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Co-Cure Weekly Digest of research and medical posts only - 23 Apr 2007 to 30 Apr 2007

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Date:    Tue, 24 Apr 2007 12:59:12 -0400
From:    Fred Springfield <fredspringfield VERIZON.NET>
Subject: RES: Nitric oxide synthase partial uncoupling as a key  switching mechanism for the NO/ONOO- cycle

Nitric oxide synthase partial uncoupling as a key switching mechanism for
the NO/ONOO- cycle.

Journal: Med Hypotheses. 2007 Apr 18; [Epub ahead of print]

Author: Pall ML.

Affiliation: School of Molecular Biosciences, Washington State University,
Pullman, WA 99164-4234, USA.

NLM Citation: PMID: 17448611


Short-term stressors, capable of increasing nitric oxide levels, act to
initiate cases of illnesses including chronic fatigue syndrome, multiple
chemical sensitivity, fibromyalgia and posttraumatic stress disorder. These
stressors, acting primarily through the nitric oxide product,
peroxynitrite, are thought to initiate a complex vicious cycle mechanism,
known as the NO/ONOO- cycle that is responsible for chronic illness.

The complexity of the NO/ONOO- cycle raises the question as to whether the
mechanism that switches on this cycle is this complex cycle itself or
whether a simpler mechanism is the primary switch.

It is proposed here that the switch involves a combination of two variable
switches, the increase of nitric oxide synthase (NOS) activity and the
partial uncoupling of the NOS activity, with uncoupling caused by a
tetrahydrobiopterin (BH4) deficiency. NOS uncoupling causes the NOS enzymes
to produce superoxide, the other precursor of peroxynitrite, in place of
nitric oxide.

Thus partial uncoupling will cause NOS proteins to act like peroxynitrite
synthases, leading, in turn to increased NF-kappaB activity. Peroxynitrite
is known to oxidize BH4, and consequently partial uncoupling may initiate a
vicious cycle, propagating the partial uncoupling over time.

The combination of high NOS activity and BH4 depletion will lead to a
potential vicious cycle that may be expected to switch on the larger
NO/ONOO- cycle, thus producing the symptoms and signs of chronic illness.

The role of peroxynitrite in the NO/ONOO- cycle also implies that such
uncoupling is part of the chronic phase cycle mechanism such that agents
that lower uncoupling will be useful in treatment.

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Date:    Tue, 24 Apr 2007 17:52:29 -0400
From:    "Bernice A. Melsky" <bernicemelsky@VERIZON.NET>
Subject: RES: Thermal and Visceral Hypersensitivity in Irritable Bowel Syndrome Patients With and Without Fibromyalgia

Thermal and Visceral Hypersensitivity in Irritable Bowel Syndrome Patients
With and Without Fibromyalgia.

Clin J Pain. 2007 May;23(4):323-330.

Moshiree B, Price DD, Robinson ME, Gaible R, Nicholas Verne G.

Departments of Medicine, Oral and Maxillofacial Surgery, Neuroscience,
Clinical and Health Psychology, University of Florida Colleges of Medicine,
Dentistry, Public Health and Health Professions, Gainesville, FL  and North
Florida/South Georgia Veteran Health System.

PMID: 17449993


BACKGROUND: Irritable bowel syndrome (IBS) is a chronic gastrointestinal
disorder characterized by both visceral and somatic hyperalgesia, producing
a similar effect seen with the central hypersensitivity mechanism in
fibromyalgia (FM).

OBJECTIVES: The aim of the current study was to compare magnitudes of
visceral and thermal hypersensitivity in IBS patients and FM patients with
IBS (FM+IBS) compared with healthy controls.

METHODS: Female patients with IBS (n=12), FM+IBS (n=12), and control
participants (n=13) rated pain intensity to hot water immersion (45 and 47
degrees C) of the hand/foot and to phasic distension of the rectum (35, 55
mm Hg) on a Mechanical Visual Analog Scale. The data were analyzed with 3
separate 1-way analyses of variance with post hoc Tukey tests.

RESULTS: For both thermal and visceral stimuli, the control group had lower
pain ratings than either the IBS or FM+IBS groups (P<0.001). IBS patients
rated rectal distension as more painful than the FM+IBS group (P=0.005).
During hot water immersion of the foot, the FM+IBS group had higher pain
ratings than the IBS group (P<0.001). During hand immersion, FM+IBS and IBS
patients did not significantly differ in their pain intensity ratings (P=0.4).

CONCLUSIONS: FM+IBS patients show greater thermal hypersensitivity compared
with IBS patients. However, IBS patients exhibit higher pain ratings to
rectal distension compared with FM+IBS patients. This data suggests that
regions of primary and secondary hyperalgesia are dependent on the primary
pain complaint.

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Date:    Wed, 25 Apr 2007 14:38:46 -0400
From:    Fred Springfield <fredspringfield VERIZON.NET>
Subject: RES: Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Is cognitive behaviour therapy for chronic fatigue syndrome also effective
for pain symptoms?

Journal: Behav Res Ther. 2007 Mar 14; [Epub ahead of print]

Authors: Hans Knoop [a, *], Maja Stulemeijer [b], Judith B. Prins [b], Jos
W.M. van der Meer [c] and Gijs Bleijenberg [a]

Affiliations:
[a] Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical
Centre, Post Box 9011, 6525 EC Nijmegen, The Netherlands
[b] Department of Medical Psychology, Radboud University Nijmegen Medical
Centre, Nijmegen, The Netherlands
[c]Department of Internal Medicine, Radboud University Nijmegen Medical
Centre, Nijmegen, The Netherlands

[*] Corresponding author. Tel.: +31 243610030; fax: +31 243610041.

Received 25 August 2006;
revised 7 March 2007;
accepted 8 March 2007.
Available online 14 March 2007.

NLM Citation: PMID: 17451642


Patients with chronic fatigue syndrome (CFS) frequently report chronic pain
symptoms. Cognitive behavioural therapy (CBT) for CFS results in a
reduction of fatigue, but is not aimed at pain symptoms.

In this study, we tested the hypothesis that a successful treatment of CFS
can also lead to a reduction of pain. The second objective was to explore
possible mechanisms of changes in pain. The third objective was to assess
the predictive value of pain for treatment outcome.

Data from two previous CBT studies were used, one of adult CFS patients
(n=96) and one of adolescent CFS patients (n=32). Pain severity was
assessed with a daily self-observation list at baseline and post-treatment.
The location of pain in adults was assessed with the McGill Pain
Questionnaire (MPQ). Patients were divided into recovered and non-recovered
groups. Recovery was defined as reaching a post-treatment level of fatigue
within normal range.

Recovered adult and adolescent CFS patients reported a significant
reduction of pain severity compared to non-recovered patients. Recovered
adult patients also had fewer pain locations following treatment.

The decrease in fatigue predicted the change in pain severity. In adult
patients, a higher pain severity at baseline was associated with a negative
treatment outcome.


Keywords: Chronic fatigue syndrome; Cognitive behavioural therapy; Pain
symptoms; Outcome

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Date:    Wed, 25 Apr 2007 15:04:57 -0400
From:    Fred Springfield <fredspringfield VERIZON.NET>
Subject: RES: The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and
fibromyalgia syndrome.

