Unique pattern of gene expression can indicate acetaminophen overdose

Contact: Robin Mackar
rmackar@niehs.nih.gov
919-541-0073
NIH/National Institute of Environmental Health Sciences

May lead to new tool for physicians

In a new study, researchers found they could detect toxic levels of acetaminophen in laboratory animals by analyzing gene expression in the blood. This study by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, could be a first step in developing accurate new tools to detect acetaminophen overdose in humans. Overdose of acetaminophen, the active ingredient in many over-the-counter pain relievers, is a leading cause of liver failure in the United States and is often difficult to diagnose. An estimated 50,000 people seek emergency room treatment for acetaminophen overdose each year.

The research published online this week in the Proceedings of the National Academy of Sciences shows that gene expression data from blood cells can provide valuable information about acetaminophen levels well before liver damage can be detected by other methods, including serum markers and liver biopsies.

“In time, this approach could give physicians a powerful new genomics tool to help patients who cannot estimate how much acetaminophen they consumed. Early detection of acetaminophen overdoes can be helpful in preventing or treating resulting liver damage,” said Richard S. Paules, Ph.D., principal investigator and director, Microarray Core Facility at NIEHS and senior author on the new paper.

The researchers would like to build on this body of research to develop a simple procedure that clinicians could use in the emergency room to estimate the level of acetaminophen exposure and the potential damage to the liver. This would be especially beneficial for patients such as the elderly, suicidal, semi-comatose who are unable to provide an accurate estimate.

To carry out their study, the researchers developed and then analyzed gene expression signatures — patterns of gene activity —in rats exposed to various doses of acetaminophen. Using microarrays, or tools that allow scientists to see how differences in gene expression are linked to specific diseases, the researchers were able to determine which genes were turned on or turned off in response to the different levels of acetaminophen. Once they selected the gene sets, they tested them for accuracy, and found the signature gene lists were able to predict exposure to toxic versus nontoxic doses with very high accuracy (88.9-95.8 percent), while the more traditional predictors, of clinical chemistry, hematology and pathology were approximately 65 to 80 percent accurate.

“Although it was not the main focus of our study, we wanted to see how applicable this gene expression profiling of blood cells was to humans,” said Raymond W. Tennant, Ph.D., in the NIEHS Laboratory of Molecular Toxicology, and a co-author on the study.

The NIEHS researchers compared the animal data with data from RNA from blood drawn from individuals who had been admitted to the University of North Carolina emergency room for acetaminophen overdose intoxication. When they compared the toxic blood samples to the samples from normal healthy volunteers they saw a striking difference.

“Although there are already some good tools available to emergency room physicians to detect liver injury, additional information concerning the level of exposures and/or the degree of liver injury could significantly help us in treating acetaminophen overdose patients,” said Paul Watkins, M.D., Director, General Clinical Research Center at the University of North Carolina, Chapel Hill and co-author on the paper.

###
The National Institute of Environmental Health Sciences (NIEHS), a component of the National Institutes of Health, supports research to understand the effects of the environment on human health. For more information on environmental health topics, please visit our website at http://www.niehs.nih.gov/.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Reference: Bushel PR, Heinloth AN, Li J, Huang L, Chou JW, Boorman GA, Malarkey DE, Houle CD, Ward SW, Wilson RE, Fannin RD, Russo MW, Watkins PB, Tennant RW, and Paules RS. Blood gene expression signatures predict exposure levels. Proceedings of the National Academy of Science DOI 10.1073 PNAS.0706987104 (2007).

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New insights into inflammation in osteoarthritis

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

Study indicates role of inflammatory mechanism distinct from joint cartilage

The most common degenerative joint disease, osteoarthritis (OA) is marked by the breakdown of articular cartilage, which is the type of cartilage that lines the ends of most limb bones. It can afflict any joint—fingers, toes, wrists, ankles, elbows, shoulders, and the spine, as well as the weight-bearing knees and hips. As OA progresses, sufferers often experience inflammation around the affected joint. This inflammation has been attributed to bits of cartilage breaking off and aggravating the synovium, the thin, smooth membrane lining a joint. Yet, MRI detection of prominent synovitis in early OA—when joint cartilage appears normal—suggests that other joint structures may be involved in triggering this inflammation. Recent studies of inflammation in spinal arthritis implicate the enthesis, which is the attachment site of ligament or tendon to bone as being a potential driving factor in joint inflammation.

