New research indicates that a disruption of brain signals for reward and punishment contributes to increased pain sensitivity, known as hyperalgesia, in fibromyalgia patients. Results published in Arthritis & Rheumatism, a journal of the American College of Rheumatology, suggest that this altered brain processing might contribute to widespread pain and lack of response to opioid therapy in patients with fibromyalgia.

Fibromyalgia is a chronic, musculoskeletal syndrome characterized by widespread joint and muscle pain along with other symptoms such as fatigue, sleep disturbances, and cognitive difficulty. Previous research estimates that fibromyalgia affects 3.4% of women and 0.5% of men in the U.S. Prevalence of this pain disorder increases with age, affecting more than 7% of women between 60 and 79 years of age.

“In patients with fibromyalgia there is an alteration in the central nervous system pain processing and a poor response to topical pain treatments, trigger point injections and opioids,” said lead author Dr. Marco Loggia from Massachusetts General Hospital and Harvard Medical School in Boston. “Our study examines the disruption of brain function involved in the individual experience of pain anticipation and pain relief.”

For the present study, the research team enrolled 31 patients with fibromyalgia and 14 healthy controls. Functional magnetic resonance imaging (MRI) and cuff pressure pain stimuli on the leg were performed on all subjects. During the MRI, participants received visual cues alerting them of impending pain onset (pain anticipation) and pain offset (relief anticipation).

Results show that during pain anticipation and relief, fibromyalgia patients displayed less robust response within brain regions involved in sensory, affective, cognitive and pain regulating processes. The ventral tegmental area (VTA)—a group of neurons in the center of the brain involved in the processing of reward and punishment—displayed activation during pain anticipation and stimulation, but deactivation during anticipation of relief in healthy controls. In contrast, VTA responses during periods of pain, and anticipation of pain and relief, in fibromyalgia patients were significantly reduced or inhibited.

Dr. Loggia concludes, “Our findings suggest that fibromyalgia patients exhibit altered brain responses to punishing and rewarding events, such as expectancy of pain and relief of pain. These observations may contribute to explain the heightened sensitivity to pain, as well as the lack of effectiveness of pain medications such as opioids, observed in these patients. Future studies should further investigate the neurochemical basis underlying these dysfunctions.”

Added by: Craig Payne

Research is among several Mayo studies being presented at American College of Rheumatology meeting

SAN DIEGO — It may seem counterintuitive, but young and middle-aged fibromyalgia patients report worse symptoms and poorer quality of life than older patients, a Mayo Clinic study shows. Fibromyalgia most often strikes women. It is characterized by widespread musculoskeletal pain with fatigue, sleep, memory and mood issues. The research, one of several Mayo studies being presented at the American College of Rheumatology annual meeting, suggests the disorder plays out differently among different age groups.

MULTIMEDIA ALERT: Video of Dr. Oh is available for download from the Mayo Clinic News Network.

Researchers studied 978 fibromyalgia patients and divided them into three age groups: those 39 or younger, those 50 to 59, and those 60 or older. The younger and middle-aged patients were likelier to be employed, unmarried, smokers and have a higher education level, lower body mass index, more abuse history and a shorter duration of fibromyalgia symptoms than older patients.

“Among the three age groups of young, middle-aged and older, symptom severity and quality of life differs,” says senior author Terry Oh, M.D., a physical medicine and rehabilitation physician at Mayo Clinic in Rochester, Minn. The study’s findings were surprising, because quality of life and physical health are considered to be negatively associated with age, Dr. Oh says.

Dr. Oh notes that women in all three groups with fibromyalgia reported a lower quality of life than average U.S. women, and that the difference between their physical health and that of the average woman was more significant than mental health differences, particularly in young patients.