Journal: Stress. 2007 Mar;10(1):13-25.

Authors: Tanriverdi F,Karaca Z, Unluhizarci K,Kelestimur F.

Department of Endocrinology, Medical School, Erciyes University. Kayseri.
Turkey.

NLM Citation: PMID: 17454963


The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the
regulation of responses to stress. Human stress-related disorders such as
chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic
pain and post-traumatic stress disorder are characterized by alterations in
HPA axis activity.

However, the role of the HPA axis alterations in these stress-related
disorders is not clear. Most studies have shown that the HPA axis is
underactive in the stress-related disorders, but contradictory results have
also been reported, which may be due to the patients selected for the
study, the methods used for the investigation of the HPA axis, the stage of
the syndrome when the tests have been done and the interpretation of the
results.

There is no structural abnormality in the endocrine organs which comprise
the HPA axis, thus it seems that hypocortisolemia found in the patients
with stress-related disorder is functional. It may be also an adaptive
response of the body to chronic stress.

In this review, tests used in the assessment of HPA axis function and the
HPA axis alterations found in CFS and FMS are discussed in detail.

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Date:    Wed, 25 Apr 2007 16:26:37 +0200
From:    Jan van Roijen <j.van.roijen CHELLO.NL>
Subject: act,med: MEA - recent letters - RiME

~~~~~~~~~~~~~~~~~~~~~~~~~~~~


Send an Email for free membership
~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~
       >>>> Help ME Circle  <<<<
 >>>>       24 April 2007       <<<<
Editorship : j.van.roijen chello.nl
Outgoing mail scanned by Norton AV
~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~


PERMISSION TO REPOST



Campaigning for Research into Myalgic Encephalomyelitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RiME



The following letters have been sent to (1) Neil Riley, Chair of
Trustees MEA (2) Professor L Findley, National ME Centre.



21/4/07


Dear Mr Riley,

I am writing to you again re. the NHS Centres.

It would appear from articles in ME Essential and Charles
Shepherd's address to the APPG Nov. 2005 that the MEA
supports them blanket-style.

The MEA's position is not consistent with feedback RiME gets
from around the UK. I enclose with this letter no fewer than 12
pages of criticism of the NHS Centres.

If you look at this evidence you will see that the concern which
crops up consistently is one which relates to nomenclature:
people saying that the CNCC or clinic in their area is not to do
with neurological ICD-ME.

It is clear from meetings with Govt officials that the MEA
supports the WHO Code G93.3 which lists ME as a neurological
illness (confusing in that the MEA changed its title from ME -itis
to -opathy a while ago).

The members of the MEA, incidentally, have voted for the
Canadian Criteria which, like the WHO classification, describes
ME as a neurological illness.

On Nov. 6 last year, I wrote to you about the issue of the Kent
Clinics (enclosed were a batch of letters from people in Kent
expressing their concerns). I pointed out that at the July 20
APPG meeting, Charles Shepherd appeared to support the
Clinics in Kent but that admittance is based on a 'version of the
Fukuda Criteria'; the Kent Criteria actually excludes people who
meet the G93.3 classification ie ME = Neurological illness -
Section 5.4.


You replied Nov. 15 saying, 'Thank you for your letter. Your
comments have been noted'.


RiME and its supporters do not find your reply, as Chair of the
MEA's Board of Trustees, satisfactory. There is a clear anomaly,
here, and it needs to be addressed. How can the MEA on the
one hand ask the Govt to recognise the WHO code, in what it
does, and then support clinics which exclude those who meet the
G93.3 classification?

In the 12 pages mentioned above is a batch of letters from
people in London expressing their concerns re. the Barts
CNCC. As you can see, several believe that (1) people who
meet the WHO code do not fit this clinic's admittance criteria (2)
the treatment is not for people with neurological ICD-ME (3) the
treatment is potentially harmful for people with neurological
ICD-ME.



There are some serious issues and questions, here. I ask that
this time you address them please...

This letter will be put in the public domain.

````


April 21 2007

Dear Professor Findley,

I am writing to you about the neurological illness Myalgic
Encephalomyelitis (ME) and the pivotal issue of nomenclature.

In 2005 you supported the Canadian Criteria, which describes
ME as a neurological illness.

The same year you were involved in the setting up of the NHS
Clinics in Kent. The admittance criteria to the Kent Clinics is set
out in a letter from the West Kent NHS and Social Trust to GPs
28/6/05 (enclosed). The criteria has been dubbed by people in
Kent 'a version of the Fukuda Criteria' and excludes persons
who meet the WHO G93.3 Classification ie ME = a neurological
illness - Section 5.4.

Several in Kent say, 'it is difficult to find two criteria further
apart'.

Can you explain the anomaly? ...

This letter will be put in the public domain.



Card Appeal:
RiME welcomes old cards - Easter, Birthday,
Anniversary, New Home, Blank, Postcards...


10 Carters Hill Close Mottingham SE9 4RS



rimexx tiscali.co.uk

www.erythos.com/RiME

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Date:    Thu, 26 Apr 2007 10:42:34 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain or Depression in Patients with Fibromyalgia

Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain
or Depression in Patients with Fibromyalgia.

Clin Neuropsychol. 2007 May;21(3):532-46.

Iverson GL, Page JL, Koehler BE, Shojania K, Badii M.

University of British Columbia & Riverview Hospital. Vancouver, BC.

PMID: 17455036


Neuropsychologists routinely give effort tests, such as the Test of Memory
Malingering (TOMM). When a person fails one of these tests, the clinician
must try to determine whether the poor performance was due to suboptimal
effort or to chronic pain, depression, or other problems.

Participants were 54 community-dwelling patients who met American College
of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM,
they completed the Beck Depression Inventory-Second Edition,
Multidimensional Pain Inventory-Version 1, Oswestry Disability Index-2.0,
British Columbia Cognitive Complaints Inventory, and the Fibromyalgia
Impact Questionnaire.

The majority endorsed at least mild levels of depressive symptoms (72%),
and 22% endorsed "severe" levels of depression. The average scores on the
TOMM were 48.8 (SD = 1.9, range = 40-50) for Trial 1, 49.8 (SD = 0.5, range
= 48-50) for Trial 2, and 49.6 (SD = 0.9, range = 45-50) for Retention.

Despite relatively high levels of self-reported depression, chronic pain,
and disability, not a single patient failed the TOMM. In this study, the
TOMM was not affected by chronic pain, depression, or both.

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Date:    Fri, 27 Apr 2007 13:16:32 +0200
From:    "Dr. Marc-Alexander Fluks" <fluks COMBIDOM.COM>
Subject: RES,NOT: Is CBT for CFS effective for pain symptoms ?

