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Posted to Co-Cure Sat, 7 Apr 2001 19:08:25 -0700 by Melissa O'Toole

Complementary and alternative therapies for fibromyalgia

Full Title: Complementary and alternative therapies for fibromyalgia.

Journal: Curr Rheumatol Rep 2001 Apr;3(2):147-56

Authors: Crofford LJ, Appleton BE.

Affiliation: University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109-0680, USA. crofford@umich.edu

NLM Citation: PMID: 11286671

Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders.

These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments.

This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mind-body therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes.

Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up.

However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.

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Posted to Co-Cure Wed, 11 Apr 2001 22:19:27 -0400 by Fred Springfield

Immunotherapy of Chronic Fatigue Syndrome...

Full Title: Immunotherapy of Chronic Fatigue Syndrome: Therapeutic Interventions Aimed at Modulating the Th1/Th2 Cytokine Expression Balance

Journal: Journal of Chronic Fatigue Syndrome, Vol.8(1) 2001, pp. 3-37

Authors: Roberto Patarca-Montero, MD, PhD; Nancy G. Klimas, MD; Mary Ann Fletcher, PhD

Affiliation: Roberto Patarca-Montero, Nancy G. KIimas, and Mary Ann Fletcher are Directors, E.M. Papper Laboratory of Clinical Immunology, Department of Medicine, University of Miami School of Medicine, 1600 NW 10th Street, Miami, FL 33136, USA. Address correspondence to: Roberto Patarca-Montero at the above address (E-mail: rpatarca@pol.net).

ABSTRACT.
Based on the postulates of viral and autoimmune etiolo­gies of CFS, several interventions have been designed and tested by different research groups around the world, including the United States, Sweden, United Kingdom, Italy, and Japan. This review addresses those interventions aimed at altering the balance of certain cytokines, the mediators of immune responses.

Patients with CFS who show evidence of activation of the immune system have poor immune cell function and a predominance of what is called a T-helper (Th)2-type cytokine re­sponse when their lymphocytes are activated. A Th2-type response, which is characterized by production of cytokines such as interleukin (IL)-4, -5, and -10, favors the function of B lymphocytes, the cellular factories of immunoglobulins. A predominance of a Th2-type response is therefore consistent with pathologies, such as autoimmunity and atopy, which are based on inappropriate production of immunoglobulins.

Many of the CFS therapies discussed decrease the Th2-type pre­dominance seen at baseline in CFS patients, thereby allowing a greater predominance of a Th1-type response, which favors the function of macrophages and natural killer cells. The function of the latter cells, which have the natural ability of directly destroying invading microbes and cancer cells, is defective in untreated CFS patients. Typical Th1-type cytokines include IL-2 and interferon-gamma, and some of the thera­pies induce their production.

The interventions discussed in this review cover a wide spectrum of therapeutic tools ranging from lymph node cell immunotherapy, herbal products, and small molecules to vaccines. Despite the controversies on the etiology of CFS, immunotherapy research is useful and necessary.

[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 ]

KEYWORDS. Vaccine, lymph node, cytokines, viruses

© 2001 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Wed, 28 Feb 2001 23:07:31 -0500 by Fred Springfield

Differential Diagnosis: The Challenge of Chronic Fatigue

Full Title: Differential Diagnosis: The Challenge of Chronic Fatigue

Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(4) 2000, pp. 17-31

Author: John Pearn, MD, FRCP (Lond), FRCP (Glas)

Affiliation: Major General John Pearn is The Surgeon General, Australian Defence Force, CP2-7-124, Campbell Park Offices, Department of Defence, Canberra Act 2600, Australia.

The author thanks Professor Peter Behan and Professor Mina Behan, of Glasgow, for particular encouragement and the stimulation of their professional involvement in discussions of the fundamental pathogenesis of the symptom of chronic fatigue.

The Ramsay Lecture—2000, delivered at The London Medical Society, 14th April, 2000.

ABSTRACT.
The chronic fatigue syndrome comprises one of the most challenging issues in contemporary medicine. The condition remains distressing for patients and perplexing to medical science. Clinicians face a management path which has no “gold standard” of investigational mileposts; and are locked into a progression where the extremes of either undertreatment or over-investigation may lead to iatrogenic disaster.

