The Fibromyalgia and Chronic Fatigue Self-Help Group – Quest 4 Life

For Immediate Press Release

Thursday, June 14, 2007 Meeting

6:30 pm at Quest 4 Life in Lenoir, NC

The Fibromyalgia and Chronic Fatigue Self-Help Group meets monthly except July and August. The focus of the group is on Positive Self-Help for those attending. The June meeting will focus on Using Your Talents, Frustrations and Rewards. A special performance by Debra Greene, muscian, vocalist, and poet will be the highlight of the meeting. Debra’s story tells how one with severe pain can use their talents to soothe and ease their pain. For more info, call Nancy at 828-758-2156 or Lindy at 828-754-2064.

“LOVE BEARS ALL THINGS.” ICor.13:7

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JRRD releases single-topic issue on pain and pain management

Effects of depression and pain severity on satisfaction in medical outpatients: Analysis of the Medical Outcomes Study, pg. 143

Patient satisfaction is a critical measure of healthcare quality. We performed this study to see how depression and pain severity affected patient satisfaction in medical outpatients. We analyzed data from the Medical Outcomes Study and found that pain was very common and patients with depression and pain were much more likely to be dissatisfied with their healthcare. These findings may also have care-delivery implications, should dissatisfaction indicate poorer quality of care. Further study is needed to determine the reasons for dissatisfaction with care in patients with depression and pain.

Veterans seeking treatment for posttraumatic stress disorder: “What about comorbid chronic pain” pg. 153

In veterans who were being treated for posttraumatic stress disorder (PTSD), many (66%) were also diagnosed with chronic pain problems by their doctors. This is the first study to show that people with PTSD have pain-related conditions according to their doctors. The veterans who told their primary care doctor that they had pain before PTSD treatment said that their pain was less during and after the PTSD treatment. However, this finding was based on a review of charts, so other reasons could also explain the improvement in pain symptoms. More research about treatment for veterans with pain and PTSD is needed.

Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients, pg. 167

This study contributes to the growing literature on the co-occurrence of posttraumatic stress disorder (PTSD) and chronic severe pain. We found moderate rates of PTSD (46%) and chronic severe pain (40%) in a sample of psychiatric outpatients. In addition, 24% of the sample had both disorders. We found that persons with both disorders were significantly different from those with neither disorder on all variables and that they had greater physical and psychosocial stressors. In addition, persons with either PTSD or chronic severe pain alone were more likely to have a chronic medical condition, higher ratings of psychiatric distress, and more stressful life events than those with neither disorder. Mental health treatment providers should routinely assess and develop management strategies for these two disorders in psychiatric outpatients.

Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice, pg. 179

Operations Enduring Freedom and Iraqi Freedom have resulted in a growing number of seriously injured soldiers evacuated to the United States for medical care. Trauma-related pain is almost always present among these war-injured soldiers. Several military and Department of Veterans Affairs programs have been implemented to improve pain care. We describe several of these new approaches. We also present data on the soldiers treated, the services provided, and the effects of treatment. Finally, we identify some of the challenges emerging from work with this population and recommend future research and practice priorities.

Efficacy of selected complementary and alternative medicine interventions for chronic pain, pg. 195

We review published research on commonly used complementary and alternative medicine (CAM) approaches to treating chronic pain. Our findings show that CAM therapies, as a group, have a mixed track record of efficacy. The modalities that have the best track records for pain management include biofeedback, hypnosis, and massage (mostly for low back pain and shoulder pain). In selecting a CAM modality, practitioners must weigh the pros and cons and tailor the interventions to the needs of patients with chronic pain. Other issues relevant to practitioners include additional time and energy investments, need for specialized training to administer the modality, side effects or potential toxic effects, safety in combining CAM and other modalities, likely acceptance by clients and the public, and ease of incorporation into traditional pain management practices.

Preliminary evaluation of reliability and criterion validity of Actiwatch-Score, pg. 223

Restoration of normal physical activity is a primary objective of most chronic pain rehabilitative interventions, yet few clinically practical objective measures of activation exist. We evaluated the measurement properties of the Actiwatch-Score (AW-S). We conducted separate trials to examine concordance between units when worn concurrently at the same and different body sites and to compare the AW-S with a validated optical three-dimensional motion-tracking system. The data indicate that the AW-S has excellent interunit reliability and good criterion validity, but its intersite reliability varies with activity type. These results suggest that this device, and those like it, warrants further investigation and is likely to yield valuable data regarding the optimal application of this technology.

