASD in families. METHODS: Probands with and without MDD, together with their first-degree relatives, were interviewed using the Structured Clinical Interview for DSM-IV and a supplemental interview for other forms of ASD. The familial aggregation and coaggregation of disorders were analyzed using proband predictive logistic regression models, including a novel bivariate model for the presence or absence of each of 2 disorders in a relative as predicted by the presence or absence of each of 2 disorders in the associated proband. RESULTS: In the 178 interviewed relatives of 64 probands with MDD and 152 relatives of 58 probands without MDD, the estimated odds ratio (95% confidence interval) for the familial aggregation of ASD as a whole was 2.5 (1.4-4.3; P =.001) and for the familial coaggregation of MDD with at least one other form of ASD was 1.9 (1.1-3.2; P =.02). CONCLUSIONS: Affective spectrum disorder aggregates strongly in families, and MDD displays a significant familial coaggregation with other forms of ASD, taken collectively. These results suggest that forms of ASD may share heritable pathophysiologic features. 761 PMID- 12782744 AU - Huibers MJ, Beurskens AJ, Prins JB, Kant IJ, Bazelmans E, Van Schayck CP, Knott+ TI - Fatigue, burnout, & CFS among employees on sick leave: do attributions make the difference? SO - Occup Environ Med 2003 Jun;60 Suppl 1:i26-31. IN - D o Epidemiology, Maastricht U, Netherlands. marcus.huibers+ AB - +IN: @hag.unimaas.nl +AU: nerus JA, Bleijenberg G BACKGROUND: Persistent fatigue among employees, burnout, and chronic fatigue syndrome (CFS) are three fatigue conditions that share some characteristics in theory. However, these conditions have not been compared in empirical research, despite conceptual similarities. METHODS: This cross sectional study aimed to investigate relations between persistent fatigue, burnout, and CFS by describing the clinical features of a sample of 151 fatigued employees on sick leave. Using validated instruments, subgroups based on research criteria for CFS and burnout within the sample of fatigued employees and a reference group of 97 diagnosed CFS patients were compared. Analyses of covariance were performed. RESULTS: A total of 66 (43.7%) fatigued employees met research criteria for CFS (except symptom criteria) and 76 (50.3%) met research criteria for burnout. "CFS-like employees" (fatigued employees who met CFS criteria) reported stronger somatic attributions than "non-CFS-like employees". Burnt out CFS-like employees were more depressed and distressed than CFS-like employees who were not burnt out. Burnout cases among the non-CFS-like employees had stronger psychological attributions than fatigued employees who were not burnt out. Compared to diagnosed CFS patients, CFS-like employees merely had a shorter duration of fatigue complaints. Burnt out CFS-like employees had stronger psychological attributions and were more distressed than CFS patients. CONCLUSIONS: Fatigued employees shared many important characteristics with CFS patients, regardless of burnout status, and many fatigued employees met CFS criteria and/or burnout criteria. Differences however concerned the causal attributions that were made. This raises questions about the role of causal attributions: are they modified by fatigue complaints or do they determine illness outcome? 762 PMID- 12710915 AU - Hyams KC TI - The investigation of CFS: a case-study of the limitations of inductive inferences & non-falsifiable hypotheses in medical research. SO - Med Hypotheses 2003 May;60(5):760-6. IN - D o Veterans Affairs, Office o Public Health & Environmenta+ AB - +IN: l Hazards, Washington, DC, USA. hyams@paol.com Karl Popper's argument that deductive logic and falsifiable hypotheses are necessary for the growth of scientific knowledge has been controversial. One approach to assess the relevance of his ideas to medical science has been to evaluate examples of successful research. Another approach is to analyze an unsuccessful investigation. The inconclusive search for a unique 'chronic fatigue syndrome' offers a well-documented case-study for this analysis. Over the past 130 years, numerous studies have provided clinical and epidemiological data, which have supported competing hypotheses about the etiology of chronic fatigue. However, few hypotheses have been refuted because it has not been possible to establish objective standards of inquiry for a subjective symptom like fatigue. As a result, intensive research efforts have not converged on correct explanations by eliminating erroneous ideas. This unsuccessful investigation illustrates how non-falsifiable hypotheses are insufficient to advance medical knowledge, even when there is an abundance of empirical data. 763 PMID- 14554250 AU - Ikuta K, Yamada T, Shimomura T, Kuratsune H, Kawahara R, Ikawa S, Ohnishi E, So+ TI - Diagnostic evaluation of 2', 5'-oligoadenylate synthetase activities & antibodies against Epstein-Barr virus & Coxiella burnetii in pts w CFS in Japa+ SO - Microbes Infect 2003 Oct;5(12):1096-102. IN - Division o Biosignaling, D o Biomedical Sciences, Faculty o+ AB - +TI: n. +IN: Med, School o Life Science, Tottori U, Yonago 683-8503, Japan. +AU: kawa Y, Fukushi H, Hirai K, Watanabe Y, Kurata T, Kitani T, Sairenji T To investigate the association of viral infections with chronic fatigue syndrome (CFS), we assayed 2', 5'-oligoadenylate synthetase (2-5AS) activities in peripheral blood mononuclear cells from CFS patients in Japan. These patients were diagnosed in two hospitals, H1 and H2, located in different areas of the country. The activities were detected in 19 (86%) and 7 (32%) of each of the 22 patients in H1 and H2, respectively, while they were detected in only four (11%) out of the 38 healthy controls. IFN-alpha was similarly detected in a few CFS patients and healthy controls. We also assayed the antibody titers against Epstein-Barr virus (EBV) and Coxiella burnetii in these patients. The EBV anti-EA-IgG antibodies were detected in two (9%) and seven (32%) of each of the 22 patients in H1 and H2, respectively. Anti-C. burnetii IgG antibodies were detected in six (27%) out of 22 patients in H1 but not in 22 patients in H2, while they were detected in one (11%) of the nine healthy controls. Some CFS patients may be associated with EBV or C. burnetii infection. There were some statistical correlations between the 2-5AS activities and antibody titers of EA-IgG (P < 0.05, Student's t-test) but not to the antibody titers of C. burnetii. The up-regulation of 2-5AS activities suggests immunological dysfunctions with some virus infections in the CFS patients. Our results indicate that 2-5AS activities are useful for a diagnostic marker of CFS and for exploring the complicated pathogenesis of CFS. 764 PMID- 12600792 AU - Imbierowicz K, Egle UT TI - Childhood adversities in pts w FM & somatoform pain disorder. SO - Eur J Pain 2003;7(2):113-9. IN - D o Psychotherapy & Psychosomatics, U Hosp Bonn, Bonn, Germ+ AB - +IN: any. Primary fibromyalgia is regarded as disorder with a complex symptomatology, and no morphological alterations. Findings increasingly point to a dysfunction of the central nervous pain processing. The study aims to discuss vulnerability for fibromyalgia from a developmental psychopathological perspective. We investigated the presence of psychosocial adversities affecting the childhood of adult fibromyalgia patients (FM) and compared them to those of patients with somatoform pain disorders (SOM) and a control group (CG) with medically explained chronic pain. Using the structured biographical interview for pain patients (SBI-P), 38 FM patients, 71 SOM patients, and 44 CG patients were compared on the basis of 14 childhood adversities verified as relevant regarding longterm effects for adult health by prospective studies. The FM patients show the highest score of childhood adversities. In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parents' physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7. These experiences were found to a similar extent in the SOM patients, but distinctly less frequently in the CG. The results point to early psychosocial adversities as holding a similar etiological meaning in fibromyalgia as well as in somatoform pain disorders. The potential role of these factors as increasing the vulnerability for fibromyalgia is discussed. 765 PMID- 12627607 AU - Jason LA, Taylor RR, Kennedy CL, Jordan KM, Song S, Johnson D, Torres-Harding S TI - CFS: Sx subtypes in a community based sample. SO - Women Health 2003;37(1):1-13. IN - Center for Community Research, DePaul U, Chicago, IL 60614,+ AB - +IN: USA. ljason@wppost.depaul.edu Most studies of Chronic Fatigue Syndrome (CFS) have been based on patients recruited from primary or tertiary care settings. Patients from such settings might not be typical of patients in the general population. The present investigation involved examining individuals with CFS from a community-based study. A random sample of 18,675 respondents in Chicago were first interviewed by telephone. A group of individuals with chronic fatigue accompanied by at least four Fukuda et al. (1994) symptoms associated with CFS were given medical and psychiatric examinations. From this sample, a physician review group diagnosed individuals with CFS. Those diagnosed with CFS were subclassified based on frequency of symptoms. Important differences emerged on measures of sociodemographics and disability. The implications of these findings and others are discussed. 766 PMID- 12629919 AU - Jason LA, Helgerson J, Torres-Harding SR, Carrico AW, Taylor RR TI - Variability in diagnostic criteria for CFS may result in substantial differences in patterns of Sx & disability. SO - Eval Health Prof 2003 Mar;26(1):3-22. IN - Center for Community Research, DePaul U, 990 W. Fullerton A+ AB - +IN: ve., Chicago, IL 60614, USA. Chronic fatigue syndrome (CFS) is an illness that involves severe, prolonged exhaustion as well as neurologic, immunologic, and endocrine system pathology. Because the pathogenesis of CFS has yet to be determined, case definitions have relied on clinical observation in classifying signs and symptoms for diagnosis. The current investigation examined differences between CFS as defined by Fukuda and colleagues and a set of criteria that has been stipulated for myalgic encephalomyelitis (ME). Dependent measures included psychiatric comorbidity, symptom frequency, symptom severity, and functional impairment. The ME and Fukuda et al. (1994) CFS criteria were compared with a group having chronic fatigue due to psychiatric reasons. Significant differences occurred primarily with neurologic, neuropsychiatric, fatigue/weakness, and rheumatological symptoms. These findings suggest that it might be inappropriate to synthesize results from studies of this illness that use different definitions to select study populations. 767 PMID- 12892250 AU - Jensen B, Wittrup IH, Bliddal H, Danneskiold-Samsoe B, Faber J TI - Bone mineral density in FM pts--correlation to disease activity. SO - Scand J Rheumatol 2003;32(3):146-50. IN - Parker Inst, Frederiksberg Hosp, Copenhagen, Denmark. Bjens+ AB - +IN: en@aab11.dk OBJECTIVE: To compare bone mass (BMD) in women with fibromyalgia (FM) with healthy females, and to evaluate whether self-reported pain and lack of functional capacity correlate to reduced BMD in FM patients. METHODS: Thirty-one FM patients (20 pre- and 11 postmenopausal) and fourty-one healthy women (30 pre- and 10 postmenopausal) were enrolled in the study. BMD of the lumbar spine and the femoral neck was measured by a DEXA (Norland) scanner. Self reported pain was measured on a Visual Analog Scale (VAS). The Activity of Daily Living (ADL) component of the Fibromyalgia Impact Questionnaire (FIQ-ADL) was used as measure for physical capacity. RESULTS: BMD-lumbar spine and BMD-femoral neck did not differ significantly between FM patients and controls, though premenopausal FM patients tended to have lower BMD-femoral neck (p = 0.09). Self reported pain and FIQ-ADL among FM patients correlated with BMD-femoral neck (r(s) = -0.52, p = 0.003); (r(s) = -0.31, p = 0.09). CONCLUSION: Premenopausal FM patients tended to have lower BMD of hip than controls. Self reported pain correlated negatively to BMD. Thus, the severity of FM might have a negative impact on bone mass. 768 PMID- 12927625 AU - Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML TI - Readiness to self-manage pain is associated w coping & w psychological & physical functioning among pts w chr pain. SO - Pain 2003 Aug;104(3):529-37. IN - D o Rehabilitation Med, P.O. Box 356490, U o Washington Sch+ AB - +IN: ool o Medicine, Seattle, WA 98195-6490, USA. mjensen@u.washington.edu A patient's readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed. 769 PMID- 14505280 AU - Kagawa FT, Wehner JH, Mohindra V TI - Q fever as a biological weapon. SO - Semin Respir Infect 2003 Sep;18(3):183-95. IN - Santa Clara Valley Med Ctr, San Jose, CA 95128, USA. Frank.+ AB - +IN: Kagawa@hhs.co.santa-clara.ca.us Q fever is a bacterial zoonosis caused by Coxiella burnetii, a unique intracellular coccobacillus, adapted to live within the phagolysosomes of macrophages and monocytes. It is highly infectious, with as little as one organism needed to cause clinical infection, making it an attractive organism for use in biowarfare. Despite its high infectivity, it has low virulence, and most patients undergo only asymptomatic seroconversion. Acute clinical manifestations are a nonspecific febrile illness, pneumonia, hepatitis, and neurologic abnormalities ranging from headache to meningoencephalitis. Chronic Q fever can result in endocarditis, hepatitis, or a chronic fatigue syndrome. Diagnosis usually is made by serology because culture of the highly contagious organism is potentially hazardous. Tetracyclines are the antibiotics of choice. When individualized therapy is possible, a 14- to 21-day course of doxycycline usually is used. In a mass casualty situation, a 5- to 7-day course of doxycycline is recommended, both for therapy and prophylaxis. For chronic infections such as endocarditis, 18 months of doxycycline supplemented with hydroxychloroquine is currently the best therapy. 770 PMID- 14527077 AU - Kakumanu SS, Mende CN, Lehman EB, Hughes K, Craig TJ TI - Effect of topical nasal corticosteroids on pts w CFS & rhinitis. SO - J Am Osteopath Assoc 2003 Sep;103(9):423-7. IN - Division o Biology & Med, Brown MS, Brown U, Providence, RI+ AB - +IN: , USA. BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling illness of persistent fatigue. Recent studies have shown that patients with CFS have an increased prevalence of nonallergic rhinitis. Inflammation of the nasal passages due to allergic rhinitis can cause nasal congestion resulting in an increased number of sleep disturbances and daytime fatigue. While topical nasal corticosteroids have been shown to alleviate nasal obstruction effectively in patients with rhinitis who do not have CFS, it is unknown whether topical nasal corticosteroids will reduce CFS symptoms. STUDY OBJECTIVE: The purpose of this study is to determine whether topical nasal corticosteroids will reduce daytime sleepiness in patients with CFS and rhinitis. METHODS: Twenty-eight of 31 subjects with rhinitis and a diagnosis of CFS completed the double-blind, randomized, placebo-controlled trial. Two subjects failed screening, and 3 subjects withdrew from the study prior to its completion. Subjects were randomized according to Balaam's crossover design, and one of the following interventions was used for each group in the study: 8-week treatment with a topical nasal corticosteroid, 8-week treatment with a placebo saline spray, 4-week treatment with a topical nasal corticosteroid followed by a 4-week treatment with a placebo saline spray, or a 4-week treatment with a placebo saline spray followed by a 4-week treatment with a topical nasal corticosteroid. Data focusing on rhinitis symptoms, severity of chronic fatigue symptoms, and quality of life were gathered at biweekly office visits and with daily diaries. RESULTS: The results indicated that daytime sleepiness was reduced when patients with rhinitis and CFS were treated with topical nasal corticosteroids. The severity of associated CFS symptoms, specifically fatigue, muscle pain, postexertional fatigue, and daily activity, did not improve with treatment. CONCLUSION: Treating the symptoms of rhinitis in patients with CFS does not appear to alleviate daytime fatigue or associated nasal, musculoskeletal, or cognitive complaints. Therefore, it is unlikely that aggressive treatment of such symptoms with topical nasal corticosteroids will provide significant benefit to patients with CFS who do not have allergic rhinitis. These results indicate that the nonallergic rhinitis seen in patients with CFS may arise from a mechanism other than chronic inflammation. 771 PMID- 12522021 AU - Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM TI - Post-traumatic stress disorder & CFS-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. SO - Am J Epidemiol 2003 Jan 15;157(2):141-8 IN - Veterans Health Administration, D o Veterans Affairs, Washi+ AB - +IN: ngton, DC, USA. han.kang@mail.va.gov The authors estimated the prevalence of post-traumatic stress disorder (PTSD) and illness resembling chronic fatigue syndrome (CFS) in the entire population of Gulf War and non-Gulf-War veterans. They also evaluated the relation between the extent of deployment-related stress and the risk of either PTSD or CFS. In 1995-1997, the authors conducted a health survey in which these two symptom-based medical diagnoses in a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared with those of 15,000 non-Gulf veteran controls. Gulf War veterans, compared with non-Gulf veteran controls, reported significantly higher rates of PTSD (adjusted odds ratio = 3.1, 95% confidence interval: 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval: 3.9, 5.9). The prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend: p < 0.01), while the prevalence of CFS rose only at the low end of the stress spectrum. While deployment-related stress could account for the higher risks of both PTSD and CFS, additional factor(s) unique to the Gulf environment may have contributed to the risk of CFS among Gulf War veterans. 772 PMID- 14501305 AU - Karper WB, Stasik SC TI - A successful, long-term exercise program for women w FM syndrome & chr fatigue & immune dysfunction syndrome. SO - Clin Nurse Spec 2003 Sep;17(5):243-8. IN - U o North Carolina at Greensboro, PO Box 26170, Greensboro,+ AB - +IN: NC 27402, USA. wbkarper@uncg.edu This article describes an ongoing, long-term clinical exercise program for women with fibromyalgia syndrome (FMS), some of whom also have chronic fatigue and immune dysfunction syndrome (CFIDS). The recorded outcomes from the most recent year of the program also are reported. Participants engaged in sessions lasting 50-70 minutes, 5 days per week; each session involved aerobic activity, resistance training, and other dynamic exercise. One group was in the program for 3 years and another group was in the program for 2 years. Program outcomes for the year (comparing beginning and end-of-year results) are presented for both groups on physical fitness, psychosocial, and FMS/CFIDS symptoms. The outcomes support that all of the women appear to have benefited from the program in numerous ways, suggesting that the program works. Also, those outcomes are in agreement with past research reported in this journal. Implications for clinical nurse specialists working with FMS/CFIDS patients are discussed. 773 PMID- 12715326 AU - Kerr JR, Cunniffe VS, Kelleher P, Bernstein RM, Bruce IN TI - Successful intravenous immunoglobulin therapy in 3 cases of parvovirus B19-associated CFS. SO - Clin Infect Dis 2003 May 1;36(9):e100-6. IN - D o Microbiology, Royal Brompton Hosp, Imperial Coll London+ AB - +IN: , Sydney St, London SW3 6NP, United Kingdom. j.kerr@imperial.ac.uk Three cases of chronic fatigue syndrome (CFS) that followed acute parvovirus B19 infection were treated with a 5-day course of intravenous immunoglobulin (IVIG; 400 mg/kg per day), the only specific treatment for parvovirus B19 infection. We examined the influence of IVIG treatment on the production of cytokines and chemokines in individuals with CFS due to parvovirus B19. IVIG therapy led to clearance of parvovirus B19 viremia, resolution of symptoms, and improvement in physical and functional ability in all patients, as well as resolution of cytokine dysregulation. 774 PMID- 12950326 AU - Khan F, Spence V, Kennedy G, Belch JJ TI - Prolonged acetylcholine-induced vasodilatation in the peripheral microcirculation of pts w CFS. SO - Clin Physiol Funct Imaging 2003 Sep;23(5):282-5. IN - Vascular Diseases Research Unit, U D o Med, Ninewells Hosp + AB - +IN: & MS, Dundee, UK. f.khan@dundee.ac.uk Although the aetiology of chronic fatigue syndrome (CFS) is unknown, there have been a number of reports of blood flow abnormalities within the cerebral circulation and systemic blood pressure defects manifesting as orthostatic intolerance. Neither of these phenomena has been explained adequately, but recent reports have linked cerebral hypoperfusion to abnormalities in cholinergic metabolism. Our group has previously reported enhanced skin vasodilatation in response to cumulative doses of transdermally applied acetylcholine (ACh), implying an alteration of peripheral cholinergic function. To investigate this further, we studied the time course of ACh-induced vasodilatation following a single dose of ACh in 30 patients with CFS and 30 age- and gender-matched healthy control subjects. No differences in peak blood flow was seen between patients and controls, but the time taken for the ACh response to recover to baseline was significantly longer in the CFS patients than in control subjects. The time taken to decay to 75% of the peak response in patients and controls was 13.7 +/- 11.3 versus 8.9 +/- 3.7 min (P = 0.03), respectively, and time taken to decay to 50% of the peak response was 24.5 +/- 18.8 versus 15.1 +/- 8.9 min (P = 0.03), respectively. Prolongation of ACh-induced vasodilatation is suggestive of a disturbance to cholinergic pathways, perhaps within the vascular endothelium of patients with CFS, and might be related to some of the unusual vascular symptoms, such as hypotension and orthostatic intolerance, which are characteristic of the condition. 775 PMID- 12701343 AU - Khouzam HR, Emes R, Gill T, Raroque R TI - The antidepressant sertraline: a review of its uses in a range of psychiatric & medical conditions. SO - Compr Ther 2003 Spring;29(1):47-53. IN - Chemical Dependency Treatment Program, VA Central Californi+ AB - +IN: a Health Care System (VACCHCS), U o California, San Francisco MS, Med Education Program, Fresno, California, USA. Although sertraline was initially introduced as an antidepressant, it can be prescribed for a wide range of psychiatric and medical conditions. We review the pharmacology, the adverse effects, the dosing guidelines, as well as the indications of sertraline. 776 PMID- 12534357 AU - Kizildere S, Gluck T, Zietz B, Scholmerich J, Straub RH TI - During a corticotropin-releasing hormone test in healthy subjects, administration of a beta-adrenergic antagonist induced secretion of cortisol &[FM]+ SO - Eur J Endocrinol 2003 Jan;148(1):45-53 IN - D o Internal Med I, U Hosp o Regensburg, 93042 Regensburg, + AB - +TI: dehydroepiandrosterone sulfate & inhibited secretion of ACTH. +IN: Germany. OBJECTIVE: In chronic inflammatory diseases, serum levels of dehydroepiandrosterone (DHEA) sulfate (DHEAS) are low. Interestingly, several non-inflammatory diseases display similarly low levels of DHEAS which points to other inhibitory factors such as an activated sympathetic nervous system (SNS) (e.g. in patients with heart failure, fibromyalgia, or cancer cachexia). We aimed to identify the influence of the SNS tone on stimulated adrenal steroid secretion in 16 male and 12 female healthy subjects. METHODS: One group were given oral propranolol 2 h before a corticotropin-releasing hormone (CRH) test, and levels of adrenocorticotropin (ACTH), cortisol, 17-hydroxyprogesterone (17OHP), androstenedione, DHEA, and DHEAS were measured. RESULTS: Propranolol treatment decreased heart rate (by 20%), diastolic blood pressure (by 20%), and plasma ACTH, and increased serum cortisol, serum DHEAS, and the molar ratio of cortisol/17OHP, cortisol/DHEA, and DHEAS/DHEA similarly in female and male subjects. CONCLUSIONS: A beta-adrenergic influence seems to decrease CRH-stimulated cortisol in relation to ACTH and 17OHP, and decreases DHEAS in relation to DHEA. Although other workers have found beta-adrenergic stimulation of steroid secretion in cultured adrenocortical cells, the overall systemic influence of the SNS via beta-adrenoceptors seems to inhibit adrenal steroids under unstimulated and stimulated conditions. Sympathetic hyperactivity may be a common denominator for low levels of DHEAS in inflammatory and non-inflammatory diseases. 777 PMID- 12830308 AU - Kroenke K TI - Pts presenting w somatic complaints: epidemiology, psychiatric comorbidity & management. SO - Int J Methods Psychiatr Res 2003;12(1):34-43. IN - D o Med & Regenstrief Inst for Health Care, Indiana U Schoo+ AB - +IN: l o Medicine, Indianapolis, USA. kkroenke@regenstrief.org Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms. 778 PMID- 12745627 AU - Kurup RK, Kurup PA TI - Hypothalamic digoxin, cerebral chemical dominance & ME. SO - Int J Neurosci 2003 May;113(5):683-701. IN - D o Neurology, Med Coll Hosp, Trivandrum, Kerala, India. AB - The isoprenoid pathway was assessed in 15 patients with chronic fatigue syndrome. The pathway was also assessed in individuals with differing hemispheric dominance to assess whether hemispheric dominance had any correlation with these disease states. The isoprenoid metabolites--digoxin, dolichol, and ubiquinone--RBC membrane Na+-K+ ATPase activity, serum magnesium and tyrosine/tryptophan catabolic patterns were assessed. The free-radical metabolism, glycoconjugate metabolism, and RBC membrane composition was also assessed. Membrane Na+-K+ ATPase activity and serum magnesium levels were decreased while HMG CoA reductase activity and serum digoxin levels were increased in myalgic encephalomyelitis (ME). There were increased levels of tryptophan catabolites--nicotine, strychnine, quinolinic acid, and serotonin--and decreased levels of tyrosine catabolites--dopamine, noradrenaline, and morphine in ME. There was an increase in dolichol levels, carbohydrate residues of glycoproteins, glycolipids, total/individual GAG fractions, and lysosomal enzymes in ME. Reduced levels of ubiquinone, reduced glutathione, and free-radical scavenging enzymes, as well as increased lipid peroxidation products and nitric oxide, were noticed in ME. The biochemical patterns in ME correlated with those obtained in right hemi spheric chemical dominance. The role of hypothalamic digoxin and neurotransmitter induced immune activation, altered glycoconjugate metabolism, and resultant defective viral antigen presentation, NMDA excitotoxicity and cognitive dysfunction, and mitochondrial dysfunction related myalgia in the pathogenesis of ME is stressed. ME occurs in individuals with right hemispheric chemical dominance. 779 PMID- 12792254 AU - Landis CA, Frey CA, Lentz MJ, Rothermel J, Buchwald D, Shaver JL TI - Self-reported sleep quality & fatigue correlates w actigraphy in midlife women w FM. SO - Nurs Res 2003 May-Jun;52(3):140-7. IN - D o Biobehavioral Nursing & Health Systems, U o Washington,+ AB - +IN: Seattle, 98195-7266, USA. calandis@u.washington.edu BACKGROUND: Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). OBJECTIVES: To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. METHODS: Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. RESULTS: Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01). DISCUSSION: Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies. 780 PMID- 14570830 AU - Lane RJ, Soteriou BA, Zhang H, Archard LC TI - Enterovirus related metabolic myopathy: a postviral fatigue syndrome. SO - JNeurNSPsy 2003 Oct;74(10):1382-6. IN - Division o Clinical Neurosciences & Psychological Med, Impe+ AB - +IN: rial Coll, London SW7, UK. r.lane@imperial.ac.uk OBJECTIVE: To detect and characterise enterovirus RNA in skeletal muscle from patients with chronic fatigue syndrome (CFS) and to compare efficiency of muscle energy metabolism in enterovirus positive and negative CFS patients. METHODS: Quadriceps muscle biopsy samples from 48 patients with CFS were processed to detect enterovirus RNA by two stage, reverse transcription, nested polymerase chain reaction (RT-NPCR), using enterovirus group specific primer sets. Direct nucleotide sequencing of PCR products was used to characterise the enterovirus. Controls were 29 subjects with normal muscles. On the day of biopsy, each CFS patient undertook a subanaerobic threshold exercise test (SATET). Venous plasma lactate was measured immediately before and after exercise, and 30 minutes after testing. An abnormal lactate response to exercise (SATET+) was defined as an exercise test in which plasma lactate exceeded the upper 99% confidence limits for normal sedentary controls at two or more time points. RESULTS: Muscle biopsy samples from 20.8% of the CFS patients were positive for enterovirus sequences by RT-NPCR, while all the 29 control samples were negative; 58.3% of the CFS patients had a SATET+ response. Nine of the 10 enterovirus positive cases were among the 28 SATET+ patients (32.1%), compared with only one (5%) of the 20 SATET- patients. PCR products were most closely related to coxsackie B virus. CONCLUSIONS: There is an association between abnormal lactate response to exercise, reflecting impaired muscle energy metabolism, and the presence of enterovirus sequences in muscle in a proportion of CFS patients. 781 PMID- 12861752 AU - Lash AA, Ehrlich-Jones L, McCoy D TI - FM: evolving concepts & management in primary care settings. SO - Medsurg Nurs 2003 Jun;12(3):145-59, 190; quiz 160. IN - Northern Illinois U School o Nursing, DeKalb, IL, USA. AB - During the last 10 years, fibromyalgia (FM) research shifted focus from psychological and behavioral issues to sleep, nociception, and neuroendocrinology. Although there are still no definitive markers of the disease, a barrage of studies in physiological, psychological, and behavioral sciences have now dispelled the belief that FM is solely psychosomatic. Studies in the late 1990s as well as in the early part of the current decade reaffirm earlier research that sleep abnormalities and alterations in nociception may partly be responsible for FM. While sleep research shows that FM patients typically are deficient in stage IV (restorative) sleep, most current studies in nociception now affirm that patients with FM exhibit low serum serotonin in combination with increased substance P levels in the cerebrospinal fluid. Although there is still no cure, treatment aimed at promoting sleep, interrupting nociception, and actively involving patient and family in FM management can bring lifetime control for the disease. 782 PMID- 12701994 AU - Lashley FR TI - A review of sleep in selected immune & autoimmune disorders. SO - Holist Nurs Pract 2003 Mar-Apr;17(2):65-80. IN - College o Nursing, Rutgers, The St U o New Jersey, Newark, + AB - +IN: NJ 07102, USA. lashley@nightingale.rutgers.edu Evidence for the reciprocal role of the immune system in sleep is growing. Sleep disturbances are believed to be both a cause and a consequence of various immune and autoimmune conditions. 783 PMID- 14527650 AU - Le Bon O, Minner P, Van Moorsel C, Hoffmann G, Gallego S, Lambrecht L, Pelc I, + TI - First-night effect in the CFS. SO - Psychiatry Res 2003 Sep 30;120(2):191-9. IN - D o Psychiatry, CHU Brugmann S48, Place Van Gehuchten 4, 10+ AB - +IN: 20 Brussels, Belgium. lebono@ulb.ac.be +AU: Linkowski P Since the magnitude of the first-night effect has been shown to be a function of medical conditions and of settings in which polysomnographies are performed, it is essential to evaluate the habituation phenomenon in each case in order to determine the optimal recording methodology. A first-night effect was evidenced in certain cases of chronic fatigue syndrome, but not in others. To clarify this issue, a large group of patients with chronic fatigue syndrome who had no primary sleep disorders were selected and recorded for two consecutive nights in a hospital sleep unit. Several parameters, frequently associated with the first-night effect, were found to be influenced by the recording methodology: Total Sleep Time, Sleep Efficiency, Sleep Efficiency minus Sleep Onset, Sleep Onset Latency, Wake Time, Slow Wave Sleep, Rapid Eye Movement Sleep, Rapid Eye Movement Sleep Latency and Number of Sleep Cycles. Bland and Altman plots determined that the difference scores between the nights included a systematic bias linked to the order of recordings (first-night effect). Factorial analysis grouped the difference scores into three factors. No significant difference was observed between patients with generalized anxiety comorbidity and those with no psychiatric comorbidity, or between those with and without psychiatric comorbidity. Chronic fatigue syndrome must thus be added on the list of conditions where a clinically significant habituation effect takes place. 784 PMID- 12692412 AU - Lee HS, Oh KT, Kim TH, Jung S, Yoo DH, Bae SC TI - A Korean rheumatic diseases screening questionnaire. SO - J Korean Med Sci 2003 Apr;18(2):171-8. 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 The aim of our study was to develop a Korean rheumatic diseases-screening questionnaire. The questionnaire was constructed based on American College of Rheumatology criteria for rheumatic diseases and a connective tissue diseases screening questionnaire. Two groups of patients were selected and completed the questionnaire: (i) those with osteoarthritis (n=46), rheumatoid arthritis (n=52), systemic lupus erythematosus (n=50), scleroderma (n=8), polymyositis or dermatomyositis (n=7), Sjogren's disease (n=4), and mixed connective-tissue disease (n=9) as case subjects; and (ii) those with fibromyalgia (n=8) and general disease without evidence of any rheumatic disease (n=72) as controls. Laboratory results were analyzed for correlation with actual data using kappa (kappa) statistics. Test-retest reliability was performed in 12 patients, and showed strong agreement between the first and second interviews (kappa=0.91). The sensitivity of the questionnaire ranged from 77.8 to 100%, and specificity ranged from 68.8 to 95.0%. Negative predictive values were very high in the general population, from 98.4 to 99.99%. The kappa statistic for agreement between laboratory items was 0.22-0.56, except for rheumatoid factor, antinuclear antibody test, and muscle enzyme level. We have developed a simple and sensitive Korean rheumatic diseases-screening questionnaire for the epidemiologic study of rheumatic diseases in Korea. 785 PMID- 14649853 AU - Lim BR, Tan SY, Zheng YP, Lin KM, Park BC, Turk AA TI - Psychosocial factors in CFS among Chinese Americans: a longitudinal community-based study. SO - Transcult Psychiatry 2003 Sep;40(3):429-41. IN - Fuller Theological Seminary, Graduate School o Psychology, + AB - +IN: Pasadena, California, USA. blim@fuller.edu Chronic fatigue syndrome (CFS) is a relatively new condition of unknown etiology. Research suggests that psychosocial factors such as perceived social support, life stress, and acculturation may significantly influence individuals who are prone to CFS. For 57 Chinese American individuals initially diagnosed with CFS, those who recovered after one year reported lower levels of life stress than those who did not recover. Effects of changes in perceived social support also appeared to be mediated by life stress. 786 PMID- 14744043 AU - Liu Z, Wang D, Xue Q, Chen J, Li Y, Bai X, Chang L TI - Determination of fatty acid levels in erythrocyte membranes of pts w CFS. SO - Nutr Neurosci 2003 Dec;6(6):389-92. IN - D o Neurology, Beijing Friendship Hospital, Affiliated Hosp+ AB - +IN: o Capital U o Med Science, 95 Yong-an Rd, Beijing 100050, China. liuzhandong99@sina.com.cn Chronic fatigue syndrome (CFS) is an illness characterized by persistent and relapsing fatigue, often accompanied by numerous symptoms involving various systems of whole body. The etiology of CFS remains unclear. Literature reported whether the concentrations of the essential fatty acids in red cell membranes of CFS patients were decreased is controversial. In our study, Forty-two patients who fulfilled the diagnostic criteria defined by Centers for Disease Control and Prevention (CDC). Thirty-seven age- and sex-matched controls were selected from healthy medical staffs and volunteers. After lipid analysis, we found that the levels of the arachidonic acid (ARA) and docosahexanoic acid (DHA) were decreased in patients suffered from CFS. However, the levels of the palmitic acid and oleic acid were increased. We speculated that there are two possible mechanisms--one of which is that oxidative stress has led to an excessive oxidation and resulting in the above fatty acids. Alternatively, insufficiency of ingestion of fatty acids might not be the major cause. 787 PMID- 12699726 AU - Logan AC, Venket Rao A, Irani D TI - CFS: lactic acid bacteria may be of therapeutic value. SO - Med Hypotheses 2003 Jun;60(6):915-23. IN - CFS-FM Integrative Care Centre, Toronto, Canada. aclnd@cfs-+ AB - +IN: fm.org Chronic fatigue syndrome (CFS) is complex illness with unknown aetiology. Recent research shows that patients with CFS have marked alterations in microbial flora, including lowered levels of bifidobacteria and small intestinal bacterial overgrowth (SIBO). Research also indicates that CFS patients are under increased oxidative stress, have a type 2 helper cell dominate cytokine profile, frequently report allergies, have altered essential fatty acid (EFA) status and may have malabsorption of certain micronutrients. Lactic acid bacteria (LAB) have the potential to influence the immune system in CFS patients by supporting T helper cell 1 driven cellular immunity and may decrease allergies. In addition LAB are strong antioxidants, may improve EFA status, can enhance absorption of micronutrients by protecting the intestinal epithelial barrier, and have been used to treat SIBO. It is our contention that LAB may have a therapeutic role in the treatment of CFS. 788 PMID- 12892249 AU - Lund E, Kendall SA, Janerot-Sjoberg B, Bengtsson A TI - Muscle metabolism in FM studied by P-31 magnetic resonance spectroscopy during aerobic & anaerobic exercise. SO - Scand J Rheumatol 2003;32(3):138-45. IN - Div o Radiation Physics, Dept o Med & Care, U Hosp, Faculty+ AB - +IN: o Health Sciences, Linkoping, Sweden. Eva.Lund@imv.liu.se OBJECTIVE: To investigate mechanisms underlying the reduced work capacity of fibromyalgia (FM) patients were compared to healthy controls at specified workloads, using P-31 magnetic resonance spectroscopy (MRS). METHODS: The forearm flexor muscle group was examined with MRS at rest, at sub maximal and at maximal controlled dynamic work as well as at maximal isometric contraction. Aerobic fitness was determined by bicycle ergonometry. RESULTS: Metabolite concentrations and muscle pH were similar for patients and controls at lower workloads. At maximal dynamic and static contractions the concentration of inorganic phosphate was lower and at static contractions the pH decrease was smaller in patients. The performed work by patients was only 50% compared to controls and the patients experienced more pain. Maximal oxygen uptake was lower in the fibromyalgia group. Expired gas-analysis in this group showed ventilatory equivalents at similar relative levels of maximal work capacity. CONCLUSION: Fibromyalgia patients seem to utilise less of the energy rich phosphorous metabolites at maximal work despite pH reduction. They seemed to be less aerobic fitted and reached the anaerobic threshold earlier than the controls. 789 PMID- 12932505 AU - Lyall M, Peakman M, Wessely S TI - A systematic review & critical evaluation of the immunology of CFS. SO - J Psychosom Res 2003 Aug;55(2):79-90. IN - D o Psychological Med, Guy's, King's & St. Thomas' School o+ AB - +IN: Medicine, 103 Denmark Hill, London SE5 8AZ, UK. OBJECTIVE: Immune dysfunction in patients with chronic fatigue syndrome (CFS) has been widely but inconsistently reported. Traditional reviews of the literature have produced a variety of conclusions. We present the results of the first systematic review of the subject. METHODS: EMBASE, MEDLINE and PSYCHINFO databases were searched, and leading researchers in the field were contacted. Inclusion criteria were applied, and studies were then divided into groups based on the quality of their methodology. Study results were collated and described. RESULTS: Studies ranged widely in quality. There was an inverse association between study quality and finding low levels of natural killer cells, suggesting that the association may be related to study methodology. On the other hand, reports of abnormalities in T cells and cytokine levels were not related to study quality. CONCLUSIONS: The conclusions of this systematic review differ from a recent traditional narrative review of the immunology of CFS. No consistent pattern of immunological abnormalities is identified. 790 PMID- 14592601 AU - Madariaga MG, Rezai K, Trenholme GM, Weinstein RA TI - Q fever: a biological weapon in your backyard. SO - Lancet Infect Dis 2003 Nov;3(11):709-21. IN - Division o Infectious Disease, Cook County Hosp, Chicago & + AB - +IN: the Sect o Infectious Diseases, Rush-Presbyterian-St Luke's Med Ctr, Chicago, IL 60612, USA. migmad@worldnet.att.net Coxiella burnetii, which causes Q fever, is a highly infectious agent that is widespread among livestock around the world. Although the culture process for coxiella is laborious, large amounts of infectious material can be produced. If used as an aerosolised biological weapon, coxiella may not cause high mortality, but could provoke acute disabling disease. In its late course, Q fever can be complicated by fatal (eg, endocarditis) or debilitating (eg, chronic fatigue syndrome) disorders. The diagnosis of Q fever might be delayed because of non-specific and protean presentations. Effective antibiotic treatment is available for the acute form of disease but not for the chronic complications. Vaccination and chemoprophylaxis in selected individuals may be used in the event of bioterrorism. 791 PMID- 12836502 AU - Maekawa K, Kuboki T, Inoue E, Inoue-Minakuchi M, Suzuki K, Yatani H, Clark GT TI - Function of beta 2-adrenergic receptors in chr localized myalgia. SO - J Orofac Pain 2003 Spring;17(2):140-4. IN - D o Oral & Maxillofacial Rehabilitation, Okayama U Graduate+ AB - +IN: School o Med & Dentistry, 2-5-1 Shikata-cho, Okayama, Japan, 700-8525. maekawa@md.okayama-u.ac.jp AIMS: To investigate alteration of beta 2-adrenergic receptor (beta 2 AR) function in chronic localized myalgia subjects by evaluating levels of the beta 2 AR second messenger, cyclic adenosine monophosphate (cAMP), in mononuclear cells after beta AR-agonist stimulation. METHODS: Eleven chronic localized myalgia subjects and 21 matched healthy controls participated in this study. Peripheral blood (30 cc) was drawn from the subjects' anterocubital vein. Mononuclear cells were isolated from the total blood by using the Ficoll-Hypaque gradient technique. Basal and stimulated intracellular cAMP levels were determined by enzyme immunoassay using a commercially available kit. Aliquots of 5 x 10(6) cells were incubated with or without stimulation of the beta AR-agonist isoproterenol for 5 minutes. Five different concentrations of isoproterenol (10(-3) M to 10(-7) M) were utilized. cAMP levels in both groups were tested statistically by a 2-way repeated-measures ANOVA with 2 predictors, group difference and isoproterenol concentration difference. As with isoproterenol stimulation, the cAMP responses to forskolin, which activates adenylyl cyclase directly and produces cAMP, bypassing the cell surface receptors were also measured. RESULTS: The basal cAMP levels in both groups (myalgia: 0.33 +/- 0.02 pmol/5 x 10(6) cells; control: 0.43 +/- 0.10 pmol/5 x 10(6) cells) were almost identical, and isoproterenol-produced cAMP levels increased dose-dependently in both groups. No significant differences in the mean cAMP levels were observed between the groups (P = .909). Significant increases were observed according to the isoproterenol concentration increase (P < .0001). The cAMP responses to forskolin stimulation also showed no significant group difference (P = .971). CONCLUSION: These results suggest that beta 2 AR function is not different between localized myalgia subjects and healthy individuals. 792 PMID- 12563697 AU - Maekawa K, Twe C, Lotaif A, Chiappelli F, Clark GT TI - Function of beta-Adrenergic Receptors on Mononuclear Cells in Female Pts w FM. SO - J Rheumatol 2003 Feb;30(2):364-8 IN - Division o Oral Biology & Med, UCLA School o Dentistry, Los+ AB - +IN: Angeles, California, USA. OBJECTIVE: To investigate the beta-adrenergic receptors (betaAR) in patients with chronic fibromyalgia syndrome (FM). These receptors are present on circulating mononuclear cells, and activation of G-protein coupled receptors like betaAR leads to an increase in the intracellular level of cyclic aminosine monophosphate (cAMP). Therefore, cAMP levels can be used to indirectly assess the functional status of the receptor. METHODS: Eight female patients with FM and 9 matched healthy female controls participated in this study. Blood samples were drawn from subjects' anterocubital vein in the morning. Mononuclear cells were isolated from the whole blood according to Boyum's method. Basal and stimulated intracellular cAMP levels were determined by enzyme immunoassay. Aliquots of 106 cells were incubated with or without stimulation of beta-agonist isoproterenol for 5 min. Two different concentrations of isoproterenol (10-3 M and 10-5 M) were utilized. RESULTS: The basal cAMP levels in patients with FM (3.02 +/- 0.44 pmol/106 cells) were slightly more elevated (but not statistically different; p = 0.124, Mann-Whitney U test) than that of the control group (2.26 +/- 0.39 pmol/106 cells). Proterenol 10-3 M stimulation significantly increased intracellular cAMP from the basal levels in both groups (FM group, p = 0.008; control group, p = 0.011). However, isoproterenol 10-5 M did not increase mean intracellular cAMP levels in the FM group (p = 0.74), while a significant increase was observed in the control group (p = 0.012). CONCLUSION: These preliminary results suggest that diminished betaAR function is associated with the chronic FM state. 793 PMID- 12781354 AU - Malt EA, Olafsson S, Aakvaag A, Lund A, Ursin H TI - Altered dopamine D2 receptor function in FM pts: a neuroendocrine study w buspirone in women w FM compared to female population based controls. SO - J Affect Disord 2003 Jun;75(1):77-82. IN - D o Psychiatry, Haukeland U Hosp, Bergen, Norway. eva.alber+ AB - +IN: tson@psych.uib.no BACKGROUND: To what extent fibromyalgia belongs to affective spectrum disorders or anxiety spectrum disorders remains disputed. Buspirone induces a hypothermic response, which most likely is due to 5-HT(1A) autoreceptor stimulation, and growth hormone (GH) release, which probably is related to postsynaptic 5-HT(1A) receptor stimulation. The prolactin response to buspirone has been suggested to be mediated through dopamine (DA) antagonistic effects. OBJECTIVES: Based on the assumption that fibromyalgia is more strongly related to stress and anxiety than affective spectrum disorders, we hypothesized that compared to population controls, fibromyalgia patients should demonstrate an increased prolactin response (DA sensitivity) to buspirone challenge test, but no difference in hypothermic response or GH release (5HT sensitivity). METHOD: A 60-mg dose of buspirone was given orally to 22 premenopausal women with fibromyalgia and 14 age and sex matched healthy control subjects. Core body temperature, growth hormone and prolactin levels were analyzed at baseline and after 60, 90, and 150 min. RESULTS: Fibromyalgia patients showed an augmented prolactin response to buspirone compared to controls. Temperature and growth hormone responses did not differ from controls. CONCLUSIONS: Dopaminergic rather than serotonergic neurotransmission is altered in fibromyalgia, suggesting increased sensitivity or density of dopamine D(2) receptors in fibromyalgia patients. Stress and anxiety is an important modulator of dopaminergic neurotransmission. Our results suggest that fibromyalgia is related to anxiety and associated with disturbance in the stress response systems. 794 PMID- 12781306 AU - Malt EA, Ursin H TI - Mutilation anxiety differs among females w FM & functional dyspepsia & population controls. SO - J Psychosom Res 2003 Jun;54(6):523-31. IN - D o Psychiatry, U o Bergen, Haukeland U Hosp, Bergen N-5022+ AB - +IN: , Norway. eva.albertsen@psych.uib.no BACKGROUND: Studies using self-report rating scales suggest a considerable overlap regarding symptom complaints in patients with fibromyalgia (FM) and functional dyspepsia (FD), while clinical assessments point to important psychological differences. PURPOSE: To test the hypothesis that measurement of psychological state by means of content analysis of speech will demonstrate differentiation between the two patient groups and between patients with these disorders and age-matched population-based random sample controls. METHOD: The Giessener Symptom Complaints Checklist assessed somatic complaints. The computerised Gottschalk-Gleser content analysis method assessed psychological state in 42 females with FM, 17 females with FD and 48 population-based, randomly selected control subjects. RESULTS: FM patients score higher on mutilation anxiety than FD and control subjects. FD patients had the highest score for death anxiety. Mutilation anxiety and low hope score identified FM patients (sensitivity 68%, specificity 81%, overall classification 75%), but only 19% of the variation in total somatic complaints could be predicted from these or other psychological state scores. In FD patients, however, death anxiety explained 59% of the variance in gastrointestinal complaints. INTERPRETATION: Psychological state was differentiated among the three groups. Mutilation anxiety may be a psychological marker of an underlying neurobiological vulnerability for FM or may represent a secondary long-term consequence of chronic illness. In FD, death anxiety is directly related to symptom complaints, suggesting a stronger etiological association between emotions and somatic complaints in this disorder. 795 PMID- 12849716 AU - Mannerkorpi K, Iversen MD TI - Physical exercise in FM & related syndromes. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):629-47. IN - D o Rheumatology & Inflammation Research, Goteborg U, Swede+ AB - +IN: n. kaisa.mannerkorpi@rheuma.gu.se Fibromyalgia and related syndromes are characterized by chronic pain and fatigue. This chapter identifies the types of exercise that are effective for these patients and provides recommendations for exercise prescriptions. Based on a systematic review of randomized controlled studies of exercise, we suggest that low-intensity aerobic exercise, such as walking, can improve function and symptoms. Aerobic exercise performed twice a week at moderate intensity can improve aerobic capacity and reduce tenderness. Pool exercise can improve function, distress and symptoms. Strength training at adequate load can improve strength without exacerbation of symptoms. Most patients tolerate low-intensity exercise. High-intensity exercise should be undertaken with caution. Due to the large variability of functioning and symptom severity in patient populations, exercise prescriptions should be individualized and should include a long-term plan to maximize functioning and wellbeing. Studies with larger populations, allowing subgroup analyses regarding benefits and adverse effects of programmes, are needed. 796 PMID- 14501575 AU - Martinez JE, Cruz CG, Aranda C, Boulos FC, Lagoa LA TI - Disease perceptions of Brazilian FM pts: do they resemble perceptions from other countries? SO - Int J Rehabil Res 2003 Sep;26(3):223-7. IN - Medical School o Sorocaba, Catholic U o Sao Paulo, Rua Riac+ AB - +IN: huelo 460/103, Sorocaba, SP, Brazil 18035-330. jemartinez@sorocaba.pucsp.br The purpose of this study was to discover how Brazilian fibromyalgia patients perceive their disease. Fifteen women who fulfilled the American College of Rheumatology Classification Criteria for Fibromyalgia were given an individual semi-structured interview about their perception of fibromyalgia. There was a marked uniformity in the description of clinical symptoms, with diffuse pain and fatigue being considered the most important symptoms. Pain descriptions were imprecise as to the main localization but insidious pain of moderate intensity was frequently described. Other referred symptoms were: sleep disturbances, anxiety and memory and concentration difficulties. The following points were considered to be trigger events for pain: intense physical efforts, physical trauma, climate variation and genetic heritage. The reported modulating factors were: stressful events, emotional disturbances, climate variation and period of the day. Most patients reported being unable to control the symptoms of fibromyalgia. Religious support, reduction of tasks, physical exercises and short resting periods during the day were the main coping strategies mentioned by the interviewed patients. Their main concern was an eventual evolution to total physical incapacity and loss of independence in self-care. The clinical characteristics and patient perceptions in these Brazilian patients are very similar to those described in international studies. 797 PMID- 12833249 AU - Martinez-Lavin M, Lopez S, Medina M, Nava A TI - Use of the leeds assessment of neuropathic Sx & signs questionnaire in pts w FM. SO - Semin Arthritis Rheum 2003 Jun;32(6):407-11. IN - Rheumatology D, Instituto Nacional de Cardiologia Ignacio C+ AB - +IN: havez, Mexico. OBJECTIVE: Neuropathic pain syndrome is characterized by chronic, stimulus-independent pain sensation accompanied by hyperalgesia/allodynia and paresthesia. Fibromyalgia (FM) syndrome displays such features. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is an instrument developed and validated to recognize neuropathic pain and set it apart from nociceptive pain. METHODS: This study assessed the responses of patients with FM versus patients with rheumatoid arthritis (RA) to the LANSS Pain Scale questionnaire. Twenty patients with FM and 20 patients with RA answered the Fibromyalgia Impact Questionnaire and LANSS Pain Scale questions related to the following neuropathic sensory disturbance domains: dysesthetic, autonomic, evoked, paroxysmal, and thermal. RESULTS: Pain severity was similar in both groups according to visual analog scale values (5.3 +/- 3.0 for FM v 5.4 +/- 3.1 for RA). There were sharp differences between FM and RA groups in the percentage of affirmative responses to 4 of 5 sensory disturbance questions: dysesthetic (95 v 30), evoked (95 v 35), paroxysmal (90 v 15), and thermal (90 v 20); P <.0001 for each comparison. CONCLUSIONS: The high prevalence of associated sensory disturbances supports the notion that FM is a neuropathic pain syndrome. Clinical Relevance: The LANSS Pain Scale items may become a useful, easily applied bedside test to differentiate FM pain from the nociceptive pain present in RA and in similar arthritic illnesses. 798 PMID- 14518687 AU - Matano S, Kinoshita H, Tanigawa K, Terahata S, Sugimoto T TI - Acute parvovirus B19 infection mimicking CFS. SO - Intern Med 2003 Sep;42(9):903-5. IN - D o Hematology, Tonami General Hosp, Tonami, Toyama. AB - A Japanese woman developed prolonged fatigue, neck and shoulder pain, headache, pyrexia, insomnia, anorexia, lymphadenopathy, and diarrhea for two months. She had experienced various stressors before these symptoms developed. Serological test demonstrated that she had acute parvovirus B19 infection. Major depressive disorder was also diagnosed by a psychiatrist. Her symptoms disappeared after administration of selective serotonin reuptake inhibitors and oriental herbs, although human parvovirus B19 viral genome has been present in her serum for nine months. These findings suggest that parvovirus B19 causes clinical features similar to those of chronic fatigue syndrome in cases who have prior life stressors. 799 PMID- 12794837 AU - McBeth J, Silman AJ, Macfarlane GJ TI - Association of widespread body pain w an increased risk of cancer & reduced cancer survival: a prospective, population-based study. SO - Arthritis Rheum 2003 Jun;48(6):1686-92. IN - Unit o Epidemiology, The MS, U o Manchester, Manchester, UK. AB - OBJECTIVE: To determine whether reported widespread body pain is related to an increased incidence of cancer and/or reduced survival from cancer, since our previous population surveys have demonstrated a relationship between widespread body pain and a subsequent 2-fold increase in mortality from cancer over an 8-year period. METHODS: A total of 6565 subjects in Northwest England participated in 2 health surveys during 1991-1992. The subjects were classified according to their reported pain status (no pain, regional pain, and widespread pain), and were subsequently followed up prospectively until December 31, 1999. During followup, information was collected on incidence of cancer and survival rates among those developing cancer. Associations between the original pain status and development of cancer and cancer survival were expressed as the incidence rate ratio (IRR) and mortality rate ratio (MRR), respectively. All analyses were adjusted for age, sex, and study location, the latter being a proxy measure of socioeconomic status. RESULTS: Among the study population, 6331 had never been diagnosed with cancer at the time of participation in the survey. Of these subjects, 956 (15%) were classified as having widespread pain, 3061 (48%) as having regional pain, and 2314 (37%) as having no pain. There were a total of 395 first malignancies recorded during followup. In comparison with subjects reporting no pain, those with regional pain (IRR 1.19, 95% confidence interval [95% CI] 0.94-1.50) and widespread pain (IRR 1.61, 95% CI 1.21-2.13) experienced an excess incidence of cancer during the followup period. The increased incidence among subjects previously reporting widespread pain was related, most strongly, to breast cancer (IRR 3.67, 95% CI 1.39-9.68), but there were also cancers of the prostate (IRR 3.46, 95% CI 1.25-9.59), large bowel (IRR 2.35, 95% CI 0.96-5.77), and lung (IRR 2.04, 95% CI 0.96-4.34). Subjects reporting widespread pain who subsequently developed cancer, in comparison with those previously reporting no pain, had an increased risk of death (MRR 1.82, 95% CI 1.18-2.80). This decreased survival was highest among subjects with cancers of the breast and prostate, although the effects on site-specific survival were nonsignificant. CONCLUSION: This study has demonstrated that widespread pain reported in population surveys is associated with a substantial subsequent increased incidence of cancer and reduced cancer survival. At present there are no satisfactory biologic explanations for this observation, although several possible leads have been identified. 800 PMID- 12672204 AU - McCall-Hosenfeld JS, Goldenberg DL, Hurwitz S, Adler GK TI - Growth hormone & insulin-like growth factor-1 concentrations in women w FM. SO - J Rheumatol 2003 Apr;30(4):809-14. IN - Endocrine-Hypertension Div, D o Med, Brigham & Women's Hosp+ AB - +IN: , Harvard MS, Boston, Mass 02115, USA. OBJECTIVE: To determine activity of the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis in women with fibromyalgia (FM). METHODS: Premenopausal women with FM (n = 24) and premenopausal healthy women (n = 27) were studied. IGF-1 was measured in 23 patients with FM and 25 controls. GH was measured during a stepped hypoglycemic hyperinsulinemic clamp procedure (blood glucose decreased from 90 to 40 mg/dl every 30 min in 10 mg/dl decrements) in 12 FM and 13 control subjects. RESULTS: IGF-1 concentrations were similar in the FM (200 +/- 71 ng/ml, mean +/- SD) and control (184 +/- 70 ng/ml) groups. By multiple variable analysis, IGF-1 was negatively associated with age (p = 0.0006), body mass index (BMI) (p = 0.006), and 24 h urinary free cortisol (p = 0.007) in healthy controls. Even after accounting for these factors, there was no association between FM and IGF-1. The average peak GH achieved during hypoglycemia was lower in patients with FM (range 5 to 58 ng/ml, median 13 ng/ml) versus controls (6 to 68 ng/ml, median 21 ng/ml) (p = 0.04). However, BMI was a significant predictor of average peak GH in FM (r = -0.62, p < 0.01) and control subjects (r = -0.40, p = 0.06). After considering BMI, there was no significant association between FM subjects and the average peak GH (p = 0.20). CONCLUSION: In this sample of premenopausal women with FM, the activity of the GH-IGF-1 axis was similar to that of healthy controls. Increases in age and obesity were both strongly associated with lower activity of this axis, suggesting that these factors must be considered when studying activity of the GH-IGF-1 axis in FM. 801 PMID- 12756425 AU - McCarberg B, Barkin RL, Wright JA, Cronan TA, Groessl E, Schmidt SM TI - Tender points as predictors of distress & the pharmacologic management of FM syndrome. SO - Am J Ther 2003 May-Jun;10(3):176-92. IN - Kaiser Permanente, San Diego St U, San Diego, CA, USA. bill+ AB - +IN: .h.mccarberg@kp.org The object of this study was to determine the association between tender point pain ratings, tender point counts and distress in people with fibromyalgia and to review the pharmacotherapy of fibromyalgia. Demographic, psychosocial, and health status information was collected from 316 health maintenance organization members with fibromyalgia. A manual tender point exam was conducted. Tender point counts predicted 3.0%, and tender point severity ratings predicted 8.3%, of the variance in distress. Little difference was found between the variance predicted for physical versus psychologic distress. A principal components analysis of all measures produced four distinct factors: global-physical functioning, tender points, psychologic, and physical. Tender point pain ratings and counts predicted a small but significant amount of variance in distress. In addition, FMS involves at least four rather distinct factors, one of which is related to tender points. Pharmacotherapeutic management is provided on a patient-specific basis including pharmacokinetics, pharmacodynamic, pathophysiologic, and psychosocial needs designed and modulated for each individual patient. 802 PMID- 12622304 AU - McCrone P, Darbishire L, Ridsdale L, Seed P TI - The economic cost of chr fatigue & CFS in UK primary care. SO - Psychol Med 2003 Feb;33(2):253-61. IN - Centre for the Economics o Mental Health, Health Services R+ AB - +IN: esearch D, Inst o Psychiatry, King's Coll, London. BACKGROUND: Chronic fatigue and chronic fatigue syndrome are most often encountered in primary care settings. Given the disabling nature of chronic fatigue it may have a substantial impact on service use and costs as well as on employment. This study estimates this impact. METHOD: Patients presenting to general practitioners with unexplained chronic fatigue were recruited to the study. Service use over a 3 month period was measured and lost employment recorded. These data were used to estimate economic costs. Patients with chronic fatigue syndrome were compared to patients with only chronic fatigue using a multiple regression model with sample differences controlled. RESULTS: The mean total cost of services and lost employment across the sample was Pound Sterling1906 for the 3-month period with formal services accounting for 9.3% of this figure. Service use was higher for patients with chronic fatigue syndrome compared to those with chronic fatigue alone. Total 3-month costs were on average higher for chronic fatigue syndrome (Pound Sterling3515 v. Pound Sterling1176) but when sample differences were taken account of the mean difference was reduced to Pound Sterling1406 (P = 0.086). Over 90% of the cost was accounted for by care provided by friends and family members and by lost employment. Patients with dependants had significantly higher costs than those with none and costs were also significantly higher for greater levels of functional impairment. CONCLUSION: Chronic fatigue imposes substantial economic costs on society, mainly in the form of informal care and lost employment. Treatments need to be developed which recognize these impacts. 