In other studies, Mayo researchers found:

• About 7 percent of fibromyalgia patients had inflammatory rheumatic conditions, and that in general, those fibromyalgia patients didn’t do as well with treatment as those without rheumatic diseases.
• Fibromyalgia patients may also have skin-related symptoms such as excessive sweating or burning or other sensations.
• Obese patients with polymyalgia rheumatica have more pain and disability than other polymyalgia rheumatica patients. They also tend to need higher doses of glucocorticoids.
• Rheumatoid arthritis patient experiences and symptoms do not always reflect what medical literature shows when it comes to pain, morning stiffness, the relationship between swelling and damage, and what worsens or improves symptoms.
• Hospitalization is a significant risk factor for gout flares in people already diagnosed with gout.

Added By Craig Payne

Patients with fibromyalgia resistant to more routine therapies have a new pain relief treatment available, according to a study presented at theANESTHESIOLOGY™ 2013 annual meeting. Intravenous (IV) lidocaine infusion provided significant pain relief to fibromyalgia patients, although the pain relief was much less for African-Americans and smokers.

Fibromyalgia is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the United States and an estimated three to six percent of the world population. Women account for 80 to 90 percent of those with the condition. Fibromyalgia is a central nervous system disorder characterized by widespread pain throughout the body as well as a heightened, painful response to pressure. Additional symptoms include fatigue, sleep disorders and joint stiffness.

“Fibromyalgia is a truly debilitating disease that can have a severe impact on quality of life,” said Billy K. Huh, M.D., Ph.D., professor and medical director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and adjunct professor of the Department of Anesthesiology at Duke University Medical Center, Durham, N.C.

The study was a retrospective review of 55 fibromyalgia patients whose pain did not respond to more conservative treatments. Statistics were collected for sex, race, body weight, pain duration, pain relief duration after lidocaine infusion, and scores on the brief pain inventory scale, visual analog scale and pain interference scale before and after the infusion.

The study found an almost 10 percent average decrease in the brief pain inventory scale score, which dropped from 83.18 before the infusion to 73.68 after the infusion. The average pain interference score dropped from 7.73 to 6.88. The brief pain inventory score was much lower for non-smokers than for smokers; non-smokers’ average score was 72.63, while smokers’ average score was 89.98.

Dr. Huh hypothesized that because smokers frequently have vascular damage that impairs blood circulation, the lidocaine may not reach the painful area because of poor blood flow. He also suggested that the benefit of lidocaine may be reduced because smokers have significant amounts of toxic chemicals in their blood.

The difference in pain interference scores for white patients and African-American patients was .028. For this test, a score less than .05 is considered statistically significant. Dr. Huh could not be certain about the reason for the difference, but noted, “Many drugs are more effective or less effective for certain ethnic groups. For example, some blood pressure medications are more effective for certain races. I think this finding is quite possibly related to genetic makeup.”

The American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 50,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

Curated: Craig Payne

Small study could lead to identification of treatable diseases for some with chronic pain syndrome

About half of a small group of patients with fibromyalgia – a common syndrome that causes chronic pain and other symptoms – was found to have damage to nerve fibers in their skin and other evidence of a disease called small-fiber polyneuropathy (SFPN). Unlike fibromyalgia, which has had no known causes and few effective treatments, SFPN has a clear pathology and is known to be caused by specific medical conditions, some of which can be treated and sometimes cured. The study from Massachusetts General Hospital (MGH) researchers will appear in the journal Pain and has been released online.

“This provides some of the first objective evidence of a mechanism behind some cases of fibromyalgia, and identifying an underlying cause is the first step towards finding better treatments,” says Anne Louise Oaklander, MD, PhD, director of the Nerve Injury Unit in the MGH Department of Neurology and corresponding author of the Pain paper.

The term fibromyalgia describes a set of symptoms – including chronic widespread pain, increased sensitivity to pressure, and fatigue – that is believed to affect 1 to 5 percent of individuals in Western countries, more frequently women. While a diagnosis of fibromyalgia has been recognized by the National Institutes of Health and the American College of Rheumatology, its biologic basis has remained unknown. Fibromyalgia shares many symptoms with SFPN, a recognized cause of chronic widespread pain for which there are accepted, objective tests.

