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Posted to Co-Cure Mon, 16 Jul 2001 14:02:41 -0500 by Co-Cure Moderators

CFS: Assessing Symptoms and Activity Levels for Treatment Planning

Full Title: Chronic Fatigue Syndrome: Assessing Symptoms and Activity Levels for Treatment Planning

Source: Directions in Clinical and Counseling Psychology. (pp. 125-135). Long Island City, NY: Hatherleigh Co., Ltd.

Authors: Constance W. Van der Eb & Leonard A. Jason

Affiliation: DePaul University

Abstract:
Chronic fatigue syndrome (CFS) is a heterogeneous, debilitating disease that affects a significant portion of the U.S. population. This condition impacts not only all aspects of life functioning but also exhibits a high degree of inter- and intra-individual variability of symptoms and disability.

Current approaches to diagnosis and assessment of CFS pose methodological problems that obscure not only the complexities and dynamic interrelations among a patient's symptoms but also the enormous variability of CFS symptoms from one patient to another.

A survey of empirical research and case studies suggests that a more fruitful approach for the clinician involves use of self-report rating scales designed for CFS diagnosis and assessment in combination with an instrument that measures frequency and intensity of physical activity.

Application of this dual approach measurement system is discussed in the context of treatment planning and implementation.

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Posted to Co-Cure Thu, 21 Jun 2001 13:17:19 -0400 by Barbara Evans

Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins

Full Title: Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins.

Journal: Ann Pharmacother 2001 Jun;35(6):702-6

Authors: Smith JD, Terpening CM, Schmidt SO, Gums JG.

Affiliation: Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA.

NLM Citation: PMID: 11408989

BACKGROUND: Fibromyalgia is a common rheumatologic disorder that is often difficult to treat effectively.

CASE SUMMARY: Four patients diagnosed with fibromyalgia syndrome for two to 17 years are described. All had undergone multiple treatment modalities with limited success. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. All patients were women with multiple comorbidities prior to elimination of MSG. All have had recurrence of symptoms whenever MSG is ingested.

DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate, that act as excitatory neurotransmitters, and can lead to neurotoxicity when used in excess. We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia. We suggest that identification of similar patients and research with larger numbers of patients must be performed before definitive conclusions can be made.

CONCLUSIONS: The elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.

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Posted to Co-Cure Wed, 20 Jun 2001 19:57:01 -0400 by Fred Springfield

FMS v. RA: A Comparison of Psychological Disturbance and Life Satisfaction

Full Title: Fibromyalgia versus Rheumatoid Arthritis: A Comparison of Psychological Disturbance and Life Satisfaction

Journal: Journal of Musculoskeletal Pain, Vol. 9(1) 2001, pp. 35-45

Authors: Reyhan Çeliker and Pinar Borman

Affilialtions: Reyhan Çeliker, MD, is Associate Professor in Hacettepe University, Medical School, Department of Physical Medicine and Rehabilitation, Ankara 06100, Turkey.
Pinar Borman, MD, is Specialist in Physical Medicine and Rehabilitation, Ankara Numune Hospital, Ankara 06100, Turkey.
Address correspondence to: Reyhan Çeliker, MD, Hacettepe University, Medical School, Department of Physical Medicine and Rehabilitation, 06100, Ankara, Turkey [E-mail: celiker@tr-net.net.tr].

Submitted: July 13, 1999.
Revision Accepted: May 22, 2000.

ABSTRACT.
Objectives: The aim of this study was to compare the intensity of anxiety, depression, and hopelessness in fibromyalgia syndrome [FMS] and rheumatoid arthritis [RA] patients and to determine the differences of life satisfaction in these patient groups.

Methods: Twenty patients with RA, 20 patients with FMS, and 20 healthy control subjects were included in this study. All the subjects were female. The Beck Depression Inventory [BDI], Spielberger State and Trait Anxiety Inventory [STAI], and Beck Hopelessness Scale [BHS] were used to evaluate psychological disturbance, and the life satisfaction index [LSI] was used to measure psychological well-being.

Results: The mean BDI scores were higher in both the FMS and RA groups, trait anxiety scores in FMS and state anxiety scores in RA were significantly higher compared with the control group. The mean BHS score was higher in the RA group. The LSI results were similar in FMS and RA but significantly lower than the control group. The BDI was found to be correlated with functional status which was measured by health assessment questionnaire in the RA group. There was a negative correlation between LSI and STAI in both the FMS and RA groups but LSI was correlated with BDI only in the RA group.