Source Behaviour Research and Therapy
       Preprint
Date:  March 14, 2007
URL:      http://www.sciencedirect.com/science/journal/00057967


Is cognitive behaviour therapy for chronic fatigue syndrome also effective
for pain symptoms?
--------------------------------------------------------------------------
Hans Knoop(a,*), Maja Stulemeijer(b), Judith B. Prins(b), Jos W.M. van der
Meer(c), Gijs Bleijenberg(a)
a Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre,
  Post Box 9011, 6525 EC Nijmegen, The Netherlands
b Department of Medical Psychology, Radboud University Nijmegen Medical
  Centre, Nijmegen, The Netherlands
c Department of Internal Medicine, Radboud University Nijmegen Medical
  Centre, Nijmegen, The Netherlands
* Corresponding author. Tel.: +31 243610030; fax: +31 243610041.
  E-mail address: j.knoop nkcv.umcn.nl (H. Knoop).


Received 25 August 2006; received in revised form 7 March 2007; accepted
8 March 2007


Abstract

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain
symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction
of fatigue, but is not aimed at pain symptoms. In this study, we tested the
hypothesis that a successful treatment of CFS can also lead to a reduction
of pain. The second objective was to explore possible mechanisms of changes
in pain. The third objective was to assess the predictive value of pain for
treatment outcome. Data from two previous CBT studies were used, one of
adult CFS patients (n=96)  and one of adolescent CFS patients (n=32). Pain
severity was assessed with a daily self-observation list at baseline and
post-treatment. The location of pain in adults was assessed with the McGill
Pain Questionnaire (MPQ). Patients were divided into recovered and
non-recovered groups. Recovery was defined as reaching a post-treatment
level of fatigue within normal range. Recovered adult and adolescent CFS
patients reported a significant reduction of pain severity compared to
non-recovered patients. Recovered adult patients also had fewer pain
locations following treatment. The decrease in fatigue predicted the change
in pain severity. In adult patients, a higher pain severity at baseline was
associated with a negative treatment outcome.

Keywords: Chronic fatigue syndrome; Cognitive behavioural therapy; Pain
symptoms; Outcome


Introduction

Chronic fatigue syndrome (CFS) is characterised by severe fatigue lasting
longer than 6 months and leading to functional impairment. CFS is neither
the result of an organic disease or ongoing exertion nor alleviated by rest.
According to the Centre for Disease Control (CDC) definition of CFS, the
patient should have four out of eight additional symptom criteria (Fukuda et
al., 1994). Four of these are pain symptoms, i.e. muscle pain, multi-joint
pain, headaches and a sore throat. The other four are post-exertional
malaise, unrefreshing sleep, concentration and/or memory impairments and
sensitive lymph nodes. The frequency of pain symptoms in CFS differs between
studies (King & Jason, 2005; Meeus, Nijs, & De Meirleir, 2007; Vercoulen et
al., 1994) but is usually high. In the study of Vercoulen et al. (1994), the
frequency of spontaneously reported pain symptoms ranged from 13% (sore
throat) to 71% (muscle pain). King and Jason (2005) systematically assessed
complaints and found much higher frequencies ranging from 60% for a sore
throat to 93% for headaches and muscle pain. The chronic pain symptoms in
CFS are disabling and compromise physical and social functioning (Meeus et
al., 2007).

The aetiology of CFS is unknown, but cognitions and behaviour can perpetuate
CFS (Prins, van der Meer, & Bleijenberg, 2006; Suraway, Hackmann, Hawton, &
Sharpe, 1995). A statistically tested model of perpetuating factors in CFS
showed that a low sense of control of symptoms and a focus on bodily
symptoms had a direct causal effect on fatigue (Vercoulen et al., 1998).
Furthermore, attributing the symptoms of CFS to a somatic cause produced low
levels of physical activity which in turn had a negative causal effect on
fatigue. More recently, it was found that a perceived lack of social support
can also perpetuate the fatigue (Prins et al., 2004).

Several controlled trials have found that cognitive behaviour therapy (CBT)
aimed at the perpetuating factors of CFS leads to a reduction of fatigue and
disabilities (Whiting et al., 2001). A recent systematic review showed that
of the eight CBT trials for CFS that have been performed, six reported a
positive outcome (Chambers, Bagnall, Hempel, & Forbes, 2006). Most studies
used fatigue as an outcome measure.

There are no interventions in the different treatment protocols for CFS that
focus on pain symptoms, but it is implicitly assumed that an effective
treatment of fatigue will also lead to a reduction of pain. Recently, it was
shown that adolescents indeed report a decrease of muscle pain and headache
following CBT for CFS (Stulemeijer, de Jong, Fiselier, Hoogveld, &
Bleijenberg, 2005). However, the measure used was a four-point Likert scale
in which the prevalence of pain had to be evaluated retrospectively over a
period of 6 months. This type of pain assessment is easily influenced by
situational circumstances and memory biases which can be prevented with the
use of a pain diary (Smith & Safer, 1993). To our knowledge, there are no
published data pertaining to the effect of CBT for CFS on pain in adult
patients.

The first objective of this study was to determine whether an effective
treatment of CFS with CBT also leads to a significant reduction of pain
symptoms when these symptoms are evaluated with an appropriate assessment
method. CBT is considered effective if a patient is recovered, that is
reporting a level of fatigue within the range of healthy individuals (Prins,
Bleijenberg, & van der Meer, 2002). In assessing pain symptoms we looked at
pain severity and the location of the pain symptoms.

The second objective was to investigate the mechanisms of possible changes
in pain severity following CBT. A central feature of CBT for CFS is the
gradual increase of physical activity. It is possible that the increased
activity levels also lead to a decrease of pain. CBT for CFS also aims to
modify those cognitions and cognitive processes that perpetuate fatigue. The
persistent focus on bodily symptoms or body consciousness is one of these
cognitive processes (Vercoulen et al., 1998). If this focus is lessened as a
consequence of therapy, it is likely that this generalises to other symptoms
than fatigue, e.g. pain. Finally, CBT for CFS leads to a reduced negative
affectivity, which could lead to a diminished report of physical symptoms
(i.e. pain).

The third objective was to assess the predictive value of pain severity at
baseline on the outcome of the treatment. Although physical activity has a
positive effect on chronic pain in the long term (Busch, Schachter, Peloso,
& Bombardier, 2002), increase in activity can have a negative influence on
pain symptoms in the short term. Whiteside, Hansen, and Chauduri (2005)
found that CFS patients reported a lower pain threshold following physical
activity. In their study, the pain threshold of patients was repeatedly
determined after graded exercise. Since graded activity is an important
feature of CBT, this could mean that CBT leads to a lower pain threshold.
This lower pain threshold might hamper the increase in activity level during
therapy and could lead to a less favourable outcome of CBT. We suspected
that this was especially true for those patients who already had a high pain
severity at the start of the therapy. In determining the predictive value of
pain for treatment outcome, we controlled for the relationship between pain
and physical activity.