Designed to investigate possible connections between the two conditions, the current study enrolled 27 adult patients with fibromyalgia diagnoses and 30 healthy volunteers. Participants went through a battery of tests used to diagnose SFPN, including assessments of neuropathy based on a physical examination and responses to a questionnaire, skin biopsies to evaluate the number of nerve fibers in their lower legs, and tests of autonomic functions such as heart rate, blood pressure and sweating.

The questionnaires, exam assessments, and skin biopsies all found significant levels of neuropathy in the fibromyalgia patients but not in the control group. Of the 27 fibromyalgia patients, 13 had a marked reduction in nerve fiber density, abnormal autonomic function tests or both, indicating the presence of SFPN. Participants who met criteria for SFPN also underwent blood tests for known causes of the disorder, and while none of them had results suggestive of diabetes, a common cause of SFPN, two were found to have hepatitis C virus infection, which can be successfully treated, and more than half had evidence of some type of immune system dysfunction.

“Until now, there has been no good idea about what causes fibromyalgia, but now we have evidence for some but not all patients. Fibromyalgia is too complex for a ‘one size fits all’ explanation,” says Oaklander, an associate professor of Neurology at Harvard Medical School. “The next step of independent confirmation of our findings from other laboratories is already happening, and we also need to follow those patients who didn’t meet SFPN criteria to see if we can find other causes. Helping any of these people receive definitive diagnoses and better treatment would be a great accomplishment.”

Other authors of the Pain report are Zeva Daniela Herzog, Heather Downs and Max Klein, PhD, all of MGH Neurology. Preliminary results of the study were presented at the 2012 American Neurological Association meeting, and it was supported by Public Health Service grants NINDS K24NS059892 and UIL RR025758, Department of Defense grant GW093049, and a donation from Jane Cheever Powell.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $775 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.

Curated: Craig Payne

Fibromyalgia is not all in your head, new research confirms

Researchers discover a rational source of pain in the skin of patients with fibromyalgia

		This schematic illustrates the organization of blood vessels and the regulation of blood flow (arrows) in the palm of the hands. Arteriole-venule shunts are small muscular valves that connect…

[June 17, 2013, Rensselaer, NY] – Fibromyalgia, a painful condition affecting approximately 10 million people in the U.S., is not imaginary after all, as some doctors have believed. A discovery, published this month in PAIN MEDICINE (the journal of the American Academy of Pain Medicine), clearly now demonstrates that fibromyalgia may have a rational biological basis located in the skin.

Fibromyalgia is a severely debilitating affliction characterized by widespread deep tissue pain, tenderness in the hands and feet, fatigue, sleep disorders, and cognitive decline. However, routine testing has been largely unable to detect a biological basis for fibromyalgia, and standard diagnosis is based upon subjective patient pain ratings, further raising questions about the true nature of the disease. For many years, the disorder was believed to be psychosomatic (“in the head”) and often attributed to patients’ imagination or even faking illness. Currently approved therapeutics that provide at least partial relief to some fibromyalgia patients are thought to act solely within the brain where imaging techniques have detected hyperactivity of unknown origin referred to as “central sensitization.” However, an underlying cause has not been determined, leaving many physicians still in doubt about the true origins or even the existence of the disorder.

Now, a breakthrough discovery by scientists at Integrated Tissue Dynamics LLC (Intidyn), as part of a fibromyalgia study based at Albany Medical College, has provided a biological rationale for this enigmatic disease. The small biotechnology research company, founded by neuroscientists Dr. Frank L. Rice and Dr. Phillip J. Albrecht, reports on a unique peripheral neurovascular pathology consistently present in the skin of female fibromyalgia patients which may be a driving source of the reported symptoms.

“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” said Dr. Rice, President of Intidyn and the senior researcher on the study.

“This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics.”

Nerve Endings Come In Many Forms

Three years ago, Intidyn scientists published the discovery of an unknown nervous system function among the blood vessels in the skin in the journal PAIN.