A closer look at pain and hepatitis C: Preliminary data from a veteran population, pg. 231

Many veterans who have hepatitis C also experience pain. Researchers are learning how to care for patients who experience hepatitis C and pain. They are also learning how hepatitis C and pain can affect patients’ lives. We review research on the relationship between hepatitis C and pain. We also present findings from a survey given to patients at two Department of Veterans Affairs hospitals. Finally, we suggest how physicians and mental health providers can best care for patients with hepatitis C and pain.

Overview of the relationship between pain and obesity: “What do we know. Where do we go next” pg. 245

Many veterans who struggle with being overweight also experience pain. Researchers are beginning to learn more about how being overweight or obese can affect several health conditions, including pain. We reviewed recent research examining the relationship between pain and overweight/obesity to promote understanding of when, why, and how these conditions occur together. Additionally, we suggest ways researchers can better study the problem of weight and pain to help veterans who experience both.

Medical residents’ beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: A pilot study, pg. 263

Chronic pain from conditions such as arthritis or nerve injuries may be disabling and poorly controlled with aspirin, acetaminophen (Tylenol), or ibuprofen (Advil). In selected cases, opioid analgesics (e.g., morphine), combined with other treatments, can safely and more effectively relieve pain and improve function. We surveyed less experienced doctors and found that they had many fears, concerns, and negative beliefs toward using opioids to treat noncancer pain such as low back pain. If other doctors share these feelings, finding ways to increase their comfort by identifying and treating patients who might safely benefit from opioids to reduce their suffering and disability is important.

Persistent benefits of rehabilitation on pain and life quality for nonambulatory patients with spinal epidural metastasis, pg. 271

We evaluated the long-term effects of a 2-week course of rehabilitation on people with paraplegia caused by cancer compressing the spinal cord. Twelve patients received rehabilitation that focused on transfers, skin care, bladder and bowel management, nutrition, and incentive spirometry. We compared these study patients with a historical control group of 30 patients who had paraplegia from cancer but did not receive rehabilitation. Subjects were followed until death. The study patients had less pain and depression and more satisfaction with life; these benefits persisted for the remainder of their lives. In contrast, the control patients had worsening pain levels, declining satisfaction with life, and higher pain medication use for the remainder of their lives. While our study suggests that rehabilitation benefits people with cancer-related spinal cord injury, it needs to be supported by a randomized study.

Pain and palliative medicine, pg. 279

Pain control is an important part of medical care for patients with advanced illnesses. We summarize available information on pain in different patient groups near the end of life and on developments using behavioral and physical therapy methods to treat pain. Clinical trials to treat pain in patients within healthcare systems are the next topic, followed by ideas on how information technology and clinical databases can be used to guide future patient care. Finally, we present perspectives on how pain control can be studied and further improved within healthcare systems.

Moving to new settings: Pilot study of families’ perceptions of professional caregivers’ pain management in persons with dementia, pg. 295

Pain in persons with severe dementia is often not recognized or treated because these persons cannot communicate their needs. Family caregivers are in the best position to provide information to hospital care personnel about the patients’ needs, including pain. Little research has evaluated the role of the family caregiver when patients move between care facilities. This study describes family caregivers’ experiences when their family members with dementia were admitted to unfamiliar care sites and provides the caregivers’ recommended changes to healthcare settings. This article is relevant to family members and healthcare professionals who care for persons with severe dementia.

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents, pg. 305

More than 80% of nursing home residents have chronic pain, and of these, many are not getting adequate treatment. Good pain treatment begins with knowing how severe the pain is. Several different pain-intensity tools are available: one uses a number (0–10) scale, another uses words, and a third shows pictures of people in pain. We asked nursing home residents to rate their pain using all three scales. We wanted to know how the pain reported on one scale translated onto another scale. The 42,000 veterans who live in nursing homes and their families will benefit from this study.

Cognitive impairment and pain management: Review of issues and challenges, pg. 315

Research shows that pain is often not recognized in persons with communication problems related to brain disease. Older persons with dementia experience memory loss, and seriously ill and dying patients experience confusion. Treating pain will increase the comfort of all these persons. In this article, we review the types of problems that affect the brain and interfere with pain management, how pain is measured, what pain management approaches help, and future research needs. Those who care for adults with brain-related disease will find this article relevant.

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Now Available Online and in Print–http://www.rehab.research.va.gov

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Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome.

1: Arthritis Rheum. 2007 May 25;57(5):830-836 [Epub ahead of print]

Thieme K, Turk DC, Flor H.

University of Heidelberg, Mannheim, Germany.

OBJECTIVE: To predict the effects of cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT) in fibromyalgia syndrome (FMS).

