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Posted to Co-Cure Sat, 2 Jun 2001 22:23:47 -0400 by Fred Springfield

Respiratory Function and Dyspnea in Fibromyalgia Syndrome

[Note: Taber's Medical Encyclopedia defines dyspnea as: "Air hunger resulting in labored or difficult breathing, sometimes accompanied by pain. It is normal when due to vigorous work or athletic activity. SYN: air hunger; breathlessness."]

Title: Respiratory Function and Dyspnea in Fibromyalgia Syndrome

Journal: Journal of Musculoskeletal Pain, Vol.9 (1) 2001, pp. 7-15

Authors: Alp Çetin, MD and Aysen Sivri, MD

Affiliation: Hacettepe University Medical School,, Department of Physical Medicine and Rehabil­itation., Ankara, Turkey

Address correspondence to: Alp Çetin, MD, Hacettepe University Medical School, Department of Physical Medicine and Rehabilitation, Z Kati, 06100, Ankara, Turkey [E-Mail:]

Submitted: March 15, 2000.
Revision accepted: August 14, 2000.

Objectives: To evaluate the presence of dyspnea and its association with the pulmonary function test or any other clinical pa­rameters in patients with fibromyalgia syndrome [FMS].

Methods: Thirty-five females satisfying the American College of Rheumatology criteria for EMS and 20 healthy controls were included in this study. A history of dyspnea was obtained and classified into five grades according to the World Health Organization's [WHO] dyspnea classification. Spirometric pulmonary functions were measured in each subject including forced vital capacity, forced expiratory volume in one second, peak and forced expiratory and inspiratory flow, and maximum voluntary ventilation.

Results: Patients with FMS and controls did not differ in age and body mass index. Dyspnea was the fifth most common associated symp­torn and found in 57.1% of the patients. Spirometric values were normal among patients and controls, and the differences in pulmonary functions between patients and controls were not statistically significant [P> 0.05]. There was a statistically significant positive correlation between pain score measured by visual analog scale and the WHO dyspnea grade [R = 0.532, P < 0.001]. The WHO dyspnea grade was also found to be correlated positively with chest pain [R = 0.464, P < 0.005].

Conclusions: Dyspnea is a common symptom in patients with FMS and is not explained by pulmonary causes, but may partly be due to chest wall discomfort and pain intensity. Understanding the cause of this symptom in FMS may help in the management of these patients who are suffering from dyspnea.

KEYWORDS. Dyspnea, fibromyalgia syndrome, spirometry, respira­tory functions


Fibromyalgia syndrome [FMS] is a common nonrheumatic disorder of unknown etiology characterized by generalized chronic musculo­skeletal pain and tenderness on palpation of tendinomusculoskeletal sites called tender points (1). In addition to diffuse chronic musculo­skeletal pain, the syndrome is associated with a variety of other char­acteristics such as fatigue, headache, irritable bowel syndrome, poor sleep, paresthesias, Raynaud's like symptoms, dysmenorrhea, depres­sion, and anxiety (2). Although dyspnea and other respiratory prob­lems are not mentioned in the description of FMS, several studies have reported a high prevalence of dyspnea in FMS (3-5). It is considered that dyspnea is associated with low physical performance in FMS (3,6). But mechanisms of breathlessness in this syndrome are not clear.

In this study, we investigated the presence of dyspnea and its association with pulmonary function and other clinical properties in FMS.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Web site:]

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

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Posted to Co-Cure Fri, 1 Jun 2001 16:11:08 -0400 by Fred Springfield

Effect of Physician-Recommended Treatment on Mental Health Practitioners' Attributions for CFS

Full Title: Effect of Physician-Recommended Treatment on Mental Health Practitioners' Attributions for Chronic Fatigue Syndrome

Journal: Rehabilitation Psychology, 2001, Vol. 46, No. 2, 165–177

Authors and Affiliations: Renee R. Taylor, Leonard A. Jason, and Cara L. Kennedy DePaul University
Fred Friedberg State University of New York at Stony Brook

Objective: To evaluate whether differing treatment recommendations for chronic fatigue syndrome (CFS) by physicians influence attributions about CFS among mental health practitioners.

