The Fibromyalgia Research Blog

Changes in Hippocampal Metabolites After Effective Fibromyalgia Treatment

2009-11-08T08:00:00.001-08:00

The Clinical Journal of Pain just published a case study that evaluates the impact of fibromyalgia on hippocampal brain metabolite ratios. Researchers at the Department of Family Medicine, Anesthesiology and Psychiatry at Louisiana State University's Biomedical Research Institute based this case study on the results of previous studies that used single voxel magnetic resonance spectroscopy (1H-MRS) to reveal an association between fibromyalgia and disruptions in hippocampal brain metabolite ratios in fibromyalgia patients with no psychiatric conditions. The hippocampus is an area of the brain located in the temporal lobes and near the amygdala. It is part of the limbic system and is involved in long-term memory (it's the first area to be affected by Alzheimer's Disease) as well as spatial navigation. It is extremely vulnerable to stress.

Exposure to stress is considered a risk factor for the development and exacerbation of fibromyalgia symptoms. Basic science has demonstrated the hippocampus to be exquisitely sensitive to the effects of stressful experience, which results in changes including alterations in metabolite content and frank atrophy.

The case study detailed in the report is of a 47-year old female fibromyalgia patient who, when evaluated, was shown to have a "profound depression of the ratio of N-acetylaspartate to creatine in her right hippocampus" when she participated in another study assessing brain metabolite disturbances in fibromyalgia. This irregularity had been diagnosed using single voxel proton magnetic resonance spectroscopy. The research team came up with an individualized treatment strategy based on the "physiological abnormalities associated with the disorder and symptoms that characterized the patient's unique clinical profile." What they discovered upon evaluating her after nine months of treatment was an "improvement in her clinical profile and normalization of the NAA/Cr ratio within her right hippocampus." The researchers concluded that:

Therapeutic strategies aimed at demonstrable lesions associated with fibromyalgia appear to represent rational targets for pharmacological intervention. The rationale for development of novel pharmacotherapies for this unusual disorder is discussed.

Study Details: Clin J Pain. 2009 Nov-Dec;25(9):810-4. PMID: 19851163.

Elavil (Amitryptiline) vs. Physical Therapy - What Works Better for Fibromyalgia?

2009-11-08T07:52:00.000-08:00

In a recently published study entitled Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: What predicts a clinical benefit?, researchers in Maharashtra, India, compared the efficacy of treating fibromyalgia with amitriptyline (Elavil) versus physiotherapy. The research subjects were 175 fibromyalgia patients at a rural hostpial in Central India. After six months of treatment with physical therapy or amitryptiline, they conducted a follow-up in which they assessed the benefits of the two different approaches. They used the fibromyalgia impact questionnaire (FIQ) score as their primary measure. They found a "significant but similar (P=0.82) improvement in disability in both groups." They found that a "high FIQ score at baseline and low socioeconomic status scores were significant predictors of benefit," and concluded that amitryptiline and physical therapy are of equal efficacy in improving fibromyalgia symptoms over a 6-month period.

Study details: PMID: 19884743. J Postgrad Med. 2009 Jul-Sep;55(3):159-60.

Yet Another Study Showing Decreased Gray Matter in the Brains of Fibromyalgia Patients

2009-05-12T09:22:00.001-07:00

In their study findings, titled Decreased Gray Matter Volumes in the Cingulo-Frontal Cortex and the Amygdala in Patients With Fibromyalgia, researchers at the University Hospital Münster (Germany) present the results of their investigation into the gray matter of fibromyalgia patients. Because previous studies supported the assertion that fibromyalgia involves central pain augmentation, they aimed to find out "whether structural changes in areas of the pain system are additional preconditions for the central sensitization in fibromyalgia." To do so, they performed MRI's and a neuroimaging technique called voxel based morphometry on 14 fibromyalgia patients and 14 healthy controls. They scanned and analyzed the brains of their subjects, finding that there were "[r]egional differences of the segmented and normalized gray matter volumes in brain areas of the pain system between both groups." They analyzed the "correlation of disease-related factors with gray matter volumes." The researchers found that there was a decrease in gray matter volume in the prefrontal cortex, the amygdala, and the anterior cingulate cortex (ACC) of fibromyalgia patients.

Our results suggest that structural changes in the pain system are associated with fibromyalgia. As disease factors do not correlate with reduced gray matter volume in areas of the cingulo-frontal cortex and the amygdala in patients, one possible interpretation is that volume reductions might be a precondition for central sensitization in fibromyalgia.

Biochemical Basis of Myofascial Pain Syndrome

2008-12-21T11:35:00.000-08:00

Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome is the title of an article published by members of the Rehabilitation Medicine Department of the National Institutes of Health (Bethesda, MD). The article "discusses muscle pain concepts in the context of myofascial pain syndrome (MPS) and summarizes microdialysis studies that have surveyed the biochemical basis of this musculoskeletal pain condition." Myofascial pain condition is extremely common in fibromyalgia patients, though it is unclear whether MPS can cause fibromyalgia or vice versa.