METHODS: A total of 125 patients who fulfilled the American College of Rheumatology FMS criteria were randomly assigned to CBT (n = 42), OBT (n = 43), or attention placebo (AP; n = 40). The pretreatment to 12-month followup reliability change index was used to determine clinically meaningful changes in pain intensity and physical impairment. Multinominal logistic regression analyses were used to determine the predictors of improvement in pain intensity and physical impairment for the entire sample. Analyses of variance were computed to compare the characteristics of responders and nonresponders in each of the 3 interventions.

RESULTS: At the 12-month followup, 53.5%, 45.2%, and 5% of patients in the OBT, CBT, and AP groups, respectively, reported clinically meaningful improvements in pain intensity. Similarly, 58.1%, 38.1%, and 7.5% of patients treated with OBT, CBT, and AP, respectively, reported clinically significant improvements in physical impairment. Prior to treatment, the OBT physical impairment responders displayed significantly more pain behaviors, physical impairment, physician visits, solicitous spouse behaviors, and level of catastrophizing compared with nonresponders. The CBT physical impairment responders, compared with nonresponders, reported higher levels of affective distress, lower coping, less solicitous spouse behavior, and lower pain behaviors.

CONCLUSION: The results of this study suggest that pretreatment patient characteristics are important predictors of treatment response and may serve as a basis for matching treatments to patient characteristics. Prospective outcome studies are needed to confirm whether the tailoring of treatment actually leads to better outcomes for patients with FMS.

PMID: 17530683 [PubMed - as supplied by publisher]

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University of Leicester academics publish results of one of the largest studies of physical activity among inner city school children

Contact: Kamlesh Khunti
kk22@le.ac.uk
University of Leicester

Inactive kids storing up illness for the future

A new University of Leicester study funded by the British Heart Foundation reveals that the level of physical inactivity among children today has reached epidemic levels. Researchers from Leicester -Professor Kamlesh Khunti, Professor Melanie Davies and Dr Margaret Stone- have just published one of the largest studies of physical activity levels of inner city school children.

They surveyed over 3500 pupils from five inner city secondary schools in Leicester. They identified low levels of physical activity in both South Asian and white children. For example only half the children walked to school although south Asian children were less likely to walk to school compared to white children. Furthermore, half the pupils spent 4 hours or more a day watching television or videos or playing computer games. Family history of diabetes or heart disease in parents is a risk factor for development of diabetes or heart disease in their children. However, the researchers found that children of parents with a family history of diabetes or heart disease were just as likely to have sedentary behaviours as those without a family history.

Professor Khunti said: “People of South Asian origin comprise significant-sized minority ethnic populations in many countries worldwide. A consistent finding in South Asian migrant populations, wherever they are located, is a higher incidence and prevalence of premature coronary heart disease compared with the local population.

“Metabolic abnormalities precede the development of diabetes by some years and risk factors for cardiovascular in children often persist into adulthood. There is also evidence of increased risk of cardiovascular disease risk factors in children of South Asian origin compared to white children. The need to implement prevention strategies for childhood obesity is therefore a major target for the government and health care professionals.

“Inactive behaviour, such as watching television, may predict subsequent adult overweight and obesity in children and adolescent. However, there is a lack of data on physical activity levels of South Asian children despite them having a higher cardiovascular risk profile.

‘This study shows that overall the physical activity levels in inner city school children are very low and parents, schools and community health providers need to address the results of these findings to reduce their future risks of developing diabetes and heart disease in children ”.

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NOTE TO NEWSDESK

For more information, please contact:

Professor Kamlesh Khunti, Division of General Practice and Primary Health Care, Department of Health Sciences, University of Leicester. kk22@le.ac.uk

Or contact Ather Mirza, University of Leicester press office, 0116 252 3335; mobile 07711 927821

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Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation.

1: Pain Physician. 2007 May;10(3):441-52.

Jordan SE, Ahn SS, Gelabert HA.

Neurological Associates of West Los Angeles, Santa Monica, CA and UCLA Department of Vascular Surgery, Los Angeles, CA.

OBJECTIVE: The present study was undertaken to determine which factors differentiate patients with a good outcome after treatment for Thoracic Outlet Syndrome (TOS) from patients with a poor outcome.

METHODS: A total of 85 patients, who were examined during one year, had at least 6 months of follow up after treatment for TOS with either surgery or botulinum chemodenervation.