803 PMID- 1002003021 AU - McCully KK, Smith S, Rajaei S, Leigh Jr JS, Natelson BH TI - Blood flow & muscle metabolism in CFS. SO - Clin Sci (Lond) 2003 Feb 18 AB - The purpose of this study was to determine if chronic fatigue syndrome (CFS) is associated with reduced blood flow and oxidative delivery to skeletal muscle. Patients with CFS according to CDC criteria (n=19) were compared to normal sedentary subjects (n = 11). Muscle blood flow was measured with Doppler ultrasound after cuff ischemia and after exercise. Muscle oxygen delivery was measured as the rate of post-exercise and post-ischemic oxygen-heme resaturation. Oxygen-heme resaturation was measured in the medial gastrocnemius muscle using continuous wavelength near-infrared spectroscopy. Muscle metabolism was measured using 31P magnetic resonance spectroscopy. CFS and controls were not different in the peak blood flow after cuff ischemia, the rate of recovery of phosphocreatine after submaximal exercise, and the rate of recovery of oxygen saturation after cuff ischemia. In conclusion, CFS patients showed no deficit in blood flow or oxidative metabolism. This suggests that CFS symptoms do not require abnormal peripheral function. 804 PMID- 12589704 AU - McCully KK, Smith S, Rajaei S, Leigh JS Jr, Natelson BH TI - Blood flow & muscle metabolism in CFS. SO - Clin Sci (Lond) 2003 Jun;104(6):641-7. IN - D o Exercise Science, U o Georgia, 300 River Road, Athens, + AB - +IN: GA 30602, U.S.A. kmccully@coe.uga.edu The purpose of this study was to determine if chronic fatigue syndrome (CFS) is associated with reduced blood flow and oxidative delivery to skeletal muscle. Patients with CFS according to CDC (Center for Disease Control) criteria ( n =19) were compared with normal sedentary subjects ( n =11). Muscle blood flow was measured with Doppler ultrasound after cuff ischaemia and exercise. Muscle oxygen delivery was measured as the rate of post-exercise and post-ischaemic oxygen-haem resaturation. Oxygen-haem resaturation was measured in the medial gastrocnemius muscle using continuous wavelength near-IR spectroscopy. Muscle metabolism was measured using (31)P magnetic resonance spectroscopy. CFS patients and controls were not different in the peak blood flow after cuff ischaemia, the rate of recovery of phosphocreatine after submaximal exercise, and the rate of recovery of oxygen saturation after cuff ischaemia. In conclusion, CFS patients showed no deficit in blood flow or oxidative metabolism. This suggests that CFS symptoms do not require abnormal peripheral function. 805 PMID- 14524403 AU - Mies Richie A, Francis ML TI - Diagnostic approach to polyarticular joint pain. SO - Am Fam Physician 2003 Sep 15;68(6):1151-60. IN - D o Family & Community Med, Southern Illinois U School o Me+ AB - +IN: dicine, Springfield, Illinois 62794-9671, USA. amiesrichie@siumed.edu Identifying the cause of polyarticular joint pain can be difficult because of the extensive differential diagnosis. A thorough history and a complete physical examination are essential. Six clinical factors are helpful in narrowing the possible causes: disease chronology, inflammation, distribution, extra-articular manifestations, disease course, and patient demographics. Patients with an inflammatory arthritis are more likely to have palpable synovitis and morning stiffness; if the condition is severe, they may have fever, weight loss, and fatigue. Viral infections, crystal-induced arthritis, and serum sickness reactions are common causes of acute, self-limited polyarthritis. Because chronic arthritides may present abruptly, they need to be considered in patients who present with acute polyarticular joint pain. Joint palpation can help to distinguish inflammatory synovitis from the bony hypertrophy and crepitus that typically occur with osteoarthritis. Extra-articular manifestations of rheumatologic disease may be helpful in arriving at a more specific diagnosis. Many classic rheumatologic laboratory tests are nonspecific. A complete blood count, urinalysis, and a metabolic panel may provide more useful diagnostic clues. Plain-film radiographs may demonstrate classic findings of specific rheumatologic diseases; however, radiographs can be normal or only show nonspecific changes early in the disease process. 806 PMID- 12804333 AU - Moss-Morris R, Petrie KJ TI - Experimental evidence for interpretive but not attention biases towards somatic information in pts w CFS. SO - Br J Health Psychol 2003 May;8(Pt 2):195-208. IN - D o Health Psychology, The U o Auckland, New Zealand. r.mos+ AB - +IN: s-morris@auckland.ac.nz OBJECTIVE: This study tested whether CFS patients have an attentional information processing bias for illness-related information and a tendency to interpret ambiguous information in a somatic fashion. DESIGN: 25 patients meeting research criteria for a diagnosis of CFS were compared to 24 healthy matched controls on a modified Stroop task and an ambiguous cues task. METHOD: In the modified Stroop task, participants colour named a series of somatic, depressed and neutral words in order to ascertain whether the somatic words were more distracting to the CFS patients than the depressed and neutral words when compared to controls. In the ambiguous cues task, participants were presented with a tape-recorded list of 30 words including 15 ambiguous illness words (e.g., vein/vain) and 15 unambiguous words. For each word, they were asked to write down the first word that came into their head. A somatic bias score was obtained for each subject by summing the number of somatic responses to the ambiguous word cues. RESULTS: Although CFS patients were significantly slower in colour naming all of the Stroop word categories than controls, there was no evidence for illness or depressed words creating greater interference than neutral words. However, on the ambiguous cues task, CFS patients made significantly more somatic interpretations than controls and this bias was significantly associated with the extent to which they currently reported symptoms. CONCLUSION: CFS patients have an interpretive bias for somatic information which may play a part in the maintenance of the disorder by heightening patients' experience of physical symptoms and helping to maintain their negative illness schemas. Although patients did not show an attentional bias in this study, this may be related to the methodology employed. 807 PMID- 14507540 AU - Moss-Morris R, Chalder T TI - Illness perceptions & levels of disability in pts w CFS & RA. SO - J Psychosom Res 2003 Oct;55(4):305-8. IN - Health Psychology, The Faculty o Med & Health Sciences, The+ AB - +IN: U o Auckland, Private Bag 92 019, Auckland, New Zealand. r.moss-morris@auckland.ac.nz OBJECTIVE: To investigate the strength of chronic fatigue syndrome (CFS) patients' negative illness perceptions by comparing illness perceptions and self-reported disability in patients with CFS and rheumatoid arthritis (RA). METHODS: Seventy-four RA patients and 49 CFS patients completed the Illness Perception Questionnaire-Revised and the 36-item Short-Form Health Survey. RESULTS: When compared to the RA group, the CFS group attributed a wider range of everyday somatic symptoms to their illness, perceived the consequences of their illness to be more profound and were more likely to attribute their illness to a virus or immune system dysfunction. Both groups reported equivalent levels of physical disability but the CFS group reported significantly higher levels of role and social disability. CONCLUSION: Although the symptoms of CFS are largely medically unexplained, CFS patients have more negative views about their symptoms and the impact that these have had on their lives than do patients with a clearly defined and potentially disabling medical condition. The data support the cognitive behavioural models of CFS that emphasise the importance of patients' illness perceptions in perpetuating this disorder. 808 PMID- 12600798 AU - Mueller A, Hartmann M, Mueller K, Eich W TI - Validation of the arthritis self-efficacy short-form scale in German FM pts. SO - Eur J Pain 2003;7(2):163-71. IN - D o Internal Med II, Med Clinic, U o Heidelberg, Bergheimer+ AB - +IN: Str. 58, 69115, Heidelberg, Germany. annette.mueller@urz.uni-heidelberg.de Self-efficacy is assumed to account for significant variance in the treatment outcome of chronic pain patients. The aim of this study was to provide a German version of an approved measure of disease-related self-efficacy in fibromyalgia (FM) patients which assesses treatment outcomes and specific differences compared to other pain patients. The 8-item short-form of the arthritis self-efficacy scale was translated into German (ASES-D) and administered to 148 FM patients and 53 patients with rheumatoid arthritis (RA). In addition, similar cognitive constructs (locus of control, optimism/pessimism, and general self-efficacy) and disease-related variables (pain, functioning, depression, and coping) were assessed. The instrument was further applied to 43 FM patients who underwent interdisciplinary group therapy. Validation methods consisted of correlation, principal component analysis and difference testing between the disease groups. The instrument met good psychometric properties. Evidence for construct validity was provided. Self-efficacy was sensitive to changes and could be used in predicting the treatment outcome in FM patients. The German short-form ASES-D is a further step toward an internationally comparable assessment of disease-related self-efficacy in FM. 809 PMID- 14650782 AU - Murdoch JC TI - CFS. The patient centred clinical method--a guide for the perplexed. SO - Aust Fam Physician 2003 Nov;32(11):883-7. IN - School o Primary, Aboriginal & Rural Health Care, Rural Cli+ AB - +IN: nical School, U o Western Australia. cmurdoch@rcs.uwa.edu.au BACKGROUND: Chronic fatigue states are common in general practice and over the past 20 years there has been considerable worldwide consensus developed on the criteria for chronic fatigue syndrome (CFS) also commonly known as myalgic encephalomyelitis (ME). Chronic fatigue syndrome is an illness characterised by the new onset of disabling fatigue, accompanied by cognitive, musculoskeletal and sleep symptoms. There are no specific diagnostic tests or biological markers and the diagnosis is made by ruling out other causes of fatigue. The pathophysiology of CFS is still unclear. OBJECTIVE: This article discusses the application of the patient centred clinical method to the diagnosis and treatment of CFS. DISCUSSION: There is no new breakthrough in the diagnosis or management of CFS in spite of much research and controversy. There is considerable evidence that the best place to manage CFS is in primary care under the care of the patient's own general practitioner, but it has been suggested that doctors feel unable to deal with the problem. The patient centred clinical method offers a constructive guide to management. The author considers that the best hope for sufferers is self management guided by a supportive and helpful health professional, preferably the patient's own GP. 810 PMID- 14529252 AU - Nagelkirk PR, Cook DB, Peckerman A, Kesil W, Sakowski T, Natelson BH, LaManca JJ TI - Aerobic capacity of Gulf War veterans w CFS. SO - Mil Med 2003 Sep;168(9):750-5. IN - Center for the Study o War-Related Illnesses, Veterans Affa+ AB - +IN: irs New Jersey Health Care, East Orange, NJ, USA. A large overlap exists between the diagnosis of chronic fatigue syndrome (CFS) and the unexplained symptoms reported by many Gulf War veterans (GV). Previous investigations have reported reduced aerobic capacity in civilians with CFS. The present investigation examined metabolic responses to maximal exercise in GVs with CFS compared with healthy GVs. Cardiorespiratory and metabolic responses were recorded during a maximal exercise test on a cycle ergometer. The groups were not different in any demographic category (p > 0.05) or self-reported physical activity (p > 0.05). No differences were observed between groups for maximal oxygen uptake (28.9 +/- 6.7 mL/kg/min for CFS vs. 30.8 +/- 7.1 mL/kg/min for controls; p = 0.39), heart rate (155.8 +/- 16.1 bpm for CFS vs. 163.3 +/- 14.9 bpm for controls; p = 0.17), exercise time (9.6 +/- 1.5 minutes for CFS vs. 10.2 +/- 1.4 minutes for controls; p = 0.26), or workload achieved (208 +/- 36.7 W for CFS vs. 224 +/- 42.9 W for controls; p = 0.25). Likewise, no differences were observed at submaximal intensities (p > 0.05). Compared with healthy controls, GVs who report multiple medically unexplained symptoms and meet criteria for CFS do not show a decreased exercise capacity. Thus, it does not appear that the pathology of the GVs with CFS includes a deficiency with mobilizing the cardiopulmonary system for strenuous physical effort. 811 PMID- 14592408 AU - Narita M, Nishigami N, Narita N, Yamaguti K, Okado N, Watanabe Y, Kuratsune H TI - Association between serotonin transporter gene polymorphism & CFS. SO - Biochem Biophys Res Commun 2003 Nov 14;311(2):264-6. IN - Institute o Basic Med Sciences, U o Tsukuba, Tennoudai 1-1-+ AB - +IN: 1, Tsukuba, Ibaraki 305-8575, Japan. Interaction between the hypothalamo-pituitary-adrenal axis and the serotonergic system is thought to be disrupted in chronic fatigue syndrome (CFS) patients. We examined a serotonin transporter (5-HTT) gene promoter polymorphism, which affects the transcriptional efficiency of 5-HTT, in 78 CFS patients using PCR amplification of the blood genomic DNA. A significant increase of longer (L and XL) alleic variants was found in the CFS patients compared to the controls both by the genotype-wise and the allele-wise analyses (both p<0.05, by chi(2) test and Fisher's exact test). Attenuated concentration of extracellular serotonin due to longer variants may cause higher susceptibility to CFS. 812 PMID- 12574789 AU - Naschitz JE, Itzhak R, Shaviv N, Khorshidi I, Sundick S, Isseroff H, Fields M, + TI - Assessment of cardiovascular reactivity by fractal & recurrence quantification analysis of heart rate & pulse transit time. [CFS] SO - J Hum Hypertens 2003 Feb;17(2):111-8 AB - +AU: Priselac RM, Yeshurun D, Sabo E Methods used for the assessment of cardiovascular reactivity are flawed by nonlinear dynamics of the cardiovascular responses to stimuli. In an attempt to address this issue, we utilized a short postural challenge, recorded beat-to-beat heart rate (HR) and pulse transit time (PTT), assessed the data by fractal and recurrence quantification analysis, and processed the obtained variables by multivariate statistics. A 10-min supine phase of the head-up tilt test was followed by recording 600 cardiac cycles on tilt, that is, 5-10 min. Three groups of patients were studied, each including 20 subjects matched for age and gender- healthy subjects, patients with essential hypertension (HT), and patients with chronic fatigue syndrome (CFS). The latter group was studied on account of the well-known dysautonomia of CFS patients, which served as contrast against the cardiovascular reactivity of the healthy population. A total of 52 variables of the HR and PTT were determined in each subject. The multivariate model identified the best predictors for the assessment of reactivity of healthy subjects vs CFS. Based on these predictors, the 'Fractal & Recurrence Analysis-based Score' (FRAS) was calculated: FRAS=76.2+0.04*HR-supine-DET -12.9*HR-tilt-R/L -0.31*HR-tilt-s.d. -19.27*PTT-tilt-R/L -9.42*PTT-tilt-WAVE. The median values and IQR of FRAS in the groups were: healthy=-1.85 (IQR 1.89), hypertensives=+0.52 (IQR 5.78), and CFS=-24.2 (5.34) (HT vs healthy subjects: P=0.0036; HT vs CFS: P<0.0001). Since the FRAS differed significantly between the three groups, it appears likely that the FRAS may recognize phenotypes of cardiovascular reactivity.Journal of Human Hypertension (2003) 17, 111-118. doi:10.1038/sj.jhh.1001517 813 PMID- 14650107 AU - Naschitz JE, Sabo E, Dreyfuss D, Yeshurun D, Rosner I TI - The head-up tilt test in the Dx & management of CFS. SO - Isr Med Assoc J 2003 Nov;5(11):807-11. IN - D o Internal Med A, Bnai Zion Med Ctr, Technion Faculty o M+ AB - +IN: edicine, Haifa, Israel. Naschitz@tx.technion.ac.il 814 PMID- 12589011 AU - Naschitz JE, Rosner I, Rozenbaum M, Naschitz S, Musafia-Priselac R, Shaviv N, F+ TI - The head-up tilt test w haemodynamic instability score in diagnosing CFS. SO - QJM 2003 Feb;96(2):133-42 IN - Departments o Internal Med A and. Rheumatology, Bnai Zion M+ AB - +IN: ed Ctr & Bruce Rappaport Faculty o Medicine, Technion-Israel Inst o Technology, Haifa, Israel. +AU: ields M, Isseroff H, Zuckerman E, Yeshurun D, Sabo E BACKGROUND:Studying patients with chronic fatigue syndrome (CFS), we have developed a method that uses a head-up tilt test (HUTT) to estimate BP and HR instability during tilt, expressed as a 'haemodynamic instability score' (HIS). Aim: To assess HIS sensitivity and specificity in the diagnosis of CFS. DESIGN:Prospective controlled study. METHODS:Patients with CFS (n=40), non-CFS chronic fatigue (n=73), fibromyalgia (n=41), neurally mediated syncope (n=58), generalized anxiety disorder (n=28), familial Mediterranean fever (n=50), arterial hypertension (n=28), and healthy subjects (n=59) were evaluated with a standardized head-up tilt test (HUTT). The HIS was calculated from blood pressure (BP) and heart rate (HR) changes during the HUTT. RESULTS:The tilt was prematurely terminated in 22% of CFS patients when postural symptoms occurred and the HIS could not be calculated. In the remainder, the median(IQR) HIS values were: CFS +2.14(4.67), non-CFS fatigue -3.98(5.35), fibromyalgia -2.81(2.62), syncope -3.7(4.36), generalized anxiety disorder -0.21(6.05), healthy controls -2.66(3.14), FMF -5.09(6.41), hypertensives -5.35(2.74) (p<0.0001 vs. CFS in all groups, except for anxiety disorder, p=NS). The sensitivity for CFS at HIS >-0.98 cut-off was 90.3% and the overall specificity was 84.5%. DISCUSSION:There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by HIS >-0.98. The HIS can reinforce the clinician's diagnosis by providing objective criteria for the assessment of CFS, which until now, could only be subjectively inferred. 815 PMID- 12707492 AU - Neri S, Pistone G, Saraceno B, Pennisi G, Luca S, Malaguarnera M TI - L-carnitine decreases severity & type of fatigue induced by interferon-alpha in the Rx of pts w hepatitis C. SO - Neuropsychobiology 2003;47(2):94-7. IN - D o Senescence, Urological & Neurological Sciences, U o Cat+ AB - +IN: ania, Catania, Italy. BACKGROUND: Hepatitis C virus (HCV) is one of the major agents of chronic hepatitis and liver disease worldwide. Infection with HCV leads to chronic hepatitis in about 80% of the cases. The most used treatment is based on interferon (IFN)-alpha, which is effective in less than 50% of patients; however, a high proportion of responders may relapse after interferon withdrawal. Fatigue is a common complaint in patients with liver disease. The aim of our study was to evaluate the efficacy of carnitine on IFN-induced fatigue in subjects with chronic hepatitis C. PATIENTS AND METHODS: We studied 50 patients (30 males and 20 females) with chronic hepatitis C. Chronic hepatitis was diagnosed by determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (at least 2-fold upper normal values for 1 year). Our study series was divided into two groups and matched as to number, age, sex, as well as grade and duration of disease. Group 1, composed of 25 patients, was treated with leucocytic IFN-alpha at a dosage of 3 million IU thrice a week; group 2 (25 patients) was treated with the same protocol as group 1, but was also administered carnitine 2 g per os daily. Patients' response was evaluated on the basis of serum levels of AST and ALT as well as liver functions; fatigue was evaluated by Wessely and Powell scores. All patients studied were tested before treatment and then 1, 3 and 6 months after the beginning of IFN administration. RESULTS: The difference of physical fatigue between the two groups after 1 month of therapy was significant (p < 0.01) for patients treated with carnitine. This significance continued at the end of month 3 (p < 0.01). With reference to mental fatigue, the comparison between the two groups showed a significant difference for group 2 after 1 month (p < 0.01). Finally, with respect to the fatigue severity, the comparison between the two groups showed that after 1 and 3 months of therapy, fatigue was significantly less severe in group 2 than group 1 (p < 0.0005). CONCLUSIONS: If we take into account baseline values of mental and physical fatigue as well as the severity of this symptom in our study series, one observes that therapy with IFN alone induces fatigue in the majority of cases after 1 and 3 months, while at month 6, the values decrease. In contrast, patients treated with IFN + carnitine show a marked and early significant reduction of fatigue levels. These data suggest that the greater energetic substrate utilised by group 2 patients may in some way provide a better response of the patients to this side-effect. Abnormalities of neurotransmission concerning serotonine seem involved in the genesis of depression and fatigue. In addition, depression and fatigue commonly occur together, and the former is the most commonly observed symptom in patients with chronic fatigue syndrome. 816 PMID- 12701042 AU - Neumann L, Zeldets V, Bolotin A, Buskila D TI - Outcome of posttraumatic FM: a 3-year follow-up of 78 cases of cervical spine injuries. SO - Semin Arthritis Rheum 2003 Apr;32(5):320-5. IN - Epidemiology D, D o Med, Soroka Med Ctr, Faculty o Health S+ AB - +IN: ciences, Ben-Gurion U o the Negev, Beer Sheva, Israel. OBJECTIVE: To assess the outcome of fibromyalgia syndrome (FMS) after cervical spine injury. METHODS: Seventy-eight of 102 (77%) patients with neck injury were recruited 3 years after the original study in 1996. Twenty of the original 22 patients with FMS were available for reevaluation in 1999. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed by using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life. RESULTS: Sixty percent of the 20 patients who had FMS in 1996 still had it 3 years later. All the 11 women with FMS, but only 1 of the 9 men with FMS, met FMS criteria in 1999. Only 1 of 58 patients who had no FMS in 1996 developed FMS. The quality of life scores for most patients improved, their tenderness scores decreased, and all remained employed. CONCLUSIONS: The outcome of posttraumatic FMS in patients with neck injury seems to be more favorable in men than in women; however, this finding should be interpreted with caution because of the small sample. Patients who do not develop FMS within 1 year of neck injury have a low probability of developing FMS in the future, comparable to the incidence of FMS in the general population. 817 PMID- 12887507 AU - Nicolson GL, Gan R, Haier J TI - Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of CFS pts: association w signs & Sx. SO - APMIS 2003 May;111(5):557-66. IN - The Inst for Molecular Med, Huntington Beach, California 92+ AB - +IN: 649, USA. gnicolson@immed.org Previously we and others found that a majority of chronic fatigue syndrome (CFS) patients showed evidence of systemic mycoplasmal infections, and their blood tested positive using a polymerase chain reaction assay for at least one of the four following Mycoplasma species: M. fermentans, M. hominis, M. pneumoniae or M. penetrans. Consistent with previous results, patients in the current study (n=200) showed a high prevalence (overall 52%) of mycoplasmal infections. Using forensic polymerase chain reaction we also examined whether these same patients showed evidence of infections with Chlamydia pneumoniae (overall 7.5% positive) and/or active human herpes virus-6 (HHV-6, overall 30.5% positive). Since the presence of one or more infections may predispose patients to other infections, we examined the prevalence of C. pneumoniae and HHV-6 active infections in mycoplasma-positive and -negative patients. Unexpectedly, we found that the incidence of C. pneumoniae or HHV-6 was similar in Mycoplasma-positive and -negative patients, and the converse was also found in active HHV-6-positive and -negative patients. Control subjects (n=100) had low rates of mycoplasmal (6%), active HHV-6 (9%) or chlamydial (1%) infections, and there were no co-infections in control subjects. Differences in bacterial and/or viral infections in CFS patients compared to control subjects were significant. Severity and incidence of patients' signs and symptoms were compared within the above groups. Although there was a tendency for patients with multiple infections to have more severe signs and symptoms (p<0.01), the only significant differences found were in the incidence and severity of certain signs and symptoms in patients with multiple co-infections of any type compared to the other groups (p<0.01). There was no correlation between the type of co-infection and severity of signs and symptoms. The results indicate that a large subset of CFS patients show evidence of bacterial and/or viral infection(s), and these infections may contribute to the severity of signs and symptoms found in these patients. 818 PMID- 15088282 AU - Nielson WR, Harth M TI - FM: beyond the rhetoric. SO - [CON: J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918]; [CON: J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919]; [CON: J Rheumatol. 2003 Aug;30(8):1671-2. PMID: 12913920]; J Rheumatol 2004 Apr;31(4):631. 819 PMID- 12684286 AU - Nijs J, De Becker P, De Meirleir K, Demanet C, Vincken W, Schuermans D, McGrego+ TI - Associations between bronchial hyperresponsiveness & immune cell parameters in pts w CFS. SO - Chest 2003 Apr;123(4):998-1007. IN - D o Human Physiology, Faculty o Physical Education & Physic+ AB - +IN: al Therapy, Academic Hosp, Vrije Universiteit Brussel, Belgium. Jo.Nijs@vub.ac.be +AU: r N STUDY OBJECTIVE: To examine whether bronchial hyperresponsiveness (BHR) in patients with chronic fatigue syndrome (CFS) is caused by immune system abnormalities. DESIGN: Prospective comparative study. SETTING: A university-based outpatient clinic (Vrije Universiteit; Brussels, Belgium). PARTICIPANTS: One hundred thirty-seven CFS patients and 27 healthy volunteers. MEASUREMENTS: Pulmonary function testing, histamine bronchoprovocation test, immunophenotyping, and ribonuclease (RNase) latent determination. RESULTS: Seventy-three of 137 patients presented with BHR, of whom 64 had normal results of the histamine bronchoprovocation test. No significant differences were found in age or sex characteristics between the groups. There were no differences in the RNase L ratio, total lung capacity, or FEV(1)/FVC ratio between CFS patients with or without BHR. The group of patients in whom BHR was present (BHR+) differs most significantly from the control group with eight differences in the immunophenotype profile in the cell count analysis and seven differences in the percentage distribution profile. The group of patients in whom no BHR was detected (BHR-) only differed from the control subjects in CD25+ count and in the percentage of CD25+ cells. We observed a significant increase in cytotoxic T-cell count and in the percentage of BHR+ patients compared to BHR- patients, which is consistent with the significant reduction in percentage naive T cells. CONCLUSIONS: These results refute any association between the cleaving of 80 kd RNase L and BHR. Immunophenotyping of our sample confirmed earlier reports on (chronic) immune activation in patients with CFS, compared to healthy control subjects. BHR+ CFS patients have more evidence of immune activation compared to BHR- patients. Inflammation and the consequent IgE-mediated activation of mast cells and eosinophils, as seen in asthma patients, is unlikely to be responsible for the presence of BHR in patients with CFS. 820 PMID- 12450768 AU - Nijs J, De Meirleir K, Englebienne P, McGregor N TI - CFS: a risk factor for osteopenia? SO - Med Hypotheses 2003 Jan;60(1):65-8 IN - D o Human Physiology, Faculty o Physical Education & Physio+ AB - +IN: therapy, Vrije Universiteit Brussel, Brussel, Belgium No data documenting a possible depletion of bone mineral density in patients with chronic fatigue syndrome (CFS) are currently available. However, recent pathophysiological observations in CFS patients may have deleterious consequences on bone density. Firstly, the deregulation of the 2,5A synthetase RNase L antiviral pathway and its associated channelopathy, implicates increased demands for calcium and consequent increased calcium-re-absorption from the skeletal system. Secondly, Mycoplasma fermentans which has been frequently associated with CFS, produces a lipopeptide, named 2-kDa macrophage-activating lipopeptide (MALP-2), which stimulates macrophages. MALP-2 has been shown to enhance bone resorption in a dose-dependent manner, at least in part by stimulating the formation of prostaglandins. Thirdly, decreased levels of insulin-like growth factor I (IGF-I) have been reported in CFS-patients. IGF-I is critical to the proliferation of osteoblasts. Consequently, depleted levels of IGF-I may shift the balance between osteoclastic and osteoblastic activity towards bone resorption. 821 PMID- 12718710 AU - Nijs J, Vaes P, McGregor N, Van Hoof E, De Meirleir K TI - Psychometric properties of the Dutch CFS--Activities & Participation Questionnaire (CFS-APQ). SO - Phys Ther 2003 May;83(5):444-54. IN - D o Human Physiology, Faculty o Physical Education & Physic+ AB - +IN: al Therapy, Vrije Universiteit Brussel, Belgium. Jo.Nijs@vub.ac.be BACKGROUND AND PURPOSE: The Chronic Fatigue Syndrome-Activities and Participation Questionnaire (CFS-APQ) is a recently developed disease-specific assessment tool for monitoring activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS). In this study, the convergent validity, content validity, and test-retest reliability of data obtained with the Dutch-language version of the questionnaire were examined. SUBJECTS AND METHODS: One hundred eleven consecutive patients with CFS were enrolled, of whom 47 fulfilled all inclusion criteria. The subjects were first asked to rate their pain, fatigue, and ability to concentrate using 3 visual analog scales, to list at least 5 activities that had become difficult to perform due to their complaints, and to complete the CFS-APQ. Furthermore, subjects were asked to complete a modified version of the CFS-APQ at home and return it to the investigators. The content of the questionnaire was reviewed using the World Health Organization's International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Spearman rank correlation coefficients (R) were used for the convergent validity analysis, and intraclass correlation coefficients were computed for the assessment of the test-retest data. RESULTS: Overall scores on the CFS-APQ correlated with the scores from the visual analog scales for pain (R=.51, P<.001) and fatigue (R=.50, P<.001). The majority of the responses (157 out of 183 answers [85.8%]) to the request to "list difficult activities" matched the content of the CFS-APQ. Using the ICIDH beta II draft, 21 out of 26 questions were found to address activities, and the remaining 5 questions measured the participation level. The Cronbach alpha coefficient was.94, and intraclass correlation coefficients for test-retest reliability of the overall scores were >or= .95 (P<.001). DISCUSSION AND CONCLUSION: The results substantiate the convergent validity, content validity, and reliability of the CFS-APQ scores for patients with CFS. 822 PMID- 12515836 AU - Olson LG, Ambrogetti A, Sutherland DC TI - A pilot randomized controlled trial of dexamphetamine in pts w CFS. SO - Psychosomatics 2003 Jan-Feb;44(1):38-43 IN - D o Respiratory & Sleep Med, John Hunter Hosp, Faculty o Me+ AB - +IN: dicine, U o Newcastle, Australia. lolson@mail.newcastle.edu.au This study determined whether dexamphetamine improved symptoms and quality of life in patients with chronic fatigue syndrome. The setting was a specialized clinic within a tertiary referral hospital. This was a 6-week parallel-group, placebo-controlled trial with random allocation. There was a 2-week dose-adjustment phase and a 4-week stable treatment period. Outcome measures were the Fatigue Severity Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, and two patient-determined outcomes. Ten patients were randomly assigned to dexamphetamine, and 10 were assigned to placebo. Fatigue Severity Scale scores improved in nine of 10 dexamphetamine and four of 10 placebo patients. The change in mean score was statistically significant. There were large but statistically nonsignificant changes in scores for the Short-Form Health Survey domains vitality and physical functioning. Dexamphetamine may be useful in the management of chronic fatigue syndrome; a larger and longer trial is justified by these results. 823 PMID- 12759293 AU - Ozgocmen S, Yoldas T, Kamanli A, Yildizhan H, Yigiter R, Ardicoglu O TI - Auditory P300 event related potentials & serotonin reuptake inhibitor Rx in pts w FM. SO - Ann Rheum Dis 2003 Jun;62(6):551-5. IN - D o Physical Med & Rehabilitation, Div o Rheumatology, Fira+ AB - +IN: t U, Faculty o Medicine, 23119 Elazig Turkey. sozgocmen@hotmail.com BACKGROUND: The P300 components of auditory event related potentials (ERPs) are objective measures related to information and cognitive processing. OBJECTIVES: To assess P300 ERPs in female patients with fibromyalgia (FM) in comparison with healthy age matched controls. To investigate the relationship between P300 potentials and pain threshold levels of patients, and subsequent effect of sertraline treatment on P300 potentials. METHODS: P300 auditory ERPs were studied in 13 untreated female patients with FM and 10 healthy controls matched for age, sex, and education. Pain pressure thresholds and total myalgic scores (TMS) were assessed with an algometer. Patients were evaluated for clinical measures and P300 potentials (recorded from the vertex) at the first visit, and then in the fourth and eighth weeks of sertraline treatment. RESULTS: Patients with FM had significantly lower P300 amplitudes, but not significantly different P300 latencies, than controls at entry. P300 latencies in patients correlated negatively with TMS (r(s)=-0.79, p<0.01) and P300 amplitudes correlated significantly with TMS (r(s)=0.53, p<0.05). Anxiety and depression scores did not correlate significantly with P300 latencies or amplitudes at the study entry. P300 auditory ERPs had increased amplitudes that had reached nearly the same levels as those of the controls at the eighth week without any significant change in their latencies. CONCLUSION: The results show reduced P300 amplitudes in patients with FM. Further studies assessing the relationship between P300 ERPs and neuropsychiatric tests are required for better clarification of the clinical relevance of P300 potentials in FM. 824 PMID- 14500310 AU - Patel MX, Smith DG, Chalder T, Wessely S TI - CFS in children: a cross sectional survey. SO - Arch Dis Child 2003 Oct;88(10):894-8. IN - Institute o Psychiatry & GKT School o Med, De Crespigny Par+ AB - +IN: k, London SE5 8AF, UK. BACKGROUND: Chronic fatigue syndrome (CFS) in children is a controversial diagnosis with unclear aetiology, ill defined but likely increasing incidence, and debatable clinical management options. However these children experience real and considerable suffering. Appropriate research in this clinical population is sparse and usually occurs in tertiary referral units. METHODS: Cross sectional survey of 36 children attending a GP specialist interest clinic in southeast England. RESULTS: Patient sociodemographics and clinical morbidity were largely comparable to the literature from tertiary referral research centres. Some prognostic indicators for adults did not readily transfer to this younger age group, although several children had a positive family psychiatric history. Receiving treatment was associated with increased school attendance, but one third of subjects obtained no qualifications. Return to normal health or significant overall improvement was reported by 29/36 subjects. CONCLUSIONS: The outcomes in this setting are favourable and comparable to those seen in a controlled setting; this study supports the concept that the prognosis for CFS in children and adolescents is generally good. However, the impact of the illness is significant and this is perhaps most evident in terms of education. Current methods of reporting educational outcomes in the literature are varied and merit development of standardised tools. 825 PMID- 12773276 AU - Patkar AA, Bilal L, Masand PS TI - Management of FM. SO - Curr Psychiatry Rep 2003 Jul;5(3):218-24. IN - D o Psychiatry, Thomas Jefferson U, 833 Chestnut Street, Su+ AB - +IN: ite 210E, Philadelphia, PA 19107, USA. ashwin.patkar@mail.tju.edu Fibromyalgia is characterized by widespread pain, persistent fatigue, nonrestorative sleep, and generalized morning stiffness. The diagnosis is based on patients' reports of pain and fatigue, clinical findings of multiple tender points, and exclusion of a range of connective tissue and other medical disorders. Treatment of fibromyalgia is multidisciplinary with an emphasis on active patient participation, medications, cognitive behavioral therapy, and physical modalities. No single medication has been found to effectively control all the symptoms, and a rational combination of different medications is often necessary. Currently available medication classes include the selective serotonin uptake inhibitors, the serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, analgesics, hypnotic agents, and anticonvulsants. Treatment modalities should be individualized for patients based on target symptoms and impairment in functioning. As is the case with several chronic disorders, the treatment is often prolonged and improvement may occur slowly. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. 826 PMID- 12603556 AU - Paulson M, Norberg A, Soderberg S TI - Living in the shadow of fibromyalgic pain: the meaning of female partners' experiences. SO - J Clin Nurs 2003 Mar;12(2):235-43. IN - D o Nursing & Health Sciences, Mid Sweden U, Ostersund, Swe+ AB - +IN: den. margareta.paulson@mh.se The aim of this study was to elucidate the meaning of being a female partner living with a man with fibromyalgic pain. Fourteen partners were interviewed about the meaning of their experiences, using a narrative approach. A phenomenological hermeneutic method, inspired by the French philosopher Ricoeur, was used to interpret the interview text. The structural analysis is presented in three major themes: struggling to give support and comfort, struggling to keep going on, and experiencing lack of understanding and support. The findings elucidate that the meaning of living with a man with fibromyalgic pain meant living a life strongly influenced by the man's illness and in the shadow of the man's pain. Taking daily life for granted was interrupted and restricted family and social life. Prominent in this study was the frustration partners felt as a result of men's reluctance to communicate. This led to feelings of being excluded from men's emotions. The responsibility day in and day out meant that women's own caring and tenderness were replaced, which brought about an almost constant sense of fatigue. Women became drained by the long duration of men's illness. This gave them a feeling of being alone, although they were a couple. Gaining comfort outside the family helped partners to reach a new insight and appreciation for life, which was viewed from a renewed perspective. This involved feelings of both togetherness and separateness in the relationship. The findings also consider the lack of support from the health care system for female partners living with men with fibromyalgic pain. 827 PMID- 12920435 AU - Peckerman A, LaManca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH TI - Abnormal impedance cardiography predicts Sx severity in CFS. SO - AJM Sci 2003 Aug;326(2):55-60. IN - D o Neurosciences, CFS Cooperative Research Ctr, U o Med & + AB - +IN: Dentistry o New Jersey, Newark, NJ, USA. apeckerm@njneuromed.org BACKGROUND: Findings indicative of a problem with circulation have been reported in patients with chronic fatigue syndrome (CFS). We examined this possibility by measuring the patient's cardiac output and assessing its relation to presenting symptoms. METHODS: Impedance cardiography and symptom data were collected from 38 patients with CFS grouped into cases with severe (n = 18) and less severe (n = 20) illness and compared with those from 27 matched, sedentary control subjects. RESULTS: The patients with severe CFS had significantly lower stroke volume and cardiac output than the controls and less ill patients. Postexertional fatigue and flu-like symptoms of infection differentiated the patients with severe CFS from those with less severe CFS (88.5% concordance) and were predictive (R2 = 0.46, P < 0.0002) of lower cardiac output. In contrast, neuropsychiatric symptoms showed no specific association with cardiac output. CONCLUSIONS: These results provide a preliminary indication of reduced circulation in patients with severe CFS. Further research is needed to confirm this finding and to define its clinical implications and pathogenetic mechanisms. 828 PMID- 14508037 AU - Peckerman A, LaManca JJ, Qureishi B, Dahl KA, Golfetti R, Yamamoto Y, Natelson + TI - Baroreceptor reflex & integrative stress responses in CFS. SO - Psychosom Med 2003 Sep-Oct;65(5):889-95. IN - VA Med Ctr, War-Related Illness & Injury Study Center, East+ AB - +IN: Orange, New Jersey 07018, USA. apeckerm@njneuromed.org +AU: BH OBJECTIVE: Altered cardiovascular responses to mental and postural stressors have been reported in chronic fatigue syndrome (CFS). This study examined whether those findings may involve changes in baroreceptor reflex functioning. METHODS: Chronotropic baroreceptor reflex (by sequential analysis) and cardiovascular stress responses were recorded during postural (5-minute of active standing) and cognitive (speech task) stress testing in patients with CFS grouped into cases with severe (N = 21) or less severe (N = 22) illness, and in 29 matched control subjects. RESULTS: Patients with CFS had a greater decline in baroreceptor reflex sensitivity (BRS) during standing, although only those with severe CFS were significantly different from the controls. Systolic blood pressure declined during standing in the control group but was maintained in the CFS patients. In contrast, the patients with less severe CFS had blunted increases in blood pressure during the speech task, which could not, however, be explained by inadequate inhibition of the baroreceptor reflex, with all groups showing an appropriate reduction in BRS during the task. CONCLUSIONS: These results indicate that in CFS, deficiencies in orthostatic regulation, but not in centrally mediated stress responses, may involve the baroreceptor reflex. This study also suggests that classifying patients with CFS on illness severity may discriminate between patients with abnormalities in peripheral vs. central mechanisms of cardiovascular stress responses. 829 PMID- 14614966 AU - Peckerman A, Dahl K, Chemitiganti R, LaManca JJ, Ottenweller JE, Natelson BH TI - Effects of posttraumatic stress disorder on cardiovascular stress responses in Gulf War veterans w fatiguing illness. SO - Auton Neurosci 2003 Oct 31;108(1-2):63-72. IN - VA Med Ctr, East Orange, NJ 07018, USA. apeckerm@njneuromed+ AB - +IN: .org Abnormal cardiovascular stress responses have been reported in Gulf War veterans with chronic fatigue. However, many of these veterans also suffer from posttraumatic stress disorder (PTSD), which could potentially explain the reported abnormalities. To test this hypothesis, 55 Gulf veterans (GVs) with chronic fatigue syndrome (CFS) or idiopathic chronic fatigue (ICF) were stratified into groups with (N=16) and without (N=39) comorbid PTSD, and were compared to healthy Gulf veterans (N=47) on cardiovascular responses to a series of stressors. The CFS/ICF with PTSD group had lower blood pressure responses to speech and arithmetic tasks, and more precipitous declines and slower recoveries in blood pressure after standing up than the controls. Similar trends in the CF/ICF group without PTSD were not significant, however. Both CFS/ICF groups had blunted increases in peripheral vascular resistance during mental tasks. However, only the veterans with comorbid PTSD had diminished cardiac output responses to the mental stressors and excessive vasodilatory responses to standing. Symptoms of posttraumatic stress were significant predictors of hypotensive postural responses, but only in veterans reporting a significant exposure to wartime stress. We conclude that comorbid PTSD contributes to dysregulation of cardiovascular responses to mental and postural stressors in Gulf veterans with medically unexplained fatiguing illness, and may provide a physiological basis for increased somatic complaints in Gulf veterans with symptoms of posttraumatic stress. 830 PMID- 12583836 AU - Peres MF TI - FM, fatigue, & headache disorders. SO - Curr Neurol Neurosci Rep 2003 Mar;3(2):97-103 IN - Sao Paulo Headache Ctr, Al. Joaquim Eugenio de Lima, 881 cj+ AB - +IN: 708/709, Sao Paulo, Brazil. Fibromyalgia, chronic fatigue, and primary headaches are common and debilitating disorders, and their related symptoms of widespread pain, fatigue, and headache have complex interactions and different implications for classification, diagnosis, mechanisms, and treatment. The "continuum" or "spectrum" idea and the modular headache theory are fundamental concepts in understanding these interactions. The overlap between symptom-based conditions leads the reasons to consider them as "functional somatic syndromes." Management of these patients includes a correct diagnosis, appropriate investigation for associated conditions, adequate treatment, and considering the therapeutic opportunities and limitations the comorbid disorders may impose. 831 PMID- 12734906 AU - Perrot S, Dumont D, Guillemin F, Pouchot J, Coste J TI - Quality of life in women w FM syndrome: validation of the QIF, the French version of the FM impact questionnaire. SO - J Rheumatol 2003 May;30(5):1054-9. IN - Centre de la Douleur & the Service de Rhumatologie, Hopital+ AB - +IN: Cochin, Paris, France. serge.perrot@cch.ap-hop-paris.fr OBJECTIVE: To validate a translated and adapted version of the Fibromyalgia Impact Questionnaire (FIQ) for use in French-speaking populations. METHODS: The FIQ was translated into French by 2 independent translators and then back-translated into English to assess the conceptual equivalence. The translated version was tested and adapted by an expert committee to obtain the Questionnaire de mesure d'Impact de la Fibromyalgie (QIF), the French version of the FIQ. We administered the QIF to 102 women with fibromyalgia (FM): 71 women who consulted once, and 31 women who were follow for 3 visits (D0, M1, and M3). The patients were also asked to answer 4 other questionnaires: the McGill Pain Questionnaire, the Medical Outcome Study Short Form-36 (SF-36), the short form of the Arthritis Impact Measurement Scale 2 (AIMS2), and the General Health Questionnaire (GHQ) (for psychiatric assessment). To ensure test-retest reliability, the patients were asked to complete the QIF 7 days after the first visit and to send it back to the investigators by mail. During each visit, all patients were asked about pain intensity. A tender point count was obtained by thumb palpation and the tenderness threshold of each specific point was assessed by a 4-point scale score to determine the global tender point index. RESULTS: No major cultural adaptation was needed to obtain the French version of the FIQ. Test-retest reliability coefficients (intraclass correlation coefficient) for each question ranged from 0.04 to 0.84. Two items from the QIF (number of days when the patient felt good and visual analog scale stiffness) did not reach significant levels of test-retest reliability. Internal validity was good. The QIF score correlated well with the SF-36 and AIMS2 scores. The psychological aspects of the QIF were well correlated with those of GHQ-28. None of the items from the McGill Pain Questionnaire was correlated with QIF items. Similarly the clinical data concerning pain assessment were not correlated with QIF items. CONCLUSIONS: QIF is a valid instrument for measuring functional disability and health status in French women with FM. Some of the items were of a limited reliability, perhaps due to the variability of the multiple aspects of this syndrome. 832 PMID- 14527701 AU - Petzke F, Clauw DJ, Ambrose K, Khine A, Gracely RH TI - Increased pain sensitivity in FM: effects of stimulus type & mode of presentation. SO - Pain 2003 Oct;105(3):403-13. IN - D o Anesthesiology, U o Cologne, Cologne, Germany. AB - Fibromyalgia (FM) is defined in part by sensitivity to blunt pressure. Pressure pain sensitivity in FM is evaluated typically by the use of 'ascending' testing methods such as tender point counts or dolorimetry, which can be influenced by response bias of both the subject and examiner. Methods that present stimuli in a random, unpredictable fashion might minimize the influence of these factors. In this study, we compared the results of ascending and random assessments of both pressure and thermal pain sensitivities in 43 FM patients and 28 age- and gender-matched controls. Even though FM is defined on the basis of pressure sensitivity, this group was also more sensitive to heat stimuli, presented in either ascending or random paradigms. In both the patient and control groups, the pain ratings to painful sensations evoked by both thermal and pressure stimuli were significantly greater in the random, compared with the ascending method. The number of subjects classified as 'expectant' because they rated pain higher in ascending than random paradigms was similar for FM and control groups. Both patients and controls exhibited a similar degree of sensitization to pressure and thermal stimuli. The increased sensitivity to both pressure and thermal stimuli for threshold and suprathreshold stimuli in FM patients is consistent with central augmentation of pain processing. 833 PMID- 12610818 AU - Petzke F, Gracely RH, Park KM, Ambrose K, Clauw DJ TI - What do tender points measure? Influence of distress on 4 measures of tenderness. SO - J Rheumatol 2003 Mar;30(3):567-74. IN - Chronic Pain & Fatigue Research Ctr, Georgetown U Med Cente+ AB - +IN: r, Washington, DC, USA. OBJECTIVE: To examine the relationship between current pain, distress, and ascending and random measures of tenderness. METHODS: Manual tender point counts and dolorimeter measures of the pressure pain threshold were determined in a sample of 47 women representative of the general population with respect to tenderness. In addition, discrete pressure stimuli of varying intensities to the left thumb were applied in random fashion. Distress was measured with the Brief Symptom Inventory and the Beck Depression Inventory, and pain was evaluated with the Short Form McGill Pain Questionnaire. RESULTS: Only the random measure of tenderness was relatively independent of an individual's current psychological state. The respective correlation coefficients between measures of tenderness and psychological state were generally greatest for the manual tender point count and also significant for the dolorimeter measures. In contrast, all measures were highly correlated with ratings of spontaneous pain, again with the manual tender point count showing the strongest, and the random method the weakest, correlations. Linear regression analysis replicated the results of the correlational analysis. CONCLUSION: As a measure of tenderness, the number of positive tender points is clearly influenced by an individual's distress. Other more sophisticated measures of tenderness that randomly present stimuli in an unpredictable fashion appear to be relatively immune to these biasing effects, although our results obtained in a research setting have yet to be replicated in clinical practice. 834 PMID- 12595770 AU - Pfeiffer A, Thompson JM, Nelson A, Tucker S, Luedtke C, Finnie S, Sletten C, Po+ TI - Effects of a 1.5-day multidisciplinary outpatient Rx program for FM: a pilot study. SO - AJPM&R 2003 Mar;82(3):186-91 AB - +AU: stier J Pfeiffer A, Thompson JM, Nelson A, Tucker S, Luedtke C, Finnie S, Sletten C, Postier J: Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: A pilot study. 2003;82:186-191.OBJECTIVE The purpose of this pilot study was to determine the effect of a 1.5-day multidisciplinary fibromyalgia treatment program on impact of illness, depression, and life fulfillment.DESIGN A sample of 100 consecutive enrollees in a 1.5-day multidisciplinary group outpatient fibromyalgia treatment program between February 14, 2000, and May 9, 2000, in a tertiary medical center was used for this study. The Fibromyalgia Impact Questionnaire, the Life Fulfillment and Satisfaction Scales, and the Center for Epidemiologic Studies Depression Scale were administered to subjects immediately preceding the treatment program and by mail 1 mo after completing the program.RESULTS The 78 subjects who returned their surveys 1 mo after treatment demonstrated significant improvement in the area of the impact of illness as measured by the Fibromyalgia Impact Questionnaire total score (51.3-44.7, < 0.002). There was no significant improvement in depressive symptoms ( < 0.056) or the level of life fulfillment ( < 0.53). Subjects with depression improved on the Fibromyalgia Impact Questionnaire to the same degree as those without depression. The 22 nonresponders did not differ significantly from the responders in the variables of sex, age, pretreatment Fibromyalgia Impact Questionnaire score, marital status, educational level, family income, duration of symptoms, or history of depression.CONCLUSIONS These results suggest that a 1.5-day multidisciplinary fibromyalgia treatment program does have a significant positive effect on the impact of illness among patients with fibromyalgia with or without concomitant depression and may be a cost-effective model for the treatment of these patients. 835 PMID- 14740974 AU - Phan C, Mindrum M, Silverman C, Paris K, Spanos W TI - Matched-control retrospective study of the acute & late complications in pts w collagen vascular diseases treated w radiation therapy. SO - Cancer J 2003 Nov-Dec;9(6):461-6. IN - James Graham Brown Cancer Center/Radiation Oncology D, U o + AB - +IN: Louisville, Kentucky, USA. chris.phan@louisville.edu BACKGROUND: Controversy surrounds the potential complication rate of patients with collagen vascular diseases (CVD) after radiation. We assess the acute and late complications (based on Radiation Therapy Oncology Group criteria) by a matched-control retrospective study. PATIRNTS/METHODS: The charts of 12,000 patients treated with radiation therapy at the University of Louisville from 1982 to 2001 were reviewed for CVD. A total of 38 patients with documented CVD were compared with a matched-control group of 38 patients without CVD. Median follow-up for patients with CVD was 35 months. The patients were matched on the basis of site treated, age, dose, date of treatment, sex, treatment goal, follow-up, tumor site and histology, therapeutic technique, and general treatment method. The patients with CVD included 21 patients with systemic lupus erythematosus (55%), two with scleroderma (5%), four with Raynaud's phenomena (11%), three with fibromyalgia (8%), three with polymyalgia rheumatica (8%), three with Sjogren's syndrome (8%), and two with polymyositis-dermatomyositis (5%). Twenty-nine patients received curative doses, and nine patients received palliative doses. RESULTS: No difference was observed in the incidence of acute or late complications between the two groups. For CVD and matched-control patients receiving curative doses, the incidence of acute reaction for grade II was 49% versus 58% and for grade III was 7% versus 7%, respectively. The incidence of late reactions for patients with CVD and the matched control patients for grade I was 3% versus 7%, for grade II was 7% versus 3%, and for grade III was 7% versus 7%, respectively. The patients treated with palliation had a similar incidence of acute reaction in the CVD and the matched-control groups. No patients in the CVD or matched-control group had fatal complications. Only patients with scleroderma had a slight increase in acute and late complications. CONCLUSION: This is the largest matched-control study thus far in the literature. In the comparison between the patients with CVD and the matched-control patients, there was no significant difference in the incidence of acute or late complication. However, there was a higher incidence of radiation complications in patients with scleroderma. Importantly, no fatal complication was noted in any of the patients with CVD. 836 PMID- 12810427 AU - Picavet HS, Hazes JM TI - Prevalence of self reported musculoskeletal diseases is high. SO - Ann Rheum Dis 2003 Jul;62(7):644-50. IN - National Inst o Public Health & the Environment, The Nether+ AB - +IN: lands. Academic Hosp Rotterdam, The Netherlands. susan.picavet@rivm.nl OBJECTIVES: To present the prevalence of self reported musculoskeletal diseases, the coexistence of these diseases, the test-retest reliability with six months in between, and the association with musculoskeletal pain symptoms. METHODS: Twelve layman descriptions of common musculoskeletal diseases were part of the questionnaires of a prospective cohort study of a random sample in the general Dutch population aged 25 years or more (baseline: n=3664, follow up after six months: n=2338). Data collection also included information about pain relating to five different anatomical areas. RESULTS: Osteoarthritis of the knee (men 10.1%, women 13.6%) was amongst the most reported musculoskeletal diseases, whereas the figures for self reported rheumatoid arthritis (RA) were 1.6% and 4.6% for men and women, respectively. The coexistence of these diseases is high: 47 of the 66 combinations were reported more often than would be expected if they were independent of each other (p<0.05). For most diseases the test-retest reliability was good (kappa between 0.6 and 0.8), but for repetitive strain injury (kappa=0.37) and chronic arthritis other than RA (kappa=0.44) the agreement was fair to moderate. All complaints of pain were more often reported by those with musculoskeletal diseases than those without those diseases, and the pain pattern was disease-specific. CONCLUSIONS: Self reported musculoskeletal diseases are highly prevalent, with a fair to good reliability and a disease-specific pain pattern. Health surveys are a limited but valuable source of information for this group of health problems, which is not available from most other sources of information. 837 PMID- 12617422 AU - Pinching AJ TI - AIDS & CFS/ME: a tale of 2 syndromes. SO - Clin Med 2003 Jan-Feb;3(1):78-82. IN - Barts & the London, Queen Mary's School o Med & Dentistry. AB - Both HIV/AIDS and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) presented major challenges for medicine, science and society. This article explores what could have impeded investigation of--and specifically pharmaceutical engagement with--CFS/ME, in contrast to the impressive achievements seen in HIV/AIDS. It explores the obstruction of mind-body dualism in a historical context, and examines some of the possible obstacles to pharmaceutical enquiry. Nothing of real substance is identified that would justify the lack of investment and interest in solutions for patients with CFS/ME. 838 PMID- 12680690 AU - Planz O, Rziha HJ, Stitz L TI - Genetic relationship of Borna disease virus isolates. SO - Virus Genes 2003 Jan;26(1):25-30. IN - Institut fur Immunologie, Bundesforschungsanstalt fur Virus+ AB - +IN: krankheiten der Tiere, Tubingen. oliver.planz@tue.bfav.de The infection of humans with Boma disease virus (BDV) is still a matter of debate. In a recent publication, we described a BDV (RW98) isolated from the blood of a psychiatric patient. The RNA of this virus differed more than 5% from that of the widely used strain He/80, which was supposed to represent our laboratory virus. Here, we show that the virus used in our laboratory was not He/80 and, furthermore, that RW98 has sequence identity to the laboratory strain. We also present data that BDV-specific nucleic acid detected in blood of the donor of the presumed RW98 isolate and one other patient differs from all known BDV-p24 sequences, arguing for the existence of BDV sequences in man. 839 PMID- 12852720 AU - Prins JB, Elving LD, Koning H, Bleijenberg G, van der Meer JW TI - Diagnosing CFS: comparison of a protocol & computerised questionnaires. SO - Neth J Med 2003 Apr;61(4):120-6. IN - D o Med Psychology, U Med Centre St Radboud, PO Box 9101, 6+ AB - +IN: 500 HB Nijmegen, The Netherlands. j.prins@cukz.umcn.nl BACKGROUND: In the context of outpatient care and within the framework of scientific research, guidelines and measuring instruments have been developed to help improve CFS diagnostics. The purpose of this study was to measure the agreement between the evaluations of chronically fatigued patients by physicians using a CFS protocol and by researchers using computerised questionnaires. METHODS: The sample consisted of 516 patients referred to an internal medicine outpatient clinic with complaints of chronic fatigue. Retrospectively the medical records and the computerised questionnaires were checked separately and compared to see whether the criteria for diagnosis of CFS had been met. In addition, the reasons for not diagnosing CFS were evaluated. RESULTS: Agreement between the physicians' and the researchers' evaluations was 84%. Disagreement mostly concerned severity of fatigue and functional impairment, or premorbid exclusion criteria. A physical cause for the chronic fatigue was only found in 3% of the cases. CONCLUSIONS: For physicians, questionnaire assessment may be complementary to the CFS protocol in optimising the process of diagnosing CFS. 840 PMID- 12582976 AU - Prochazka H, Anderberg UM, Oreland L, Knorring LV, Agren H TI - Self-Rated Aggression Related to Serum Testosterone & Platelet MAO Activity in Female Pts w the FM Syndrome. SO - World J Biol Psychiatry 2003 Jan;4(1):35-41 IN - Dr. Helena Prochazka, Arbrogagatan 7, 418 71 Goteborg, Swed+ AB - +IN: en. prochazkahelena@hotmail.com To investigate self-rated aggression in relation to platelet MAO activity and serum testosterone in patients with fibromyalgia syndrome (FMS), we administered the Aggression Questionnaire - Revised Swedish Version (AQ-RSV) to 30 female patients with FMS. After correction for age, significant positive correlations were seen between serum testosterone concentrations and the AQ-RSV scores for Verbal Aggression (r=0.36, p<0.05) and Anger (r=0.37, p<0.05), whereas the platelet MAO activity was negatively correlated with the score for Verbal Aggression (r=-0.44, p<0.05). Our results suggest that aggression and irritability in female FMS patients might be increased by elevated testosterone concentrations in combination with reduced capacity of the serotonergic system as reflected by low platelet MAO activity. 