Methods

Subjects

To answer our research questions, data from two previous CBT studies with
patients with CFS were used. In the first study, the outcome of CBT for CFS
in adults was evaluated (Knoop, Bleijenberg, Gielissen, van der Meer, &
White, 2007). The effect of CBT on pain symptoms was not determined in this
study. Ninety-six adult patients who met the CDC criteria for CFS
participated in the study. They were severely fatigued and functionally
impaired. Severe fatigue was defined by a cut-off score of 35 or higher on
the subscale fatigue severity of the Checklist Individual Strength (CIS;
Vercoulen et al., 1994). Functional impairment was assessed with the
Sickness Impact Profile (SIP). The SIP consists of eight subscales measuring
functional impairments of different domains of functioning. The scores on
the subscales were added to provide one weighted score of general
disability. A score of 700 or higher was used as a cut-off score (Van der
Werf, De Vree, van der Meer, & Bleijenberg, 2003). The mean age of the adult
patients was 37 years (S.D.=11.5). Seventy-three patients were women (76%),
and the median duration of the illness was 48.0 months (range=264 months).

The second study used was a randomised controlled trial testing the
effectiveness of CBT for adolescents with CFS (Stulemeijer et al., 2005).
Patients included in this study were between 10 and 17.2 years old. They met
the CDC criteria for CFS. In this study, severe fatigue was defined as
having a score of 40 or higher on the CIS subscale fatigue severity. The
cut-off score for adolescents is higher than for adults because the mean
fatigue severity in healthy adolescents is also higher (Stulemeijer et al.,
2005). Severe functional impairment was operationalised as having a weighted
score of 65 or less on the SF-36 Physical Functioning scale. The score on
this subscale can range from 0 (maximum physical limitations) to 100
(ability to do vigorous activity). The CBT group consisted of 35 adolescents
with a mean age of 15.6 years (S.D.=1.3); 31 patients were female (89%) and
the median duration of the illness was 16.0 months (range=44 months). Three
patients did not start with the treatment and only the data of the 32
patients who started with CBT after baseline assessment were used for
further analysis.


Design

All patients were assessed at baseline and post-treatment. Patients were
divided into a recovered and non- recovered group based on their
post-treatment score on the CIS subscale fatigue severity. The definition of
recovery in adult CFS patients was based on a previous randomised controlled
trial that tested the effectiveness of CBT for adult CFS patients (Prins et
al., 2001). In this study, adult patients were considered recovered if their
score on the CIS subscale fatigue was lower than 36. This score is within
two standard deviations of the mean of a healthy adult control group
(Vercoulen, Alberts, & Bleijenberg, 1999; Vercoulen et al., 1994). Using
this criterion created a potential overlap with the cut-off score that was
used for including patients in the adult study (scoring 35 or higher on the
CIS subscale fatigue; Knoop et al., 2007). However, as no patient in this
latter study actually scored lower than 36, we could use scoring lower than
36 as a criterion for recovery for adult patients. The original CBT study
with adolescent CFS patients used a criterion of scoring lower than 35.7 on
the CIS subscale fatigue (Stulemeijer et al., 2005). This is a more strict
criterion than the one used in adult patients, as a score of 35.7 represents
the mean plus one standard deviation of a healthy adolescent control group
(Stulemeijer et al., 2005). We used this cut-off score as a criterion for
recovery for adolescent patients.

Sixty-three adult patients (66%) had a CIS score lower than 36 at
post-treatment and were considered recovered; the remaining 33 patients
formed the non-recovered adult group. Of the 32 adolescents, 21 (66%) scored
lower than 35.7 and were considered recovered, 11 did not recover. In the
analysis, the effect of CBT on pain for recovered and non-recovered patients
was compared. For the adolescent study, there were also data available from
a waiting list control group. We did an additional analysis in which the
effect of CBT on pain symptoms was compared with the waiting list condition.


Assessment

Fatigue

The CIS subscale fatigue severity indicates the level of fatigue experienced
over the past 2 weeks. The CIS consists of eight items on a seven-point
scale. The score can range between 8 and 56. The CIS has been validated and
is reliable (Stulemeijer et al., 2005; Vercoulen et al., 1994, 1999).


Pain

Adolescent and adult patients rated their pain on a daily self-observation
list four times a day during a period of 12 days, on a scale ranging from 0
(no pain) to 4 (very severe pain). The daily pain score could range between
0 and 16, and the total 12 daily pain scores were averaged into one daily
observed pain (DOP) score. The DOP score was compared with the scores of a
reference group of 90 healthy people, consisting of 35 men and 55 women
(mean age=37.1, S.D.=10.9) who participated as healthy controls in previous
studies. Their mean DOP score is 1.0 (S.D.=1.3).

Adult patients also completed the McGill Pain Questionnaire (MPQ; Melzack,
1975; Van der Kloot, Oostendorp, van der Meij, & van den Heuvel, 1995). The
MPQ included a whole body outline to indicate the distribution of pain. To
determine the frequency of CDC pain symptoms at baseline, both adolescent
and adult patients filled in a questionnaire where they had to report on a
four-point scale how often during the last 6 months they had experienced
muscle pain, headache, multi-joint pain and sore throat. Scores on each of
the four items ranged from 1 to 4 (1=never, 2=several times a month,
3=several times a week, 4=every day).


Physical activity

Physical activity level was measured in adolescent and adult patients at
baseline with an actometer, a motion-sensing device worn at the ankle that
quantifies physical activity. The actometer detects movements of the leg
(e.g. during walking or climbing stairs). The actometer was worn 12
consecutive days and nights. A general physical activity score that
expressed the mean activity level over this period in the mean number of
accelerations per 5-min interval was calculated (Van der Werf, Prins,
Vercoulen, van der Meer, & Bleijenberg, 2000). Research has shown that the
actometer yields highly reliable data and is a valid instrument for
measuring physical activity (Vercoulen et al., 1997).


Negative affectivity

Negative affectivity was operationalised as the level of depressive symptoms.
This was assessed only in adults with the subscale depression of the SCL90
(Arrindell & Ettema, 1981).


Body consciousness

The subscale private body consciousness of the Body Consciousness
Questionnaire was used to measure the tendency of adolescent and adult
patients to focus on bodily symptoms. This subscale has five items that can
be answered on a scale from 0 (extremely uncharacteristic) to 4 (extremely
characteristic). It has been used before in studies of CFS patients (Van der
Werf, De Vree, van der Meer, & Bleijenberg, 2002).

There were two assessments, one at baseline and one directly following
termination of the treatment. At each assessment the patient visited the
hospital twice in a period of 2 weeks. During the first visit, the patient
completed all the questionnaires and received the actometer and daily
self-observation list. After 2 weeks, the patient brought the daily
self-observation list and actometer back.


Intervention

Adult patients received CBT for CFS according to the protocol described by
Bleijenberg, Prins and Bazelmans (2003). The treatment consisted of 16
sessions over a period of 6 months and was aimed at changing fatigue-related
cognitions and a gradual increase of activities. For adolescents, a protocol
was designed that consisted of 10 sessions over a period of 5 months (see
also Stulemeijer et al., 2005). Adolescents received fewer sessions because
experience has found that a positive outcome can be reached quicker.