The pathophysiology of MPS is "only beginning to be understood due to its enormous complexity." It is considered to be characterized by the presence of myofascial trigger points (MTrPs), which should not be confused with fibromyalgia tender points. Myofascial trigger points are hyperirritable nodules located within a taut band of skeletal muscle. These bumps or bands can usually be felt through the skin. The authors of this article write that "MTrPs may be active (spontaneously painful and symptomatic) or latent (non-spontaneously painful)." Active trigger points can refer pain to other parts of the body as well as being painful to direct touch.

Painful MTrPs activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. This process is called sensitization.

The researchers sought to discover what influences this sensitization process using a microdialysis technique that was created in order to "quantitatively measure the biochemical milieu of skeletal muscle."

They found significant biochemical differences between active and latent myofascial trigger points (MTrPs) as well as biochemical differences between healthy muscle tissue and muscle tissue afflicted with trigger points.

40% of Patients with Cervical (Neck) Myofascial Pain Syndrome Also Have Fibromyalgia

2008-12-21T11:27:00.000-08:00

A study from Selcuk University in Turkey (PMID: 19085177) recently analyzed the demographic features, clinical findings and functional status of a group of cervical (neck) myofascial pain syndrome patients. They evaluated the patients using the short form health survey (SF-36), pain and depression levels, patient demographics and physical examinations. They used the visual analog scale, Beck Depression Inventory, and medical history to evaluate the patients. A total of 82 patients had a diagnosis of cervical myofascial syndrome. Almost 88% of these patients were female, and they were around 37 years of age on average.

53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome.

They concluded that younger female patients who present with autonomic system dysfunctions and early onset cervical spine injury should be "examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients."

Neurocognitive Defects & Brain Structure in Fibromyalgia: Are Pain & Cognitive Problems Related?

2008-10-06T11:54:00.000-07:00

The journal Brain [2008 Sep 26] just published a study on a fascinating study from the University of Regensburg's Clinic for Rheumatology in Germany. The researchers write that fibromyalgia patients often report memory and attention problems in addition to pain, stiffness and sleep disturbance. While "[a]ccumulating evidence suggests that [fibromyalgia] is associated with CNS [central nervous system] dysfunction and with an altered brain morphology," there have been few studies that have specifically focused on fibromyalgia patients' neuropsychological issues. Therefore the authors of this study aimed to determine whether fibromyalgia patients' memory and attention problems have any correllation with changes in the morphology (structure and shape) of the brain. They focused specifically on the frontal, temporal and cingulate cortices.

Twenty [fibromyalgia] patients underwent extensive testing for potential neuropsychological deficits, which demonstrated significantly reduced working memory and impaired non-verbal long-term memory (limited to free recall condition) in comparison with normative data from age- and education-matched control groups.

The researchers used a neuroimaging technique called Voxel-based morphometry (VBM) to determine whether there were correlations between neurocognitive test results and the shape/size of the brain in the regions mentioned above.

They found that non-verbal working memory performance was positively correlated with the amount of grey matter in the left dorsolateral prefontal cortex, and verbal working memory performance "was positively correlated with grey matter values in the supplementary motor cortex."

On the other hand, pain scores were negatively correlated with grey matter values in the medial frontal gyrus. White matter analyses revealed comparable correlations for verbal working memory and pain scores in the medial frontal and prefrontal cortex and in the anterior cingulate cortex.

The researchers conclude that the study's results provide clear evidence of memory and attention problems in fibromyalgia as well as the correlation of both pain and neurocognitive problems with brain structure:

Our data suggest that, in addition to chronic pain, [fibromyalgia] patients suffer from neurocognitive deficits that correlate with local brain morphology in the frontal lobe and anterior cingulate gyrus, which may be interpreted to indicate structural correlates of pain-cognition interaction.

Study Reveals Subgroups of Fibromyalgia Patients - Not All Experience Psychological Distress

2008-10-06T11:41:00.001-07:00

In an article entitled Fibromyalgia subgroups: profiling distinct subgroups using the Fibromyalgia Impact Questionnaire, researchers at the Université de Sherbrooke in Quebec, Canada, describe the results of their investigation of whether there are multiple types of fibromyalgia. Published in Rheumatology International [2008 Sep 27], the article describes the goal of the research study as identifying fibromyalgia subgroups using a "simple and frequently used clinical tool, the Fibromyalgia Impact Questionnaire (FIQ)."

A total of 61 women diagnosed with [fibromyalgia] participated in this study. [Fibromyalgia] subgroups were created by applying a hierarchical cluster analysis on selected items of the FIQ (pain, fatigue, morning tiredness, stiffness, anxiety and depressive symptoms). We also tested for group differences on experimental pain, psychosocial functioning and demographic characteristics.