841 PMID- 14620489 AU - Quintner J, Buchanan D, Cohen M, Taylor A TI - Signification & pain: a semiotic reading of FM. SO - Theor Med Bioeth 2003;24(4):345-54. IN - quintner@aceonline.com.au AB - Patients with persistent pain who lack a detectable underlying disease challenge the theories supporting much of biomedical body-mind discourse. In this context, diagnostic labeling is as inherently vulnerable to the same pitfalls of uncertainty that beset any other interpretative endeavour. The end point is often no more than a name rather than the discovered essence of a pre-existent medical condition. In 1990 a Committee of the American College of Rheumatology (ACR) formulated the construct of Fibromyalgia in an attempt to rectify a situation of diagnostic confusion faced by patients presenting with widespread pain. It was proposed that Fibromyalgia existed as a "specific entity", separable from but curiously able to co-exist with any other painful condition. Epistemological and semiotic analyses of Fibromyalgia have failed to find any sign, clinical or linguistic, which could differentiate it from other diffuse musculoskeletal pain states. The construct of Fibromyalgia sought to define a discernable reality outside the play of language and to pass it off as a natural phenomenon. However, because it has failed both clinically and semiotically, the construct also fails the test of medical utility for the subject in persistent pain. 842 PMID- 12585783 AU - Raak R, Hurtig I, Wahren LK TI - Coping strategies & life satisfaction in subgrouped FM pts. SO - Biol Res Nurs 2003 Jan;4(3):193-202 IN - D o Welfare & Care at Linkoping U, Faculty o Health Science+ AB - +IN: s, Norrkoping, Sweden. ragnhild.raak@ivv.liu.se The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced. 843 PMID- 12505558 AU - Rains JC, Penzien DB TI - Sleep & chr pain. Challenges to the alpha-EEG sleep pattern as a pain specific sleep anomaly. [FM/CFS] SO - J Psychosom Res 2003 Jan;54(1):77-83 IN - Center for Sleep Evaluation, Elliot Hosp, One Elliot Way, M+ AB - +IN: anchester, NH, USA OBJECTIVE: The alpha-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who exhibited the alpha-EEG sleep anomaly with pain-free psychiatric and medical patients who also were found to exhibit the alpha-EEG anomaly. METHODS: The alpha-EEG sleep was identified in the polysomnographic records of 5% of over 1000 consecutive sleep patients. Objective sleep parameters, daytime sleepiness and psychological characteristics (Minnesota Multiphasic Personality Inventory [MMPI] scores) of patients exhibiting this anomaly were examined. RESULTS: The alpha-EEG anomaly was identified in only 5% of the total patient sample. Patients with the alpha-EEG anomaly could be further classified into three diagnostic subgroups: chronic pain, psychiatric and other medical/sleep disorders, The subgroups were compared on sleep parameters and psychological characteristics. Less than 40% of the patients exhibiting the alpha-EEG anomaly experienced chronic pain. Chronic pain patients evidenced disturbed sleep patterns and psychological characteristics that were for the most part similar to those observed in some pain-free medical and psychiatric patients. Only the medical subgroup exhibited objective daytime sleepiness. The alpha-EEG sleep disturbance was not accounted for by psychological characteristics. CONCLUSIONS: These findings challenge the notion that alpha-EEG sleep is of direct etiological significance in producing the pain complaint among patients with chronic pain since the alpha-EEG sleep was not a sufficient condition for pain. 844 PMID- 12622307 AU - Rangel L, Garralda ME, Hall A, Woodham S TI - Psychiatric adjustment in CFS of childhood & in juvenile idiopathic arthritis. SO - Psychol Med 2003 Feb;33(2):289-97. IN - Academic Unit o Child & Adolescent Psychiatry, Faculty o Me+ AB - +IN: d, Imperial Coll at St Mary's Campus, London. BACKGROUND: High rates of psychopathology and of personality problems have been reported in children and adolescents with chronic fatigue syndrome (CFS). It is not clear whether this is consequent on the experience of chronic physical ill health. We compare psychiatric adjustment in children with CFS and in children suffering from another chronic physical disorder (juvenile idiopathic arthritis or JIA). METHOD: Our sample consisted of 28 children with CFS and 30 with JIA attending tertiary paediatric centres (age range, 11 to 18 years, mean 15, S.D. 2.3). In order to assess psychiatric status and functioning, we used the K-SADS psychiatric interviews, CGAS and Harter Self-Esteem Questionnaire with child subjects; behavioural questionnaires (CBCL) and child personality assessment interviews (PAS) with parent informants. RESULTS: Psychiatric disorders in the year prior to interview had been present significantly more commonly in the CFS group (72% v. 34% in JIA) and were more impairing to them (CGAS scores of 45 v. 77). Most common diagnoses in both groups were depressive and anxiety disorders. Personality problems were also significantly more frequent in CFS subjects (48% disorder and 26% difficulty v. 11% and 11% in JIA). There were few differences between the two groups in self-esteem. CONCLUSIONS: Psychopathology and personality problems are common in children and adolescents with severe forms of CFS and cannot be explained strictly through the experience of chronic physical illness. 845 PMID- 12849715 AU - Rao SG, Bennett RM TI - Pharmacological therapies in FM. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):611-27. IN - Cypress Bioscience, 4350 Executive Drive, Suite 325, San Di+ AB - +IN: ego, CA 92121, USA. srao@cypressbio.com The fibromyalgia syndrome (FMS) is a common, chronic, widespread pain disorder that mainly affects middle-aged women. In addition to pain complaints, fatigue and disturbed sleep are symptoms frequently reported by these patients. Many FMS patients also meet diagnostic criteria for mood disorders (e.g. depression) as well as other so-called 'functional somatic syndromes', including irritable bowel syndrome, temporomandibular joint disorder, and subsets of chronic low-back pain. A wide variety of medications are used to manage the eclectic symptomatology of FMS patients, although relatively few have been rigorously tested. This chapter provides a contemporary update of the state of FMS pharmacotherapy, with an emphasis on compounds that have been tested in double-blind, randomized, controlled trials. Particular attention is paid to the efficacy of these therapies on the associated symptoms and co-morbid syndromes commonly seen in FMS patients. 846 PMID- 15168987 AU - Rao UR TI - Soft tissue rheumatism. SO - J Indian Med Assoc 2003 Sep;101(9):528, 530. AB - Soft tissue rheumatism includes disorders of tendons and their sheaths, ligaments, bursae, joint capsules, muscles, fasciae and others. Inflammatory signs or systemic manifestations may be lacking in these disorders. Fibrositis, bursitis, tenosynovitis, myositis are some of the common types of soft tissue rheumatism. The disorders can be classified broadly into two groups ie, diffuse and local. Proper history taking and performing detailed examination are very important in arriving at diagnosis. Management includes pain relief by suitable measures. In fibromyalgia diffuse musculoskeletal pain is observed having at least 11 or 18 tender points involving upper and lower body bilaterally. 847 PMID- 12708560 AU - Rashbaum IG, Lacerte M, Braverman DL, Ericksen JJ TI - Interventions in chr pain management. 5. Disease-specific issues in chr pain. [FM] SO - Arch Phys Med Rehabil 2003 Mar;84(3 Suppl 1):S57-62; quiz S+ IN - D o Rehabilitation Med, New York U Med Ctr, New York, NY 10+ AB - +SO: 63-8. +IN: 016, USA. rashbi01@endeavor.med.nyu.edu This self-directed learning module highlights the importance of applying principles described earlier in the Study Guide to specific diseases encountered by practitioners managing chronic pain in order to administer appropriate treatment. This chapter focuses on several challenging and increasingly common maladies and attempts to delineate rationales for holistic, comprehensive care. OVERALL ARTICLE OBJECTIVE: To explore diagnostic concepts and therapeutic strategies in fibromyalgia syndrome, central pain, multiple sclerosis, complex regional pain syndrome, and postherpetic neuralgia. 848 PMID- 12593133 AU - Razumovsky AY, DeBusk K, Calkins H, Snader S, Lucas KE, Vyas P, Hanley DF, Rowe+ TI - Cerebral & systemic hemodynamics changes during upright tilt in CFS. SO - J Neuroimaging 2003 Jan;13(1):57-67 IN - Departments o Anesthesiology/Critical Care Med, Neurology, + AB - +IN: Johns Hopkins Med Institutions, Baltimore, Maryland, USA. arazumov@surgicalmonitoring.net +AU: PC BACKGROUND AND PURPOSE: During head-up tilt (HUT), patients with chronic fatigue syndrome (CFS) have higher rates of neurally mediated hypotension (NMH) and postural tachycardia syndrome (POTS) than healthy controls. The authors studied whether patients with CFS were also more likely to have abnormal cerebral blood flow velocity (CBFV) compared with controls in response to orthostatic stress. METHODS: Transcranial Doppler monitoring of middle cerebral artery (MCA) CBFV was performed during 3-stage HUT prospectively in 26 patients with CFS and 23 healthy controls. At the same time, continuous monitoring of arterial blood pressure (BP), heart rate (HR), endtidal CO2 (ET-CO2) were performed. Results are reported as mean +/- SD. RESULTS: NMH developed in 21 patients with CFS and in 14 controls (P = .22). POTS was present in 9 CFS patients and 7 controls (P = .76). Supine HR was higher in CFS patients, but all other hemodynamics and CBFV measures were similar at baseline. The median time to hypotension did not differ, but the median time to onset of orthostatic symptoms was shorter in those with CFS (P < .001). The CBFV did not differ between groups in the supine posture, at 1 or 5 minutes after upright tilt, at 5 or 1 minute before the end of the test, or at termination of the test. Mean CBFV fell at termination of tilt testing in those with CFS and controls. ET-CO2 was lower at termination of the test in those with CFS versus controls (P = .002). CONCLUSIONS: The results of this study are not consistent with the hypothesis that patients with CFS have a distinctive pattern of MCA CBFV changes in response to orthostatic stress. 849 PMID- 12967415 AU - Reid S, Chalder T, Cleare A, Hotopf M, Wessely S TI - CFS. SO - Clin Evid 2003 Jun;(9):1172-85. IN - St Mary's Hosp, London, UK. 850 PMID- 12966614 AU - Reisine S, Fifield J, Walsh SJ, Feinn R TI - Do employment & family work affect the health status of women w FM? SO - J Rheumatol 2003 Sep;30(9):2045-53. IN - D o Behavioral Sciences & Community Health, U o Connecticut+ AB - +IN: School o Med, 263 Farmington Avenue, Farmington, CT 06030, USA. Reisine@nsol.uchc.edu OBJECTIVE: To assess health status differences of women with fibromyalgia syndrome (FM) who are employed and not employed, and to evaluate whether employment and family work influence the health status of women with FM as it does for women in community studies. METHODS: Participants were 287 women recruited from 118 randomly selected rheumatology practices. They completed telephone interviews that collected data on demographic characteristics, health status, symptoms, family work, and social support. One hundred thirty-seven were employed and 150 were not employed. Formal statistical analysis, including estimation and testing, focused on the relationship between employment and 4 health status measures: Modified Health Assessment Questionnaire (MHAQ), visual analog scale (VAS) for pain on the interview day, number of painful areas, and VAS for fatigue on the interview day. The relationship between employment and these measures was evaluated using analysis of variance, chi-square, linear regression, and ordinal logistic regression. RESULTS: The majority of participants reported high levels of symptoms and poor health status. In the bivariate analyses, employed women reported significantly less pain, less fatigue, and better functional status than those who were not employed. In the multivariate analyses, employment remained a significant factor in explaining number of painful areas, functional status (MHAQ), and fatigue, with employed women reporting better health status than those not employed. Employment was not associated with pain on the day of the interview when other factors were considered in the analysis. The psychological demands of family work were consistently related to all dependent measures of health status, as those with greater psychological demands reported worse health status. CONCLUSION: As in community studies, employed women with FM report better health status than women who are not employed. The demands of family work exert a serious and significant effect on every dimension of health status and should be the focus of greater clinical attention. Further followup will assess whether employment has a protective effect for women with FM as in community studies or whether women with less severe FM tend to remain in the workforce. 851 PMID- 12778361 AU - Renan MJ TI - Is hypercortisolaemia a factor in CFS? SO - Horm Metab Res 2003 Apr;35(4):201-3. IN - Division o Med Microbiology, Health Sciences Faculty, U o C+ AB - +IN: ape Town, South Africa. mrenan@curie.uct.ac.za 852 PMID- 12860574 AU - Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C, Randall B, Stewart JA, Ab+ TI - Prevalence & incidence of CFS in Wichita, Kansas. SO - Arch IM 2003 Jul 14;163(13):1530-6. IN - Division o Viral & Rickettsial Diseases, Nat Ctr for Infect+ AB - +IN: ious Diseases, Centers for Disease Control & Prevention, Public Health Service, US D o Health & Human Services, Atlanta, GA 30333, USA. +AU: bey S, Jones JF, Gantz N, Minden S, Reeves WC BACKGROUND: Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence and incidence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources and for practicing physicians when examining and caring for patients. METHODS: We conducted a random digit-dialing survey and clinical examination to estimate the prevalence of CFS in the general population of Wichita, Kan, and a 1-year follow-up telephone interview and clinical examination to estimate the incidence of CFS. The survey included 33 997 households representing 90 316 residents. This report focuses on 7162 respondents aged 18 to 69 years. Fatigued (n = 3528) and randomly selected nonfatigued (n = 3634) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. The clinical examination included the Diagnostic Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, laboratory testing, and a physical examination. RESULTS: The overall weighted point prevalence of CFS, adjusted for nonresponse, was 235 per 100,000 persons (95% confidence interval, 142-327 per 100,000 persons). The prevalence of CFS was higher among women, 373 per 100,000 persons (95% confidence interval, 210-536 per 100,000 persons), than among men, 83 per 100,000 persons (95% confidence interval, 15-150 per 100,000 persons). Among subjects nonfatigued and fatigued for less than 6 months, the 1-year incidence of CFS was 180 per 100,000 persons (95% confidence interval, 0-466 per 100,000 persons). CONCLUSIONS: Chronic fatigue syndrome constitutes a major public health problem. Longitudinal follow-up of this cohort will be used to further evaluate the natural history of this illness. 853 PMID- 12784409 AU - Robinson RL, Birnbaum HG, Morley MA, Sisitsky T, Greenberg PE, Claxton AJ TI - Economic cost & epidemiological characteristics of pts w FM claims. SO - J Rheumatol 2003 Jun;30(6):1318-25. IN - Eli Lilly & Company, Indianapolis, Indiana 46285, USA. rlro+ AB - +IN: binson@lilly.com OBJECTIVE: Fibromyalgia (FM) is characterized by widespread pain that can lead to significant patient disability, complex management decisions for physicians, and economic burden on society. We investigated the total costs of FM in an employer population. METHODS: Administrative claims data of a Fortune 100 manufacturer were used to quantify direct (i.e., medical and pharmaceutical claims) and indirect (i.e., disability claims and imputed absenteeism) costs associated with FM. A total of 4699 patients with at least one FM claim between 1996 and 1998 were contrasted with a 10% random sample of the overall beneficiary population. Employee-only subsets of both samples also were drawn. RESULTS: Medical utilization, receipt of prescription drugs, and annual total costs were proportionately similar yet significantly greater among FM claimants than the overall sample (all p < 0.0001). Total annual costs for FM claimants were $5945 versus $2486 for the typical beneficiary (p < 0.0001). Six percent of these costs were attributable to FM-specific claims. The prevalence of disability was twice as high among FM employees than overall employees (p < 0.0001). For every dollar spent on FM-specific claims, the employer spent another $57 to $143 on additional direct and indirect costs. CONCLUSION: Hidden costs of disability and comorbidities greatly increase the true burden of FM. Regardless of the clinical understanding of FM, when a claim for FM is present, considerable costs are involved. Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient, physician, and employer burdens. 854 PMID- 12583873 AU - Roelofs J, Peters ML, McCracken L, Vlaeyen JW TI - The pain vigilance & awareness questionnaire (PVAQ): further psychometric evaluation in FM & other chr pain syndromes. [FM] SO - Pain 2003 Feb;101(3):299-306 IN - D o Med, Clinical & Experimental Psychology, Maastricht U, + AB - +IN: P.O. Box 616, 6200 MD, Maastricht, The Netherlands In chronic pain patients, preoccupation with or attention to pain is associated with pain-related fear and perceived pain severity. The current study investigated psychometric properties of the pain vigilance and awareness questionnaire (PVAQ). An exploratory factor analysis on Dutch fibromyalgia patients indicated that a two-factor solution was most suitable. The first factor could be referred to as attention to pain and the second factor was interpreted as attention to changes in pain. A confirmatory factor analysis, testing three different factor structures in two independent samples (Dutch fibromyalgia patients and American pain patients with various diagnoses) showed that the goodness-of-fit indicators for all models were satisfactory. The existence of the previously reported intrusion subscale of the PVAQ as a unique construct within the PVAQ was discussed. This subscale should be further extended by non-reverse-keyed items. With regard to the convergent validity, the PVAQ was highly correlated with related constructs such as the pain catastrophizing scale (PCS), pain anxiety symptoms scale (PASS), and Tampa scale of kinesiophobia (TSK). The attention to pain subscale was significantly stronger associated with these pain-related measures than the attention to changes in pain subscale, indicating that attention to changes in pain is a distinctive construct. The uniqueness of the attention to changes in pain subscale was also supported by an exploratory factor analysis on all items of the PVAQ, PCS, PASS, and TSK which showed that all items from that scale loaded on one separate factor. Overall, the PVAQ showed good internal consistency. Implications for future research and treatment interventions are discussed. 855 PMID- 14689760 AU - Rubinow A TI - FM: a distinct entity? SO - Isr Med Assoc J 2003 Dec;5(12):885-6. IN - Rheumatology Unit, Hadassah U Hosp, Hebrew University-Hadas+ AB - +IN: sah MS, Jerusalem, Israel. rubinov@cc.huji.uc.il 856 PMID- 14604502 AU - Rudin NJ TI - Evaluation of Rxs for myofascial pain syndrome & FM. SO - Curr Pain Headache Rep 2003 Dec;7(6):433-42. IN - D o Orthopedics & Rehabilitation, U o Wisconsin MS, 5249 Ea+ AB - +IN: st Terrace Drive, Mail Code 9950, Madison, WI 53718-8339, USA. nj.rudin@hosp.wisc.edu Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear. 857 PMID- 12801429 AU - Sabin TD TI - An approach to CFS in adults. SO - Neurologist 2003 Jan;9(1):28-34. IN - D o Neurology, Tufts U School o Med & New England Med Ctr, + AB - +IN: Boston, Mass, USA. tsabin@lifespan.org BACKGROUND: The neurologist is often asked to evaluate patients with a chief complaint of fatigue. Many neurologists do not believe in the pathologically based disease known as chronic fatigue syndrome, yet as a group, neurologists are well suited to guide the diagnostic work up of such patients to pinpoint treatable disorders in the realm of neurology, general medicine, and psychiatry. REVIEW SUMMARY: Every patient should be carefully evaluated for certain medical, psychiatric, and neurologic disease that can cause fatigue as the most prominent symptom. This is most pressing because new work in virology, immunology, and imaging holds promise but still does not provide any diagnostic test or a mechanism for the production of these symptoms. Only a few treatments meet with even modest success in CFS. The goal of this paper is to provide the clinical neurologist with a framework for the investigation and management of this challenging group of patients. CONCLUSIONS: Neurologists are typically also trained in psychiatry and general medicine, and this is a strong position to evaluate the patient with fatigue. Because no presently available test can make the diagnosis of CFS, the assessment is vital to seek out more treatable illnesses. 858 PMID- 12508404 AU - Salemi S, Rethage J, Wollina U, Michel BA, Gay RE, Gay S, Sprott H TI - Detection of Interleukin 1beta (IL-1beta), IL-6, & Tumor Necrosis Factor-alpha in Skin of Pts w FM. SO - J Rheumatol 2003 Jan;30(1):146-50 IN - Center o Experimental Rheumatology, D o Rheumatology & Inst+ AB - +IN: o Physical Med, U Hosp, Zurich, Switzerland & the D o Dermatology Allergology, Friedrich-Schiller University, Jena, Germany. OBJECTIVE: To determine if abnormal collagen metabolism is correlated with neurogenic inflammation, a potential activator of collagen metabolism, in patients with fibromyalgia (FM). METHODS: The presence of inflammatory cytokines, interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-a was investigated in skin tissues by using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Fifty-three skin biopsies from female patients with FM (30-65 years of age) were examined and compared to skin biopsies of 10 age and sex matched healthy controls. Biopsies were obtained from the left deltoid region. Rheumatoid arthritis synovial fibroblasts and tissues were used as positive controls for the expression of cytokines. Total RNA isolated from the tissue samples were reverse transcribed (RT) by random hexamers as the primer for RT followed by PCR amplification using specific primers for IL-1beta, IL-6 or TNF-a. Expression of IL-1beta, and TNF-a protein was investigated in the skin by immunohistochemistry using specific antibodies (avidin-biotin method). RESULTS: Positive signals (RT-PCR) were detected in skin tissues of 19/50 (38%) FM patients for IL-1beta, in 14/51 FM patients (27%) for IL-6, and in 17/53 patients (32%) for TNF-a. None of the cytokines could be detected in healthy control skin. Immunoreactivity for IL-1beta and TNF-a was demonstrated in certain skin tissues of our FM patients. CONCLUSION: The detection of cytokines in FM skin indicates the presence of inflammatory foci (neurogenic inflammation) in the skin of certain patients (about 30% of FM patients), suggesting an inflammatory component in the induction of pain. This may explain the response to nonsteroidal antiinflammatory therapy in a subset of FM patients. 859 PMID- 14613295 AU - Salemi S, Aeschlimann A, Gay RE, Michel BA, Gay S, Kaeser L, Sprott H TI - Expression & localization of opioid receptors in muscle satellite cells: no difference between FM pts & healthy subjects. SO - Arthritis Rheum 2003 Nov;48(11):3291-3. IN - U Hosp Zurich, Switzerland. 860 PMID- 12942697 AU - Sarzi-Puttini P, Atzeni F, Fiorini T, Panni B, Randisi G, Turiel M, Carrabba M TI - Validation of an Italian version of the FM Impact Questionnaire (FIQ-I). SO - Clin Exp Rheumatol 2003 Jul-Aug;21(4):459-64. IN - D o Rheumatology & Internal Med, U Hosp L. Sacco, Milan, It+ AB - +IN: aly. sarzi@tiscalinet.it OBJECTIVE: To validate a translated Italian version of the Fibromyalgia Impact Questionnaire (FIQ). METHODS: The Italian version of the FIQ was administered to 50 patients affected by fibromyalgia (FM) (48 patients filled out the questionnaire again 10 days later) together with the Italian version of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC) obtained by summing the score (0-3) of each tender point tested by thumb palpation. All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlations between the HAQ and subscales of the SF-36 as well as the TPC. RESULTS: The mean duration of symptoms was 6.5 years and the mean age of the participants was 57.4 years. Test-retest reliability was between 0.74 and 0.95 for physical functioning as well as for the total FIQ and other components. Internal consistency was 0.90 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ and the SF-36. CONCLUSIONS: The Italian FIQ is a reliable and valid instrument for detecting and measuring functional disability and health status in Italian patients with FM. 861 PMID- 14565792 AU - Sayar K, Aksu G, Ak I, Tosun M TI - Venlafaxine Rx of FM. SO - Ann Pharmacother 2003 Nov;37(11):1561-5. IN - Karadeniz Technical U School o Med, Farabi Hosp, Trabzon, T+ AB - +IN: urkey. mkemalsayar@superonline.com BACKGROUND: Although the pathophysiology of fibromyalgia is unknown, central monoaminergic transmission may play a role. Antidepressants have proved to be successful in alleviating symptoms of fibromyalgia. Medications that act on multiple neurotransmitters may be more effective in symptom management. OBJECTIVE: To assess the efficacy of venlafaxine, a potent inhibitor of both norepinephrine and serotonin reuptake, in the treatment of patients with fibromyalgia. METHODS: Fifteen patients with fibromyalgia were assessed prior to and after treatment with fixed-dose venlafaxine 75 mg/d. Before initiation of pharmacotherapy, patients were interviewed with the Structured Clinical Interview for Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The study lasted for 12 weeks, and patients were evaluated in weeks 6 and 12. The primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score and pain score. The anxiety and depression levels of the patients were measured with the Beck Depression, the Beck Anxiety, the Hamilton Anxiety, and the Hamilton Depression scales. RESULTS: There was a significant improvement in the mean intensity of pain (F = 14.3; p = 0.0001) and in the disability caused by fibromyalgia (F = 42.7; p = 0.0001) from baseline to week 12 of treatment. The depression and anxiety scores also decreased significantly from baseline to week 12. The improvement in the FIQ scores did not correlate with the decrease of scores in both patient- and physician-rated depression and anxiety inventories. Change in pain scores also was not correlated with the change in depression and anxiety scores. CONCLUSIONS: Venlafaxine was quite promising in alleviating the pain and disability associated with fibromyalgia. This effect seems to be independent of its anxiolytic and antidepressant properties. Blockade of both norepinephrine and serotonin reuptake might be more effective than blockade of either neurotransmitter alone in the treatment of fibromyalgia. 862 PMID- 12665405 AU - Schachter CL, Busch AJ, Peloso PM, Sheppard MS TI - Effects of short versus long bouts of aerobic exercise in sedentary women w FM: a randomized controlled trial. SO - Phys Ther 2003 Apr;83(4):340-58. IN - School o Physical Therapy, U o Saskatchewan, 1121 Coll Dr, + AB - +IN: Saskatoon, Saskatchewan, S7N 0W3 Canada. schachter@usask.ca BACKGROUND AND PURPOSE: The purposes of this study were: (1) to assess the effectiveness of a 16-week progressive program of home-based, videotape-based, low-impact aerobic exercise on physical function and signs and symptoms of fibromyalgia in previously sedentary women aged 20 to 55 years and (2) to compare the effects of 1 long exercise bout versus 2 short exercise bouts per training day (fractionation) on physical function, signs and symptoms of fibromyalgia, and exercise adherence. SUBJECTS: One hundred forty-three sedentary women were randomly assigned to 1 of 3 groups: a group who trained using a long bout of exercise (LBE group, n=51), a group who trained using short bouts of exercise (SBE group, n=56), and a group who performed no exercise (NE group, n=36). METHODS: The SBE group exercised twice daily, and the LBE group worked out once daily. Both groups progressed in total daily training duration from 10 to 30 minutes, 3 to 5 times a week, for 16 weeks. Physical and psychological well-being, symptoms, and self-efficacy were evaluated using a multivariate analysis of variance. RESULTS: Dropout rates for the NE, SBE, and LBE groups were 14%, 38%, and 29%, respectively. The NE group differed from the LBE group in disease severity, self-efficacy, and psychological well-being (midtest, efficacy analysis) and from the SBE group in disease severity and self-efficacy (posttest, efficacy analysis). Exercise adherence was greater for the LBE group than for the SBE group between weeks 5 and 8 of the training program. No other differences between exercise groups were found. DISCUSSION AND CONCLUSION: Progressive, home-based, low-impact aerobics improved physical function and fibromyalgia symptoms minimally in participants who completed at least two thirds of the recommended exercise. Fractionation of exercise training provided no advantage in terms of exercise adherence, improvements in fibromyalgia symptoms or physical function. High attrition rates and problems with exercise adherence were experienced in both exercise groups. 863 PMID- 12784895 AU - Schaefer KM TI - Sleep disturbances linked to FM. SO - Holist Nurs Pract 2003 May-Jun;17(3):120-7. IN - D o Nursing, Temple University-CAHP, Philadelphia, Pa 19140+ AB - +IN: , USA. karen.schaefer@temple.edu Fibromyalgia (FM) is a chronic muscle disorder characterized by muscle aches and pain of varying intensities. Sleep disturbances have been recognized as one of the probable causes of this disorder. Pharmacological and nonpharmacological approaches are often used to manage the symptoms of sleep disturbances. This article provides a brief background on FM, discusses the physiology of sleep, reviews the current literature on sleep disturbances associated with FM, provides insight to interventions that might be beneficial given the data available, and recommends ongoing research. 864 PMID- 12734908 AU - Scharf MB, Baumann M, Berkowitz DV TI - The effects of sodium oxybate on clinical Sx & sleep patterns in pts w FM. SO - J Rheumatol 2003 May;30(5):1070-4. IN - Tri-State Sleep Disorders Ctr, Cincinnati, Ohio 45246, USA. AB - OBJECTIVE: Fibromyalgia (FM) is associated with the sleep phenomenon of alpha intrusion, and with low growth hormone secretion. Sodium oxybate has been shown to increase both slow-wave sleep and growth hormone levels. This double blind, randomized, placebo controlled crossover trial was conducted to evaluate the effects of sodium oxybate on the subjective symptoms of pain, fatigue, and sleep quality and the objective polysomnographic (PSG) sleep variables of alpha intrusion, slow-wave (stage 3/4) sleep, and sleep efficiency in patients with FM. METHODS: Patients received either 6.0 g/day sodium oxybate or placebo for 1 month, with an intervening 2 week washout period. Efficacy measures included PSG evaluations, tender point index (TPI), and subjective measurements from daily diary entries. Safety measures included clinical laboratory values, vital signs, and adverse events. RESULTS: Twenty-four female patients were included in the study; 18 completed the trial. TPI was decreased from baseline by 8.5, compared with an increase of 0.4 for placebo (p = 0.0079). Six of the 7 pain/fatigue scores (overall pain, pain at rest, pain during movement, end of day fatigue, overall fatigue, and morning fatigue) were relieved by 29% to 33% with sodium oxybate, compared with 6% to 10% relief with placebo (p < 0.005). Alpha intrusion, sleep latency, and rapid-eye-movement sleep were significantly decreased, while slow-wave (stage 3/4) sleep was significantly increased, compared with placebo (p < 0.005). Two of the 5 subjective sleep related variables were significantly different from placebo: morning alertness (improved by 18% with sodium oxybate, compared with 2% for placebo; p = 0.0033) and quality of sleep (improved by 33% and 10%, respectively; p = 0.0003). CONCLUSION: Sodium oxybate effectively reduced the symptoms of pain and fatigue in patients with FM, and dramatically reduced the sleep abnormalities (alpha intrusion and decreased slow-wave sleep) associated with the nonrestorative sleep characteristic of this disorder. 865 PMID- 12554824 AU - Schmaling KB, Lewis DH, Fiedelak JI, Mahurin R, Buchwald DS TI - Single-photon emission computerized tomography & neurocognitive function in pts w CFS. SO - Psychosom Med 2003 Jan-Feb;65(1):129-36 IN - College o Health Sciences (K.B.S.), U o Texas, El Paso, Tex+ AB - +IN: as, & the Departments o Psychiatry & Behavioral Sciences (K.B.S., R.M.), Radiology (D.H.L.), & Med (J.I.F., D.S.B.), U o Washington, Seattle. OBJECTIVE: The purposes of this study were to compare functional imaging under control and experimental conditions among patients with chronic fatigue syndrome (CFS) and healthy persons and to examine perceived and objective performance on a test of attention and working memory previously found to be difficult for persons with CFS. METHODS: Single-photon emission computerized tomography scans were completed on 15 subjects with CFS and 15 healthy persons twice: at rest and when performing the Paced Auditory Serial Addition Test (PASAT). RESULTS: No group differences were found for performance on the PASAT despite CFS subjects' perceptions of exerting more mental effort to perform the task than healthy subjects. Inspection of the aggregate scans by group and task suggested a pattern of diffuse regional cerebral blood flow among subjects with CFS in comparison with the more focal pattern of regional cerebral blood flow seen among healthy subjects. Between-group region-of-interest analysis revealed that although CFS subjects showed less perfusion in the anterior cingulate region, the change in CFS subjects' activation of the left anterior cingulate region during the PASAT was greater than that observed for healthy subjects. The differences were not attributable to lesser effort by the subjects with CFS, confounding effects of mood perturbation, or to poorer performance on the experimental task. CONCLUSIONS: Further research regarding CFS subjects' diffuse cerebral perfusion and its relationship to inefficient neuropsychological performance is warranted. 866 PMID- 12730531 AU - Schochat T, Raspe H TI - Elements of FM in an open population. SO - Rheumatology (Oxford) 2003 Jul;42(7):829-35. Epub 2003 Mar + IN - Institute for Occupational, Social & Environmental Med, Med+ AB - +SO: 31. +IN: U Ulm, Frauensteige 10, 89075 Ulm, Germany. thomas.schochat@medizin.uni-ulm.de OBJECTIVE: To examine the nosological concept of fibromyalgia in the general population. METHODS: A postal survey of rheumatic pain and non-specific bodily complaints was sent to all 3174 German female residents of Bad Sackingen, Germany, aged 35 to 74 yr. A stratified random sample of 653 subjects was further examined in a clinical survey. RESULTS: On the population level the point prevalence of chronic widespread pain was 13.5%. In the clinical survey, tender point count was associated not only with the extent of rheumatic pain, but also independently with the extent of bodily complaints. Subjects with no history of rheumatic pain but with non-specific bodily complaints had as many positive tender points as subjects without bodily complaints but with a history of rheumatic pain. Subjects could be identified who met the tender point criterion of the ACR without a history of widespread pain. Multivariate analyses demonstrated that some symptoms carry a risk for positive tender points (low physical mobility, pain, bodily complaints) and some for chronic widespread pain (poor health status, catastrophizing, emotional reactions, low energy level, sleep disturbances) that are independent of each other and of age. CONCLUSIONS: The results do not only question the relevance and specificity of a history of widespread pain in diagnosing fibromyalgia, but also the concept of fibromyalgia as a distinct rheumatological disorder. The results support the concept of fibromyalgia as part of a wider spectrum of dysfunctional syndromes. 867 PMID- 12918479 AU - Schofield C TI - How do I treat a pts' FM pain? SO - Nursing 2003 Aug;33(8):26. IN - Vanderbilt U School o Med, Nashville, TN, USA. 868 PMID- 12525386 AU - Schulpen GJ, Vierhout WP, Van Der Heijde DM, Landewe RB, Winkens RA, Van Der Li+ TI - Joint consultation of general practitioner & rheumatologist: does it matter? [FM] SO - Ann Rheum Dis 2003 Feb;62(2):159-61 IN - D o Transmural Care, U Hosp Maastricht, Maastricht, The Net+ AB - +IN: herlands D o Rheumatology, U Hosp Maastricht D o General Practice, Maastricht University. +AU: nden S OBJECTIVE: To assess the effects of joint consultation on referral behaviour of general practitioners (GPs) in a prospective cohort study. METHODS: All patients with rheumatological complaints that 17 participating GPs, from the area of the University Hospital Maastricht, wanted to refer during a two year inclusion period (n=166) were eligible for inclusion. These patients were either referred to the outpatient clinic, or presented at a joint consultation held every six weeks at the practice of the GP, where groups of three GPs presented their patients to a visiting, consulting rheumatologist. The number of patients referred by each GP a year at the end of the trial, comparing participating and non-participating GPs, was the main outcome measure. RESULTS: During two years of inclusion, the 17 participating GPs presented 166 patients. The number of patients referred by each GP a year decreased for the participating GPs by 62% at the end of the whole study. By contrast, non-participating GPs maintained the same rate of referral. The range of diagnoses remained proportionally the same throughout the study, with the exception of fibromyalgia. The referral rate of this diagnosis decreased significantly (p=0.001). CONCLUSIONS: Joint consultation seems to be a good strategy in influencing the referral behaviour of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists. 869 PMID- 15206740 AU - Schwarz MJ, Offenbaecher M, Neumeister A, Ackenheil M TI - Experimental evaluation of an altered tryptophan metabolism in FM. SO - Adv Exp Med Biol 2003;527:265-75. IN - Psychiatric Hosp, U o Munich, Nussbaumstr. 7, D - 80336 Mun+ AB - +IN: ich, Germany. mschwarz@psy.med.uni-muenchen.de Fibromyalgia (FM) is a prevalent syndrome with chronic pain and a hypothesised underlying disturbance of the tryptophan (TRP) metabolism. We performed a tryptophan depletion (TD) test in 17 FM patients and 17 controls. TRP, 5-hydroxyindoleacetic acid (5-HIAA), kynurenine (KYN), and Interleukin-6 (IL-6) were measured. Additionally pain perception was monitored in the FM patients. FM patients and controls exhibited a decrease of TRP and KYN during TD. 5-HIAA levels also decreased in all controls and in 11 FM patients, but showed a marked increase in 6 FM patients. IL-6 significantly increased during TD in the patients, but not in the controls. Pain perception was not affected in the FM patients. These data demonstrate an altered TRP metabolism in a subgroup of FM patients, where the TD seems to activate 5-HT metabolism and IL-6 production. Our findings may have diagnostic as well as therapeutic implications in the field of fibromyalgia. 870 PMID- 12873360 AU - Shapiro B TI - Building bridges between body & mind: The analysis of an adolescent w paralyzing chr pain. SO - Int J Psychoanal 2003 Jun;84(Pt 3):547-61. IN - barbarashapiro@earthlink.net AB - This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach. 871 PMID- 12566557 AU - Shee CD TI - Phantom lymphadenopathy. An association w CFS. SO - Postgrad Med J 2003 Jan;79(927):59-60 IN - D o Med, Queen Mary's Sidcup NHS Trust. AB - Ten patients with self diagnosed enlarged lymph glands were referred to a general medicine outpatient clinic and careful examination did not confirm lymphadenopathy. All patients also complained of severe chronic fatigue associated with aches and miscellaneous somatic symptoms, and fulfilled criteria for diagnosis of chronic fatigue syndrome (CFS). Phantom lymphadenopathy may be a symptom in some people with CFS, and possible reasons for this are discussed. 872 PMID- 14686792 AU - Shin HY, Shin CH, Shin TY, Lee EJ, Kim HM TI - Effect of bojungikki-tang on lipopolysaccharide-induced cytokine production from peripheral blood mononuclear cells of CFS pts. SO - Immunopharmacol Immunotoxicol 2003 Nov;25(4):491-501. IN - D o Pharmacology, Coll o Oriental Med, Kyung Hee U, Dongdae+ AB - +IN: mun-Gu, Seoul, South Korea. Bojungikki-tang (BIT) has been widely used to treat patients suffering from chronic fatigue syndrome (CFS). However, its effect has not been yet investigated experimentally. Based upon the clinical presentation of CFS, we hypothesized that cytokines may play a role in the pathogenesis of the disease. We studied the effect of BIT on lipopolysaccharide (LPS)-induced various cytokines production in peripheral blood mononuclear cells (PBMC) of CFS patients. Bojungikki-tang (1 mg/mL) significantly inhibited LPS-induced tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, transforming growth factor (TGF)-beta1 production by 63.55% +/- 0.19%, 55.06% +/- 0.27%, 48.23% +/- 0.48%, 54.09% +/- 0.76%, respectively (P < 0.05). Bojungikki-tang showed a slightly lower inhibitory effect of LPS-induced Interferon (IFN)-gamma production. These results suggest that BIT may be useful in treating fatigue associated with chronic diseases. 873 PMID- 12766785 AU - Shipton E TI - Controversies, new risk factors & the neuroendocrine approach to FM: can therapeutic progress be made at last? SO - N Z Med J 2003 May 16;116(1174):U439. IN - D o Anaesthesia, Christchurch School o Med & Health Science+ AB - +IN: s, U o Otago, Christchurch, New Zealand. shiptonea@xtra.co.nz. 874 PMID- 14610300 AU - Shuer ML TI - FM: Sx constellation & potential therapeutic options. SO - Endocrine 2003 Oct;22(1):67-76. IN - Mood & Menopause Clinic, P.O. Box 462223, Escondido, CA 920+ AB - +IN: 46-2223, USA. MLShuer@ispwest.com Fibromyalgia (FM) is a disease entity consisting of a heterogeneous cluster of symptoms that has thus far eluded identification of a causative etiology. The disease onset appears to follow physiological and/or psychological stressors and involves a subset of symptoms that are consistent with varied disorders found in multiple medical specialties to include rheumatology, immunology, endocrinology, neurology, and psychiatry. Owing to the heterogeneity of the symptom complex and the heretofore absence of serum markers that might serve as concrete diagnostic criteria, this disease has baffled clinicians and basic scientists alike. Recent findings regarding sleep architecture, immunology, and endocrinology have provided clues that may help in the understanding and resultant treatment of this entity. Women with fibromyalgia tend to present with an alpha-delta sleep anomaly, which when treated with a growth hormone secretagogue (GHS), reduces the rheumatological pain and restores slow-wave sleep architecture. These findings suggest the somatotrophic axis may be involved in the etiology and the treatment of this disorder. Those diagnosed with FM respond to various stressors with increased disruption of their physiological homeostasis. When compared to healthy age-matched cohorts, there are quantitative differences in various neuroactive steroid levels, immunological markers, and feedback mechanisms. The varied physiological alterations in patients diagnosed with fibromyalgia when compared to controls will be discussed along with the potential treatment options for this population. 875 PMID- 12810781 AU - Siessmeier T, Nix WA, Hardt J, Schreckenberger M, Egle UT, Bartenstein P TI - Observer independent analysis of cerebral glucose metabolism in pts w CFS. SO - JNeurNSPsy 2003 Jul;74(7):922-8. IN - D o Nuclear Med, Johannes Gutenberg U, Mainz, Germany. sies+ AB - +IN: smeier@nuklear.klinik.uni-mainz.de OBJECTIVES: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits. METHODS: 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in all the subjects. After stereotactic normalisation, single subject comparisons with an age and sex matched normal database (n = 18) and a group comparison between the patients and normal controls were undertaken, along with additional correlation analyses between brain metabolism and psychometric test scores. RESULTS: 12 of the 26 patients showed no significant decrease in FDG uptake compared with the controls. Of the remaining 14, 12 showed hypometabolism bilaterally in the cingulate gyrus and the adjacent mesial cortical areas. Five of these 12 patients also had decreased metabolism in the orbitofrontal cortex. The two remaining patients had hypometabolism in the cuneus/praecuneus. Correlation analyses showed significant correlations between some test scores (anxiety, depression, health related quality of life) but not fatigue and regional reductions in glucose metabolism. CONCLUSIONS: Although abnormalities in FDG-PET were only detectable in approximately half the CFS patients examined, and no specific pattern for CFS could be identified, PET may provide valuable information in helping to separate CFS patients into subpopulations with and without apparent alterations in the central nervous system. 876 PMID- 12600799 AU - Sim J, Adams N TI - Therapeutic approaches to FM syndrome in the United Kingdom: a survey of occupational therapists & physical therapists. SO - Eur J Pain 2003;7(2):173-80. IN - Primary Care Sciences Research Centre, Keele U, Keele, Staf+ AB - +IN: fordshire, ST5 5BG, UK. pta05@keele.ac.uk BACKGROUND AND PURPOSE: This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS. Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS: Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION: These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs. 877 PMID- 12769170 AU - Sitzman K TI - Working w FM. SO - AAOHN J 2003 May;51(5):236. IN - Weber St U, Ogden, UT, USA. sitzmank@webpipe.net 878 PMID- 12877400 AU - Skapinakis P, Lewis G, Mavreas V TI - One-year outcome of unexplained fatigue syndromes in primary care: results from an international study. SO - Psychol Med 2003 Jul;33(5):857-66. IN - D o Psychiatry, U o Bristol, Cotham Hill. AB - BACKGROUND: Outcome studies of chronic fatigue, neurasthenia and other unexplained fatigue syndromes are few and have been carried out in developed Western countries. This paper aimed to study the outcome of unexplained fatigue syndromes in an international primary care sample and to identify risk factors for persistence. METHOD: We used data from the WHO collaborative study of psychological problems in general health care, in which 3201 primary care attenders from 14 countries were followed-up for 12 months. The assessment included a modified version of the Composite International Diagnostic Interview. RESULTS: Unexplained fatigue persisted in one-fifth to one-third of the subjects depending on the definition of fatigue. From the factors studied only severity of fatigue and psychiatric morbidity at baseline were associated with persistence 12 months later. Outcome did not differ between countries of different stages of economic development. CONCLUSIONS: The prognosis of fatigue syndromes in international primary care is relatively good. The study underlines the importance of psychological factors in influencing short-term prognosis. 879 PMID- 12668371 AU - Skapinakis P, Lewis G, Mavreas V TI - Unexplained fatigue syndromes in a multinational primary care sample: specificity of definition & prevalence & distinctiveness from depression & gene+ SO - Am J Psychiatry 2003 Apr;160(4):785-7. IN - D o Psychiatry, U o Bristol, Cotham Hill, UK. p.skapinakis@+ AB - +TI: ralized anxiety. +IN: bristol.ac.uk OBJECTIVE: The authors investigated whether narrow definitions of unexplained fatigue syndromes that require additional minor somatic symptoms are more strongly associated with psychiatric morbidity than wider ones. METHOD: This was a secondary analysis of the World Health Organization Collaborative Project on Psychological Problems in General Health Care. A total of 5,438 primary care patients from 14 countries were assessed with the Composite International Diagnostic Interview. RESULTS: The prevalence of fatigue syndromes fell from 7.99 to 1.69 as somatic criteria were added. Patients with depression or anxiety were more likely to report unexplained fatigue, but this association was stronger for definitions of unexplained fatigue with more somatic criteria. CONCLUSIONS: Definitions of unexplained fatigue syndromes that require more somatic criteria selected more patients with psychiatric disorders in this culturally diverse sample. These findings might have implications for the revision of existing international diagnostic criteria for neurasthenia or chronic fatigue syndrome. 880 PMID- 12870659 AU - Smirnova IV, Pall ML TI - Elevated levels of protein carbonyls in sera of CFS pts. SO - Mol Cell Biochem 2003 Jun;248(1-2):93-5. IN - D o Med, Div o Nephrology, New York Med Coll, Valhalla, NY,+ AB - +IN: USA. Protein carbonyl levels, a measure of protein oxidation, were found to be significantly elevated (p < 0.0005) in the sera of chronic fatigue syndrome (CFS) patients vs. controls. In contrast, the total protein levels in sera CFS patients were unchanged from those of controls. The elevated protein carbonyl levels confirm earlier reports suggesting that oxidative stress is associated with chronic fatigue syndrome and are consistent with a prediction of the elevated nitric oxide/peroxynitrite theory of chronic fatigue syndrome and related conditions. 881 PMID- 12671155 AU - Smith MS, Martin-Herz SP, Womack WM, Marsigan JL TI - Comparative study of anxiety, depression, somatization, functional disability, & illness attribution in adolescents w chr fatigue or migraine. SO - Pediatrics 2003 Apr;111(4 Pt 1):e376-81. IN - Children's Hosp & Regional Med Ctr, D o Pediatrics, U o Was+ AB - +IN: hington, Seattle 98105, USA. mark.smith@seattlechildrens.org OBJECTIVE: To compare adolescents with migraine, unexplained profound chronic fatigue of >6 months duration, and normal school controls on measures of anxiety, depression, somatization, functional disability, and illness attribution. METHODS: Adolescents referred to Children's Hospital and Regional Medical Center for behavioral treatment of migraine (n = 179) or evaluation of chronic fatigue (n = 97) were compared with a group of healthy controls of similar age and sex from a middle school (n = 32). Subjects completed the Spielberger State-Trait Anxiety Inventory-Trait Form, the Children's Depression Inventory, the Childhood Somatization Inventory, and estimated the number of school days missed in the past 6 months because of illness. Migraine and fatigued subjects completed an illness attribution questionnaire. RESULTS: Subjects in the 3 groups were 56% to 70% female and ranged from 11 years old to 18 years old with a mean age of 14.0 +/- 2.0. Forty-six of the 97 chronically fatigued adolescents met 1994 Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome (CDC-CFS), while 51 had idiopathic chronic fatigue syndrome (I-CFS) that did not meet full CDC criteria. Adolescents with migraine had significantly higher anxiety scores than those with I-CFS or controls and higher somatization scores than controls. Adolescents with CDC-CFS had significantly higher anxiety scores than those with I-CFS or controls, and higher depression and somatization scores than all other groups. There were significant differences between all groups for school days missed with CDC-CFS more than I-CFS more than migraine more than controls. Parents of adolescents with unexplained I-CFS had significantly lower attribution scores relating illness to possible psychological or stress factors than parents of adolescents with CDC-CFS or migraine. CONCLUSIONS: Adolescents referred to an academic center for evaluation of unexplained chronic fatigue had greater rates of school absenteeism than adolescents with migraine or healthy controls. Those meeting CDC-CFS criteria had higher anxiety scores than controls and higher depression and somatization scores than migraineurs or controls. Parents of adolescents with I-CFS were less likely to endorse psychological factors as possibly contributing to their symptoms than parents of adolescents with CDC-CFS or migraine. 882 PMID- 12967546 AU - Smith M, Gokula RR, Weismantel A TI - Does physical therapy improve Sx of FM? SO - J Fam Pract 2003 Sep;52(9):717-9. IN - Michigan St U Coll o Human Med, East Lansing, MI, USA. 883 PMID- 12763708 AU - Smith S, Sullivan K TI - Examining the influence of biological & psychological factors on cognitive performance in CFS: a randomized, double-blind, placebo-controlled, crosso+ SO - Int J Behav Med 2003;10(2):162-73. IN - U o Queensland, Australia; Karen Sullivan, Queensland U o T+ AB - +TI: ver study. +IN: echnology, Australia. ssmith@psy.uq.edu.a The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as "chemical." No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS. 884 PMID- 15088281 AU - Smythe HA TI - FM among friends. SO - [CON: J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918]; [CON: J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919]; [CON: J Rheumatol. 2003 Aug;30(8):1671-2. PMID: 12913920]; J Rheumatol 2004 Apr;31(4):627-30. 885 PMID- 12670383 AU - Soderberg S, Strand M, Haapala M, Lundman B TI - Living w a woman w FM from the perspective of the husband. SO - J Adv Nurs 2003 Apr;42(2):143-50. IN - Division o Nursing, D o Health Science, Lulea U o Technolog+ AB - +IN: y, Lulea, Sweden. siv.soderberg@hv.luth.se BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome, which affects mostly middle-aged women. The syndrome is poorly understood and treatment is mainly palliative. The diagnosis is established from diagnostic criteria. Living with FM means living a life greatly influenced by the illness in various ways for people affected. Aim of the study. The aim of this study was to describe the experiences of living with a woman with FM from the husbands' perspective. METHODS: Five men married to women with FM were interviewed using a narrative approach. The interviews were analysed using qualitative thematic content analysis. FINDINGS: The analysis resulted in the following seven themes: increasing responsibility and work in the home; being an advocate for and supporting the wife; learning to see the woman's changing needs; changing relationship between spouses; changing relationship with friends and relatives; deepening relationship with the children and lacking information and knowledge about FM. The findings show that the women's illness had a great impact on husbands' lives, and that husbands lacked information about the woman's illness. CONCLUSION: This study shows that it is not only the women with FM who experience a changed life; the whole family life is influenced and limited by FM. The husband's role in the family changes, first and foremost concerning responsibility and workload within the family. This must be taken into consideration in care planning. This study also highlighted the need of information and knowledge about FM expressed by the participants, information that health care personnel have a great responsibility to give. 886 PMID- 12787511 AU - Sokka T TI - Assessment of pain in pts w rheumatic diseases. SO - Best Pract Res Clin Rheumatol 2003 Jun;17(3):427-49. IN - Vanderbilt University/Rheumatology, 203 Oxford House, Nashv+ AB - +IN: ille, TN 37232-4500, USA. tuulikki.sokka@vanderbilt.edu Pain is the most prominent symptom in people with musculoskeletal disorders and the most common reason for patients to seek medical help. However, pain generally is not recorded quantitatively in usual medical care. A quantitative measure of pain is not needed in acute medical care but is essential over long periods as patients and health professionals cannot gauge accurately changes in levels of pain over years. The experience of pain is subjective, and early efforts by health professionals to estimate pain through an 'objective' measure of pain status were useful in clinical research but not in clinical care. Over the last three decades, self-report questionnaires have been developed in which a patient may record quantitatively a pain score, as well as other data concerning clinical status, which may be repeated over time to discern whether patients are improved, similar or worse. The most robust quantitative pain measure appears to be a simple 10-cm visual analogue scale (VAS) which can be completed by the patient and scored by a health professional in less than 30 s. These data cannot be obtained from any source other than the patient. Pain scores are correlated with 'objective' measures such as radiographs, laboratory tests and physical examination findings, but more strongly correlated with scores for functional status and psychological distress in patients with rheumatic diseases. It is recommended that quantitative assessment of pain be included at each visit in routine rheumatology care, along with assessment of functional disability, global status and other patient variables, using a patient self-report questionnaire to improve patient care. 887 PMID- 15055693 AU - Sollecito TP, Stoopler ET, DeRossi SS, Silverton S TI - Temporomandibular disorders & FM: comorbid conditions? SO - Gen Dent 2003 Mar-Apr;51(2):184-7; quiz 188-9. IN - Oral Med Residency Program, U o Penn School o Dental Medici+ AB - +IN: ne, Philadelphia, USA. Temporomandibular disorders (TMDs) and fibromyalgia (FM) are two clinical conditions prevalent in today's society. Many individuals suffer from chronic pain in various muscle groups, including the muscles of mastication. Previously, TMDs and FM were thought to be separate, unrelated clinical entities. New research has shown a possible link between the two conditions; this article sheds light on possible correlations between them. 888 PMID- 12897748 AU - Sorensen B, Streib JE, Strand M, Make B, Giclas PC, Fleshner M, Jones JF TI - Complement activation in a model of CFS. SO - J Allergy Clin Immunol 2003 Aug;112(2):397-403. IN - D o Pediatrics, Nat Jewish Med & Research Ctr, Denver, CO, + AB - +IN: USA. BACKGROUND: A need exists to identify biological markers in chronic fatigue syndrome (CFS). OBJECTIVE: To use an exercise and/or allergen challenge to induce the symptoms of CFS and to identify a biological marker that correlates with these symptoms. METHODS: Patients with CFS (n = 32) and age-matched, normal control patients (n = 29) exercised for 20 minutes on a stationary bike at 70% of their predicted max work load (Watts). Patients from each group with positive skin test results were also challenged with intranasally administered relevant allergens. Symptoms were recorded for 2 weeks before and 1 week after each challenge, using 3 different instruments. Blood samples were taken before, and 0, 1, 6, and 24 hours after challenges. Levels of complement split products, cell-associated cytokines, and eosinophilic cationic protein were measured. Mean preexercise and postexercise symptom scores were evaluated for each group. RESULTS: Exercise challenge induced significant increases of the complement split product C4a, but not C3a or C5a, at 6 hours after exercise only in the CFS group (P <.01), regardless of allergy status. Mean symptom scores were significantly increased after exercise through the use of a daily diary (P <.03) and a weekly diary (P <.01) for the CFS group only. Mean scores for the Multidimensional Fatigue Inventory categories "reduced activity" and "mental fatigue" were significantly increased in the CFS group only (P <.04 and P <.02, respectively). CONCLUSIONS: Exercise challenge may be a valuable tool in the development of diagnostic criteria and tests for CFS. Establishment of a role for complement activation products as markers or participants in production of illness require further study. 889 PMID- 12598803 AU - Sprott H TI - What can rehabilitation interventions achieve in pts w primary FM? SO - Curr Opin Rheumatol 2003 Mar;15(2):145-50. IN - Privatdozent o the U o Zurich, Switzerland. haiko.sprott@us+ AB - +IN: z.ch Symptoms of primary fibromyalgia (FM) persist for years, independent of applied therapy. That is the sad reality we have to deal with. But is that really true? The following review is a scan of literature from September 1, 2001 to August 31, 2002, concerning rehabilitation interventions for patients with FM, to find progress in this field and to ascertain state-of-the-art treatment strategies for the disease. The main problem when treating patients with FM successfully is the heterogeneity of the patients' group. Several investigators determined subgroups within FM patients diagnosed by the 1990 American College of Rheumatology classification criteria of FM. Therefore, uniform recommendations for treatment cannot be given. Current treatment recommendations for FM include reassurance and explanation of the nature of the illness, evaluation and eradication of mechanical stressors as far as possible, symptomatic analgesic drug treatment, moderate individually adapted physical exercises, and adjuvant psychotherapeutic support in an interdisciplinary setting. Individually adapted measures are highly emphasized to differentially treat FM subgroups, as far as identified. This review will focus on these points on the one hand, and provide an overview about the current symptomatically-oriented therapy on the other hand. This all occurs against the background of an unknown etiology of the disease so far. Experimental approaches will be noted as well. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. 890 PMID- 12507711 AU - Staud R, Robinson ME, Vierck CJ, Price DD TI - Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or FM pts. SO - Pain 2003 Jan;101(1-2):167-74 IN - D o Med, U o Florida, P.O. Box 100221, 32610-0221, Gainesvi+ AB - +IN: lle, FL, USA Diffuse noxious inhibitory control (DNIC) is part of a central pain modulatory system that relies on spinal and supraspinal mechanisms. Previous studies have shown that fibromyalgia (FMS) patients are lacking DNIC effects on experimental pain, compared to normal control (NC) subjects. Because DNIC has a greater effect on second pain than on first pain, we hypothesized that wind-up (WU) of second pain should be attenuated by a strong conditioning stimulus. Thus, we compared DNIC's effect on WU in three groups of subjects: 11 NC males, 22 NC females, and 11 FMS females. To separately assess the contributions of distraction related mechanisms to inhibition of second pain, we designed the experiment in such a way that directed the subjects' attention to either the test or conditioning stimulus. Repeated heat taps to the thenar surface of the right hand were used as test stimuli to generate WU of second pain. Immersion of the left hand into a hot water bath was the conditioning stimulus. As previous experiments have shown, DNIC requires a strong conditioning stimulus for pain attenuation, which may be at least partly dependent on a distraction effect. DNIC significantly inhibited thermal WU pain in normal male subjects, but adding distraction to the DNIC effect did not increase the extent of this inhibition. In contrast, neither DNIC nor DNIC plus distraction attenuated thermal WU pain in female NCs. DNIC plus distraction but not DNIC alone produced significant inhibition of thermal WU pain in female FMS patients. Our results indicate that DNIC effects on experimental WU of second pain are gender specific, with women generally lacking this pain-inhibitory mechanism. 891 PMID- 14499438 AU - Staud R, Robinson ME, Vierck CJ Jr, Cannon RC, Mauderli AP, Price DD TI - Ratings of experimental pain & pain-related negative affect predict clinical pain in pts w FM syndrome. SO - Pain 2003 Sep;105(1-2):215-22. IN - D o Med, McKnight Brain Inst, U o Florida Coll o Medicine, + AB - +IN: SW Archer Road, PO Box 100221, Gainesville, FL 32610-0221, USA. staudr@ufl.edu Patients with fibromyalgia syndrome (FMS) report chronic pain related to abnormal sensitivity of muscles that is reflected by so-called tender points (TP). TP represent areas of abnormal mechanical pain thresholds that have only shown a minor correlation with clinical pain of FMS patients and seem to be better suited for predicting distress. Pain-related negative affect (PRNA), abnormal temporal summation of second pain (termed wind-up or WU), and abnormal WU decay are frequently present in FMS patients. WU and WU decay can provide measures of central sensitization, which may contribute to clinical FMS pain. We therefore investigated the role of WU, WU decay, TP count, and PRNA as predictors of clinical pain in FMS subjects.Fifty-five FMS subjects rated their clinical pain at entry into the study using a visual analogue scale (VAS). After a TP evaluation, all subjects received two trials of thermal WU and WU decay testing. Hierarchical regression analysis demonstrated that the combination of PRNA ratings, TP count, and WU decay ratings predicted 49.7% of the variance of clinical pain in FMS. This model demonstrates independent relationships of biological and psychological factors to clinical pain and underscores the important role of abnormal peripheral and central pain mechanisms for FMS. Therefore, the combination of PRNA, TP count, and WU decay may provide an excellent measure for future clinical studies of FMS patients. 892 PMID- 12620600 AU - Staud R, Cannon RC, Mauderli AP, Robinson ME, Price DD, Vierck CJ Jr TI - Temporal summation of pain from mechanical stimulation of muscle tissue in normal controls & subjects w FM syndrome. SO - Pain 2003 Mar;102(1-2):87-95. IN - D o Med, McKnight Brain Inst, U o Florida Coll o Medicine, + AB - +IN: 1600 SW Archer Rd, PO Box 100221, Gainesville, FL 32610-0221, USA. staudr@ufl.edu Individuals diagnosed with fibromyalgia syndrome (FMS) report chronic pain that is frequently worsened by physical activity and improved by rest. Palpation of muscle and tendinous structures suggests that nociceptors in deep tissues are abnormally sensitive in FMS, but methods of controlled mechanical stimulation of muscles are needed to better characterize the sensitivity of deep tissues. Accordingly, force-controlled mechanical stimulation was applied to the flexor digitorum muscle of the forearm in a series of brief contacts (15 stimuli, each of 1s duration, at 3 or 5s interstimulus intervals). Repetitive stimulation was utilized to determine whether temporal summation of deep muscular pain would occur for normal subjects and would be enhanced for FMS subjects. Moderate temporal summation of deep pain was observed for normal controls (NC), and temporal summation was greatly exaggerated for FMS subjects. Temporal summation for FMS subjects occurred at substantially lower forces and at a lower frequency of stimulation. Furthermore, painful after-sensations were greater in amplitude and more prolonged for FMS subjects. These observations complement a previous demonstration that temporal summation of pain and after-sensations elicited by thermal stimulation of the skin are moderately enhanced for FMS subjects. Abnormal input from muscle nociceptors appears to underlie production of central sensitization in FMS that generalizes to input from cutaneous nociceptors. 