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Posted to Co-Cure Tue, 3 Oct 2000 19:01:03 -0400 by Kimberly Hare

Fitness and perceived exertion in patients with fibromyalgia syndrome

Journal: Clin J Pain 2000 Sep;16(3):209-13
Authors: Nielens H, Boisset V, Masquelier E
Affiliation: Physical Medicine and Rehabilitation Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
NLM Citations: PMID: 11014394, UI: 20466322

OBJECTIVE: The aim of this study was to evaluate the cardiorespiratory fitness and perceived exertion of female patients with fibromyalgia syndrome (FMS) compared with that of healthy female subjects.

DESIGN AND SUBJECTS: This was designed as a cross-sectional case-control study, with a consecutive sample of 30 female patients with FMS and an age-matched control group of 67 healthy female subjects.

SETTING: This study was conducted at the multidisciplinary pain center of a university hospital in a city of more than 1 million inhabitants.

OUTCOME MEASURES: A cardiorespiratory fitness index (PWC65%/kg) and an original perceived exertion index (B65%) were obtained from the heart rates and perceived exertions scored on a 10-point Borg scale during a submaximal cycle ergometer test. Average indexes for the FMS patients and control subjects were compared.

RESULTS: The mean cardiorespiratory fitness index of the FMS patients was not significantly different from that of the controls. The mean perceived exertion index in the FMS patients was significantly greater than that of the controls, meaning that the FMS patients systematically reported higher ratings of perceived exertion during exercise.

CONCLUSIONS: Cardiorespiratory fitness, as expressed by a submaximal work capacity index, seems normal in female patients with FMS compared with age- and sex-matched healthy individuals. The fact that FMS patients overscore their perception of exertion may be due to a greater overlap of peripheral pain and perceived exertion perceptions during exercise. This observation should be noted when using perceived exertion scores to prescribe and monitor exercise in FMS patients.

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Posted to Co-Cure Sat, 30 Sep 2000 14:56:31 -0700 by Melissa O'Toole

CFS: occupation, medical utilization, and subtypes in a community-based sample

Full Title: Chronic fatigue syndrome: occupation, medical utilization, and subtypes in a community-based sample.
Journal: J Nerv Ment Dis 2000 Sep;188(9):568-76
Authors: Jason LA, Taylor RR, Kennedy CL, Song S, Johnson D, Torres S
Affiliation: Department of Psychology, DePaul University, Chicago, Illinois 60614, USA.
NLM Citations: PMID: 11009329, UI: 20462853

Most studies of chronic fatigue syndrome (CFS) have been based on patients recruited from primary or tertiary care settings. Patients from such settings might not be typical of patients in the general population.

The present investigation involved examining individuals with CFS from a community-based study. A random sample of 18,675 respondents in Chicago was first interviewed by telephone. A group of individuals with chronic fatigue accompanied by at least four minor symptoms associated with CFS were given medical and psychiatric examinations. From this sample, a physician review group diagnosed individuals with CFS.

Those diagnosed with CFS were subclassified based on a variety of categories, including duration of illness, mode of illness onset, and presence or absence of a stressful life event directly preceding onset. In addition, we examined medical utilization among those diagnosed with CFS, as well as whether individuals with CFS were disproportionately represented in health care professions.

Important differences emerged on measures of sociodemographics, symptoms, and functional disability. The implications of these findings and others are discussed.

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Posted to Co-Cure Tue, 26 Sep 2000 21:49:06 -0400 by Kimberly Hare

Environmental Immunogens and T-Cell-Mediated Responses in Fibromyalgia: ...

Full Title: Environmental Immunogens and T-Cell-Mediated Responses in Fibromyalgia: Evidence for Immune Dysregulation and Determinants of Granuloma Formation.
Journal: Experimental and Molecular Pathology, Vol. 69, No. 2, October 2000, pp.102-118
ISSN: 0014-4800
Authors: Shanklin DR [1], Stevens MV [2], Hall MF [2], Smalley DL [2]
Affiliations: Department of Pathology
[1] Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee, 38163
[2] Memphis Pathology Laboratory, Baptist Memorial Health Care System, Memphis, Tennessee, 38105
NLM Citation: PMID: 11001860
Thirty-nine patients with fibromyalgia syndrome (FMS) according to American College of Rheumatology criteria were studied for cell-mediated sensitivity to environmental chemicals. Lymphocytes were tested by standard [3H]thymidine incorporation in vitro for T cell memory to 11 chemical substances. Concanavalin A (Con A) was used to demonstrate T cell proliferation.

Lymphocytes were tested by standard [3H]thymidine incorporation in vitro for T cell memory to 11 chemical substances. Concanavalin A (Con A) was used to demonstrate T cell proliferation. Controls were 25 contemporaneous healthy adults and 252 other concurrent standard controls without any aspect of FMS.

