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Posted to Co-Cure Sun, 7 Jan 2001 23:36:08 -0500 by Kimberly Hare

Effectiveness of a learner-centred training programme for primary care physicians in using a patient-centred consultation style

Full Title: Effectiveness of a learner-centred training programme for primary care physicians in using a patient-centred consultation style.
Journal: Fam Pract 2001 Jan;18(1):60-63
Authors: Moral RR, Alamo MM, Jurado MA, de Torres LP
Affiliation: Unidad Docente de Medicina de Familia y Comunitaria de Cordoba, Spain.
NLM Citation: PMID: 11145630

OBJECTIVE: The aim of the present study was to find out if a training programme adapted to family physicians with several years of clinical experience changes their behaviour when they deal with fibromyalgia patients in the sense of introducing the communication skills that define the 'patient-centred' approach.

METHODS: A randomized, and simple blind, educative study was carried out. Twenty full-time family physicians were invited to participate. They were allocated randomly to two groups: an intervention and a control group. A total of 110 patients were recruited from people attending physicians' surgeries for the first time and who complained of generalized pain that finally fulfilled criteria for generalized musculoskeletal chronic pain / fibromyalgia. This was done for an entire year. The intervention group received an 18 hour intensive course. One week after the course, all doctors carried out a video-recorded encounter with a patient who played the part of a typical fibromyalgia clinical case. The interviews were coded by an observer blind to the training status of the participants, using the GATHARES-CP questionnaire. All patients were contacted by telephone during a 1-2-month period by a different interviewer who was 'blinded' to the patient's experimental status. They were asked to respond to three questions that represent the key components of patient-centred style.

RESULTS: The average score on the GATHARES-CP questionnaire was 11.3 +/- 0.9 and 9 +/- 2.3, for doctors from the intervention and control groups, respectively (P: < 0.01). For 11 items, scores were higher in the intervention group. The patients' answers to all three questions showed statistically significant differences in a positive direction for the trained doctors.

CONCLUSIONS: The doctors improved the use of strategies and skills for carrying out patient-centred consultations after they had received an interactive course. The doctors' behaviour appeared to have changed as much in a more experimental situation as in the actual consultations. Moreover, the gain was observed inmediately after the intervention was completed, and after having run for a variable period of time up to 1 year.

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Posted to Co-Cure Thu, 4 Jan 2001 13:40:38 -0500 by Fred Springfield

CFS: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis

Full Title: Chronic Fatigue Syndrome: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 63-74
Author: John W. Addington, BS
Affiliation: John W. Addington is a Medical Researcher and a Patient Rights Paralegal specializing in consent issues. As a freelance writer with a bachelor’s degree in science, he regularly publishes on the topics of Chronic Fatigue Syndrome and Fibromyalgia.
Address correspondence to: John W. Addington, 2800 Route 22, Patterson, NY 12563 (E-mail: jaddingt@onebox.com).

ABSTRACT.
Chronic fatigue syndrome is a severe, often disabling disorder with prevalence as high as 422 cases per 100,000 in the United States. Aside from the adverse effects to patients’ quality of life, sequeIa of the disorder include a negative impact on the economy as well as a burden on public health care costs. Some avenues of current research into the possible genesis of the syndrome are neurally mediated hypotension, viral pathogen, immunological disorders, lymphocyte enzyme system abnormalities, or a purely psychological root. This paper is a review of the literatures as to a neuroendocrinologic cause, namely dysfunction of the hypothalamic-pituitary-adrenal axis.