893 PMID- 12745760 AU - Steihaug S, Malterud K TI - Part process analysis: a qualitative method for studying provider-patient interaction. SO - Scand J Public Health 2003;31(2):107-12. IN - Health D, Stovner Urban District/Oslo, Ekornvien 4, N-07777+ AB - +IN: , Norway. sissel.steihaug@skk.uio.no AIMS: Communication between patients and healthcare providers is vital for quality care. Complaints about doctors often arise from unfortunate communication. Research methods suited for the study of relationship and interaction are essential to understand how communication can be improved. The principles and procedures of a qualitative research method with the capacity to explore details and foundations of interaction between patients and doctors is presented. METHODS: Anne-Lise Lovlie Schibbye's Part Process Analysis Method is a qualitative approach for studying communication at the microlevel. Attention is drawn both to verbal dialogue and to body communication, and the method is particularly suited for studying relationships and change. RESULTS: The application of the Part Process Analysis Method is described, exemplified by material from a group discussion between participants and leaders in a group-based treatment programme for women with chronic muscle pain. How the method can be used to explore reciprocity, relationships, and development is demonstrated in this context. CONCLUSIONS: The Part Process Analysis Method is proposed as a useful tool for studying communication between doctor and patient, providing knowledge about relationships and reciprocity, aspects that are important both in doctors' medical work and for patients' feeling of being understood. 894 PMID- 12717688 AU - Stewart CC, Cookfair DL, Hovey KM, Wende KE, Bell DS, Warner CL TI - Predictive immunophenotypes: disease-related profile in CFS. SO - Cytometry 2003 May;53B(1):26-33. IN - Laboratory o Flow Cytometry, Roswell Park Cancer Inst, Buff+ AB - +IN: alo, New York 14263, USA. flow@attglobal.net BACKGROUND: There is a growing body of evidence supporting the theory that problems with immune function play an important role in chronic fatigue syndrome (CFS). METHODS: We studied 90 CFS cases and 50 healthy controls from two different areas of upstate New York to determine whether there were differences in the absolute number and pattern of natural killer (NK) and cytotoxic T-cell phenotypes between CFS cases and healthy controls in the two regions. One group was from a small town where a cluster of cases existed; the other was from a large metropolitan area where there was not a known cluster. RESULTS: The number of CD56+CD3+CD8+ and CD56+CD3+CD8- cells in cases from the two areas were both significantly elevated over that of controls from the metropolitan area (P < 0.03). The number of CD56+CD3-CD8+ and CD56+CD3-CD8- cells was significantly reduced in the two case groups compared to that of controls from the metropolitan area (P = 0.04). However, controls who were from the same town as the cluster cases had numbers of CD56+CD3+CD8+, CD56+CD3+CD8-, and CD56+CD3-CD8- cells that were more like that of cases than controls. Only the number of CD56+CD3-CD8+ cells (an NK cell subset) was significantly different in cases versus controls from the cluster area (P = 0.022). CONCLUSIONS: These data suggest that differences in controls from cluster and noncluster areas may be responsible for some of the inconsistencies in results from other studies. Furthermore, they suggest the possibility that NK cell function may play an important role in preventing the development of CFS in individuals who live in a community where a cluster of cases have been identified. 895 PMID- 12924832 AU - Stone KJ, Viera AJ, Parman CL TI - Off-label applications for SSRIs. SO - Am Fam Physician 2003 Aug 1;68(3):498-504. IN - Naval Hosp Jacksonville, Florida 32214, USA. AB - Selective serotonin reuptake inhibitors (SSRIs) are widely used because of their safety, tolerability, and demonstrated efficacy across a broad range of clinical conditions. Medical literature supports the use of SSRIs for the treatment of many conditions outside of the indications approved by the U.S. Food and Drug Administration. SSRIs offer a reasonable alternative to traditional therapy for generalized anxiety disorder. A side effect of SSRIs coincidentally provides therapy for premature ejaculation. SSRIs may reduce the frequency and severity of migraine headaches and are possibly effective in reducing the pain of diabetic neuropathy. When taken in combination with tricyclic antidepressants, SSRis offer more potent therapy for fibromyalgia than either agent alone. SSRIs appear to be effective in some patients with neurocardiogenic syncope that is refractory to standard therapies. Clinical experience supported by ongoing research continues to expand on the broad array of therapeutic applications for this class of medication. 896 PMID- 12951840 AU - Stratz T, Kees F, Muller W TI - Do cytochrome enzymes influence the therapeutic effect of tropisetron in FM? SO - Drugs Exp Clin Res 2003;29(2):91-4. IN - Hochrhein-Institut fur Rehabilitationsforschung, Bergseestr+ AB - +IN: asse 61, D-79713 Bad Sackingen, Germany. It is well known that the 5-HT3 receptor tropisetron shows a bell-shaped dose-response curve in the treatment of pain associated with fibromyalgia. The best results are achieved with a daily oral dose of 5 mg for 10 days. Dosages of 10 and 15 mg per day have a much weaker effect. If tropisetron is administered by intravenous injection, a regimen of 5 mg per day over 5 days will suffice to reduce pain substantially. An open study of selected cases revealed that 2 mg of tropisetron daily for 5 days also yielded satisfactory pain reduction, whereas this was not observed in a placebo-controlled double-blind study. We therefore investigated which factors might be responsible for the different effects of the drug. Judging from the above-mentioned studies, the effect of a minimum dosage of tropisetron could be assumed to be partly attributable to the different half-life periods. This is supported by the markedly different rates of constipation, a characteristic side effect of the drug, reported by the two studies. 897 PMID- 14507543 AU - Suhr JA TI - Neuropsychological impairment in FM: relation to depression, fatigue, & pain. SO - J Psychosom Res 2003 Oct;55(4):321-9. IN - Ohio U, 200 Porter Hall, Athens, OH 45701, USA. suhr@ohiou.+ AB - +IN: edu OBJECTIVE: The present study assessed the relationship of depression, pain, and fatigue to subjective cognitive complaints and objective impairment in patients with fibromyalgia (FM), patients with other chronic pain disorders, and healthy controls. METHOD: Neuropsychological assessment was conducted on 28 FM patients, 27 chronic pain patients, and 21 healthy controls. Five FM patients and five chronic pain patients were excluded due to poor effort on cognitive tasks. Assessment included measures of depression, pain, fatigue, subjective cognitive complaints, memory, executive functioning, intellect, attention, and psychomotor speed. Analysis of covariance was used to assess group differences in cognitive complaints and cognitive test performance, after controlling for depression, pain, and fatigue. Hierarchical regression was used to assess whether objective test performance was related to subjective cognitive complaints, after controlling for depression, pain, and fatigue. RESULTS: FM patients had more memory complaints and reported more fatigue, pain, and depression than other groups. Groups were not different in cognitive performance, after controlling for fatigue, pain, and depression; depression was related to memory performance and fatigue was related to psychomotor speed. Neuropsychological test results did not add significantly to the variance accounted for in subjective cognitive complaints, after accounting for depression, pain, and fatigue. CONCLUSION: Psychological factors, particularly effort, depression, and fatigue, are important in understanding both subjective cognitive complaints and objective cognitive impairment in FM and other chronic pain disorders. 898 PMID- 12622305 AU - Sullivan PF, Kovalenko P, York TP, Prescott CA, Kendler KS TI - Fatigue in a community sample of twins. [CFS] SO - Psychol Med 2003 Feb;33(2):263-81. IN - Virginia Inst for Psychiatric & Behavioral Genetics, Virgin+ AB - +IN: ia Commonwealth U, Richmond, VA 23298-0126, USA. BACKGROUND: Fatigue is a complex symptom associated with many physiological, psychological and pathological processes. Its correlates and typology remain inadequately understood. METHOD: These data were from two large, longitudinal twin studies. Trained interviewers enquired as to the presence of a > or = 5 day period in the previous year of fatigue or tiredness that interfered with daily activities. A range of potential correlates was assessed in a structured interview: demography; health beliefs; the presence of nine physical disorders; mood, anxiety and addictive disorders; neuroticism and extraversion; recollections of parental rearing; and nine stressful life events. Statistical analyses included logistic regression, CART, MARS, latent class analysis and univariate twin modelling. RESULTS: Data were available for interfering fatigue (IF) on 7740 individual twins (prevalence 9.9% in the previous year). IF was significantly associated with 42 of 52 correlates (most strongly with major depression, generalized anxiety disorder, reported major health problems and neuroticism). Multivariate analyses demonstrated that IF is a highly complex construct with different sets of correlates in its subtypes. There were two broad clusters of correlates of IF: (a) major depression, generalized anxiety disorder and neuroticism; and (b) beliefs of ill health coexisting with alcoholism and stressful life events. Twin analyses were consistent with aetiological heterogeneity--genetic effects may be particularly important in women and shared environmental effects in men. CONCLUSIONS: IF is a complex and common human symptom that is highly heterogeneous. More precise understanding of the determinants of IF may lead to a fuller understanding of more extreme conditions like chronic fatigue syndrome. 899 PMID- 12625098 AU - Szyndler JE, Towns S, Hoffman RC, Bennett DL TI - Clinical assessment, management & outcomes of a group of adolescents presenting w complex medico-psychosocial conditions. SO - Ann Acad Med Singapore 2003 Jan;32(1):51-7. IN - D o Adolescent Med, Children's Hosp at Westmead, Locked Bag+ AB - +IN: 4001, Westmead NSW 2145, Australia. BACKGROUND: Adolescents with complex medico-psychosocial presentations are often seen as a management challenge. The Medical Family Therapy model provides a useful framework for working with these patients in the context of a multidisciplinary approach to treatment. MATERIALS AND METHODS: A retrospective case analysis of 38 patients referred over a two-year period to the Department of Adolescent Medicine was carried out. These patients met DSM-IV criteria for somatoform disorder or had a diagnosis of chronic fatigue syndrome (CFS). Duration of symptomatology, diagnosis, the presence of psychiatric conditions in the young person and their immediate family and the type and duration of the intervention were examined in relation to outcome. Two case presentations illustrate the complexity of the assessment and treatment process. RESULTS: Clinicians rated 47% of patients who engaged with the service as improved. There was no relationship between diagnosis, length of intervention and outcome. No significant differences emerged between the group of young people diagnosed with CFS and those with somatoform disorders in terms of outcome. Nine patients presented with symptoms which were similar or identical to those of one of their parents. Physical illness was more likely to be reported as a precipitating factor in the CFS group. Poor school attendance and psychiatric morbidity were linked to poor outcome. CONCLUSIONS: A comprehensive evaluation of presenting symptomatology and focussed intervention with measurable outcomes are important aspects of the clinical approach to complex medico-psychosocial conditions in adolescents. Families' beliefs about the presenting symptomatology and experiences of illness should be explored. 900 PMID- 14595996 AU - Taggart HM, Arslanian CL, Bae S, Singh K TI - Effects of T'ai Chi exercise on FM Sx & health-related quality of life. SO - Orthop Nurs 2003 Sep-Oct;22(5):353-60. IN - Armstrong Atlantic St U, Savannah, GA, USA. AB - BACKGROUND: Fibromyalgia (FM), one of the most common musculoskeletal disorders, is associated with high levels of impaired health and inadequate or limited symptom relief. The cause of this complex syndrome is unknown, and there is no known cure. Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management. T'ai Chi, an ancient Chinese exercise, combines physical exercise with mindbody therapy. PURPOSE: To investigate the effects of T'ai Chi exercise on FM symptoms and health-related quality of life. DESIGN: Pilot study, one group pre-to-post posttest design. METHODS: Participants with FM (n = 39) formed a single group for 6 weeks of 1-hour, twice weekly T'ai Chi exercise classes. FM symptoms and health-related quality of life were measured before and after exercise. FINDINGS: Twenty-one participants completed at least 10 of the 12 exercise sessions. Although the dropout rate was higher than expected, measurements on both the Fibromyalgia Impact Questionnaire (FIQ) (Buckhardt, Clark, & Bennett, 1991) and the Short Form-36 (SE-36) (Ware & Sherbourne, 1992) revealed statistically significant improvement in symptom management and health-related quality of life. IMPLICATIONS FOR NURSING RESEARCH: Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority. Tai Chi is potentially beneficial to patients with FM. Further research is needed to support evidence-based practice. 901 PMID- 12765866 AU - Tahmaz N, Soutar A, Cherrie JW TI - Chronic fatigue & organophosphate pesticides in sheep farming: a retrospective study amongst people reporting to a UK pharmacovigilance scheme. SO - Ann Occup Hyg 2003 Jun;47(4):261-7. IN - D o Environmental & Occupational Med, U o Aberdeen, Foreste+ AB - +IN: rhill Road, Aberdeen AB25 2ZP. The Department of Health has recently published a report from the CFS/ME Working Group which concluded that chronic fatigue syndrome (CFS) should be recognized as a chronic illness. Symptoms consistent with CFS are often reported by people who consider their health has been affected by exposure to pesticides, but the Working Group concluded that this type of exposure is not a common trigger for the syndrome. The Veterinary Medicines Directorate (VMD) collects self-assessed reports of ill health in humans associated with veterinary medicines under their Suspected Adverse Reaction Surveillance Scheme. The reporters have mainly been sheep farmers. These reports were used to investigate the possible relationship between chronic fatigue (CF) and exposure to organophosphate pesticides in sheep farming. The overall aim of the study was to investigate a possible association between exposure to organophosphates and the development of CF amongst people who consider their health has been affected by pesticides in sheep farming. The hypothesis investigated was that repeated exposure to organophosphate pesticides in sheep dip may increase the probability of developing CF. A group of mostly sheep farmers who had reported to the VMD surveillance scheme were identified. We planned to use a retrospective case-control study design but the initial symptoms reports were not sufficiently reliable to enable this. The study population was asked to complete two questionnaires. The first questionnaire was designed to identify the history of exposure of subjects to organophosphate pesticides, and their exposure was then reconstructed using a metric specifically developed for this purpose. The second questionnaire collected detailed information to identify whether the subjects had CF when they originally reported to the VMD and at the time of the survey. The questionnaire was sent to a total of 206 subjects, of whom 28 had moved home. A total of 37% of the remaining 178 subjects participated. There was a high prevalence of CF amongst those who completed the questionnaire and this has generally persisted since the subjects reported to the VMD. Higher CF scores were associated with higher exposure to organophosphate pesticides. CF is very common amongst those who consider their health was affected by pesticides and we have shown there is limited evidence of an association between exposure to organophosphates and CF. Further research is needed to investigate the cause of this syndrome amongst farmers exposed to pesticides. 902 PMID- 12670610 AU - Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC TI - Correlates of illness worry in CFS. SO - J Psychosom Res 2003 Apr;54(4):331-7. IN - D o Psychology, Universite de Montreal, Quebec, Canada. AB - BACKGROUND: Anxiety about illness leading to restriction of activity and physical deconditioning has been hypothesized to contribute to the chronicity of fatigue. Pathological symptom attributions, personality traits, and depression have all been hypothesized to contribute to illness worry. METHODS: We compared 45 chronic fatigue syndrome (CFS) and 40 multiple sclerosis (MS) outpatients using a battery of psychometric instruments comprising the 12-item Illness Worry scale, the Symptom Interpretation Questionnaire (SIQ), the NEO Five-Factor Inventory (NEO-FFI), and a modified version of the SCL-90R Depression scale. RESULTS: There was no difference between the two diagnostic groups on neuroticism, depressive symptoms, as well as the three scales of the SIQ. On the illness worry index, the CFS group had significantly higher scores than the MS group. This difference was due to items tapping vulnerability to illness and the perception that others are not taking their illness seriously. Somatic attributional style, neuroticism, depressive symptoms, and age were all significant predictors of illness worry in both CFS and MS patients. CONCLUSIONS: Somatic attributions, neuroticism, and depression all contribute to illness worry in chronic illness. However, these factors do not account for the higher levels of illness worry in CFS as opposed to MS, which may be due to other specific cognitive and social interactional processes. 903 PMID- 12851722 AU - Tanaka S, Kuratsune H, Hidaka Y, Hakariya Y, Tatsumi KI, Takano T, Kanakura Y, + TI - Autoantibodies against muscarinic cholinergic receptor in CFS. SO - Int J Mol Med 2003 Aug;12(2):225-30. IN - D o Laboratory Medicine, Osaka U Graduate School o Med (D2)+ AB - +IN: , Suita-shi, Osaka 565-0871, Japan. tanaka@labo.med.osaka-u.ac.jp +AU: Amino N The disturbance of the central nervous system and immunological abnormalities have been suggested in patients with chronic fatigue syndrome (CFS). We focused on immunological abnormalities against neurotransmitter receptors in CFS. Using a sensitive radioligand assay, we examined serum autoantibodies to recombinant human muscarinic cholinergic receptor 1 (CHRM1), mu-opioid receptor (OPRM1), 5-hydroxytryptamine receptor 1A (HTR1A), and dopamine receptor D2 (DRD2) in patients with CFS (n=60) and results were compared with those in patients with autoimmune disease (n=33) and in healthy controls (n=30). The mean anti-CHRM1 antibody index was significantly higher in patients with CFS (p<0.0001) and autoimmune disease (p<0.05) than that in healthy controls, and positive reaction was found in 53.3% of patients with CFS. Anti-OPRM1 antibodies, anti-HTR1A antibodies, and anti-DRD2 antibodies were found in 15.2, 1.7, and 5.0% of patients with CFS, respectively. Anti-nuclear antibodies were found in 56.7% (34/60) of patients with CFS, but anti-nuclear antibody titers did not correlate with the activities of the above four autoantibodies. The patients with positive autoantibodies to CHRM1 had a significantly higher mean score (1.81) of 'feeling of muscle weakness' than negative patients (1.18) among CFS patients (p<0.01). Higher scores on 'painful node', 'forgetfulness', and 'difficulty thinking' were also found in CFS patients with anti-CHRM1 antibodies but did not reach statistical significance. In conclusion, autoantibodies to CHRM1 were detected in a large number of CFS patients and were related to CFS symptoms. Our findings suggested that subgroups of CFS are associated with autoimmune abnormalities of CHRM1. 904 PMID- 12803365 AU - Terr AI TI - Environmental sensitivity. SO - Immunol Allergy Clin North Am 2003 May;23(2):311-28. IN - D o Med, U o California San Francisco MS, 450 Sutter Street+ AB - +IN: , #2534, San Francisco, CA 94108, USA. abbaterrmed@attglobal.net The concept of environmental sensitivity is popular among a small group of physicians who believe that exposure to low levels of numerous environmental chemicals can cause a disease with numerous symptoms but no objective physical or laboratory abnormalities. The condition lacks a clear definition. Numerous theories that have been offered to explain the condition encompass immunotoxic, allergic, autoimmune, neurotoxic, cytotoxic, metabolic, behavioral, psychiatric, iatrogenic, and sociologic mechanisms. Environmental sensitivity has many features in common with other controversial syndromes, such as the chronic fatigue syndrome. Patients with environmental sensitivity frequently are subjected to unproven and unnecessary diagnostic tests and therapeutic modalities. In spite of the lack of physical illness and absence of pathology, patients often experience extreme disability, because their symptoms are triggered by common environmental exposures. The phenomenon of environmental sensitivity needs to be evaluated critically using scientifically sound methods. The practice of clinical ecology encompasses the practices of environmental sensitivity and its theories. Most methods of diagnosis and treatment have been disproved, and the concepts underlying these theories are not scientific. Alternative means of diagnosis and management are presented. 905 PMID- 14692441 AU - The GK, Prins J, Bleijenberg G, van der Meer JW TI - The effect of granisetron, a 5-HT3 receptor antagonist, in the Rx of CFS pts--a pilot study. SO - Neth J Med 2003 Sep;61(9):285-9. IN - U Med Centre Nijmegen, D o Internal Med, PO Box 9101, 6500 + AB - +IN: HB Nijmegen, The Netherlands. g.the@aig.umcn.nl OBJECTIVE: To explore the effect of granisetron, a 5-HT3 antagonist, on fatigue and functional impairment in patients with chronic fatigue syndrome (CFS). METHODS: Five female patients were eligible to receive oral granisetron for one month (1 mg a day for the first two weeks and 2 mg a day for the second two weeks). The patients had to be between 18 and 65 years of age and suffering from CFS according to the CDC criteria. The effect was assessed by pre- and post-testing, using validated instruments designed to assess the different dimensions of CFS. Treatment response was also evaluated by visual analogue scales (VAS) for fatigue. Analysis was based on intention to treat. RESULTS: Treatment with granisetron resulted in significant improvement in fatigue severity and functional impairment. Activity level showed no significant increase. CONCLUSION: The promising results of this study have encouraged us to perform a placebo-controlled, double-blind study to evaluate the efficacy of 5-HT3 receptor antagonists in the treatment of CFS. 906 PMID- 12794785 AU - Thieme K, Gromnica-Ihle E, Flor H TI - Operant behavioral Rx of FM: a controlled study. SO - Arthritis Rheum 2003 Jun 15;49(3):314-20. IN - D o Psychosomatic & Psychotherapeutic Med, U o Heidelberg, + AB - +IN: Central Inst o Mental Health, Mannheim, Germany. thieme@zi-mannheim.de OBJECTIVE: To evaluate the efficacy of operant pain treatment for fibromyalgia syndrome (FMS) in an inpatient setting. METHODS: Sixty-one patients who fulfilled the American College of Rheumatology criteria for FMS were randomly assigned to the operant pain treatment group (OTG; n = 40) or a standardized medical program with an emphasis on physical therapy (PTG; n = 21). Pain assessments were performed before, immediately after, 6 months after, and 15 months after treatment. RESULTS: The OTG patients reported a significant and stable reduction in pain intensity, interference, solicitous behavior of the spouse, medication, pain behaviors, number of doctor visits, and days at a hospital as well as an increase in sleeping time. Sixty-five percent of the OTG compared with none of the patients in the PTG showed clinically significant improvement. CONCLUSION: These results suggest that operant pain treatment provided in an inpatient setting is an effective treatment for FMS, whereas a purely somatically oriented program may lead to a deterioration of the pain problem. 907 PMID- 12773275 AU - Thompson D, Lettich L, Takeshita J TI - FM: an overview. SO - Curr Psychiatry Rep 2003 Jul;5(3):211-7. IN - D o Psychiatry, Queen's Med Ctr, John A Burns School o Med,+ AB - +IN: 1356 Lusitana Street, Fourth Floor, Honolulu, HI 96813, USA. dithompson@queens.org In this article, the authors review current concepts in fibromyalgia. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiologic links are discussed. Although fibromyalgia continues to be a complex disorder, there are specific criteria one must meet. Fibromyalgia questionnaires, along with commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms, may aid in the diagnosis. Additionally, the close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illness. The relationship between fibromyalgia and irritable bowel syndrome, migraine headaches, and obesity are addressed. The roles of the hypothalamic-pituitary-axis, potential effects of neurotransmitters, and gender-specific hormones all substantiate this diagnosis and provide clues to causality, as well as venues for future treatment. 908 PMID- 12819552 AU - Tiersky LA, Matheis RJ, Deluca J, Lange G, Natelson BH TI - Functional status, neuropsychological functioning, & mood in CFS (CFS): relationship to psychiatric disorder. SO - J Nerv Ment Dis 2003 May;191(5):324-31. IN - Fairleigh Dickinson U, School o Psychology, Williams Hall (+ AB - +IN: T-WH1-01), 1000 River Road, Teaneck, NJ 07666, USA. Individuals with chronic fatigue syndrome (CFS) face chronic physical debilitation, reduced neuropsychological functioning, and changes in emotional well-being that significantly detract from quality of life. The role of psychiatric disturbance in reducing quality of life in CFS remains unclear. In the current investigation, the role of psychiatric status in reducing health-related quality of life in CFS was examined. Four subject groups were compared on measures of functional well-being, mood, and neuropsychological status: individuals with CFS and no history of psychiatric illness, individuals who had current symptoms of psychiatric illness that began after their CFS diagnosis, individuals who had current symptoms of psychiatric illness that began before their CFS diagnosis, and a healthy sedentary control group. Overall, it was found that individuals with CFS suffer from profound physical impairment. Concurrent psychiatric illness, however, did not adversely affect physical functional capacity. Physical functional capacity was not worse in individuals with a concurrent psychiatric illness. As expected, concurrent psychiatric illness was found to reduce emotional well-being. Moreover, individuals with a psychiatric illness that predated the onset of CFS suffered the greatest emotional distress. Thus, an individual's psychiatric history should be considered when attempting to understand the factors maintaining disability in CFS. 909 PMID- 12626460 AU - Tiev KP, Demettre E, Ercolano P, Bastide L, Lebleu B, Cabane J TI - RNase L levels in peripheral blood mononuclear cells: 37-kilodalton/83-kilodalton isoform ratio is a potential test for CFS. SO - Clin Diagn Lab Immunol 2003 Mar;10(2):315-6. IN - Service de Medecine Interne, Hopital Saint Antoine, 75571 P+ AB - +IN: aris Cedex 12, France. kiet.tiev@sat.ap-hop-paris.fr Chronic fatigue syndrome (CFS) is a disorder characterized by debilitating fatigue associated with immunological abnormalities. The etiology remains unclear. A low-molecular-mass (37 kDa) isoform of RNase L has been described in peripheral blood mononuclear cell (PBMC) extracts, and the ratio of two isoforms of RNase L (37 kDa/83 kDa) has been proposed as a potential biochemical marker of CFS. In a prospective case-control study, we tested whether the RNase L 37-kDa/83-kDa ratio could discriminate a SFC population. We compared the ratio of RNase L isoforms in PBMCs from 11 patients with CFS (6 women and 5 men; mean age +/- standard deviation, 43.2 +/- 13.8 years) and PBMCs from 14 healthy well-matched volunteers (10 women and 4 men; age, 39.1 +/- 11.6 years). A ratio of RNase L of 0.4 used as a threshold allowed diagnosis of CFS with high sensitivity (91%; 95% confidence interval [CI], 57 to 99%) and specificity (71%; 95% CI, 41 to 90%). The positive and negative prognostic values were 71% (95% CI, 41 to 90%) and 91% (95% CI, 57 to 99%), respectively. In the absence of acute infection or chronic inflammation, a high RNase L ratio could distinguish CFS patients from healthy volunteers. Additional large studies and follow-up studies are required to confirm the stability of this high ratio of RNase L isoforms in a CFS group. 910 PMID- 12756495 AU - Tishler M, Smorodin T, Vazina-Amit M, Ramot Y, Koffler M, Fishel B TI - FM in diabetes mellitus. SO - Rheumatol Int 2003 Jul;23(4):171-3. Epub 2003 May 20. IN - D o Med 'B' & the Rheumatology Service, Assaf Harofe Med Ct+ AB - +IN: r, Zerifin, Israel. tishler@asaf.health.gov.il OBJECTIVE: The aim of this study was to evaluate the prevalence of fibromyalgia (FM) in patients with diabetes mellitus (DM). SUBJECTS: The study included 100 consecutive unselected patients with DM attending our diabetes clinic. Patients were divided into two groups: 45 patients with type 1 diabetes and 55 patients with type 2 diabetes. A group of 50 healthy hospital staff members served as controls. The FM was diagnosed according to the 1990 American College of Rheumatology criteria. Counts of 18 tender points were performed by thumb palpation and assessed by dolorimeter. Routine biochemical tests and levels of HbA(1c) were recorded in each patient. RESULTS: The main outcome measure was the association of FM with DM. Fibromyalgia was diagnosed in 17 patients (17%) with DM and in only one (2%) healthy control ( P=0.008). No differences in patients were noted in the prevalence of FM between type 1 and type 2 diabetes (18.5% vs 15.5%, respectively). Patients with both FM and DM had significantly higher levels of HbA(1c) than DM patients without FM (9.2+/-1.1% vs 6.4+/-1.5%) ( P<0.05). Similarly, the numbers of tender points, pain scores, and the prevalence of sleep disturbances, fatigue, and headaches were higher in this group of patients. A significant correlation was observed between the numbers of tender points and HbA(1c) levels in the DM patients with FM ( r=0.72, P=0.027). CONCLUSION: Fibromyalgia is a common finding in patients with types 1 and 2 diabetes, and its prevalence could be related to control of the disease. As with other diabetes complications, FM might be prevented by improved control of blood glucose levels. 911 PMID- 12828565 AU - Ulvestad E TI - Modelling autoimmune rheumatic disease: a likelihood rationale. SO - Scand J Immunol 2003 Jul;58(1):106-11. IN - D o Microbiology & Immunology, The Gade Inst, Haukeland U H+ AB - +IN: osp, Bergen, Norway. elling.ulvestad@haukeland.no Immunoglobulins (Igs) and autoantibodies are commonly tested in sera from patients with suspected rheumatic disease. To evaluate the clinical utility of the tests in combination, we investigated sera from 351 patients with autoimmune rheumatic disease (ARD) rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) and 96 patients with nonautoimmune rheumatic disease (NAD) (fibromyalgia, osteoarthritis, etc.). Antinuclear antibodies (ANA), rheumatoid factor (RF), antibodies against DNA and extractable nuclear antigens (anti-ENA), IgG, IgA and IgM were measured for all patients. Logistic regression analysis of test results was used to calculate each patient's probability for belonging to the ARD or NAD group as well as likelihood ratios for disease. Test accuracy was investigated using receiver-operating characteristic (ROC) plots and nonparametric ROC analysis. Neither concentrations of IgG, IgA, IgM, anti-DNA nor anti-ENA gave a significant effect on diagnostic outcome. Probabilities for disease and likelihood ratios calculated by combining RF and ANA performed significantly better at predicting ARD than utilization of the diagnostic tests in isolation (P < 0.001). At a cut-off level of P = 0.73 and likelihood ratio = 1, the logistic model gave a specificity of 93% and a sensitivity of 75% for the differentiation between ARD and NAD. When compared at the same level of specificity, ANA gave a sensitivity of 37% and RF gave a sensitivity of 56.6%. Dichotomizing ANA and RF as positive or negative did not reduce the performance characteristics of the model. Combining results obtained from serological analysis of ANA and RF according to this model will increase the diagnostic utility of the tests in rheumatological practice. 912 PMID- 12734907 AU - Valim V, Oliveira L, Suda A, Silva L, de Assis M, Barros Neto T, Feldman D, Nat+ TI - Aerobic fitness effects in FM. SO - J Rheumatol 2003 May;30(5):1060-9. IN - D o Med, Sao Paulo Federal U, Sao Paulo, Brazil. AB - +AU: our J OBJECTIVE: To compare 2 exercise modalities, aerobic fitness training and stretching exercises, in patients with fibromyalgia (FM) in relation to function, pain, quality of life, depression, and anxiety, and to correlate the cardiorespiratory fitness gain with symptom improvement. METHODS: Seventy-six women with FM between 18 and 60 years old were randomized to either an aerobic program or stretching program, for 20 weeks. They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness, flexibility, function, Fibromyalgia Impact Questionnaire (FIQ), Short-form Health Survey (SF-36), and depression and anxiety levels. Ventilatory anaerobic threshold (VT) and maximum oxygen uptake (VO2max) were determined by expired gas analyses. RESULTS: Aerobic exercise was superior to stretching in relation to VO2 max, VT, function, depression, pain, and the emotional aspects and mental health domains of SF-36. Patients in the stretching group showed no improvement in depression, "role emotional," and "mental health." No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain, function, or scores in FIQ and SF-36. CONCLUSION: Our results confirm that aerobic exercise is beneficial to patients with FM, but the cardiorespiratory fitness gain is not related to improvement of FM symptoms. 913 PMID- 14692438 AU - van Gelder T, Smits P TI - Pilot studies: 1 swallow does not make a summer... SO - Neth J Med. 2003 Sep;61(9):285-9. PMID: 14692441; Neth J Me+ AB - +SO: d 2003 Sep;61(9):270-2. What should we expect from pilot studies, done in small series of patients? In the literature there are many examples of small studies with very promising results, that in subsequent larger or better controlled studies proved to be much less promising, or even disastrous. In some instances the initial favourable outcome was due to selection bias. In others the use of nonvalidated methods of measuring outcome made the reproducibility of promising observations problematic. However, we have to start somewhere. In ths issue The et al. report favourable results of granisetron treatment in four out of five patients with chronic fatigue syndrome. A prospective, randomised, placebo-controlled, double-blind clinical trial with granisetron in patients with chronic fatigue syndrome is now ongoing. 914 PMID- 12781640 AU - Van Hoof E, Cluydts R, De Meirleir K TI - Atypical depression as a secondary Sx in CFS. SO - Med Hypotheses 2003 Jul;61(1):52-5. IN - D o Human Physiology, Vrije Universiteit Brussel, Brussel, + AB - +IN: Belgium. elke.van.hoof@vub.ac.be Chronic fatigue syndrome (CFS) has gained prominence since 1988 and a substantial amount of research has been done in this domain. However, it is still regarded as a controversial condition. Moreover, most of the symptoms of CFS itself are non-specific, occurring in many illnesses; some of the symptoms are also common in depression. Indeed, an area of continued controversy and debate involves the diagnostic overlap between CFS and psychiatric disorders. Through anecdotal evidence, atypical depression appears to be common in CFS. Recent developments in psychobiology underscore the role of the acute phase response and its associated sickness behavior in affective disorders. Thus, we hypothesize that atypical depression is sickness behavior rather than an affective disorder as shown by anecdotal evidence in CFS. 915 PMID- 12605308 AU - Van Houdenhove B TI - FM: a challenge for modern medicine. SO - Clin Rheumatol. 2003 Feb;22(1):8-11. PMID: 12605310; Clin R+ AB - +SO: heumatol 2003 Feb;22(1):1-5. 916 PMID- 12920327 AU - van Hout MS, Wekking EM, Berg IJ, Deelman BG TI - Psychological Rx of pts w chr toxic encephalopathy: lessons from studies of chr fatigue & whiplash. SO - Psychother Psychosom 2003 Sep-Oct;72(5):235-44. IN - Medical Spectrum Twente Hosp, Enschede, The Netherlands. MS+ AB - +IN: EvanHout@ziekenhuis-mst.nl BACKGROUND: Chronic toxic encephalopathy (CTE), which can result from long-term exposure to organic solvents, is characterized by problems of attention and memory, fatigue and affective symptoms. There is little experience with (neuro)psychological treatment in this patient group. We reviewed treatment outcome studies of CTE and comparable syndromes, namely, chronic whiplash-associated disorder (WAD) and chronic fatigue syndrome (CFS), with a view to providing recommendations for the psychological treatment of patients with CTE. METHODS: PubMed and PsychLIT were systematically searched and reference lists of retrieved articles were studied. The articles were classified according to study design and level of evidence. RESULTS: The studies of CFS provided high-level evidence for the effectiveness of cognitive-behavior therapy (CBT) in challenging dysfunctional cognitions regarding the effectiveness of rest and in stimulating graded activity. The studies of WAD were methodologically weaker, and most evaluated a combination of CBT and graded activity training. There was some evidence that changing fatigue- or pain-related behaviors may result in cognitive improvement. Two uncontrolled studies of CTE evaluated cognitive rehabilitation techniques but yielded inconsistent findings. CONCLUSIONS: CBT techniques focusing on changing illness attributions and on stimulating graded activity might be useful for patients with CTE, diminishing fatigue-related problems of concentration and memory. Future studies should evaluate whether cognitive deficits of CTE patients as a result of neurotoxic effects of exposure should be treated by cognitive rehabilitation. 917 PMID- 12783037 AU - Vanness JM, Snell CR, Strayer DR, Dempsey L 4th, Stevens SR TI - Subclassifying CFS through exercise testing. SO - Med Sci Sports Exerc 2003 Jun;35(6):908-13. IN - U o the Pacific, D o Sport Sciences, Stockton, CA 95211, US+ AB - +IN: A. mvanness@uop.edu PURPOSE: The purpose of this study was to examine physiological responses of persons with chronic fatigue syndrome (CFS) to a graded exercise test. METHODS: Cardiopulmonary exercise tests were performed on 189 patients diagnosed with CFS. Based on values for peak oxygen consumption, patients were assigned to one of four impairment categories (none, mild, moderate, and severe), using American Medical Association (AMA) guidelines. A one-way MANOVA was used to determine differences between impairment categories for the dependent variables of age, body mass index, percentage of predicted [OV0312]O(2), resting and peak heart rates, resting and peak systolic blood pressure, respiratory quotient (RQ), and rating of perceived exertion. RESULTS: Significant differences were found between each impairment level for percentage of predicted [OV0312]O(2) and peak heart rate. Peak systolic blood pressure values for the "moderate," and "severe" groups differed significantly from each other and both other groups. The more impaired groups had lower values. The no impairment group had a significantly higher peak RQ than each of the other impairment levels (all P < 0.001). Peak [OV0312]O(2) values were less than predicted for all groups. Compared with the males, the women achieved actual values for peak [OV0312]O(2) that were closer to their predicted values. CONCLUSION: Despite a common diagnosis, the functional capacity of CFS patients varies greatly. Stratifying patients by function allows for a more meaningful interpretation of the responses to exercise and may enable differential diagnosis between subsets of CFS patients. 918 PMID- 12744811 AU - Vassilopoulos D, Calabrese LH TI - Rheumatic manifestations of hepatitis C infection. SO - Curr Rheumatol Rep 2003 Jun;5(3):200-4. IN - D o Rheumatic & Immunologic Diseases, The Cleveland Clinic + AB - +IN: Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. calabrl@ccf.org Among chronic viral infections, hepatitis C virus (HCV) infection is uniquely associated with an array of rheumatic manifestations and autoimmune laboratory findings. These include, among others, arthralgias, arthritis, fatigue, fibromyalgia, vasculitis, and sialadenitis (Sjogren-like). The mechanisms that are involved in the pathogenesis of these diverse manifestations have not yet been clarified. Regardless of the direct or indirect pathogenetic role of HCV in these clinical entities, the concomitant presence of a chronic viral infection creates a number of diagnostic and therapeutic problems. This is particularly true when immunosuppressive therapy is needed for control of disease activity (eg, HCV-associated cryoglobulinemic vasculitis). The emerging treatment options for chronic HCV offer a major chance for viral eradication and conceivably for cure of these HCV-associated conditions. In this review, the recent advances in the epidemiology, pathogenesis, clinical findings, and treatment of HCV-associated rheumatic conditions are presented. 919 PMID- 12531455 AU - Vecchiet J, Cipollone F, Falasca K, Mezzetti A, Pizzigallo E, Bucciarelli T, De+ TI - Relationship between musculoskeletal Sx & blood markers of oxidative stress in pts w CFS. SO - Neurosci Lett 2003 Jan 2;335(3):151-4 IN - D o Med & Science o Aging, 'G. D'Annunzio' U o Chieti, Italy AB - +AU: Laurentis S, Affaitati G, De Cesare D, Giamberardino MA In 21 patients with chronic fatigue syndrome (CFS) versus 20 normal subjects, we investigated the oxidant/antioxidant balance and its correlation with muscle symptoms. Patients versus controls showed significantly: lower Lag Phase and Vitamin E (Vit E) concentrations in plasma and low-density lipoproteins (LDL), higher LDL thiobarbituric acid reactive substances (TBARS), higher fatigue and lower muscle pain thresholds to electrical stimulation. A significant direct linear correlation was found between fatigue and TBARS, thresholds and Lag Phase, thresholds and Vit E in plasma and LDL. A significant inverse linear correlation was found between fatigue and Lag Phase, fatigue and Vit E, thresholds and TBARS. Increased oxidative stress and decreased antioxidant defenses are related to the extent of symptomatology in CFS, suggesting that antioxidant supplementation might relieve muscle symptoms in the syndrome. 920 PMID- 12559185 AU - Velanovich V TI - The effect of chr pain syndromes & psychoemotional disorders on symptomatic & quality-of-life outcomes of antireflux surgery. [FM] SO - J Gastrointest Surg 2003 Jan;7(1):53-8. IN - Division o General Surgery, Henry Ford Hosp, Detroit, Michi+ AB - +IN: gan 48202-2689, USA. vvelanol@hfhs.org Psychoemotional disorders (PED) and chronic pain syndromes (CPS) are common problems. Many patients with these disorders also suffer from gastroesophageal reflux disease (GERD). It is unclear how PED/CPS affect outcomes of antireflux surgery; therefore, the purpose of this study was to determine if PED/CPS adversely affects the results of surgical therapy for GERD. All patients referred for surgical therapy for GERD completed both the GERD-HRQL symptom severity instrument and the SF-36 generic quality-of-life instrument prior to surgery. To be candidates for surgery, patients must have symptomatic GERD and objective evidence of pathologic reflux by upper endoscopy, esophageal manometry and 24-hour pH monitoring. Patients underwent either laparoscopic or open Nissen or Toupet fundoplication. Six to 24 months postoperatively, patients were evaluated for satisfaction and quality-of-life. Ninety-three percent of control patients compared to 25% of PED/CPS patients were satisfied with surgery (P < 0.001). Dissatisfaction in PED/CPS patients was generally due to persistent or new somatic complaints. Median total GERD-HRQL scores improved for both groups, although postoperative scores were worse in the PED/CPS group. PED/CPS patients had significantly worse SF-36 scores both preoperatively and postoperatively compared to control patients. SF-36 scores improved in four of eight domains in control patients and none in the PED/CPS patients. In conclusion, PED/CPS patients are generally dissatisfied with antireflux surgery. Although some patients do benefit from surgery, careful patient selection is required. 921 PMID- 12847301 AU - Ventegodt S, Merrick J, Anderson NJ TI - Quality of life as medicine: a pilot study of pts w chr illness & pain. SO - ScientificWorldJournal 2003 Jun 16;3:520-32. IN - The Quality o Life Research Ctr & Research Clinic for Holis+ AB - +IN: tic Med, Copenhagen K, Denmark. ventegodt@livskvalitet.org An intensive 5-day quality-of-life (QoL) session was constructed based on a psychosomatic model. The session was comprised of teaching on philosophy of life, psychotherapy, and body therapy. The three elements were put together in such a way that they mutually supported each other. The synergy attained was considerable. The pilot study demonstrated that in the course of only 1 week, patients had time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. Consequently, the patients became more present in the body's blocked-off areas and subjectively healthier. Nineteen persons with chronic illness and pain (fibromyalgia, chronic tiredness, whiplash, mild depression, and problems involving pain in arms and legs including osteoarthritis), and unemployed for 5-7 years attended the course. In the week before and after the 5-day course, the participants completed the validated SEQOL (Self-Evaluation of Quality of Life Questionnaire) including questions on self-evaluated health and the unvalidated "Self-Evaluation of Working-Life Quality Questionnaire" (SEQWL). This pilot study was without a control group or clinical control. As far as diagnoses were concerned, the group was inhomogeneous. Common for the group was a low QoL, poor quality of working life QWL, and numerous health problems. The study showed an 11.2% improvement in QoL (p < 0.05), a 6.3% improvement in QWL (p < 0.05), and a 12.0% improvement in self-perceived physical health (p = 0.08). There was a 17.3% improvement in self-perceived psychological health (p < 0.05) and satisfaction with health in general improved by 21.4% (p < 0.05). Symptoms like pain were almost halved and several of the participants were free of pain for the first time in years. In conclusion it seemed that the combination of training in philosophy of life, psychotherapy, and body therapy can give patients a large, fast, and efficient improvement in QoL, QWL, and health. It is not known if these changes will be permanent and if all kinds of patients with different health problems will gain from this cure. Further research should be conducted. 922 PMID- 14528527 AU - Vermeulen RC, Scholte HR TI - Rupture of silicone gel breast implants & Sx of pain & fatigue. SO - J Rheumatol 2003 Oct;30(10):2263-7. IN - Chronic Pain & Fatigue Research Centre, Waalstraat 25, 1078+ AB - +IN: BR Amsterdam, The Netherlands. rcwvermeulen@cfscentrumamsterda m.nl OBJECTIVE: To compare symptoms of women with silicone gel breast implants and women with chronic fatigue syndrome (CFS), and to study the effect of rupture of the silicone implant. METHODS: Five hundred readers of the Dutch silicone breast implant support group magazine were asked to respond if they had been informed by the surgeon about the silicone implant status at operation, and to answer questions about symptoms of CFS. Their complaints were compared with those of 100 female patients with CFS and 40 female controls. RESULTS: The questionnaires were returned by 319 women. Of these, 227 had symptoms of debilitating chronic fatigue. The patterns of symptoms differed from those in patients with CFS. An analysis of the relation between integrity of the implants and the symptoms could be carried out in 176 women, and 74% of these latter women reported ruptured implants. Significantly more women with ruptured implants than those with intact implants had debilitating chronic fatigue (75% vs 51%), postexertional malaise > 24 h (77% vs 51%), impaired short term memory (58% vs 38%), and multi-joint pain (77% vs 60%). CONCLUSION: Women with silicone breast implants often report severe pain and chronic fatigue. Rupture of the implant is associated with an increase in symptoms of pain and chronic fatigue. 923 PMID- 14581112 AU - Viane I, Crombez G, Eccleston C, Poppe C, Devulder J, Van Houdenhove B, De Cort+ TI - Acceptance of pain is an independent predictor of mental well-being in pts w chr pain: empirical evidence & reappraisal. SO - Pain 2003 Nov;106(1-2):65-72. IN - Faculty o Psychology & Educational Sciences, Ghent U, Henri+ AB - +IN: Dunantlaan 2, 9000 Ghent, Belgium. Ilse.Viane@ugent.ac.be +AU: e W This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change. 924 PMID- 15088283 AU - Wallace DJ TI - To FM nihilists: stop pontificating & test your hypothesis. SO - [CON: J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918]; J Rheumatol 2004 Apr;31(4):632. 925 PMID- 14563106 AU - Warnock JK, Clayton AH TI - Chronic episodic disorders in women. SO - Psychiatr Clin North Am 2003 Sep;26(3):725-40. IN - D o Psychiatry, U o Oklahoma Health Sciences Center-Tulsa, + AB - +IN: 4502 East 41st Street, Tulsa, OK 74135-2553, USA. faye-biggs@ouhsc.edu Chronic episodic disorders, such as depressive disorders, IBS, migraine, and FMS, have important commonalities, including cormorbidities, an absence of classic anatomic pathology in the tissues, a lack of objective findings on physical examination, and a lack of abnormal findings by routine laboratory and radiologic tests. These CED are more prevalent in women (perhaps due to changes in estrogen levels), are generally worsened by stress (with resultant hyperactivity of the HPA axis), and often improve with aerobic exercise and common classes of medications affecting serotonin function, such as antidepressants. Thus, an increased understanding of the CED may result in improved treatment and functioning of many patients. 926 PMID- 12617403 AU - Watkins P TI - Changing perceptions of disease. SO - Clin Med 2003 Jan-Feb;3(1):5-6. 927 PMID- 12749553 AU - Watson NF, Kapur V, Arguelles LM, Goldberg J, Schmidt DF, Armitage R, Buchwald D TI - Comparison of subjective & objective measures of insomnia in monozygotic twins discordant for CFS. SO - Sleep 2003 May 1;26(3):324-8. IN - D o Neurology & Sleep Disorders Ctr, U o Washington, Seattl+ AB - +IN: e 98104-2499, USA. nwatson@u.washington.edu STUDY OBJECTIVES: To examine the objective and subjective measures of insomnia in chronic fatigue syndrome (CFS). DESIGN: Monozygotic co-twin control study. SETTING: Academic medical center. PATIENTS OR PARTICIPANTS: Twenty-two pairs of monozygotic twins where 1 member of the pair had CFS and the other did not. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Twenty-two CFS-discordant twin pairs completed a Sleep Disorders Questionnaire, overnight polysomnography, and a postpolysomnography sleep survey. Mean and percent differences in the sleep measures were compared between the CFS and healthy twins using matched-pair methods of analysis. Compared with their healthy co-twins, the CFS twins more frequently endorsed 8 subjective measures of insomnia and poor sleep (all p < or = 0.05). However, the CFS and healthy twins did not differ in objective polysomnographic measures of insomnia, including sleep latency, total sleep time, sleep efficiency, arousal number, arousal index, hypnogram awakenings, rapid eye movement (REM)-sleep latency, and percent stages 1, 2, and 3-4 (delta). Percent stage REM sleep was increased in the CFS twins compared with the healthy twins (27.7% vs. 24.4%, p < or = 0.05). On the postpolysomnography survey, CFS twins reported that they had slept fewer hours (6.2 vs. 6.7; p < or = 0.05), and were less well rested (p < or = 0.001) compared to their co-twins. CONCLUSIONS: CFS patients had worse subjective sleep than their co-twins despite little objective data supporting this discrepancy, suggesting they suffer from an element of sleep-state misperception. The higher percentage of REM sleep in the CFS twins implies that REM sleep may play a role in this illness. 928 PMID- 12927471 AU - Werner A, Malterud K TI - It is hard work behaving as a credible patient: encounters between women w chr pain & their doctors. SO - Soc Sci Med 2003 Oct;57(8):1409-19. IN - Centre for Women's Studies & Gender Research, U o Oslo, P.O+ AB - +IN: . Box 1040 Blindern, N-0315 Oslo, Norway. anne.werner@skk.uio.no In various studies during the last decade, women with medically unexplained disorders have reported negative experiences during medical encounters. Accounts of being met with scepticism and lack of comprehension, feeling rejected, ignored, and being belittled, blamed for their condition and assigned psychological explanation models are common. Women patients exerted themselves to attract the doctor's medical attention and interest, and were anxious to be considered as whiners or complainers. Here, we explore the nature of "work" done by the patients in order to be believed, understood, and taken seriously when consulting the doctor. A qualitative study was conducted with in-depth interviews including a purposeful sampling of 10 women of varying ages and backgrounds with chronic muscular pain. The main outcome measures were descriptions reflecting the patients' activities or efforts invested in being perceived as a credible patient. We focused on the gendered dimensions of the experiences. The women patients' accounts indicated hard work to make the symptoms socially visible, real, and physical when consulting a doctor. Their efforts reflect a subtle balance not to appear too strong or too weak, too healthy or too sick, or too smart or too disarranged. Attempting to fit in with normative, biomedical expectations of correctness, they tested strategies such as appropriate assertiveness, surrendering, and appearance. The most important activities or efforts varied. However, the informants were not only struggling for their credibility. Their stories illustrated a struggle for the maintenance of self-esteem or dignity as patients and as women. The material was interpreted within a feminist frame of reference, emphasising the relationship between dignity and shame, power and disempowerment for women patients' with medically unexplained disorders. 929 PMID- 14634458 AU - Westropp JL, Welk KA, Buffington CA TI - Small adrenal glands in cats w feline interstitial cystitis. SO - J Urol 2003 Dec;170(6 Pt 1):2494-7. IN - D o Veterinary Clinical Sciences, Coll o Veterinary Med, Oh+ AB - +IN: io St U, Columbus 43210-1089, USA. PURPOSE: We documented the uncoupling of sympathetic nervous system activity from the hypothalamic-pituitary-adrenal axis in cats with feline interstitial cystitis (FIC). Altered hypothalamic-pituitary-adrenal activity was recently suggested in some humans with interstitial cystitis (IC) but to our knowledge no information exists on adrenal gland size and histopathology in this disease. To investigate further adrenal function in cats with FIC we determined cortisol responses to 125 microg synthetic adrenocorticotropic hormone (ACTH) as well as adrenal size and histology. MATERIALS AND METHODS: ACTH stimulation studies were performed in 11 healthy cats and 20 with FIC. Adrenal glands obtained at autopsy in 8 healthy cats and 13 with FIC were weighed, measured and examined histologically. RESULTS: Cats with FIC had significantly decreased responses to ACTH (2-way repeated measures ANOVA p <0.05). Mean weight +/- SD (58 +/- 50 vs 241 +/- 60 mg) and volume (264 +/- 72 vs 410 +/- 115 mm3) of adrenal glands were significantly smaller in cats with FIC than in healthy cats (p <0.05). CONCLUSIONS: These results suggest that cats with FIC may have mild primary adrenal insufficiency. Decreased adrenal size has been observed in patients with chronic fatigue syndrome, which can be a co-morbid condition in some patients with IC. If these abnormalities are confirmed in humans with IC, hormone replacement therapy may be indicated in select patients. 930 PMID- 15088285 AU - White KP TI - FM: the answer is blowin' in the wind. SO - [CON: J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918]; [CON: J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919]; [CON: J Rheumatol. 2003 Aug;30(8):1671-2. PMID: 12913920]; J Rheumatol 2004 Apr;31(4):636-9. 931 PMID- 12622299 AU - White PD TI - Costs, correlates & consequences of fatigue in children & adults. [CF] SO - Psychol Med. 2003 Feb;33(2):253-61. PMID: 12622304; Psychol+ AB - +SO: Med. 2003 Feb;33(2):263-81. PMID: 12622305; Psychol Med. 2003 Feb;33(2):283-7. PMID: 12622306; Psychol Med. 2003 Feb;33(2):289-97. PMID: 12622307; Psychol Med 2003 Feb;33(2):197-201. 932 PMID- 12508403 AU - White PD, Henderson M, Pearson RM, Coldrick AR, White AG, Kidd BL TI - Illness behavior & psychosocial factors in diffuse upper limb pain disorder: a case-control study. [FM] SO - J Rheumatol 2003 Jan;30(1):139-45 IN - Queen Mary School o Med & Dentistry, U o London, London, UK. AB - OBJECTIVE: To compare behavioral and other psychosocial factors in patients with diffuse upper limb pain disorder (ULPD) and patients with carpal tunnel syndrome (CTS). METHODS: We compared 37 hospital outpatients with diffuse ULPD with 36 hospital outpatients with CTS, matched by sex, pain intensity, and duration of illness. We assessed psychiatric morbidity by a standardized interview, and both symptoms and personality by self-rated questionnaires. We measured illness behavior by assessing financial benefits and compensation, coping strategies, illness beliefs, treatments received, and 24 hours of monitoring movements of the most affected arm and the body as a whole. RESULTS: There were no significant differences in the prevalence of either current or premorbid psychiatric disorders, personality scores, symptom amplification, disability, or treatments received. Subjects with ULPD had significantly lower self-rated scores for depression, somatic distress, sleep disturbance, and physical fatigue than subjects with CTS, although there were more than normal levels of anxiety, fatigue, and sleep disturbance in both groups. There were no significant differences in the numbers of arm or body movements by day and night. Significantly more ULPD subjects had been involved in litigation, but litigating patients were a minority. CONCLUSION: The primary etiology of endemic diffuse ULPD, presenting in secondary care, is no more psychiatric, psychological, behavioral, or related to personality than is the case with a similarly chronic and painful condition of known pathology. We cannot exclude either a specific role for psychosocial factors at work, or a more general role for psychosocial factors in maintaining disability in patients with chronic pain. 933 PMID- 12587099 AU - Whitehead J, Matsushita T TI - Stopping clinical trials because of Rx ineffectiveness: a comparison of a futility design w a method of stochastic curtailment. SO - Stat Med 2003 Mar 15;22(5):677-87. IN - Medical & Pharmaceutical Statistics Research Unit, The U o + AB - +IN: Reading, Reading, UK. j.r.whitehead@reading.ac.uk This paper introduces a simple futility design that allows a comparative clinical trial to be stopped due to lack of effect at any of a series of planned interim analyses. Stopping due to apparent benefit is not permitted. The design is for use when any positive claim should be based on the maximum sample size, for example to allow subgroup analyses or the evaluation of safety or secondary efficacy responses. A final frequentist analysis can be performed that is valid for the type of design employed. Here the design is described and its properties are presented. Its advantages and disadvantages relative to the use of stochastic curtailment are discussed. 934 PMID- 13679005 AU - Wiesmuller GA, Ebel H, Hornberg C, Kwan O, Friel J TI - Are syndromes in environmental medicine variants of somatoform disorders? SO - Med Hypotheses 2003 Oct;61(4):419-30. IN - Institute o Hygiene & Environmental Med, U Hosp Aachen, Aac+ AB - +IN: hen, Germany. To date, relatively little is known about the etiology, pathophysiology, diagnosis, therapy, prevention and prognosis of environment-related syndromes like multiple chemical sensitivity (MCS), idiopathic environmental intolerance (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), candida syndrome (CS) and burnout syndrome (BS). Part of the reason is that these syndromes have not been clearly defined and classified in scientific categories distinct from each other, and that they show clinical similarities to classified somatoform disorders. Furthermore, there are at least three possible explanations for the existence of these syndromes: (1) The syndromes may result from the interaction of environmental factors, individual susceptibility and psychological factors (i.e., how they are perceived and seen by the patient); (2) they may reflect socially and culturally accepted methods of expressing distress; and/or (3) they may be iatrogenic. Despite all the uncertainties in evaluation of environmental syndromes, physicians have the duty to take the affected person's problems seriously. A comprehensive systematic classification which better accounts for these complex clinical manifestations is long overdue. Until these syndromes are well defined, the terms used for them should definitely not be applied to connote a specific disease process. 935 PMID- 12657898 AU - Wik G, Fischer H, Bragee B, Kristianson M, Fredrikson M TI - Retrosplenial cortical activation in the FM syndrome. SO - Neuroreport 2003 Mar 24;14(4):619-21. IN - D o Psychiatry, U o Bergen, Sandviken Hosp, N-5035, Bergen,+ AB - +IN: Norway. gustav.wik@psyk.uib.no To study the CNS in chronic muscular pain typical of fibromyalgia we compared PET measures of regional cerebral blood flow (rCBF) in eight fibromyalgic patients and controls at rest. Higher rCBF for patients than controls was found bilaterally in the retrosplenial cortex. Lower rCBF for patients than controls were seen in the left frontal, temporal, parietal, and occipital cortices. The higher retroplenial rCBF in patients than controls may reflect increased attention towards sub-noxious somatosensory signaling, and agrees with the notion that fibromyalgic pain reflects secondary hyperalgesia. The brain regions with lower rCBF in fibromyalgic patients than controls participate in the normal cognitive processing of pain, which may be dysfunctional in fibromyalgia. 936 PMID- 12849717 AU - Williams DA TI - Psychological & behavioural therapies in FM & related syndromes. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):649-65. IN - U o Michigan, Room 5510D, MSRB-1, 1150 W. Med Ctr Dr., Ann + AB - +IN: Arbor, MI 48109-0680, USA. daveawms@umich.edu Psychological and behavioural therapies are being applied to patients with fibromyalgia (FM) with increasing frequency. The rationale for including psychological therapies is not for the treatment of co-morbid mood disorders, but rather to manage the many non-psychiatric psychological and social factors that comprise pain perception and its maintenance. This chapter reviews the involvement of mental health professionals under both the biomedical and biopsychosocial models of illness and describes cognitive behavioural therapy (CBT), a commonly used form of psychological therapy in the management of chronic pain conditions. The empirical literature supports the use of CBT with FM in producing modest outcomes across multiple domains, including pain, fatigue, physical functioning and mood. Greatest benefits appear to occur when CBT is used adjunctively with exercise. While the benefits are not curative or universally obtained by all patients, the benefits are sufficiently large to encourage future refinement of CBT for this population of patients. 