The research indicates that while all fibromyalgia patients experience pain and stiffness and hyperalgesic responses to experimental pain, only some patients experience psychological distress. The researchers designate patients without morning fatigue, anxiety and/or depression, or with low levels of those symptoms, as Fibromyalgia - Type I. Patients who have "elevated levels of pain, fatigue, morning tiredness, stiffness, anxiety and depressive symptoms" as Fibromyalgia - Type II. This study is particularly relevance to the debate within both medical and patient communities as to the relationship between fibromyalgia and anxiety/depression. Some patients experience depression and/or anxiety before developing fibromyalgia. Some develop these symptoms long after the onset of pain and other fibromyalgia symptomsm. Still others never experience depression and anxiety at all, even as they struggle with the stress of chronic widespread pain. It also brings up questions about whether those fibromyalgia patients who do have depression or anxiety experience more severity of their pain and fatigue symptoms.

FDA Approves Cymbalta for Fibromyalgia

2008-06-17T13:21:00.000-07:00

The FDA approved duloxetine (Cymbalta) as a medication for fibromyalgia earlier this week. Cymbalta is a serotonin-norepinphrine reuptake inhibitor. It is also used for anxiety, major depression and peripheral diabetic neuropathy. It has been shown to be effective for some fibromyalgia patients. Cymbalta, made by Lilly, is the second drug to ever be approved for fibromyalgia. Last year Lyrica (pregabalin), an anti-convulsant, became the first fibromyalgia drug approved by the FDA.

The added indication [for fibromyalgia] was approval on the basis of data from two three-month clinical trials of 874 fibromyalgia patients. In both studies, compared with placebo, duloxetine was associated with more than a 30% reduction in pain as measured by the Brief Pain Inventory (BPI) 24-hour average pain scale.

Moreover, patients randomized to duloxetine reported significant pain relief during the first week of treatment.

In both studies the majority of duloxetine patients -- 65% in one study and 66% in the other -- said they felt better since beginning treatment with 60 mg of duloxetine daily, as measured by a self-assessment (Patient Global Impression of Improvement).

Cymbalta's side effects include nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating, and agitation. Twenty percent of duloxetine patients discontinued the study drug because of side effects.

Are Fibromyalgia Patients More Sensitive to Sound?

2008-02-29T08:51:00.001-08:00

Fibromyalgia is characterized by widespread tenderness, including sensitivity to touch. But do fibromyalgia patients also more sensitive to other stimuli, such as sound? In their article A Psychophysical Study of Auditory and Pressure Sensitivity in
Patients With Fibromyalgia and Healthy Controls, researchers at the Chronic Pain and Fatigue Research Center at the University of Michigan, Ann Arbor, discuss their recent research into this question [Journal of Pain, 2008 Feb 14]. Because past studies reported that people with fibromyalgia are sensitive to other stimuli, such as auditory tones, they hypothesized "that subjects with [fibromyalgia] would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities" and that fibromyalgia involves a global central nervous system amplification of sensory information.

The study administered auditory tones and physical pressure to 30 fibromyalgia patients and 28 healthy controls. They used the same psychophysical methods to deliver the stimuli and a similar way of scaling responses. Subjects also completed a self-report questionnaire regarding sensitivity to everyday sounds.

Participants with [fibromyalgia] displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between [fibromyalgia] patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with [fibromyalgia]... patients also were more sensitive to everyday sounds (t = 8.65, P < .001).

The research team suggests that these findings support the concept that fibromyalgia is "associated with a global central nervous system augmentation in sensory processing." They suggest further research to examine which neural substrates are associated with this abnormality of sensory processing and its role in the etiology of fibromyalgia. The research findings may also help explain why fibromyalgia patients frequently display a number of other physical symptoms besides pain.

Cost-Effectiveness of Aquatic Training for Women with Fibromyalgia

2008-02-29T08:42:00.000-08:00

The results of a randomized controlled trial were published in the most recent issue of Arthritis Research and Therapy [2008 Feb 22;10(1):R24]. Knowing that physical therapy in warm water has been shown to be highly effective for fibromyalgia patients, the study was designed to evaluate whether it is an efficient investment for patients or health care managers. The research aimed to "assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia."

The study evaluated costs to the health care system and to society. It included 33 participants, all women with fibromyalgia. Seventeen participants were randomly assigned to an experimental group and sixteen to a control group.

The intervention in the experimental group consisted of a one-hour, supervised, water-based exercise sessions, three times per week for 8 months. The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EQ-5D. Sensitivity analyses was performed for variations in the staff salary, number of women attending sessions and time spent going to the pool. The cost-effectiveness acceptability curves were created using a non-parametric bootstrap technique.

