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Co-Cure Weekly Digest of research and medical posts only - 21 Jul 2007 to 23 Jul 2007

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Date:    Sun, 22 Jul 2007 09:59:30 -0400
From:    "Bernice A. Melsky" <bernice.melsky1 VERIZON.NET>
Subject: RES: Tender point count and total myalgic score in  fibromyalgia: changes over a 28-day period

Tender point count and total myalgic score in fibromyalgia: changes over a
28-day period.

Rheumatol Int. 2007 Jul 20; [Epub ahead of print]

McVeigh JG, Finch MB, Hurley DA, Basford JR, Sim J, Baxter GD.

Health and Rehabilitation Sciences Research Institute, School of Health
Sciences, University of Ulster, Jordanstown, Belfast, Northern Ireland,
j.mcveigh ulster.ac.uk.

PMID: 17641895


Tender point count (TPC) is central to fibromyalgia syndrome (FMS), and
with total myalgic score (TMS) is often used to monitor the patient's
condition. This study aimed to determine the stability of TPC and TMS over
time, and to examine how well these measures reflected patients'
perceptions of their condition.

Twenty-four patients with FMS completed the Fibromyalgia Impact
Questionnaire (FIQ) and a visual analogue scale (VAS) measuring well-being,
at entrance into the study, and 7 and 28 days later.

There was no significant change in TPC (P = 0.074), FIQ score (P = 0.291)
or VAS (P = 0.079) of well-being with time. However, mean TMS score did
change over time (P = 0.021). There was no correlation between total FIQ
score and the other measures (all P-values > 0.05).

The significant change in TMS over time may reflect the natural fluctuation
in the clinical presentation of FMS.

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Date:    Sun, 22 Jul 2007 10:04:41 -0400
From:    "Bernice A. Melsky" <bernice.melsky1 VERIZON.NET>
Subject: RES: Fibromyalgia: a rheumatologic diagnosis?

Fibromyalgia: a rheumatologic diagnosis?

Rheumatol Int. 2007 Jul 20; [Epub ahead of print]

Endresen GK.

Department of Rheumatology, The National Hospital Rikshospitalet,
Forskningsvn. 2, Block B, 0027, Oslo, Norway,
gerhard.endresen rikshospitalet.no

PMID: 17641896


Fibromyalgia (FM) is a medically unexplained or functional somatic syndrome
(FSS). The two classification criteria are chronic widespread pain (CWP)
and the finding of 11/18 tender points (TP).

FM overlaps and co-occurs with other FSSs, and auxiliary symptoms that are
not included in the criteria may be clues to other FSSs.

About ten FSSs include chronic fatigue syndrome, myofascial pain syndromes
and irritable bowel syndrome. TP do not reflect demonstrable pathology, and
are locations where everyone is generally more tender. In FM they are more
tender than normal due to lowered pain threshold. High TP counts are
associated with the extent of distress or unspecific somatic symptoms in
the absence of chronic pain. TP lack validity and should be excluded.

CWP and distress are outside the domain of rheumatology, and abnormal
mechanisms in FM relate to the central nervous system, as compared to
"peripheral" mechanisms studied in rheumatology. FM should not be
considered as a rheumatologic condition but rather as part of a broader
spectre of FSSs. Patients with FSSs should be considered and treated
together across medical specialities by general physicians in primary
health care.

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Date:    Sun, 22 Jul 2007 09:56:03 -0400
From:    "Bernice A. Melsky" <bernice.melsky1 VERIZON.NET>
Subject: RES: Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

Cost-effectiveness of Spa treatment for fibromyalgia: general health
improvement is not for free.

Rheumatology (Oxford). 2007 Jul 17; [Epub ahead of print]

Zijlstra TR, Braakman-Jansen LM, Taal E, Rasker JJ, van de Laar MA.

Medisch Spectrum Twente Hospital, Department of Rheumatology, Enschede,
University Twente, Faculty of Behavioural Sciences, Department of
Psychology and Communication of Health and Risk (PCHR), Enschede and Isala
Klinieken, Department of Rheumatology, Zwolle, The Netherlands.

PMID: 17636181


Objectives. To estimate the cost-effectiveness of an adjuvant treatment
course of spa treatment compared with usual care only in patients with
fibromyalgia syndrome (FM).

Methods. 134 patients with FM, selected from a rheumatology outpatient
department and from members of the Dutch FM patient association were
randomly assigned to a 2(1/2) week spa treatment course in Tunisia or to
usual care only. Results are expressed as quality-adjusted life years
(QALYs) for a 6-month as well as a 12-month time horizon. Utilities were
derived form the Short Form 6D (SF-6D) scores and the visual analogue scale
(VAS) rating general health. Costs were reported from societal perspective.
Mean incremental cost per patient and the incremental cost utility ratio
(ICER) were calculated; 95% confidence intervals (CIs) were estimated using
double-sided bootstrapping.

Results. The data of 128 (55 spa and 73 controls) of the 134 patients (96%)
could be used for analysis. Improvement in general health was found in the
spa group until 6 months of follow-up by both the SF-6D (AUC 0.32 vs 0.30,
P < 0.05) and the VAS (AUC 0.23 vs 0.19, P < 0.01). After 1yr no
significant between-group differences were found. Mean incremental cost of
spa treatment was euro1311 per patient (95% CI 369-2439), equalling the
cost of the intervention (thalassotherapy including airfare and lodging),
or euro885 per patient based on a more realistic cost estimate.

Conclusions. The temporary improvement in quality of life due to an
adjuvant treatment course of spa therapy for patients with FM is associated
with limited incremental costs per patient.



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End of Co-Cure Weekly Digest of research and medical posts only - 21 Jul 2007 to 23 Jul 2007

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