As Dr. Rice explained, “we analyzed the skin of a particularly interesting patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for our highly sensitive and richly nuanced sense of touch. Interestingly however, this patient had surprisingly normal function in day to day tasks. But, the only sensory endings we detected in his skin were those around the blood vessels”. Dr. Rice continued, “We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidencs that the blood vessel endings could also contribute to our conscious sense of touch… and also pain.”

		These are digital images of what the arteriole-venule shunts look like in a tiny biopsy of human palmar skin as seen under the microscope. All of the nerve fibers that…

Now, in collaboration with renowned Albany Medical Center neurologist and pain specialist Dr. Charles E. Argoff, the study primary investigator, and his collaborators Dr. James Wymer also at Albany Medical College and Dr. James Storey of Upstate Clinical Research Associates in Albany, NY, clinical research proposals were funded by Forest Laboratories and Eli Lilly. Both pharmaceutical companies have developed FDA-approved medications with similar functions (Serotonin/Norepinephrine Reuptake Inhibitors, SNRI) that provide at least some degree of relief for many fibromyalgia patients.

“Knowing how these drugs were supposed to work on molecules in the brain,” Dr. Albrecht added, “we had evidence that similar molecules were involved in the function of nerve endings on the blood vessels. Therefore, we hypothesized that fibromyalgia might involve a pathology in that location”. As the results demonstrate, they were correct.

To analyze the nerve endings, Drs. Rice, Albrecht, and postdoctoral researcher Dr. Quanzhi Hou, used their unique microscopic technology to study small skin biopsies (less than half the size of a pencil eraser) collected from the palms of fibromyalgia patients, who were being diagnosed and treated by Drs. Argoff, Wymer, and Storey. The study was limited to women, who have over twice the occurrence of fibromyalgia than men. What the team uncovered was an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves, called arteriole-venule (AV) shunts, which form a direct connection between arterioles and venules (see diagram).

As Dr. Rice describes their function, “We are all taught that oxygenated blood flows from arterioles to capillaries, which then convey the deoxygenated blood to the venules. The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature.”

A Thermostat for the Skin

In humans, these types of shunts are unique to the palms of our hands and soles of our feet which work like the radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold and put on gloves.

According to Dr. Albrecht, “the excess sensory innervation may itself explain why fibromyalgia patients typically have especially tender and painful hands. But, in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients.”

A role in regulating blood flow throughout the body.

Although they are mostly limited to the hands and feet, the shunts likely have another important function which could account for the widespread deep pain, achiness, and fatigue that occurs in fibromyalgia patients. “In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism” noted Dr. Rice. “As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactvity in the brain.”

		These are digital images showing what the arteriole-venule shunts in a tiny biopsy of human palmar skin look like as seen under the microscope. The processing of the biopsy caused…

Dr. Albrecht also points out that alterations of normal blood flow may underlie other fibromyalgia symptoms, such as non-restful sleep or cognitive dysfunctions. “The data do appear to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients” he stated. Senior Research Chair of the Alan Edwards Center for Pain Research at McGill University, Dr. Gary Bennett, commented after seeing the results that “It is exciting that something has finally been found. We can hope that this new finding will lead to new treatments for fibromyalgia patients who now receive little or no relief from any medicine.”

This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not “all in your head”, which should provide an enormous relief to fibromyalgia patients, while changing the clinical opinion of the disease and guiding future approaches for successful treatments.

About Integrated Tissue Dynamics LLC (Intidyn)

Integrated Tissue Dynamics LLC, located in Rensselaer, NY amid the Capital region’s Technology Valley, provides flexible and scalable pre-clinical and clinical research and consulting capabilities on skin and nerve related chronic pain afflictions in collaboration with the pharmaceutical industry, government agencies, academia, and a network of pain specialists throughout the United States. The Intidyn ChemoMorphometric Analysis (CMA) platform can be used to detect chemical and structural changes in the skin and other tissues related to chronic pain, numbness, and itch associated with a wide variety of afflictions, including diabetes, shingles, complex regional pain syndrome, carpal tunnel syndrome, sciatica, fibromyalgia, psoriasis, chemotherapy, unintended side effects of pharmaceuticals, and others.