937 PMID- 12849710 AU - Witter J, Simon LS TI - Chronic pain & FM: the regulatory perspective. SO - Best Pract Res Clin Rheumatol 2003 Aug;17(4):541-6. IN - Division o Anti-inflammatory, Analgesic & Ophthalmic Drug P+ AB - +IN: roducts, Ctr for Drug Evaluation & Research, Food & Drug Administration, Rockville, MD, USA. Chronic pain is an important clinical entity that represents a currently unmet medical need. Relief of pain is an important public health goal for patients of all ages, from perinatal to geriatric. This article will describe some of the current regulatory issues in developing and approving drugs to treat chronic pain. It will also begin to familiarize the reader with the importance of the so-called 'label' and some of its roles to enable the best 'risk-benefit' decisions be made for, and by, patients with chronic pain. 938 PMID- 12563698 AU - Wolfe F TI - Pain extent & Dx: development & validation of the regional pain scale in 12,799 pts w rheumatic disease. [FM] SO - J Rheumatol 2003 Feb;30(2):369-78 IN - National Data Bank for Rheumatic Diseases Arthritis Researc+ AB - +IN: h Ctr Foundation & U o Kansas School o Med, Wichita, Kansas, USA. OBJECTIVE: To develop and validate a pain scale that measures the extent of body pain. METHODS: A total of 12,799 patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM) completed a mailed survey regarding the location and intensity of their pain in 38 articular and nonarticular regions. The data were analyzed using item response theory (IRT) by nonparametric Mokken analysis followed by Rasch analysis. The resultant scale was examined for its association with clinical severity variables and its ability to distinguish patients diagnosed with and without FM. RESULTS: The resultant 19 item regional pain scale (RPS) was composed primarily of nonarticular regions. The scale had strong scalability as measured by the Mokken H statistic (H = 0.52), and satisfied the Mokken monotonicity and double monotonicity criteria. The RPS also fit the Rasch model and had satisfactory reliability and separation statistics. Of all clinical variables assessed by survey, the RPS best identified patients diagnosed with FM. In addition, the scale correlated with measures of clinical severity, regardless of diagnosis, and predicted measures of utilization. CONCLUSION: The RPS is a valid scale of pain extent. It can be useful to identify patients with FM or can be used to develop a new definition of FM, even among patients with concomitant illnesses such as RA and OA. In addition, it is a measure of pain extent that is disease independent, and works as well in RA and OA as in FM to identify patients with increased severity and resource utilization. 939 PMID- 12913920 AU - Wolfe F TI - Stop using the American College of Rheumatology criteria in the clinic. SO - J Rheumatol. 2003 Aug;30(8):1835-40. PMID: 12913943; J Rheu+ AB - +SO: matol 2003 Aug;30(8):1671-2. 940 PMID- 12563023 AU - Yamamoto Y, LaManca JJ, Natelson BH TI - A measure of heart rate variability is sensitive to orthostatic challenge in women w CFS. SO - Exp Biol Med (Maywood) 2003 Feb;228(2):167-74 IN - D o Neurosciences, New Jersey MS, East Orange, New Jersey 0+ AB - +IN: 7018-1095, USA. The use of symptoms generated by head up tilt (HUT) is not a useful tool in identifying chronic fatigue syndrome (CFS). We investigated whether heart rate variability (HRV) assessed early during HUT might be useful. A sample of 46 female subjects (24 with CFS and 22 sedentary, age-matched healthy controls; CON) who had exhibited no difference in time to syncope during tilt was examined for HRV responses to 10 min of 70 degrees HUT after 5 min of baseline in the supine position. HRV data were analyzed by the method of coarse graining spectral analysis. Variables compared between groups included mean and standard deviation (SD(RRI)) of RR intervals (RRI), amplitudes of low- (A(LF); 0.04-0.15 Hz) and high-frequency (A(HF); >0.15 Hz) harmonic as well as aperiodic, fractal (A(FR); 1/f(beta)) spectral components, the spectral exponent beta, and the difference in these values between baseline and HUT for each subject. In the supine baseline, only mean RRI was significantly (P < 0.01) lower in CFS than in CON. During HUT, however, mean RRI (P < 0.01), SD(RRI) (P < 0.01), A(HF) (P < 0.05), and A(FR) (P < 0.01) were significantly lower in CFS than in CON. When the difference in values between baseline and HUT for each subject was examined, only the difference for A(FR) (deltaA(FR)) was significantly (P < 0.01) lower in CFS than in CON, suggesting that A(FR)is a disease-specific response of HRV to HUT. When a cut-off level was set to deltaA(FR) = -2.7 msec, the sensitivity and the specificity in differentiating CFS from controls were 90% and 72%, respectively. The data suggest that a decrease in aperiodic fractal component of HRV in response to HUT can be used to differentiate patients with CFS from CON. 941 PMID- 14725374 AU - Yip HK, Li DK, Yau DC TI - Dental amalgam & human health. SO - Int Dent J 2003 Dec;53(6):464-8. IN - Faculty o Dentistry, The U o Hong Kong, SAR, PR China. AB - The use of dental amalgam as a restorative material has long been a contentious issue because of its elemental mercury component. While microleakage of mercury from amalgam has been conclusively confirmed over the past 30 years intensive research has failed to identify deleterious health outcomes. Mercury, as with other metals entering the body tissues, appears to be tolerated at low levels. Nevertheless, a contrary opinion is held by some professional and lay groups who advocate a zero tolerance for inhaled or ingested elemental mercury. They identify dental amalgam as an aetiological factor for neurological conditions such as chronic fatigue syndrome, multiple sclerosis and Alzheimer's disease resulting from chronic mercury poisoning. Epidemiological and clinical evidence of widespread chronic mercury toxicity associated with a body burden of amalgam has consistently failed to be established even in populations with a high prevalence of dental amalgam restorations. On current evidence, international consensus heavily supports the statement that amalgam does not constitute a health risk to patients. However, exposure to volatile free mercury in dental clinics should be controlled to eliminate occupational risk. This paper provides a general review of the current situation and issues. It offers a consensus viewpoint for practitioners and lay people in reaching an informed decision on dental amalgam restorations. 942 PMID- 12619180 AU - Yoldas T, Ozgocmen S, Yildizhan H, Yigiter R, Ulvi H, Ardicoglu O TI - Auditory p300 event-related potentials in FM pts. SO - Yonsei Med J 2003 Feb;44(1):89-93. IN - Firat U, Tip Fakultesi, Noroloji Anabilim Dali, 23119, Elaz+ AB - +IN: ig, Turkey. sozgocmen@hotmail.com This study assessed the cognitive brain function measured by the cognitive P300 auditory event-related potentials (ERPs) in female fibromyalgia (FM) patients and compared the results with those from healthy age and education-matched controls. The relationship of the P300 potentials to the pain threshold of patients was also investigated. The P300 component of the auditory ERPs were studied in 11 female FM patients and 10 age and education-matched healthy controls. None of the patients were taking antidepressants such as amitriptyline or serotonin-reuptake inhibitors. The P300 latencies of the patients were not significantly different whereas the N2P3 amplitudes were significantly lower than the controls. The P300 latencies in the patients negatively correlated with the total myalgic scores (TMS) (r= -0.73) and the control point scores (CPS) (r=-0.85). On the other hand, the P300 amplitudes showed a significant correlation with the TMS (r=0.61) and the CPS (r=0.60). There was no significant correlation between the anxiety and depression scores with the P300 latency or amplitudes. These results showed cognitive impairment, which was mainly expressed by the lower N2P3 amplitudes in patients with FM, and its clinical relevance requires further research. 943 PMID- 12881841 AU - Yuruten B, Ozerbil OM TI - Trigeminocervical reflex in FM pts. SO - Arch Phys Med Rehabil 2003 Jul;84(7):1087-9. IN - Departments o Neurology, School o Med, Selcuk, Konya, Turke+ AB - +IN: y. OBJECTIVE: To describe the properties of trigeminocervical reflex in normal subjects and in patients with primary fibromyalgia syndrome (PFS) having neck pain. DESIGN: Prospective testing of trigeminocervical reflex. SETTING: University hospital electromyography laboratory in Turkey. PARTICIPANTS: Patients with PFS (n=16) and healthy volunteers (n=20). INTERVENTIONS: Trigeminocervical reflex is a brainstem reflex that is evoked by stimulating the sensory branches of the trigeminal nerve and can be recorded from the neck muscles. Electric stimulation of the supraorbital nerve evokes a reflex response (C3) and early reflex response (C1). The mean latencies of C1 and C3 of patients with PFS were compared with normal values.Main Outcome Measure: The C1 and C3 latencies of trigeminocervical reflex. RESULTS: In healthy volunteers, C3 latency +/- standard deviation was 54.17+/-6.00ms ipsilaterally and 51.25+/-9.26ms contralaterally. The difference was not significant (P=.26). The C1 latency was 17.46+/-4.89ms. In patients with PFS, C1 latency was 13.83+/-4.48ms and the C3 latency was 62.70+/-18.22ms. The difference was not significant between the patients (P=.08) and healthy volunteers (P=.17). CONCLUSION: In patients with PFS having neck pain, trigeminocervical connections were not influenced and some other mechanisms may be responsible for pain in these patients. 944 PMID- 12741468 AU - Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E TI - Presentations of adult celiac disease in a nationwide patient support group. [FM] SO - Dig Dis Sci 2003 Apr;48(4):761-4. IN - D o Med, Harbor-UCLA Med Ctr, Torrance, California, USA. AB - Recent epidemiological studies primarily from Europe document that adult celiac disease often lacks the classic presentation of steatorrhea and weight loss. There are few surveys of adult celiac disease in the United States. We surveyed the large population of a nationwide patient support group to determine their disease presentations. In the initial survey (N = 1032 respondents), the median age at onset was 46 years, and the diagnosis of adult celiac disease was often delayed (median 12 months, with 21% delayed over 10 years). Only 32% of adults were underweight, and only about 50% reported frequent diarrhea and weight loss. A second survey documented that common presenting symptoms were fatigue (82%), abdominal pain (77%), bloating or gas (73%), and anemia (63%). Initial physician diagnoses were often irritable bowel syndrome (37%), psychological disorders (29%), and fibromyalgia (9%). These initial presentations are similar to those in Europe and often resemble irritable bowel syndrome. 945 PMID- 12647509 TI - Systematic review of the current literature related to disability & CFS. SO - Evid Rep Technol Assess (Summ) 2002 Dec;(66):1-3. 946 PMID- 12056987 AU - [No authors listed] TI - CFS. Clinical practice guidelines--2002. SO - Med J Aust 2002 May 6;176 Suppl:S23-56 947 PMID- 12356546 AU - [No authors listed] TI - FM pain visible on brain scans. SO - Harv Womens Health Watch 2002 Sep;10(1):2 948 PMID- 11925085 AU - [No authors listed] TI - Information from your family doctor. CFS: how to help yourself. SO - Am Fam Physician 2002 Mar 15;65(6):1095 949 PMID- 12415604 AU - Aaron LA, Arguelles LM, Ashton S, Belcourt M, Herrell R, Goldberg J, Smith WR, + TI - Health & functional status of twins w chr regional & widespread pain. [FM] SO - J Rheumatol 2002 Nov;29(11):2426-34 IN - D o Oral Med, U o Washington, Seattle, Washington 98195, US+ AB - +IN: A. laaron@u.washington.edu +AU: Buchwald D OBJECTIVE: To examine the independent effects of chronic regional and widespread pain syndromes on health and functional status after accounting for comorbid chronic fatigue using a co-twin control design. METHODS: We identified 95 twin pairs discordant for pain in which one twin had chronic regional or widespread pain and the other denied chronic pain. Demographic data, functional and psychological status, health behaviors, and symptoms based on the 1994 criteria for chronic fatigue syndrome (CFS) were assessed by questionnaire. Psychiatric diagnoses were based on structured interview. Random effects regression modeling estimated associations between chronic regional and widespread pain and each health measure with and without adjustment for CFS. RESULTS: Significant differences (p /=4 (consistent with joint hypermobility), 60% versus 24%, P <.0001. Incident and prevalent CFS cases had similar Beighton scores. The odds ratio for hypermobility in all patients with CFS versus healthy controls was 3.5 (P <.001; 95% CI, 1.6-7.5). CONCLUSIONS: Joint hypermobility is more common in patients with CFS than in otherwise healthy children with common skin disorders. The etiologic significance of the observed association remains to be defined. 970 PMID- 12079910 AU - Baumgartner E, Finckh A, Cedraschi C, Vischer TL TI - A 6 year prospective study of a cohort of pts w FM. SO - Ann Rheum Dis 2002 Jul;61(7):644-5 IN - Division o Rheumatology, U Hosp, Geneva, Switzerland. AB - OBJECTIVES: To examine the long term prognosis in patients with fibromyalgia (FM). METHODS: Forty five of 70 patients who had participated in a three week trial six years earlier completed again the same questionnaires used previously. RESULTS: Most symptoms had remained stable. Pain had increased, but some aspects of quality of life had improved over time. CONCLUSION: Symptoms of FM persisted over the six years, but patients appeared better able to cope with them. 971 PMID- 11959160 AU - Bayazit YA, Gursoy S, Ozer E, Karakurum G, Madenci E TI - Neurotologic manifestations of the FM syndrome. SO - J Neurol Sci 2002 Apr 15;196(1-2):77-80 IN - D o Otolaryngology, Faculty o Med, Gaziantep U, Kolejtepe, + AB - +IN: Gaziantep, Turkey The purpose was to assess otologic symptoms, and audiologic and vestibular findings in fibromyalgia (FM) syndrome. Twenty-four female patients with FM syndrome (FMS) were included in the study. The assessments were based on history, physical examination, audiometry, bithermal caloric testing and auditory brainstem response (ABR) testing.Dizziness was the most common complaint of the patients, and was followed by tinnitus, hearing loss and vertigo. Almost 50% of the patients had some sort of otologic symptoms.Dix-Halpike maneuver proved positional rotary vertigo in 5 (20.8%) patients. The audiometry results of 23 patients were normal. None of the patients had abnormal bithermal caloric testing. Although there were a variety of ABR abnormalities, the ABR results of the patients with and without cochleovestibular symptoms were not significantly different (p<0.05).In conclusion, FM patients can complain otologic symptoms even though they do not have any clinically or audiologically detectable ear disease. A neural disintegration or some other events related to neural mediators may be the mechanisms involved in the pathogenesis of otoneurologic as well as systemic manifestations of the disease that possibly leads to abnormal perception of the stimuli coming from internal or external environment. 972 PMID- 12096218 AU - Bengtsson A TI - The muscle in FM. SO - Rheumatology (Oxford) 2002 Jul;41(7):721-4 973 PMID- 12166411 AU - Bennett RM TI - A raw vegetarian diet for pts w FM. SO - Curr Rheumatol Rep 2002 Aug;4(4):284 974 PMID- 12166413 AU - Bennett RM TI - A survey of Sx & Rx of FM. SO - Curr Rheumatol Rep 2002 Aug;4(4):285 975 PMID- 12126582 AU - Bennett RM TI - Adult growth hormone deficiency in pts w FM. SO - Curr Rheumatol Rep 2002 Aug;4(4):306-12 IN - Oregon Health & Science U, D o Med (OP09), Portland, OR 972+ AB - +IN: 01, USA. bennetrob1@attbi.com Adult growth hormone (GH) deficiency is a well-described clinical syndrome with many features reminiscent of fibromyalgia. There is evidence that GH deficiency as defined in terms of a low insulin-like growth factor-1 (IGF-1) level occurs in approximately 30% of patients with fibromyalgia and is probably the cause of some morbidity. It seems most likely that impaired GH secretion in fibromyalgia is related to a physiologic dysregulation of the hypothalamic-pituitary-adrenal axis (HPA) with a resulting increase in hypothalamic somatostatin tone. It is postulated that impaired GH secretion is secondary to chronic physical and psychological stressors. It appears that impaired GH secretion is more common than clinically significant GH deficiency with low IGF-1 levels. The severe GH deficiency that occurs in a subset of patients with fibromyalgia is of clinical relevance because it is a treatable disorder with demonstrated benefits to patients. 976 PMID- 12166412 AU - Bennett RM TI - Antidepressants do not have better results than placebo in the Rx of FM in Brazil. SO - Curr Rheumatol Rep 2002 Aug;4(4):284-5 977 PMID- 12166410 AU - Bennett RM TI - Mayo Clinic FM program. SO - Curr Rheumatol Rep 2002 Aug;4(4):283-4 978 PMID- 12122930 AU - Bennett RM TI - Rational management of FM. SO - Rheum Dis Clin North Am 2002 May;28(2):xiii-xv 979 PMID- 12122913 AU - Bennett RM TI - The rational management of FM pts. SO - Rheum Dis Clin North Am 2002 May;28(2):181-99, v IN - D o Med (OP09), Oregon Health & Science U, 3181 SW Sam Jack+ AB - +IN: son Park Road, Portland, OR 97201, USA. bennetrob1@attbi.com The exponential increase in pain research over the last 10 years has established fibromyalgia (FM) as a common chronic pain syndrome with similar neurophysiologic aberrations to other chronic pain states. As such, the pathogenesis is considered to involve an interaction of augmented sensory processing (central sensitization) and peripheral pain generators. The notion, that FM symptomatology results from an amplification of incoming sensory impulses, has revolutionized the contemporary understanding of this enigmatic problem and provided a more rational approach to treatment. To date, the management of FM has been mainly palliative, with the aims of reducing pain, improving sleep, maintaining function, treating psychologic distress and diminishing the impact of associated syndromes. The rapidly evolving neurophysiologic, psychophysiologic and molecular biologic basis for chronic pain states has already opened up new avenues for management which should be applicable to this difficult group of patients. Indeed, it is now possible to think about a "rational" approach to managing FM patients that was unthinkable just a few years ago. 980 PMID- 12204931 AU - Bentall RP, Powell P, Nye FJ, Edwards RH TI - Predictors of response to Rx for CFS. SO - Br J Psychiatry 2002 Sep;181:248-52 IN - D o Psychology, U o Manchester, Coupland I Building, Oxford+ AB - +IN: Road, Manchester M13 9PL, UK. BACKGROUND: Controlled trials have shown that psychological interventions designed to encourage graded exercise can facilitate recovery from chronic fatigue syndrome. AIMS: To identify predictors of response to psychological treatment for chronic fatigue syndrome. METHOD: Of 114 patients assigned to equally effective treatment conditions in a randomised, controlled trial, 95 completed follow-up assessments. Relationships between variables measured prior to randomisation and changes in physical functioning and subjective handicap at 1 year were evaluated by multiple regression. RESULTS: Poor outcome was predicted by membership of a self-help group, being in receipt of sickness benefit at the start of treatment, and dysphoria as measured by the Hospital Anxiety and Depression scale. Severity of symptoms and duration of illness were not predictors of response. CONCLUSIONS: Poor outcome in the psychological treatment of chronic fatigue syndrome is predicted by variables that indicate resistance to accepting the therapeutic rationale, poor motivation to treatment adherence or secondary gains from illness. 981 PMID- 11932073 AU - Berglund B, Harju EL, Kosek E, Lindblom U TI - Quantitative & qualitative perceptual analysis of cold dysesthesia & hyperalgesia in FM. SO - Pain 2002 Mar;96(1-2):177-87 IN - Institute o Environmental Med, Karolinska Institutet & D o + AB - +IN: Psychology, Stockholm U, SE-106 91, Stockholm, Sweden Somatosensory perception thresholds, perceived intensity, and quality of perceptions were assessed in 20 women with fibromyalgia syndrome (FMS) and in 20 healthy age-matched female controls. All patients and controls scaled perceived intensity and described perceived quality of randomized thermal (Thermotest) and tactile (von Frey filaments) stimulation. Perceived intensity was scaled by free-number magnitude estimation and interindividual comparability was accomplished by Master Scaling. Perceived quality was assessed by choosing verbal descriptors from a list. Thenar was used as a reference for each modality tested. All patients were able to reliably scale perceived intensity at thenar, as well as in pain-affected body areas. Perception thresholds for cold pain, heat pain, cold-pain tolerance and heat-pain tolerance were significantly lower in patients than controls. For cold and tactile stimulation, the master scaled perceived intensities were significantly higher in patients' pain-affected areas, whereas for warmth/heat stimulation, the intensities were significantly lower. In the qualitative perceptual analysis the most striking and significant finding was the aberration of cold-evoked perceptions in all patients: most stimuli in the range of 30-10 degrees C were reported as heat or other paresthetic or dysesthetic perceptions. The perceptual quality of warmth, and of touch, did not differ from the controls. Another aberration was observed in the nociceptive range of thermal and of tactile stimulation as significantly more frequent pain-related descriptors than in controls. This indicates a general nociceptive facilitation in addition to the lower thermal pain thresholds. The combination of cold hyperesthesia, cold dysesthesia, and multimodal hyperalgesia suggests a selective pathophysiology at a particular level of integration, possibly in the insular cortex. It is suggested that the aberrations revealed by the supraliminal sensory evaluation may be generic for FMS. Particularly, the aberrations established in all patients for perceived quality and intensity in the cold sensory channel may be an additional diagnostic criterion. 982 PMID- 12039092 AU - Berner I, Gaubitz M, Jackisch C, Pfleiderer B TI - Comparative examination of complaints of pts w breast-cancer w & without silicone implants. [CFS] SO - Eur J Obstet Gynecol Reprod Biol 2002 Apr 10;102(1):61-6 IN - Institute for Clinical Radiology, Universitat Munster, Albe+ AB - +IN: rt-Schweitzer-Street 33, D-48129 Munster, Germany. OBJECTIVE: To measure the relationship between silicone breast implants and various symptoms using a control group. STUDY DESIGN: A matched-pair-analysis of 96 women with breast-cancer (32 with silicone implants (K I); 64 without implants (K II)) was performed with help of a standardized questionnaire in respect to 50 single criteria. The condition of implants was monitored by MR-imaging. RESULTS: Athralgias and myalgias were not significantly more frequent in K I. Only six symptoms were reported significantly more often in patients with implants. Positive correlation with implant rupture was given only for the numb feeling/tingling sensation in extremities (P=0.02). There was no correlation between silicone implants and the symptoms of the "chronic-fatigue syndrome" nor any other described silicone-induced disease. CONCLUSIONS: According to our analysis many of the symptoms examined here are present in middle-aged women regardless of silicone implants and underlying disease. 983 PMID- 12048970 AU - Bigatti SM, Cronan TA TI - A comparison of pain measures used w pts w FM. SO - J Nurs Meas 2002 Spring-Summer;10(1):5-14 IN - D o Psychology, Indiana University, Purdue U Indianapolis, + AB - +IN: LD 124, 402 North Blackford Street, Indianapolis, IN 46202-3275, USA. sbigatti@iupui.edu The objective of the present study was to evaluate instruments used to assess pain in patients with fibromyalgia (FMS). Participants were 602 patients with FMS. Pain was measured with five scales: a visual analog scale (VAS), the Pain Rating, Present Pain, and Number of Words Chosen Indexes from the McGill Pain Questionnaire; and intensity of pain obtained from a manual tender point exam. The VAS had the highest correlations with other measures of pain and with self-efficacy for pain, physical functioning, fatigue, and stiffness. The correlations between the VAS and fatigue and stiffness were significantly higher than those of other pain measures (p < .01). Our findings suggest that the easy-to-administer VAS may be the most useful measure of pain with patients with FMS. 984 PMID- 11950106 AU - Bigatti SM, Cronan TA TI - An examination of the physical health, health care use, & psychological well-being of spouses of people w FM syndrome. SO - Health Psychol 2002 Mar;21(2):157-66 IN - D o Psychology, Indiana U Purdue U Indianapolis, 46202-3275+ AB - +IN: , USA. sbigatti@iupui.edu The present study compared the physical and mental health and the health care use of spouses of patients with fibromyalgia syndrome (FS group; n = 135) with that of spouses of healthy individuals (n = 153). FS group participants reported lower health and affective states and scored higher on depression, loneliness, and subjective stress than comparison group participants (p < .017). Husbands in the FS group who reported more illness impact and whose wives reported worse sleep quality and less self-efficacy had more psychological difficulties. No differences were found in health care costs between groups. These findings suggest that chronic illness in a partner may negatively affect an individual's physical and mental health. 985 PMID- 12471294 AU - Birtles DB, Minden D, Wickes SJ, M Puxley KP, A Llewellyn MG, Casey A, Rayson+ TI - Chronic exertional compartment syndrome: muscle changes w isometric exercise. [CF] SO - Med Sci Sports Exerc 2002 Dec;34(12):1900-6 IN - Applied Biomedical Research Group, GKT School o Biomedical + AB - +IN: Sciences, King's Coll London, Shepherd's House, Guy's Campus, London SE1 1UL, UK. +AU: MP, Jones DA, Newham DJ Chronic exertional compartment syndrome (CECS) is a well-documented cause of lower leg pain in active individuals. The pathophysiology is unclear, although it is generally believed to be associated with increased intramuscular pressure, but there is very little information about muscle function in relation to the onset of pain. PURPOSE: To investigate strength, fatigue, and recovery of the anterior tibial muscles in CECS patients and healthy subjects during an isometric exercise protocol. METHODS: Twenty patients and 22 control subjects (mean age 27.6 yr and 33.0 yr, respectively) performed a 20-min isometric exercise protocol consisting of intermittent maximal voluntary contractions (MVC). Central fatigue was evaluated by comparing changes in electrically stimulated (2 s at 50 Hz) and voluntary contraction force before and during the exercise, and then throughout 10 min of recovery. Muscle size was measured by ultrasonography. Pain and cardiovascular parameters were also examined. RESULTS: The absolute MVC forces were similar, but MVC:body mass of the patients was lower (P < 0.05) as was the ratio of MVC to muscle cross-sectional area (P < 0.01). The extent of central and peripheral fatigue was similar in the two groups. The patients reported significantly higher levels of pain during exercise (P < 0.05 at 4 min) and after the first minute of recovery (P < 0.001). An 8% increase in muscle size after exercise was observed for both groups. There were no differences in the cardiovascular responses of the two groups. CONCLUSIONS: CECS patients were somewhat weaker than normal but fatigued at a similar rate during isometric exercise. Patients reported higher pain than controls despite comparable changes in muscle size, suggesting that abnormally tight fascia are not the main cause of CECS symptoms. 986 PMID- 11990644 AU - Blumenthal DE TI - Tired, aching, ANA-positive: does your patient have lupus or FM? SO - Cleve Clin J Med 2002 Feb;69(2):143-6, 151-2 IN - D o Rheumatic & Immunologic Diseases, The Cleveland Clinic + AB - +IN: Foundation, OH 44195, USA. The symptoms of fibromyalgia and lupus can be similar, but the treatments are very different. Although the antinuclear antibody (ANA) test has often been used to make the distinction, this approach has its pitfalls. This paper offers strategies for more accurate diagnosis. 987 PMID- 12122919 AU - Borg-Stein J TI - Management of peripheral pain generators in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):305-17 IN - Spaulding Rehabilitation Hosp, Harvard D o Physical Med & R+ AB - +IN: ehabilitation, 125 Nashua Street, Boston, MA 02114, USA. jborgstein@partners.org Fibromyalgia is a widespread chronic pain disorder that is characterized in part by central sensitization and increased pain response to peripheral nociceptive and non-nociceptive stimuli. Part of the comprehensive pain management of patients with fibromyalgia should include a thoughtful evaluation and search for peripheral pain generators that either are associated with fibromyalgia or are coincidentally present. The identification and treatment of these pain generators lessens the total pain burden, facilitates rehabilitation and decreases the stimuli for ongoing central sensitization. 988 PMID- 11790996 AU - Bradley LA, McKendree-Smith NL TI - Central nervous system mechanisms of pain in FM & other musculoskeletal disorders: behavioral & psychologic Rx approaches. SO - Curr Opin Rheumatol 2002 Jan;14(1):45-51 IN - Division o Clinical Immunology & Rheumatology, U o Alabama + AB - +IN: at Birmingham, 35294, USA. Larry.Bradley@ccc.uab.edu Pain is one of the most important and challenging consequences of musculoskeletal disorders. This article examines the role of central nervous system structures in the physiology of pain. It also describes the neuromatrix, a construct that provides a framework for understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain. This construct suggests that behavioral and psychologic interventions may alter the pain experience primarily through their effects on emotional states and cognitive processes. The literature on cognitive-behavioral interventions for patients with rheumatoid arthritis and osteoarthritis indicates that they are well-established treatments for these disorders. However, the efficacy of these interventions for patients with fibromyalgia has not been established. It is anticipated that the development of valid measures of readiness for behavioral change may allow investigators to identify the patients with musculoskeletal disorders who are most likely to benefit from cognitive-behavioral intervention. 989 PMID- 11872181 AU - Bradley LA, McKendree-Smith NL, Alarcon GS, Cianfrini LR TI - Is FM a neurologic disease? SO - Curr Pain Headache Rep 2002 Apr;6(2):106-14 IN - U o Alabama at Birmingham, Div o Clinical Immunology & Rheu+ AB - +IN: matology, 475 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35294, USA. Larry.Bradley@ccc.uab.edu Fibromyalgia (FM) is characterized by abnormal pain sensitivity in response to diverse stimuli as well as persistent widespread pain and other symptoms such as fatigue and sleep disturbance. Progress has been made in identifying factors that contribute to the etiopathogenesis of abnormal pain sensitivity, but there is no single model of pathophysiology or treatment of FM that has gained wide acceptance among health care professionals. We review the literature on the etiopathogenesis of abnormal pain sensitivity in FM and describe an explanatory model that serves as a source of testable hypotheses in our laboratory. This model posits that interactions of exogenous (eg, environmental stressors) and endogenous (eg, neuroendocrine dysfunction) abnormalities in genetically predisposed individuals lead to a final common pathway, ie, alterations in central nervous system function and neuropeptide production that underlie central sensitization and abnormal pain sensitivity. This model also suggests that efforts to develop and evaluate treatments for FM should focus on interventions with direct or indirect effects on central functions that influence pain sensitivity. 990 PMID- 12184366 AU - Brenner A TI - Macrophagic myofasciitis: a summary of Dr. Gherardi's presentations. [CF] SO - Vaccine 2002 May 31;20 Suppl 3:S5-6 IN - Rhevmatological Services, Inc., Framington, MA 01702, USA. + AB - +IN: alanrsi@aol.com Dr. R.K. Gherardi presented two papers at the symposium, detailing his researches into a proposed new clinical entity which he has entitled Macrophagic Myofasciitis (MMF). In his first paper he described the histopathologic and immunologic characteristics of the condition, and in the second, the clinical and serologic features. Dr. Gherardi believes that MMF, a syndrome of ascending myalgias, fatigue and diffuse musculoskeletal pain, may be related to a chronic immune response to aluminum granulomas persisting at the sites of prior immunization with aluminum adjuvated vaccines. 991 PMID- 12371687 AU - Brimacombe M, Helmer DA, Natelson BH TI - Birth order & its association w the onset of CFS. SO - Hum Biol 2002 Aug;74(4):615-20 AB - Chronic fatigue syndrome (CFS) is a medically unexplained illness that is diagnosed on the basis of a clinical case definition; so it probably is an illness with multiple causes producing the same clinical picture. One way of dealing with this heterogeneity is to stratify patients based on illness onset. We hypothesized that either the whole group of CFS patients or that group which developed CFS gradually would show a relation with birth order, while patients who developed CFS suddenly, probably due to a viral illness, would not show such a relation. We hypothesized the birth order effect in the gradual onset group because those patients have more psychological problems, and birth order effects have been shown for psychological characteristics. We compared birth order in our CFS patients to that in a comparison group derived from U.S. demographic data. We found a tendency that did not reach formal statistical significance for a birth order effect in the gradual onset group, but not in either the sudden onset or combined total group. However, the birth order effect we found was due to relatively increased rates of CFS in second-born children; prior birth order studies of personality characteristics have found such effects to be skewed toward first-born children. Thus, our data do support a birth order effect in a subset of patients with CFS. The results of this study should encourage a larger multicenter study to further explore and understand this relation. 992 PMID- 12372983 AU - Brimacombe M, Zhang Q, Lange G, Natelson BH TI - Immunological variables mediate cognitive dysfunction in gulf war veterans but not civilians w CFS. SO - Neuroimmunomodulation 2002-2003;10(2):93-100 IN - D o Preventive Medicine, U o Med & Dentistry - New Jersey M+ AB - +IN: S, Newark, NJ 070718, USA. We explored the relationship between a set of immunological variables and a set of cognitive and functional status measures and a diagnosis of chronic fatigue syndrome (CFS) in civilians and veterans using various regression and factor analytic methods. Our approach emphasized the extraction of a few distinct factors in order to limit statistical problems associated with doing large numbers of multiple comparisons. This approach led to our finding cytokine data grouping into type 1 and type 2 clusters. A type 2 cluster plus a T and B cell factor predicted CFS caseness for Gulf War veterans but not for civilians with CFS. When a cognitive variable, reaction time, was added into the model, both immunological factors lost statistical significance; this indicates that the cognitive variable reaction time moderated the effects of the immunological factors in predicting patient status. We did a similar analysis on the roles of the immunological and cognitive variables in functional status using SF-36 data. Higher levels of these same two immunological factors predicted poorer general health as well as poorer physical and social functioning in Gulf War veterans but not in civilians with CFS. When the reaction time factor was added, only the lymphocyte factor remained significant. This implies that lymphocytes are directly related to functional status in Gulf War veterans with CFS, but the Th2 factor produces its effect on functional status via changes in cognitive abilities. 993 PMID- 12324640 AU - Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JW TI - The effect of a polynutrient supplement on fatigue & physical activity of pts w CFS: a double-blind randomized controlled trial. SO - QJM 2002 Oct;95(10):677-83 IN - Departments o. General Internal Med &. Med Psychology, U Me+ AB - +IN: d Ctr Nijmegen, The Netherlands. BACKGROUND:The efficacy of dietary supplements in chronic fatigue syndrome (CFS) is uncertain, with conflicting evidence. Aim: To assess the effect of a polynutrient supplement on fatigue and physical activity of patients with CFS. DESIGN:Prospective randomized placebo-controlled, double-blind trial. METHODS:Fifty-three patients (16 males, 37 females) fulfilling the CDC criteria of CFS. The entry criteria were a score on the Checklist Individual Strength subscale fatigue severity (CIS fatigue) >or=40 and a weighted sum score of >or=750 for the eight subscales of the Sickness Impact Profile (SIP8) and no use of nutritional supplements in the 4 weeks prior to entry. The exclusion criteria were pregnancy and lactose intolerance. The intervention-a polynutrient supplement containing several vitamins, minerals and (co)enzymes, or placebo, twice daily for 10 weeks-was preceded by 2 weeks of baseline measurements. Outcome measurements took place in week 9 and 10 of the intervention. Five participants dropped out (4 supplement, 1 placebo). The main outcome measures were CIS fatigue score, number of CDC symptoms and SIP8 score. Efficacy analyses were performed on an intention-to-treat basis. RESULTS:No significant differences were found between the placebo and the treated group on any of the outcome measures: CIS fatigue +2.16 (95%CI -4.3 to +4.39, p=0.984); CDC symptoms +0.42 (95%CI -0.61 to +1.46, p=0.417); SIP8 +182 (95%CI -165 to +529, p=0.297). No patient reported full recovery. DISCUSSION:The findings do not support the use of a broad-spectrum nutritional supplement in treating CFS-related symptoms. 994 PMID- 12126580 AU - Brown SL, Duggirala HJ, Pennello G TI - An association of silicone-gel breast implant rupture & FM. SO - Curr Rheumatol Rep 2002 Aug;4(4):293-8 IN - US Food & Drug Administration, Epidemiology Branch, Ctr for+ AB - +IN: Devices & Radiological Health, HFZ-541, 1350 Piccard Drive, Rockville, MD 20850, USA. syb@cdrh.fda.gov Silicone-gel breast implant rupture is common. Silicone-gel from ruptured implants may escape the scar capsule that forms around breast implants and become "extracapsular silicone." Our previously published study found that women with extracapsular silicone gel were at higher risk of reporting that they were diagnosed with fibromyalgia. There has been a limited number of studies addressing this association in the literature. Some studies addressing the issue of silicone breast implants and connective tissue disease specifically exclude patients with fibromyalgia from the sample or do not include the syndrome in the analysis. Case series describing fibromyalgia in patients with implants have been published, but many of these papers lack information on extracapsular silicone and are not representative because the patients are typically from referral populations. In addition, most studies do not have control groups of women without implants for comparison or do not distinguish between saline and silicone implants. Additional observational studies of women from nonreferral populations are necessary to validate an association. These studies should provide information on how the rupture is diagnosed, state whether the rupture extended beyond the capsule, and provide an appropriate control group for comparison. The findings from such studies may be important to physicians as they describe potential risks associated with implants to their patients. These findings should also be important for regulatory decision making on silicone-gel breast implants. 995 PMID- 12122918 AU - Burckhardt CS TI - Nonpharmacologic management strategies in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):291-304 IN - School o Nursing, SN-5N, Oregon Health & Science U, 3181 SW+ AB - +IN: Sam Jackson Park Road, Portland, OR 97201, USA. burckhac@ohsu.edu Clinicians using the results of the extant research base can take an optimistic view of the role of nonpharmacologic treatment strategies for fibromyalgia. There were no negative outcomes in any of the reviewed studies, although in a few studies the experimental treatment did not prove to be more effective than the attention control. Rather than viewing this negatively, one could look more closely at the attention control groups and attempt to better understand what they contained that worked as an active treatment. A number of trials include a follow-up component and all but one of them find maintenance of at least one outcome change. Maintenance of changes is more likely to occur when the patient continues to participate in the experimental activity long-term. Patients especially need strategies that help them continue in exercise regimens. Unlike cognitive skills strategies that once learned are likely to become part of a person's coping repertoire, both exercise and behavioral strategies, like progressive muscle relaxation, need to be performed on a consistent basis in order to have their effect. The goals of increased self-efficacy, symptom reduction, increased functional status and quality of life along with decreased inappropriate use of health care resources are realistic when patients persevere in their use of strategy combinations and receive support from their providers. 996 PMID- 12137713 AU - Busch A, Schachter CL, Peloso PM, Bombardier C TI - Exercise for treating FM syndrome. SO - Cochrane Database Syst Rev 2002(3):CD003786 IN - 1121 Coll Drive, Saskatoon, Saskatchewan, Canada, S7N 0W3. + AB - +IN: angela.busch@usask.ca BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. OBJECTIVES: The objective of this systematic review was to examine the efficacy of exercise training as an treatment for FMS. SEARCH STRATEGY: We searched 6 electronic bibliographies for studies of exercise training in FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR (1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000) and the Cochrane Controlled Trials Register (2000, issue 4). We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. SELECTION CRITERIA: Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified trials meeting inclusion criteria, rated the methodologic quality using 2 standardized validated instruments, evaluated the adequacy of the exercise training stimulus using the American College of Sports Medicine (ACSM) criteria and evaluated the results. Disagreements were resolved through active discussion and consensus. High quality training studies had scores of 50% or greater on van Tulder methodologic criteria and met the minimum training standards of ACSM. Outcome variables were grouped into 7 constructs: pain, tender points, physical function, global well being, self efficacy, fatigue & sleep, and psychological function. Two reviewers independently extracted data on study characteristics, results and point estimates for selected variables, and used consensus to address discrepancies. MAIN RESULTS: Sixteen trials involving a total of 724 participants were assigned at random to: exercise intervention groups (n=379), control groups (n=277), or groups receiving an alternate treatment (n=68). Seven studies were high quality training studies: 4 aerobic training, 1 a mixture of aerobic, strength and flexibility training, 1 strength training and 2 with exercise training as part of a composite treatment. Flexibility protocols were never described in sufficient detail to allow evaluation. The four high quality aerobic training studies reported significantly greater improvements in the exercise groups versus control groups in aerobic performance (17.1% increase in aerobic performance with exercise versus 0.5% increase in the control groups), tender point pain pressure threshold (28.1% increase versus 7.0% decrease) and improvements in pain (11.4% decrease in pain versus 1.6% increase). Poor description of exercise protocols was common, with insufficient information on intensity, duration, frequency and mode of exercise. Adverse events were also poorly reported. REVIEWER'S CONCLUSIONS: Supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed. 997 PMID- 12392128 AU - Candy B, Chalder T, Cleare AJ, Wessely S, White PD, Hotopf M TI - Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review. [CFS] SO - Br J Gen Pract 2002 Oct;52(483):844-51 IN - D o Psychological Med, Guy's, King's & St. Thomas' School o+ AB - +IN: Medicine, London. Infectious mononucleosis is usually an acute, transiently incapacitating condition, but for some sufferers it precipitates chronic illness. It is unclear which patients are at risk of a prolonged state of illness following onset of infectious mononucleosis and if there are any useful preventive measures that would facilitate recovery. The aim of this study was to review all cohort studies and intervention trials that provide information on: (a) the longitudinal course of ill health subsequent to the onset of infectious mononucleosis; (b) the relationship between psychosocial and clinical factors and recovery rate; and (c) the effect of interventions on recovery. A systematic review was conducted, based on a search of the PSYCHINFO, MEDLINE, EMBASE and CINHAL databases up to October 2001, and ISI Science and Social Sciences Citation Indices up to 22 November 2001. Eight papers were identified that gave data on illness following onset of infectious mononucleosis. The best evidence concluded that there is a distinct fatigue syndrome after infectious mononucleosis. Eight papers explored risk factors for prolonged illness following acute infectious mononucleosis. Results varied on the association of acute illness characteristics and psychological features with prolonged ill health. Poor physical functioning, namely lengthy convalescence and being less fit or active, consistently predicted chronic ill health. Three trials reported on interventions that aimed to shorten the time taken to resolve symptoms after uncomplicated infectious mononucleosis. None of the drug trials found any evidence that drug therapy shortens recovery time. The trial that compared the effect of activity with imposed bed rest, found that those patients allowed out of bed as soon as they felt able reported a quicker recovery. More information is needed on the course of ill health subsequent to the onset of infectious mononucleosis. Certain risk factors associated with delay may be amenable to a simple intervention in primary care. 998 PMID- 12412191 AU - Cardiel MH, Rojas-Serrano J TI - Community based study to estimate prevalence, burden of illness & help seeking behavior in rheumatic diseases in Mexico City. A COPCORD study. [FM] SO - Clin Exp Rheumatol 2002 Sep-Oct;20(5):617-24 IN - D o Immunology & Rheumatology, Instituto Nacional de Cienci+ AB - +IN: as Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. mcardiea@sni.conacyt.mx OBJECTIVE: To estimate the prevalence, burden of illness and help seeking behavior of musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis and gout among adult population in a suburban community in Mexico city. METHODS: Home survey of adults in a balanced and stratified sample validated against physical exam. Three trained interviewers applied a validated COPCORD core questionnaire. Subjects with pain (in the last seven days or ever) > or = 4 (0-10) and no trauma; or with current or past disability were evaluated preferably the same day by a trained clinician in a structured interview. A diagnosis using ACR criteria when available, recommendation or referral was provided as required. Analysis was based on descriptive statistics of participant characteristics, pain site and distribution, patterns of help seeking behavior. Point prevalence with 95% confidence intervals of most common diseases and associated disability rate. RESULTS: 1169 men and 1331 women were included. Pain in the last 7 days not associated with trauma was reported in 419 (17%) participants. The most common sites of involvement were knee (12.3%); low back (6.3%); ankles (6%) and shoulders (5.3%). The mean/SD pain score was 4.8/2.5. Thirteen percent of the total sample had some treatment. The general practitioner treated 72% of those; 75% perceived good efficacy with medications. Point prevalence estimates and 95% CI were: disability: 1.4% (0.0-1.9); osteoarthritis: 2.3% (1.7-2.9); fibromyalgia: 1.4 (1.0-2.0); low back pain: 6.3% (5.4-7.3); rheumatoid arthritis: 0.3% (0.1-0.6) and gout 0.4% (0.1-0.7). CONCLUSION: Pain in the last 7 days due to musculoskeletal disorders is 17% in this community. Medications were commonly prescribed. Point prevalence estimates of most common diagnoses was similar to other community surveys using COPCORD methodology but very different help seeking behavior. 999 PMID- 11841066 AU - Cardol M, de Jong BA, van den Bos GA, Beelem A, de Groot IJ, de Haan RJ TI - Beyond disability: perceived participation in people w a chr disabling condition. [FM] SO - Clin Rehabil 2002 Feb;16(1):27-35 IN - D o Rehabilitation, Academic Med Centre, U o Amsterdam, The+ AB - +IN: Netherlands. M.Cardol@nivel.nl OBJECTIVE: To describe the impact of a chronic disabling condition on participation and to identify variables that may explain perceived restrictions in participation. STUDY DESIGN: Cross-sectional. SETTING: People were recruited from the outpatient clinics of two rehabilitation centres and the rehabilitation department of an academic hospital. SUBJECTS: One hundred and twenty-six people from five diagnostic groups (neuromuscular disease, rheumatoid arthritis, spinal cord injury, stroke, fibromyalgia) participated in the study. METHOD: The IPA (Impact on Participation and Autonomy) questionnaire was used to describe perceived participation. Explanatory variables were studied in terms of sociodemographic factors and health status variables. RESULTS: Some restrictions in participation seem comparable among diagnostic groups, others are specific to one or two groups. People with stroke, rheumatoid arthritis or fibromyalgia perceived more restrictions in participation than people with spinal cord injury or neuromuscular disorders. Emotional distress was the most important factor contributing to restrictions in participation. CONCLUSIONS: Perceived participation remains a complex concept in which many factors are involved. To make a contribution to meaningful participation of people with a chronic disabling condition, rehabilitation treatment should address physical, social, emotional and environmental aspects. 1000 PMID- 12467997 AU - Carli G, Suman AL, Biasi G, Marcolongo R TI - Reactivity to superficial & deep stimuli in pts w chr musculoskeletal pain. [FM] SO - Pain 2002 Dec;100(3):259-69 IN - Istituto di Fisiologia Umana & Istituto di Reumatologia, Un+ AB - +IN: iversita degli Studi, 53100, Siena, Italy In this study, we evaluated pain sensitivity in patients with fibromyalgia or other types of chronic, diffuse musculoskeletal pain to establish whether fibromyalgia represents the end of a continuum of dysfunction in the nociceptive system. One hundred and forty five patients and 22 healthy subjects (HS) completed an epidemiological questionnaire to provide information about fatigue, stiffness, sleep, the intensity of pain (VAS 0-100) and its extent both at onset and at present. Algometry was performed at all American College of Rheumatology (ACR) tender points and at ten control points. Patients were divided into five main groups: fibromyalgia (FS) patients, secondary-concomitant fibromyalgia (SCFS) patients, patients with widespread pain (WP) but not reaching the ACR criterion of 11 tender points, patients with diffuse multiregional pain (MP) not reaching the ACR criteria (widespread pain, tender point counts), and patients with multiregional pain associated with at least 11 tender points (MPTE). von Frey monofilaments were used to assess superficial punctate pressure pain thresholds. Heat and cold pain thresholds were determined with a thermal stimulator. Ischemic pain was assessed by the cold pressure test and the submaximal effort tourniquet test. The scores for stiffness and present pain intensity gradually increased concomitantly with the increase in tender point count and pain extent. The pressure pain thresholds for positive tender and positive control points were significantly lower in the SCFS, FS and MPTE groups than in HS, MP and WP groups, the latter three groups displaying similar values. In all groups, there were no differences in pain thresholds between positive tender and positive control points. The heat pain threshold and the pain threshold in the cold pressure test were lower in the FS and SCFS groups than in HS. The cold pressure tolerance was lower in patients with widespread pain than in HS. In the von Frey test, all patient groups except MP had similar values, which were significantly lower than in HS. Finally, all patient groups displayed lower tourniquet tolerance than HS. In each psychophysical test, patients with widespread pain and patients with multiregional pain showed similar thresholds; however, the thresholds in the MP or MPTE groups differed from those in the FS and SCFS groups. In the FS group, pain thresholds and pain tolerance did not differ according to the presence of ongoing pain at the stimulated site and were not correlated to ongoing pain. The results indicate that dysfunction in the nociceptive system is already present in patients with multiregional pain with a low tender point count; it becomes more and more severe as the positive tender point count and pain extent increase and it is maximal in fibromyalgia patients. 1001 PMID- 12359868 AU - Cavanaugh RM Jr TI - Evaluating adolescents w fatigue: ever get tired of it? [CF] SO - Pediatr Rev 2002 Oct;23(10):337-48 IN - D o Pediatrics, SUNY Upstate Med U, Syracuse, NY, USA. 1002 PMID- 11827901 AU - Chalder T, Tong J, Deary V TI - Family cognitive behaviour therapy for CFS: an uncontrolled study. SO - Arch Dis Child 2002 Feb;86(2):95-7 IN - Academic D o Psychological Med, Guy's, King's & St Thomas' + AB - +IN: School o Medicine, 103 Denmark Hill, London SE5 8AZ, UK. t.chalder@iop.kcl.ac.uk AIM: To examine the efficacy of family focused cognitive behaviour therapy for 11-18 year olds with chronic fatigue syndrome. METHODS: Twenty three patients were offered family focused cognitive behaviour therapy. The main outcome was a fatigue score of less than 4 and attendance at school 75% of the time. RESULTS: Twenty patients completed treatment. Eighteen had completed all measures at six months follow up; 15 of these (83%) improved according to our predetermined criterion. Substantial improvements in social adjustment, depression, and fear were noted. CONCLUSIONS: Family focused cognitive behaviour therapy was effective in improving functioning and reducing fatigue in 11-18 year olds. Gains were maintained at six months follow up. 1003 PMID- 12078061 AU - Chial HJ, Camilleri M TI - Gender differences in irritable bowel syndrome. [FM] SO - J Gend Specif Med 2002 May-Jun;5(3):37-45. IN - Enteric Neuroscience Program, Gastroenterology Research Uni+ AB - +IN: t, Mayo Clinic & Mayo Foundation, Rochester, MN, USA. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal discomfort or pain associated with changes in stool frequency and/or stool form. It is the most common gastrointestinal disorder in both primary care and gastroenterology clinics. IBS is associated with high health care costs, disability, work absenteeism, and significant morbidity. In this article, we review the gender differences in epidemiology, diagnostic criteria, physiology, psychological features, and responses to therapy of IBS. 1004 PMID- 12395614 AU - Chu J, Neuhauser DV, Schwartz I, Aye HH TI - The efficacy of automated/electrical twitch obtaining intramuscular stimulation (atoims/etoims) for chr pain control: evaluation w [FM] + SO - Electromyogr Clin Neurophysiol 2002 Oct-Nov;42(7):393-401 IN - D o Rehabilitation Med, Ground Floor, White Building, Hosp + AB - +TI: statistical process control methods. +IN: o the U o Penn, 3400 Spruce Street, Philadelphia, PA 19104, USA. jechu@mail.med.upenn.edu INTRODUCTION: Automated and/or electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) evoke twitches at/or near motor end plate zones to relieve muscle pain. OBJECTIVES: To demonstrate that pain levels recorded daily by patients enable statistical process control (SPC) analysis of ATOIMS & ETOIMS effects over time. METHODS: Four chronic fibromyalgic patients received ATOIMS & ETOIMS treatments to bilateral C3-C8 and L3-S1 myotomes and recorded daily pain on a visual analogue scale. Mechanical stimulation with ATOIMS involved a custom device to insert, oscillate and retract a monopolar needle (MN) at 2 Hz x2s. ETOIMS involved manual insertion of the MN and stimulating with 5 Volts, 0.5 ms pulse duration at 2 Hz for 2s to multiple sites. Positive outcome measures include two pain scales reduction. RESULTS: Patient 1-4 had 89, 38, 40, 36 treatments during a follow-up time of 625, 1018, 378, 466 days with 5.4 +/- 3.7, 8.0 +/- 4.9, 4.2 +/- 2.4 and 4.6 +/- 2.7 days between treatments (DBT) during the first 6 months and 4.7 +/- 3.0, 21.8 +/- 15.6, 6.2 +/- 4.4 and 4.3 +/- 2.5 DBT respectively in the latter phase of the therapy. The average pain level (APL) in 1st week of treatment for patient 1-4 were 6.4 +/- 1.1, 3.7 +/- 1.1, 6.6 +/- 2.8 and 7.5 +/- 0.4 and in the last week of treatment were 4.5 +/- 0.4, 1.2 +/- 0.1, 4.2 +/- 1.0 and 4.7 +/- 0.7 respectively. APL correlated negatively with time during the first 6 months for patients 2-4 and also after 6 months for patients 4 & 1 who had unchanged and reduced DBT respectively. APL correlated positively with time for patient 2 with no correlation for patient 3 (both had increased DBT) after 6 months. CONCLUSIONS: Patients will chronically record their pain scales daily enabling analysis by SPC. ATOIMS & ETOIMS applied periodically can be helpful in relieving fibromyalgic pain. 1005 PMID- 12710426 AU - Ciliska D TI - Review: aerobic exercise improves cardiovascular fitness & tender points in FM. SO - Cochrane Database Syst Rev. 2002;(3):CD003786. PMID: 121377+ IN - School o Nursing, McMaster U, Hamilton, Ontario, Canada. AB - +SO: 13; Evid Based Nurs 2003 Apr;6(2):50-1. 1006 PMID- 11809249 AU - Clark C, Buchwald D, MacIntyre A, Sharpe M, Wessely S TI - CFS: a step towards agreement. SO - Lancet 2002 Jan 12;359(9301):97-8 IN - Action for ME, 4 Dean's Court, St Paul's Churchyard, EC4V 5+ AB - +IN: AA, London, UK. chris@afme.org.uk 1007 PMID- 12444233 AU - Clayton AH, Kaltsounis-Puckett J TI - Combination therapy in the Rx of major depressive disorder complicated by FM & menopause. SO - Psychosomatics 2002 Nov-Dec;43(6):491-3 IN - D o Psychiatric Med, U o Virginia, Charlottesville, VA 2290+ AB - +IN: 3, USA. ahc8v@virginia.edu 1008 PMID- 12219319 AU - Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D TI - Prevalence of post-traumatic stress disorder in FM pts: Overlapping syndromes or post-traumatic FM syndrome? SO - Semin Arthritis Rheum 2002 Aug;32(1):38-50 IN - Ministry o Health Mental Health Ctr, Anxiety & Stress Resea+ AB - +IN: rch Unit, Epidemiology D, Rheumatic Disease Unit, D o Med, Soroka Med Center, Faculty o Health Sciences, Ben-Gurion U o the Negev, Beer Sheva, Israel. OBJECTIVES: The primary aim of this study was to assess the frequency of post-traumatic stress disorder (PTSD) in patients with the fibromyalgia syndrome (FMS). The influence of gender on measures of PTSD in fibromyalgia (FM) patients also was examined. METHODS: Seventy-seven consecutive patients (40 women and 37 men) who fulfilled the criteria for FM were asked to complete questionnaires measuring the prevalence and severity of symptoms of PTSD, anxiety, and depression. The subjects were divided in 2 groups based on the presence or absence of PTSD symptoms. RESULTS: In this study, 57% of the FM sample had clinically significant levels of PTSD symptoms. The FM patients with PTSD reported significantly greater levels of avoidance, hyperarousal, reexperiencing, anxiety, and depression than did the patients without clinically significant levels of PTSD symptoms. The prevalence of PTSD among the FM patients in this study was significantly higher than in the general population. Women with FM and PTSD reported a greater number of past traumatic events than did their male counterparts. CONCLUSIONS: The results represent the first comprehensive study applying structured clinical assessment of trauma exposure and PTSD to a group of FM patients. This study shows a significant overlap between FM and PTSD, according to the currently accepted diagnostic criteria for each. Semin Arthritis Rheum 32:38-50. 1009 PMID- 11925084 AU - Craig T, Kakumanu S TI - CFS: evaluation & Rx. SO - Am Fam Physician 2002 Mar 15;65(6):1083-90 IN - D o Med, Penn St U Coll o Medicine, Hershey 17033, USA. tcr+ AB - +IN: aig@psu.edu Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise. Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or physical findings. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive. It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation. 1010 PMID- 12217449 AU - Creswell C, Chalder T TI - Underlying self-esteem in CFS. SO - J Psychosom Res 2002 Sep;53(3):755-61 IN - Sub-D o Clinical Health Psychology, U Coll London, Gower St+ AB - +IN: reet, London WC1E 6BT, UK. c.creswell@ucl.ac.uk OBJECTIVE: It has been suggested that people with chronic fatigue syndrome (CFS) have low self-esteem; however, this is not necessarily apparent when self-esteem is measured overtly. This study is the first to investigate underlying self-esteem using information-processing measures and overtly administered measures of self-esteem with this population. METHODS: The study comprised 68 participants (24 CFS, 24 healthy volunteers, and 20 chronic illness volunteers). A Self-Statements Questionnaire (SSQ) and an Emotional Stroop Test (EST) using neutral, positive, and negative trait words were administered. RESULTS: Participants with CFS reported lower self-esteem than the two comparison groups on overt measures. Overt responses, however, did not fully account for the full extent of the interference effect from the negative word Stroop compared to the positive word Stroop. CONCLUSION: In contrast to previous studies, participants with CFS reported lower levels of self-esteem on overt measures than two comparison groups. It is suggested, however, that the extent to which participants reported low self-esteem did not fully reflect their underlying low self-esteem and that this may result from the use of rigidly held defence mechanisms. Further use of information-processing measures, in contrast to relying only on self-report measures, is advocated for future research. 1011 PMID- 12115214 AU - Crofford LJ, Clauw DJ TI - FM: where are we a decade after the American College of Rheumatology classification criteria were developed? SO - Arthritis Rheum 2002 May;46(5):1136-8 1012 PMID- 12055982 AU - Crofford LJ TI - The hypothalamic-pituitary-adrenal axis in the pathogenesis of rheumatic diseases. [CF/FM] SO - Endocrinol Metab Clin North Am 2002 Mar;31(1):1-13 IN - D o Internal Med & Rheumatology, U o Michigan, Room 5510, M+ AB - +IN: SRB I, 1150 W. Med Ctr Dr., An Arbor, MI 48109-0680, USA. crofford@umich.edu Many studies have demonstrated altered HPA axis activity in patients with rheumatic diseases. In the case of autoimmune inflammatory diseases, circumstantial evidence suggests that failure of the neuroendocrine-immune regulatory loop may lead to insufficient production of endogenous glucocorticoid. Nevertheless, in human autoimmune disease, it is not possible to determine if altered HPA axis activity predates the onset of chronic inflammation. Animal studies and some early genetic studies in RA patients lend credibility to the argument that insufficient HPA axis response to inflammatory stimuli may increase susceptibility to, or severity of, these diseases. Most patients with rheumatic diseases complain of musculoskeletal pain. There is evidence of HPA axis involvement in acute and chronic pain. In the case of FM, pain cannot be explained on the basis of inflammation or altered musculoskeletal anatomy. This has led to the hypothesis that central nervous system mechanisms contribute to the symptom of somatic pain. Again, it is unclear if the observed HPA axis abnormalities reflect pre-existing vulnerability to the FM spectrum of disease, or whether chronic somatic symptoms alter HPA axis activity. Availability of technology to study better central components of the HPA axis may shed further light on its role in the pathogenesis of inflammatory autoimmune rheumatic diseases and musculoskeletal pain syndromes. 