Intrigued by the potential role of tendon or ligament attachment sites in synovitis, Professors Michael Benjamin of Cardiff University and Dennis McGonagle of the University of Leeds decided to investigate the extent to which different entheses could contribute to inflammation by forming a functional unit and destructive partnership with adjacent synovium. Featured in the November 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), their findings shed light on a potential novel mechanism for synovial inflammation in degenerative arthritis. This is based on a structure that the authors have called the “synovial-entheseal complex” (SEC). Basically insertions have a different type of cartilage called fibrocartilage near the bone. Although this is different from articular cartilage that lines the ends of bones, the authors speculated that this type of cartilage could also derive nourishment from synovium. However, this close integration although desirable in health could have unfortunate consequences if the enthesis was damaged.

To validate the widespread formation and to explore further, the possible inflammatory function of SECs, researchers collected ligament and tendon attachment samples from 60 cadavers, 35 male and 25 female, with a mean age of 84 years at death. 49 different entheses—19 from the arms, 26 from the legs, and 4 from the spinal column—were preserved for examination. To exclude cartilage degeneration as a trigger for synovial inflammation, 17 of the selected entheses were not immediately adjacent to joint cartilage. Each sample was studied for evidence of inflammatory cells and soft tissue microdamage, as well as for the composition of SECs.

At 82 percent of the entheses, the formation of a SEC was found. As expected, this occurred in entheses very close to joint cartilage, where the synovium was often part of the joint itself. However, a SEC was also detected in 47 percent of the sites separated from joint cartilage. For example, the SEC found at the Achilles tendon was formed with synovium that protruded from a cavity called a “bursa”, located a considerable distance from the ankle joint.

Joint insertions are sites of high mechanical stressing and the authors speculated that this could lead to damage within them, including their fibrocartilage This is exactly what the authors found. Degenerative changes—at least one and sometimes several—were detected on the soft tissue side of attachment sites. Most notably, cell clustering and/or fissuring was found in 76 percent of entheses. In 85 percent of SECs, the synovial component also showed evidence of mild inflammatory change. Finally, in 73 percent of the attachments, small numbers of inflammatory cells were present in the enthesis itself. Therefore the authors suggest that joint degeneration of fibrocartilage at insertions could trigger inflammation within SECs.

As Professors Benjamin and McGonagle note, one their most striking findings was the large number of attachment sites with evidence of changes in the entheses mirroring those typically seen in joint cartilage in OA—fibrocartilage cell clusters, cell hypertrophy, and fissuring among them. “Such changes at certain entheses could be directly relevant to older subjects with joint symptoms due to degenerative disease,” Professor McGonagle observes, “and some of the symptoms could be emanating from the SEC.”

Affirming the concept of a “synovio-etheseal complex” as widely applicable at many sites in the body, both right next to and removed from joint cartilage, this study also supports the idea that biomechanical factors related to the enthesis could play an important role in synovial inflammation in both degenerative and inflammatory arthritis.

###

Article: “Histopathologic Changes at ‘Synovio-Entheseal Complexes’ Suggesting a Novel Mechanism for Synovitis in Osteoarthritis and Spondylarthritis,” Michael Benjamin and Dennis McGonagle, Arthritis & Rheumatism, November 2007; (DOI: 10.1002/art.23078).

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American Band, The Next Great American Band

(Detroit Michigan, October 25, 2007). It’s no big secret that the new Fox TV show “The Next Great American Band” is becoming a huge success, surpassing americal Idol in only one episode. Let me tell you what makes this show so great.

A few month’s ago I contacted Detroits own “The Muggs” about helping us with a benefit concert to raise research funding for Fibromyalgia and Chronic Fatigue Syndrome. Within a couple of hours I received an e-mail from Tony DeNardo, the bass player for the Muggs. Tony expressed a serious interest in helping us because he has himself overcome a serious disability to follow his lifes dream of being a musician.

The Muggs first formed in 2000 and began to grow in popularity until in September of 2001 Tony suffered a hemorrhagic stroke that nearly cost him his life. Having been the band’s bass player and losing the ability to use his right hand, Tony began to learn his bass lines on a Fender Rhodes Keyboard. Tony’s drive and determination to persue his dream of being a musician was so strong that he found a way to overcome his stroke and make a come back to the band after 2 years of extensive physical therapy and spending 3 hours daily practicing his bass lines on the Fender Rhodes.