Conclusion: In conclusion, life satisfaction was similar in RA and FMS patients although RA patients were more disabled because of the arthritic disease. Both depression and anxiety were predictors of low life satisfaction in RA, but in FMS only anxiety had a negative role on life satisfaction.

KEYWORDS. Fibromyalgia, rheumatoid arthritis, depression, anxiety, life satisfaction

INTRODUCTION
Fibromyalgia syndrome [FMS] is a common rheumatologic condition involving widespread musculoskeletal pain and multiple tender points. The etiology of this disorder is not definitely known but psychological disturbances have been noted frequently and also considered as etiological or modifying factors (1,2). Pain is the cardinal symptom in most of the rheumatic diseases including FMS and rheumatoid arthritis [RA] (3,4). Several studies have been done to examine the psychological disturbance in RA and FMS patients. Use of the Minnesota Multiphasic Personality Inventory [MMPI] assessment has shown psychological abnormalities in a subgroup of FMS patients compared with normal controls and with RA patients (3,4). Quality of life and life satisfaction are very important parameters especially in chronically ill patients. Although there are some studies on quality of life in FMS and RA, there are not any published articles about life satisfaction of the patients with these disorders and satisfaction with life must be evaluated independent of quality of life.

The aim of this study was to compare the intensity of anxiety, depression, and hopelessness in FMS and RA patients and to determine the differences of life satisfaction in these patient groups.

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

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

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Posted to Co-Cure Tue, 19 Jun 2001 11:39:17 -0400 by Barbara Evans

The prevalence of musculoskeletal pain and fibromyalgia in patients hospitalized on internal medicine wards

Full Title: The prevalence of musculoskeletal pain and fibromyalgia in patients hospitalized on internal medicine wards.

Journal: Semin Arthritis Rheum 2001 Jun;30(6):411-417

Authors: Buskila D, Neumann L, Odes LR, Schleifer E, Depsames R, Abu-Shakra M.

Affiliations:
Rheumatic Disease Unit and Epidemiology Department, Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel., Dan Buskila, MD: Professor in Internal Medicine, Head of Rheumatic Disease Unit, Soroka Medical Center, Beer Sheva, Israel; Lily Neumann, PhD: Professor in Biostatistics, Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Lisa R. Odes, MD: Resident in Internal Medicine, Soroka Medical Center, Beer Sheva, Israel; Elena Schleifer, MD: Instructor in Internal Medicine, Soroka Medical Center, Beer Sheva, Israel; Roman Depsames, MD: Resident in Internal Medicine, Soroka Medical Center, Beer Sheva, Israel; Mahmoud Abu-Shakra, MD: Associate Professor in Internal Medicine, Soroka Medical Center, Beer Sheva, Israel.

NLM Citation: PMID: 11404824

Summary:
OBJECTIVES: To estimate the prevalence of nonarticular pain complaints (chronic widespread pain, chronic localized pain, transient pain) and fibromyalgia in hospitalized patients and to study utilization patterns of health services associated with pain related problems.

METHODS: Five hundred twenty-two patients hospitalized on internal medicine wards were enrolled. Data were collected with a questionnaire covering demographic background, information on pain and other symptoms, utilization of health services, and drug consumption. All subjects were classified into four pain groups: those with no pain, transient pain, chronic regional pain, and chronic widespread pain. Tenderness was assessed by thumb palpation, and patients were diagnosed as having fibromyalgia if they met the 1990 American College of Rheumatology criteria.

RESULTS: Sixty-two percent of the patients reported pain; 36% reported chronic regional pain, 21% reported chronic widespread pain, and 5% reported transient pain. Fifteen percent of all patients had fibromyalgia, most of whom (91%) were women. The prevalence of chronic widespread pain and of fibromyalgia in women increased with age. Sleep problems, headache, and fatigue were highly prevalent, especially among those with chronic widespread pain. Patients with chronic widespread pain reported more visits to family physicians (6.2 visits per year) and more frequent use of drugs. They also were more frequently referred to rheumatologists, and they reported more hospitalizations.

CONCLUSIONS: Pain syndromes and related symptoms are prevalent among hospitalized patients on the medicine wards. The internist taking care of these patients should be aware of the presence of these syndromes and realize that some of the reported symptoms are partly related to these (undiagnosed) pain syndromes rather than to the cause of hospitalization.

Copyright 2001 by W.B. Saunders Company

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Posted to Co-Cure Sat, 16 Jun 2001 21:34:28 -0400 by Fred Springfield

Effect of Modafinil on Fatigue Associated with Neurological Illnesses

Full Title: Effect of Modafinil on Fatigue Associated with Neurological Illnesses

Journal: J of Chronic Fatigue Syndrome, Vol. 8(2) 2001, pp. 65-70

Author: John W. Cochran, MD, FACP

Affiliation: John W. Cochran is affiliated with Drs. Cochran, Eberly & Howe, PC, 1500 North Beauregard Street, Suite 300, Alexandria, VA 22311 (E-mail: JackCochranMD@aol.com).