The themes of investigation, diagnosis and management of patients with the chronic fatigue syndrome remain controversial. This condition joins in historical perspective a series of other diseases such as pink disease, post-traumatic stress disorder (by a variety of names), the Royal Free disease, Q Fever, Ross River disease and chronic ciguatera— all of which have occupied windows of historical time in the twentieth century during which their genesis remained an enigma. In some cases, they still do. New and puzzling diseases will undoubtedly arise in the future. Both patients and medical science are best served if the formal discipline of differential diagnosis is followed unswervingly under these circumstances or “new” diseases. The rigour of this discipline—the rank listing of formal possibilities after the clinical history and objective signs have been elicited—forms the pivot of best-practice contemporary medicine. An example of its power is no more dramatically illustrated by the example of a “new” enigmatic disease, chronic ciguatera, which “reappeared” in the 1950s. Ciguatoxins are some of the most potent biological substances known. Their neurotropic effects produce a protean array of symptoms which are distressing in the acute-phase syndrome and which are enervating throughout the often-prolonged progression of convalescence. It is now appreciated that such effects are due to sodium channel activation and subsequent dysfunction at the receptor sites on the cell surface of all excitable tissues.

Dr. A. Melvin Ramsay, the Honorary Consultant Physician in Infectious Diseases at the Royal Free Hospital in London, was at the clinical epicentre of the presentation of another new disease in July 1955. His approach to its diagnosis, in the best traditions of differential diagnosis, is an exemplar of the objective response to the appearance of a new or enigmatic disease; and especially to that type in which experience has not generated sufficient case familiarity to define syndrome barriers or to establish pathogenesis. Under such conditions, the correct diagnostic paradigm is to follow the discipline of differential diagnosis, an evolved phenomenon of the last one hundred years of medicine. This paper traces the evolution of the process of differential diagnosis, in the perspective of the enigma of chronic fatigue, which remains an unmet challenge today.

KEYWORDS. Chronic Fatigue Syndrome, ciguatoxins, differential diagnosis, Royal Free Disease

[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 Mon, 26 Feb 2001 15:19:53 -0500 by Kimberly Hare

Alpha sleep characteristics in fibromyalgia

Full Title: Alpha sleep characteristics in fibromyalgia.

Journal: Arthritis Rheum 2001 Jan;44(1):222-30

Authors: Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S

Affiliation: Departamento de Psicobiologia, Sao Paulo Federal University, Brazil.

NLM Citation: PMID: 11212164

OBJECTIVE: To characterize the patterns of alpha electroencephalographic sleep and their associations with pain and sleep in patients with fibromyalgia.

METHODS: Pain and sleep symptoms of 40 female patients with fibromyalgia and 43 healthy control subjects were studied before and after overnight polysomnography. Blinded analyses of alpha activity in non-rapid eye movement (non-REM) sleep were performed using time domain, frequency domain, and visual analysis techniques.

RESULTS: Three distinct patterns of alpha sleep activity were detected in fibromyalgia: phasic alpha (simultaneous with delta activity) in 50% of patients, tonic alpha (continuous throughout non-REM sleep) in 20% of patients, and low alpha activity in the remaining 30% of patients. Low alpha activity was exhibited by 83.7% of control subjects (P < 0.01). All fibromyalgia patients who displayed phasic alpha sleep, activity reported worsening of pain after sleep, compared with 58.3% of patients with low alpha activity (P < 0.01) and 25.0% of patients with tonic alpha activity (P < 0.01). Postsleep increase in the number of tender points occurred in 90.0% of patients with phasic alpha activity, 41.7% of patients with low alpha activity, and 25.0% of patients with tonic alpha activity (P < 0.01). Self ratings of poor sleep were reported by all patients with phasic alpha activity, 58.3% of patients with low alpha activity (P < 0.01), and 12.5% of patients with tonic alpha activity (P < 0.01). Patients with phasic alpha activity reported longer duration of pain than patients in other subgroups (P < 0.01). Additionally, patients with phasic alpha sleep activity exhibited less total sleep time than patients in other subgroups (P < 0.05), as well as lower sleep efficiency (P < 0.05) and less slow wave sleep (P < 0.05) than patients with a tonic alpha sleep pattern.

CONCLUSION: Alpha intrusion during sleep can be of different patterns Phasic alpha sleep activity was the pattern that correlated better with clinical manifestations of fibromyalgia.