Participants and Study Design: Ninety-three mental health practitioners (social work interns, clinical psychology trainees, licensed clinical social workers, and licensed clinical psychologists) were randomly assigned to 1 of 3 conditions. All groups read the same case study of a person diagnosed with CFS, with the only difference between groups being the type of treatment recommended by a physician. The treatment conditions included a drug trial (Ampligen) or 1 of 2 differing psychotherapy approaches, cognitive-behavior therapy with graded activity or cognitive coping skills therapy.

Main Outcome Measures: Attributions regarding the illness, including impressions about its etiology, diagnostic accuracy, severity, prognosis, and the expected outcome of the proposed treatment; familiarity with CFS. Results: Participants in the 3 groups did not differ with respect to their prior familiarity with CFS. Participants who read the case study proposing treatment with Ampligen were more likely to report that the patient was correctly diagnosed and more likely to perceive the patient as disabled than those whose case study described cognitive-behavioral therapy with graded activity as the treatment.

Conclusions: Results of this investigation support the hypothesis that physician recommendations for CFS treatment can influence subsequent attributions about a patient's illness among mental health practitioners.

©2001 American Psychological Association

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Posted to Co-Cure Wed, 30 May 2001 16:58:15 -0400 by Fred Springfield

Nickel Allergy Is Found in a Majority of Women with CFS and Muscle Pain...

Full Title: Nickel Allergy Is Found in a Majority of Women with Chronic Fatigue Syndrome and Muscle Pain - And May Be Triggered by Cigarette Smoke and Dietary Nickel Intake

Journal: Journal of Chronic Fatigue Syndrome, Vol.8(1) 2001, pp. 57-65

Authors: Björn Regland, MD; Olof Zachrisson, MD; Vera Stejskal, PhD; Cari-Gerhard Gottfries, MD

Affiliations: Björn Regland is Assistant Professor, Olof Zachrisson is Assistant Professor, and Cari-Gerhard Gottfries is Professor, all affiliated with the Department of Psychiatry, Sahlgrenska University Hospital/Mölndal and Institute of Clinical Neuroscience, Göteborg, Sweden.
Vera Stejskal is Assistant Professor, Department of Clinical Chemistry, Danderyd Hospital and Karolinska Institute, Stockholm.
Address correspondence to: Björn Regland, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, SE-431 80 Mölndal, Sweden (E-mail:

The authors express their thanks to Swiss Serum & Vaccine Institute Berne for providing them with the Staphylococcus vaccine, and to Veronica Nordman for the performance of in vitro testing.

ABSTRACT. Two hundred and four women with chronic fatigue and muscle pain, with no signs of autoimmune disorder, received immune stimulation injections with a Staphylococcus vaccine at monthly inter­vals over 6 months. Good response was defined as a decrease by at least 50% of the total score on an observer's rating scale. Nickel allergy was evaluated as probable if the patient had a positive history of skin hyper­sensitivity from cutaneous exposure to metal objects. The patient's smoking habits were recorded. Fifty-two percent of the patients had a positive history of nickel contact dermatitis. There were significantly more good responders among the non-allergic non-smokers (39%) than among the allergic smokers (6%). We also present case reports on nickel-allergic patients who apparently improved after cessation of cig­arette smoking and reducing their dietary nickel intake. Our observa­tions indicate that exposure to nickel, by dietary intake or inhalation of cigarette smoke, may trigger systemic nickel allergy and contribute to syndromes of chronic fatigue and muscle pain.

KEYWORDS. Nickel allergy, cigarette smoking, dietary nickel, fa­tigue, muscle pain


Nickel is a common sensitizing agent responsible for the high prev­alence of allergic contact dermatitis. However, the health hazards of nickel allergy with regard to diffuse and general symptomatology, such as chronic fatigue and muscle pain, appear not to be fully under­stood and are probably underestimated.

