Study Finds a High Rate of Restless Legs Syndrome in Adults with Fibromyalgia

Press release:

DARIEN, IL – A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that adults with fibromyalgia had a much higher prevalence and risk of restless legs syndrome than healthy controls. 

The study suggests that treating RLS may improve sleep and quality of life in people with fibromyalgia. Results show that the prevalence of restless legs syndrome was about 10 times higher in the fibromyalgia group (33 percent) than among controls (3.1 percent).  After statistical adjustments for potential confounders such as age, gender and ethnicity, participants with fibromyalgia were 11 times more likely than controls to have RLS (odds ratio = 11.2).  As expected, considerable sleep disruption was reported by participants with fibromyalgia using the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. In the fibromyalgia group these sleep problems were more severe among people who also had RLS.   “Sleep disruption is common in fibromyalgia, and often difficult to treat,” said contributing author Dr. Nathaniel F. Watson, associate professor of neurology at the University of Washington in Seattle, Wash. “It is apparent from our study that a substantial portion of sleep disruption in fibromyalgia is due to restless legs syndrome.”     The research team led by Dr. Watson and lead author Dr. Mari Viola-Saltzman of Loyola University Medical Center in Maywood, Illinois, studied 172 people with fibromyalgia who had a mean age of 50 years; 93 percent were female.  They were compared with 63 healthy controls who had a mean age of 41 years.  

Fibromyalgia was identified by self-report or review of the medical records, and it was confirmed on examination according to published guidelines regarding the presence of pain that is chronic and widespread. Pain was assessed by subjective report and by objective measurement with a dolorimeter, a spring-loaded gauge that is used to apply standardized rates of pressure to tender points on the arms and legs.   According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia can cause significant pain and fatigue.  It is estimated to affect 5 million Americans age 18 or older, and between 80 and 90 percent of those diagnosed with fibromyalgia are women.  The causes of fibromyalgia remain unknown.  

Restless legs syndrome was diagnosed using a self-administered, validated questionnaire.  RLS is a sleep-related movement disorder that involves an urge to move the legs that is usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.  This urge begins or worsens during periods of rest or inactivity, is partially or totally resolved by movement, and worsens or only occurs at night.  RLS occurs 1.5 to two times more commonly in women than in men.   Watson noted that treating restless legs syndrome may be one of the keys to reducing fatigue and improving quality of life in people with fibromyalgia.  RLS often can be successfully treated with a medication such as pramipexole or ropinirole.   “Since restless legs syndrome is a treatable condition, diagnosing and treating RLS in fibromyalgia patients has the potential to improve their sleep,” Watson said.  

According to the authors, the cross-sectional nature of the study did not allow for an examination of causality. However, several aspects of the two syndromes suggest a logical overlap.  Both disorders involve sensory abnormalities, and a similar pathophysiology of the system that regulates the neurotransmitter dopamine has been proposed for both syndromes.  Furthermore, restless legs syndrome may be induced by antidepressants, which are a common treatment for pain and depression in fibromyalgia.  Also, exercise has been shown to improve the symptoms of both syndromes.   The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by the National Fibromyalgia Research Association.

Foods that might trigger Fibromyalgia

The following foods may worsen symptoms of fibromyalgia by increasing inflammation:

Sugar. Lowering or removing sugar can have a significant influence on wellness for two reasons. Initially, the clinical literature has actually shown that consuming foods high in sugar is linked to boosted fibromyalgia discomfort.

Second, limiting sugar assists control weight. Being obese puts added stress on the body, contributing to fatigue, and also kept fat might bring about inflammation in some cases. Sugar is a popular active ingredient in sweet as well as soft drinks, but is additionally in foods thought about to be healthy and balanced– such as yogurt. When inspecting nourishment tags, it is helpful to recognize that glucose, fructose, and sucrose are various other names for sugar.

Carbohydrates. Fine-tuned carbs such as cookies, several breads, breads, as well as white rice are absorbed quickly, creating blood sugar level levels to surge. The effect does not last, nonetheless, and also blood glucose quickly goes down, making the specific starving once more. These changes can make the fatigue and discomfort of fibromyalgia worse as well as contribute to overeating.

When eating carbohydrates, entire wheat resources ought to be selected. Entire wheat foods absorb a lot more slowly, preventing the highs and lows that accompany various other carbs.