KEYWORDS. Chronic fatigue syndrome, fibromyalgia, hypothalamic-pituitary-adrenal axis, adrenal glands, neuroendocrinology, immune dysfunction, steroids

INTRODUCTION

One of the more promising areas of research as to a possible pathogenesis for chronic fatigue syndrome (CFS) is hypothalamic-pituitary-adrenal (HPA) axis dysfunction. A recent clinical text describes research indicating patients with chronic fatigue syndrome (CFS) have reduced production of corticotropin-releasing hormone (CRH), diminished serum cortisol concentrations with corresponding high levels of adrenocorticotropic hormone (ACTH) (1). This text then states that “[h]ypothetically, these neuroendocrine abnormalities could contribute to the impaired energy and mood of patients” (1). Questions not answered by this clinician’s guide are whether the “neuroendocrine abnormalities” are the primary problem or merely the sequela of another impairment relating to psychiatric or immune function and what portion of CFS patients may have these abnormalities. Although as of yet the answers to these questions are unclear, much ongoing work in this discrete area of CFS research may soon lead to more definitive conclusions warranting consistent therapeutic applications. In fact, as this review highlights, many clinicians are already reporting limited success in therapy addressing (HPA) axis dysfunction in their CFS patients.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com   Website: www.HaworthPress.com ]

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Sun, 31 Dec 2000 19:05:08 -0500 by Fred Springfield

The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 2...

Full Title: The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 2. Essential Fatty Acids and Cholesterol
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 59-62
Authors: R. H. Dunstan, DPhil; N. R. McGregor, MDSc; T. K. Roberts, PhD; H. Butt, PhD; W. G. Taylor, BSc; A. Carter, BSc
Affiliation: Collaborative Pain Research Unit, Department of Biological Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia.

ABSTRACT.
Objectives: To investigate fatty acid and sterol homeostasis in patients with CFS.

Methods: Plasma samples were collected from CFS and control subjects and analyzed for lipid composition by GC-MS metabolic profiling techniques.

Results: CFS patients had significantly different profiles of fatty acids and sterols compared with control subjects. The 1st and 2nd most important factors discriminating the CFS patients from the controls, were a decrease in elaidic acid (trans-9-octadecenoic acid) and an increase in stearic acid (octadecanoic acid), respectively. The CFS patients also had lower levels of cholesterol, which has potential impact on membrane integrity and function, steroid hormone synthesis, energy metabolism and bile production. The CFS patients could also be subdivided into subgroups based on their fatty acid and sterol composition. The results of cluster analyses and multivariate analyses revealed that several types of homeostasis exist in different types of CFS patients, whereas the control group was largely homogeneous. Viral infections can contribute to the nature of the lipid-based anomalies in CFS patients and lipid profiles from patients with prior viral infections could be differentiated from those without viral histories.

Conclusions: The assessment of fatty acids and sterols in fasting plasma samples can indicate essential fatty acid deficits, suggest appropriate types of essential fatty acid oils for formulations, indicate potential cholesterol deficit-associated anomalies, provide evidence for mitochondrial dysfunction and categorize CFS patients into biochemical subgroups. These evaluations provide a basis for devising individually tailored patient management protocols.

KEYWORDS. Fatty acids, cholesterol, sterols, chronic fatigue syndrome

INTRODUCTION

Chronic fatigue syndrome (CFS) comprises poly-symptomatic patients with a commonality of prolonged, severe and debilitating fatigue, for which there is no clear aetiology. Some investigators have proposed the involvement of viruses in the initiation of CFS, but there is no single virus that can be universally associated with CFS. Viruses can cause a long-term alteration to host metabolism of essential fatty acids. Other nutritional, disease and genetic factors may also result in conditionally essential requirements of certain fatty acids or their cofactors necessary for the associated enzyme systems. A cohort of CFS patients was therefore investigated to determine whether there was any evidence of disturbance to fatty acid and sterol homeostasis (1-3).

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com   Website: www.HaworthPress.com ]

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Sun, 31 Dec 2000 18:41:19 -0500 by Fred Springfield

The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 1...

Full Title: The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 1. Muscle Catabolism and Coagulase Negative Staphylococci Which Produce Membrane Damaging Toxins
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 53-57
Authors: R. H. Dunstan, DPhil; N. R. McGregor, MDSc; T.K. Roberts, PhD; H. Butt, PhD; S.H. Niblett, BSc; T. Rothkirch, BSc
Affiliation: Collaborative Pain Research Unit, Department of Biological Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.