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Posted to Co-Cure Tue, 6 Mar 2001 13:41:40 -0500 by Fred Springfield

Psychological Adjustment of Adolescent Girls With CFS

Full Title: Psychological Adjustment of Adolescent Girls With Chronic Fatigue Syndrome

Authors: Henriët van Middendorp, Msc*, §, Rinie Geenen, PhD§, Wietse Kuis, MD, PhDDagger , Cobi J. Heijnen, PhDDagger , and Gerben Sinnema, PhD*

Journal: Pediatrics Vol. 107 No. 3 March 2001, p. e35 [Electronic Article]

Affiliations: From the Departments of * Pediatric Psychology and Dagger Pediatric Immunology/Rheumatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, The Netherlands; and the § Department of Health Psychology, Utrecht University, The Netherlands.

NLM Citation: PMID: 11230616

Abstract:
Objective. To examine psychosocial problems and adaptation of adolescent girls with chronic fatigue syndrome (CFS).

Methodology. Thirty-six adolescent girls with CFS (mean age: 15.2 years; mean syndrome duration: 19.7 months) who fulfilled the criteria of the Centers for Disease Control and Prevention were examined by interviews regarding premorbid problems and by questionnaires regarding psychosocial functioning and distress, psychological attitudes, and coping resources. Data were compared with normative data.

Results. Of the adolescents, 86.1% reported 1 or more premorbid problems (58.3% physical, 38.9% psychological, and 52.8% familial). Normal adjustment was reported for psychosocial self-esteem, social abilities, and attentional abilities. High adjustment to adult social standards of behavior was found, but low perceived competence in specific adolescent domains, such as athletic ability, romance, and participation in recreational activities. The girls reported predominantly internalizing problems. Normal achievement motivation, no debilitating fear of failure, and high internal locus of control were observed. Palliative reaction patterns and optimism were predominantly used as coping strategies.

Conclusions. The large number of premorbid problems suggests a possible contributing factor to the onset of the syndrome, although there were no reference data of healthy adolescents. In distinct domains of psychosocial adjustment, the adolescent girls with CFS showed strengths such as adequate self-esteem and scholastic and social abilities, and weaknesses such as low competence in adolescent-specific tasks and internalizing distress, which may partly be explained by syndrome-specific somatic complaints. The use of optimistic and palliative reaction patterns as coping strategies in this patient group indicates that the patients with CFS seem to retain an active and positive outlook on life, which may result in a rather adequate psychological adaptation to the syndrome, but also in maintenance of the syndrome by exceeding the physical limits brought about by the CFS. Our results on adjustment and coping strategies may be helpful to implement (individual) rehabilitation programs.

Key words: chronic fatigue syndrome, adolescents, female, psychological adjustment, coping behavior.

Full Text of Article

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Posted to Co-Cure Sat, 17 Feb 2001 18:03:57 +0100 by Mette Marie Andersen, M.D.

RNAs in the plasma of patients with Chronic Fatigue Syndrome...

At the AACFS conference in Seattle there was an abstract presented by Drs. Cheney and Urnovitz entitled:

"RNAs in the plasma of patients with Chronic Fatigue Syndrome: A novel mechanism for Chronic illness expression with both treatment and diagnostic implications."

I will like to draw attention to this abstract, which included the following text (in short):

Objective: This study was conducted to determine the presence or absence of plasma RNA's in CFS and to determine if the amplified sequences (of RNA) were similar to or different from GWS.

Method: Sixty-six CFS patients and 53 healthy blood donors were analyzed using reverse-transcriptase (RT) PCR using primers for nontranslated enteroviral sequences. CFS patients were tested for the presence of et prominent 750 bp band previously reported in 12 of 24 GWS patients.

Results: Fifty-one of 66 CFS patients (77.3%) had a prominent 750 bp band and none of the 53 healthy controls.

Conclusion: All chronic illnesses so far studied, including GWS, CFS, AIDS and Multiple Myeloma show prominent circulating plasma RNAs not observed in normal controls. Prominent RNA bands so far sequenced show homology with human genes which are noted for their tendency for gene rearrangement under severe physiologic stress. The most amplified or prominent sequences appear to be disease specific and vary by less than 1% between individuals with the same or similar illness. These findings point to novel diagnostic possibilities in CFS and GWS, which are both sensitive and specific using genetic probes of acquired human gene arrangements, which are disease specific.