The mean incremental treatment costs for fibromyalgia patients participating in this aquatic therapy program exceeded those for usual care per patient by 517 Euros for health care costs and 1032 Euros for societal costs. The researchers conclude that "the addition of an aquatic exercise programme to the usual care for fibromyalgia in women, is cost-effective in terms of both health care costs and societal costs." However, the fact that appropriate facilities (warm water pools) are often far from patients' homes and cannot accommodate many patients per session is something that must be considered before investing in such a program.

Study Suggests Fibromyalgia Pain is Neuropathic

2008-02-29T08:25:00.000-08:00

In the March issue of the journal Pain Medicine [2008 Mar;9(2):149-160] researchers at three institutions in Florida conducted a study to determine whether the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, as well as to determine whether there is a cut-off score that can be used reliably to make this distinction between types of pain. This study evaluated 305 chronic pain patients (CPPs) admitted to The Rosomoff Pain Center (Miami, FL). All were administered the NPS, a diagnostic tool designed to assess thedistinct pain qualities associated with neuropathic pain, and were given a diagnosis on the basis of a physical examination and all available test results.

Using patients known to have neuropathic or non-neuropathic pain conditions as a reference, esearchers were able to derive "an NPS cut-off score above which CPPs would be classified as having neuropathic pain." Patients who had diagnoses of myofascial pain syndromes, spinal stenosis, epidural fibrosis, fibromyalgia, complex regional pain syndromes, and failed back surgery syndrome, a predicted NPS score was calculated and compared with the cut-off score.

The NPS appeared to be able to separate CPPs into neuropathic pain vs non-neuropathic pain subtypes. The cut-off score the researchers derived was 5.53 on the NPS. Myofascial pain syndrome and spinal stenosis had scores lower than this cut-off score at 3.81 and 4.26, respectively - Therefore they did not meet the criteria for neuropathic pain. Epidural fibrosis, fibromyalgia, complex regional pain syndromes, and failed back surgery syndrome had predictive scores higher than the cut-off score at 6.15, 6.35, 6.87, 9.34, and 7.19, respectively. Thus, these syndromes did meet the qualifications for neuropathic pain according to this study's criteria. The researchers conclude that the NPS does appear to be able to discriminate between patients experiencing neuropathic and non-neuropathic pain.

A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.

Immunological Changes in Fibromyalgia & Other Chronic Pain Conditions?

2008-02-04T10:27:00.000-08:00

The newest issue of the medical journal Neuroimmunomodulation [2008 Feb 1;14(5):272-280] includes the results of a study conducted by Department of Anesthesiology of Ludwig Maximilians University, Munich, Germany. The study address immunological changes in chronic pain patients, specifically complex regional pain syndrome (CRPS) and fibromyalgia (FMS), both of which the researchers describe as "chronic pain syndromes occurring in highly stressed individuals."

Despite the known connection between the nervous system and immune cells, information on distribution of lymphocyte subsets under stress and pain conditions is limited. Lymphocytes are white blood cells that play a critical role in the body's defenses. They include T cells, B cells, and natural killer cells. They also modulate the activities of other cells.

The researchers performed a comparative study of 15 patients with CRPS, 22 patients with FMS and 37 age- and sex-matched healthy controls. Their aim was to investigate the influence of pain and stress on lymphocyte number, subpopulations and the Th1/Th2 cytokine ratio in T lymphocytes.

Lymphocyte numbers did not differ between the groups studied. However, when the subtypes of lymphocytes were studied using quantitative analyses, it became evident that there was "a significant reduction of cytotoxic CD8+ lymphocytes in both CRPS... and [fibromyalgia]... patients as compared with healthy controls. Additionally, CRPS patients were characterized by a lower percentage of IL-2-producing T cell subpopulations reflecting a diminished Th1 response in contrast to no changes in the Th2 cytokine profile."

The article concludes that future studies are necessary in order to answer "whether such immunological changes play a pathogenetic role in CRPS and [FMS] or merely reflect the consequences of a pain-induced neurohumoral stress response, and whether they contribute to immunosuppression in stressed chronic pain patients."

Effects of the Drug Pyridostigmine Along with Exercise in Treatment of Fibromyalgia

2008-02-04T10:13:00.000-08:00

A subset of fibromyalgia patients are known to have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 (IGF-1) axis, which is diagnosed by low blood serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that the drug pyridostigmine (PYD) can improve the acute response of growth hormone to exercise in fibromyalgia patients. Researchers at Oregon Health & Science University in Portland, OR, conducted a 6-month randomized controlled trial of pyridostigmine in conjunction with exercise, in order to evaluate the effectiveness of this treatment on fibromyalgia treatment.

The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on [fibromyalgia] symptoms. The researchers randomized patients into one of four groups: PYD PYD plus exercise, PYD without exercise but with diet recall, placebo plus exercise, and placebo plus diet recall but no exercise. To assess the results of the treatments, they used the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. They also used other secondary outcome measures including the Fibromyalgia Impact Questionnaire (FIQ) and scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) evluation and level of physical fitness (lower body strength/endurance, upper and lower body flexibility, balance, and time on the treadmill).