Statistics

The t-tests were used to analyse the effect of CBT on pain severity. The
change in DOP score from baseline to post-treatment of the recovered groups
was compared with the change in DOP score of the non-recovered groups. The
differences in the percentage of recovered and non-recovered patients who
had a DOP score within normal limits (when compared to healthy controls)
were tested with a chi-square test. Within normal limits was defined as
having a DOP score of 2.3 or lower (i.e. within the range of the mean plus
one standard deviation of the controls). The same analyses with the DOP
score were done when the total group of adolescents who received CBT was
compared with the group of patients from the waiting list. The differences
in the percentages of recovered and non- recovered adult patients who report
pain at the locations identified with the MPQ at baseline and post-treatment
were tested with a chi-square test. To determine the possible mechanisms of
a change in pain, a stepwise multiple regression was performed with change
in DOP score as dependent factor, the change in fatigue severity score,
activity level, negative affectivity and body consciousness as predictors
and the DOP score at baseline as covariate. For the adolescent group, the
same regression was done but without the variable negative affectivity (no
data available). For all the predictors, the differences between baseline
and post-treatment were first tested with a pairwise t-test. To determine
the predictive value of pain symptoms, a multiple regression analysis was
performed with the change in CIS fatigue as dependent variable and the mean
DOP score, mean activity level and CIS score at baseline as predictors.
Finally, all regression analyses were repeated with residualised instead of
raw change scores. Significance in all analyses was assumed at p<0.05.
Statistical analysis was performed using SPSS version 12.0.


Results

Pain symptoms at baseline

All but one of the adult patients had one or more of the four CDC pain
symptoms. All adolescent patients had one or more CDC pain symptoms. Table 1
shows the percentage of patients who reported at baseline that daily or
several times a week they experienced muscle pain, headache, multi-joint
pain or a sore throat.

The percentage of adult patients with pain at a location identified with the
bodily outline of the MPQ is shown in Table 2. Seventy-three patients (78%)
reported pain in two or more locations. The MPQ also assesses the duration
of pain complaints in five categories: <1 year, 1-2 years, 2-3 years, 3-4
years or >4 years. In 53% of the patients, the pain complaints were present
for more than 3 years. At baseline, 37% reported on the MPQ that they used
pain medication.


The effect of CBT on pain: comparison of recovered with non-recovered patients

In both the adult and the adolescent CFS patients, the DOP score decreased
from baseline to post-treatment (Fig. 1). The difference in the mean change
in DOP score of the recovered adult group (-2.01; 95% CI -2.62 to -1.39) and
the non-recovered adults (-0.22; 95% CI -0.85 to 0.41) was statistically
significant (t=3.74, d.f.=93, p<0.001). In the adolescent study, the mean
change in DOP score of recovered patients (-3.76; 95% CI -5.69 to -1.84) was
also significantly larger than that of non-recovered patients (0.14; 95% CI
-0.77 to 1.04; t=2.96, d.f.=30, p=0.006).

Fourteen out of the 21 recovered adolescent CFS patients (67%) had a pain
level within the range of healthy controls after CBT. In the non-recovered
adolescent group, four out of 11 reached this level (36%, chi2=2.694, d.f.=
=1, p=0.10). Significantly more recovered adults (36/63; 57%) than
non-recovered adults (3/33; 9%) reached a normal pain level (chi2=20.73,
d.f.=1, p<0.001).

The percentage of adult CFS patients with pain in locations identified with
the MPQ at baseline did not differ significantly between recovered and
non-recovered adults. Following treatment, recovered patients reported
significantly less pain in neck and/or shoulders, legs, arms and chest
compared to non-recovered patients (see Table 3).


The effect of CBT on pain compared to a waiting list in the original
adolescent study

The original adolescent study was a randomised controlled trial in which CBT
for CFS was compared with a waiting list condition (Stulemeijer et al.,
2005). We also calculated the DOP scores for all patients of the original
study. In case of missing data, the last observation was carried forward.
The difference in DOP score in the CBT group (n=35) between baseline and
second assessment was significantly greater than in the waiting list (n=34)
condition (-2.21, S.D.=3.85 versus -0.36, S.D.=2.19; t=2.44, d.f.=67,
p=0.017). Furthermore, at the second assessment there were significantly
fewer patients in the waiting list with a pain level within the range of
healthy controls (29%) than in the CBT condition (56%, chi2=4.38, d.f.=1,
p=0.04).


The mechanism of changes in pain

In both adults and adolescents, there was a significant decrease in fatigue
and a significant increase in physical activity following treatment (see
Table 4). In adults, body consciousness and negative affectivity decreased
significantly. In adolescents, the decrease in body consciousness was not
significant. A stepwise multiple regression with the baseline DOP score as
covariate showed that the change in fatigue severity between baseline and
post-treatment was significantly related to the decrease in the DOP score
(see Table 5) of both adults and adolescents. The other change scores were
not related to the change in DOP score. We repeated the stepwise multiple
regression but now used residualised change scores. This gave the same
pattern of results. In adults the residual change score in fatigue was the
only significant predictor of the change in pain (beta=0.61, p=<0.001; R2
adjusted =0.36). The residual change score in fatigue was also the only the
predictor of the change in pain in adolescents (beta=0.55, p=0.002; R2
adjusted=0.28).


The predictive value of pain symptoms for treatment outcome

Multiple regression showed that the DOP score at baseline was a significant
predictor of the change in fatigue in adult patients (see Table 6). The
regression with the residualised change in fatigue gave the same result
(beta DOP = -0.26, p=0.011; R2 adjusted=0.06). In adolescent CFS patients,
DOP did not predict outcome (Table 6). This was also true when the
residualised change in fatigue was used (beta DOP = -0.09, p=0.612). In all
analyses the level of physical activity at baseline was not a predictor of
the change in fatigue in both groups.


Discussion

The first objective of this study was to determine if an effective treatment
of CFS with CBT leads to a reduction of pain symptoms. It was remarkable to
find that a treatment aimed at reducing fatigue also had an effect on pain.
Patients who recovered following CBT for CFS reported a reduction of pain
severity. Furthermore, more recovered than non-recovered adults had a level
of pain following treatment that is comparable to healthy controls. The
results also showed that most adults report widespread pain before treatment
and that after CBT the number of pain locations decreased in the recovered
patients.

The second objective of the study was to look at possible mechanisms for the
decrease in pain. Changes in physical activity, changes in negative
affectivity or changes in body consciousness could not explain the decrease
in pain severity. Only a relationship between the decrease in fatigue and
the decrease in pain was found. This implies that pain in CFS is part of the
syndrome and is directly related to chronic fatigue. It would be interesting
to look at other variables that could explain the decrease in pain (and
fatigue). Perhaps not focussing on bodily symptoms per se, but the negative
labelling of those symptoms might be a more important factor. The role of
catastrophising pain symptoms in the perception of pain has been extensively
studied (Vlaeyen & Linton, 2000). The role of catastrophising fatigue in CFS
is largely unknown. It would be interesting to study the relationship
between changes in the catastrophising of fatigue and pain in CFS and the
reduction of these symptoms following CBT.

The third objective was to investigate the predictive value of pain severity
for the outcome of CBT for CFS. Although the amount of variance explained
was modest, pain severity at baseline was a significant predictor: a high
pain severity at the start of the treatment was associated with a smaller
decrease in fatigue. This was not the case in the group of adolescent
patients, possibly because of the relatively small group size in the
adolescent study, resulting in a lack of statistical power. Alternatively,
pain symptoms in adolescents might be different from those in adults.
However, the fact that the pattern of results after treatment was the same
in both groups speaks against the latter explanation.