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Posted to Co-Cure Fri, 16 Feb 2001 23:21:17 -0500 by Fred Springfield

Toxicant-induced loss of tolerance

Full Title: Toxicant-induced loss of tolerance.
Journal: Addiction 2001 Jan;96(1):115-137
Author: Miller CS
Affiliation: Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
NLM Citation: PMID: 11177524

Drug addiction and multiple chemical intolerance (abdiction) appear to be polar opposites - the former characterized by craving and dependency, the latter by aversion. However, when the two are viewed in juxtaposition similarities emerge, revealing a common underlying dynamic, one which appears to be a new paradigm of disease.

TILT, or toxicant-induced loss of tolerance, bridges the gap between addiction and abdiction and has the potential to explain a variety of illnesses, including certain cases of asthma, migraine headaches and depression, as well as chronic fatigue syndrome, fibromyalgia and "Gulf War syndrome".

This paper argues that both addiction and chemical intolerance involve a fundamental breakdown in innate tolerance, resulting in an amplification of various biological effects, particularly withdrawal symptoms. While addicts seek further exposures so as to avoid unpleasant withdrawal symptoms, chemically intolerant individuals shun their problem exposures, but for the same reason - to avoid unpleasant withdrawal symptoms.

These observations raise critical questions: do addictive drugs and environmental pollutants initiate an identical disease process? Once this process begins, can both addictants and pollutants trigger symptoms and cravings? TILT opens a new window between the fields of addiction and environmental medicine, one that has the potential to transform neighboring realms of medicine, psychology, psychiatry and toxicology.

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Posted to Co-Cure Tue, 13 Feb 2001 17:20:07 -0500 by Kimberly Hare

Both pain and EEG response to cold pressor stimulation occurs faster in FM patients than in control subjects

Full Title: Both pain and EEG response to cold pressor stimulation occurs faster in fibromyalgia patients than in control subjects.
Journal: Psychiatry Res 2000 Dec 27;97(2-3):237-247
Authors: Stevens A, Batra A, Kotter I, Bartels M, Schwarz J
Affiliation: Department of Psychiatry, University of Tubingen, Universitatsklinik fur Psychiatrie und Psychotherapie, Osianderstr. 24, 72076, Tubingen, Germany
NLM Citation: PMID: 11166094

Pain-evoked brain potentials elicited by laser stimulation have been repeatedly shown to be abnormal in fibromyalgia syndrome. However, to our knowledge this is the first study assessing enduring (cold pressor) pain and correlated EEG changes in fibromyalgia.

EEG power and subjective pain ratings during the cold pressor test were analyzed and contrasted with tasks not involving sensory stimulation (rest, mental arithmetic and pain imagery) in 20 patients with fibromyalgia and 21 healthy control subjects.

Fibromyalgia patients both perceived pain and judged pain as intolerable earlier than control subjects, while pain intensity ratings and EEG power changes during subjective awareness of pain were similar in both groups. In patients and control subjects, pain was correlated with a rise in delta, theta and beta power. EEG power spectra during pain imagery and mental arithmetic were significantly different from those observed during the cold pressor test.

In conclusion, fibromyalgia patients seem to process painful stimuli abnormally in a quantitative sense, thus producing both the sensation of pain, as well as the associated EEG patterns, much earlier than control subjects. However, the quality of the pain-associated EEG changes seems similar.

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Posted to Co-Cure Tue, 13 Feb 2001 17:22:53 -0500 by Kimberly Hare

An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with FMS

Full Title: An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with fibromyalgia syndrome.
Journal: Pain 2001 Jan;89(2-3):111-115
Authors: Nielson WR, Jensen MP, Hill ML
Affiliation: Department of Medicine, Division of Rheumatology and Department of Psychology, University of Western Ontario, ON, London, Canada
NLM Citation: PMID: 11166466

Patients with fibromyalgia syndrome (FS) experience a decreased ability to participate in both vocational and avocational activities. Although many treatment programs advocate activity pacing techniques, "pacing" is a poorly understood concept for which there are no available measures.

The present study describes a brief six-item pacing scale that can be administered as part of the Chronic Pain Coping Inventory (CPCI). Preliminary data indicate that this scale is a valid, reliable index of the pacing construct that is associated with physical impairment in patients with FS and is unrelated to simple task persistence.

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