In 2003, Drummer Matt Rost got a call from Tony saying, I’m ready, I learned all my bass lines on the Fender Rhodes, lets do this. The rest is history, as the Muggs have been gaining popularity by the scores, adding new fans every time they play.

Ken Euteneier of Fibrohugs.com stated “people like Tony inspire me and other disabled people worldwide, because he has proven to us that if we want something bad enough we can find a way to do it, and I think these guys deserve the votes of the disabled community”.

FMS Global News and Fibrohugs.com fully supports the Muggs as The Next Great American Band.

Please tune in to Fox this Friday night, November 2ND. at 8PM EST and 7PM Central and cast your votes for the Muggs. 1-866-856-8307 (Please Note: phone number is subject to change).

The Muggs

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Stop this very useful CFS web from closing!

Friends,

I don’t know if you are familiar with this very useful web on CFS and FMS. It is full of bibliographical references. It is a gold mine for advocates, practicians and anyone who wants to find relevant studies quickly. The person who runs it, Dr.Mette Marie Andersen of Denmark, I believe is tired of running it and is thinking of closing it. I for one, think it would be a great loss. We, here in Barcelona, use this web and it makes our political and advocacy work much easier and efficient. We need more access to information, not less.
So I am sending you a link to the web and if you think it should continue, perhaps you can send Dr. Andersen an email to encourage her to keep it going (mma@doktor.dk).

Thank you,
Clara Valverde
LigaSFC, Barcelona, Spain

http://www.cfids-cab.org/cfs-inform/index.html

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FIBROMYALGIA SUPPORT FOR HIGH FLYERS

by Jeanne Hambleton © 2007

Good morning Folks,

This came to me from Julia from the Fibro Fighters (UK) who with her friend Diane is seeking support for our precious Red Arrows – the Royal Air Force Aerobatic Team, a formidable bunch of pilots who do fly pasts for royalty and other important occasions.

The team has already been threatened by budget cuts and survived – now they are said to be “too British” to appear at an international event in the UK. What rot! It is time for the stiff upper lip and all that tosh old bean!

If the Olympics are to be held in the UK surely we will be flying the Union Jack – and that is very British – and even St. George’s flag. I just cannot see the justification for this decision!

To us UK-iers, the Red Arrows are known worldwide as a British flying team. To me this is red tape gone barmy – another case of politically correct with a very small ‘p’. What do you think?

If you would like to know more about the RAF Red Arrows look at their website (www.raf.mod.uk/reds/) where they are described a world ambassadors. The website states,
The Red Arrows are renowned throughout the world as ambassadors for both the Royal Air Force and the United Kingdom. Since the Team was officially formed in 1965, the Red Arrows have completed over 4,000 displays in 52 countries.

Why are they not booked to perform in their own country on this auspicious occasion? If you agree they should be flying at the Olympics to be held in the UK in 2012, please sign the petition. Those ‘daring young men in their flying machines’ need all the support they can get.

I know it is not quite fibromyalgia news – but I guess some of us have been ‘high flyers’ ourselves before being diagnosed with fibromyalgia, chronic fatigue, irritable bowel syndrome, cognitive problems, sleeplessness – shall I go on? I think you know the rest. They are all nasties associated with the syndrome along with tingling in the arms and legs and that pain in the butt (literally- pass me a soft cushion please!).

Subject: Red Arrows 2012 from Julia, Fibro Fighter
(http://z15.invisionfree.com/Fibro_Fighters/index.php?act=idx)

Dear Jeanne
 
I thought you might like to sign this? The world-famous Red Arrows have been banned from appearing at the 2012 London Olympics because they are deemed “too British”.

Organisers of the event say that the Arrows military background might be “offensive” to other countries taking part in the Games. The display team has performed at more than 4000 events worldwide, but the Department of Culture, Media and Sport have deemed the display team “too militaristically British”. Red Arrows pilots were said to be “outraged”, as they had hoped to put on a truly world class display for the Games, something which had never been seen before. Being axed from a British-based event for being “too British” is an insult – the Arrows are a symbol of Britain.