How to Support Further Research on Fibromyalgia and Other Types of Chronic Pain

Tax deductable donations to support the research of a nationwide network of pain specialists, which includes Drs. Argoff and Wymer at Albany Medical College, can be made to the Clinical Pain Research Program at the University of California San Diego, an American Pain Society Center of Excellence, by contacting the UC San Diego Office of Development (giving.ucsd.edu; 858-534-1610; specify area of research) or UC San Diego Center for Pain Medicine (anes-cppm.ucsd.edu; 858-657-7072). This network, referred to informally as the Neuropathic Pain Research Consortium, includes top neurologists, anesthesiologists, and research scientists at leading universities and pain treatment centers in California, Illinois, Maryland, Massachusetts, Minnesota, New York, Utah, Washington, and Wisconsin.

Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL (2013). Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue.

Pain Medicine, May 20. doi: 10.1111/pme.12139 [Epub ahead of print].

Posted at the National Library of Medicine (PubMed): http://www.ncbi.nlm.nih.gov/pubmed/23691965

A description of this study for the general public can be found at: http://www.intidyn.com/Newsroom/article-0008.html

Curated by:  Craig Payne

Individual patients may experience some weather sensitivity

Dutch researchers report that weather conditions including temperature, sunshine, and precipitation have no impact on fibromyalgia symptoms in female patients. Results published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), suggest that individual patients may be sensitive to some changes in the weather.

Medical evidence shows that fibromyalgia affects 2% of the world population with a greater prevalence among women. In the U.S., the ACR estimates that five million people experience the widespread pain, unexplained fatigue, headaches, and sleep disturbances from this chronic pain syndrome. While the cause of fibromyalgia remains a mystery, studies suggest patients have increased sensitivity to a range of stimuli and up to 92% cite weather conditions exacerbate their symptoms.

“Many fibromyalgia patients report that certain weather conditions seem to aggravate their symptoms,” explains first author, Ercolie Bossema, Ph.D. from Utrecht University in the Netherlands. “Previous research has investigated weather conditions and changes in fibromyalgia symptoms, but an association remains unclear.”

To further explore the impact of weather on pain and fatigue in fibromyalgia, the team enrolled 333 female patients with this pain syndrome in the study. Participants had a mean age of 47 years and had a diagnosis of fibromyalgia for nearly 2 years. The patients completed questions regarding their pain and fatigue symptoms over a 28-day period. Researchers obtained air temperature, sunshine duration, precipitation, atmospheric pressure, and relative humidity from the Royal Netherlands Meteorological Institute.

Findings indicate that in 10% of analyses, weather variables showed a significant but small effect on pain or fatigue symptoms. In 20% of analyses, researchers found significant small differences between patients’ responses to weather, suggesting pain and fatigue symptoms were differentially affected by some weather conditions, i.e. greater pain with either low or high atmospheric pressure. The differences in individual symptom response to weather conditions did not appear to be associated with any demographic, functional or mental health status, nor seasonal or weather-related variations.

“Our analyses provide more evidence against, than in support of, the daily influence of weather on fibromyalgia pain and fatigue,” concludes Dr. Bossema. “This study is the first to investigate the impact of weather on fibromyalgia symptoms in a large cohort, and our findings show no association between specific fibromyalgia patient characteristics and weather sensitivity.” The authors suggest that future research include more patient characteristics, such as personality traits, beliefs about chronic pain, and attitude regarding the influence of weather on symptoms, to help explain individual differences in weather sensitivity and its impact on fibromyalgia pain and fatigue.

Added by Craig Payne

Physicians from the McGill University Health Centre (MUHC) and the University of Calgary have published a review article in the CMAJ (Canadian Medical Association Journal) to help family doctors diagnose and treat fibromyalgia. The article represents the first time researchers have published Canadian guidelines to help manage the condition.