ABSTRACT.
Background: The diagnosis of chronic fatigue syndrome (CFS) requires the exclusion of other known fatigue-related diseases because the core symptoms of CFS represent a general host response to many well-defined diseases. The patient set derived by this process is heterogeneous in their polysymptomatic presentation and has proved very difficult to study clinically and scientifically.

Objectives: To investigate the alterations in urine excretion and microbiology in patients with CFS.

Results: CFS patients had multiple anomalies in their amino acid and organic acid homeostasis. Sub-groups of CFS patients could be delineated on the basis of their urine excretion and their symptom presentation. The most common feature was an active muscle catabolism resulting in a depletion of amino acids and associated organic and keto-acids. The extent of muscle catabolism was directly correlated to pain severity. The carriage of toxin-producing coagulase negative staphylococci (MDT-C0NS) was strongly correlated with the catabolic response and pain severity.

Conclusions: An hypothesis has been constructed where an occult pathogen, such as MDT-CoNS, may be an aetiological agent contributing to the sustenance of a chronic fatigue/pain disorder, a comorbid pathogen. Urine analysis offers an opportunity for assessment of muscle catabolism and sub-classification of chronic fatigue patients leading to a number of management options. The detection of MDTCoNS identifies potentially treatable agents that contribute to the fatigue and pain condition.

KEYWORDS. Staphylococcus, toxin, pain, fatigue, urine

INTRODUCTION

Chronic fatigue syndrome (CFS) represents a group of patients with a commonality of a prolonged severe and debilitating fatigue, for which there is no clear aetiology. However, the core symptoms of CFS (1) can be defined as host-response symptoms which occur when the body is challenged by potential pathogens and can be associated with a large number of disease states. Any cohort of CFS patients is therefore likely to represent a heterogeneous group of subjects varying in aetiology and symptom expression.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com   Website: www.HaworthPress.com ]

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Sat, 30 Dec 2000 16:07:48 -0500 by Kimberly Hare

Mind-body therapies for the treatment of fibromyalgia

Full Title: Mind-body therapies for the treatment of fibromyalgia. A systematic review.
Journal: J Rheumatol 2000 Dec;27(12):2911-8
Authors: Hadhazy VA, Ezzo J, Creamer P, Berman BM
Affiliation: Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, USA.
NLM Citations: PMID: 11128685, UI: 21011301

OBJECTIVE: To assess the effectiveness of mind-body therapy (MBT) for fibromyalgia syndrome (FM) by systematically reviewing randomized/quasirandomized controlled trials using methods recommended by the Cochrane Collaboration.

METHODS: Nine electronic databases, 69 conference proceedings, and several citation lists were searched for relevant trials in any language. Eligible trials were scored for methodological quality using a validated instrument. Information on major outcomes was extracted. Insufficient data reporting prevented statistical pooling, therefore a best-evidence synthesis was performed.

RESULTS: Thirteen trials involving 802 subjects were included. Seven trials received a high methodological score. Compared to waiting list/treatment as usual, there is strong evidence that MBT is more effective for self-efficacy, limited evidence for quality of life, inconclusive evidence for all other outcomes. There is limited evidence that MBT is more effective than placebo (for pain and global improvement); inconclusive evidence that MBT is more effective than physiotherapy, psychotherapy, or education/attention control for all outcomes; strong evidence that moderate/high intensity exercise is more effective than MBT (for pain and function). There is moderate evidence that MBT plus exercise (MBT+E) is more effective than waiting list/treatment as usual (for self-efficacy and quality of life); limited evidence that MBT+E is more effective than education/attention control; inconclusive for other outcomes. There is inconclusive evidence for MBT+E vs other active treatments for all outcomes. Longterm within-groups results show greatest benefit for MBT+E.

CONCLUSION: MBT is more effective for some clinical outcomes compared to waiting list/treatment as usual or placebo. Compared to active treatments, results are largely inconclusive, except for moderate/high intensity exercise, where results favor the latter. Further research needs to focus on the synergistic effects of MBT plus exercise and/or plus antidepressants.