The Red Arrows have been excellent ambassadors for British overseas trade, as they display their British-built Hawk aircraft all over the world. The Arrows performed a short fly past in 2005 when the winning bid was announced, but their fly past at the Games was to have been truly spectacular. It is to be hoped that common sense prevails If you disagree with this decision, sign the petition on the link below
 

http://petitions.pm.gov.uk/RedArrows2012/?ref=redArrows2012

It takes less than a couple of minutes. You then receive an email for confirmation and you are done. I should add that at the time of writing there were already 191,910 signatures for the petition and a cryptic comment from the Government saying it is not banning the Red Arrows. Either way we must make a lot of noise and make our feelings known to the nation and hope the Prime Minister intervenes. He said he would listen to the public – one of those many promises. .

Incidentally if you are interested in fibromyalgia forums, Fibro Fighters is a good site – not all moans and groans and depression. It is bright, cheerful, and friendly and can do you a tonic of good if you register and join in. A great bunch of fibromites. Certainly worth a look.

Take care. Keep well. Jeanne

FLYING HIGH WITH FIBROMYALGICS

by Jeanne Hambleton © 2007

In support of the belief that laughter is the best medicine, I am offering my fibromyalgic readers something to read that I hope will brighten their day.

By the time I got to the end of this offering that dropped on my desktop I laughed until I ached and just felt I had to share it and make someone else happy. No I do not have shares in Australian airways but I love their sense of fun. I hope you enjoy reading this silly missive but may I say, I have no idea of the origins of this but no copyright infringement is meant.

The comment with the email from my dear friend Linda Allen, who is badly disabled with fibromyalgia, read: This is brilliant!! Would you ever catch English pilots having this kind of sense of humour?

It is alleged that Australian airline attendants make an effort to make the in-flight “safety lecture” and their other announcements a bit more entertaining. Here are some real examples that have been heard or reported:

(1) On an Air NZ Flight with a very “senior” flight attendant crew, the pilot said, “Ladies and gentlemen, we’ve reached cruising altitude and will be turning down the cabin lights. This is for your comfort and to enhance the appearance of your flight attendants.”

(2) On landing the hostess said, “Please be sure to take all your belongings. If you’re going to leave anything, please make sure it’s something we’d like to have.”

(3) “There may be 50 ways to leave your lover, but only 4 ways to leave the aircraft.”

(4) After a particularly rough landing during thunderstorms in Adelaide, a flight attendant on a Qantas flight announced, “Please take care when opening the overhead compartments because, after a landing like that, sure as S**T everything has shifted!”

(5) “In the event of a sudden loss of cabin pressure, masks will descend from the ceiling. Stop screaming, grab the mask, and pull it over your face. If you have a small child travelling with you, secure your mask before assisting with theirs. If you are travelling with more than one small child, pick your favourite.”

(6) “Weather at our destination is 32 degrees with some broken clouds, but we’ll try to have them fixed before we arrive. Thank you, and remember nobody loves you, or your money, more than Qantas Airlines. “

(7) “Your seat cushions can be used for flotation; and in the event of an emergency water landing, please paddle to shore and take them with our compliments.”

(8) Heard on Qantas Airlines just after a very hard landing in Hobart: The flight attendant came on the intercom and said, “That was quite bumpy and I know what you are all thinking. I’m here to tell you it wasn’t the airline’s fault, it wasn’t the pilot’s fault, it wasn’t the flight
attendant’s fault… it was the asphalt!”

(9) Another flight attendant’s comment on a less than perfect landing:
“We ask you to please remain seated as Captain Kangaroo bounces us to the terminal.”

(10) An airline pilot wrote that on this particular flight he had hammered his ship into the runway really hard. The airline had a policy which required the first officer to stand at the door while the passengers exited, smile, and give them a “Thanks for flying United.”
He said that, in light of his bad landing, he had a hard time looking the passengers in
the eye, thinking that someone would have a smart comment. Finally everyone had got off except for an old lady walking with a cane. She said, “Sonny, mind if I ask you a question?” “Why no Ma’am,” said the pilot. “What is it?”
The little old lady said, “Did we land or were we shot down?”

(11) After a real crusher of a landing in Sydney, the Flight Attendant came on with, “Ladies and Gentlemen, please remain in your seats until Capt. Crash and the Crew have brought the aircraft to a screeching halt against the gate. And, once the tire smoke has cleared and the warning bells are silenced, we’ll open the door and you can pick your way through the wreckage to the terminal.”

(12) Part of a flight attendant’s arrival announcement: “We’d like to thank you folks for flying with us today. And, the next time you get the insane urge to go blasting through the skies in a pressurized metal tube, we hope you’ll think of Qantas.”