How can we understand that pain in CFS can be successfully treated with CBT
and closely follows the decrease in fatigue while at the same time
recognising that pain is a negative predictor of treatment outcome? A review
by Cho, Skowera, Cleare, and Wessely (2006) suggests that there is a
possible distinction between CFS and chronic widespread pain (as in
fibromyalgia) with only a partial overlap. One could assume that if pain in
CFS patients becomes more severe, these patients become more comparable to
patients with syndromes in which the chronic widespread pain is the central
feature (like fibromyalgia). In those cases, interventions exclusively aimed
at the fatigue do not seem sufficient to reach recovery. This would be in
accordance with the finding of different alterations in hypothalamic-pituitary-
adrenal axis (HPA axis) functioning between CFS, fibromyalgia and patients
meeting criteria for both conditions (Cho et al., 2006).

The fact that pain severity predicted therapy outcome suggests that a subset
of CFS patients could possible benefit from additional interventions aimed
at pain symptoms. A gradual increase of physical activity and the
reformulation of pain-related beliefs into more adaptive beliefs can be
considered important elements of CBT for chronic pain (Morley, Eccleston, &
Williams, 1999). Increasing physical activity is already an element of CBT
for CFS. Additional interventions should be focussed on the reformulation of
pain-related cognitions, e.g., the catastrophising of pain or fear of pain
(Vlaeyen & Linton, 2000).

In this study, we wanted to know if a successful CBT would have an effect on
pain symptoms. We only looked at the effect of a successful treatment of
fatigue because clinical experience suggested that only then pain symptoms
decrease. To generalise our findings to CBT for CFS in general (successful
or not), we had to test whether the pain reduction in CBT for CFS is greater
than in a control group in a randomised controlled trial. The original
adolescent study was a randomised controlled trial and a comparison of the
CBT group with the waiting list also showed that the decrease in pain
severity following CBT for CFS was larger than in a non-treated control
group. This confirmed the positive effect of CBT for CFS on pain symptoms.
For adults no data were available of a controlled study with a no-treatment
control group.

A weakness of our study is that the role of medication on pain symptoms
could not be properly analysed. In the adult study, information about the
type of medication and the dosage was missing, and for adolescent CFS
patients information about pain medication was lacking entirely.

A second weakness of the study is that we did not correct the significance
level for the number of hypotheses tested and/or the number of statistical
analyses used to test the hypotheses. This increases the risk for type I
errors. We think this is justified, as our study is explorative and one of
the first to investigate the effect of CBT for CFS on pain. However, our
findings have to be replicated.

The most clinical relevant finding of the present study is that pain
symptoms improve following CBT for CFS. A possible clinical implication is
that adding interventions aimed at the restructuring of pain-related
cognitions, especially in adult CFS patients with higher pain scores, may
increase the percentage of patients who benefit from CBT for CFS. Future
research will have to show if this hypothesis is correct.


Acknowledgements

The authors thank Theo Fiselier for his contribution in the selection of
adolescent CFS patients, Lammy Elving for her contribution in the selection
of adult patients, and Ria te Winkel for assisting in data collection.
Funding for the study of adolescent CFS patients was provided by the
Children's Welfare Stamps Netherlands (Stichting Kinderpostzegels Nederland)
and the ME Foundation (ME Stichting).


Figure caption

Fig. 1. Mean DOP score of adult and adolescent CFS patients before and after
        treatment.


Tables

Table 1. Percentage (and number) of CFS patients with pain symptoms daily or
several times a week
------------------------------------------------------------------------------
Symptom               Adults (n=95^a)             Adolescents (n=32)
                      with pain                   with pain
------------------------------------------------------------------------------
Muscle pain           72% (n=68)                  60% (n=19)
Headache              50% (n=48)                  75% (n=24)
Multi-joint pain      58% (n=55)                  60% (n=19)
Sore throat           17% (n=16)                  19% (n=6)
------------------------------------------------------------------------------
^a For one adult patient there were no data of the pain assessment available.


Table 2. Percentage (number) of adult patients at baseline with pain on
         locations identified with the MPQ
------------------------------------------------------------------------------
Localisation                    Adults (n=94^a) with pain
------------------------------------------------------------------------------
Head                                    64% (n=60)
Neck and/or shoulders                   61% (n=57)
Legs                                    56% (n=53)
Arms                                    48% (n=45)
Low back                                34% (n=32)
Stomach                                 22% (n=21)
Chest                                   11% (n=10)
------------------------------------------------------------------------------
^a For two adult patients there were no data of the MPQ at baseline available.


Table 3. Percentage of adult patients with pain on a specific location
         following CBT
------------------------------------------------------------------------------
Localisation         Recovered adults  Non-recovered      chi2-   p-value
                     (%) (n=63)        adults (%) (n=33)  value^a
------------------------------------------------------------------------------
Head                  29               46                  2.74     0.098
Neck and/or shoulders 22               55                 10.18     0.001
Legs                  22               52                  8.50     0.004
Arms                  16               46                  9.84     0.002
Low back              22               30                  0.75     0.385
Stomach               10               12                  0.16     0.692
Chest                  0               18                 12.22    <0.001
------------------------------------------------------------------------------
^a chi2-test.


Table 4. Change scores in scores of predictors after treatment
------------------------------------------------------------------------------
                Adults      t-value   p-value  Adolescents  t-value^a  p-value
                            ^a        (d.f.)                           (d.f.)
------------------------------------------------------------------------------
Delta-Fatigue   19.7 (14.1) 13.6 (95) <0.001   24.3 (15.7)  8.7 (31)   <0.001
  (CIS)
Delta-Physical) 10.4 (21.3)  4.7 (94) <0.001   10.3 (21.7)  2.5 (27)    0.019
  activity (actometer)
Delta-Body       0.7 (1.8)   4.0 (95) <0.001    0.1 (1.8)   0.5 (28)    0.780
  consciousness (BCS)
Delta-Negative   6.2 (8.4)   7.5 (95) <0.001
  affectivity (SCL-90b)
------------------------------------------------------------------------------
^a Pairwise t-test.
^b No data on the SCL90 available in adolescents.


Table 5. Stepwise multiple regression with change in DOP score as dependent
         variable and baseline DOP score as covariate
------------------------------------------------------------------------------
                          Adults (n=95^a)             Adolescents (n=28^a)
                          B               beta        B               beta
------------------------------------------------------------------------------
Constant                 -2.59                       -4.83
Baseline DOP score        0.43            0.53**      0.72            0.69**
Delta-Fatigue (CIS)       0.07            0.54**      0.13            0.45**
Not in equation
  Delta-Physical activity (actometer)
  Delta-Negative affectivity (SCL90)^b
  Delta-Body consciousness (BCS)
R2 adjusted              0.46                        0.54
------------------------------------------------------------------------------
^a Data of one adult and four adolescents missing.
^b No data on the SCL90 available in adolescents.
** p<0.01.