One little research study focused on ladies identified with fibromyalgia that likewise had irritable digestive tract syndrome (IBS) and also a food intolerance. (Many individuals with fibromyalgia also have irritable bowel syndrome.).

When the ladies reduced on consuming a certain group of carbs, they reported a 50% reduction in short-tempered bowel signs and symptoms and a 22% decline in other signs, consisting of pain. The restricted carbohydrates were a type not well soaked up in the small intestine. Such carbohydrates include lactose (a component in milk and also other dairy products foods), fructose (in some vegetables and fruits, honey, and also various other sugar), as well as grains.

Processed foods. Sugar as well as harmful fats, which boost inflammation, are a big part of numerous processed foods. Flavors and preservatives typically utilized in processed foods likewise may set off food sensitivities.

Unhealthy fats. Veggie oils, such as corn oil, safflower oil, as well as peanut oil, have an inflammatory impact, especially when utilized to fry food. The clinical literature has actually linked deep-fried foods to aggravating of fibromyalgia signs. Harmful oils are an usual ingredient in numerous refined foods, such as cookies, doughnuts, and crackers. Pizza and cheese are additionally major resources of undesirable fats.

Alcohol. While some research study has located moderate alcohol use can reduce symptoms, some people with fibromyalgia report alcohol triggers signs to flare. Consuming alcohol while taking specific medicines prescribed for fibromyalgia– such as anti-convulsants, antidepressants, as well as acetaminophen (a component in several drugs) can create damaging interactions.

The above is not a comprehensive list of foods that may trigger symptoms. Other foods and ingredients that may trigger symptoms for some include, but are not limited to:

Gluten
Red meat
Some fruits and vegetables
Dairy products
Eggs
Caffeine

Research teams find widespread inflammation in the brains of fibromyalgia patients

A study by Massachusetts General Hospital (MGH) researchers – collaborating with a team at the Karolinska Institutet in Sweden – has documented for the first time widespread inflammation in the brains of patients with the poorly understood condition called fibromyalgia. Their report has been published online in the journal Brain, Behavior and Immunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” says Marco Loggia, PhD, of the MGH-based Martinos Center for Biomedical Imaging, co-senior author of the report. “And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

Characterized by symptoms including chronic widespread pain, sleep problems, fatigue, and problems with thinking and memory, fibromyalgia affects around 4 million adults in the U.S., according to the Centers for Disease Control and Prevention. Previous research from the Karolinska group led by Eva Kosek, MD, PhD, co-senior author of the current study, suggested a potential role for neuroinflammation in the condition – including elevated levels of inflammatory proteins in the cerebrospinal fluid – but no previous study has directly visualized neuroinflammation in fibromyalgia patients.

A 2015 study by Loggia’s team used combined MR/PET scanning to document neuroinflammation – specifically activation of glial cells – in the brains of patients with chronic back pain. Hypothesizing that similar glial activation might be found in fibromyalgia patients as well, his team used the same PET radiopharmaceutical, which binds to the translocator protein (TSPO) that is overexpressed by activated glial cells, in their study enrolling 20 fibromyalgia patients and 14 control volunteers.

At the same time, Kosek’s team at Karolinska had enrolled a group of 11 patients and an equal number of control participants for a similar study with the TSPO-binding PET tracer. Since that radiopharmaceutical binds to two types of glial cells – microglia and astrocytes – they also imaged 11 patients, 6 who had the TSPO imaging and 5 others, and another 11 controls with a PET tracer that is thought to bind preferentially to astrocytes and not to microglia. At both centers, participants with fibromyalgia completed questionnaires to assess their symptoms. When the MGH team became aware of the similar investigation the Karolinska group had underway, the teams decided to combine their data into a single study.

The results from both centers found that glial activation in several regions of the brains of fibromyalgia patients was significantly greater than it was in control participants. Compared to the MGH team’s chronic back pain study, TSPO elevations were more widespread throughout the brain, which Loggia indicates corresponds to the more complex symptom patterns of fibromyalgia. TSPO levels in a structure called the cingulate gyrus – an area associated with emotional processing where neuroinflammation has been reported in patients with chronic fatigue syndrome – corresponded with patients reported levels of fatigue. The Karolinska team’s studies with the astrocyte-binding tracer found little difference between patients and controls, suggesting that microglia were primarily responsible for the increased neuro-inflammation in fibromyalgia patients.