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Posted to Co-Cure Sat, 30 Dec 2000 16:04:30 -0500 by Kimberly Hare

Search for Borna disease virus in Danish fibromyalgia patients

Full Title: Search for Borna disease virus in Danish fibromyalgia patients.
Journal: Scand J Rheumatol 2000;29(6):387-90
Authors: Wittrup IH, Christensen LS, Jensen B, Danneskiold-Samsee B, Bliddal H, Wiik A
Affiliation: Parker Research Institute, Dept. of Rheumatology, Frederiksberg University Hospital, Copenhagen, Denmark. Irenewittrup@fh.hosp.dk
NLM Citations: PMID: 11132208, UI: 21015499

OBJECTIVE: The purpose of this study was to look for Borna disease virus (BDV) in 18 patients with acute onset of fibromyalgia (FMS) following a "flu-like" episode. BDV is a neurotropic RNA virus affecting horses and sheep. Infections in animals have been reported to cause immune mediated disease characterized by abnormalities in behavior. A possible link between BDV and neuropsychiatric diseases in man has been described, and lately a connection to chronic fatigue syndrome (CFS) has been suggested.

METHODS: A BDV-specific nested PCR (RT-PCR) was performed on serum and spinal fluid.

RESULTS: The BDV genome was not detected in any of the FMS cases.

CONCLUSION: Although BDV was not demonstrated in spinal fluid or serum from the tested patients with FMS, we believe that it is important to report our results, since FMS can exhibit many manifestations in common with CFS. Possible reasons for the discrepant findings are discussed.

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Posted to Co-Cure Thu, 28 Dec 2000 11:47:46 +0100 by Dr. Marc-Alexander Fluks

Chronic fatigue syndrome: An examination of the phases

Full Title: Chronic fatigue syndrome: An examination of the phases
Journal: Journal of Clinical Psychology, Volume 56, December 2000, Issue 12, 2000. Pages: 1497-1508
Authors: Leonard A. Jason(1,*), Guy Fricano(1), Renee R. Taylor(1), Jane Halpert(1), Patricia A. Fennell(2), Susan Klein(3), Susan Levine(4)
Affiliations:
1 DePaul University
2 Albany Health Management Associates, Inc.
3 Bowling Green State University
4 Beth Israel Hospital,
* Correspondence to Leonard A. Jason, Correspondence concerning this article should be addressed to: Leonard A. Jason, Department of Psychology, DePaul University, 2219 N. Kenmore Ave., Chicago, IL 60614; E-Mail: ljason@wppost.depaul.edu

Abstract
The present study examined the Fennell Phase Inventory, an instrument designed to measure the phases typically experienced by individuals with chronic fatigue syndrome (CFS). This inventory yields three factor scores of Crisis, Stabilization, and Integration.

These factor scores have been employed in a cluster analysis, yielding four clusters that matched the four phases predicted by Fennell: Crisis, Stabilization, Resolution, and Integration. The present study represents a partial replication study of a prior investigation of the Fennell Phase Inventory by Jason et al. (in press), but that earlier study did not have an independent physician examination to diagnose patients with CFS.

In the present study, 65 patients diagnosed with chronic fatigue syndrome by a physician were recruited and administered the Fennell Phase Inventory and other measures assessing CFS-related symptoms, disability, and coping. Each of the 65 patients was classified into one of four predefined clusters measuring a Crisis phase, a Stabilization phase, a Resolution phase, and an Integration phase.

Relationships were explored between three of these cluster groupings and measures of symptoms, disability, and coping. Results confirmed Fennell's model, revealing significant differences between the three clusters in terms of levels of disability and modes of coping.

Results suggest that the Fennell Phase Inventory accurately differentiates phases of adaptation to illness experienced by individuals with CFS.

(c) 2000 John Wiley & Sons, Inc.