Table 6. Prediction of change in CIS-fatigue with DOP, CIS-fatigue and physical
         activity score at baseline
------------------------------------------------------------------------------
Predictor^a              Adults (n=95^b)             Adolescents (n=31^b)
                         B                beta       B                beta
------------------------------------------------------------------------------
Constant                -17.64                       11.62
DOP                      -1.35           -0.28**     -0.34           -0.08
CIS-fatigue               0.81            0.30**      0.21            0.05
Physical activity score   0.06            0.09        0.05            0.08
R2 adjusted              0.09                       -0.09
------------------------------------------------------------------------------
^a Multiple regression, method enter.
^b In both groups the data of one person was missing.
** P<0.01.


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Date:    Fri, 27 Apr 2007 19:01:22 -0400
From:    Fred Springfield <fredspringfield VERIZON.NET>
Subject: RES: Complementary and Alternative Medical Therapy Utilization by People with Chronic Fatiguing Illnesses in the United States

Complementary and Alternative Medical Therapy Utilization by People with
Chronic Fatiguing Illnesses in the United States.

Journal: BMC Complement Altern Med. 2007 Apr 25;7(1):12 [Epub ahead of print]

Authors: Jones JF [*], Maloney EM, Boneva R, Jones AB, Reeves WC.

Affiliation: Division of Viral and Rickettsial Diseases, Coordinating
Center for Infectious Diseases,
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA

[*] Corresponding author. E-Mail: <jaj9 cdc.gov>

NLM Citation: PMID: 17459162


ABSTRACT:
BACKGROUND: Chronic fatiguing illnesses, including chronic fatigue syndrome
(CFS), pose a diagnostic and therapeutic challenge. Previous clinical
reports addressed the utilization of health care provided to patients with
CFS by a variety of practitioners with other than allopathic training, but
did not examine the spectrum of complementary and alternative medicine
(CAM) therapies used. This study was designed to measure CAM therapy use by
persons with fatiguing illnesses in the United States population.

METHODS: During a random-digit dialing survey to estimate the prevalence of
CFS-like illness in urban and rural populations from different geographic
regions of the United States, we queried the utilization of CAM including
manipulation or body-based therapies, alternative medical systems,
mind-body, biologically-based, and energy modalities.

RESULTS: Four hundred forty fatigued and 444 non-fatigued persons from
2,728 households completed screening. Fatigued subjects included 53 persons
with prolonged fatigue, 338 with chronic fatigue, and 49 with CFS-like
illness. Mind-body therapy (primarily personal prayer and prayer by others)
was the most frequently used CAM across all groups. Among women, there was
a significant trend of increasing overall CAM use across all subgroups
(p-trend = 0.003). All categories of CAM use were associated with
significantly poorer physical health scores, and all but one (alternative
medicine systems) were associated with significantly poorer mental health
scores. People with CFS-like illness were significantly more likely to use
body-based therapy (chiropractic and massage) than non-fatigued
participants (OR = 2.52, CI = 1.32, 4.82). Use of body-based therapies
increased significantly in a linear trend across subgroups of non-fatigued,
prolonged fatigued, chronic fatigued, and CFS-like subjects (p-trend =
0.002). People with chronic fatigue were also significantly more likely to
use body-based therapy (OR = 1.52, CI = 1.07, 2.16) and mind-body
(excluding prayer) therapy than non-fatigued participants (OR = 1.73, CI =
1.20 - 2.48).

CONCLUSIONS: Utilization of CAM was common in fatiguing illnesses, and was
largely accounted for by the presence of underlying conditions and poor
physical and mental health. Compared to non-fatigued persons, those with
CFS-like illness or chronic fatigue were most likely to use body-based and
mind-body therapies. These observations have important implications for
provider education programs and development of intervention strategies for CFS.


[Note: this is an Open Access article.  The PDF of the full text is
available at
http://www.biomedcentral.com/content/pdf/1472-6882-7-12.pdf ]

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Date:    Fri, 27 Apr 2007 19:04:56 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Treatment of torture victims -- a longitudinal clinical  study

Treatment of torture victims -- a longitudinal clinical study.

Torture. 2007;17(1):11-7.

Danneskiold-Samsoe B, Bartels EM, Genefke I.

The Parker Institute, Frederiksberg Hospital, Copenhagen University
Hospital, Frederiksberg, Denmark. bente.danneskiold@fh.hosp.dk

PMID: 17456902


AIM: To look at the effect of physiotherapy as part of the
multidisciplinary treatment of torture victims.

METHODS: Monitoring of an extended, personally designed, multidisciplinary
treatment of 21 torture victims, earlier exposed to both physical and
psychological torture, over nine months with assessment of outcome. The
physiotherapy comprised elements such as massage, exercise on land, balance
training and stimulation of proprioception, all aiming at regaining body
awareness. Effect of treatment was measured using the fibrositis index.
Non-parametric statistics using the Wilcoxon test was applied.

RESULTS: Prior to treatment the median score of the fibrositis index was 15
points (range 2-34). After nine months of multidisciplinary treatment the
median score of the fibrositis index was 2 points (range 0-3415). This
decrease in experienced muscle pain was statistically significant (p<0,0001).

CONCLUSION: A high percentage of the torture victims in our study suffered
from fibromyalgia prior to treatment. A multidisciplinary treatment
involving individualised physiotherapy and psychotherapy had a significant
effect on musculoskeletal pain in torture victims. Following nine months of
treatment, only one torture victim in our study could be classified as
suffering from fibromyalgia when applying the fibrositis index.

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Date:    Fri, 27 Apr 2007 19:09:21 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Spatial summation of mechanically evoked muscle pain and  painful aftersensations in normal subjects and fibromyalgia patients

Spatial summation of mechanically evoked muscle pain and painful
aftersensations in normal subjects and fibromyalgia patients.

Pain. 2007 Apr 23; [Epub ahead of print]

Staud R, Koo E, Robinson ME, Price DD.

Department of Medicine, University of Florida, College of Medicine,
Gainesville, FL 32610-0221, USA.

PMID: 17459587


Impulse frequency and number of recruited central neurons are relevant for
pain encoding and temporal as well as spatial summation of pain (SSP).
Whereas SSP of heat-induced pain is well characterized, mechanical SSP
(MSSP) has been less studied. MSSP may be relevant for chronic pain
conditions like fibromyalgia (FM) and play an important role in the
pathogenesis of this chronic pain syndrome.

Our study was designed to determine MSSP in 12 normal controls (NC) and 11
FM subjects. MSSP testing consisted of 5s suprathreshold pressure-pain
stimulations of forearm muscles by up to three identical probes (separated
by 4 or 8cm). The stimulated areas ranged between 0.79 and 2.37cm(2). The
subjects rated the pain intensity of mechanical stimuli as well as pain
aftersensations.

Although MSSP increased monotonically in NC and FM subjects, pressure pain
and pressure pain aftersensations were greater in FM subjects and highly
associated with clinical pain intensity (r(2)=.44-.64), suggesting that
spatial and temporal summation factors may contribute to overall clinical
pain. However, despite higher experimental pain ratings, the magnitude of
MSSP was not statistically different between NC and FM subjects.
Furthermore, muscle stimuli elicited more MSSP when separated by 8cm than
4cm and this finding was not different between NC and FM subjects. Thus,
mechanisms of MSSP were similar for both FM and NC subjects.