“The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue,” says Loggia, an assistant professor of Radiology at Harvard Medical School. “The ability to join forces with our colleagues at Karolinska was fantastic, because combining our data and seeing similar results at both sites gives confidence to the reliability of our results.”

Concussion and Fibromyalgia: Is There A Link?

Fibromyalgia is an insidious disease. It’s challenging to diagnose with a host of complicated and differed symptoms, much of which can be attributed to other problems. These consist of, yet are not restricted to, increased sensitivity to pain, fatigue, memory loss and concerns with concentration, and also headaches. The specific root cause of fibromyalgia is unknown, yet study suggests it relates to chemical inequalities in the brain as well as, subsequently, exactly how the central nerves refines discomfort. Usually it’s thought to be triggered by a literally or emotionally traumatic event like the loss of a close friend or relative, giving birth, a severe medical procedure, or an injury. Such as, as an example, a terrible brain injury, also referred to as a concussion.

As we remain to learn more about fibromyalgia as well as its causes, so, as well, does the clinical area considerably discover more concerning concussion and traumatic brain injuries (TBI). Both are mostly misunderstood conditions, linked by injury to the brain as well as the nervous system. Thus, there are theories that head injury might result in fibromyalgia. But why? Just how does bumping your head after a fall link to a long-term incapacitating persistent pain condition? In the end, it’s all in your head!

When you strike your head, your brain tissue is wounded. This is, essentially, what a concussion is. Depending upon the level of seriousness of the injury, and exactly how treatment and recovery are approached, you can, in theory, be back up as well as running within a week or so. Nevertheless, most cases of TBI’s aren’t dealt with very carefully enough and result in long-lasting signs frequently characterized as post-concussion syndrome (PCS). Without appropriate therapy and also rest, concussions can end up being a months-long recovery process, and PCS can take anywhere up to a year to get over. This prolonged healing time implies that your brain is distressed for the duration, attempting to recoup however not able to heal from its preliminary contusion made considerably even worse by overuse.

It’s consequently medical experts are beginning to speculate a direct relationship between traumas, concussion, and fibromyalgia. Research studies on the cognitive function of clients with fibromyalgia lend really certain understandings into how the brain reacts to the problem. Evidence of declined handling speed, memory lapses, as well as fogginess are lastly being connected to the lasting effect of a concussion and also PCS, including enhanced recognizing to the consequences of fibromyalgia.

So what does this mean for people that have recuperated from a concussion? Are they imminently at risk of creating fibromyalgia? Should they rush to their doctors for an examination? No, not always. But what this does imply is, if you have actually experienced a concussion eventually in your life, and also you begin to discover some similar signs and symptoms resurfacing unexpectedly together with chronic, mysterious discomfort, it would concern discuss your previous TBI to your doctor or group of experts. Keeping a comprehensive medical history is essential, and can aid with future diagnoses. If you or someone you understand has actually suffered a concussion, take the needed time to rest and recoup to prevent long-term damage or PCS.

JOGO Health Launches COVID-19 Chronic Fatigue Syndrome Study

BRIDGEWATER, N.J., May 13, 2020 /PRNewswire/ — JOGOHEALTH Inc., a Bridgewater, New Jersey based privately held digital therapeutics company focused on the development and commercialization of treatments for neuromuscular (NM) and chronic pain conditions today announced that it will launch a study on COVID-19 related Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS).

According to the patient advocacy group Solve ME/CFS Initiative, nearly 35% of COVID-19 patients are experiencing ME/CFS symptoms post infection. Since the onset of ME/CFS usually follows a viral infection, experts estimate up to 3,570,000 new ME/CFS cases following the COVID-19 pandemic. This would more than double the existing cases of ME/CFS in the United States in just 36 months, according to Solve ME/CFS Initiative.

“The science behind JOGO has shown to work for Fibromyalgia in many peer reviewed studies. Fibromyalgia and CFS/ME are both illnesses characterized by extreme amounts of fatigue. In fact, the conditions seem to be so intertwined that the medical community continues to debate whether fibromyalgia fatigue is simply a different expression of the same disorder that causes CFS. So, we approached some of the top experts the field of COVID and the researchers were convinced, JOGO is a potential candidate for ME/CFS,” said Siva Nadarajah, Co-Founder and President of JOGO Health Inc.