A total of 165 [fibromyalgia] patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated.

The research team concluded that "neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most fibromyalgia symptoms." However, they noted that pyridostigmine (PYD) did improve anxiety and sleep, and exercise improved fatigue and fitness. They speculate that pyridostigmine (PYD) "may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study."

Online Support Groups Empowering for Patients with Fibromyalgia & Other Conditions

2008-02-04T10:06:00.001-08:00

In an article in the journal Qualitative Health Research [2008 Mar;18(3):405-17] researchers at the University of Twente in the Netherlands present the results of their research into the effects of online support groups on the wellbeing of fibromyalgia, breast cancer and arthritis patients.

Ever since the rise of online support groups it has been presumed that there is an empowering effect from patients' participating in these groups, despite a lack of evidence to back up this assumption. In this study we explored if, and in which ways, patients feel empowered by participation. Additionally, we studied which empowering and disempowering processes occur as a result of taking part in these groups.

Their study consisted of interviewing 32 participants of online support groups. Analyzing this interviews showed empowering processes that fell into the following categories: exchanging information, encountering emotional support, finding recognition, sharing experiences, helping others, and amusement. They found that few people mentioned disempowering processes.

Empowering outcomes mentioned were being better informed; feeling confident in the relationship with their physician, their treatment, and their social environment; improved acceptance of the disease; increased optimism and control; enhanced self-esteem and social well-being; and collective action.

The researchers concluded that participation in online support groups "can make a valuable contribution to the emergence of empowered patients."

Medications for Fibromyalgia

2008-01-09T09:31:00.000-08:00

According to an article in the Italian rheumatology journal Reumatismo [2007;59(4):280-291], the medications Italian physicians have found the most effective for fibromyalgia "include the tricyclic drugs and mixed reuptake inhibitors. Recent works suggest that the anticonvulsant medications pregabalin and gabapentin are also effective. Moreover, two serotonin and norepinephrine-reuptake inhibitors-duloxetine and milnacipran show encouraging results in treating FM symptoms. The results of clinical trials of anti-inflammatory medications have been generally disappointing, but three RCTs have found that tramadol (with or without acetaminophen) is effective in FM.

Effects of Yoga and Tui Na on Fibromyalgia

2008-01-09T09:19:00.000-08:00

A study conducted by the Pulmonary Division at University of São Paulo (Brazil) intended to verify whether techniques of yoga with and without the addition of traditional Chinese medicine modality Tui Na would "improve pain and the negative impact of fibromyalgia on patients' daily life." The results are published in the Journal of Alternative and Complementary Medicine [2007 Dec; 13(10):1107-14].

Forty women with fibromyalgia were randomly assigned to two groups. One group participated in Relaxing Yoga (RY) and the other received Relaxing Yoga plus Touch (RYT), for "eight weekly sessions of stretching, breathing, and relaxing yogic techniques." RYT patients also received manipulative techniques of Tui Na, an ancient hands-on Chinese technique that uses acupressure to bring the body into balance.

The outcome of the study was measured using the Fibromyalgia Impact Questionnaire (FIQ), pain threshold at the 18 FMS tender points, and a verbal assessment of pain. The visual analog scale (VAS) for pain was assessed before and after each session and on the follow-up.

Seventeen (17) RYT and 16 RY patients completed the study. Both RY and RYT groups showed improvement in the FIQ and VAS scores, which decreased on all sessions. The RYT group showed lower VAS and verbal scores for pain on the eighth session, but this difference was not maintained on the follow-up. Conversely, RY VAS and verbal scores were significantly lower just on the follow-up.

The results of this study show that yoga techniques are "valid therapeutic methods" for fibromyalgia. The addition of a touch-based modality further improved the outcome of treatments. However, over a longer period of time patients who received only Relaxing Yoga (without Tui Na) reported less pain, which suggests that "a passive therapy may possibly decrease control over fibromyalgia symptoms."

Warm Water Exerise Effective for Fibromyalgia Symptom Relief

2008-01-09T08:56:00.000-08:00

In the most recent issue of Clinical and Experimental Rheumatology [2007 Nov-Dec;25(6):823-30] researchers at the Section of Physical Education and Sports, University Pablo de Olavide, Seville (Spain) describe their study of the effects of warm water exercise on middle-aged women with fibromyalgia. They aimed to compare cognitive function between fibromyalgia patients and health controls, as well as to evaluate the efficacy of warm water exercise.

Sixty middle-aged women with fibromyalgia were randomly assigned to either an exercise training group that participated in 3 sessions a week of aquatic training in chest-high 32 C / 89.6 F water for 16 weeks. The program included mobility, aerobic, strengthening, and relaxation exercises. The control group did not receive this treatment. Twenty-five healthy women without fibromyalgia were also assessed. Pain was assessed in patients using pressure applied by a "syringe calibrated like a pressure dolorimeter", and a visual analog scale.