ABSTRACT. Fatigue is a common symptom of a variety of neurological illnesses, such as Alzheimer's disease, chronic fatigue syndrome, multiple sclerosis, Parkinson's disease, and stroke. Fatigue severely impairs productivity, performance, social functioning, and quality of life. Modafinil (PROVIGIL®) has been shown to significantly improve fatigue associated with multiple sclerosis and depression. Here, a retrospective review of the medical charts of 25 patients treated with modafinil for fatigue associated with various neurological illnesses was conducted. Modafinil was effective for the treatment of fatigue in 21 of 25 patients (84%), and was well tolerated. Therefore, modafinil appears to be a potentially attractive candidate for the treatment of fatigue associated with neurological disorders.

KEYWORDS. Modafinil, fatigue, Alzheimer's disease, neurological illnesses, stroke

INTRODUCTION
Fatigue, which is often confused with daytime sleepiness, is a common symptom associated with a variety of neurological illnesses, such as Alzheimer's disease, chronic fatigue syndrome, multiple sclerosis, Parkinson's disease, and stroke. Indeed, all patients with chronic fatigue syndrome (1), up to 96% of patients with multiple sclerosis (2,3), and 44% of patients with Parkinson's disease (4) experience persistent, debilitating fatigue. Not only does fatigue severely impair productivity and performance, but it also has detrimental effects on social functioning and overall quality of life. Fatigue has been rated as the worst or one of the worst symptoms by 69% patients with multiple sclerosis (2).

PROVIGIL® (modafinil) is a novel wake-promoting agent that is chemically and pharmacologically distinct from other central nervous system stimulants, such as the amphetamines and methylphenidate. Although the precise mechanism of action for modafinil is not definitively known, modafinil is not a direct or indirect acting dopaminergic agent and the wake-promoting effects of modafinil are not inhibited by dopamine receptor antagonists or depletion of catecholamines (5,6). Instead, preclinical studies have demonstrated that modafinil can selectively activate hypothalamic neurons in both the tuberomamillary nucleus (histaminergic) and lateral hypothalamus (hypocretin/orexin). These neurons have substantial projections throughout the cerebral cortex which can mediate normal wakefulness and enhanced cortical activity (7). This enhancement of hypothalamo-cortical pathways by modafinil may underlie its wake-promoting activity.

Modafinil, which significantly improves the excessive daytime sleepiness (EDS) associated with narcolepsy (8,9), sleep apnea (10), and other disorders of sleep (11-13), has recently been found to effectively manage the fatigue associated with multiple sclerosis (14,15) and depression (16). In a 9-week, forced-titration, placebo-controlled study of 72 patients with multiple sclerosis, 200 mg doses of modafinil taken once daily were found to significantly improve fatigue as measured by three different fatigue scales (14). Similar results were obtained during a 12-week, open-label study that evaluated the efficacy of 100 mg doses of modafinil taken twice daily in 40 patients with multiple sclerosis (15). Modafinil was found to effectively manage the fatigue in 85% of the patients and was more effective in patients in the early stages of the disease. In depression, Menza and coworkers conducted a retrospective review of the medical charts of 7 patients who had no response or partial response to treatment with antidepressants (16). Augmentation of their treatment with modafinil at daily doses of 100 mg or 200 mg resulted in significant improvements in Hamilton Depression Rating Scale scores, as well as improvements in fatigue and overall well being. These improvements generally occurred within one or two weeks after initiating treatment with modafinil. Taken together, these data suggest that modafinil may be a viable pharmacotherapeutic option for treatment of fatigue associated with other neurological illnesses. Here, a case review of 25 patients was conducted in order to preliminarily determine whether modafinil was effective for the treatment of fatigue in a variety of neurological illnesses.

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

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

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Posted to Co-Cure Fri, 15 Jun 2001 14:24:00 -0400 by Fred Springfield

Treatment of fibromyalgia incorporating EEG-Driven stimulation: A clinical outcomes study

Full Title: Treatment of fibromyalgia incorporating EEG-Driven stimulation: A clinical outcomes study.

Journal: J Clin Psychol 2001 Jul;57(7):933-52

Authors: Mueller HH, Donaldson CC, Nelson DV, Layman M.

Affiliation: Myosymmetries International Inc., Edmonton, Alberta.

NLM Citation: PMID: 11406805

Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were followed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS.