“We are excited by the opportunity to help patients, during post COVID-19 recovery phase. There are no treatments for ME/CFS yet – CDC has shown special interest in this condition as it impacts patients’ return to normal life. In a befitting honor to the memory of Florence Nightingale – who suffered from ME/CFS – her birthday, May12th, is marked as World ME/CFS Day,”  said Sanjai Murali, Founder and CEO of JOGO Health Inc.

According to CDC, prior to COVID-19, ME/CFS affected up to 2.5 million Americans. The Arthritis Foundation estimates that 50 to 70 percent of people with fibromyalgia also fit the criteria of ME/CFS

About JOGO Health.

JOGO Health is a digital therapeutic company that developed JOGO, a patent protected prescription digital therapeutics product to treat neuromuscular (NM) diseases, chronic pain, incontinence and chronic constipation. JOGO helps enhance rewiring of the CNS to improve voluntary control of muscles and neuromuscular reeducation.  JOGO is composed of wireless, wearable surface EMG sensors, and a patent protected Mobile App that provide treatment protocols and games that can be adapted for muscle relaxation, movement coordination, and neuro-muscular reeducation, all leveraging neuroplasticity. In March 2020, JOGO received FDA 510(K) Exemption for JOGO-Gx, its general purpose product for neuromuscular reeducation.

Ultralaser treatment for fibromyalgia yields 75 percent pain reduction when applied to the hands

A new device that combines low-intensity laser light and therapeutic ultrasound considerably reduces the pain experienced by patients with fibromyalgia.

A scientific study has shown that application to the palms instead of to tender points on different parts of the body has better analgesic and anti-inflammatory effects. As a result of pain reduction, patients also sleep better and are able to perform daily tasks with less discomfort. Their overall quality of life also improves.

In an article published in the Journal of Novel Physiotherapies, researchers at the Optics and Photonics Research Center (CEPOF), one of the Research, Innovation and Dissemination Centers (RIDCs) supported by the São Paulo Research Foundation – FAPESP, describe the concomitant application of low-intensity laser light and therapeutic ultrasound for three minutes to the palms of the hands of patients diagnosed with fibromyalgia. The treatment consisted of ten twice-weekly sessions.

“The study describes two innovations: the device and the treatment protocol. By emitting laser light and ultrasound simultaneously, we succeeded in normalizing the patient’s pain threshold. Application to the palms differs from the focus on tender points found practically everywhere today in fibromyalgia care,” said Antônio Eduardo de Aquino Junior, a researcher at the University of São Paulo’s São Carlos Physics Institute (IFSC-USP) in Brazil and a coauthor of the article.

The research was also funded by the National Council for Scientific and Technological Development (CNPq) and the Brazilian Innovation Agency (FINEP).

The principal investigator for the project was Vanderlei Salvador Bagnato, Full Professor and Director of IFSC-USP.

In the study, 48 women aged 40-65 and diagnosed with fibromyalgia were divided into six groups of eight at the Clinical Research Unit run by IFSC-USP in partnership with the Santa Casa de Misericórdia hospital in São Carlos, São Paulo State.

Three groups received applications of laser or ultrasound separately or combined in the region of the trapezius muscle. The other three groups received applications only to the palms.

The results showed that treatment involving application to the palms was more effective regardless of the technique, but the laser-ultrasound combination significantly improved the patients’ condition. Assessments were performed using the Fibromyalgia Impact Questionnaire (FIQ) and the Visual Analogue Scale for Pain (VASP).

A comparison of the groups showed a difference of 57.72% in functionality improvement and of 63.31% in pain reduction for the ultrasound-laser group in the case of application to the trapezius. Ultrasound-laser application to the palms produced a 73.37% difference in pain reduction compared with application to the trapezius.

Tender points

The idea of testing the effects of the new device in application to the palms of the hands arose from a review of the scientific literature.

“Previous studies showed that patients with fibromyalgia had larger numbers of neuroreceptors near blood vessels in the hands. Some patients even had red points in this region. We therefore changed focus to test the direct action of the technique on these sensory cells in the hands rather than just so-called pain trigger points, such as the trapezius, which is typically very painful in fibromyalgia patients,” said Juliana da Silva Amaral Bruno, a physical therapist and first author of the study.

The study showed that application to the hands affects all pain points in the patient’s body. The same FAPESP-funded center group had previously published an article in the Journal of Novel Physiotherapies describing a case study in applying the device to pain points. Although the results of this first study were satisfactory, global pain reduction proved impossible.