The prevalence of nickel contact dermatitis among women has in­creased remarkably and there is a clear relationship between ear pierc­ing and induction of nickel allergy (1). In two Norwegian unselected populations, the prevalence figures for women were reported to be 27.5 and 31.1%, respectively (2). Although in the same study the prevalence for men was 5%, the modern fashion of piercing also anticipates an increasing prevalence among men (3). Nickel allergy is associated with fatigue syndromes with or without autoimmunity (4). In women with chronic fatigue syndrome the prevalence of nickel contact dermatitis has been reported to be as high as 52% (5).

Recently we chanced upon findings regarding nickel allergy in a study set up with quite another purpose. Immune stimulation with a Staphylococcus vaccine was tested in clinical trials of female patients with chronic fatigue and muscle pain (see 6 for a preliminary report). The patients received subcutaneous injections at monthly intervals. The results are interesting, showing clinical improvement in a substan­tial number of patients. Moreover, we unexpectedly found that nickel allergy influenced the efficiency of the treatment and that nickel allergy was interrelated with cigarette smoking.

The primary incidental finding of nickel sensitization came out of a Memory Lymphocyte Immuno Stimulation Assay (MELISA®) in 16 patients who did not improve or had reacted adversely to the vaccine treatment (7). MELISA® is an optimized lymphocyte proliferation test (8). The purpose of using MELISA® in the study was to check wheth­er the unresponsiveness to the vaccine could be due to hypersensitivity to the preservative thiomersal (syn. merthiolate, thimerosal). In addi­tion, reactivity was tested to various metals such as nickel, although the vaccine compound does not contain nickel. The main finding was that 13 of the 16 tested patients (81%) reacted strongly against nickel in vitro (7). Moreover, we found a substantial number of cigarette smokers among the non-responding and MELISA®-positive nickel-al­lergic patients, whereas the combination of smoking and contact aller­gy was hardly seen at all in the group of patients rated as good re­sponders. Thus, we were made attentive to the intriguing possibility that a connection might exist between nickel allergy and cigarette smoking. As nickel and a variety of other metals occur in trace amounts in mainstream cigarette smoke (9), it would be a plausible suggestion that exposure to cigarette smoke may be nickel-sensitizing or, at least, a potential trigger of hyperreactivity in a person already sensitized to nickel.

The aim of this study was to further explore the impact of nickel allergy and its interrelation with cigarette smoking in a large number of women with chronic fatigue and muscle pain included in clinical trials of immune stimulation therapy.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Web site:]

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

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Posted to Co-Cure Wed, 30 May 2001 13:30:56 -0400 by Fred Springfield

The effect of exercise on gait and balance in patients with CFS

Full Title: The effect of exercise on gait and balance in patients with chronic fatigue syndrome.

Journal: Gait Posture 2001 Jul;14(1):19-27

Authors: Paul LM, Wood L, Maclaren W.

Affiliation: Department of Physiotherapy, Podiatry and Radiography, Glasgow Caledonian University, City Campus, Cowcaddens Road, Scotland G4 OBA, Glasgow, UK

NLM Citation: PMID: 11378421

Abstract: This study investigated anecdotal reports of gait and balance abnormalities in subjects with Chronic Fatigue Syndrome (CFS) by examining the effects of a light exercise test on postural sway and various gait parameters.

Tests were performed on 11 CFS patients and 11 age- and sex-matched sedentary controls.

Results demonstrated that postural sway was not significantly different in both groups before or after the exercise test.

There were, however, significant differences in gait parameters between the two groups confirming anecdotal evidence, but these differences were not exacerbated by the exercise test. Heart rate responses demonstrated that both groups were exercising at similar loads, although this was perceived to be higher by the CFS group.

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Posted to Co-Cure Wed, 30 May 2001 13:20:59 -0400 by Kimberly Hare

Pain evaluation of patients with FM, osteoarthritis, and low back pain

Full Title: Pain evaluation of patients with fibromyalgia, osteoarthritis, and low back pain.