The important role of MSSP for pain encoding suggests that decreasing pain
in some muscle areas by local anesthetics or other means may improve
overall clinical pain of FM patients.

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Date:    Sat, 28 Apr 2007 14:05:23 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Firing rate and conduction velocity of single motor units in the trapezius muscle in fibromyalgia patients and healthy controls

Firing rate and conduction velocity of single motor units in the trapezius
muscle in fibromyalgia patients and healthy controls.

J Electromyogr Kinesiol. 2007 Apr 23; [Epub ahead of print]

Gerdle B, Ostlund N, Gronlund C, Roeleveld K, Karlsson JS.

Department of Rehabilitation Medicine, Faculty of Health Sciences,
University Hospital, Linkoping, Sweden; Pain and Rehabilitation Centre,
University Hospital, Linkoping, Sweden.

PMID: 17459728


Fibromyalgia is a common chronic pain condition in the population (2-4%),
which often is associated with prominent negative consequences with respect
to participation in daily activities. There are several reports in the
literature concerning the effects of acute experimental pain on motor control.

However, a more heterogeneous picture exists in the literature with respect
to whether chronic pain conditions affect motor control. This study
compares firing rate and conduction velocity (CV) of single motor units
(MUs) in the trapezius muscle of fibromyalgia patients (FM) and healthy
controls (CON).

Multi-channel surface electromyography was used to estimate both MU firing
rate and CV because this technique allows simultaneous estimation of both
these variables and the measurements are easy and non-invasive. In this
study, 29 FM and 30 CON subjects participated and performed isometric
shoulder elevations using weights up to 4kg.

No significant differences in the firing rate of MUs in the trapezius
muscle were found between the FM and CON groups (95% confidence interval
was -1.9 and 1.3 pulses per second). There were no significant differences
in CV between the groups at 1 and 2kg load. However, the FM group had
significantly higher CV in contractions without external load (p=0.004).

We were unable to confirm the pain-adaptation model since no differences in
firing rate between the two groups were found. CV was significantly higher
in FM than in healthy controls; this might be due to alterations in
histopathology and microcirculation.

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Date:    Sun, 29 Apr 2007 15:07:11 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Effects of Lifestyle Physical Activity on Health Status, Pain, and Function in Adults with Fibromyalgia Syndrom

Effects of Lifestyle Physical Activity on Health Status, Pain, and Function
in Adults with Fibromyalgia Syndrome

Journal of Musculoskeletal Pain, Volume: 15 Issue: 1 Page Range: 3 - 9 [2007]

Kevin R. Fontaine PhD, Steffany Haaz MFA


Objective: To test the effects of a lifestyle physical activity [LPA]
program on health status, pain, fatigue, and function in adults with the
fibromyalgia syndrome [FMS].

Methods: Forty-eight sedentary adults with FMS were randomized to either
LPA or a FMS education control [FME] group. The LPA participants gradually
worked toward accumulating 30 minutes of self-selected moderate-intensity
LPA, five to seven days per week. Thirty-four participants [71 percent]
completed the study.

Results: The LPA group increased their physical activity by 70 percent, as
assessed by pedometer. Seventy-one percent of participants randomized to
LPA reported that their health status was improved, compared with 25
percent of the FME group [P = 0.013]. There were no statistically
significant post-intervention differences between the LPA and FME groups in
pain, fatigue, FMS impact, or six-minute walk distance.

Conclusion: The LPA group increased their physical activity and improved
global ratings of FMS-related change. Lifestyle physical activity might be
a new way to assist persons with FMS to become more physically active.


Keywords: Fibromyalgia syndrome, lifestyle physical activity, pain, fatigue

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Date:    Mon, 30 Apr 2007 21:31:54 +0100
From:    Tom Kindlon <tomkindlon OCEANFREE.NET>
Subject: RES: "Chronic fatigue syndrome in young people: the spectrum and the myths" by Dr. Esther Crawley

FWIW

Chronic fatigue syndrome in young people: the spectrum and the myths

Esther Crawley

British Journal of Hospital Medicine, Vol. 67, Iss. 9, 08 Sep 2006, pp 452 -
453

Editorial

Full text can be read at:
http://tinyurl.com/285dmq
 i.e.
http://66.102.9.104/search?q=cache:yp8rLkAyG68J:www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi%3Fuid%3D21994%3Barticle%3Dhm_67_9_452_453+%22spectrum+and+the+myths%22&hl=en&ct=clnk&cd=1&gl=ie

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Date:    Mon, 30 Apr 2007 22:28:47 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Effects of Topical O24 Essential Oils on Patients with Fibromyalgia Syndrome: A Randomized, Placebo Controlled Pilot Study

Effects of Topical O24 Essential Oils on Patients with Fibromyalgia
Syndrome: A Randomized, Placebo Controlled Pilot Study

Journal of Musculoskeletal Pain, Volume: 15 Issue: 1 Page Range: 11 - 19 [2007]

Gordon D. Ko MD, CCFP[EM], FRCPC, Annie Hum MD, CAFCI, George Traitses DC,
David Berbrayer MD, MCFP, FRCPC


Objectives: To review the literature on topical pain management in
fibromyalgia [FMS] and to report on effective treatment with topical O24
essential oils.

Methods: Following a literature review of MEDLINE and EMBASE for published
randomized controlled trials on topical therapies for FMS pain treatment, a
double-blinded placebo controlled trial was carried out in outpatient
clinics on 153 subjects meeting the American College of Rheumatology
criteria for FMS using topical O24 essential oils for a treatment period of
one month. Main outcome measures were pain visual analog scale ratings, a
diary, the Fibromyalgia Impact Questionnaire, Jamar grip strength, pressure
algometry measurements of tender point [TeP] pain threshold, and
seven-point Lanier scale rating of treatment.

Results: In the 133 participants with complete data, improvements were
noted in the visual analog scale night pain rating [P = 0.018], Jamar grip
strength [P < 0.001], number of TePs [P < 0.001] and average TeP pain
threshold [P < 0.001], and the Lanier scale [P = 0.001] with topical O24
over the placebo.

Conclusion: This pilot randomized controlled trial suggests that FMS
patients may be effectively managed for pain with topical O24. This would
need to be confirmed with larger and longer randomized controlled trials.
The topical O24 essential oils appear to have a clinically important effect
in FMS.


Keywords: Essential oils, fibromyalgia, chronic pain syndrome, trigger
point, low back pain, naturopathy, alternative medicine

[Copies of the full text of this article are available for a fee at
https://www.haworthpress.com/store/ArticleAbstract.asp?sid=P9LW58J54AFS9PW4KPH4XXV8U4J2A06D&ID=95271

It is also possible that your local library may be able to help you obtain
a copy of this article.]


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End of Co-Cure Weekly Digest of research and medical posts only - 23 Apr 2007 to 30 Apr 2007

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