Significantly higher (P < 0.01) stimulation indexes (SI) were found in FMS for aluminum, lead, and platinum; borderline higher (0.05 > P > 0.02) SI were found for cadmium and silicon. FMS patients showed sporadic responses to the specific substances tested, with no high-frequency result (>50%) and no obvious pattern. Mitogenic responses to Con A indicated some suppression of T cell functionality in FMS.

Possible links between mitogenicity and immunogenic T cell proliferation, certain electrochemical specifics of granuloma formation, maintenance of connective tissue, and the fundamental nature of FMS are considered.

Key Words: fibromyalgia; cell-mediated immune response; T cells; mitogen-immunogen pathways; metal sensitivity; siloxane sensitivity; epitope commonality; self-costimulation; concanavalin A; granuloma formation; electrochemical effects.

Copyright 2000 Academic Press.

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Posted to Co-Cure Mon, 25 Sep 2000 01:09:58 -0700 by Melissa O'Toole

Pain Complaints in Patients with Fibromyalgia Versus CFS

Full Title: Pain Complaints in Patients with Fibromyalgia Versus Chronic Fatigue Syndrome.
Journal: Curr Rev Pain 2000;4(2):148-157
Authors: Bradley LA, McKendree-Smith NL, Alarcon GS
Affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, School of Medicine, 475 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35294, USA.
NLM Citation: PMID: 10998728

Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia.

We identify the abnormalities in the neuroendocrine axes that are common to FM and CFS as well as the abnormalities in central neuropeptide levels and functional brain activity that differentiate these disorders.

These two sets of factors, respectively, may account for the similiarities and differences in the pain experiences of persons with FM and CFS.

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Posted to Co-Cure Mon, 25 Sep 2000 01:06:35 -0700 by Melissa O'Toole

Physical activity for the chronically ill and disabled

Journal: Sports Med 2000 Sep;30(3):207-19
Authors: Durstine JL, Painter P, Franklin BA, Morgan D, Pitetti KH, Roberts SO
Affiliation: Department of Exercise Science, University of South Carolina, Columbia 29208, USA.
NLM Citations: PMID: 10999424, UI: 20452053

Exercise prescription principles for persons without chronic disease and/or disability are based on well developed scientific information. While there are varied objectives for being physically active, including enhancing physical fitness, promoting health by reducing the risk for chronic disease and ensuring safety during exercise participation, the essence of the exercise prescription is based on individual interests, health needs and clinical status, and therefore the aforementioned goals do not always carry equal weight.

In the same manner, the principles of exercise prescription for persons with chronic disease and/or disability should place more emphasis on the patient's clinical status and, as a result, the exercise mode, intensity, frequency and duration are usually modified according to their clinical condition. Presently, these exercise prescription principles have been scientifically defined for clients with coronary heart disease.

However, other diseases and/or disabilities have been studied less (e.g. renal failure, cancer, chronic fatigue syndrome, cerebral palsy). This article reviews these issues with specific reference to persons with chronic diseases and disabilities.

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Posted to Co-Cure Thu, 21 Sep 2000 21:00:02 -0400 by Andrew Martin

Treatment of chronic fatigue syndrome with 5-HT3 receptor antagonists – preliminary results

Journal: Scandinavian Journal of Rheumatology, 2000, vol. 166, no. 113, pp. 72-77(6)
Authors: Späth M.; Welzel D.; Färber L.

Objective: The serotonin system presumably is involved in the pathogenesis of chronic fatigue syndrome (CFS). Results from a few studies led to the hypothesis of a “postsynaptic hyperresponsiveness” in CFS. Therefore we intended to evaluate the efficacy of 5-HT3 receptor antagonists in the treatment of CFS.

Patients and Methods: 2 patient groups (10 patients each; CFS according to the CDC classification criteria) received either oral tropisetron (5 mg once daily) or oral ondansetron (2×8 mg daily), open-labelled. Treatment duration was 15 days. Treatment response was evaluated by visual analog scales (VAS) for fatigue and capability.

Results: 19 patients finished their respective study. In the tropisetron group 6/9 (VAS fatigue) and 7/9 (VAS capability) patients documented benefit, 8/10 rsp. 8/10 patients in the ondansetron group. The score changes (VAS before and after treatment) in case of response were more pronounced in the tropisetron group. The frequency of concomitant symptoms did not differ significantly in the treatment groups. The overall analysis of both studies showed a remarkable improvement (35%) of approximately one third of the patients in both VAS. Treatment was well tolerated.

Conclusion: Our preliminary results encourage to perform placebo-controlled, double-blind studies to further evaluate the efficacy of 5-HT3 receptor antagonists in the treatment of CFS.