(13) A plane was taking off from Mascot Airport. After it reached a comfortable cruising altitude, the captain made an announcement over the intercom, “Ladies and gentlemen, this is your Captain speaking. Welcome to Flight Number XYZ, non-stop from Sydney to Auckland. The weather ahead is good and, therefore, we should have a smooth and uneventful flight. Now sit back and relax – “S**T! ARGHHH! OH, MY GOD!”
Silence followed and after a few minutes, the Captain came back on the intercom and said, “Ladies and Gentlemen, I am so sorry if I scared you earlier, but, while I was talking, the flight attendant brought me a cup of coffee and spilled the hot coffee in my lap. You should see the front of my pants!”
A passenger in Economy said, “That’s nothing. He should see the back of mine!”

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A FABLE FOR FIBROMITES

by Jeanne Hambleton © 2007

I did warn you – WSYSIWYG – what you see is what you get. This time I hope I am getting to the bottom of this matter, if you will excuse the pun. Yes, you have guessed it, this is a lavatorial story.

I am inclined to be a bit frivolous as I not entirely convinced this story is true but in these days, we fibromites, just cannot afford to take chances especially as we are probably the ones who ‘sit down on the job’. If you know this story is true, please tell me. Before you start laughing at me and taking the Mickey, I am acting in good faith and following information from a friend.

This came to me from someone in the States and would you believe this was headed, Because there isn’t already enough to worry about…….

Three women in North Florida turned up at hospitals over a 5-day period, all with the same symptoms. Fever, chills, and vomiting, followed by muscular collapse, paralysis, and finally, death. There were no outward signs of trauma.  Autopsy results showed toxicity in the blood.

These women did not know each other, and seemed to have nothing in common. It was discovered, however, that they had all visited the same restaurant (Olive Garden) within days of their deaths. The health department descended on the restaurant, shutting it down. The food, water, and air conditioning were all inspected and tested, to no avail.

The big break came when a waitress at the restaurant was rushed to the hospital with similar symptoms. She told doctors that she had been on vacation, and had only went to the restaurant to pick up her check. She did not eat or drink while she was there, but had used the restroom.

That is when one toxicologist, remembering an article he had read, drove out to the restaurant, went into the restroom, and lifted the toilet seat. Under the seat, out of normal view, was a small spider. The spider was captured and brought back to the lab, where it was determined to be the Two-Striped Telamonia (Telamonia dimidiata), so named because of its reddened flesh color. This spider’s venom is extremely toxic, but can take several days to take effect. They live in cold, dark, damp climates, and toilet rims provide just the right atmosphere.

Several days later a lawyer from Jacksonville showed up at a hospital emergency room. Before his death, he told the doctor, that he had been away on business, had taken a flight from Indonesia, changing planes in Singapore, before returning home. He did not visit (Olive Garden), while there. He did, as did all of the other victims, have what was determined to be a puncture wound, on his right buttock.
Investigators discovered that the flight he was on had originated in India. The Civilian Aeronautics Board (CAB) ordered an immediate inspection of the toilets of all flights from India and discovered the Two-Striped Telamonia (Telamonia dimidiata) spider’s nests on 4 different planes!

It is now believed that these spiders can be anywhere in the country. So please, before you use a public toilet, lift the seat to check for spiders. It can save your life! And please pass this on to everyone you care about.

I should add “anywhere in the country” means the States. However planes in India do fly to the UK and other countries. These little devils could be catching planes to just about anywhere by now.
THIRTY MINUTES LATER

I decided to check this story on the Internet but that was in hindsight. Oh dear, oh dear, oh dear! Yes someone has been pulling my chain! But it was all very plausible!

http://www.truthorfiction.com/rumors/b/bushspiders.htm

This truth or fiction website told me Beware of Deadly Spiders Hiding Under Toilet Seats-Fiction!

The eRumor 
It seems there are two fictitious versions in existence. These refer to an alleged story in the Journal of the United Medical Association. One version claims the spider originates from South American and was seen in a restaurant toilet in Blare airport, Chicago.  The second version has spiders in a restaurant in North Florida all of them arriving aboard airplanes from India.
 
The Truth
The website points out

· The “Blare” airport does not exist in Chicago.
· Neither does the “Journal of the United Medical Association.”
· “Arachnius gluteus” is fictitious and may be a guise for “butt spider.”
· The “Civil Aeronautics Board” closed down 1984.
· And reports of these spiders and toilet seats in Florida or Illinois could not be found.