The severity of [fibromyalgia] was evaluated using the Fibromyalgia Impact Questionnaire. Cognitive function was measured in healthy individuals and patients using several standardized neuropsychological tests. All patients were measured at baseline and post-treatment.

Before treatment, the healthy women showed significantly superior cognitive performance to the fibromyalgia patients in all neuropsychological tests. The group that participated in the exercise program had major improvements in their pain threshold, tender point count, self-reported pain, severity of fibromyalgia symptoms, and cognitive function. No significant differences were seen in the control group.

An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of [fibromyalgia] as well as to improve cognitive function in previously unfit women with [fibromyalgia] and heightened painful symptomatology.

Nabilone (Synthetic Cannibanoid) for the Treatment of Fibromyalgia Pain

2007-11-25T23:25:00.000-08:00

Research conducted at the University of Manitoba's Rehabilitation Hospital [Canada] into the effectiveness of a synthetic cannibanoid for fibromyalgia pain was recently published in the Journal of Pain [2007 Oct 30] .

Nabilone is a synthetic cannabinoid that mimics THC, the main ingredient of marijuana, but it can be dosed more uniformly and has more predictable side effects. It causes no or minimal euphoria, and is not derived from the cannabis plant. Nabilone has been used medically as an anti-nausea drug as well as for neuropathic pain. It is sold in many countries as a drug called Cesamet and is FDA approved in the US for the treatment of chemotherapy-induced nausea and vomiting as well as for the treatment of anorexia and weight loss in AIDS patients. It is widely used "off-label" as an adjunct therapy for chronic pain management. Studies have shown it has benefits for multiple sclerosis as well as fibromyalgia.

In the University of Manitoba study, a randomized, double-blind, placebo-controlled trial was conducted to determine whether or not nabilone had any impact on pain management and quality of life in 40 fibromyalgia patients. Some patients were assessed before the treatment and then received slowly increasing doses of nabilone, starting at 0.5 mg PO at bedtime and going up to 1 mg BID over 4 weeks. Others received a placebo with similar titration instructions.

After four weeks there were significant decreases in the Visual Analog Score for pain (VAS) (-2.04, P < .02), Fibromyalgia Impact Questionnaire rating (-12.07, P < .02), and anxiety (-1.67, P <.02) in the nabilone treated group. There were no significant improvements in the placebo group. The treatment group also experienced more side effects. The research summarizes that Nabilone "appears to be a beneficial, well-tolerated treatment option for fibromyalgia patients" particularly because of the significant benefits it provides for pain relief and improvement of functioning:

To our knowledge, this is the first randomized, controlled trial to assess the benefit of nabilone, a synthetic cannabinoid, on pain reduction and quality of life improvement in patients with fibromyalgia. As nabilone improved symptoms and was well-tolerated, it may be a useful adjunct for pain management in fibromyalgia.

Fibromyalgia Has Highly Negative Impact on Lives of Muslim Bedouin Women

2007-11-25T23:24:00.000-08:00

Though research frequently focuses on patient populations in urban areas of developed countries, fibromyalgia "has been described and studied in various sociocultural settings in both developed and developing countries." In their study published in Seminars in Arthritis and Rheumatism [2007 Oct 29] researchers at Ben Gurion University of the Negev (Beer Sheva, Israel) aimed to assess the clinical manifestations of fibromyalgia and describe its effect on quality of life in the "unique setting of Muslim Bedouin women in the southern Israel Negev desert area."

They evaluated 102 Bedouin women were recruited from a primary health care clinic in the Negev, all of whom fulfilled the American College of Rheumatology (ACR) criteria for fibromyalgia diagnosis. Tender points were assessed using manual dolorimetry (an instrument used to measure pain tolerance) and pain level, anxiety, depression, and quality of life were also assessed using various questionnaires.

The study population was characterized by a low educational level, a high rate of consanguinity, a high number of children per mother, and a high rate of polygamy. There was a high frequency of classic [fibromyalgia] symptoms such as pain and fatigue, as well as anxiety and depression. The overall impact of [fibromyalgia] on quality of life was exceedingly high (8.9 on a scale of 0 to 10).

The researchers concluded that fibromyalgia is relatively common among Muslim Bedouin women and has a "very significant impact on their quality of life as well as on their dependents." They suggest that physicians who provide primary care to this population must be attentive to the manifestation and impact of fibromyalgia and its related disorders.

Transcranial Direct Current Stimulation for Pain and Sleep

2007-11-22T11:28:00.000-08:00

Medical researchers from the Department of Psychobiology, Universidade Federal de São Paulo (São Paulo, Brazil) conducted a randomized, sham-controlled study on the "site-specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia." The results are published in Pain Practice (2007 Nov 6).