Keywords: chronic fatigue syndrome; fibromyalgia; serotonin; 5-HT3 receptor antagonists; tropisetron; ondansetron

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Posted to Co-Cure Sun, 17 Sep 2000 17:03:13 -0400 by Kimberly Hare

Update in Sjogren syndrome

Journal: Curr Opin Rheumatol 2000 Sep;12(5):391-8
Authors: Fox RI, Stern M, Michelson P
Affiliation: Allergy and Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, California 92037, USA.
NLM Citations: PMID: 10990175, UI: 20443582

Sjogren syndrome (SS), the second most common autoimmune rheumatic disease, refers to keratoconjunctivitis sicca and xerostomia resulting from immune lymphocytes that infiltrate the lacrimal and salivary glands. However, differential diagnosis remains confusing due to the high prevalence of vague symptoms of dryness, fatigue, and myalgias in the general population.

The problems of diagnosis are further compounded by the finding of "positive" antinuclear antibodies in a high percent of the general population. Unless minor salivary gland biopsies are read by experienced observers, nonspecific changes of sialadenitis are frequently confused with the focal lymphocytic infiltrates that are characteristic of SS.

The distinction between fibromyalgia patients with low titer antinuclear antibodies and primary SS remains difficult. Even in patients fulfilling strict criteria for SS, the genomic search for critical genes has proven difficult due to the multigenic pattern of inheritance and strong role of currently undefined environmental factors. No single environmental factor has been detected in the majority of SS patients. SS-like syndrome has been detected in certain patients with HTLV-1 and hepatitis C infection, providing clues to pathogenesis. Even in SS patients with marked sicca symptoms, minor salivary gland biopsy shows that almost 50% of glandular cells are still detected on biopsy.

These results imply the importance of immune factors such as cytokines and autoantibodies in decreasing neuro-secretory circuits and induction of glandular dysfunction. Of potential importance, an antibody against muscarinic M3 receptor that can decrease secretory function when injected into rodents is frequently found in the sera of SS patients. Newly developed topical and oral therapies can ease the oral and ocular dryness. Orally administered agonists of the muscarinic M3 receptor (pilocarpine and cevimeline) have recently been approved by the US Food and Drug Administration to increase salivary secretion. Topical ocular use of low-dose corticosteroids or cyclosporin may decrease conjunctival surface inflammation. In a Phase II double-blind study, orally administered interferon alpha (150 U) led to improved saliva flow and symptoms. In pregnant patients with evidence of fetal distress, oral dexamethasone is preferred because this agent crosses the placenta effectively. In animal models, antagonists of tumor necrosis factor and inhibitors of de novo pyrimidine synthesis appear promising.

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Posted to Co-Cure Sun, 17 Sep 2000 17:01:54 -0400 by Kimberly Hare

Diffuse pain syndromes in the elderly

Journal: Rheum Dis Clin North Am 2000 Aug;26(3):673-82
Author: Gowin KM
Affiliation: Asheville Arthritis and Osteoporosis Center, North Carolina, USA.
NLM Citations: PMID: 10989517, UI: 20444660

Diffuse pain syndromes are common in older persons. Fibromyalgia and PMR are the most common but other inflammatory, endocrine and neoplastic diseases may cause diffuse pain as well. A thorough history and physical examination, screening laboratories and response to a trial of low-dose steroids may help to differentiate between syndromes. Fibromyalgia may be a secondary phenomenon associated with some of the other diffuse pain syndromes. This should be kept in mind if a patient fails to respond appropriately to treatments directed at a particular disease.

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Posted to Co-Cure Sun, 17 Sep 2000 15:49:57 -0400 by Kimberly Hare

Fibromyalgia, hypermobility, and breast implants

Journal: J Rheumatol 2000 Sep;27(9):2237-41
Authors: Lai S, Goldman JA, Child AH, Engel A, Lamm SH
Affiliation: Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA.
NLM Citations: PMID: 10990240, UI: 20443647

OBJECTIVE: To examine possible relationships among fibromyalgia (FM, American College of Rheumatology 1990 criteria), hypermobility, and breast implants.

METHODS: The medical records of 2,500 female patients (ages 25-65) who had been seen for the first time in a rheumatology practice in Atlanta, GA, during 1986-92 were abstracted and analyzed. In each analysis, patients whose records indicated that the patient met the full case criteria were compared with patients whose records had no indication of the disease. Patients whose medical records indicated the clinical onset of FM prior to breast implantation were identified.

RESULTS: Univariate and multivariate regression analyses were performed, adjusting for age, income, and the presence of connective tissue disease or rheumatoid arthritis. Significant associations were found between hypermobility and FM (adjusted OR 2.20, 95% CI 1.73, 2.80) and between hypermobility and breast implantation (adjusted OR 1.80, 95% CI 1.19, 2.69). No association was found between breast implantation and subsequent FM (adjusted OR 0.74, 95% CI 0.42, 1.32).

CONCLUSION: Hypermobility was found to be independently associated with both FM and with breast implantation, but FM and breast implantation were not found to be independently associated with each other.

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Note: All abstract summaries, unless otherwise noted, were prepared by Margaret Bailey.

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