Journal: Rev Hosp Clin Fac Med Sao Paulo 2001 Jan;56(1):5-10

Authors: Marques AP, Rhoden L, Siqueira Jd J, Joao SM.

Affiliation: Service of Rheumatology, Department of Physiotherapy, Speech and Occupational Therapy, Faculty of Medicine, University of Sao Paulo.

NLM Citation: PMID: 11378677

The purpose of this study was to evaluate and compare pain as reported by outpatients with fibromyalgia, osteoarthritis, and low back pain, in view of designing more adequate physical therapy treatment.

PATIENTS AND METHODS: A Portuguese version of the McGill Pain Questionnaire - where subjects are asked to choose, from lists of pre-categorized words, one or none that best describes what they feel - was used to assess pain intensity and quality of 64 patients, of which 24 had fibromyalgia, 22 had osteoarthritis, and 18 had low back pain. The pre-categorized words were organized into 4 major classes - sensory, affective, evaluative, and miscellaneous.

RESULTS: Patients with fibromyalgia reported, comparatively, more intense pain through their choice of pain descriptors, both sensory and affective; they also chose a higher number of words from these classes than patients in the other groups and were the only ones to choose specific affective descriptors such as "vicious", "wretched", "exhausting", "blinding".

CONCLUSION: Assuming that each disease presents unique qualities of pain experience, and that these can be pointed out by means of this questionnaire by patients' choice of specific groups of words, the findings suggest that fibromyalgia include not only a physical component, but also a psycho-emotional component, indicating that they require both emotional/affective and physical care.

Full text of article in PDF format

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Posted to Co-Cure Thu, 24 May 2001 11:12:24 -0400 by Co-Cure Moderators

A community based study of seasonal variation in the onset of CFS...

Full Title: A community based study of seasonal variation in the onset of chronic fatigue syndrome and idiopathic chronic fatigue.

Journal: Chronobiological International, 18, 315-319 (2001).

Authors: Jason, L.A., Taylor, R.R., & Carrico, A.W.

Affiliation: DePaul University.

Summary: One proposed hypothesis regarding the etiology of CFS is that there is a subgroup of patients in which symptom onset is precipitated by a viral infection. If this is indeed true, then one would anticipate a greater incidence of the emergence of CFS symptoms during months when viral infections occur with the greatest frequency. The current community-based epidemiology study examined the month of symptom onset for 31 patients with CFS and 44 with idiopathic chronic fatigue (ICF). It was determined that the distribution of the month of illness onset for the CFS and ICF groups was nonrandom with greater numbers of participants than expected reporting an onset of CFS and ICF during January.

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Posted to Co-Cure Mon, 21 May 2001 20:29:54 -0400 by Co-Cure Moderators

Is CFS Linked to Vaccinations?

Full Title: Is CFS Linked to Vaccinations?

Source: The CFS Research Review, Winter 2001

Author: Charles Shepherd, MD

Affiliation: ME Association, United Kingdom

There is widespread agreement that a variety of infections are capable of precipitating chronic fatigue syndrome (CFS) in susceptible individuals. In l988, Lloyd et al reported that several of their patients had linked the onset of CFS to receiving a vaccination in the absence of any coincidental infection. Since then, other anecdotal reports have also linked vaccinations to the onset of CFS.

The explanation for vaccine-induced CFS may be because the primary purpose of any vaccine is to mimic the effects of infection on the immune system. If an antigenic challenge by infection can precipitate CFS, then it is conceivable that vaccines could act in a very similar manner.

Read the entire article

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Posted to Co-Cure Sat, 19 May 2001 10:40:05 -0400 by Co-Cure Moderators

Directions in Immunotherapy

Full Title: Directions in Immunotherapy

Source: The CFS Research Review, Winter 2001

Author: Roberto Patarca-Montero, MD, PhD

Affiliation: University of Miami School of Medicine

In a subset of chronic fatigue syndrome (CFS) patients, the immune system is always activated. Although it is unknown why this happens, one hypothesis is that it is caused by a lingering infection or an infection that leaves an autoimmune sequelae.