Transcranial direct current stimulation (tDCS) involves applying weak electrical currents to the body so that the electromagnetic field they create will modulate the activity of brain neurons. It has been found to alter neuron firing rates. It is being studied as a treatment for a variety of conditions such as stroke recovery, depression and migraines. Do not confuse tDCS with electroconvulsive therapy or transcranial magnetic stimulation. tDCS does not independently cause nerve cells to fire, nor does it cause muscle twitches, seizures or other negative side effects of older forms of electrical stimulation.

The fibromyalgia sleep and pain study investigated whether or not transcranial direct current stimulation (tDCS) of two different parts of the brain, dorsolateral prefrontal cortex [DLPFC] and primary motor cortex [M1], would be more effective than sham treatment in its impact on the sleep patterns of fibromyalgia sufferers.

Thirty-two patients randomly received sham stimulation or active tDCS with the anode centered over M1 or DLPFC (2 mA, 20 minutes for five consecutive days). "A blinded evaluator rated the clinical symptoms of fibromyalgia. All-night polysomnography was performed before and after five consecutive sessions of tDCS."

The results of the study showed that anodal tDCS did have an effect on both sleep and pain that was specific to what site was stimulated. Stimulation of M1 and DLPFC treatments induced opposite effects on sleep and pain, whereas sham stimulation induced no significant sleep or pain changes.

Specifically, M1 treatment significantly increased increased sleep efficiency and decreased arousals, whereas DLPFC stimulation was decreased sleep efficiency, increased rapid eye movement (REM) latency (the time it takes to go from wakefulness to REM sleep) and sleep latency (the time it takes to go from full wakefulness to the point where you have fallen asleep). "A decrease in REM latency and increase in sleep efficiency were associated with an improvement in fibromyalgia symptoms (as indexed by the Fibromyalgia Impact Questionnaire)." The study also found that patients with a higher body mass index (BMI) had the worse sleep outcome as evaluated by changes in sleep efficiency after M1 stimulation.

The researchers conclude that "[o]ur findings suggest that one possible mechanism to explain the therapeutic effects of tDCS in fibromyalgia is via sleep modulation that is specific to modulation of primary M1 activity."

Muscle Strengthening vs. Aerobic Exercise for Fibromyalgia

2007-11-22T11:17:00.001-08:00

What is more effective in the treatment of fibromyalgia, aerobic exercise or muscle strengthening? That is what researchers at the Department of Physical Medicine and Rehabilitation, Dokuz Eylül University (Ýzmir, Turkey) decided to find out. This month's edition of Rheumatology International [2007 Nov 3] reveals their conclusions.

The study involved 30 women with fibromyalgia who were randomly assigned to either an aerobic exercise (AE) program or a strengthening exercise (SE) program for eight weeks. "Outcome measures included the intensity of fibromyalgia-related symptoms, tender point count, fitness (6-min walk distance), hospital anxiety and depression (HAD) scale, and short-form health survey (SF-36)."

There were significant improvements in both groups regarding pain, sleep, fatigue, tender point count, and fitness after treatment. HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores. Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group, whereas seven subscales of SF-36, physical component summary, and mental component summary improved significantly in the SE group. When the groups were compared after treatment, there were no significant differences in pain, sleep, fatigue, tender point count, fitness, HAD scores, and SF-36 scores.

The study shows that both types of exercise are more or less equally effective in improving symptoms for fibromyalgia. In particular they both have similar effects on reducing tender point count, improving fitness, reducing depression, and increasing quality of life. However, neither were shown to affect the anxiety that plagues some fibromyalgia patients.

Does Resistance Exercise Improve Heart Rate Variability in Women with Fibromyalgia?

2007-11-22T11:04:00.001-08:00

In the journal Clinical Physiology and Functional Imaging this month, researchers in the Department of Nutrition, Food and Exercise Sciences at Florida State University (Tallahassee, FL) present their findings regarding treating the reduced heart rate variability (HRV) that is found in fibromyalgia patients. Reduced heart rate variability increases fibromyalgia patients' risk for illness and death from cardiovascular problems.

The researchers hypothesized that resistance exercise training (RET) would improve heart rate variability, baroreflex (a bodily mechanism for maintaining blood pressure) sensitivity and muscle strength in women with fibromyalgia. They studied 10 FMS patients and 9 healthy controls, aged 27-60 years. Only women with fibromyalgia underwent RET two days per week for 16 weeks. Both groups of subjects were measured before and after the intervention and evaluated on their HRV and spontaneous baroreflex sensitivity (BRS) using a continuous electrocardiogram as well as blood pressure monitoring using finger plethysmography.

At baseline "RR interval, total power, log transformed (Ln) squared root of the standard deviation of RR interval (RMSSD), low-frequency power and BRS were lower... and [heart rate] and pulse pressure were higher in women with fibromyalgia than in healthy controls." After the resistance exercise treatment, "mean total power increased, RMSSD increased and Ln of high-frequency power increased in women with FM. Upper and lower body muscle strength increased by 63% and 49%... and pain perception decreased by 39% in women with FM." No changes were found in baroreflex sensitivity, heart rate and blood pressure after the treatment.

