Topics of the week:
9. RES: Treatment of torture victims -- a longitudinal clinical study 10. RES: Spatial summation of mechanically evoked muscle pain and painful aftersensations in normal subjects and fibromyalgia patients
[Return to digest index] --------------------------------------------- This is a special digest of Co-Cure Research & Medical posts only Problems? Write to mailto:firstname.lastname@example.org --------------------------------------------- ---------------------------------------------------------------------- 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. [Return to top] ------------------------------ 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. [Return to top] ------------------------------ 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 [Return to top] ------------------------------ 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. [Return to top] ------------------------------ 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 [Return to top] ------------------------------ 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. [Return to top] ------------------------------ 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. References Arrindell, W. A., & Ettema, H. (1981). Dimensional structure, reliability and validity of the Dutch version of the Symptom Checklist (SCL-90): Data based on a phobic and ``normal'' population. Nederlands Tijdschrift voor de Psychologie en haar grensgebieden, 36, 77-108. Bleijenberg, G., Prins, J., & Bazelmans, E. (2003). 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[Return to top] ------------------------------ 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 ] [Return to top] ------------------------------ 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. email@example.com 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. [Return to top] ------------------------------ 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. [Return to top] ------------------------------ 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. [Return to top] ------------------------------ 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  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 [Return to top] ------------------------------ 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://188.8.131.52/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 [Return to top] ------------------------------ 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  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.] [Return to top] ------------------------------
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