And it is not even April 1st? I even received a photograph of the little devil. How gullible can you be? But at least now we know we can sit on toilet seats without the fear of a venomous spider biting our butt. That is not say you will not catch something almost as sinister – but at least you should not be bitten by the butt spider.

No I do not want to be the butt of your jokes, thanks.

Take care and still be careful. Jeanne

Exercise for treating fibromyalgia syndrome.

Busch A, Barber K, Overend T, Peloso P, Schachter C.

BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This is an update of a review published in Issue 2, 2002.

OBJECTIVES: The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FMS.

SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005. We also reviewed reference lists from reviews and meta-analyses of treatment studies.

SELECTION CRITERIA: Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected.

DATA COLLECTION AND ANALYSIS: Two of four reviewers independently extracted data for each study. All discrepancies were rechecked and consensus achieved by discussion. Methodological quality was assessed by two instruments: the van Tulder and the Jadad methodological quality criteria. We used the American College of Sport Medicine (ACSM) guidelines to evaluate whether interventions had provided a training stimulus that would effect changes in physical fitness. Due to significant clinical heterogeneity among the studies we were only able to meta-analyze six aerobic-only studies and two strength-only studies.

MAIN RESULTS: There were a total of 2276 subjects across the 34 included studies; 1264 subjects were assigned to exercise interventions. The 34 studies comprised 47 interventions that included exercise. Effects of several disparate interventions on global well-being, selected signs and symptoms, and physical function in individuals with FMS were summarized using standardized mean differences (SMD). There is moderate quality evidence that aerobic-only exercise training at recommended intensity levels has positive effects global well-being (SMD 0.44, 95% confidence interval (CI 0.13 to 0.75) and physical function (SMD 0.68, 95% CI 0.41 to 0.95) and possibly on pain (SMD 0.94, 95% CI -0.15 to 2.03) and tender points (SMD 0.26, 95% CI -0.28 to 0.79). Strength and flexibility remain under-evaluated.

AUTHORS’ CONCLUSIONS: There is ‘gold’ level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

PMID: 17943797 [PubMed - in process]

Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003786. DOI: 10.1002/14651858.CD003786.pub2.

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IASP declares the Global Year Against Pain in Women

Contact: Sejal Sedani
sejal.sedani@resolutecommunications.com
44-207-397-7474
WeissComm Partners

‘Real Women, Real Pain’ campaign highlights the suffering caused by disparities in pain recognition and treatment in women around the world

Seattle, WA – October 15, 2007 — Today, the International Association for the Study of Pain (IASP) has declared 2008 the Global Year Against Pain in Women to draw attention to the significant impact of chronic pain on women and the need for more effective care. Lack of awareness of pain issues affecting women and gender disparities in treatment and research contribute to the suffering of millions of women.

“Chronic pain affects a higher proportion of women than men, but unfortunately they are also less likely to receive treatment compared to men due to various cultural, economic and political barriers,” said Troels S. Jensen, MD, President of IASP, Professor of Experimental and Clinical Pain Research, University of Aarhus, Aarhus, Denmark. “IASP hopes to provide a voice to these women by drawing attention to this global issue as a first step towards reducing pain and suffering of women around the world.”

Real Women, Real Pain

Research has shown that women generally experience more recurrent pain, more severe pain and longer lasting pain than men. Chronic pain conditions which affect women more than men include fibromyalgia, irritable bowel syndrome (IBS), rheumatoid arthritis, osteoarthritis, chronic pelvic pain, temporomandibular joint disorder (i.e., TMJ) and migraine headache.

Women appear to experience pain differently than men, although the reason is not entirely understood. It is believed that this difference is due to numerous biological reasons including genetic, hormonal and pharmacological factors/influences. In addition, psychosocial and cultural disease factors/influences play an important role in how women experience pain.

Taking Action

Over the next year, the ‘Real Women, Real Pain’ campaign will educate the public, healthcare providers and government leaders/agencies about the lack of diagnosis and adequate treatment of chronic pain in women. This will help to:

Increase awareness of pain conditions predominantly affecting women and help women and healthcare providers recognize signs and symptoms

Raise awareness of disparities between female/male pain issues

Empower women to become advocates for themselves and others, by encouraging them to affirm their pain is real and seek proper treatment

Increase female-specific research

Encourage the development of new female-specific treatment options

To further these objectives, IASP will initiate a number of national and local activities in conjunction with their 69 local chapters worldwide. A special issue of the IASP journal Pain will be dedicated to pain in women in November 2007. The IASP website will also feature campaign information including local IASP chapter initiatives.