RSULTS: Socioeconomic factors of work disability or workers’ compensation claims did not differentiate treatment-responsive TOS from treatment-resistant cases. There was no difference between the 2 groups regarding the presence of anomalous anatomy detected by ultrasonography or regarding the presence of subclavian artery flow acceleration or occlusion detected by duplex sonography. Several factors were noted more frequently in treatment-resistant patients: sensory complaints extending beyond lower trunk dermatomes (42% vs. 10%), weakness extending beyond lower trunk myotomes (19% vs. 2%), histories of previous non-TOS surgery of the neck or upper limbs (50% vs.17%), comorbidities of fibromyalgia or complex regional pain syndrome (81% vs. 12%), and depression (35% vs. 10%). Treatment-resistant patients complained about more widespread functional impairments on a validated Cervical Brachial Symptom Questionnaire (CBSQ) than treatment-responsive patients. Resistant cases responded less often to a scalene test block (38% vs. 100%), which is designed to simulate the effects of targeted treatment.

CONCLUSION: In summary, compared to patients with a good outcome after targeted treatment, patients with a poor outcome had more diffuse complaints and responded less often to a scalene test block.

PMID: 17525778 [PubMed - in process]

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Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial.

1: Altern Ther Health Med. 2007 May-Jun;13(3):32-4.

Massey PB.

Complementary and Alternative Medicine at Alexian Brothers Hospital Network, Elk Grove Village, Ill, USA.

OBJECTIVE: To evaluate the effectiveness of a modified Myers’ formula of intravenous nutrient therapy (IVNT) on the symptoms of fibromyalgia (FM) in therapy-resistant FM patients. Methods: In this pilot clinical trial, 7 participants with therapy resistant FM were given IVNT once per week for 8 weeks. Patient’s pain levels, fatigue, and activities of daily living were evaluated weekly.

RESULTS: All participants reported decreased pain levels, decreased fatigue, and increased activities of daily living. Participants noted increased energy levels within 24-48 hours of the initial infusion. At the end of the study, all participants reported increased energy and activities of daily living as well as a 60% reduction in pain (P=.005) and an 80% decrease in fatigue (P=-.005). No participants, however, reported complete or lasting resolution of pain or fatigue. No side effects were reported.

DISCUSSION: Anecdotal reports have indicated benefit for IVNT for patients with chronic pain, including FM. However, except for 2 reports, the medical literature is devoid of any studies of IVNT for the treatment of FM. In this pilot study, 7 participants received IVNT once a week for 8 weeks. All participants had long-standing FM (at least 8 years) and had tried conventional therapies, such as antidepressants, nonsteroidal anti-inflammatory drugs, and exercise, without significant or lasting relief. All had improvement in symptoms and increases in their activities of daily living, although no participant reported complete resolution of symptoms. IVNT appears to be safe to reduce FM symptoms.

PMID: 17515022 [PubMed - in process]

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Aggressive treatment for whiplash does not promote faster recovery

Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.

Whiplash, the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in a significant burden of disability and health care utilization. Although there are few effective treatments for whiplash, a growing body of evidence suggests that the type and intensity of treatment received shortly after the injury have a long-lasting influence on the prognosis. A new study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined whether the association between early types of care and recovery time shown in an earlier study was reproducible with whiplash compensated under tort insurance.

A previous study led by Pierre Côté, of the University of Toronto in Toronto, Canada, found that patients compensated under no-fault insurance had a longer recovery if they visited general practitioners numerous times and/or consulted chiropractors or specialists than if they just visited general practitioners once or twice. In the current study, the authors examined patterns of care for 1,693 patients with whiplash injuries who were compensated under tort insurance.

The results showed that increasing the intensity of care to more than 2 visits to a general practitioner, 6 visits to a chiropractor, or adding chiropractic care to general practitioner care was associated with slower recovery. “The results agree with our previous analysis in a cohort of patients compensated under a no-fault insurance scheme and support the hypothesis that the prognosis of whiplash injuries is influenced by the type and intensity of care received within the first month after injury,” the authors state.

They note that effective care, if medically needed, improves the prognosis of patients and that practice guidelines recommend treatment shortly after the injury. However, it may be that doctors responding to pressure from patients use treatments, schedule follow-up visits and refer patients to specialists when not medically needed. “This in turn may lead to adverse outcomes and even prolong recovery by legitimizing patients’ fears and creating unnecessary anxiety,” according to the authors. It is also possible that early aggressive treatment delays recovery by encouraging the use of passive coping strategies. “Reliance on frequent clinical care, a form of passive coping strategy, may have a negative effect on recovery by reinforcing the patients’ belief that whiplash injuries often lead to disability,” the authors state. They cite another study that showed that whiplash patients who used coping strategies such as wishing for pain medication or believing that they couldn’t do anything to lessen the pain had a slower recover than those who did not use such strategies.