The researchers conclude as follows:

Our study demonstrates that RET improves total power, cardiac parasympathetic tone, pain perception and muscle strength in women with fibromyalgia who had autonomic dysfunction before the exercise programme.

1 in 4 Chronic Pain Patients Has Vitamin D Deficiency, Which Can Worsen Pain

2007-11-22T10:51:00.000-08:00

Vitamin D deficiency has been known for a while to be common in fibromyalgia patients, and research has even linked it with anxiety and depression in fibromyalgia. New research, however, shows that Vitamin D deficiency may in fact cause worsening of chronic pain in general. The American Society of Anesthesiologists recently released results of a Mayo Clinic study that shows that 1/4 of chronic pain patients have inadequate blood levels of vitamin D. The study also suggests that such a deficiency can possibly contribute to the severity of chronic pain. Their study showed that patients who have vitamin D deficiency needed a higher dose of morphine for a longer time in order to alleviate their pain.

Researchers recorded the serum vitamin D levels of 267 adults undergoing outpatient treatment for chronic pain, as well as their pain medication (morphine) dose and duration of use, and physical and general health functioning. Of the patients tested, 26 percent had vitamin D inadequacy. Among these patients, the morphine dose was nearly twice that of the group with adequate vitamin D levels. In addition, the vitamin D inadequacy group used morphine for an average of 71.1 months versus 43.8 months. The vitamin D deficient group also reported lower levels of physical functioning and had a poorer view of their overall health.

Low blood levels of Vitamin D can cause pain and muscle weakness in addition to inhibiting bone formation and negatively effecting the immune system. According to the researchers, "[p]revious studies also have suggested that pain-related symptoms of vitamin D inadequacy respond poorly to pain medications... The implications are that in chronic pain patients, vitamin D inadequacy is not the principal cause of pain and muscle weakness, however, it could be a contributing but unrecognized factor."

Vitamin D deficiency is easily treated with prescription supplements taken once or twice a week for 4-6 weeks.

Abnormalities Found in Nerve Cells in the Skin of Fibromyalgia Patients

2007-10-11T17:01:00.000-07:00

In this month's Clinical Rheumatology [2007 Oct 3], researchers at Dongguk University College of Medicine in South Korea published the results of a blinded study conducted to "determine if there are any abnormal electron microscopic (EM) findings in the skin of fibromyalgia syndrome (FMS) patients, which might contribute to or be due to the increased pain sensitivity seen in this condition."

They collected skin biopsy samples from 13 fibromyalgia patients and 5 control subjects, which were read by an individual who did not have any knowledge of whether the biopsy was from a study participant or not. All five skin biopsies from healthy controls "showed relatively even distribution of variegated sized unmyelinated axons sheathed well by complicatedly folded Schwann cell membranes." However, in the tissue samples from 9 of the 13 fibromyalgia petients, unmyelinated Schwann cells were noted to be ballooned, a finding not found in any of the controls.

Axons in most patients trended towards being localized in the periphery of the unmyelinated Schwann cell sheaths (p = 0.002). Particularly, peripheral localization of axon in the unmyelinated Schwann cell sheath had a strong relationship with ballooning of Schwann cell (p =0.042), simplified folding of Schwann cell sheath (p = 0.039) and smaller axon (p = 0.034). Myelinated nerve fibers were unremarkable.

The skin of fibromyalgia patients showed unusual patterns of unmyelinated nerve fibers as well as associated Schwann cells. The researchers conclude that if these findings can be replicated in a larger study, it could be concluded that these abnormalities contribute or even cause fibromyalgia patients' lower pain threshold.

Gender Differences in Fibromyalgia Patients' Medical and Social Experiences

2007-10-11T16:35:00.000-07:00

Researchers in Spain set about evaluating the sociodemographic, clinical and psychosocial differences between men and women with fibromyalgia, as well as analyzing the differences in how fibromyalgia symptoms impact male and female patients in their daily activities and work environment, and how they are treated by the healthcare system. In this study, published in Revista Clínica Española [2007 Oct;207(9):433-9], they used a detailed survey, distributed to patients with currently diagnosed fibromyalgia in three different rheumatology clinics in Spain.

The sociodemographic characteristics were very similar in men and women. However, there was a greater proportion of men diagnosed with [fibromyalgia] on sick leave, compared to women with the same diagnosis. Men had a worse perception of their health, a higher percentage of psychiatric history and current mental illness and more impact of the disease.

The researchers explain their belief that these results support their theory that in fibromyalgia, as with other diseases, "there are gender differences in the clinical and psychosocial characteristics of men and women diagnosed with [fibromyalgia]."