Although the immune systems of some CFS patients are chronically activated, parts function poorly, particularly the T cells (the "generals" of the immune system army) and natural killer cells (destroyers of infected or cancerous cells). CFS patients' T cells have a decreased capacity to divide and generate new T cells, and their natural killer cells have significantly decreased cytotoxic activity.

Read the entire article

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Posted to Co-Cure Wed, 16 May 2001 15:10:09 -0700 by Melissa O'Toole

Decreased tryptophan CFS

Full Title: Decreased tryptophan availability but normal post-synaptic 5-HT2c receptor sensitivity in chronic fatigue syndrome.

Journal: Psychol Med 2001 May;31(4):585-91

Authors: Vassallo CM, Feldman E, Peto T, Castell L, Sharpley AL, Cowen PJ.

Affiliation: University Department of Psychiatry, Warneford Hospital, Oxford.

NLM Citation: PMID: 11352361

BACKGROUND: Chronic fatigue syndrome (CFS) has been associated with increased prolactin (PRL) responses to the serotonin (5-HT) releasing agent fenfluramine. It is not known whether this abnormality is due to increased 5-HT release or heightened sensitivity of post-synaptic 5-HT receptors.

METHODS: We measured the increase in plasma PRL produced by the directly acting 5-HT receptor agonist, m-chlorophenylpiperazine (mCPP), in patients with CFS and healthy controls. We also compared the ability of mCPP to lower slow wave sleep (SWS) in the sleep polysomnogram of both subject groups. Finally, we measured plasma amino-acid levels to determine whether tryptophan availability differed between CFS subjects and controls.

RESULTS: mCPP elevated plasma PRL equivalently in patients with CFS and controls. Similarly, the decrease in SWS produced by mCPP did not differ between the two subject groups. Plasma-free tryptophan was significantly decreased in CFS.

CONCLUSIONS: The sensitivity of post-synaptic 5-HT2c receptors is not increased in patients with CFS. This suggests that the increased PRL response to fenfluramine in CFS is due to elevated activity of pre-synaptic 5-HT neurones. This change is unlikely to be due to increased peripheral availability of tryptophan.

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Posted to Co-Cure Wed, 16 May 2001 18:18:52 -0400 by Fred Springfield

Patients' perceptions of medical care in chronic fatigue syndrome

Full Title: Patients' perceptions of medical care in chronic fatigue syndrome.

Journal: Soc Sci Med 2001 Jun;52(12):1859-64

Authors: Deale A, Wessely S.

Affiliation: Academic Department of Psychological Medicine, Guy's, King's and St Thomas's School of Medicine, Kings College, University of London, UK.

NLM Citation: PMID: 11352411

This study investigated perceptions of medical care among patients with chronic fatigue syndrome (CFS) referred to a specialist clinic.

Sixty-eight patients completed a questionnaire survey on their overall satisfaction with medical care received since the onset of their illness, and their views on specific aspects of care. Two-thirds of patients were dissatisfied with the quality of medical care received.

Dissatisfied patients were significantly more likely to describe delay, dispute or confusion over diagnosis; to have received and rejected a psychiatric diagnosis; to perceive doctors as dismissive, skeptical or not knowledgeable about CFS and to feel that the advice given was inadequate or conflicting.

Satisfied patients were significantly more likely to perceive doctors as caring, supportive and interested in their illness; to state that they did not expect their doctors to cure CFS and to perceive their GP or hospital doctor as the source of greatest help during their illness. Many patients were critical of the paucity of treatment, but this was not associated with overall satisfaction.

The findings suggest that medical care was evaluated less on the ability of doctors to treat CFS, and more on their interpersonal and informational skills. Dissatisfaction with these factors is likely to impede the development of a therapeutic doctor-patient alliance, which is central to the effective management of CFS. The findings suggest a need for better communication and better education of doctors in the diagnosis and management of CFS.

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