Fibromyalgia is a chronic condition that affects the central nervous system causing pain throughout the body. It is often accompanied by fatigue, depression and sleep problems. It affects mostly women and their multiple symptoms often go years without a proper diagnosis and treatment.

“One million Canadians have fibromyalgia and the time has come to take their suffering seriously. This is a real condition that greatly impacts patients and their families. Finally there are national guidelines to help diagnose and treat this syndrome,” says Dr. John Pereira, a study co-author from the University of Calgary’s Faculty of Medicine and a physician at the Calgary Chronic Pain Centre.

Fibromyalgia is usually diagnosed by rheumatologists but due to the high prevalence of the disease many patients are not able to seek advice from a specialist. Therefore, primary care physicians are best positioned to take over this role, as recommended by the 2012 Canadian Fibromyalgia Guidelines. In the review, the authors provide evidence-based tools for primary care physicians to make the diagnosis and manage the condition long-term.

“We are the first ones to develop guidelines that look at diagnosis, treatment and follow-up of fibromyalgia,” says Dr. Mary-Ann Fitzcharles, corresponding author from the Research Institute of the MUHC and MUHC’s rheumatologist. “Currently, there is no cure for fibromyalgia but the guidelines set out the most appropriate management strategy.”

Authors recommend non-pharmaceutical interventions such as exercise, relaxation techniques, cognitive behavioral therapy as well as medications tailored to the individual patient. The main treatment goal is to improve quality of life by alleviating the most troublesome symptom(s), with pain recognized as the most common and serious.

The authors also urge more research into the effects of early diagnosis and treatment as well as other treatment options. For more information on fibromyalgia, visit http://fmguidelines.ca/.

Added by Craig Payne

WINSTON-SALEM, N.C., – May 2, 2013 – For many people who have fibromyalgia, even the thought of exercising is painful.

Yet a new study from Wake Forest Baptist Medical Center shows that exercise does not worsen the pain associated with the disorder and may even lessen it over time. The findings are published in the current online issue of the journal Arthritis Care & Research.

According to Dennis Ang, M.D., associate professor of internal medicine at Wake Forest Baptist and senior author of the study, doing light to moderate exercise over a prolonged period of time improves overall symptoms, such as fatigue and trouble sleeping, while not increasing pain.

“For many people with fibromyalgia, they will exercise for a week or two and then start hurting and think that exercise is aggravating their pain, so they stop exercising,” Ang said. “We hope that our findings will help reduce patients’ fear and reassure them that sustained exercise will improve their overall health and reduce their symptoms without worsening their pain.”

To evaluate the relationship between long-term maintenance of moderate intensity exercise, defined as light jogging or brisk walking for 20 minutes a day, the research team enrolled 170 volunteers to participate in a 36-week study. Participants received individualized exercise prescriptions and completed baseline and follow-up physical activity assessments using the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire at weeks 12, 24 and 36.

The study found that participants who engaged in moderate intensity exercise for at least 12 weeks showed greater improvements in clinical symptoms as compared to participants who were unable to achieve higher levels of physical activity.

More importantly, Ang said, the findings showed that long-term physical activity at levels consistent with current medical recommendations is not associated with worsening pain symptoms in fibromyalgia.

Approximately 10 percent of the adult population in the United States has fibromyalgia or fibromyalgia-like conditions. The disorder is characterized by widespread musculoskeletal pain accompanied by sleep disturbance, fatigue and memory issues. Experts believe that fibromyalgia is a disorder of pain processing due to abnormalities in how pain signals are processed in the central nervous system.

Added by: Craig Payne

Among fibromyalgia patients taking either of two commonly prescribed drugs to reduce pain, 22 percent report substantial improvement while 21 percent had to quit the regimen due to unpleasant side effects, according to a new review in The Cochrane Library.

People with fibromyalgia suffer from chronic widespread pain, sleep problems and fatigue. The illness affects more than 5 million Americans, 80 percent of whom are women. The cause of fibromyalgia is unknown and currently there is no cure. Using a Quality of Life (QOL) scale for fibromyalgia, the studies reviewed reported QOL ratings lower than 15 on a scale of 0 to 100 even among patients on medications. The two medications often prescribed to treat fibromalgia are duloxetine, known by the brand name Cymbalta or milnacipran, commonly known as Savella.

