NOVEMBER 2004 FIBROMYALGIA
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|Prolonged fibromyalgia pain linked to nervous system|
|Alt med's time has come with fibromyalgia therapy|
EDITOR'S NOTE: I recommend you use your search engine for fibromyalgia support groups - or yellow pages for a group in your vicinity. There are a number of excellent articles and updates available on the Internet - well worth taking the time to surf. Lastly, I cannot overstate that anyone who is in pain without receiving relief should not give up hope. Nor should a patient believe any doctor who would tell them "Sorry, there simply is no cure, and nothing we can do for you ... just exercise and diet." Find a different doctor! While it is true there is no known cure or known cause of fibromyalgia no one need suffer needlessly. Remember, fibromyalgia, like so many other diseases and sydromes is a invisible disability - whenever I am told "You look so good! You don't look sick!" I simply smile and say, "Thanks to Revlon I look better than I feel." People understand such comments and usually chuckle. You may have lost your good health, but please don't let it rob you of your sense of humor and good looks ; - )
Fibromyalgia Epidemiology Study should yield further information about the disease that costs the Canadian health-care system an estimated $350 million annually. http://www.medicalpost.com/mpcontent/article.jsp?content=/content/EXTRACT/RAWART/3602/66.html
By David Hodges
PHILADELPHIA – Symptoms of fibromyalgia, the syndrome associated with
generalized muscular pain and fatigue that affects 2% of the population, may be
the result of a central nervous system that "remembers" pain
sensations for an abnormally long time, say researchers at the University of
The researchers applied heat stimuli to the hands of healthy controls and of fibromyalgia patients, and found that compared to normal controls, fibromyalgiapatients experienced a great amount of cumulative pain from these stimulations, indicating abnormalities in spinal cord pain processing. Furthermore, they experienced residual pain when the stimuli were applied at intervals, whereas healthy controls were not affected.
Normally, pain sensation quickly subsides after a single heat stimulus but will accumulate with repetitions if they occur frequently enough. This "pain memory" appears to linger for an abnormally long time in fibromyalgia patients.
Researchers also found that the residual pain experienced by the patients was widespread and not limited to a single area of the body.
These findings provide evidence for an abnormal central nervous system mechanism of pain in fibromyalgia, according to lead investigator Dr. Roland Staud, who spoke at the annual meeting here.
The findings also have significant implications for future therapies to treat the disease, sometimes called fibrositis. Those therapies would involve targetting the abnormal central pain mechanisms of the disorder, Dr. Staud said.
"The final outcome of this study was that fibromyalgia patients have increased sensitivity to not just stimulation per se, which is hyperalgesia. Patients with fibromyalgia have extensive windup (or temporal summation), which is not only excessive but also abnormal because it occurs under circumstances where normal controls did not feel any change in sensation," he said.
"The changes are best described as neuropathic, so what I'm hoping to show here is first of all the characterization of these sensations."
Moreover, he noted that because neuropathic pain is very difficult to treat in many fibromyalgiapatients, results of the study should also temper expectations about a quick cure or easy improvement of these patients symptoms.
For the study, Dr. Staud and colleagues applied a thermode (51.5º C) in a series of brief contacts to different sites on the smooth and bare skin of both hands of 65 normal controls and of 59 age-sex matched fibromyalgia patients. Sensation intensity was measured of the first and last stimulus of each series.
Each subject was trained to numerically rate the magnitude of late sensations felt following 700 milliseconds of contact with the preheated thermode. The interval between stimuli varied between two and five seconds within each series.
In contrast to controls,fibromyalgia subjects' average rating of the first stimulus in each series was slightly above pain threshold and was significantly different from that of the controls. Excessive windup occurred both at high and low rates of thermal stimulation in fibromyalgia subjects but not controls. Overall, across all sensitivity indices, maximal ratingswere significantly higher forfibromyalgia subjects than for controls.
By Amanda Kreidié
BALTIMORE – Mind-body therapy should be incorporated into the treatment of
fibromyalgia patients early, said Dr. Brian Berman, director of the
complimentary medicine program at the University of Maryland.
Dr. Berman, who recently led a systematic review of randomized and quasi-randomized controlled trials of mind-body therapy (MBT) in this patient population, found MBT stands for a clutch of interventions that aim to equip patients with greater control over reactivity to life circumstances by increasing self-awareness of the relationship between mental processes and physical sensations.
"That's an important factor in someone with a chronic disease like fibromyalgia because it gives them a sense of control over their own medical destiny," he said.
This category includes autogenic training, relaxation exercises, meditation, cognitive-behavioural training, hypnosis, guided imagery, biofeedback and education.
At present, MBT is offered "very sporadically" to fibromyalgia patients, said Dr. Berman, "and when it is, it tends to be as a last resort."
A search of nine electronic databases, 69 conference proceedings and several citation lists revealed 13 trials involving 802 subjects. The studies represented 10 types of comparisons of MBT for fibromyalgia. Treatment phases ranged from three weeks to three months, and nine of the trials reported followup evaluations beyond immediate post-treatment measures.
Dr. Berman's team found strong evidence MBT is more effective than treatment as usual for enhancing a fibromyalgia patient's sense of self-efficacy, defined here "as the patient's belief he or she can cope effectively with a challenging situation."
Self-efficacy is considered an important measure in this patient population because many have difficulty coping with symptoms. Studies have shown improvements in self-efficacy predict significant improvements in physical activity, pain and disease severity.
But the analysis, which was published in the Journal of Rheumatology, found only limited evidence MBT improved quality of life, and inconclusive evidence it decreased pain or improved physical function, depression and global improvement ratings.
"I was really surprised by the finding," remarked Dr. Berman. "I think it is more likely to be a reflection of the flaws in the designs of lots of the studies than anything else. Intuitively and based on what we've seen in some of our studies involving back pain, MBT is associated with improvements in other domains such as pain, mood and physical functioning."
A potential positive outcome of MBT alluded to by the review is its ability to enhance patient adherence to healthy behaviours.
While the investigators found strong evidence exercise (especially of the high-intensity variety) was superior to MBT in reducing pain and enhancing physical function, they noted long-term adherence to the intervention was as much as 45% greater among those trained in MBT.
This observation prompted them to suggest combining MBT with exercise may improve adherence to exercise regimens and lead to long-term improvements on several fronts.
"I think we should be looking at MBT techniques at a much earlier stage because the longer you wait, the more anxious and depressed the patient becomes," said Dr. Berman. "We're all finding that (fibromyalgia syndrome) is difficult to treat. We're not getting results with conventional therapy and I think the time has come for us to be more open to alternative and complementary approaches."
To Dr. Berman, that means offering MBT as a first-line treatment for fibromyalgia, either alone or with a conventional treatment, like a tricyclic antidepressant, and exercise.
Dr. Berman's team is conducting a randomized, controlled trial involving 110 patients with fibromyalgia. Under the protocol, half the cohort will receive eight weekly training sessions in MBT (mindful meditation, quijong and education), while controls will attend an equal number of education-only sessions offered by the Arthritis Foundation. Study results are not expected before year's end.
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