1013 PMID- 12146512 AU - Cronan TA, Serber ER, Walen HR, Jaffe M TI - The influence of age on FM Sx. SO - J Aging Health 2002 Aug;14(3):370-84 IN - San Diego St U, USA. AB - OBJECTIVES. Studies of the influence of age on health and well-being in chronically ill patients have produced mixed findings. This study examined young (20-39), middle-aged (40-59), and older (60-85) individuals with fibromyalgia (FMS), a chronic pain condition. The purpose of this study was to determine whether there were differences among the age groups in symptomatology and to examine potential mediating psychosocial variables. METHODS. Participants were 600 (95% female, mean age = 54, SD = 11) diagnosed FMS patients who were members of a health maintenance organization. Multivariate analyses of covariance were used to examine differences. RESULTS. There were significant differences among the age groups in most of the variables: With increasing age symptom duration increased but FMS symptomatology decreased. No age differences were found among the psychosocial mediators. The results suggest that the effects of FMS decrease over time. 1014 PMID- 11913226 AU - Cudney SA, Butler MR, Weinert C, Sullivan T TI - Ten rural women living w FM tell it like it is. SO - Holist Nurs Pract 2002 Apr;16(3):35-45 IN - College o Nursing, Montana St University-Bozeman, Bozeman, + AB - +IN: Montana, USA. The purpose of this qualitative study was to gain an understanding of the personal experiences of 10 rural women dealing with fibromyalgia based on the theoretical frameworks of adaptation to chronic illness and social support. The data were gathered from a nursing intervention that provided computer-based peer support and encouragement. The women described themes of pain, fatigue, depression, and sleep disturbances; expressed views on the experience of rural isolation; and shared positive philosophies of dealing with this disease. With this understanding, professionals and significant others can compassionately respond to the needs of sufferers of fibromyalgia. 1015 PMID- 11993585 AU - Cullen W, Kearney Y, Bury G TI - Prevalence of fatigue in general practice. [CF] SO - Ir J Med Sci 2002 Jan-Mar;171(1):10-2 IN - D o General Practice, U Coll Dublin, Ireland. walter.cullen+ AB - +IN: @ucd.ie BACKGROUND: Fatigue is an important symptom in general practice due to its association with physical, psychological and social problems. AIM: To determine the prevalence of fatigue as an unsolicited symptom during general practice consultations. METHODS: A random sample of GPs practising in Ireland was invited to provide data on consultations held over one day. Data were recorded on the presence of fatigue as a main or supporting symptom, social and demographic characteristics. RESULTS: Data were recorded by 89 GPs on 1,428 consultations. The prevalence of fatigue was 25%. It was the main reason for attending the doctor in 6.5% and a secondary reason in 19%. Sixty-two per cent of patients were female and 48% were eligible for free GP services. The mean age was 47.1 years. The presence of fatigue was associated with: attending a female GP, being female, attending a GP who had been qualified for fewer years and attending the GP frequently. CONCLUSION: The prevalence of fatigue reported in this study is over three times higher than that reported in earlier work. Doctor characteristics appear to be as important as patient characteristics in determining fatigue. 1016 PMID- 12095463 AU - Daoud KF, Barkhuizen A TI - Rheumatic mimics & selected triggers of FM. SO - Curr Pain Headache Rep 2002 Aug;6(4):284-8 IN - Oregon Health & Science U, Div o Rheumatology, 3181 SW Sam + AB - +IN: Jackson Park Road, Portland, OR 97201, USA. Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain and tender points, which have been present for more than 3 months. Many patients with systemic illnesses can have diffuse pain similar to that found in fibromyalgia, including rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and joint hypermobility. Osteomalacia and thyroid disease are also in the differential diagnosis of diffuse pain and are imminently treatable. In addition, there has been interest throughout the past 10 years in infectious diseases including hepatitis C, Lyme disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger fibromyalgia. This paper provides a framework to use when identifying these diseases as part of the evaluation of a patient with chronic widespread musculoskeletal pain. 1017 PMID- 12118002 AU - Demettre E, Bastide L, D'Haese A, De Smet K, De Meirleir K, Tiev KP, Englebienn+ TI - Ribonuclease L proteolysis in peripheral blood mononuclear cells of CFS pts. SO - J Biol Chem 2002 Sep 20;277(38):35746-51 IN - UMR 5124 CNRS, Universite Montpellier 2, 34293 Montpellier,+ AB - +IN: France. +AU: e P, Lebleu B A 37-kDa binding polypeptide accumulates in peripheral blood mononuclear cell (PBMC) extracts from chronic fatigue syndrome (CFS) patients and is being considered as a potential diagnostic marker (De Meirleir, K., Bisbal, C., Campine, I., De Becker, P., Salehzada, T., Demettre, E., and Lebleu, B. (2000) Am. J. Med. 108, 99-105). We establish here that this low molecular weight 2-5A-binding polypeptide is a truncated form of the native 2-5A-dependent ribonuclease L (RNase L), generated by an increased proteolytic activity in CFS PBMC extracts. RNase L proteolysis in CFS PBMC extracts can be mimicked in a model system in which recombinant RNase L is treated with human leukocyte elastase. RNase L proteolysis leads to the accumulation of two major fragments with molecular masses of 37 and 30 kDa. The 37-kDa fragment includes the 2-5A binding site and the N-terminal end of native RNase L. The 30-kDa fragment includes the catalytic site in the C-terminal part of RNase L. Interestingly, RNase L remains active and 2-5A-dependent when degraded into its 30- and 37-kDa fragments by proteases of CFS PBMC extract or by purified human leukocyte elastase. The 2-5A-dependent nuclease activity of the truncated RNase L could result from the association of these digestion products, as suggested in pull down experiments. 1018 PMID- 12522838 AU - Dick B, Eccleston C, Crombez G TI - Attentional functioning in FM, RA, & musculoskeletal pain pts. SO - Arthritis Rheum 2002 Dec 15;47(6):639-44 IN - Dalhousie University/IWK Health Centre, Halifax, Nova Scoti+ AB - +IN: a, Canada. OBJECTIVES: To investigate whether chronic pain patients have deficits in attentional functioning compared with pain-free controls, and whether fibromyalgia patients have larger deficits in attentional functioning compared with rheumatoid arthritis and musculoskeletal pain patients. METHODS: Sixty patients (20 in each of 3 patient groups) and 20 pain-free controls completed measures assessing pain intensity, mood, pain-related disability, somatic awareness, and catastrophic thinking about pain. Attentional functioning was assessed using an age-standardized, ecologically valid test battery. Analyses were made of between-group differences. RESULTS: Sixty percent of patients had at least one score in the clinical range of neuropsychological impairment, independent of demography and mood. Fibromyalgia patients were more anxious and somatically aware than rheumatoid arthritis or musculoskeletal pain patients, but did not show larger attentional deficits than other patient groups. CONCLUSION: All 3 groups of chronic pain patients, regardless of diagnosis, had impaired cognitive functioning on an ecologically sensitive neuropsychological test of everyday attention. 1019 PMID- 12016346 AU - Donaldson CC, MacInnis AL, Snelling LS, Sella GE, Mueller HH TI - Characteristics of Diffuse Muscular Coactivation (DMC) in persons w FM -- Part 2. SO - NeuroRehabilitation 2002;17(1):41-8 IN - Myosymmetries, #300, 290 Midpark Way S.E., Calgary, AB T2X + AB - +IN: 1P1, Canada. This study examined the electrical characteristics (Root Mean Square -- RMS and median frequency) of Diffuse Muscular Coactivation (DMC) associated with the tender points of fibromyalgia. DMC is defined as an increase from resting levels (tonus) in the electrical activity of any muscle during a movement which does not involve that muscle and is not part of the agonist -- antagonist unit. The results show an increase in RMS in fibromyalgia sufferers as compared to controls. Coactivation was stronger proximal to the neck and decreased in intensity as the area recorded moved distally. Median frequency changed over time but not significantly between groups. Possible neurological mechanisms are discussed. 1020 PMID- 12016345 AU - Donaldson CC, Snelling LS, MacInnis AL, Sella GE, Mueller HH TI - Diffuse Muscular Coactivation (DMC) as a potential source of pain in FM -- Part 1. SO - NeuroRehabilitation 2002;17(1):33-9 IN - Myosymmetries, #300, 290 Midpark Way S.E., Calgary, AB T2X + AB - +IN: 1P1, Canada. Fibromyalgia is characterized by diffuse pain, the origin of which remains obscure. This study explored a phenomenon labeled Diffuse Muscle Coactivation (DMC) as a possible source of pain in fibromyalgia. DMC is defined as an increase from resting levels (tonus) in the electrical activity of any muscle during a movement which does not involve that muscle and is not part of the agonist-antagonist unit. When compared to controls this activity in persons with fibromyalgia was 1.75 times more prevalent and demonstrated significantly higher peak amplitudes. Possible neurological mechanisms are discussed. 1021 PMID- 12412199 AU - Drexler AR, Mur EJ, Gunther VC TI - Efficacy of an EMG-biofeedback therapy in FM pts. A comparative study of pts w & without abnormality in (MMPI) psychological scales. SO - Clin Exp Rheumatol 2002 Sep-Oct;20(5):677-82 IN - Institute o Communication in the Professional Field & Psych+ AB - +IN: otherapy, Innsbruck U Hosp, Innsbruck, Austria. OBJECTIVE: The aim of the present study was to investigate the efficacy of EMG-biofeedback in female fibromyalgia patients with and without abnormality in the MMPI. METHODS: According to their MMPI profile out of a total of 24 patients, 12 patients were classified as 'psychologically abnormal' (at least one scale with a T-score higher than 70) and 12 as 'normal'. In a quasi-experimental setting, all patients underwent EMG-biofeedback therapy (12 sessions, twice weekly), after a waiting period of six weeks. Clinical symptoms (pressure point sensitivity, secondary symptoms), subjective pain dimensions as well as quality of life were assessed before and after the waiting period, immediately after the biofeedback training and at a three month follow up. RESULTS: Within the 'psychologically abnormal' patients primarily depressive, hypochondriacal and hysterical symptoms were found. Statistical evaluation showed that 'psychologically normal' patients experience long-term relief from pain measured in terms of pressure point sensitivity; vitality and mental health. 'Psychologically abnormal' patients, on the other hand, showed improvements in all the measured parameters (clinical symptoms, sensory and affective pain components, quality of life) after EMG-biofeedback. Long-term improvement, however, was observed only in pressure point sensitivity and the sensory pain dimension. CONCLUSION: The results suggest, that assessment of FM-patients should not only consist of commonly used ACR diagnostic criteria but should also include psychodiagnostic criteria, as these may co-determine treatment outcome. One approach to treating FM patients with additional psychological abnormality might be combining EMG-biofeedback that enhances self-efficacy with psychotherapy that helps patients to become aware of their basic psychological problems. 1022 PMID- 12030424 AU - Durlach J, Pages N, Bac P, Bara M, Guiet-Bara A TI - Biorhythms & possible central regulation of magnesium status, phototherapy, darkness therapy & chronopathological forms+ [CFS/FM] SO - Magnes Res 2002 Mar;15(1-2):49-66 IN - SDRM, Univ P et M Curie, Paris VI, France. Jean.Durlach@wan+ AB - +TI: of magnesium depletion +IN: adoo.fr Biological clock and magnesium status are linked. Central magnesium regulation may be hypothetized. Balanced magnesium status is requested to obtain efficiency of suprachiasmatic nuclei and of pineal gland. Conventional bright light therapy appears as a speedy and efficient antidepressant medication useful for the treatment of various types of depression, and of non migrainous headaches also. Although decrease in melatonin production seems accessory, increases of serotonergy and perhaps of Reactive Oxygen Species constitute the main mechanisms of action. Chromatotherapy emphazizes the effects of short exposure to specific colors. Although the increased production of melatonin constitutes the best marker of darkness, it is only an accessory mechanism of its action. The psycholeptic sedative effects of darkness, like those of magnesium, rely on direct membraneous and oxidant actions, neural mediated effects (i.e. stimulation of inhibitory neuromodulators such as GABA and taurine), and on antagonism of neuroactive gases (CO and NO). Darkness therapyper se, partial substitutive therapy with melatonin and with their mimicking agents (Mg, L-Tryptophan,Taurine) apply to all the chronopathological forms of magnesium depletion with decreased production of melatonin: sleep disorders, migraine, chronic fatigue syndrome, fibromyalgia, some forms of asthma and of sudden infant death syndrome. Further research should assess the importance of the chronopathological forms of magnesium depletion in the physiopathology of these disorders. 1023 PMID- 11777785 AU - Eaton L TI - Chronic fatigue report delayed as row breaks out over content. [CF] SO - BMJ 2002 Jan 5;324(7328):7 1024 PMID- 11799023 AU - Eaton L TI - Recognising chr fatigue is key to improving outcomes. SO - BMJ 2002 Jan 19;324(7330):131 1025 PMID- 12120699 AU - Egg R, Hogl B, Glatzl S, Beer R, Berger T TI - Autonomic instability, as measured by pupillary unrest, is not associated w multiple sclerosis fatigue severity. [CFS] SO - Mult Scler 2002 May;8(3):256-60 IN - D o Neurology, U Hosp Innsbruck, Austria. AB - Multiple sclerosis (MS) fatigue is one of the most common symptoms in MS, but its pathophysiology is still not understood Sympathovagal imbalance was suggested as a reason for fatigue in chronic fatigue syndrome. We examined the role of an imbalance in the central autonomic nervous system (ANS) as a cause of MS fatigue in 51 MS patients and a control group of 22 healthy volunteers. Fatigue was assessed with the revised MS Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Depression was evaluated with the Beck Depression Inventory (BDI). Disintegration of the central ANS expressed by pupillary fatigue waves was measured with pupillography and documented in the pupillary unrest index (PUI). All subjects had less than five points on the seven-point Stanford Sleepiness Scale and were therefore not sleepy. MS patients had significant higher mean FSS scores (p=0.001) and mean MFIS scores (p=0.003) than our control group. Mean BDI scores were significant higher (p=0.001) in the MS group, but were in the lowest score range (0-10 points) in both groups. Surprisingly, we found a statistically significant inverse correlation between PUI values and either FSS scores (p=0.001; r=-0.521) or MFIS scores (p=0.002; r=-0.423) in the MS group, but not in healthy participants. We therefore conclude that autonomic instability, as measured by pupillary unrest is not associated with MS fatigue severity. 1026 PMID- 12225618 AU - Ejlertsson G, Eden L, Leden I TI - Predictors of positive health in disability pensioners: a population-based questionnaire study using Positive Odds Ratio. [FM] SO - BMC Public Health 2002 Sep 11;2(1):20 IN - D o Health Sciences, Kristianstad U, S-291 88 Kristianstad,+ AB - +IN: Sweden. goran.ejlertsson@hv.hkr.se BACKGROUND: Determinants of ill-health have been studied far more than determinants of good and improving health. Health promotion measures are important even among individuals with chronic diseases. The aim of this study was to find predictors of positive subjective health among disability pensioners (DPs) with musculoskeletal disorders. METHODS: Two questionnaire surveys were performed among 352 DPs with musculoskeletal disorders. Two groups were defined: DPs with positive health and negative health, respectively. In consequence with the health perspective in this study the conception Positive Odds Ratio was defined and used in the logistic regression analyses instead of the commonly used odds ratio. RESULTS: Positive health was associated with age > or = 55 years, not being an immigrant, not having fibromyalgia as the main diagnosis for granting an early retirement, no regular use of analgesics, a high ADL capacity, a positive subjective health preceding the study period, and good quality of life. CONCLUSION: Positive odds ratio is a concept well adapted to theories of health promotion. It can be used in relation to positive outcomes instead of risks. Suggested health promotion and secondary prevention efforts among individuals with musculoskeletal disorders are 1) to avoid a disability pension for individuals <55 years of age; if necessary, to make sure rehabilitation actions continue, 2) to increase efforts to support immigrants to adjust to circumstances connected to ill-health and retirement, 3) to pay special attention to individuals with fibromyalgia and other general pain disorders, and 4) to strengthen ADL activities to support an independent active life among disability pensioners. 1027 PMID- 12194900 AU - Engel CC Jr, Adkins JA, Cowan DN TI - Caring for medically unexplained physical Sx after toxic environmental exposures: effects of contested causation. [CFS] SO - Environ Health Perspect 2002 Aug;110 Suppl 4:641-7 IN - Deployment Health Clinical Ctr, Walter Reed Army Med Center+ AB - +IN: , Washington, DC, USA. cengel@usuhs.mil Medically unexplained physical symptoms (MUPS) are persistent idiopathic symptoms that drive patients to seek medical care. MUPS syndromes include chronic fatigue syndrome, fibromyalgia syndrome, and multiple chemical sensitivities. When MUPS occur after an environmental exposure or injury, an adversarial social context that we call "contested causation" may ensue. Contested causation may occur publicly and involve media controversy, scientific disagreement, political debate, and legal struggles. This adversarial social context may diminish the effectiveness of the provider-patient relationship. Contested causation also may occur privately, when disagreement over the causes of MUPS takes place in the patient-provider context. These patient-provider disagreements over causation often occur because of the enigmatic nature of MUPS. We suggest that a context of contested causation may have serious negative effects on healthcare for individuals with MUPS. Context plays a larger role in MUPS care than it does for most medical care because of the uncertain nature of MUPS, the reliance of standard MUPS therapies on a potentially tenuous patient-provider partnership, and the clinical need to rely routinely on subjective MUPS assessments that often yield discordant patient and provider conclusions. Contested causation may erode patient-provider trust, test the provider's self-assurance and capacity to share power with the patient, and raise problematic issues of compensation, reparation, and blame. These issues may distract patients and providers from therapeutic goals. In occupational and military settings, the adverse impact of contested causation on the patient-provider partnership may diminish therapeutic effectiveness to a greater degree than it does in other medical settings. Contested causation therefore raises questions regarding generalizability of standard therapies for MUPS and related syndromes to these settings. Future research is needed to learn whether intuitively sensible and evidence-based MUPS therapies benefit occupational and military medical patients who are afforded care in the context of contested causation. 1028 PMID- 12070676 AU - Evcik D, Kizilay B, Gokcen E TI - The effects of balneotherapy on FM pts. SO - Rheumatol Int 2002 Jun;22(2):56-9 IN - A.K.U. Arastirma Hastanesi, Fiziksel Tip ve Reh A.D. Inonu + AB - +IN: Bulvan; 03200 Afyon, Turkey. ezgievcik@ixir.c Fibromyalgia syndrome (FMS) is a very common rheumatological diagnosis. There are various treatment modalities. This study was planned to investigate the effects of balneotherapy in the treatment of FMS. A total of 42 primary fibromyalgia patients diagnosed according to American College of Rheumatology criteria were included in the study. Their ages ranged between 30 and 55 years. Patients were randomly assigned to two groups. None of them had had a cardiovascular disease before. Group 1 n=22) received 20-min bathing, once a day and five times per week. Patients participated in the study for 3 weeks (total of 15 sessions). Group 2 (n=20) was accepted as the control group. Patients were evaluated by the number of tender points, Visual Analogue Scale for pain, Beck's Depression Index for depression, and Fibromyalgia Impact Questionnaire for functional capacity. Measurements were assessed initially, after the therapy, and at the end of the 6th month. In group 1, there were statistically significant differences in numbers of tender points, Visual Analogue scores, Beck's Depression Index, and Fibromyalgia Impact Questionnaire scores after the therapy program (P<0.001). Also, 6 months later in group 1, there was still an improvement in the number of tender points (P<0.001), Visual Analogue scores, and Fibromyalgia Impact Questionnaire (P<0.005). But there was not a statistical difference in Beck's Depression Index scores compared to the control group (P>0.05). Patients with FMS mostly complain about pain, anxiety, and the difficulty in daily living activities. This study shows that balneotherapy is effective and may be an alternative method in treating fibromyalgia patients. 1029 PMID- 12421101 AU - Evengard B, Klimas N TI - CFS: probable pathogenesis & possible Rxs. SO - Drugs 2002;62(17):2433-46 IN - D o Immunology, Microbiology & Pathology, Karolinska Instit+ AB - +IN: utet at Huddinge U Hosp, Stockholm, Sweden. Chronic fatigue syndrome (CFS) belongs in the medically unexplained illnesses. It affects approximately 0.2-0.7% of the population in Western countries. It is characterised by unexplained fatigue, lasting 6 months or more, impairment of neurocognitive functions and quality of sleep, and of somatic symptoms, such as recurrent sore throat, muscle aches, arthralgias, headache and postexertional malaise. No link between infections and CFS has been clearly established but the immune system is activated, there are aberrations in several hypothalamic-pituitary axes and involvement of other parts of the central nervous system. No specific treatment has been found. Cognitive behavioural therapy is established to be of value to improve quality of life. More effective treatment should result, as advances in biomedical as well as psychological research continue. 1030 PMID- 11748048 AU - Farquhar WB, Hunt BE, Taylor JA, Darling SE, Freeman R TI - Blood volume & its relation to peak O(2) consumption & physical activity in pts w chr fatigue. [CF] SO - Am J Physiol Heart Circ Physiol 2002 Jan;282(1):H66-71 IN - Center for Autonomic & Peripheral Nerve Disorders, D o Neur+ AB - +IN: ology, Beth Israel Deaconess Med Ctr, Harvard MS, Boston, MA 02215, USA. Individuals with chronic fatigue syndrome (CFS) experience a number of somatic complaints including severe, disabling fatigue, and exercise intolerance. We hypothesized that hypovolemia, through its interaction with central hemodynamics, would contribute to the exercise intolerance associated with this disorder. We examined blood volume, peak aerobic power, habitual physical activity, fatigue level, and their interrelations to understand the physiological basis of this disorder. Seventeen patients who met the Centers for Disease Control criteria for CFS and 17 age-matched controls participated in the study. Blood volume was assessed using a single bolus injection of Evans blue dye. Peak oxygen consumption was measured during exercise on an upright cycle ergometer. Supine cardiac output and stroke volumes were measured using CO(2) rebreathing. Questionnaires were used to assess habitual physical activity and fatigue. Patients displayed a trend for a 9% lower blood volume (58.3 +/- 2.1 vs. 64.2 +/- 2.5 ml/kg, P = 0.084) and had a 35% lower peak oxygen consumption (22.0 +/- 1.2 vs. 33.6 +/- 1.9 ml/kg, P < 0.001). These two variables were highly related within the patients (r = 0.835, P < 0.001) and the controls (r = 0.850, P < 0.001). Peak ventilation and habitual physical activity were significantly lower in the patients. Fatigue level was not related to any of the measured physiological parameters within the CFS group. In conclusion, individuals with CFS have a significantly lower peak oxygen consumption and an insignificant trend toward lower blood volume compared with controls. These variables were highly related in both subject groups, indicating that blood volume is a strong physiological correlate of peak oxygen consumption in patients with CFS. 1031 PMID- 12528076 AU - Ferreira AC, de Marchena E TI - Grading autonomic dysfunction in CFS. SO - Semin Arthritis Rheum 2002 Dec;32(3):137-8 1032 PMID- 12613112 AU - Fisher M, Krilov LR, Ovadia M TI - CFS & eating disorders: concurrence or coincidence? SO - Int J Adolesc Med Health 2002 Oct-Dec;14(4):307-16. IN - Division o Adolescent Med, Div o Pediatric Infectious Disea+ AB - +IN: ses, Div o Pediatric Cardiology, North Shore U Hosp, North Shore-Long Island Jewish Health System, Manhasset, NY, USA. Fisher@nshs.edu In this report we present four patients who were found to have both an eating disorder and the chronic fatigue syndrome (CFS). Two of the patients presented for evaluation of an eating disorder and also had CFS, while two of the patients presented for evaluation of CFS and also had an eating disorder. In all four patients the eating disorder preceded the CFS. We consider the question of whether the occurrence of these two disorders in the same patients is merely a coincidence; whether an eating disorder can act as a precipitant for CFS, perhaps through the exacerbation of an underlying vascular instability; and whether overlapping etiologies may predispose some adolescents to develop both disorders. We also discuss similarities (including diagnostic dilemmas, cultural influences, psychological correlates, demographic similarities, perceptual biases, and cardiovascular effects) encountered in the management of both of these disorders. 1033 PMID- 12014557 AU - Fitzpatrick M TI - ME--the dangers of Cartesian fundamentalism. [CFS] SO - Br J Gen Pract 2002 May;52(478):432-3 IN - fitz@easynet.co.uk 1034 PMID- 11886696 AU - Fors EA, Sexton H, Gotestam KG TI - The effect of guided imagery & amitriptyline on daily FM pain: a prospective, randomized, controlled trial. SO - J Psychiatr Res 2002 May-Jun;36(3):179-87 IN - D o Psychiatry & Behavioural Med, Norwegian U o Science & T+ AB - +IN: echnology (NTNU), PO Box 3008 Lade, NO-7441, Trondheim, Norway & Multidisciplinary Pain Ctr, RiT, Trondheim, Norway Objective: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively. Methods: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in "pleasant imagery" (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the "active workings of the internal pain control systems", "attention imagery" (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. Results: We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P<0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline x psychological interaction (P=0.76). Conclusion: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period. 1035 PMID- 11830431 AU - Fors EA, Sexton H TI - Weather & the pain in FM: are they related? SO - Ann Rheum Dis 2002 Mar;61(3):247-50 IN - D o Psychiatry & Behavioural Med & Multidisciplinary Pain C+ AB - +IN: entre, U Hosp o Trondheim, Norway. eafors@online.no OBJECTIVES: To examine the association between fibromyalgic pain and weather to determine the nature of their interrelationship. METHODS: The daily pain ratings of 55 female patients previously diagnosed with fibromyalgia were recorded on visual analogue scales (VAS) over 28 days. These ratings were then related to the official weather parameters and a composite weather variable using time series methodology. Effect sizes r were calculated from the t values and df. RESULTS: A composite weather variable did not significantly predict changes in pain, either the same day (t=-1.15, df=1483, p=0.25) or on the next day (t=-1.55, df=1483, p=0.12)-that is, the weather was not a factor for changes in the subjective pain of FM. Patients' pain did not predict weather change in this sample, and neither same day (t=-0. 69, df=1483, p<0.49) nor previous day pain (t=-1.31, df=1483, p<0.19) predicted weather changes. A post hoc exploratory analysis showed that those with <10 years of fibromyalgia experienced significantly greater weather sensitivity to pain (t=- 2.73, df=389, p<0.006) than those with longer illness. CONCLUSION: A statistically significant relationship between fibromyalgic pain and the weather was not found in this sample, although it is possible that a group of patients with less chronic fibromyalgia might be weather sensitive. 1036 PMID- 11893227 AU - Forseth K KO, Gran JT TI - Management of FM: what are the best Rx choices? SO - Drugs 2002;62(4):577-92 IN - D o Rheumatology, Betanien Hosp, Skien, Norway. karin.forse+ AB - +IN: th@tss.telemax.no Fibromyalgia still represents an enigma to modern medicine and the aetiopathogenesis is far from explored. The management of patients with fibromyalgia is thus mostly based on empirical research, and only a few controlled studies have been performed. Basic drug therapy rests on the administration of amitriptyline and conventional analgesics. Such therapy should be initiated only after careful patient information and delineation of therapeutic goals are provided. Any drug therapy should be administered in combination with physical treatment and cognitive behavioural therapy. Because of the appearing contours of pathogenic mechanisms, hopefully a number of new drugs will be available to the patients with this complex pain syndrome in the near future. 1037 PMID- 12072002 AU - Fortune DG, Richards HL, Main CJ, Griffiths CE TI - Pts' strategies for coping w psoriasis. [CFS] SO - Clin Exp Dermatol 2002 May;27(3):177-84 IN - Dermatology Centre, U o Manchester School o Med, Hope Hosp,+ AB - +IN: Salford, UK. There is a paucity of research on the types of strategies that patients with psoriasis use to cope with the impact of their condition. By contrast there are a number of studies assessing coping by patients with nondermatological disease. The purpose of the present study was to examine strategies for coping in patients with psoriasis and investigate whether they differ as compared with normal controls and patients with other major medical diseases. Two hundred and fifty patients with a definite dermatologist-confirmed diagnosis of psoriasis participated in this cross-sectional study. Patients were assessed by psoriasis area severity index and all patients completed the COPE questionnaire and psoriasis disability index. Sixty healthy, control participants completed the COPE questionnaire for comparison purposes. Mean COPE scores from patients with psoriasis were also compared with published COPE scores from other medical diseases. The coping strategies most frequently used by patients with psoriasis were acceptance, planning, active coping and positive reinterpretation. The least frequently used were alcohol and nonprescription drugs, religion, and denial of their condition. Despite reporting greater disability, patients with severe psoriasis did not significantly differ from those with mild/moderate disease in their use of particular forms of coping strategies. Patients with psoriasis as a whole tended to use significantly less active coping strategies, planning, positive reinterpretation and humour when compared with normal controls. There was marked similarity in the frequency of use of particular coping strategies between patients with psoriasis and patients with other medical conditions. Similar types of coping strategies are utilized by patients regardless of whether their illness is visible (psoriasis) invisible (chronic fatigue syndrome, atrial fibrillation), has significant physical impairment (spinal cord injury), or is life-threatening (cancer, and myocardial infarction). It appears that illness brings with it a generic form of coping that may require shaping to fit the individual demands of diseases such as psoriasis. 1038 PMID- 12357274 AU - Freeman R TI - The CFS is a disease of the autonomic nervous system. Sometimes. SO - Clin Auton Res 2002 Aug;12(4):231-3 1039 PMID- 12628637 AU - Friedberg F TI - Does graded activity increase activity? A case study of CFS. SO - J Behav Ther Exp Psychiatry 2002 Sep-Dec;33(3-4):203-15. IN - D o Psychiatry & Behavioral Science, Putnam Hall/South Camp+ AB - +IN: us, St U o New York at Stony Brook, PO Box 616, Stony Brook, NY 11794-8790, USA. fred.friedberg@stonybrook.edu The reliance on self-report outcome measures in clinical trials of graded activity-oriented cognitive-behavior therapy in chronic fatigue syndrome (CFS) makes it difficult to draw definitive conclusions about actual behavioral change. The participant in this case study was a 52-year-old married male with CFS who was working full-time. Outcome measures included a step counter to objectively measure physical activity as well as a daily diary measure of exercise activity and in vivo ratings of perceived energy, fatigue, and affect. The following psychometric instruments were also used: the CFS Symptom Inventory, the SF-36, the Beck Depression Inventory, and the Beck Anxiety Inventory. The 26-session graded activity intervention involved gradual increases in physical activity. From baseline to treatment termination, the patient's self-reported increase in walk time from 0 to 155 min a week contrasted with a surprising 10.6% decrease in mean weekly step counts. The final follow-up assessment revealed a "much improved" global rating, substantial increases in patient-recorded walk time and weight lifting intensity, yet a relatively modest increment in weekly step counts. It appeared that improvement was associated with mood-enhancing, stress-reducing activities that were substituted for stress-exacerbating activities. 1040 PMID- 12461200 AU - Gaab J, Huster D, Peisen R, Engert V, Heitz V, Schad T, Schurmeyer TH, Ehlert U TI - Hypothalamic-pituitary-adrenal axis reactivity in CFS & health under psychological, physiological, & pharmacological stimulation. SO - Psychosom Med 2002 Nov-Dec;64(6):951-62 IN - Center for Psychobiological & Psychosomatic Research (J. G.+ AB - +IN: , D.H., R.P., V.E., V.H., T.S., T.H.S., U.E.), U o Trier, Trier, Germany. OBJECTIVES: Subtle alterations of the hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a shared pathway linking numerous etiological and perpetuating processes with symptoms and observed physiological abnormalities. Because the HPA axis is involved in the adaptive responses to stress and CFS patients experience a worsening of symptoms after physical and psychological stress, we tested HPA axis functioning with three centrally acting stress tests. METHODS: We used two procedures mimicking real-life stressors and compared them with a standardized pharmacological neuroendocrine challenge test. CFS patients were compared with healthy control subjects regarding their cardiovascular and endocrine reactivity in a psychosocial stress test and a standardized exercise test, and their endocrine response in the insulin tolerance test (ITT). RESULTS: Controlling for possible confounding variables, we found significantly lower ACTH response levels in the psychosocial stress test and the exercise test, and significantly lower ACTH responses in the ITT, with no differences in plasma total cortisol responses. Also, salivary-free cortisol responses did not differ between the groups in the psychosocial stress test and the exercise test but were significantly higher for the CFS patients in the ITT. In all tests CFS patients had significantly reduced baseline ACTH levels. CONCLUSIONS: These results suggest that CFS patients are capable of mounting a sufficient cortisol response under different types of stress but that on a central level subtle dysregulations of the HPA axis exist. 1041 PMID- 11914448 AU - Gaab J, Huster D, Peisen R, Engert V, Schad T, Schurmeyer TH, Ehlert U TI - Low-dose dexamethasone suppression test in CFS & health. SO - Psychosom Med 2002 Mar-Apr;64(2):311-8 IN - Center for Psychobiological & Psychosomatic Research, U o T+ AB - +IN: rier, Trier, Germany. jgaab@klipsy.unizh.ch OBJECTIVE: Subtle dysregulations of the hypothalamus-pituitary-adrenal axis in chronic fatigue syndrome have been described. The aim of this study was to examine the negative feedback regulations of the hypothalamus-pituitary-adrenal axis in chronic fatigue syndrome. METHODS: In 21 patients with chronic fatigue syndrome and 21 healthy control subjects, awakening and circadian salivary free cortisol profiles were assessed over 2 consecutive days and compared with awakening and circadian salivary free cortisol profiles after administration of 0.5 mg of dexamethasone at 11:00 PM the previous day. RESULTS: Patients with chronic fatigue syndrome had normal salivary free cortisol profiles but showed enhanced and prolonged suppression of salivary free cortisol after the administration of 0.5 mg of dexamethasone in comparison to the control subjects. CONCLUSIONS: Enhanced negative feedback of the hypothalamus-pituitary-adrenal axis could be a plausible explanation for the previously described alterations in hypothalamus-pituitary-adrenal axis functioning in chronic fatigue syndrome. Because similar changes have been described in stress-related disorders, a putative role of stress in the pathogenesis of the enhanced feedback is possible. 1042 PMID- 12410623 AU - Gaby AR TI - Intravenous nutrient therapy: the "Myers' cocktail". [CFS] SO - Altern Med Rev 2002 Oct;7(5):389-403 AB - Building on the work of the late John Myers, MD, the author has used an intravenous vitamin-and-mineral formula for the treatment of a wide range of clinical conditions. The modified "Myers' cocktail," which consists of magnesium, calcium, B vitamins, and vitamin C, has been found to be effective against acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, cardiovascular disease, and other disorders. This paper presents a rationale for the therapeutic use of intravenous nutrients, reviews the relevant published clinical research, describes the author's clinical experiences, and discusses potential side effects and precautions. 1043 PMID- 12092435 AU - Gaines S TI - Finding Amy Peterson. An olympic speed skater battles w CFS. SO - Minn Med 2002 Jun;85(6):24-6 1044 PMID- 12090649 AU - Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR TI - Osteopathic manipulative Rx in conjunction w medication relieves pain associated w FM syndrome: results of a randomized clinical pilot project. SO - J Am Osteopath Assoc 2002 Jun;102(6):321-5 IN - D o Osteopathic Manipulative Med, Texas Coll o Osteopathic + AB - +IN: Medicine, U o North Texas Health Science Ctr, Fort Worth 76107, USA. rgamber@hsc.unt.edu Osteopathic physicians caring for patients with fibromyalgia syndrome (FM) often use osteopathic manipulative treatment (OMT) in conjunction with other forms of standard medical care. Despite a growing body of evidence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions, the role of OMT in treating patients with chronic conditions such as FM remains largely unknown. Twenty-four female patients meeting American College of Rheumatology criteria for FM were randomly assigned to one of four treatment groups: (1) manipulation group, (2) manipulation and teaching group, (3) moist heat group, and (4) control group, which received no additional treatment other than current medication. Participants' pain perceptions were assessed by use of pain thresholds measured at each of 10 bilateral tender points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory, and the Present Pain Intensity Rating Scale. Patients' affective response to treatment was assessed using the Self-Evaluation Questionnaire. Activities of daily living were assessed using the Stanford Arthritis Center Disability and Discomfort Scales: Health Assessment Questionnaire. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Significant findings between the four treatment groups on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability were found. All of these findings favored use of OMT. This study found OMT combined with standard medical care was more efficacious in treating FM than standard care alone. These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT. 1045 PMID- 11902596 AU - Garralda ME, Rangel L TI - Annotation: CFS in children & adolescents. SO - J Child Psychol Psychiatry 2002 Feb;43(2):169-76 IN - Academic Unit o Child & Adolescent Psychiatry, Imperial Col+ AB - +IN: l School o Med, London, UK. e.garralda@ic.ac.uk BACKGROUND: Over the past two decades Chronic Fatigue Syndrome (CFS) of childhood has gained increasing prominence. A number of clinical reports and case-control studies have examined the nature of the disorder, its associations, response to treatment and outcome. METHOD: A review of publications on childhood CFS was undertaken and reference to work on adult CFS made. Most studies on childhood CFS have been on markedly affected children attending specialist pediatric clinics and very little is known about the condition as it presents in the community or to general medical services. RESULTS: The main symptom is fatigue in association with a variety of physical symptoms and with marked and prolonged functional impairment. CFS is commonly reported as being brought on by acute infections. Co-morbid psychiatric (usually mood) disorders are present in at least a half. Personality problems and health attitudes have been described as possible predisposing and maintaining factors. Clinical reports indicate that family work focused on engagement and on a rehabilitation programme (including graded increasing activity and treatment of psychiatric co-morbidity) can help even the more severely impaired children. Recovery may be expected in over two-thirds. CONCLUSIONS: CFS presents as a distinct, markedly impairing disorder of childhood. In its severe form, it is often associated with mood disorders. Further research into milder forms and into the efficacy of different treatment interventions is specially needed. 1046 PMID- 11932882 AU - Geel SE, Robergs RA TI - The effect of graded resistance exercise on FM Sx & muscle bioenergetics: a pilot study. SO - Arthritis Rheum 2002 Feb;47(1):82-6 IN - Center for Health & Human Services, California St U, Sacram+ AB - +IN: ento, California, USA. 1047 PMID- 12122926 AU - Geenen R, Jacobs JW, Bijlsma JW TI - Evaluation & management of endocrine dysfunction in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):389-404 IN - D o Health Psychology, Utrecht U, P.O. Box 80140, 3508 TC U+ AB - +IN: trecht, The Netherlands. R.Geenen@fss.uu.nl Fibromyalgia-like symptoms such as muscle pain and tenderness, exhaustion, reduced exercise capacity, and cold intolerance, resemble symptoms associated with endocrine dysfunction like hypothyroidism, and adrenal or growth hormone insufficiency. To investigate the potential of management of endocrine abnormalities for relieve of symptoms of patients with fibromyalgia, we reviewed experimental and clinical studies of endocrine functioning and endocrine treatment. Serum GH, androgen, and 24-hour urinary cortisol levels of patients with fibromyalgia tend to be in the lower part of the normal range, while serum levels of thyroid hormone, female sex hormones, prolactin, and melatonin are normal. With exception of GH, these conclusions are based on studies in small samples. With respect to dynamic responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis, the dexamethasone suppression test and stimulation with ACTH show normal results, while patients show marked ACTH hypersecretion in response to severe acute stressors, perhaps indicative of chronic CRH hyposecretion. This finding and slightly altered responsiveness of growth hormone, thyroid hormone, and prolactin in pharmacologic stimulation tests suggest a central rather than peripheral origin of endocrine deviations. Because hormone level deviations were not severe, occurred in subgroups of patients only, and few controlled clinical trials were performed, there is--unless future research shows otherwise--little support for hormone supplementation as a general therapy in the common patient with fibromyalgia. In patients with clinically overt hormone deficiency, hormonal supplementation is an option. In patients with hormone levels that are in the lower part of the normal range, interventions aimed at pain, fatigue, sleep or mood disturbance, and physical deconditioning may indirectly improve endocrine functioning. 1048 PMID- 12481153 AU - Gerrity TR, Bates J, Bell DS, Chrousos G, Furst G, Hedrick T, Hurwitz B, Kula R+ TI - CFS: what role does the autonomic nervous system play in the pathophysiology of this complex illness? SO - Neuroimmunomodulation 2002;10(3):134-41 IN - Georgetown U Med Ctr, Washington, D.C., USA. AB - +AU: W, Levine SM, Moore RC, Schondorf R Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800,000 Americans of all ages, races and socioeconomic groups and both genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the autonomic nervous system (ANS). A symposium was organized in December 2000 to explore the possibility of an association between ANS dysfunction and CFS, with special emphasis on the interactions between ANS dysfunction and other abnormalities noted in the immune and endocrine systems of individuals with CFS. This paper represents the consensus of the panel of experts who participated in this meeting. 1049 PMID- 12237215 AU - Goettl VM, Huang Y, Hackshaw KV, Stephens RL Jr TI - Reduced basal release of serotonin from the ventrobasal thalamus of the rat in a model of neuropathic pain. SO - Pain 2002 Sep;99(1-2):359-66 IN - D o Physiology & Cell Biology, Coll o Med & Public Health, + AB - +IN: The Ohio St U, 304 Hamilton Hall, 1645 Neil Avenue, Coll o Med & Public Health, Columbus, OH 43210, USA. Drugs that inhibit reuptake of monoamines are frequently used to treat pain syndromes, e.g. neuropathy or fibromyalgia, where mechanical allodynia is present. Several lines of evidence suggest the involvement of supraspinal sites of action of these drugs. However, a direct study of supraspinal serotonin (5-HT) or norepinephrine (NE) release in an animal model in which allodynia is expressed, e.g. neuropathy, has not been done. The ventrobasal (VB) thalamus and the hypothalamus are major supraspinal projection regions for spinal neurons that transmit nociceptive information and are innervated by monoaminergic fibers. This study determined if peripheral neuropathy would induce changes in extracellular monoamines in VB thalamus and hypothalamus. Male Sprague-Dawley rats had spinal nerve roots L5 and L6 tightly ligated (neuropathic rats; NP) or sham (SHAM) surgery; contralateral and ipsilateral VB thalamus and contralateral hypothalamus were dialyzed with modified artificial cerebral spinal fluid (aCSF), with and without fluoxetine. NP rats had significantly decreased 5-HT content in dialysates of the contralateral VB thalamus compared with SHAM rats with (82% decrease) or without (63% decrease) fluoxetine in the perfusion medium over the 180 min of the study. There were no differences in the ipsilateral VB thalamus. In contrast, release of 5-HT was unchanged in the hypothalamic dialysates of SHAM vs. NP rats. NE release was not different in dialysates of either the VB thalamus or hypothalamus of SHAM vs. NP rats. Synthesis of 5-HT, as assessed by accumulation of 5-hydroxytrytophan after treatment with an L-amino acid decarboxylase inhibitor, was not different between NP and SHAM rats in VB thalamic and hypothalamic brain tissue. This study is the first to demonstrate changes in monoamine release supraspinally in NP rats. The differential effect between VB thalamus and hypothalamus suggests that a terminal field change may be involved. Putative mechanisms for mediating this change include alterations of GABA-ergic systems and/or plasticity related to alterations in N-methyl-D-aspartate receptor activation and nitric oxide release related to afferent hyperactivity induced by neuropathic pain. 1050 PMID- 12357273 AU - Goldberger AL TI - CFS & hidden happenings of the heartbeat. SO - Clin Auton Res. 2002 Aug;12(4):264-72. PMID: 12357280; Clin+ AB - +SO: Auton Res 2002 Aug;12(4):228-30. 1051 PMID- 12219316 AU - Goldenberg DL, Sandhu HS TI - FM & post-traumatic stress disorder: Another piece in the biopsychosocial puzzle. SO - Semin Arthritis Rheum 2002 Aug;32(1):1-2 IN - D o Med & Psychiatry, Newton-Wellesley Hosp, Newton, MA. 1052 PMID- 12122929 AU - Goldenberg DL TI - Office management of FM. SO - Rheum Dis Clin North Am 2002 May;28(2):437-46, xi IN - Division o Rheumatology, Newton-Wellesley Hosp, D o Med, Tu+ AB - +IN: fs U School o Medicine, Newton, MA 02462, USA. dgoldenb@massmed.org The office management of fibromyalgia (FM) is best determined by two variables: (1) the severity and complexity of each patient's symptoms, and (2) the specialization and interest of the treating physician. Because there are 6 to 10 million Americans with FM, most patient visits will be to the primary care physician. Rheumatologists, physiatrists, and other musculoskeletal specialists must work with primary care physicians to foster the early diagnosis and appropriate treatment of FM. Primary care physicians are faced with enormous challenges in caring for patients with chronic pain disorders like FM. Our managed health care system insists that patient encounters be brief. Specialty referrals are often discouraged. There is little if any reimbursement for patient education. FM treatment is labor-intensive. Therefore, optimal planning and use of precious office time and resources are most important. Rheumatologists should train our primary care colleagues to recognize FM. Many patients still go months or years before this common syndrome is diagnosed. Rheumatologists should also spearhead teaching primary care physicians the basic treatment principles of FM. If the diagnosis is made early, patients with FM in community practice do very well with simple management techniques. As consultants, rheumatologists should confirm the diagnosis of FM and suggest basic FM management. Some primary care providers or other specialists will be fully capable of bypassing this consultation, especially if the patient responds to simple management suggestions. Manpower surveys have not studied the cost-effectiveness of specialty care in FM. Rheumatologists should also assume the responsibility for the management of FM patients who have not responded to basic FM management. Additionally, some rheumatologists may wish to subspecialize in FM, a major career commitment to this perplexing disorder. These situations constitute advanced FM management. 1053 PMID- 12416949 AU - Goldstein DS, Robertson D, Esler M, Straus SE, Eisenhofer G TI - Dysautonomias: clinical disorders of the autonomic nervous system. [CFS] SO - Ann Intern Med 2002 Nov 5;137(9):753-63 IN - Clinical Neurocardiology Sect, Nat Inst o Neurological Diso+ AB - +IN: rders & Stroke, Nat Institutes o Health, Building 10, Room 6N252, 10 Ctr Drive MSC-1620, Bethesda, MD 20892-1620, USA. The term dysautonomia refers to a change in autonomic nervous system function that adversely affects health. The changes range from transient, occasional episodes of neurally mediated hypotension to progressive neurodegenerative diseases; from disorders in which altered autonomic function plays a primary pathophysiologic role to disorders in which it worsens an independent pathologic state; and from mechanistically straightforward to mysterious and controversial entities. In chronic autonomic failure (pure autonomic failure, multiple system atrophy, or autonomic failure in Parkinson disease), orthostatic hypotension reflects sympathetic neurocirculatory failure from sympathetic denervation or deranged reflexive regulation of sympathetic outflows. Chronic orthostatic intolerance associated with postural tachycardia can arise from cardiac sympathetic activation after "patchy" autonomic impairment or blood volume depletion or, as highlighted in this discussion, from a primary abnormality that augments delivery of the sympathetic neurotransmitter norepinephrine to its receptors in the heart. Increased sympathetic nerve traffic to the heart and kidneys seems to occur as essential hypertension develops. Acute panic can evoke coronary spasm that is associated with sympathoneural and adrenomedullary excitation. In congestive heart failure, compensatory cardiac sympathetic activation may chronically worsen myocardial function, which rationalizes treatment with beta-adrenoceptor blockers. A high frequency of positive results on tilt-table testing has confirmed an association between the chronic fatigue syndrome and orthostatic intolerance; however, treatment with the salt-retaining steroid fludrocortisone, which is usually beneficial in primary chronic autonomic failure, does not seem to be beneficial in the chronic fatigue syndrome. Dysautonomias are an important subject in clinical neurocardiology. 1054 PMID- 12528593 AU - Goudsmit E TI - CFS/ME. SO - Br J Gen Pract 2002 Dec;52(485):1023-4 1055 PMID- 12522833 AU - Gowans SE, DeHueck A, Abbey SE TI - Measuring exercise-induced mood changes in FM: a comparison of several measures. SO - Arthritis Rheum 2002 Dec 15;47(6):603-9 IN - U Health Network, Toronto, Ontario, Canada. sue.gowans@uhn.+ AB - +IN: on.ca OBJECTIVE: To compare scales measuring exercise-induced changes in mood. METHODS: Mood changes in a randomized, 23-week controlled trial of exercise were assessed using the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire, and the Mental Health Inventory (MHI). Effect sizes and t-tests were computed on 23-week change scores. Scales were deemed to be confounded if items addressed sleep disturbances, fatigue, or effort (symptoms of both mood disturbances and fibromyalgia). RESULTS: Efficacy (15 exercise subjects) and intent-to-treat analyses (27 exercise subjects) generated medium effects for BDI (total, cognitive), MHI depression (efficacy only), and CES-D (intent-to-treat only) scales. BDI (total, cognitive), MHI (depression, positive affect, total [MHI-5]), and STAI scales distinguished exercise from control subjects at 23 weeks in all analyses. BDI somatic and CES-D scales were deemed to be confounded. CONCLUSION: We recommend the BDI cognitive, STAI, and MHI-5 scales to measure depression, anxiety, and general mood, respectively, in patients with fibromyalgia. 1056 PMID- 12115241 AU - Gracely RH, Petzke F, Wolf JM, Clauw DJ TI - Functional magnetic resonance imaging evidence of augmented pain processing in FM. SO - Arthritis Rheum 2002 May;46(5):1333-43 IN - National Inst o Dental & Craniofacial Research, NIH, Bethes+ AB - +IN: da, Maryland, USA. OBJECTIVE: To use functional magnetic resonance imaging (fMRI) to evaluate the pattern of cerebral activation during the application of painful pressure and determine whether this pattern is augmented in patients with fibromyalgia (FM) compared with controls. METHODS: Pressure was applied to the left thumbnail beds of 16 right-handed patients with FM and 16 right-handed matched controls. Each FM patient underwent fMRI while moderately painful pressure was being applied. The functional activation patterns in FM patients were compared with those in controls, who were tested under 2 conditions: the "stimulus pressure control" condition, during which they received an amount of pressure similar to that delivered to patients, and the "subjective pain control" condition, during which the intensity of stimulation was increased to deliver a subjective level of pain similar to that experienced by patients. RESULTS: Stimulation with adequate pressure to cause similar pain in both groups resulted in 19 regions of increased regional cerebral blood flow in healthy controls and 12 significant regions in patients. Increased fMRI signal occurred in 7 regions common to both groups, and decreased signal was observed in 1 common region. In contrast, stimulation of controls with the same amount of pressure that caused pain in patients resulted in only 2 regions of increased signal, neither of which coincided with a region of activation in patients. Statistical comparison of the patient and control groups receiving similar stimulus pressures revealed 13 regions of greater activation in the patient group. In contrast, similar stimulus pressures produced only 1 region of greater activation in the control group. CONCLUSION: The fact that comparable subjectively painful conditions resulted in activation patterns that were similar in patients and controls, whereas similar pressures resulted in no common regions of activation and greater effects in patients, supports the hypothesis that FM is characterized by cortical or subcortical augmentation of pain processing. 1057 PMID- 12126583 AU - Graven-Nielsen T, Arendt-Nielsen L TI - Peripheral & central sensitization in musculoskeletal pain disorders: an experimental approach. [FM] SO - Curr Rheumatol Rep 2002 Aug;4(4):313-21 IN - Center for Sensory-Motor Interaction, Laboratory for Experi+ AB - +IN: mental Pain Research, Aalborg U, Fredrik Bajers Vej 7D-3, DK-9220 Aalborg E, Denmark. tgn@smi.auc.dk This report provides a brief introduction to the manifestations of peripheral and central sensitization involved in musculoskeletal pain disorders. It has become increasingly evident that muscle hyperalgesia, referred pain, referred hyperalgesia, and widespread hyperalgesia play an important role in chronic musculoskeletal pain. A better understanding of the involved basic mechanisms and better methods to assess muscle pain in the clinic may provide new possibilities for designing rational therapies and for targeting the pharmacologic intervention optimally. Peripheral sensitization plays an important role for increased sensitivity of deep tissue. However, central sensitization may be equally important but less addressed. Quantitative sensory testing provides the possibility to evaluate these manifestations in a standardized way in patients with musculoskeletal pain or in healthy volunteers (eg, experimentally induced referred pain can be used to assess the potential involvement of central sensitization in musculoskeletal pain conditions). Central sensitization may play a role in the persistence, amplification, and spread of pain. Interventions should take this aspect into consideration. 1058 PMID- 12034582 AU - Gray GC, Reed RJ, Kaiser KS, Smith TC, Gastanaga VM TI - Self-reported Sx & medical conditions among 11,868 Gulf War-era veterans: the Seabee Health Study. [CFS] SO - Am J Epidemiol 2002 Jun 1;155(11):1033-44 IN - D o Defense Ctr for Deployment Health Research, Naval Healt+ AB - +IN: h Research Center, San Diego, CA, USA. gregory-gray@uiowa.edu US Navy Seabees have been among the most symptomatic Gulf War veterans. Beginning in May 1997, the authors mailed Gulf War-era Seabees a health survey in serial mailings. As of July 1, 1999, 68.6% of 17,559 Seabees contacted had returned the questionnaire. Compared with other Seabees, Gulf War Seabees reported poorer general health, a higher prevalence of all 33 medical problems assessed, more cognition difficulties, and a higher prevalence of four physician-diagnosed multisymptom conditions: chronic fatigue syndrome, posttraumatic stress disorder, multiple chemical sensitivity, and irritable bowel syndrome. Because the four multisymptom conditions were highly associated with one another, the authors aggregated them into a working case definition of Gulf War illness. Among the 3,831 (22% cases) Gulf War Seabee participants, multivariable modeling revealed that female, Reserve, and enlisted personnel and participants belonging to either of two particular Seabee units were most likely to meet the case definition. Twelve of 34 self-reported Gulf War exposures were mildly associated with meeting the definition of Gulf War illness, with exposure to fumes from munitions having the highest odds ratio (odds ratio = 1.9, 95% confidence interval: 1.5, 2.4). While these data do not implicate a specific etiologic exposure, they demonstrate a strong association and a high prevalence of self-reported multisymptom conditions in a large group of symptomatic Gulf War veterans. 1059 PMID- 12094819 AU - Green B TI - Focus on amisulpride. [cfs] SO - Curr Med Res Opin 2002;18(3):113-7 IN - U o Liverpool, UK. ben@priory.com AB - Amisulpride is a second-generation antipsychotic, a substituted benzamide. It appears to be an effective agent in treating schizophrenia for what are characterised as positive and negative symptoms. The recommended doses are between 400 mg/day and 800 mg/day. Amisulpride demonstrates a good global safety profile, particularly when compared with first-generation antipsychotics, such as haloperidol. There are interesting studies that point towards amisulpride's antidepressant effect in dysthymia speculative on possible roles in affective psychoses and chronic fatigue syndrome. 1060 PMID- 12650226 AU - Grisart J, Van der Linden M, Masquelier E TI - Controlled processes & automaticity in memory functioning in FM pts: relation w emotional distress & hypervigilance. SO - J Clin Exp Neuropsychol 2002 Dec;24(8):994-1009. IN - Service de Medecine Physique et Readaptation, Cliniques uni+ AB - +IN: versitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium. jacques.grisart@pi.be Evidence exists that chronic pain partially consumes the limited attentional resources, with the consequence that controlled processes sustaining cognitive tasks are affected and that automatic processes are preserved. Fibromyalgia syndrome is consistently rated as more severe than other chronic painful conditions. It is assumed here that fibromyalgia is more attention-demanding, leading to a more pronounced decrease of the controlled processes in comparison with other chronic painful conditions. In this perspective, Study 1 compares fibromyalgia patients, patients with localized pain and healthy subjects in a procedure separately estimating the within-task contributions of controlled and automatic processes in a cued recall task. As predicted, controlled processes are more strongly affected in fibromyalgia patients related to the group with localized pain. Unexpectedly, contribution of automatic processes is increased in fibromyalgia. Study 2 replicates these results and reveals that memory functioning in fibromyalgia patients is related to their painful condition as a whole rather than to any particular patient's characteristics. 