Patients were initially treated with EDS until they reported noticeable improvements in mental clarity, mood, and sleep. Self-reported pain, then, having changed from vaguely diffuse to more specifically localized, was treated with very modest amounts of physically oriented therapies.

Pre- to posttreatment and extended follow-up comparisons of psychological and physical functioning indices, specific FS symptom ratings, and EEG activity revealed statistically significant improvements. EDS appeared to be the prime initiator of therapeutic efficacy.

Future research is justified for controlled clinical trials and to better understand disease mechanisms.

Copyright 2001 John Wiley & Sons, Inc.

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Posted to Co-Cure Fri, 13 Jul 2001 15:17:04 -0400 by Co-Cure Moderators

Evaluating Latent Variable Models of Functional Somatic Distress in a Community-based Sample

Full Title: Evaluating Latent Variable Models of Functional Somatic Distress in a Community-based Sample

Journal: J of Mental Health, 2001, 10, 335-349.

Authors: Renée R. Taylor & Leonard A. Jason, DePaul University, Chicago, IL; and Michael E. Schoeny, University of Illinois at Chicago, Chicago, IL

Abstract
This study evaluated the diagnostic validity of conditions that have been labeled, functional somatic syndromes.

In an effort to replicate prior work in this area, latent variable models of functional somatic distress were estimated from the responses of 213 community members to a medical questionnaire. Medical questionnaire items that closely conformed to formal diagnostic criteria for the conditions were used in model estimation.

Results of confirmatory factor analysis supported diagnostic distinctions between five syndromes (fibromyalgia, chronic fatigue syndrome, somatic depression, somatic anxiety, and irritable bowel syndrome).

Discrete diagnostic categories of fibromyalgia and chronic fatigue syndrome were then tested using logistic regression analysis, in which the outcome involved independent diagnosis of these conditions based upon physician evaluation.

Evidence for the existence of discrete diagnoses of fibromyalgia and chronic fatigue syndrome was particularly strong, since these diagnoses were cross-validated using findings from physician evaluation tailored to diagnose these conditions.

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Posted to Co-Cure Thu, 14 Jun 2001 21:59:53 -0400 by Fred Springfield

Pharmacologic treatment of fibromyalgia

Full Title: Pharmacologic treatment of fibromyalgia.

Journal: Curr Pain Headache Rep 2001 Aug;5(4):351-8

Author: Barkhuizen A.

Affiliation: Department of Medicine (L329A), Oregon Health Sciences University and Portland VA Medical Center, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.

NLM Citation: PMID: 11403739

Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms.

Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies.

The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency.

This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.

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Posted to Co-Cure Thu, 14 Jun 2001 21:53:08 -0400 by Fred Springfield

Nociceptive aspects of fibromyalgia

Full Title: Nociceptive aspects of fibromyalgia.

Journal: Curr Pain Headache Rep 2001 Aug;5(4):338-46

Authors: Larson AA, Kovacs KJ.

Affiliation: Department of Veterinary Pathobiology, University of Minnesota, 1988 Fitch Avenue, St. Paul, MN 55108, USA. larso011@tc.umn.edu

NLM Citation: PMID: 11403737

Abstract:
Although characterized by a variety of symptoms, chronic widespread pain is the primary complaint bringing most patients with fibromyalgia syndrome (FMS) into the clinic.

The etiology of this painful condition is unknown, and any possible relationship between pain and the many other symptoms of FMS is unclear.

This article focuses on the unique characteristics of nociception in patients with FMS. The intent is to present criteria that should be considered in the search for biological events that contribute to FMS pain.

Based on this approach, examples are proposed of factors that fulfill some criteria and may, therefore, deserve further study for their possible role in pain associated with FMS.

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Posted to Co-Cure Thu, 14 Jun 2001 21:40:04 -0400 by Kimberly Hare

Psychosocial aspects of fibromyalgia

Full Title: Psychosocial aspects of fibromyalgia.

Journal: Curr Pain Headache Rep 2001 Aug;5(4):330-7

Authors: Nielson WR, Merskey H

Affiliation: Arthritis Institute, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. warren.nielson@sjhc.london.on.ca

NLM Citation: PMID: 11403736

The view that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven.

The construct of posttraumatic FMS has not been adequately validated. Similarly, there is no evidence that communicating the diagnosis to patients causes iatrogenic consequences.

Research suggesting a higher rate of posttraumatic stress disorder among those with FMS is weak.

More research examining specific psychological processes in FMS is desirable. Because of the potential for harm to patients, clinicians should be cognizant of possible undue influences on medical opinion by agencies providing health care and research funding.

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