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Posted to Co-Cure Sat, 30 Dec 2000 16:35:48 -0500 by Kimberly Hare

Image analysis quantification of sustance P immunoreactivity in FM and MPS

Full Title: Image analysis quantification of sustance P immunoreactivity in the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome.
Journal: J Rheumatol 2000 Dec;27(12):2906-10
Authors: De Stefano R, Selvi E, Villanova M, Frati E, Manganelli S, Franceschini E, Biasi G, Marcolongo R
Affiliation: Institute of Rheumatology, University of Siena, Italy.
NLM Citations: PMID: 11128684, UI: 21011300

OBJECTIVE: Substance P (SP), a neurotransmitter stored within the afferent nociceptive fibers, is likely to be involved in the pathogenesis of musculoskeletal pain. We investigated SP immunoreactive (SP-ir) nerve fibers in the upper trapezius of patients with fibromyalgia (FM) and myofascial pain syndrome (MPS) by immunochemistry.

METHODS: Trapezius muscle obtained from tender points of 9 women with primary FM, from trigger points of 9 women with regional myofascial pain, and from 9 control women were immunostained with anti-SP sera. Quantitative evaluation was performed by computerized image analysis.

RESULTS: No significant differences in the number of SP-ir areas were detected between groups (one way ANOVA: p = 0.2); in contrast, mean optical density (OD) of SP-ir showed a significant difference comparing the groups (one way ANOVA: p < 0.0001). Mean OD of the immunostaining for SP was statistically greater in trapezius muscle of patients with MPS (0.594 +/- 0.096) compared to specimens from patients with FM (0.436 +/- 0.140) (p < 0.05) and controls (0.314 +/- 0.105) (p < 0.05); mean OD of immunostaining for SP was greater in FM specimens than in controls (p < 0.05).

CONCLUSION: Our results point to a peripheral hyperactivity of the peptidergic nervous system in FM as well as in MPS. These findings support the notion of pathogenetic involvement of the afferent nervous system in the development and perception of myofascial pain.

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Posted to Co-Cure Sat, 23 Dec 2000 15:03:35 -0500 by Fred Springfield

Tobacco Sensitivity in Chronic Fatigue Syndrome

Full Title: Tobacco Sensitivity in Chronic Fatigue Syndrome (CFS)
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 33-52
Authors: James N. Baraniuk, MD; Kristina Naranch, BA; Hilda Maibach, MS; Daniel J. Clauw, MD
Affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Lower Level Gorman Building, 3800 Reservoir Road, NW., Washington, DC 20007-2197. Address correspondence to: James N. Baraniuk at the above address.
(E-mail: baraniuj@gunet.georgetown.edu).

ABSTRACT.
Background: Mechanisms responsible for sensitivity to irritants such as tobacco smoke are poorly understood. A Tobacco Score questionnaire was developed to identify and characterize subjects with this sensitivity. For this pilot study, scores were assessed in populations of self-selected controls and a group with irritant sensitivity (Chronic Fatigue Syndrome, CFS).

Method: Subjects graded the severity of 21 symptoms associated with tobacco exposure. Results were compared with other instruments and a measure of pain sensitivity (dolorimetry) in 116 control and 103 CFS subjects.

Results: The Tobacco Score was positive in 16% of control and 51% of CFS subjects. Significant correlations were found between Tobacco Score, Irritant Rhinitis Score, and history of sinusitis. Intermediate relationships were found with history of allergic rhinitis, Systemic Cornplaints Score, and Multiple Chemical Setzsitivity. Factors having no influence included gender, the severity of CFS symptoms, pain thresholds, and allergy skin tests.

Conclusions: Tobacco sensitivity was correlated with measures of upper airway irritation and nonallergic sensitivity to triggers such as weather changes. The spectrum of symptoms, high prevalence in CFS, and absence of a relationship to atopy suggest that these nonallergic irritant syndromes may share a common neuropathophysiology.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com   Website: www.HaworthPress.com]

© 2000 by The Haworth Press, Inc. All rights reserved.

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