“Combined application of ultrasound and laser to pain points such as the trapezius was highly effective but did not succeed in reaching the other main innervations affected by the disorder,” Bruno said. “Application to the palms of the hands had a global result, restoring the patient’s quality of life and eliminating her pain.”

According to the study, the optimization of peripheral and brain blood flow via the activation of sensitive areas of the hands during the sessions normalized the patient’s pain threshold.

“It’s important to bear in mind that this isn’t a cure but a form of treatment that doesn’t require the use of drugs,” Aquino said.

Fibromyalgia is a chronic disease that involves widespread nonarticular high-intensity pain lasting longer than three months. It affects 3% to 10% of the adult population, with a higher prevalence in women. Although patients experience pain in practically the entire body, they do not present with injuries, inflammation or tissue degeneration. Two other mysteries are associated with fibromyalgia: its cause is unknown, and no cure has been found so far.

The standard treatment comprises physical exercise, anti-inflammatory and analgesic medication, and psychotherapy, as patients typically complain of extreme fatigue, difficulty concentrating, dizziness, depression and anxiety.

According to Aquino, the new device that combines ultrasound and laser therapy should come to market in early 2019. It is currently being tested for other pathologies by researchers at the FAPESP RIDC.

“We’re testing it for osteoarthritis, knees, hands and feet, and the results have been interesting. Other projects are being designed for other diseases,” Aquino said.

Does insulin resistance cause fibromyalgia?

GALVESTON, Texas – Researchers led by a team from The University of Texas Medical Branch at Galveston were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance.

This discovery could dramatically alter the way that chronic pain can be identified and managed. Dr. Miguel Pappolla, UTMB professor of neurology, said that although the discovery is very preliminary, it may lead to a revolutionary shift on how fibromyalgia and related forms of chronic pain are treated. The new approach has the potential to save billions of dollars to the health care system and decrease many peoples’ dependence on opiates for pain management.

The UTMB team of researchers, along with collaborators from across the U.S., including the National Institutes of Health, were able for the first time, to separate patients with fibromyalgia from normal individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance, which dramatically reduced their pain levels. The study was recently published in PlosOne.

Fibromyalgia is one of the most common conditions causing chronic pain and disability. The global economic impact of fibromyalgia is enormous – in the U.S. alone and related health care costs are about $100 billion each year. Despite extensive research the cause of fibromyalgia is unknown, so there’s no specific diagnostics or therapies for this condition other than pain-reducing drugs.

“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder,” Pappolla said. “We showed that most – if not all – patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past two to three months.”

Pre-diabetics with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders.”

The researchers identified patients who were referred to a subspecialty pain medicine clinic to be treated for widespread muscular/connective tissue pain. All patients who met the criteria for fibromyalgia were separated into smaller groups by age. When compared with age-matched controls, the A1c levels of the fibromyalgia patients were significantly higher.

“Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” said Pappolla. “The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life. Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects.”

For the fibromyalgia patients, metformin, a drug developed to combat insulin resistance was added to their current medications. They showed dramatic reductions in their pain levels.

Fibromyalgia is not all in your head, new research confirms

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.

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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].

Weather conditions do not affect fibromyalgia pain or fatigue

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.

Can Toning Shoes Help Fibromyalgia

Toning shoes are shoe that make the muscles in the foot and leg work harder and change the gait and the posture. They do that by having a rocker under the sole. They are controversial due to legal action taken against the companies by the FDA over the lack of science to support the health gains for the shoes. If you are going to make health claims for a product, then you probably need some evidence to back it up. The difference between the evidence and the hype over the claims is what leads to the skepticism. The most well known shoes in this category are the MBT’s, the Skechers Shape Up and the Reebok Easy Tones.

Will they help those with fibromyalgia?

In all honesty I really have no idea. They will change the posture and the alignment and problems with these are common in fibromaylgia. As to if the postural change induced by using these toning shoes is positive or negative for any individual is hard to say. For some it will be a positive change and for others it will be a negative change. We have no guidelines or tools to help us predict in advance who they might help.

More research is certainly needed and I see them being very helpful to some people with fibromyalgia. It is just the lack of research on it is what the problem is (and what got the companies in trouble with the authorities!). My best advice is, they are probably worth a try.