1061 PMID- 12127180 AU - Guilleminault C, Palombini L, Poyares D, Chowdhuri S TI - Chronic insomnia, premenopausal women & sleep disordered breathing: part 2. Comparison of nondrug Rx trials in normal breathing & UARS post menopausa+ SO - J Psychosom Res 2002 Jul;53(1):617-23 IN - Stanford U Sleep Disorders Clinic, Stanford 94305, USA. cgu+ AB - +TI: l women complaining of chr insomnia. +IN: il@leland.stanford.edu OBJECTIVE: The question addressed here is: Can a discrete sleep disordered breathing (SDB) play a role in the insomnia complaint of postmenopausal chronic insomniacs? To respond to the query, two groups of individuals derived from a cohort of postmenopausal chronic insomniacs recruited mostly from the community were enlisted in a treatment protocol. These subjects were all individuals identified with normal breathing (n=68) and all those recognized with Upper Airway Resistance Syndrome (UARS) (n=62) pooled from a cohort of 349 postmenopausal insomniacs. TREATMENT PROTOCOL: The 62 UARS were allocated to either treatment of chronic insomnia by behavioral approaches or treatment of SDB. Based on ENT evaluation, health professionals in charge of patients selected either treatment with nasal CPAP or treatment of nasal turbinates. A stratification correction was performed to obtain a near equal number of both treatment modalities in each of the two subgroups. The 68 individuals with normal breathing were randomly allocated to immediate behavioral treatment of insomnia or delay treatment of insomnia. The delay treatment received a list of 10 sleep hygiene recommendations by mail. METHODOLOGY: Questionnaires, visual analog scales (VAS), Epworth Sleepiness Scale (ESS), clinical interviews, clinical evaluation with oto-laryngologic clinical assessment of a presence/absence of narrow upper airway and location of narrowing. Actigraphy and polysomnography (PSG) with pressure transducer/and nasal cannula system and esophageal manometry. DATA ANALYSES: All recording data were scored blind to patient's condition. RESULTS: Two subjects in the SBD-CPAP treated group (Group B) and two subjects in the delayed treatment group (Group D) dropped out. Total sleep time was improved compared to baseline in all groups, including the delayed treatment group. One group was significantly better (ANOVA, P=.05) with a more important delta score compared to baseline, and this was the behaviorally treated non-SDB. Sleep latency was significantly decreased in the behaviorally treated group (with or without SBD), P=.05, compared to SBD-treated and delayed treatment groups. Sleep latency was, however, improved in all groups. VAS for "quality of sleep" was higher at 6 months in all the groups when compared to "baseline" values. VAS for "daytime fatigue" showed significant differences among the four groups (ANOVA, P=.01); the overall score at the end of treatment was significantly better in the SDB-treated group than the other three groups. SBD was treated either by radio frequency on nasal turbinate or by nasal CPAP. CPAP-treated patients had a lower VAS score than nasal turbinate treatment, but the difference was only a trend. The delta improvement (6-month baseline condition) in "daytime fatigue" of each subgroup was calculated and compared within and between groups. Despite the small number of subjects, the turbinate-treated subgroup was significantly different from Groups B, C and D (ANOVA, P=.05). When a similar comparison was made with the nasal CPAP group, there was only a nonsignificant trend when compared to Groups B, C and D. CONCLUSION: Abnormal breathing during sleep significantly enhanced complaints of daytime fatigue in postmenopausal chronic insomniacs and this complaint improved with SDB treatment. This improvement is significantly better compared to SDB insomniacs treated with a behavioral regimen. Behavioral treatment, however, gave the best response in the non-SDB chronic insomnia group and improved better long sleep latency even in the SDB group. These results suggest the need to find an appropriate treatment for SBD even if mild and to recognize the role of SDB in relation to symptoms seen with chronic insomnia. 1062 PMID- 12445517 AU - Gupta A TI - Unconscious amygdalar fear conditioning in a subset of CFS pts. SO - Med Hypotheses 2002 Nov;59(6):727-35 IN - Robinson Coll, U o Cambridge, CB3 9AN, Cambridge, UK AB - Here, a novel hypothesis for chronic fatigue syndrome (CFS) is proposed. CFS may be a neurophysiological disorder focussing on the amygdala. During a 'traumatic' neurological event often involving acute psychological stress combined with a viral infection or other chemical or physiological stressor, a conditioned network or 'cell assembly' may be created in the amygdala. The unconscious amygdala may become conditioned to be chronically sensitised to negative symptoms arising from the body. Negative signals from the viscera or physiological, chemical and dietary stressors, become conditioned stimuli and the conditioned response is a chronic sympathetic outpouring from the amygdala via various brain pathways including the hypothalamus.This cell assembly then produces the CFS vicious circle, where an unconscious negative reaction to symptoms causes immune reactivation/dysfunction, chronic sympathetic stimulation, leading to sympathetic dysfunction, mental and physical exhaustion, and a host of other distressing symptoms and secondary complications. And these are exactly the symptoms that the amygdala and associated limbic structures are trained to monitor and respond to, perpetuating a vicious circle. Recovery from CFS may involve projections from the medial prefrontal cortex to the amygdala, to control the amygdala's expressions.I shall firstly discuss predisposing, precipitating, and perpetuating factors involved in the possible etiology of chronic fatigue syndrome (CFS), followed by the patient's experience of the illness. Finally, I shall look at a suggested explanation for the symptoms of CFS. 1063 PMID- 11838856 AU - Gur A, Karakoc M, Nas K, Remzi, Cevik, Denli A, Sarac J TI - Cytokines & depression in cases w FM. SO - J Rheumatol 2002 Feb;29(2):358-61 IN - D o Physical Med & Rehabilitation, School o Medicine, Dicle+ AB - +IN: U, Diyarbakir, Turkey. alig@dicle.edu.tr OBJECTIVE: Fibromyalgia (FM) is a chronic, painful musculoskeletal disorder characterized by widespread pain, pressure, hyperalgesia, morning stiffness, and an increased incidence of depressive symptoms. The etiology, however, has remained elusive. The aim of the present study was to examine the inflammatory response system in FM and to investigate the effect of depression level on serum cytokines. METHODS: Serum interleukin-1 (IL-I), IL-2 receptor (IL-2r), IL-6, and IL-8 and the Hamilton Depression Rating Scale (HDRS) score were determined in 32 healthy volunteers and in 81 patients with FM, classified according to the American College of Rheumatology criteria. RESULTS: In our study, serum IL-1 and IL-6 were not statistically significant, but serum IL-8, IL2r, and HDRS score were significantly higher in patients with FM than the control group (p < 0.01). In addition, in patients with FM, IL-8 was found to be related to pain intensity (r = 0.35; p < 0.01). CONCLUSION: IL-8 may play an important role in the occurrence of pain in FM. 1064 PMID- 12215864 AU - Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Ataoglu S TI - Effects of low power laser & low dose amitriptyline therapy on clinical Sx & quality of life in FM: a single-blind, placebo-controlled trial. SO - Rheumatol Int 2002 Sep;22(5):188-93 IN - D o Physical Med & Rehabilitation, Dicle U School o Medicin+ AB - +IN: e, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr The purpose of this study was to examine the effectiveness of low power laser (LPL) and low-dose amitriptyline therapy and to investigate effects of these therapy modalities on clinical symptoms and quality of life (QOL) in patients with fibromyalgia (FM). Seventy-five patients with FM were randomly allocated to active gallium-arsenide (Ga-As) laser (25 patients), placebo laser (25 patients), and amitriptyline therapy (25 patients). All groups were evaluated for the improvement in pain, number of tender points, skin fold tenderness, morning stiffness, sleep disturbance, muscular spasm, and fatigue. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rate Scale and DSM IV criteria. Quality of life of the FM patients was assessed according to the Fibromyalgia Impact Questionnaire (FIQ). In the laser group, patients were treated for 3 min at each tender point daily for 2 weeks, except weekends, at each point with approximately 2 J/cm(2) using a Ga-As laser. The same unit was used for the placebo treatment, for which no laser beam was emitted. Patients in the amitriptyline group took 10 mg daily at bedtime throughout the 8 weeks. Significant improvements were indicated in all clinical parameters in the laser group (P = 0.001) and significant improvements were indicated in all clinical parameters except fatigue in the amitriptyline group (P = 0.000), whereas significant improvements were indicated in pain (P = 0.000), tender point number (P = 0.001), muscle spasm (P = 0.000), morning stiffness (P = 0.002), and FIQ score (P = 0.042) in the placebo group. A significant difference was observed in clinical parameters such as pain intensity (P = 0.000) and fatigue (P = 0.000) in favor of the laser group over the other groups, and a significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003), and depression score (P = 0.000) after therapy. A significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003), and depression (P = 0.000) in the amitriptyline group compared to the placebo group after therapy. Additionally, a significant difference was observed in depression score (P = 0.000) in the amitriptyline group in comparison to the laser group after therapy. Our study suggests that both amitriptyline and laser therapies are effective on clinical symptoms and QOL in fibromyalgia and that Ga-As laser therapy is a safe and effective treatment in cases with FM. Additionally, the present study suggests that the Ga-As laser therapy can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM. 1065 PMID- 11845369 AU - Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E TI - Efficacy of low power laser therapy in FM: a single-blind, placebo-controlled trial. SO - Lasers Med Sci 2002;17(1):57-61 IN - Physical Med & Rehabilitation, School o Medicine, Dicle U, + AB - +IN: Diyarbakir, Turkey. alig@dicle.edu.tr Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia, despite the lack of scientific evidence to support its efficacy. A randomised, single-blind, placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia. Patients with fibromyalgia were randomly allocated to active (Ga-As) laser or placebo laser treatment daily for two weeks except weekends. Both the laser and placebo laser groups were evaluated for the improvement in pain, number of tender points, skinfold tenderness, stiffness, sleep disturbance, fatigue, and muscular spasm. In both groups, significant improvements were achieved in all parameters (p<0.05) except sleep disturbance, fatigue and skinfold tenderness in the placebo laser group (p>0.05). It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain, muscle spasm, morning stiffness and tender point numbers in favour of laser group after therapy (p<0.05). None of the participants reported any side effects. Our study suggests that laser therapy is effective on pain, muscle spasm, morning stiffness, and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia. 1066 PMID- 12508765 AU - Gur A, Karakoc M, Erdogan S, Nas K, Cevik R, Sarac AJ TI - Regional cerebral blood flow & cytokines in young females w FM. SO - Clin Exp Rheumatol 2002 Nov-Dec;20(6):753-60 IN - D o Physical Therapy & Rehabilitation, School o Med, Dicle + AB - +IN: U, Diyarbakir, Turkey. alig@dicle.edu.tr OBJECTIVE: To determine whether there is any difference in regional cerebral blood flow (rCBF) and serum cytokine levels and association between clinical parameters and rCBF and serum cytokine levels in young females with fibromyalgia (FM). The other aim was to search whether the depression state has any effect on these two parameters. METHODS: Nineteen women with FM and 20 healthy women had 99mTc-HMPAO brain single-photon-emission computed tomography (SPECT) to evaluate rCBF. Serum interleukin (IL) levels (IL 1 beta, IL 2r, IL 6 and IL 8) were measured. Clinical and psychological evaluation was also carried out in FM patients and healthy controls. RESULTS: The patients with FM had significantly higher radioactivity uptake ratio in right and left caudate nucleus (p = 0.009, p = 0.001, respectively) than healthy controls. There was statistically significant decrease in the 99mTc-HMPAO uptake in the right superior parietal (p = 0.041), gyrus rectalis (p = 0.036) and pons (p = 0.023). FM patients had significantly higher serum IL 2r and IL 8 levels (p = 0.023, p = 0.011, respectively) than controls. Additionally, FM patients had significantly higher Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Hamilton Depression Rate scale (HDRS) scores (p = 0.000) than controls. Interestingly, the patients with mild depressive symptoms or without (i.e. HDRS-score < or = 16) had significantly higher serum IL 8 levels (p = 0.027) and increased radioactivity uptake ratio in the pons (P = 0.036) than the patients with more severe depressive symptoms (i.e. HDRS-score > 16). With regard to regional cerebral blood flow, significant correlations were detected between RSP and morning stiffness (r = 0.70, p < 0.01) and sleep disturbance (r = -0.53, p < 0.05), and between gyrus rectalis and FIQ score. There were significant correlations between LCN and IL-2 (P = 0.025), between RSP and morning stiffness (P = 0.006), sleep disturbance (P = 0.021) according to multiple regression analysis test. CONCLUSION: This study shows a significant increase in rCBF of caudate nuclei, a reduction in the pons, some cortical regions activity and a increase in IL 8, IL2r levels of young female patients with FM. These findings are more prominent in patients with low HDRS scores. 1067 PMID- 12111622 AU - Gursoy S TI - Absence of association of the serotonin transporter gene polymorphism w the mentally healthy subset of FM pts. SO - Clin Rheumatol 2002 Jun;21(3):194-7 IN - D o Physical Med Rehabilitation, Kolejtepe, Gaziantep, Turk+ AB - +IN: ey. gursoysavas@hotmail.com The serotonin transporter (5-HTT) gene is considered to be a promising candidate for genetic involvement in some mood disorders owing to its role in the regulation of serotoninergic neurotransmission. In this study, we aimed to assess the significance of the 5-HTT gene in fibromyalgia syndrome (FS) as well as to find out whether the 5-HTT gene polymorphism is associated with this disease. Fifty-three mentally healthy fibromyalgia patients and 60 unrelated healthy volunteer controls were included in the study. Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory (BDI), and State and Trait Anxiety Inventory tests (STAI-I and II) were applied to both patients and controls. A PCR analysis of 5-HTT gene polymorphism was performed, and the results of the patients with FS and healthy controls were compared. In both FS patients and healthy controls the S/S, S/L and L/L alleles of the 5-HTTLPR genotype were represented in 24.5 % and 33%, 56.6% and 38.3%, and 18.9% and 28.3%, respectively. Additionally, in FS patients and healthy controls the 10/10, 10/12 and 12/12 alleles of the VNTR variant were represented in 5.9% and 11.7, 51% and 36.7%, and 43.1% and 51.7%, respectively. The 5-HTTLPR and VNTR results of the patients and controls were not significantly different ( P>0.05). We concluded that neither 5-HTT nor its polymorphism is associated with FS. Our results also address the frequencies of 5-HTT gene alleles in our population. Further studies are required to better understand the genetic basis of FS. 1068 PMID- 12395939 AU - Gustafsson M, Ekholm J, Broman L TI - Effects of a multiprofessional rehabilitation programme for pts w FM syndrome. SO - J Rehabil Med 2002 May;34(3):119-27 IN - D o Rehabilitation Med, Karolinska Institutet, Stockholm, S+ AB - +IN: weden. monika.gustafsson@ks.se The present study sought to evaluate the efficacy of a 12-week multidisciplinary rehabilitation programme mainly emphasizing physiotherapy, for patients with either fibromyalgia syndrome or chronic, widespread pain. Forty-three non-randomized female patients with fibromyalgia syndrome or chronic, widespread pain were assigned to the programme or served as waiting-list controls. The outcome was assessed with the Body Awareness Scale-Health, the Multidimensional Pain Inventory, the Quality of Life Scale, the Visual Analogue Scale and a pain drawing. Both groups were reassessed after 3 and 6 months, the treatment group also after 1 year. The treatment group improved in quality of movement and in vegetative disturbances according to the Body Awareness Scale-Health after the programme. At the 3-month and 1-year follow-ups the improvements were partly sustained. The control group showed deterioration after 3 and 6 months in three of the main scales of the Body Awareness Scale-Health. This clinical trial of a rehabilitation programme, proved beneficial for improving quality of movement and reducing the experience of vegetative disturbances. 1069 PMID- 12122924 AU - Guymer EK, Clauw DJ TI - Treatment of fatigue in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):367-78 IN - Division o Rheumatology/Allergy/Immunology, Georgetown U Me+ AB - +IN: d Ctr, 3800 Reservoir Road NW, Washington, DC 20007, USA. Clearly, fatigue is a large and challenging problem for those suffering from fibromyalgia. It adds greatly to the morbidity and disability associated with the disease. In the management of this specific symptom in fibromyalgia, attention should first be focused on identifying comorbidities that may be present and contribute to fatigue. As with other symptoms of fibromyalgia, education is a critical component of management. This can be done by the practitioner, with available free resources, or with specialized cognitive behavioral programs. This education process can be augmented with a variety of other nonpharmacologic therapies, especially very gradually increasing, low-impact, aerobic exercise programs. Numerous pharmacologic therapies may also be helpful as an adjunct to treatment. Classes of compounds that raise central levels of norepinephrine or dopamine appear to be the most specific for management of fatigue. There are also many medications used to combat fatigue in other disorders that have not yet been adequately explored as to the possible benefits in alleviating the fatigue of fibromyalgia. Advances in the management of fatigue in fibromyalgia are likely to come from a variety of directions. Easier access to well designed nonpharmacologic therapies is essential, because these treatments are underutilized in clinical practice at present. Improvements in pharmacologic therapies will come from new insights into mechanisms, especially those that might only be present in subsets of patients and would respond to more targeted therapies. 1070 PMID- 12064848 AU - Hakkinen K, Pakarinen A, Hannonen P, Hakkinen A, Airaksinen O, Valkeinen H, Ale+ TI - Effects of strength training on muscle strength, crosssectional area, maximal electromyographic activity, & serum hormones in premenopausal women w FM SO - J Rheumatol 2002 Jun;29(6):1287-95 IN - Neuromuscular Research Ctr & D o Biology o Physical Activit+ AB - +IN: y, U o Jyvaskyla, Finland. hakkinen@maila.jyu.fi +AU: n M OBJECTIVE: To examine the effects of strength training on basal concentrations and acute responses of serum hormones, and their possible interrelationships with training induced muscle hypertrophy and strength gains of the knee extensor muscles in women with fibromyalgia (FM) and healthy controls. METHODS: Twenty-one premenopausal women with FM were randomized to 21 week strength training (FMT; n = 11) or control (FMC; n = 10) groups. Twelve premenopausal sedentary healthy women served as controls (HC). Surface electromyographic (EMG) activity, maximal unilateral isometric force of the right knee extensors, and muscle cross-sectional area (CSA) of the quadriceps femoris throughout the lengths of 3/12 to 12/15 of the femur (Lf) were measured. Serum concentrations of total and free testosterone and growth hormone (GH) were analyzed at rest and in pre- and post-exercise conditions, while levels of insulin-like growth factor and dehydroepiandrosterone sulfate were measured at rest only. RESULTS: Mean (SD) maximal force increased by 18% (10%) (p < 0.001) in the FMT group, and by 22% (12%) (p < 0.001) in the HC, while in the FMC it remained unchanged. Maximum integrated EMG of the agonists (VL + VM/2) increased in HC by 22% (p < 0.05) and in the FMT by 19% (p < 0.05). Significant increases in the CSA of the QF were observed at 5 to 12/15 Lf in FMT (p < 0.05-0.01) and at 3 to 12/15 Lf in HC (p < 0.05-0.001), while in FMC the CSA remained unchanged. No training induced changes occurred in the basal concentrations of serum hormones examined. A significant acute increase took place in the mean concentration of GH at pre-training in HC (p < 0.01) and in the FMT (p < 0.05), while at post-training the elevations after the loading (p < 0.001 and 0.05) remained elevated up to 15 min (p < 0.05) in HC and up to 30 min (p < 0.01) post-loading in the FMT. CONCLUSION: Both the magnitude and time course of adaptations of the neuromuscular system to resistance training in women with FM were completely comparable to those taking place in healthy women. Basal levels of the anabolic hormones seem to be similar in women with FM compared to age matched healthy women. Observations recorded during the acute loading conditions might be considered an indication of the training induced adaptation of the endocrine system, showing that the acute GH response may become systematic after strength training in both women with FM and controls. 1071 PMID- 12212328 AU - Hampshire M TI - Could it be ME? SO - Nurs Stand 2002 May 15-21;16(35):14-5. 1072 PMID- 12196078 AU - Hassett AL, Sigal LH TI - Unforeseen consequences of terrorism: medically unexplained Sx in a time of fear. SO - Arch IM 2002 Sep 9;162(16):1809-13 IN - Departments o Med, Family Medicine, & Psychiatry, Div o Rhe+ AB - +IN: umatology & Connective Tissue Research, UMDNJ-Robert Wood Johnson MS, One Robert Wood Johnson Place, MEB-484, New Brunswick, NJ 08903, USA. a.hassett@umdnj.edu 1073 PMID- 11902610 AU - Hedenberg-Magnusson B, Ernberg M, Alstergren P, Kopp S TI - Effect on prostaglandin E2 & leukotriene B4 levels by local administration of glucocorticoid in human masseter muscle myalgia. [FM] SO - Acta Odontol Scand 2002 Jan;60(1):29-36 IN - Clinical Oral Physiology, Inst o Odontology, Karolinska Ins+ AB - +IN: titutet, Huddinge, Sweden. britt.hedenberg-magnusson@ofa.ki.se Our aim was to determine whether masseter muscle (M) and plasma (P) levels of prostaglandin E2 (PGE2) or leukotriene B4 (LTB4) are influenced by local glucocorticoid administration and whether such changes would be associated with corresponding changes in local pain or hyperalgesia. Eighteen patients with fibromyalgia and 15 with local masseter myalgia were examined immediately before and 2 weeks after intramuscular administration of glucocorticoid with regard to masseter muscle resting pain and tenderness to palpation, pressure pain threshold, maximum voluntary mouth opening (MVM), and pain on maximum voluntary mouth opening. The primary criteria for inclusion were presence of pain for a period of at least 3 months and tenderness to digital palpation in the masseter muscle region. At both visits microdialysis samples were obtained from the masseter muscle, and venous blood was collected for analysis of POE2 and LTB4. Dialysate levels of M-PGE2 did not change significantly after glucocorticoid administration, but reduction of masseter resting pain and increase of MVM were associated with decrease of M-PGE2 in the patients with fibromyalgia. Dialysate levels of M-LTB4 increased in both groups. In the patients with local myalgia the plasma level of LTB4 also increased, and this increase was associated with a decrease of pain and masseter tenderness. In conclusion, this study shows that reduction of masseter level of POE2 after intramuscular glucocorticoid administration is associated with a decrease of resting pain in patients with fibromyalgia. In addition, the masseter muscle level of LTB4 increases in patients with fibromyalgia and local myalgia. 1074 PMID- 12136899 AU - Heikkila S, Ronni S, Kautiainen HJ, Kauppi MJ TI - Functional impairment in spondyloarthropathy & FM. SO - J Rheumatol 2002 Jul;29(7):1415-9 IN - Rehabilitation Inst o the Finnish Rheumatism Association, K+ AB - +IN: angasala, Finland. OBJECTIVE: To compare the functional ability of patients with spondyloarthropathy (SpA) and fibromyalgia (FM) using the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), and and the Health Assessment Questionnaire for Spondyloarthropathy (HAQ-S), to establish whether these indicators can differentiate between these patient groups, and to ascertain how well the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) functions in patients with FM. METHODS: Twenty-four patients with SpA and 70 with FM, all female, filled in 4 self-administered questionnaires: BASFI, DFI, HAQ-S, and the BASDAI; results were compared between the 2 groups. RESULTS: The decline in functional ability was similar in patients with SpA and FM when assessed by BASFI, but slightly greater in the SpA group when assessed by DFI and HAQ-S. BASDAI was significantly (p = 0.018) greater in the FM group. CONCLUSION: An almost similar functional decline was observed in both SpA and FM patients when measured by the indices developed for patients with AS and SpA. The specificity of BASDAI in measuring disease activity in SpA was poor, as disease activity in FM was rated higher than in SpA. 1075 PMID- 12364637 AU - Hein G, Franke S TI - Are advanced glycation end-product-modified proteins of pathogenetic importance in FM? SO - Rheumatology (Oxford) 2002 Oct;41(10):1163-7 IN - D o Internal Med IV, Rheumatology & Osteology, Friedrich-Sc+ AB - +IN: hiller-U o Jena, 07740 Jena, Germany. OBJECTIVE: To quantify the serum levels of the advanced glycation end-product (AGE) pentosidine in 41 patients with fibromyalgia (FM) and 46 healthy controls. The formation of pentosidine is closely related to oxidative stress. METHODS: Pentosidine was measured by reverse-phased high-performance liquid chromatography with gradient separation on a RP-18 column. RESULTS: Patients with FM have significantly higher pentosidine serum levels than healthy subjects. CONCLUSION: AGE modification of proteins leads to reduced solubility and high resistance to proteolytic digestion of such altered proteins (e.g. AGE-modified collagens). AGEs are also able to stimulate different kinds of cells via activation of the NFkappaB, 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 phenomena in FM patients. 1076 PMID- 12122922 AU - Henriksson KG, Sorensen J TI - The promise of N-methyl-D-aspartate receptor antagonists in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):343-51 IN - D o Rehabilitation Med, Faculty o Health Sciences, Linkopin+ AB - +IN: g University, Pain Clinic, U Hosp, Linkoping S-581 85, Sweden. karl-g@telia.com There is strong evidence that intravenous administration of ketamine following a standardized protocol could be used as a diagnostic test for a central sensitization in the central nervous system in patients with FM. The combination of a weak opioid and an NMDA-receptor antagonist with few side effects is presently a promise for treatment of pain in a subgroup of patients with FM. The response to intravenously administered ketamine may help select patients for this treatment modality. 1077 PMID- 12113393 AU - Herrell R, Goldberg J, Hartman S, Belcourt M, Schmaling K, Buchwald D TI - Chronic fatigue & CFS: a co-twin control study of functional status. SO - Qual Life Res 2002 Aug;11(5):463-71 IN - Division o Epidemiology-Biostatistics, U o Illinois at Chic+ AB - +IN: ago, USA. Chronic fatigue syndrome (CFS) and the symptom of chronic fatigue may be accompanied by substantial functional disability. A volunteer sample of twins discordant for fatigue was identified from throughout the US. Fatigued twins were classified using three increasingly stringent definitions: (1) > or = 6 months of fatigue (119 pairs); (2) CFS-like illness based on self-report of the Centers for Disease Control and Prevention CFS research definition criteria (74 pairs); and (3) CFS assessed by clinical examination (22 pairs). Twins with chronic fatigue were compared with their unaffected co-twins on the eight standard scales and two physical and mental component summary scales from the medical outcomes study short-form health survey (SF-36). Substantial impairment was observed for fatigued twins across all levels of fatigue, while scores in the healthy twins were similar to US population values. Mean scores among fatigued twins on the physical and mental component summary scales were below 97 and 77%, respectively, of the US population scores. Diminished functional status was found across increasingly stringent classifications of fatigue and was associated with a dramatic decrement in physical functioning. The symptom of fatigue has a pronounced impact on functional status, especially in the domain of physical functioning. 1078 PMID- 12418343 AU - Hoffman DB TI - CFS. Sx relief is primary goal. SO - Adv Nurse Pract 2002 Mar;10(3):97-100 IN - D o Rheumatic & Immunologic Diseases, Cleveland Clinic Foun+ AB - +IN: dation, Cleveland, USA. 1079 PMID- 12719362 AU - Hofmann SG TI - Review: cognitive behavioural interventions may be effective for CFS & chr back pain. SO - BMJ. 2002 Nov 9;325(7372):1082. PMID: 12424170; Evid Based + IN - D o Psychology, Boston U, Mass, USA. AB - +SO: Ment Health 2003 May;6(2):55. 1080 PMID- 12173574 AU - Hootman JM, Sniezek JE, Helmick CG TI - Women & arthritis: burden, impact & prevention programs. [FM] SO - J Womens Health Gend Based Med 2002 Jun;11(5):407-16 IN - Arthritis Program, Health Care & Aging Studies Branch, Div + AB - +IN: o Adult & Community Health, Nat Ctr for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA 30341, USA. OBJECTIVES: To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs. RESULTS: Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDC's Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change. CONCLUSIONS: Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions. 1081 PMID- 11815287 AU - Ikuta K, Ibrahim MS, Kobayashi T, Tomonaga K TI - Borna disease virus & infection in humans. SO - Front Biosci 2002 Feb 1;7:d470-95 IN - D o Virology, Research Inst for Microbial Diseases, Osaka U+ AB - +IN: , Suita, Osaka 565-0871, Japan. ikuta@biken.osaka-u.ac.jp Borna disease virus (BDV) is a nonsegmented, negative-, single-stranded, highly neurotropic RNA virus with noncytolytic replication in the central nervous system. This virus causes neurological and behavioral disturbances primarily in horses and sheep, in addition to a variety of other vertebrate animal species and in laboratory animal models. BDV is now gaining much of the research attention, because the disturbances seen in animals resemble those of neuropsychiatric disorders in humans. These observations raise the possibility that BDV infection may be associated with certain human disorders. Serological and molecular studies on many samples from human patients with a variety of psychiatric disorders have been performed. Some reported the presence and elevated levels of serum antibodies to BDV. Others reported the presence of BDV-RNAs or BDV-antigens in the peripheral blood samples as well as in autopsied brains. Taken together these data support the possibility of human infection with BDV. On the contrary, others reported the complete absence of such BDV-markers from their samples, supporting the absence of a link between BDV infection and psychiatric disorders as well as excluding it as a human pathogen. Thus, BDV infection in humans is highly controversial. Further investigations are required to answer the question whether BDV is a human pathogen and moreover, to elucidate the possible role, if any, of BDV in the pathogeneses of these disorders. 1082 PMID- 12172953 AU - Incel NA, Erdem HR, Ozgocmen S, Catal SA, Yorgancioglu ZR TI - Pain pressure threshold values in AS. [FM] SO - Rheumatol Int 2002 Aug;22(4):148-50 IN - Ankara St Education & Research Hosp, D o Physical Med & Reh+ AB - +IN: abilitation, Ankara, Turkey. nincel@hotmail.com Rheumatic patients experience persistent and disabling pain. We aimed to investigate the pain pressure threshold (PPT) values in ankylosing spondylitis (AS) patients compared to rheumatoid arthritis (RA) patients and healthy subjects. The relationship between lumbar and thoracal Schober, chin-to-chest distance, occiput-to-wall distance, finger-to-floor distance, chest expansion, and pain scores were also evaluated in an AS group. Our study group consisted of 17 AS patients, 20 RA patients, and 21 healthy volunteers. Eighteen tender points accepted by the American College of Rheumatism (ACR) for fibromyalgia syndrome evaluation in 1990 and three control points were evaluated with Fischer's tissue compliance meter, which can also be used as an algometer. Fourteen paravertebral points were evaluated, and mean values of paravertebral myalgic scores were recorded in the AS group. Our data indicate that AS patients do not have lower PPT with respect to healthy individuals, whereas RA patients have significantly lower PPT. A significant correlation was obtained between finger-to-floor distance and paravertebral myalgic score for AS. We conclude that AS does not have a widespread pain nature as RA. 1083 PMID- 12572221 AU - Jackson E TI - An overview of CFS. SO - Nurs Stand 2002 Dec 11-17;17(13):45-53; quiz 54-5 IN - Shaw Heath Health Centre, Stockport, Cheshire. libb.jackson+ AB - +IN: @ntlworld.com This article provides an overview of the condition known as chronic fatigue syndrome, or myalgic encephalomyelitis. The author describes common symptoms and their treatment, and discusses a model of patient care, piloted in the community, which includes elements of a range of therapeutic strategies. 1084 PMID- 12027245 AU - Jason LA, Taylor RR, Kennedy CL, Jordan K, Huang CF, Torres-Harding S, Song S, + TI - A factor analysis of chr fatigue Sx in a community-based sample. [CF] SO - Soc Psychiatry Psychiatr Epidemiol 2002 Apr;37(4):183-9 IN - D o Psychology, DePaul U, Chicago, IL 60614, USA. ljason@wp+ AB - +IN: post.depaul.edu +AU: Johnson D BACKGROUND: This study examined characteristics of fatigue in individuals with chronic fatigue from a community-based study. Most studies of chronic fatigue have been based on patients recruited from primary or tertiary care settings. Samples such as these might not be representative of patients within the general population. The purpose of this study was to determine the factor structure of participants' symptoms in a random community sample of individuals with chronic fatigue. METHOD: A random sample of 18,675 respondents in Chicago received a brief telephone questionnaire designed to identify individuals with chronic fatigue. A group of 780 (4.2%) with chronic fatigue received further interview via telephone questionnaire involving characteristics of their fatigue. The analyses for this study were based on those people identified with having chronic fatigue. A factor analysis was conducted on responses to questionnaire items, and a four-factor solution emerged. Mean factor scores were derived and analyzed in relation to sociodemographic characteristics and sample subgroups. RESULTS: The four factors were labeled: Lack of Energy, Physical Exertion, Cognitive Functioning, and Fatigue and Rest. CONCLUSIONS: Results indicated that individuals with chronic fatigue have symptoms that can be differentiated into theoretically distinct factors. 1085 PMID- 11928774 AU - Jason LA, Taylor RR, Plioplys S, Stepanek Z, Shlaes J TI - Evaluating attributions for an illness based upon the name: CFS, myalgic encephalopathy & Florence Nightingale disease. SO - Am J Community Psychol 2002 Feb;30(1):133-48 IN - Center for Community Research, DePaul U, Chicago, Illinois + AB - +IN: 60614, USA. ljason@wppost.depaul.edu In recent years, considerable discussion has occurred about stigma surrounding the name given to an illness currently known as chronic fatigue syndrome (CFS). Although patients and medical personnel have expressed varying opinions on this issue, no studies have evaluated how beliefs about the illness change based upon the type of name used for diagnostic purposes. Proposals have been put forth to rename the illness with an eponym (a famous patient's or researcher's name) or with a less trivial sounding, more medically based type of name. In this study, attributions about CFS were measured in three groups of medical trainees. All groups read the same case study of a person with classic symptoms of chronic fatigue syndrome, with the only difference being in the type of name given. Trainees then were asked to provide attributions about certain aspects of the illness, including its cause, severity, and prognosis. Results suggested that, across name conditions, most trainees appeared to consider the symptom complex of CFS a serious illness resulting in poor quality of life. In addition, findings indicated that the name, chronic fatigue syndrome, may be regarded less seriously than the Myalgic Encephalopathy name with respect to some important aspects of the illness. In this study, specialty of medical trainee also played a role in how the illness was perceived. 1086 PMID- 11790441 AU - Jason LA, Torres-Harding SR, Carrico AW, Taylor RR TI - Symptom occurrence in persons w CFS. SO - Biol Psychol 2002 Feb;59(1):15-27 IN - DePaul U, Ctr for Community Research, 990 West Fullerton Ro+ AB - +IN: ad, Chicago, IL 60614, USA. Ljason@depaul.edu This investigation compared differences in the occurrence of symptoms in participants with CFS, melancholic depression, and no fatigue (controls). The following Fukuda et al. [Ann. Intern. Med. 121 (1994) 953] criteria symptoms differentiated the CFS group from controls, but did not differentiate the melancholic depression group from controls: headaches, lymph node pain, sore throat, joint pain, and muscle pain. In addition, participants with CFS uniquely differed from controls in the occurrence of muscle weakness at multiple sites as well as in the occurrence of various cardiopulmonary, neurological, and other symptoms not currently included in the current case definition. Implications of these findings are discussed. 1087 PMID- 12126585 AU - Jones AK, Kulkarni B, Derbyshire SW TI - Functional imaging of pain perception. SO - Curr Rheumatol Rep 2002 Aug;4(4):329-33 IN - D o Human Pain Physiology, U D o Rheumatic Diseases Centre,+ AB - +IN: Hope Hosp, Stott Lane, Salford, M6 8HD, United Kingdom. ajones1@fs1.ho.man.ac.uk The application of functional imaging techniques has revolutionized the field of human pain physiology and has elaborated the understanding of mechanisms involved in pain processing at the cortical and subcortical levels. With these insights, new therapeutic interventions are being developed in the treatment of acute and chronic pain conditions. 1088 PMID- 12022321 AU - Jones KD, Burckhardt CS, Clark SR, Bennett RM, Potempa KM TI - A randomized controlled trial of muscle strengthening versus flexibility training in FM. SO - J Rheumatol 2002 May;29(5):1041-8 IN - School o Nursing, The Oregon Health & Science U, Portland 9+ AB - +IN: 7201, USA. joneskim@ohsu.edu OBJECTIVE: To determine the effectiveness of a muscle strengthening program compared to a stretching program in women with fibromyalgia (FM). METHODS: Sixty-eight women with FM were randomly assigned to a 12 week, twice weekly exercise program consisting of either muscle strengthening or stretching. Outcome measures included muscle strength (main outcome variable), flexibility, weight, body fat, tender point count, and disease and symptom severity scales. RESULTS: No statistically significant differences between groups were found on independent t tests. Paired t tests revealed twice the number of significant improvements in the strengthening group compared to the stretching group. Effect size scores indicated that the magnitude of change was generally greater in the strengthening group than the stretching group. CONCLUSION: Patients with FM can engage in a specially tailored muscle strengthening program and experience an improvement in overall disease activity, without a significant exercise induced flare in pain. Flexibility training alone also results in overall improvements, albeit of a lesser degree. 1089 PMID- 12122928 AU - Jones KD, Clark SR TI - Individualizing the exercise prescription for persons w FM. SO - Rheum Dis Clin North Am 2002 May;28(2):419-36, x-xi IN - School o Nursing, Oregon Health & Science U, SN-5S, 3181 SW+ AB - +IN: Sam Jackson Park Road, Portland, OR 97201, USA. jonjeskim@ohsu.edu "Exercise is good for you; you must exercise, and just do it" are common admonitions to fibromyalgia (FM) patients by health professionals. "I can't exercise; I hurt too much to exercise; and, I don't have enough energy to exercise" are equally common responses from patients with FM. Such exchanges can lead to frustration for both patient and provider. The factor that neither participant in the dialogue is addressing is that exercise carries both risks and benefits for persons with FM. Although for decades exercise has been acknowledged to be a key component of the treatment of FM, the majority of FM patients remain aerobically unfit, with poor muscle strength and limited flexibility. Unfit muscle is theoretically more prone to muscle microtrauma, which causes localized pain and may trigger widespread pain through disordered central processing. The purpose of this article is to provide practicing health care providers with guidelines for prescribing exercise to FM patients that take into account the risk/benefit ratio. A sample exercise prescription is included. 1090 PMID- 12011599 AU - Jones KD, Clark SR, Bennett RM TI - Prescribing exercise for people w FM. SO - AACN Clin Issues 2002 May;13(2):277-93 IN - School o Nursing, Oregon Health & Science U (Dr Jones, Dr C+ AB - +IN: lark); & the School o Med, Div o Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Ore (Dr Bennett). Fibromyalgia (FM) is a costly and debilitating pain syndrome which is commonly encountered by advanced practice nurses working in acute care settings. Fibromyalgia affects nearly 6 million people in the United States, approximately 80% to 90% of whom are women. Symptoms of FM include widespread and localized pain, disrupted sleep, fatigue, visceral pain and other pain syndromes, neurological symptoms (eg, dizziness, numbness, tingling, impaired cognition), and exercise-induced pain. Difficulties remaining active with FM may lead to extreme deconditioning, inability to remain employed, and eventually even impaired ability in complete activities of daily living. Exercise that combats deconditioning without triggering pain is, therefore, a key component in treating FM. Clinicians who understand FM pain and associated symptoms can minimize the negative impact of deconditioning by prescribing disease-specific exercise for people with FM. 1091 PMID- 12455482 AU - Katz BZ TI - Update on CFS & Epstein-Barr virus. SO - Pediatr Ann 2002 Nov;31(11):741-4 IN - D o Pediatrics, Northwestern U Feinberg, School o Med, Chic+ AB - +IN: ago, IL, USA. bkatz@northwestern.edu 1092 PMID- 12019583 AU - Kendall SA, Elert J, Ekselius L, Gerdle B TI - Are perceived muscle tension, electromyographic hyperactivity & personality traits correlated in the FM syndrome? SO - J Rehabil Med 2002 Mar;34(2):73-9 IN - D o Rehabilitation Med, Faculty o Health Sciences, Linkopin+ AB - +IN: g, Sweden. sally.a.kendall@inr.liu.se The study was performed to investigate the relationship between perceived muscle tension and electromyographic hyperactivity and to what extent electromyographic (EMG) hyperactivity relates to personality traits in fibromyalgics. Thirty-six females with fibromyalgia performed isokinetic maximal forward flexions of the shoulder combined with surface EMG recordings of the trapezius and infraspinatus muscles. Signal amplitude ratio and peak torque were calculated in the initial and endurance test phases. Pain intensity, perceived general and local shoulder muscle tension, and personality traits using the Karolinska Scales of Personality were assessed pre-test. Neither perceived muscle tension nor muscular tension personality trait correlated with EMG muscle hyperactivity. Perceived general muscle tension correlated with aspects of anxiety proneness (including muscle tension) of the Karolinska Scales of Personality. Pain intensity interacted with many of the variables. We propose that when patients with fibromyalgia report muscle tension that they may be expressing something other than physiological muscle tension. 1093 PMID- 12051466 AU - Kerns RD, Kassirer M, Otis J TI - Pain in multiple sclerosis: a biopsychosocial perspective. [FM] SO - J Rehabil Res Dev 2002 Mar-Apr;39(2):225-32 IN - VA Connecticut Healthcare System & Yale U, West Haven, CT 0+ AB - +IN: 6516, USA. robert.kerns@med.va.gov Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These painful conditions may respond to pharmacological, surgical, rehabilitation, and psychological interventions. However, unresolved pain, associated disability, and affective distress are common. In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause osteoporosis and headache or other symptoms that may exacerbate pain and pain-related disability. Conversely, efforts to manage pain may have negative effects on the symptoms of MS (e.g., increased fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive biopsychosocial model is recommended. Such an approach needs to consider the exacerbating nature of MS, MS-related pain, and interventions aimed at their management. Suggestions for future research on MS-related pain conclude the article. 1094 PMID- 11911112 AU - Kerr JR, Bracewell J, Laing I, Mattey DL, Bernstein RM, Bruce IN, Tyrrell DA TI - CFS & arthralgia following parvovirus B19 infection. SO - J Rheumatol 2002 Mar;29(3):595-602 IN - D o Microbiology, Royal Brompton Hosp, Nat Heart & Lung Ins+ AB - +IN: t, Imperial Coll School o Med, London, UK. j.kerr@ic.ac.uk OBJECTIVE: To determine the incidence of arthralgia and fatigue complicating B19 infection, along with associated B19 markers and autoantibodies. METHODS: We studied patients with acute B19 infection (n = 51), patients followed from the time of acute B19 infection (mean 22.5 mo) (n = 39), and healthy controls (n = 50). Clinical details were collected using a questionnaire and blood was tested for B19 markers and autoantibodies. RESULTS: Acute B19 arthralgia occurred in 31 patients and was associated with female sex (p = 0.007) and age > 20 years (p = 0.02). Acute B19 fatigue occurred in 8 patients and was not significantly associated with any marker. At followup, symptoms consisted of arthralgia (n = 5), arthralgia and fatigue (n = 6), fatigue (n = 7), lymphadenopathy (n = 1), and purpura due to thrombocytopenia (n = 2). Chronic B19 arthralgia was associated with persistent B19 viremia (p = 0.029). Comparison of the B19 followup group with the controls revealed a significantly increased prevalence of arthralgia (p = 0.0002), fatigue (p < 0.0001), and all other markers. Chronic B19 arthralgia was associated with both acute B19 arthralgia (p = 0.0168) and positive ANA at acute infection (p = 0.0043). Chronic B19 fatigue was associated with acute B19 fatigue (p = 0.011). Five patients fulfilled the Centers for Disease Control criteria for a diagnosis of chronic fatigue syndrome (CFS) and one of these was negative for serum anti-B19 IgG at followup by both Western blot and immunofluorescence. However, there was no characteristic pattern of B19 markers/autoantibodies in patients with B19 associated chronic fatigue. CONCLUSION: CFS may follow acute parvovirus B19 infection; however, attribution of a case of CFS to B19 infection may be extremely difficult in the absence of serological confirmation of acute infection at fatigue onset. 1095 PMID- 11961307 AU - Kim YA, Lee SS, Park K TI - Validation of a korean version of the FM impact questionnaire. SO - J Korean Med Sci 2002 Apr;17(2):220-4 IN - D o Internal Med, Chonnam Nat U MS, Gwangju, Korea. shinseo+ AB - +IN: k@chonnam.ac.kr The aim of this study was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Korean and to evaluate its reliability and validity for use with Korean-speaking patients with fibromyalgia (FM). After translating the FIQ into Korean, we administered it to 55 patients with FM (28 patients filled out the questionnaire again 7 days later) together with a Korean version of the Health Assessment Questionnaire (HAQ) and the Symptom Checklist-90-Revision (SCL-90-R). The tender-point count (TPC) was calculated from tender points identified by thumb palpation. In addition to sociodemographic characteristics, the severity of relevant current clinical symptoms, e.g., pain intensity, fatigue, and morning stiffness, were assessed by 10-cm visual analog scales (VAS). The test-retest reliability was between 0.466 and 0.780 (total 0.778). Cronbach's alpha was 0.800 for FIQ1 (the first assessment) and 0.857 for FIQ2 (the second assessment), indicating acceptable levels of internal consistency for both assessments. Significant correlations were obtained between the FIQ items, the HAQ, the severity of clinical symptoms, and the subscales of the SCL-90-R. In conclusion, the Korean version of the FIQ is a reliable and valid instrument for measuring health status and physical functioning in Korean patients with FM. 1096 PMID- 12022320 AU - King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W TI - Predictors of success of intervention programs for persons w FM. SO - J Rheumatol 2002 May;29(5):1034-40 IN - Health Science Council Office, U o Alberta, Edmonton, Canad+ AB - +IN: a. OBJECTIVE: To determine which sociodemographic, psychological, and behavioral characteristics of persons with fibromyalgia (FM) will predict a positive response to treatment; and to determine if subjects classified according to the Multidimensional Pain Inventory (MPI) responded differently to the interventions. METHODS: One hundred twenty-eight women with FM underwent baseline testing and were randomized into one of 3 intervention groups or a control group. After the 12 week program, the subjects were reexamined on the same pretest measures. Stepwise regression analyses were conducted to determine the variables that could significantly predict the change in the dependent variables. A reliability of change index was calculated to determine the proportion of responders and nonresponders. RESULTS: The stepwise regression revealed significant predictor variables for change for all dependent variables except the Fibromyalgia Impact Questionnaire; however, the percentage of the variance in the change scores explained by the independent variables ranged from 4 to 15%. Results from the reliability of change index indicated that no MPI subgroup responded more than another group on any measure. CONCLUSION: Select sociodemographic and psychosocial variables and type of intervention were not strong predictors of improvement in a variety of measures after a treatment program. The low percentage of explained variance may be due to the heterogeneity of FM. Additionally, the low percentage of responders suggests that current forms of treatment are not effective for a large portion of the FM population. 1097 PMID- 12465163 AU - King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W TI - The effects of exercise & education, individually or combined, in women w FM. SO - J Rheumatol 2002 Dec;29(12):2620-7 IN - Health Science Council Office, U o Alberta, Edmonton, Alber+ AB - +IN: ta, Canada. OBJECTIVE: To examine the effectiveness of a supervised aerobic exercise program, a self-management education program, and the combination of exercise and education for women with fibromyalgia (FM). METHODS: One hundred fifty-two women were randomized into one of 4 groups: exercise-only, education-only, exercise and education, or control. The duration of the study was 12 weeks. All subjects were analyzed at 3 times: before study, immediately upon completion, and 3 months after completion of the intervention program on measures of disability, self-efficacy, fitness, tender point count, and tender point tenderness. Of the 152 women, complete data were available for 95 and 69 who complied with the protocol. In order to determine the group time interaction, a 2 way analysis of variance with repeated measures was used for each measure. RESULTS: The only significant group time interaction was reported with the compliance analysis for the Self-Efficacy Coping with Other Symptoms subscale and the Six Minute Walk. If the program was followed, the combination of a supervised exercise program and group education provided persons with FM with a better sense of control over their symptoms. Fitness improved in the 2 groups undergoing supervised aerobic exercise programs. However, the improvement in fitness was maintained at followup in the exercise-only group and not the combined group. Conclusion. Subjects receiving the combination of exercise and education and who complied with the treatment protocol improved their perceived ability to cope with other symptoms. In addition, a supervised exercise program increased walking distance at post-test, an increase that was maintained at followup in the exercise-only group. Results demonstrate the challenges with conducting exercise and education studies in persons with FM. 1098 PMID- 12194892 AU - Kipen HM, Fiedler N TI - Environmental factors in medically unexplained Sx & related syndromes: the evidence & the challenge. [CFS] SO - Environ Health Perspect 2002 Aug;110 Suppl 4:597-9 IN - Environmental & Occupational Health Sciences Institute--Occ+ AB - +IN: upational Health Div, U o Med & Dentistry o New Jersey--Robert Wood Johnson MS, Piscataway, New Jersey 08854, USA. kipen@eohsi.rutgers.edu Symptoms, and especially those without clear underlying medical explanations, account for a large percentage of clinical encounters. Many unexplained symptoms have been organized by patients and practitioners into syndromes such as chronic fatigue syndrome, multiple chemical sensitivity, sick building syndrome, Gulf War syndrome, and the like. All these syndromes are defined solely on the basis of symptoms rather than by medical signs. Some of the above-described conditions overlap strongly with explained conditions such as asthma. The relationship of such symptoms and syndromes to environmental exposure is often sharply debated, as is the distinction between the various syndromes. This leads to problems of what type of research should be conducted and who should conduct it. It is time to develop a comprehensive research agenda to sort out nomenclature, epidemiology, and environmental causation for these conditions, moving toward comprehensive and effective public health and clinical approaches. 1099 PMID- 12194891 AU - Kipen HM, Fiedler N TI - The role of environmental factors in medically unexplained Sx & related syndromes: conference summary & recommendations. [CFS] SO - Environ Health Perspect 2002 Aug;110 Suppl 4:591-5 IN - Environmental & Occupational Health Sciences Inst, U o Med + AB - +IN: & Dentistry-Robert Wood Johnson MS, Piscataway, New Jersey 08854, USA. kipen@eohsi.rutgers.edu This monograph of peer-reviewed articles is based on presentations at the conference "Environmental Factors in Medically Unexplained Physical Symptoms and Related Syndromes" held 10-12 January 2001 in Piscataway, New Jersey, USA. The purpose of the conference was to determine research priorities for elucidating the role of environmental factors in medically unexplained symptoms and symptom syndromes. These include conditions such as chronic fatigue syndrome, multiple chemical sensitivities, sick building syndrome, Gulf War illness, and the like. Approximately 1 1/2 days were devoted to plenary talks and 1 day was devoted to break-out sessions to discuss epidemiologic, psychosocial, and experimental research. Recommendations were made for a series of epidemiologic, psychosocial, and experimental research approaches, with acknowledgment that nosology issues are clearly fundamental to advancing understanding of these conditions. 1100 PMID- 11982547 AU - Kisely SR TI - Treatments for CFS & the Internet: a systematic survey of what your pts are reading. SO - Aust N Z J Psychiatry 2002 Apr;36(2):240-5 IN - Primary Care Mental Health Ctr, U o Western Australia, Frem+ AB - +IN: antle, WA, Australia. stephenk@cyllene.uwa.edu.au OBJECTIVE: To evaluate the type, quality, and focus of patient information on the treatment of chronic fatigue syndrome on the Internet using simple search techniques. DESIGN: The search phrase 'chronic fatigue syndrome' was entered into nine common Internet search engines. The 25 most highly ranked pages identified by each of the nine search engines were analysed using a standardized pro forma. The following outcome measures were used: balance of content, consistency of content with evidence-based practice, declared authorship with credentials, information sources including the presence of references, the declaration of any potential conflict of interest, and the need to clarify information with an appropriate health professional. RESULTS: Two hundred and twenty-five websites were reviewed during a 2-week period in September 2000. A further 15 sites (6.3%) were inaccessible. Agreement between websites and systematic reviews of treatment for chronic fatigue syndrome ranged from 4 to 68%, the greatest agreement being for recommendations for graded exercise and the avoidance of prolonged rest. Most sites (64%) had a named author. Only a quarter to a third contained a declaration of interest, advised readers to clarify information with an appropriate health professional, or avoided inaccurate statements. CONCLUSIONS: The Internet contains a great deal of information on chronic fatigue syndrome that is neither balanced nor consistent with evidence-based practice. Doctors individually, and as a profession, should provide guidance on which Internet sites to trust. 1101 PMID- 11932964 AU - Kissel JT TI - The problem of FM. SO - Muscle Nerve 2002 Apr;25(4):473-6 1102 PMID- 12043728 AU - Kmietowicz Z TI - Cognitive behaviour therapy & exercise are the only effective Rxs for chr fatigue, says study. [CF] SO - BMJ 2002 Jun 1;324(7349):1298 1103 PMID- 12173124 AU - Koelle DM, Barcy S, Huang ML, Ashley RL, Corey L, Zeh J, Ashton S, Buchwald D TI - Markers of viral infection in monozygotic twins discordant for CFS. SO - Clin Infect Dis 2002 Sep 1;35(5):518-25 IN - D o Laboratory Med, U o Washington, Seattle, WA, USA. dedra+ AB - +IN: @u.washington.edu To estimate the prevalence of viruses associated with chronic fatigue syndrome (CFS) and to control for genetic and environmental factors, we conducted a co-twin control study of 22 monozygotic twin pairs, of which one twin met criteria for CFS and the other twin was healthy. Levels of antibodies to human herpesvirus (HHV)-8, cytomegalovirus, herpes simplex virus 1 and 2, and hepatitis C virus were measured. Polymerase chain reaction (PCR) assays for viral DNA were performed on peripheral blood mononuclear cell specimens to detect infection with HHV-6, HHV-7, HHV-8, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, varicella zoster virus, JC virus, BK virus, and parvovirus B19. To detect lytic infection, plasma was tested by PCR for HHV-6, HHV-8, cytomegalovirus, and Epstein-Barr virus DNA, and saliva was examined for HHV-8 DNA. For all assays, results did not differ between the group of twins with CFS and the healthy twins. 1104 PMID- 12097314 AU - Korszun A, Young EA, Singer K, Carlson NE, Brown MB, Crofford L TI - Basal circadian cortisol secretion in women w temporomandibular disorders. [FM] SO - J Dent Res 2002 Apr;81(4):279-83 IN - D o Psychological Med, U o Wales Coll o Medicine, Heath Par+ AB - +IN: k, Cardiff CF14 4XN, UK. Muscular temporomandibular disorder (TMD) is a common stress-related condition showing marked comorbidity with depression and fibromyalgia (FM), both of which are associated with dysregulation of cortisol secretion. We measured cortisol levels in 15 women with well-defined TMD and 15 matched controls by sampling blood at 10-minute intervals over 24 hours in a controlled environment. TMD patients showed markedly increased daytime cortisol levels 30% to 50% higher than those of controls (p = 0.0032) and a one-hour phase delay in the timing of maximum cortisol levels (p = 0.048). Increased activation of the stress hormone axis by conscious pain perception is a likely explanation, but the magnitude of the increase could indicate that pain in the facial region acts as a greater stimulus than pain elsewhere in the body. 1105 PMID- 12406308 AU - Korszun A TI - Facial pain, depression & stress - connections & directions. [FM] SO - J Oral Pathol Med 2002 Nov;31(10):615-9 IN - D o Psychological Med, U o Wales Coll o Medicine, Heath Par+ AB - +IN: k, Cardiff CF14 4XN, UK. korszun@cf.ac.uk Chronic facial pain is associated with depression, stress and other chronic pain disorders such as fibromyalgia. There is growing evidence that all these conditions share underlying pathophysiological processes. This review explores this relationship and examines the role of the main stress hormone axis, the hypothalamic-pituitary-adrenal axis, in the pathogenesis of facial pain including possible future therapeutic approaches. 1106 PMID- 12069867 AU - Korszun A, Young EA, Engleberg NC, Brucksch CB, Greden JF, Crofford LA TI - Use of actigraphy for monitoring sleep & activity levels in pts w FM & depression. SO - J Psychosom Res 2002 Jun;52(6):439-43 IN - D o Psychological Med, U o Wales Coll o Medicine, Monmouth + AB - +IN: House, Tenovus Building, Heath Park, CF4 4XW, Cardiff, UK. korszun@cf.ac.uk OBJECTIVE: The hallmark symptom of fibromyalgia (FM) is widespread chronic pain, but most patients are also impaired due to fatigue and sleep disturbance, and there is a strong association with depression. We compared levels of activity and sleep patterns in FM patients, with and without comorbid depression, to those of normal healthy controls and depressed patients. METHODS: Actigraphy was carried out on 16 patients with uncomplicated FM, 6 FM patients with comorbid depression, 9 patients with recurrent major depression, and 28 healthy controls over a period of 5-7 days. The means of daytime activity levels, nighttime activity levels, and percentage time spent asleep during the daytime and nighttime were calculated and compared. RESULTS: Controls showed high levels of activity during the day and uninterrupted periods of sleep at night. Patients with FM alone showed similar levels of daytime activity, but disturbed sleep with significantly increased levels of activity at night compared to normal controls. Patients with depression alone also showed disturbed sleep compared to normal controls. However, patients with FM and comorbid depression showed the most impairment, with significantly reduced daytime activity and significantly increased daytime sleeping compared to controls, as well as more sleep interruption and movement during the night. CONCLUSION: Actigraphy is a useful means of studying activity levels and sleep patterns and demonstrated significant differences between FM patients with and without comorbid depression. 1107 PMID- 11894732 AU - Kowal K, Schacterele RS, Schur PH, Komaroff AL, DuBuske LM TI - Prevalence of allergen-specific IgE among pts w CFS. SO - Allergy Asthma Proc 2002 Jan-Feb;23(1):35-9 IN - D o Allergology & Internal Disease, U MS, Bialystok, Poland. AB - The prevalence of atopy among patients having chronic fatigue syndrome (CFS) has been reported to be as high as 80% in published surveys of patients with this syndrome. However, many of the reports relied on self-assessment by patients for the presence of atopy or solely used total immunoglobulin E (IgE) levels to assess the likelihood of atopy. To more critically assess the presence of atopy among patients with CFS, testing was done for total IgE and allergen-specific IgE using the Pharmacia CAP system including 20 common allergens: trees (birch/oak/ash), grass (rye/blue), weeds (common/giant ragweed), molds (Penicillium/Aspergillus/Alternaria), dust mites (Dermatophagoides pteronyssinus/Dermatophagoides farinae), animal dander (cat/dog), and foods (egg white/milk/wheat/corn/peanut/shrimp). Testing of 50 patients having documented CFS indicated that 78% had total IgE < 100 IU/mL, among whom 26% had a positive test for allergen-specific IgE of class I or greater for one or more allergens. Among the 22% of CFS patients having a total IgE > 100 IU/mL, 73% had a positive test for allergen-specific IgE for one or more allergens. The most commonly positive allergens were dust mites (24-26%), whereas molds (0-6%) and foods (0-4%) were rarely positive. The overall frequency of positive results for the presence of allergen-specific IgE among CFS patients was 36%, not significantly different from the normal prevalence of these antibodies in the general population (20-35%). This assessment of the prevalence of allergen-specific IgE antibodies in patients with CFS fails to support a potential association between CFS and atopy. 1108 PMID- 12397854 AU - Kranzler JD, Gendreau JF, Rao SG TI - The psychopharmacology of FM: a drug development perspective. SO - Psychopharmacol Bull 2002 Winter;36(1):165-213 IN - Cypress Bioscience, Inc., 4350 Executive Drive, Suite 325, + AB - +IN: San Diego, CA 92121, USA. jkranzler@cypressbio.com The fibromyalgia syndrome (FMS) is the most frequent cause of chronic widespread pain. In this review, we summarize the state of the art on the syndrome and its pathophysiology, with an emphasis on identifying bases for the development of novel therapies. Toward this end, the anatomy and physiology of pain pathways are summarized, followed by a review of the altered biology of pain processing, neurotransmitter function, and neuroendocrine systems in FMS. The categories of drugs currently employed to treat the disorder are detailed, along with a critical review of the literature supporting such use. Throughout the article, FMS is compared with and related to both major depressive disorder and neuropathic pain, conditions that may share some common biological processes with FMS but for which new drug discovery efforts are significantly more active due to the more established nature of these diagnoses. 