“A frank discussion between the physician and patient about the potential benefits and harms of both drugs should occur,” noted the reviewers, led by Winfried Häuser, M.D. of Technische Universität München.

The authors reviewed 10 high-quality studies comprising more than 6,000 adults who received either duloxetine, milnacipran, or a placebo for up to six months. A substantial majority of study participants were middle-aged, white women.

“This is a very important study,” says Fred Wolfe, M.D. of the National Data Bank for Rheumatic Diseases. “There’s an enormous amount of advertising suggesting that these drugs really help, whereas the research data show that the improvement is really minimal.”

Treatment with drugs alone “should be discouraged,” the reviewers added. Instead, the review authors recommend a multi-faceted treatment approach including medications for those who find them helpful, exercises to improve mobility and psychological counseling to improve coping skills.

“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work.The people who seem to me to do best sort of figure it out on their own by thinking about things, getting to know themselves, and making changes in their lives to accommodate who they’ve become,” concludes Walitt.

The only other medication approved for fibromyalgia treatment in the U.S. is the anti-convulsant pregabalin, known by the brand name Lyrica. The Cochrane Library plans to publish a review of its effectiveness later this year.

Intensive neuroscientific research is needed to reveal the underlying causes of fibromyalgia and other pain syndromes, say the researchers. In the meantime, combinations of various medications as well as combinations of drug and non-drug treatments may offer better symptom control for sufferers.

Suggested by Craig Payne

Study suggests fibromyalgia is a spectrum disorder

Researchers have determined that fibromyalgia prevalence is 2.1% of the general population in Germany. Results appearing in Arthritis Care & Research, a journal published by Wiley on behalf of the American College of Rheumatology (ACR), suggest that fibromyalgia is a spectrum disorder rather than a categorical illness. Additionally, a number of fibromyalgia cases in the general population satisfy proposed criteria for physical symptom disorder—the presence of one or more physical symptoms that impair function, which cannot be explained by another clinical or psychiatric illness.

Fibromyalgia is a chronic, musculoskeletal syndrome characterized by chronic widespread pain together with fatigue, sleep disturbances, cognitive problems, and multiple somatic symptoms. In 2010 the ACR released modified diagnostic criteria for fibromyalgia, eliminating the tender point count assessment that was part of the 1990 criteria. Shortly after the modified criteria was published it was decided that the widespread pain index and symptom severity score could be combined to form a new measurement of pain and symptom severity termed the polysymptomatic distress scale (PSD).

The lead author of the current study, Dr. Frederick Wolfe with the National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine in Wichita, reported on 2,445 subjects who were randomly selected from the general German population in 2012. The team used the 2010 modified ACR preliminary diagnostic criteria for fibromyalgia to identify patients with the disease.

Findings show fibromyalgia prevalence at 2.1% with occurrence in women and men at 2.4% and 1.8%—a difference that was not statistically significant according to researchers. Furthermore, the team found evidence supporting the hypothesis that fibromyalgia is a spectrum disorder and not a distinct disease. Nearly 40% of fibromyalgia patients met the proposed criteria for a physical symptom disorder.

The authors suggest that fibromyalgia should be considered a spectrum or dimensional disorder by giving the range of polysymptomatic distress experienced by patients. A patient with a widespread pain index of 7 or more out of 19 pain sites and symptom severity score of 5 or more out of 12 will have a PSD scale score of at least 12, a cut point below which fibromyalgia criteria will not be met.

“Given the continuum of symptoms in patients, our study provides important evidence supporting fibromyalgia as a spectrum disorder,” concludes Dr. Wolfe. “Our findings have important implications for epidemiologic and neurobiologic studies, clinical diagnosis and disease management, along with determining disability in those with fibromyalgia.”

Curated: Craig Payne