Gender Inequalities in Health Care

Certain pain conditions commonly affecting women often do not receive adequate attention as historically medical research has heavily relied on male populations and conditions affecting them. The result of this male-centric research approach is that women continue to be treated based on studies in which they may not have been adequately represented.

Access to healthcare services, particularly in poverty stricken areas of the developing world, can act as a barrier for women seeking help for pain conditions.

Cultural factors also influence a woman’s likelihood of seeking treatment for medical conditions, including pain. For example, in many cultures, women believe that their suffering is part of their role in society. Additionally treatment by a male healthcare provider may also bring shame to a woman’s family, forcing her to go without treatment. Women may also encounter situations where physicians do not believe their pain is real.

“In order to promote change around the world, we need to raise awareness of pain disorders predominantly affecting women, increase research into these conditions and effective treatment options, as well as improve access to needed therapies,” said Beverly Collett, MBBS, FRCA, IASP Council member and Consultant in Pain Medicine at Leicester Royal Infirmary, UK.

###
IASP would like to recognize Pfizer Inc as a sponsor of the Global Year Against Pain in Women and thank them for supporting efforts to promote education on this important issue.

For more information on The Global Year Against Pain and Women, upcoming initiatives around the world, please visit http://www.iasp-pain.org.

About IASP

The International Association for the Study of Pain® (IASP) is the leading professional forum for science, practice, and education in the field of pain. IASP has more than 6,900 members in 106 countries, 69 national Chapters, and 14 Special Interest Groups (SIGs). IASP was founded in 1973 and is governed by an international Council, made up of Officers and Councilors elected by the members of the association.

IASP sponsors research symposia on specific pain-related topics and provides grants, awards and fellowships to support international pain research. Through its Developing Countries Project, IASP offers grants to improve pain education for clinicians in developing countries. Each year IASP launches the Global Day and Global Year Against Pain to raise awareness of different aspects of pain. The headquarters office of IASP is in Seattle, Washington, USA.

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Duloxetine for the treatment of fibromyalgia in women: pooled results from two randomized, placebo-controlled clinical trials.

Arnold LM, Pritchett YL, D’Souza DN, Kajdasz DK, Iyengar S, Wernicke JF.

Women’s Health Research Program, Department of Psychiatry, University of Cincinnati College
of Medicine, Cincinnati, Ohio.

Background: To assess the efficacy (in particular, in pain, functional impairment, and quality of life) and safety and tolerability (incidence of adverse events, discontinuation rates, changes in laboratory findings, and vital signs) of duloxetine in female patients with fibromyalgia. Methods: Data were pooled from two placebo-controlled clinical trials of similar design (randomized, 12-week, and double-blind), comparing duloxetine 60 mg a day (q.d.) or 60 mg twice daily (b.i.d.) (n = 326) with placebo (n = 212), in women who met the American College of Rheumatology criteria for primary fibromyalgia.

Results: Compared with the patients receiving placebo, duloxetine-treated female patients demonstrated a significantly greater improvement in the Brief Pain Inventory (BPI) average pain severity score and in the Fibromyalgia Impact Questionnaire (FIQ) total score, beginning at week 1 and continuing through week 12 (p < 0.001). Duloxetine was superior to placebo on all efficacy measures, including mean tender point threshold, Clinical Global Impression of Severity, Patient Global Impression of Improvement, and average interference from pain scores. The duloxetine-treated group was superior to placebo on all quality of life and functional measures, including each domain of the Medical Outcomes Study Short Form-36 (SF-36). A direct treatment effect of duloxetine on pain reduction was demonstrated and shown to be independent of secondary improvement in mood (based on BPI average pain score). Significantly more duloxetine-treated patients reported treatment-emergent adverse events (296 [90.8%] duloxetine-treated and 165 [77.8%] placebo-treated, p < 0.001). Rates of serious adverse events were similar between duloxetine-treated and placebo-treated patients.

Conclusions: The pooled results of these studies demonstrate that duloxetine is a safe and efficacious treatment for both the pain and functional impairment associated with fibromyalgia in female patients, while significantly improving quality of life.

PMID: 17937567 [PubMed - in process]

1: J Womens Health (Larchmt). 2007 Oct;16(8):1145-56.

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