Unlike the previous study, the current one did not show a slower recovery for patients who consulted a general practitioner and a specialist. This suggests that the insurance system (tort versus no-fault) can affect the association between certain patterns of care and recovery because it may influence how patients perceive their medical needs, the pressure they put on clinicians to be referred, and how insurers require them to legitimize their injury. The authors conclude that further trials “are essential to understand the influence of health care provision in preventing or facilitating disability.”

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Article: “Early Aggressive Care and Delayed Recovery From Whiplash: Isolated Finding or Reproducible Result”" Pierre Côté, Sheilah Hogg-Johnson, J. David Cassidy, Linda Carroll, John W. Frank, Claire Bombardier, Arthritis Care & Research, June 2007; (DOI: 10.1002/art.22775).

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Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial.

1: Rheumatol Int. 2007 May 23; [Epub ahead of print]

Fioravanti A, Perpignano G, Tirri G, Cardinale G, Gianniti C, Lanza CE, Loi A, Tirri E, Sfriso P, Cozzi F.

Rheumatology Unit, Department of Clinical Medicine and Immunogical Sciences, University of Siena, Siena, Italy.

The efficacy of balneotherapy in fibromyalgia syndrome (FS) has been well demonstrated, while controlled studies using mud packs are lacking. We performed a randomized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients, who are poor responders to pharmacological therapy. Eighty patients with primary FS, according to ACR criteria, were randomly allocated to two groups: 40 were submitted to a cycle of 12 mud packs and thermal baths, and 40 were considered as controls. At baseline, after thermal treatment and after 16 weeks, patients were evaluated by FIQ, tender points count, VAS for “minor” symptoms, AIMS1 and HAQ. Control patients were assessed at the same time periods. A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed. Mud packs were well tolerated and no drop-outs were recorded. Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS.

PMID: 17520260 [PubMed - as supplied by publisher]

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Vitamin d and rehabilitation: improving functional outcomes.

1: Nutr Clin Pract. 2007 Jun;22(3):297-304.

Shinchuk L, Holick MF.

Boston University Medical Center, 715 Albany Street, M-1013, Boston, MA 02118. mfholick@bu.edu.

Vitamin D inadequacy is pandemic among rehabilitation patients in both inpatient and outpatient settings. Male and female patients of all ages and ethnic backgrounds are affected. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and worsens proximal muscle strength and postural sway. Vitamin D inadequacy can be prevented by sensible sun exposure and adequate dietary intake with supplementation. Vitamin D status is determined by measurement of serum 25-hydroxyvitamin D. The recommended healthful serum level is between 30 and 60 ng/mL. 25-Hydroxyvitamin D levels of >30 ng/mL are sufficient to suppress parathyroid hormone production and to maximize the efficiency of dietary calcium absorption from the small intestine. This can be accomplished by ingesting 1000 IU of vitamin D(3) per day, or by taking 50,000 IU of vitamin D(2) every 2 weeks. Vitamin D toxicity is observed when 25-hydroxyvitamin D levels exceed 150 ng/mL. Identification and treatment of vitamin D deficiency reduces the risk of vertebral and nonvertebral fractures by improving bone health and musculoskeletal function. Vitamin D deficiency and osteomalacia should be considered in the differential diagnosis of patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or myositis. There is a need for better education of health professionals and the general public regarding the optimization of vitamin D status in the care of rehabilitation patients.

PMID: 17507730 [PubMed - in process]

Clinical features of the stomatognathic involvement in fibromyalgia syndrome

1: Cranio. 2007 Apr;25(2):127-33.

A comparison with temporomandibular disorders patients.

Salvetti G, Manfredini D, Bazzichi L, Bosco M.
Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy. salve106@inwind.it

Several studies have reported an involvement of the stomatognathic system in the course of fibromyalgia (FM) similar to that which characterizes temporomandibular disorders (TMD). The aim of this study was to investigate and compare the clinical features of stomatognathic dysfunction in patients with FM and TMD. Ninety-three FM patients underwent an assessment according to the RDC/TMD guidelines. Prevalence of the different RDC/TMD diagnoses and some clinical parameters of FM patients were compared with those of 181 patients affected by TMD. Seventy-four (79.6%) FM patients presented at least one RDC/TMD diagnosis and showed lower mean maximum voluntary and passive mouth opening values than TMD patients. Moreover, 34 FM patients presented with trigger and/or tender points. Results of the present study confirm the high rate of involvement of the stomatognathic system in the course of FM and support the need for a careful multidisciplinary approach to patients with TMD, including the rheumatologist.

PMID: 17508633 [PubMed - in process]

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