1109 PMID- 12174928 AU - Krueger GR, Brandt ME, Wang G, Berthold F, Buja LM TI - A computational analysis of Canale-Smith syndrome: chr lymphadenopathy simulating malignant lymphoma. [CFS] SO - Anticancer Res 2002 Jul-Aug;22(4):2365-71 IN - D o Pathology & Laboratory Med, U o Texas-Houston MS, 77030+ AB - +IN: , USA. Gerhard.Krueger@uth.tmc.edu OBJECTIVE: The objective of this study was to simulate changes in the human T cell system representing Canale-Smith syndrome using a dynamic computer model of T cell development and comparing with available human data. STUDY DESIGN: Physiological stepwise maturation and function of T lymphocytes in the computer model is altered by introducing functional disturbances following lymphotropic virus infection. In the present model, acute and chronic persistent infection with the human herpesvirus-6 (HHV-6) was simulated, and ensuing changes in T cell populations were compared with those measured in human patients. RESULTS: Using our computer model we previously found that simulated acute HHV-6 infection produced T cell computer data, which resembled an infectious mononucleosis-like disease in patients. Simulated chronic persistent infection, instead, resulted in variable cell changes comparing well to patients with chronic fatigue syndrome. In one setting, however, persistent immature lymphocytosis was observed similar to what initial has been described in this journal as Canale-Smith syndrome. CONCLUSION: Using a computer model developed by us we were able to produce simulations that resemble the immune system features of Canale-Smith syndrome. Further understanding of these simulation results may possibly guide future investigations into this disorder. 1110 PMID- 12414265 AU - Kuratsune H, Yamaguti K, Lindh G, Evengard B, Hagberg G, Matsumura K, Iwase M, + TI - Brain regions involved in fatigue sensation: reduced acetylcarnitine uptake into the brain. [CFS] SO - Neuroimage 2002 Nov;17(3):1256-65 IN - D o Molecular Med, Hematology & Oncology, Osaka U Graduate + AB - +IN: School o Medicine, C9, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. kura@bldon.med.osaka-u.ac.jp +AU: Onoe H, Takahashi M, Machii T, Kanakura Y, Kitani T, Langstrom B, Watanabe Y Fatigue is an indispensable sense for ordering rest. However, the neuronal and molecular mechanisms of fatigue remain unclear. Chronic fatigue syndrome (CFS) with long-lasting fatigue sensation seems to be a good model for studying these mechanisms underlying fatigue sensation. Recently, we found that most patients with CFS showed a low level of serum acetylcarnitine, which well correlated with the rating score of fatigue, and that a considerable amount of acetyl moiety of serum acetylcarnitine is taken up into the brain. Here we show by metabolite analysis of the mouse brain that an acetyl moiety taken up into the brain through acetylcarnitine is mainly utilized for the biosynthesis of glutamate. When we studied the cerebral uptake of acetylcarnitine by using [2-(11)C]acetyl-L-carnitine in 8 patients with CFS and in 8 normal age- and sex-matched controls, a significant decrease was found in several regions of the brains of the patient group, namely, in the prefrontal (Brodmann's area 9/46d) and temporal (BA21 and 41) cortices, anterior cingulate (BA24 and 33), and cerebellum. These findings suggest that the levels of biosynthesis of neurotransmitters through acetylcarnitine might be reduced in some brain regions of chronic fatigue patients and that this abnormality might be one of the keys to unveiling the mechanisms of the chronic fatigue sensation. 1111 PMID- 11885358 AU - Lacour M, Zunder T, Dettenkofer M, Schonbeck S, Ludtke R, Scheidt C TI - An interdisciplinary therapeutic approach for dealing w pts attributing CF & functional memory disorders to environmental poisoning--a pilot study SO - Int J Hyg Environ Health 2002 Feb;204(5-6):339-46 IN - Institute o Environmental Med & Hosp Epidemiology, Freiburg+ AB - +IN: U Hospital, Hugstetter Strasse 55, D-79106 Freiburg, Germany. mlac@iuk3.ukl.uni-freiburg.de Nonspecific symptoms and a general feeling of ill health that is difficult to objectify are the commonest health problems with which patients present to an Environmental Medicine Outpatient Department (OPD). Of this group, a great proportion meets the classification criteria for Chronic Fatigue Syndrome (CFS) or Functional Memory Disorders in association with Idiopathic Chronic Fatigue (FMD-ICF). This is a longitudinal study of the OPD of Environmental Medicine, Freiburg University Hospital, Germany, to determine the feasibility and impact of an interdisciplinary therapeutic approach (self-help program, acupuncture, psychosomatic support by group interventions) in 8 patients with CFS, FMD-ICF, or CFS in association with self-reported Multiple Chemical Sensitivities (sr-MCS). The intervention took into consideration the patients' need for treatment of physical aspects of their disease. This is an important step to motivate patients into required psychosomatic support. Although none of the patients was willing to accept psychosomatic support or psychotherapy at study outset, acceptance of psychosomatic group interventions was high during the study course. Additionally five patients started with personal counseling at the Psychosomatic Clinic, and, without feeling stigmatized, 4 patients started with specific psychotherapy. The patients' quality of life showed no increase after four months, but, as shown by the Sum-Score of SF-36, it had improved significantly at the end of the study, which covered eight months' treatment (p = 0.015). Two follow-up investigations showed that this improvement probably persisted in part (mainly in the dimensions mental health, social function, physical role function, and vitality). In conclusion our interdisciplinary therapeutic approach indicates successful treatment of patients attributing CFS, CFS/sr-MCS, and FMD-ICF to environmental poisoning. We now plan to conduct a randomized controlled trial in the future. 1112 PMID- 12387704 AU - Lawson K TI - Tricyclic antidepressants & FM: what is the mechanism of action? SO - Expert Opin Investig Drugs 2002 Oct;11(10):1437-45 IN - Biomedical Research Centre & Div o Biomedical Sciences, She+ AB - +IN: ffield Hallam U, School o Science & Mathematics, City Campus, UK. K.Lawson@shu.ac.uk Fibromyalgia is a chronic pain disorder of which other clinical features, such as persistent fatigue and disordered sleep, may be a secondary consequence. The initial pharmacological approach to treating the disorder is the management of the pain. Tricyclic antidepressants are the most effective drugs in use so far, especially when administered in combination with other therapies (e.g., selective serotonin re-uptake inhibitors), which suggests modulation of the neurotransmitters serotonin and noradrenaline. The effectiveness of amitriptyline and related tricyclic antidepressants, however, is consistent with the involvement of mechanisms, such as potassium channel modulation and NMDA receptor antagonism, in addition to or in place of the modulation of monoamine neurotransmitters. Investigation of the importance of each of the pharmacological properties of amitriptyline and related molecules in the management of fibromyalgia could provide clues for the rational design of new drugs. 1113 PMID- 12069870 AU - Lehman AM, Lehman DR, Hemphill KJ, Mandel DR, Cooper LM TI - Illness experience, depression, & anxiety in CFS. SO - J Psychosom Res 2002 Jun;52(6):461-5 IN - Faculty o Med, U o British Columbia, Vancouver, BC, Canada AB - OBJECTIVE: Given the high rate of psychiatric comorbidity with chronic fatigue syndrome (CFS), we considered two possible correlates of anxiety and depression: lack of illness legitimization and beliefs about limiting physical activity. METHOD: A total of 105 people diagnosed with CFS reported on their experiences with medical professionals and their beliefs about recovery and completed the depression and anxiety subscales of the Brief Symptom Inventory. RESULTS: Those who said that their physician did not legitimize their illness (36%) had higher depression and anxiety scores (P's<.05) than their counterparts. Those who believed that limiting their physical exertion was the path to recovery (55%) had lower depression and anxiety scores (P's<.01) than their counterparts. CONCLUSION: Lack of illness legitimization ranked high as a source of dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity. Many CFS patients believed that staying within what they felt to be their physical limits would improve their condition. This belief, and possibly an accompanying sense of control over their symptoms, may alleviate psychiatric morbidity. 1114 PMID- 12133023 AU - Leng S, Chaves P, Koenig K, Walston J TI - Serum interleukin-6 & hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. [CF] SO - J Am Geriatr Soc 2002 Jul;50(7):1268-71 IN - Division o Geriatric Med & Gerontology, Johns Hopkins Med I+ AB - +IN: nstitutions, Baltimore, Maryland, USA. OBJECTIVES: To determine specific physiological correlates of the geriatric syndrome of frailty that warrant further investigation. DESIGN: Population-based case-control study. SETTING: General Clinical Research Center at Johns Hopkins Bayview Medical Center. PARTICIPANTS: Community-dwelling adults aged 74 and older from Baltimore, Maryland. MEASUREMENTS: Frailty status was determined using a recently validated screening tool that consists of weight loss, fatigue, low levels of physical activity, and measurements of grip strength and walking speed. Serum interleukin-6 (IL-6) was measured using enzyme-linked immunosorbent assay, and standard complete blood count was performed using a Coulter counter. RESULTS: Eleven frail and 19 nonfrail subjects with mean age +/- standard deviation of 84.9 +/- 6.7 vs 81.3 +/- 4.1 years, respectively, completed the study. The frail subjects had significantly higher serum IL-6 levels and significantly lower hemoglobin and hematocrit than the nonfrail subjects (4.4 +/-2.9 vs 2.8 +/- 1.6 pg/mL, 12.1 +/- 1.1 vs 13.9 +/- 1.0 g/dL, and 35.8% +/- 3.1% vs 40.6% +/- 2.8%, respectively). No significant difference was observed in mean corpuscular volume, red blood cell distribution width, or white blood cell and platelet counts between the frail and nonfrail groups. Furthermore, there was an inverse correlation between serum IL-6 level and hemoglobin (Pearson's correlation coefficient: -0.46) and hematocrit (-0.48) in the frail group but not in the nonfrail group. CONCLUSION: These results suggest that frail subjects have evidence of inflammation and lower hemoglobin and hematocrit levels. This subclinical anemia is normocytic and is hence unlikely due to myelosuppression or iron deficiency and is potentially related to the increased chronic inflammatory state marked by serum IL-6 elevation. Further studies are indicated to better characterize the immune and hematological changes that underlie frailty. 1115 PMID- 12582420 AU - Lerner AM, Beqaj SH, Deeter RG, Dworkin HJ, Zervos M, Chang CH, Fitzgerald JT, + TI - A six-month trial of valacyclovir in the Epstein-Barr virus subset of CFS: improvement in left ventricular function. SO - Drugs Today (Barc) 2002 Aug;38(8):549-61 IN - School o Med, Wayne St U, Detroit, MI, USA. lerner@cdimed.c+ AB - +IN: om +AU: Goldstein J, O'Neill W This study was designed to determine safety and efficacy of a 6-month trial of valacyclovir in single-virus Epstein-Barr virus (EBV) persistent infection. Phase I of this study used four specific criteria to define a subset of patients with chronic fatigue syndrome (CFS). In the second phase, myocardial dynamics were measured by MUGA rest/stress radionuclide ventriculographic (RVG) examinations pre- and posttreatment with valacyclovir. In phase I, a trial was performed in 19 consecutive CFS patients with the following diagnostic conditions: patients met criteria for diagnosis of CFS; they had had CFS for less than 1 year. They demonstrated repetitively abnormal oscillating T waves (ischemic or flat) at 24-h Holter monitoring; and they had elevated serum IgM antibody titers to EBV viral capsid antigen and/or total diffuse early antigen as measured by the enzyme-linked immunosorbent assay method. The treatment group comprised 10 CFS patients with no serum antibodies to human cytomegalovirus, but the control group (nine CFS patients) had, additionally, high titers of serum antibodies (IgG) to conformational structural antigens of human cytomegalovirus. Both the parallel treatment and control CFS groups received valacyclovir 1.0-1.5 gm q.6.h. for 6 months. This valacyclovir dose achieved serum acyclovir C(max) of > 7 microm and high antiviral activity versus EBV (IC(50) of 4.4-13.3 m). In phase II, six additional CFS patients met the same four criteria as the 19 CFS patients in phase I. They had, however, been ill for a mean of 55.8 months. Thus, 25 CFS patients comprise this study. The studies were carried out at a single outpatient practice in Birmingham, MI, U.S.A. Before initiating valacyclovir, and after 6 months of treatment, clinical and laboratory observations were made. The CFS Energy Index point score (Table I) was used to record each CFS patient's functional capacity at baseline and after 1, 3 and 6 months of valacyclovir. Energy Index point scores, as well as EBV and human cytomegalovirus serum antibody titers were assessed. In the second phase, left ventricular dynamics were repeated after 6 months of treatment with valacyclovir. We concluded that the 16 CFS patients (included in both phases of this study) with EBV-persistent infection (EBV single-virus subset) are improved after 6 months of continuous pharmacokinetic dosing with valacyclovir. Nine CFS patients with EBV/human cytomegalovirus co-infection did not benefit from 6 months of similar treatment. Valacyclovir is not an effective anti-human cytomegalovirus antiviral drug. Unimproved CFS patients with co-infections EBV and human cytomegalovirus may require combined treatment with valacyclovir and another drug more active against human cytomegalovirus. This preliminary trial, with a small number of patients, may be critical to an appropriately designed larger, double-blind, placebo-controlled trial. 1116 PMID- 12182109 AU - Lerner MA, Beqaj SH, Deeter RG, Fitzgerald JT TI - IgM serum antibodies to human cytomegalovirus nonstructural gene products p52 & CM2(UL44 & UL57) are uniquely present in a subset of pts w CFS. SO - In Vivo 2002 May-Jun;16(3):153-9 IN - D o Med, William Beaumont Hosp, Wayne St U School o Medicin+ AB - +IN: e, Royal Oak, Michigan, USA. lerner@cdimed.com Human cytomegalovirus (HCMV) IgM serum antibodies to two nonstructural gene products UL44 and UL57 (p52 and CM2) were assayed in patients with the diagnosis of the chronic fatigue syndrome (CFS) according to criteria established by the US Centers for Disease Control and Prevention. A subset of 16 CFS patients demonstrated HCMV IgG, but no HCMV IgM serum antibodies to conformational structural HCMV antigens (designated, V). By convention, these findings are interpreted to indicate only a remote HCMV infection. However, HCMV IgM p52 and CM2 antibodies were uniquely present in these 16 CFS patients. Other CFS patients with similar HCMV (V) IgG antibodies (18 patients), non-fatigued HCMV (V) IgG-positive control patients (18 patients), random HCMV (V) IgG-positive control patients from a clinical laboratory (26 patients), and non-fatigued HCMV (V) IgG-negative control patients (15 patients) did not have HCMV, IgM p52 or CM2 serum antibodies (p < 0.05). Control HCMV (V) IgG-positive patients had no serum IgM HCMV (V) antibodies to conventional structural HCMV (V) antigen. Thus, 77 various control patients did not contain IgM p52 or CM2 serum antibodies. The presence of IgM p52 and/or CM2 HCMV serum antibodies in this subset of CSF-specific patients may detect incomplete HCMV multiplication in which a part of the HCMV protein-coding content of the HCMV genome is processed, but remains unassembled. These findings suggest that the presence of HCMV IgM p52 and CM2 serum antibodies may be a specific diagnostic test for the diagnosis of a subset of CFS patients. Further, these data suggest an etiologic relationship for HCMV infection in this group of CFS patients. 1117 PMID- 12194895 AU - Levallois P TI - Hypersensitivity of human subjects to environmental electric & magnetic field exposure: a review of the literature. [CF] SO - Environ Health Perspect 2002 Aug;110 Suppl 4:613-8 IN - Unite de Recherche en Sante Publique, Centre Hospitalier Un+ AB - +IN: iversitaire de Quebec, & Institut Nat de Sante Publique du Quebec, Beauport, Canada. patrick.levallois@msp.ulaval.ca Hypersensitivity to exposure to electric and magnetic fields (EMFs) has been reported for nearly 20 years; however, the literature on the subject is still very limited. Nearly all the literature published concerns a dermatological syndrome that consists of mainly subjective symptoms (itching, burning, dryness) and a few objective symptoms (redness, dryness) appearing after individuals begin working with video display units and decreasing during absence from work. Case-control studies as well as some good but limited double-blind trials have not found any clear relationship between this syndrome and exposure to EMFs. A "general syndrome" with more general symptoms has been rarely described but seems to have a worse prognosis. The symptoms often associated with skin disorders are mainly of neurasthenic type and can cover a lot of nonspecific symptoms present in other atypical syndromes such as multiple chemical sensitivity or chronic fatigue. Most of these symptoms are allegedly triggered by exposure to different sources of EMFs, but there have been no valid etiological studies published on this more general syndrome. It appears that the so-called hypersensitivity to environmental electric and magnetic fields is an unclear health problem whose nature has yet to be determined. 1118 PMID- 11982667 AU - Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM TI - Musculoskeletal pain & risk for falls in older disabled women living in the community. [FM] SO - J Am Geriatr Soc 2002 Apr;50(4):671-8 IN - Hebrew Rehabilitation Ctr for Aged, Boston, Mass 02131, USA+ AB - +IN: . leveille@mail.hrca.harvard.edu OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (> or = 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25-2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02-1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons. 1119 PMID- 12185372 AU - Lidbeck J TI - Central hyperexcitability in chr musculoskeletal pain: a conceptual breakthrough w multiple clinical implications.[FM] SO - Pain Res Manag 2002 Summer;7(2):81-92 IN - Pain Management Clinic, Hosp o Helsingborg, Helsingborg, Sw+ AB - +IN: eden. jan.lidbeck@helsingborgslasarett.se Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms. 1120 PMID- 11893870 AU - Lieb K, Treffurth Y, Berger M, Fiebich BL TI - Substance P & affective disorders: new Rx opportunities by neurokinin 1 receptor antagonists? [FM] SO - Neuropsychobiology 2002;45 Suppl 1:2-6 IN - D o Psychiatry & Psychotherapy, U o Freiburg, MS, Germany. + AB - +IN: klaus_lieb@psyallg.ukl.uni-freiburg.de Substance P (SP) is a neuropeptide which is abundant in the periphery and the central nervous system, where it is colocalized with other neurotransmitters such as serotonin or dopamine. SP has been proposed to play a role in the regulation of pain including migraine and fibromyalgia, asthma, inflammatory bowel disease, emesis, psoriasis as well as in central nervous system disorders. This review summarizes our current knowledge of the role of SP in the pathogenesis of neuropsychiatric disorders with special emphasis on affective disorders including bipolar disorders. It also reviews current treatment approaches with neurokinin 1 receptor antagonists which appear to be promising drugs for the future treatment of affective disorders. 1121 PMID- 12115156 AU - Liedberg GM, Henriksson CM TI - Factors of importance for work disability in women w FM: an interview study. SO - Arthritis Rheum 2002 Jun 15;47(3):266-74 IN - Linkoping U & U Hosp, Linkoping, Sweden. gunilla.liedberg@h+ AB - +IN: ul.liu.se OBJECTIVE: Fibromyalgia symptoms such as continuous pain, tiredness, hyperalgesia, and allodynia limit gainful employment. The present study examines which factors influence the decision to remain in a work role for women with fibromyalgia. This information is important for the individual and for public finances.METHODS: Qualitative interviews were performed with 39 women, 19 of whom were gainfully employed and 20 who had stopped working. The transcribed interviews were analyzed and divided into categories and subcategories.RESULTS: Four categories appear, at societal and individual levels, that were regarded as important by the women for remaining in a work role. CONCLUSIONS: The ability to remain at work depends not only on limitations in work capacity, but also on the capacity of society to adjust work environments and work tasks. More individual solutions are needed to allow women with fibromyalgia to maintain work roles. 1122 PMID- 12047700 AU - Lim A, Lubitz L TI - CFS: successful outcome of an intensive inpatient programme. SO - J Paediatr Child Health 2002 Jun;38(3):295-9 IN - D o Paediatrics, Austin & Repatriation Med Centre, Melbourn+ AB - +IN: e, Victoria, Australia. OBJECTIVE: To study the outcome of adolescents with chronic fatigue syndrome (CFS) following an intensive multi-disciplinary inpatient programme. METHODS: A follow-up questionnaire was distributed to all 57 adolescents who had completed the CFS inpatient programme at the Austin and Repatriation Medical Centre. RESULTS: Forty-two adolescents (74%) returned follow-up questionnaires. Immediately following the programme and up to five years after the programme, the majority of participants had returned to school and were functioning better in terms of physical activity and social interactions as compared with before the programme. Before the programme, 94% of adolescents were attending school half-time or less. Up to 5 years after the programme, 78% of adolescents were attending school full-time or with occasional absences only. CONCLUSIONS: A multidisciplinary inpatient programme for CFS was successful in helping to rehabilitate this group of adolescents who were significantly incapacitated prior to entering the inpatient programme. 1123 PMID- 12470318 AU - Lindal E, Stefansson JG, Bergmann S TI - The prevalence of CFS in Iceland - a national comparison by gender drawing on 4 different criteria. SO - Nord J Psychiatry 2002;56(4):273-7 IN - D o Psychiatry, Landspitalinn U Hosp, IS-101 Reykjavik, Ice+ AB - +IN: land. elindal@landspitali.is The study was carried out to estimate the prevalence of chronic fatigue syndrome (CFS) in Iceland. No previous prevalence studies known to us have been undertaken in Iceland or in Scandinavia. A 95-item custom-made questionnaire was sent to 4000 randomly selected people. The response rate was 63%. The questionnaire was constructed to include questions on all the items found in the four most common criteria for diagnosing CFS; the criteria being Australian, British and American. Results show very different prevalences according to the criteria used. The prevalence ranged from 0 to 4.9%, with the most established criteria yielding a prevalence of 1.4%. Re-test validity of the questionnaire was good, the following results are based on the selection criteria by Fukuda et al. (Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Int Med 1994;121:953-9). Women were in a majority (78%); their mean age was 44, they were fully employed and worked long hours. They believed that the onset of their symptoms was stress related. The type of work was unskilled in the majority of cases. A significant proportion of the males felt a constant buzzing in their ears (P < 0.05). Food suppliants were used daily by significantly more women than men (P < 0.01). Men had more frequently phobic symptoms (P < 0.001) than did women. Differences were found in the prevalence of phobia and panic (P < 0.001) between women in the CFS group compared to healthy ones. A positive correlation was found in the prevalence of phobia between women in the CFS group and those with Iceland Disease. 1124 PMID- 12392344 AU - Lindberg L, Iwarsson S TI - Subjective quality of life, health, I-ADL ability & adaptation strategies in FM. SO - Clin Rehabil 2002 Sep;16(6):675-83 IN - Division o Occupational Therapy, Tomelilla Health Care Cent+ AB - +IN: re, Sweden. lorry.lindberg@rehabhuset.com OBJECTIVES: To describe subjective quality of life and health, self-perceived instrumental activities of daily living (I-ADL) ability and adaptation strategies, and to explore possible relationships between these variables in fibromyalgia patients. DESIGN: Two instruments were used with fibromyalgia patients: the Fibrositis Impact Questionnaire and 'Living with fibromyalgia - adaptation to chronic disease and handicap', and correlative analyses were performed. SUBJECTS: A sample of 34 patients undergoing rehabilitation (in a specific programme). RESULTS: The majority of the patients used many adaptation strategies, demonstrating some significant relationships with perceived I-ADL ability and subjective quality of life and health. Different symptoms correlated highly significantly with self-perceived ability in I-ADL. CONCLUSION: The significant relationships between adaptation strategies and I-ADL ability and health demonstrated deserve clinical awareness and further research efforts. 1125 PMID- 11980359 AU - Linder R, Dinser R, Wagner M, Krueger GR, Hoffmann A TI - Generation of classification criteria for CFS using an artificial neural network & traditional criteria set. SO - In Vivo 2002 Jan-Feb;16(1):37-43 IN - Institute o Med Informatics, Med U o Lubeck, Ratzeburger Al+ AB - +IN: lee 160, 23538 Lubeck, Germany. linder@medinf.mu-luebeck.de OBJECTIVE: The definition of chronic fatigue syndrome (CFS) is still disputed and no validated classification criteria have been published. Artificial neural networks (ANN) are computer-based models that can help to evaluate complex correlations. We examined the utility of ANN and other conventional methods in generating classification criteria for CFS compared to other diseases with prominent fatigue, systemic lupus erythematosus (SLE) and fibromyalgia syndrome (FMA). PATIENTS AND METHODS: Ninety-nine case patients with CFS, 41 patients with SLE and 58 with FMA were recruited from a generalist outpatient population. Clinical symptoms were documented with help of a predefined questionnaire. The patients were randomly divided into two groups. One group (n = 158) served to derive classification criteria sets by two-fold cross-validation, using a) unweighted application of criteria, b) regression coefficients, c) regression tree analysis, and d) artificial neural networks in parallel. These criteria were validated with the second group (n = 40). RESULTS: Classification criteria developed by ANN were found to have a sensitivity of 95% and a specificity of 85%. ANN achieved a higher accuracy than any of the other methods. CONCLUSION: We present validated criteria for the classification of CFS versus SLE and FMA, comparing different classification approaches. The most accurate criteria were derived with the help of ANN. We therefore recommend the use of ANN for the classification of syndromes with complex interrelated symptoms like CFS. 1126 PMID- 12500173 AU - Lindh U, Hudecek R, Danersund A, Eriksson S, Lindvall A TI - Removal of dental amalgam & other metal alloys supported by antioxidant therapy alleviates Sx & improves quality of life in pts w amalgam-associated + SO - Neuroendocrinol Lett 2002 Oct-Dec;23(5-6):459-82. IN - D o Oncology, Radiology & Clinical Immunology, Rudbeck Labo+ AB - +TI: ill health. +IN: ratory, SE-751 85 Uppsala, Sweden. Ulf.Lindh@bms.uu.se OBJECTIVES: The purpose of this study was to evaluate treatment of patients suffering from chronic ill health with a multitude of symptoms associated with metal exposure from dental amalgam and other metal alloys. SETTING AND DESIGN: We included 796 patients in a retrospective study using a questionnaire about symptom changes, changes in quality of life as a consequence of treatment and assessment of care taking. METHODS: Treatment of the patients by removal of offending dental metals and concomitant antioxidant therapy was implemented according to the Uppsala model based on a close co-operation between physicians and dentists. RESULTS: More than 70% of the responders, remaining after exclusion of those who had not begun or completed removal, reported substantial recovery and increased quality of life. Comparison with similar studies showed accordance of the main results. Plasma concentrations of mercury before and after treatment supported the metal exposure to be causative for the ill health. MAIN FINDINGS: Treatment according to the Uppsala model proved to be adequate for more than 70% of the patients. Patients with a high probability to respond successfully to current therapy might be detected by symptom profiles before treatment. CONCLUSIONS: The hypothesis that metal exposure from dental amalgam can cause ill health in a susceptible part of the exposed population was supported. Further research is warranted to develop laboratory tests to support identification of the group of patients responding to current therapy as well as to find out causes of problems in the group with no or negative results. 1127 PMID- 11950012 AU - Lindvall B, Bengtsson A, Ernerudh J, Eriksson P TI - Subclinical myositis is common in primary SS & is not related to muscle pain. [FM] SO - J Rheumatol 2002 Apr;29(4):717-25 IN - D o Clinical Neurosciences & Locomotion, U Hosp, Linkoping,+ AB - +IN: Sweden. Bjorn.Lindvall@lio.se OBJECTIVE: Although muscle pain is common in primary Sjogren's syndrome (SS), the underlying mechanisms are mainly unknown. We studied all patients with SS at our rheumatology unit with respect to muscle pain in general and to fibromyalgia (FM), and correlated clinical data to muscle biopsy findings. METHODS: We investigated 48 patients with SS according to the modified European diagnostic criteria. The ACR criteria for FM were used to subgroup the patients. Muscle biopsy was performed in 36 patients. Light microscope morphology and immunohistochemical expression of MHC class I, MHC class II, and membrane attack complex (MAC) were studied. RESULTS: We found 44% of patients complained of muscle pain; 27% fulfilled the ACR criteria for FM, whereas 17% had other forms of myalgia. Muscle pain could not be related to histopathological findings. Signs of inflammation were found in 26 of 36 biopsies (72%), and inflammation combined with degeneration/regeneration (i.e., histological signs of polymyositis) in 17 biopsies (47%). However, only 5 patients (14%) had clinical as well as histological signs of polymyositis. Eight muscle biopsies (22%) showed histological features of inclusion body myositis (IBM). However, no patient had clinical symptoms suggestive of this disease. Abnormal expression of MHC class I, MHC class II, and MAC was found in 18 (50%), 16 (44%), and 27 (75%) patients, respectively. CONCLUSION: Muscle pain, especially FM, is common in SS. Histopathological signs of myositis are very common in SS. However, muscle symptoms are not related to histological signs of muscle inflammation. IBM-like findings may represent vacuolar myopathic degeneration due to previous subclinical muscle inflammation rather than a specific clinical entity. 1128 PMID- 12025528 AU - Lister RE TI - An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined w Ginkgo biloba extract in FM syndrome. SO - J Int Med Res 2002 Mar-Apr;30(2):195-9 IN - Phylax Ltd, Beaconsfield, UK. bobphylax@cs.com AB - An open, uncontrolled study was undertaken to measure the subjective effects of coenzyme Q10 combined with a Ginkgo biloba extract in volunteer subjects with clinically diagnosed fibromyalgia syndrome. Anecdotal reports from patients with fibromyalgia syndrome have claimed benefits from the use of these supplements. The aim of this study was to determine if these reports could be substantiated in a pilot clinical trial. Patient questioning had determined that poor quality of life was a major factor in the condition and a quality-of-life questionnaire was used to measure potential benefit. Subjects were given oral doses of 200 mg coenzyme Q10 and 200 mg Ginkgo biloba extract daily for 84 days. Quality of life was measured, using the well-validated Dartmouth Primary Care Cooperative Information Project/World Organization of Family Doctors (COOP/WONCA) questionnaire that measures seven different subjective responses, at 0-, 4-, 8-, and 12-week intervals. The subjects were asked for an overall self-rating at the end of the study. A progressive improvement in the quality-of-life scores was observed over the study period and at the end, the scores showed a significant difference from those at the start. This was matched by an improvement in self-rating with 64% claiming to be better and only 9% claiming to feel worse. Adverse effects were minor. A controlled study is now planned. 1129 PMID- 12126575 AU - Littlejohn GO, Walker J TI - A realistic approach to managing pts w FM. SO - Curr Rheumatol Rep 2002 Aug;4(4):286-92 IN - Centre for Inflammatory Diseases, Monash Med Centre, Rheuma+ AB - +IN: tology Unit, Block E, Level 3, 246 Clayton Road, Clayton, 3168, Victoria, Melbourne, Australia. Geoff.Littlejohn@med.monash.edu.au Fibromyalgia syndrome is common and variable in impact, with some patients having a milder and shorter duration of symptoms and others suffering significant and prolonged pain. Disability also varies. It is thought that the syndrome arises from a disordered neurophysiology that, through links to central control inputs, involves emotions, thoughts, and cognitions. Social and psychological sequelae contribute to and result from this process. The biopsychosocial model of disease epitomizes fibromyalgia. Although management may be difficult at times, and much needs to be done, the growing appreciation of strategies that use this described model and the knowledge of the potential reversibility of the syndrome are resulting in improved outcomes. 1130 PMID- 12376086 AU - Loder C, Allawi J, Horrobin DF TI - Treatment of multiple sclerosis w lofepramine, L-phenylalanine & vitamin B(12): mechanism of action & clinical importance: roles of the locus coerule+ SO - Med Hypotheses 2002 Nov;59(5):594-602. AB - +TI: us & central noradrenergic systems. In a randomized, placebo-controlled double-blind trial a combination of lofepramine, phenylalanine and vitamin B(12) was found to be effective in relieving the symptoms of multiple sclerosis (MS). The effect occurred within 2-4 weeks, and improved all types of symptoms in all types of MS. The combination was also effective in relieving symptoms in patients with chronic pain and chronic fatigue. We hypothesize that the action of this combined therapy may relate to activation of the noradrenergic locus coeruleus/lateral tegmentum (LC/LT) system which has the potential to influence the functioning of large areas of the brain and spinal cord. 1131 PMID- 12410625 AU - Logan AC, Beaulne TM TI - The Rx of small intestinal bacterial overgrowth w enteric-coated peppermint oil: a case report. [CFS] SO - Altern Med Rev 2002 Oct;7(5):410-7. IN - Integrative Care Centre, 3600 Ellesmere Road, Unit 4, Toron+ AB - +IN: to, ON M1C 4Y8, Canada. Recent investigations have shown that bacterial overgrowth of the small intestine is associated with a number of functional somatic disorders, including irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome. A number of controlled studies have shown that enteric-coated peppermint oil (ECPO) is of benefit in the treatment of IBS. However, despite evidence of strong antimicrobial activity, ECPO has not been specifically investigated for an effect on small intestinal bacterial overgrowth (SIBO). A case report of a patient with SIBO who showed marked subjective improvement in IBS-like symptoms and significant reductions in hydrogen production after treatment with ECPO is presented. While further investigation is necessary, the results in this case suggest one of the mechanisms by which ECPO improves IBS symptoms is antimicrobial activity in the small intestine. 1132 PMID- 12090385 AU - Looper KJ, Kirmayer LJ TI - Behavioral medicine approaches to somatoform disorders. [CFS] SO - J Consult Clin Psychol 2002 Jun;70(3):810-27 IN - Division o Social & Transcultural Psychiatry, McGill U, Mon+ AB - +IN: treal, Quebec, Canada. karl.looper@mcgill.ca This article reviews the research evidence for the efficacy of cognitive-behavioral therapy (CBT) for somatoform disorders. Randomized controlled studies support the efficacy of individual CBT for the treatment of hypochondriasis, body dysmorphic disorder (BDD), and undifferentiated somatoform disorders including medically unexplained symptoms, chronic fatigue syndrome, and noncardiac chest pain, and group CBT for the treatment of BDD and somatization disorder. On the basis of this review of the existing research and a theoretical model of the processes involved in somatoform disorders, the authors offer suggestions for future research and effective treatment. 1133 PMID- 11908579 AU - Lundberg G, Gerdle B TI - Tender point scores & their relations to signs of mobility, Sx, & disability in female home care personnel & the prevalence of FM syndrome. SO - J Rheumatol 2002 Mar;29(3):603-13 IN - D o Rehabilitation Med, INR, Faculty o Health Sciences, Lin+ AB - +IN: koping, Sweden. OBJECTIVE: In this study of female home care personnel employed in a municipality (n = 643; participation rate 94%) we investigated (1) the prevalence of tender points and fibromyalgia (FM); (2) the relationships between tender point score and other signs and symptoms; (3) if subgroups based on the tender point score differed with respect to signs, symptoms, disability, and health related quality of life; and (4) signs that showed the strongest intercorrelations with disability and health. METHODS: The following variables were registered: (1) Signs: joint mobility, spinal posture and mobility, tender points, and segmental mobility and pain provocation at L4-S1 levels of the low back. (2) Symptoms: pain and pain intensity and other symptoms. (3) Disability (i.e., self-rated reduced capacity for everyday activities and employment) and health: 3 indices and sick leave. RESULTS: The tender point score correlated with the number of pain regions and the pain intensities, and the amount of other symptoms, sick leave, and disability. Tender point score was the strongest regressor of the investigated signs in regression of the 2 disability indices. Segmental pain showed the strongest correlation with tender point score. Three subgroups identified by tender point score showed significant differences in segmental pain, prevalence and intensity of different symptoms, disability, and health related quality of life. The prevalence of FM was 2.0%. CONCLUSION: Tender point score together with different symptoms showed relatively strong correlations with disability. A relatively high prevalence of FM was found in occupationally active female home care personnel. 1134 PMID- 11832727 AU - Lutgendorf SK, Kreder KJ, Rothrock NE, Hoffman A, Kirschbaum C, Sternberg EM, Z+ TI - Diurnal cortisol variations & Sx in pts w interstitial cystitis. [FM] SO - J Urol 2002 Mar;167(3):1338-43 IN - D o Psychology, U o Iowa, Iowa City, Iowa, USA. AB - +AU: immerman MB, Ratliff TL PURPOSE: Little attention has focused on systemic factors that may allow a state of chronic bladder inflammation to be established and maintained in interstitial cystitis cases. Abnormalities of the hypothalamic-pituitary-adrenal feedback system result in poorer regulation of the inflammatory response and are present in many chronic inflammatory and pain conditions, of which some have high co-morbidity with interstitial cystitis. MATERIALS AND METHODS: A total of 48 patients with interstitial cystitis and 35 healthy, age matched controls collected 24-hour urine samples and 3 days of salivary samples at 7 to 8 a.m., 4 to 5 p.m. and 8 to 9 p.m. for cortisol analysis. In addition, they completed a concurrent symptom questionnaire. Prospective symptom diaries also were completed in the month before sampling. RESULTS: Mean urinary or salivary cortisol did not differ in patients and controls. However, patients with interstitial cystitis and higher morning cortisol had significantly less pain and urgency, while those with higher urinary free cortisol reported less overall symptomatology (p <0.05). Relationships with morning cortisol were also observed when controlling for co-morbid conditions known to be affected by the hypothalamic-pituitary-adrenal axis, such as fibromyalgia, chronic fatigue and rheumatoid arthritis. Patients with morning cortisol less than 12.5 nmol./l. were 12.8 times more likely to report high urinary urgency than those with values above this cutoff. CONCLUSIONS: These findings imply that regulation of the hypothalamic-pituitary-adrenal axis may be associated with interstitial cystitis symptomatology and there may be different diurnal hypothalamic-pituitary-adrenal patterns in patients with interstitial cystitis who do and do not have co-morbid conditions. These findings may have treatment implications for patients with interstitial cystitis who have early morning cortisol deficiencies. 1135 PMID- 11961178 AU - Macfarlane TV, Blinkhorn A, Worthington HV, Davies RM, Macfarlane GJ TI - Sex hormonal factors & chr widespread pain: a population study among women. [FM] SO - Rheumatology (Oxford) 2002 Apr;41(4):454-7 IN - U Dental Hosp o Manchester, Dental Health Unit, Unit o Chro+ AB - +IN: nic Disease Epidemiology &. Arthritis Research Campaign Epidemiology Unit, U o Manchester, UK. OBJECTIVE: The observation of higher rates of chronic widespread pain, the cardinal feature of fibromyalgia, in women has led to hypotheses about the role of sex hormonal factors in the aetiology of symptoms. There is little available evidence from epidemiological studies on their importance or role. METHODS: A population postal survey was carried out involving 1178 female participants living in south-east Cheshire in the north-west of England. RESULTS: Amongst pre- and peri-menopausal women, the risk of chronic widespread pain was unrelated either to the length of the menstrual cycle or the usual length of period reported by participants. Risk was similar in current users and non-users of the oral contraceptive pill, and amongst users there was no relationship with duration of use. However, the reporting of chronic widespread pain showed a relationship with total score on a premenstrual symptom questionnaire. However, this relationship was explained by pain symptoms. Amongst post-menopausal women, reporting chronic widespread pain was not related to age at menopause. An increased (but non-significant) risk of chronic widespread pain was associated with current hormone replacement therapy (HRT), which may be a consequence of HRT being prescribed for menopausal symptoms. CONCLUSION: This study, conducted on a large unselected population, has not demonstrated an association between sex hormonal factors and chronic widespread pain. 1136 PMID- 12136909 AU - Maliszewski AM, Goldenberg DL, Hurwitz S, Adler GK TI - Regulation of the renin-angiotensin-aldosterone system in FM. SO - J Rheumatol 2002 Jul;29(7):1482-7 IN - Brigham & Women's Hosp, D o Med, Harvard MS, Boston, Mass 0+ AB - +IN: 2115, USA. OBJECTIVE: To assess the function of the renin-angiotensin-aldosterone (RAA) system in women with fibromyalgia (FM) compared to healthy women. METHODS: Women with FM [n = 14, age 41.0+/-7.2 yrs, body mass index (BMI) 26.4+/-5.4 kg/m2] and healthy women (n = 13, age 40.0+/-7.7 yrs, BMI 25.0+/-5.0 kg/m2) were placed on a low sodium diet (10 mEq sodium/day) for 5 days. After being supine and fasting overnight, subjects received an intravenous infusion of angiotensin II at successive doses of 1, 3, and 10 ng/kg/min for 45 min per dose. Blood pressure (BP), plasma renin activity (PRA), aldosterone, and cortisol were measured at baseline and after each dose of angiotensin II. Prior to sodium restriction, women with FM completed the Hopkins Symptom Checklist-90, which included a question grading the extent of dizziness/faintness on a scale of 0 (none) to 4 (extremely). RESULTS: After dietary sodium restriction, baseline PRA, aldosterone, and supine BP were similar in healthy women and women with FM. Aldosterone and BP rose in response to infused angiotensin II; these responses did not differ significantly between healthy women and women with FM. In women with FM, symptoms of dizziness correlated inversely with BMI (r = -0.81, p < 0.001) and the systolic BP response to 10 ng/kg/min angiotensin II (r = -0.81, p < 0.001). CONCLUSION: The functioning of the RAA system, including the vascular response to angiotensin II, was intact in women with FM compared to healthy women. However, women with FM who complained of dizziness had a blunted vascular response to angiotensin II. This blunted vascular response may indicate intravascular volume depletion in women with symptoms of dizziness. 1137 PMID- 1002002041 AU - Malt E, Olafsson S, Lund A, Ursin H TI - Factors explaining variance in perceived pain in women w FM. SO - BMC Musculoskelet Disord 2002 Apr 25;3(1):12 IN - D o Psychiatry, U o Bergen Haukeland U Hosp, N-5022 Bergen,+ AB - +IN: Norway. eva.albertsen@psych.uib.no BACKGROUND: We hypothesized that a substantial proportion of the subjectively experienced variance in pain in fibromyalgia patients would be explained by psychological factors alone, but that a combined model, including neuroendocrine and autonomic factors, would give the most parsimonious explanation of variance in pain. METHODS: Psychometric assessment included McGill Pain Questionnaire, General Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale, and Multidimensional Health Locus of Control Scale and was performed in 42 female patients with fibromyalgia and 48 female age matched random sample population controls. A subgroup of the original sample (22 fibromyalgia patients and 13 controls) underwent a pharmacological challenge test with buspirone to assess autonomic and adrenocortical reactivity to serotonergic challenge. RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety, depression and general distress, only a minor part of variance in pain was explained by psychological factors alone. High pain score was associated with high neuroticism, low baseline cortisol level and small drop in systolic blood pressure after buspirone challenge test. This model explained 41.5% of total pain in fibromyalgia patients. In population controls, psychological factors alone were significant predictors for variance in pain. CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central sympathetic system or perturbations in the sympathetic-parasympathetic balance. This study shows that a biopsychosocial model, including psychological factors as well as factors related to perturbations of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in fibromyalgia patients. 1138 PMID- 12455823 AU - Mannerkorpi K, Ahlmen M, Ekdahl C TI - Six- & 24-month follow-up of pool exercise therapy & education for pts w FM. SO - Scand J Rheumatol 2002;31(5):306-10 IN - D o Physical Therapy, Sahlgrenska U Hosp, Goteborg, Sweden.+ AB - +IN: Kaisa.Mannerkorpi@vgregion.se OBJECTIVE: To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme. The programme comprised pool exercise therapy, adjusted to the patients' limitations, and education based on their health problems. METHODS: Twenty-six patients were examined six and 24 months after the completion of the treatment programme with the Fibromyalgia Impact Questionnaire (FIQ), SF-36, the 6-minute walk test, and the Grippit measure. The values obtained at the follow-up examinations were compared with the baseline and post-treatment values. RESULTS: As compared with baseline, symptom severity (FIQ, SF-36), physical function (FIQ, SF-36, 6-minute walk test) and quality of life (SF-36) still showed improvements six months after the completion of treatment (p <0.05). Pain (FIQ, SF-36), fatigue (FIQ, SF-36), walking ability, and social function (SF-36) still showed improvements 2 years after the completion of the programme as compared with the baseline values (p < 0.05). No significant changes were found for these variables, when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination. CONCLUSIONS: Improvements in symptom severity, physical function and social function were still found six and 24 months after the completed treatment programme. 1139 PMID- 12102276 AU - Maquet D, Croisier JL, Renard C, Crielaard JM TI - Muscle performance in pts w FM. SO - Joint Bone Spine 2002 May;69(3):293-9 IN - Faculte de Medecine, Universite de Liege, Medecine de l'App+ AB - +IN: areil Locomoteur, CHU Sart Tilman, Belgium. OBJECTIVES: To compare muscle performance in women with fibromyalgia and in healthy women. PATIENTS AND METHODS: Sixteen women with fibromyalgia syndrome (FMS) and 85 healthy women who were physically inactive or engaged in recreational sports underwent measurements of four parameters: maximal concentric isokinetic muscle strength of the knee extensors and flexors in the dominant limb, isometric grip strength on a Colin dynamometer, muscle fatigue resistance during 30 maximal concentric isokinetic contractions of the dominant knee flexors and extensors at 180 degrees angular velocity, and static endurance during posture maintenance. RESULTS: All muscle variables were decreased in the FMS patients as compared to the controls. The decreases were more marked during aerobic than during anaerobic exercise. Mean decreases were 39% (P<0.001) for muscle strength, 40% (P<0.0001) for fatigue resistance, and 81% (P<0.0001) for static endurance. Pain during exercise as evaluated using a visual analog scale was more marked in the FMS patients. CONCLUSION: This study of the three pathways supplying energy to muscle confirms that muscle function is globally impaired in FMS patients. The results suggest that the impairment predominates on aerobic processes. 1140 PMID- 12122925 AU - Martinez-Lavin M TI - Management of dysautonomia in FM. SO - Rheum Dis Clin North Am 2002 May;28(2):379-87 IN - Instituto Nacional de Cardiologia, Nat Autonomous U o Mexic+ AB - +IN: o, Juan Badiano 1, 14080 Mexico City DF, Mexico. mmlavin@infosel.net.mx The realization of dysautonomia in FM has opened the possibility for new and different therapeutic interventions. Much more research is needed to better define the role of ANS in the pathogenesis of FM. If this research supports current hypotheses, therapeutic trials with disciplines and substances intended to correct autonomic dysfunction will be indicated. 1141 PMID- 1002003001 AU - Martinez-Lavin M, Vidal M, Barbosa RE, Pineda C, Casanova JM, Nava A TI - Norepinephrine-evoked pain in FM. A randomized pilot study [ISRCTN70707830]. SO - BMC Musculoskelet Disord 2002;3(1):2 IN - Rheumatology D Instituto Nacional de Cardiologia Ignacio Ch+ AB - +IN: avez, Juan Badiano 1, 14080 Mexico D,F, Mexico. mmlavin@infosel.net.mx BACKGROUND: Fibromyalgia syndrome displays sympathetically maintained pain features such as frequent post-traumatic onset and stimuli-independent pain accompanied by allodynia and paresthesias. Heart rate variability studies showed that fibromyalgia patients have changes consistent with ongoing sympathetic hyperactivity. Norepinephrine-evoked pain test is used to assess sympathetically maintained pain syndromes. Our objective was to define if fibromyalgia patients have norepinephrine-evoked pain. METHODS: Prospective double blind controlled study. Participants: Twenty FM patients, and two age/sex matched control groups; 20 rheumatoid arthritis patients and 20 healthy controls. Ten micrograms of norepinephrine diluted in 0.1 ml of saline solution were injected in a forearm. The contrasting substance, 0.1 ml of saline solution alone, was injected in the opposite forearm. Maximum local pain elicited during the 5 minutes post-injection was graded on a visual analog scale (VAS). Norepinephrine-evoked pain was diagnosed when norepinephrine injection induced greater pain than placebo injection. Intensity of norepinephrine-evoked pain was calculated as the difference between norepinephrine minus placebo-induced VAS scores. RESULTS: Norepinephrine-evoked pain was seen in 80 % of FM patients (95% confidence intervals 56.3 -- 94.3%), in 30 % of rheumatoid arthritis patients and in 30 % of healthy controls (95% confidence intervals 11.9 -- 54.3) (p < 0.05). Intensity of norepinephrine-evoked pain was greater in FM patients (mean plus minus SD 2.5 plus minus 2.5) when compared to rheumatoid arthritis patients (0.3 plus minus 0.7), and healthy controls (0.3 plus minus 0.8) p < 0.0001. CONCLUSIONS: Fibromyalgia patients have norepinephrine-evoked pain. This finding supports the hypothesis that fibromyalgia may be a sympathetically maintained pain syndrome. 1142 PMID- 12430098 AU - Masi AT, White KP, Pilcher JJ TI - Person-centered approach to care, teaching, & research in FM syndrome: Justification from biopsychosocial perspectives in populations. SO - Semin Arthritis Rheum 2002 Oct;32(2):71-93 IN - D o Medicine, U o Illinois Coll o Med at Peoria, Peoria, IL+ AB - +IN: ; U o Western Ontario, St. Joseph's Health Ctr, London, Ontario, Canada; D o Psychology, Clemson U, Clemson, SC. OBJECTIVES: To describe complex interactions of multiple factors believed to contribute to fibromyalgia syndrome (FMS) at a person-centered level to enhance approaches to care, teaching, and research. The main factors addressed were central nervous system sensory sensitization, autonomic nervous system (ANS) activation, neurohumoral perturbations, and psychosocial and environmental stressors. A person-centered approach is defined as attention to major biopsychosocial issues of affected individuals. METHODS: Literature on classification, mechanistic pathways, course and outcomes, and management of FMS was reviewed to assess applications of person-centered approaches to care, teaching, and research. Various biopsychosocial influences were considered in relation to the heterogeneous subjective manifestations of this illness, including central hyperalgesia, ANS and other neurohumoral perturbations, functional hyperexcitability, nonrestorative sleep, and psychologic distress. RESULTS: A person-centered approach to FMS can expand on and strengthen traditional biomedical concepts. Adding such a focus can help to untangle current controversies in the course, outcomes, and treatment of FMS. A person-centered approach can also help in the subgrouping of affected patients for greater specificity in care programs and in improved clinical investigations. In the biomedical model, diverse symptoms of FMS are often addressed separately and apart from their interconnectedness and linkages to the patient's individualized biopsychosocial factors. However, the causes of FMS symptomatology are not likey to be caused by uniform biologic abnormalities across populations. Rather, the syndrome likely results from personal reactivities to varied multifactorial biopsychosocial influences. Common denominators among individuals may include varying degrees of ANS activation (or personal susceptibility to ANS activation), nonrestorative sleep, negative affectivity, and other central pain sensitization mechanisms, among the pathways reviewed. CONCLUSIONS: Innovative analytical methodologies will need to be developed to more effectively investigate complex interacting biopsychosocial dynamics at a person-centered level, including qualititative research, and multifactorial and multilevel techniques. Adding person-centered approaches to biopsychosocial concepts of FMS promises to show new physiopathogenetic insights and more effective treatment than current biomedical models alone. Person-centered approaches enhance patient-physician relationships and help prioritize patients' goals in mutually derived treatment plans. Semin Arthritis Rheum 32:71-93. 1143 PMID- 11982303 AU - Massarotti EM TI - Lyme arthritis. [FM] SO - MedClNA 2002 Mar;86(2):297-309 IN - Tufts U School o Med, Itzhak Perlman Family Arthritis Treat+ AB - +IN: ment Ctr, Div o Rheumatology, New England Med Center, Boston, Mass, USA. emassarotti@lifespan.org Infection with B. burgdorferi can cause a large joint inflammatory arthritis in patients who have not been treated for early Lyme disease; the knee is the most common joint affected. The diagnosis depends on a history of known exposure to the spirochete, characteristic clinical features, and serologic studies (ELISA and Western blot) confirming exposure to the spirochete. In most patients, antibiotic therapy is curative, but in a smaller percentage of patients, the presence of the HLA-DR beta 1*0401 haplotype can trigger treatment-resistant arthritis, in which antibiotic therapy is ineffective; in these instances, remittive agents, such as hydroxychloroquine and methotrexate, are indicated. Arthroscopic synovectomy may be considered when antibiotic therapy is not curative. Fibromyalgia can follow infection with B. burgdorferi but is unresponsive to antibiotic therapy; it is treated with tricyclic antidepressants and an exercise program. Lyme arthritis is the only chronic inflammatory arthritis in which the specific cause is known and can be cured. As such, it serves as an excellent model with which to study the pathogenesis of more common inflammatory arthritides, such as rheumatoid arthritis. 1144 PMID- 12442562 AU - Masuda A, Munemoto T, Yamanaka T, Takei M, Tei C TI - Psychosocial characteristics & immunological functions in pts w postinfectious CFS & noninfectious CFS. SO - J Behav Med 2002 Oct;25(5):477-85 IN - First D o Internal Med, Faculty o Medicine, Kagoshima U, 8-+ AB - +IN: 35-1, Sakuragaoka, Kagoshima 890-8520, Japan. Differences between patients with postinfectious chronic fatigue syndrome (CFS, n = 16) and noninfectious CFS (n = 20) were clarified. The noninfectious CFS group had problems in family and developmental history, and had chronic stresses. Members of the postinfectious CFS group were social extroverts while those in the noninfectious CFS group was neurotic and introspective. Natural killer cell activity was suppressed in both groups. These findings suggest that the postinfectious CFS group and the noninfectious CFS group differed in their pathogenesis until the onset of CFS. The latter group should be considered as a variant of psychiatric disorder and treated accordingly. 1145 PMID- 12442563 AU - Masuda A, Nakayama T, Yamanaka T, Koga Y, Tei C TI - The prognosis after multidisciplinary Rx for pts w postinfectious CFS & noninfectious CFS. SO - J Behav Med 2002 Oct;25(5):487-97 IN - First D o Internal Med, Faculty o Medicine, Kagoshima U, 8-+ AB - +IN: 35-1, Sakuragaoka, Kagoshima 890-8520, Japan. The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome (CFS, n = 9) and noninfectious CFS (n = 9) was clarified. After treatment, natural killer (NK) cell activity increased in the postinfectious CFS group but did not recover to within normal range in the noninfectious CFS group. In the postinfectious CFS group, physical and mental symptoms improved, and 8 patients returned to work. In the noninfectious CFS group, symptoms did not improve, and only 3 patients returned to work. The prognosis of postinfectious CFS group was better than that of noninfectious CFS group. Classification of CFS patients into postinfectious and noninfectious groups is useful for choosing the appropriate treatment in order to obtain better prognosis. 1146 PMID- 11972995 AU - McBeth J, Macfarlane GJ, Silman AJ TI - Does chr pain predict future psychological distress? [FM} SO - Pain 2002 Apr;96(3):239-45 IN - Arthritis Research Campaign (ARC) Epidemiology Unit, School+ AB - +IN: o Epidemiology & Health Sciences, Stopford Building, U o Manchester, Oxford Road, M13 9PT, Manchester, UK. john.mcbeth@fsl.ser.man.ac.uk Cross-sectional studies have consistently shown a relationship between chronic widespread pain, the clinical hallmark of fibromyalgia, and psychological distress. These studies cannot distinguish the direction of any causal relationship. Recent population based studies have reported that such pain is predictive of future distress. However, chronic pain is often associated with physical and psychological co-morbid features which may confound this relationship. The aim of this study was to examine the hypothesis that chronic widespread pain increases the risk of future distress after adjusting for the effects of possible confounding factors. A population based survey of 1953 individuals identified subjects' psychological status and whether they satisfied criteria for chronic widespread pain. At baseline co-morbid features of chronic widespread pain, including reporting other somatic symptoms, abnormal illness behaviour, health anxiety, fatigue and low levels of self-care, were measured. All subjects were followed up after 12 months to determine levels of psychological distress. Subjects with chronic widespread pain at baseline were much more likely to be distressed at follow up (OR=4.0, 95% CI (2.5,6.3)). As levels of distress at follow up may simply reflect those at baseline the association was adjusted for baseline levels of distress. Chronic widespread pain was, however, still associated with future distress although the relationship was slightly attenuated (odds ratio, OR=3.0, 95% CI (1.8,5.1)). To examine our main hypothesis a final analysis was undertaken adjusting this association for those co-morbid features assessed at baseline. Following these adjustments chronic widespread pain was no longer significantly associated with future distress (OR=1.5, 95% CI (0.8,2.9)). Chronic widespread pain was associated with increased levels of psychological distress at follow up. However, a more rigorous analysis indicated that the association between baseline pain status with future distress was explained by concomitant features of chronic pain rather than pain per se. These findings indicate that it is those persons with chronic widespread pain in the presence of other physical and psychosocial factors who will become distressed. 1147 PMID- 12530602 AU - McCauley LA, Joos SK, Barkhuizen A, Shuell T, Tyree WA, Bourdette DN TI - Chronic fatigue in a population-based study of Gulf War veterans. [CFS] SO - Arch Environ Health 2002 Jul-Aug;57(4):340-8 IN - Center for Research on Occupational & Environmental Toxicol+ AB - +IN: ogy, Oregon Health & Science U Portland, Oregon 97201, USA. mccauley@ohsu.edu Fatigue has been associated with illness in veterans of the Gulf War; however, few studies have confirmed self-reported fatigue by using clinical evaluation, and symptomatic veterans have not been evaluated with established criteria for Chronic Fatigue Syndrome (CFS). The authors describe the frequency and clinical characteristics of CFS in a sample of veterans residing in the northwestern United States. The sample was selected randomly from U.S. Department of Defense databases of troops deployed to southwest Asia during the Gulf War. The selected individuals were invited to participate in a clinical case-control study of unexplained illness. Of 799 survey respondents eligible for clinical evaluation, 178 had fatigue symptoms. Of the 130 veterans who were evaluated clinically, 103 had unexplained fatigue, and 44 veterans met the 1994 U.S. Centers for Disease Control criteria for CFS. In this population, the authors estimated a minimum prevalence of any unexplained fatigue to be 5.1%, and of CFS to be 2.2%. The estimated prevalence was greater among females than among males. Cases were similar to healthy controls, as determined by laboratory tests and physical findings. In comparison to several clinical studies of CFS patients, the authors of this study found a lower proportion of veterans who reported a sudden onset of symptoms (19%) vs. a gradual onset (50%). Although it has previously been suggested that veterans of the Gulf War suffer from higher rates of chronic fatigue than the general population, the study results described herein--on the basis of clinical examination of a population-based sample of veterans-actually indicate that an increased rate may indeed exist. Gulf War veterans with unexplained fatigue should be encouraged to seek treatment so that the impact of these symptoms on overall quality of life can be reduced. 1148 PMID- 1002002121 AU - McCue P, Scholey AB, Herman C, Wesnes K