Economy Down, Vasectomy Up

From the FMS Global and UK News Desk of Jeanne Hambleton

More Men Choosing Permanent Sterilization in Trying Economic Times
Courtesy of WebMD.com
By Daniel J. DeNoon – Reviewed by Louise Chang, MD – WebMD Health News

March 26, 2009 — In these tough economic times, more men are making a tough decision: vasectomy.

Urologists across the country are reporting that nearly twice as many men have been seeking permanent sterilization via vasectomy since the economic crisis began.

There is no official count but it is clearly a trend, says Lawrence Ross, MD, professor of urology at the University of Illinois at Chicago and a past president of the American Urological Association.

“We are definitely, in our experience in Chicago, seeing increasing numbers of patients requesting vasectomy. A rough estimate is perhaps twice the number per week we saw a year ago,” Ross tells WebMD.

“Since mid-November we have gone from 40 or 45 to about 70 or 75 a month,” J. Stephen Jones, MD, chairman of the Cleveland Clinic’s department of regional urology, tells WebMD.

“I am seeing a lot more men coming in for vasectomy, and they are saying the reason they are doing it now is they are losing their insurance,” David Shin, MD, chief of the Center for Sexual Health and Fertility at Hackensack University Medical Center, N.J., tells WebMD.

One of those men is Peter Collum of Upper Saddle River, N.J. Three months ago, Collum was laid off from his job as an investment banker. His severance package runs out next month.

“It is not like being out of work was the only driver for getting a vasectomy,” Collum tells WebMD. “But it is a lot easier having this done while I am unemployed.”

Collum’s third child was born four months ago. He and his wife had planned on two to four kids; when the third was born they knew their family was big enough.

Like other urologists, Shin always counsels men before performing the sterilization procedure. In previous years, he says, men simply told him they did not want another child.

“But now economics plays a role,” Shin says. “We live in a time where people are saying, ‘Times are tough, and there is not going to be the disposable income to pay for food and diapers and to save up for college tuition.’”

One of Jones’ patients did not have far to travel after losing his job.

“One very demonstrative patient was a gentleman who had a great job for three or four years, working on a federally funded road project just out the door from our clinic,” Jones says. “When the job went away, he came into my office and said, ‘In this environment, I do not feel I could have any more children.’ And I think there are a thousand more stories like that.”

Many of the men now coming into urologists’ offices had already decided on vasectomy, but were motivated to act by fear of losing their health insurance. Others had even more pragmatic concerns.

“Couples are finding ways of trying to save money, so they do not go out to a fancy dinner or an extravagant show,” Shin says. “And if they are staying home, what is the most common free activity? And what does it lead to? If sexual activity is on the rise, vasectomy is a sure way of preventing a mistake.”

Ross warns that the decision to have a vasectomy should not be made lightly. While the procedure is safe, inexpensive, and relatively minor — recovery is rapid and takes only a day — it should be considered permanent.

“Doing a vasectomy is simple and relatively inexpensive. Undoing it is very expensive and is not covered by any insurance,” Ross says. “”We have to make sure every patient we talk to knows this is permanent, and they have to be absolutely certain they do not want to father any more children.”

©2005-2009 WebMD, LLC. All rights reserved.(http://www.webmd.com/sex/news/20090326/economy_down_vasectomy_up?ecd=wnl_men_040709)

Vasectomy
A vasectomy is considered a permanent method of birth control. A vasectomy prevents the release of sperm when a man ejaculates.

During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, regardless of whether you have had a vasectomy.) Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid.

It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant.

During a vasectomy:

Your testicles and scrotum are cleaned with an antiseptic and possibly shaved.
You may be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy. If you do take this medicine, you may not remember much about the procedure.

Each vas deferens is located by touch.

A local anesthetic is injected into the area.

Your doctor makes one or two small openings in your scrotum. Through an opening, the two vas deferens tubes are cut. The two ends of the vas deferens are tied, stitched, or sealed. Electrocautery may be used to seal the ends with heat. Scar tissue from the surgery helps block the tubes.

The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and do not have to be removed.

The procedure takes about 20 to 30 minutes and can be done in an office or clinic. It may be done by a family medicine doctor, a urologist, or a general surgeon.

No-scalpel vasectomy is a technique that uses a small clamp with pointed ends. Instead of using a scalpel to cut the skin, the clamp is poked through the skin of the scrotum and then opened. The benefits of this procedure include less bleeding, a smaller hole in the skin, and fewer complications. No-scalpel vasectomy is as effective as traditional vasectomy. 1

In the Vasclip implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications. Some studies show that clipping is not as effective as other methods of sealing off the vas deferens. 2

What To Expect After Surgery

Your scrotum will be numb for 1 to 2 hours after a vasectomy. Apply cold packs to the area and lie on your back as much as possible for the rest of the day. Wearing snug underwear or a jockstrap will help ease discomfort and protect the area.

You may have some swelling and minor pain in your scrotum for several days after the surgery. Unless your work is strenuous, you will be able to return to work in 1 or 2 days. Avoid heavy lifting for a week.

You can resume sexual intercourse as soon as you are comfortable, usually in about a week. However, you can still get your partner pregnant until your sperm count is zero. You must use another method of birth control until you have a follow-up sperm count test 2 months after the vasectomy (or after 10 to 20 ejaculations over a shorter period of time). Once your sperm count is zero, no other birth control method is necessary.

A vasectomy will not interfere with your sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. You may have occasional mild aching in your testicles during sexual arousal for a few months after the surgery.

Why It Is Done

A vasectomy is a permanent method of birth control. Only consider this method when you are sure that you do not want to have a child in the future.

How Well It Works

Vasectomy is a very effective (99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy. 3

Risk of failure

Pregnancy may occur after vasectomy because of:

Failure to use another birth control method until the sperm count is confirmed to be zero. It usually takes 10 to 20 ejaculations to completely clear sperm from the semen.

Spontaneous reconnection of a vas deferens or an opening in one end that allows sperm to mix with the semen again. This is very rare.

Risks

The risk of complications after a vasectomy is very low. Complications may include:

Bleeding under the skin, which may cause swelling or bruising.

Infection at the site of the incision. In rare instances, an infection develops inside the scrotum.

Sperm leaking from a vas deferens into the tissue around it and forming a small lump (sperm granuloma). This condition is usually not painful, and it can be treated with rest and pain medication. Occasionally, surgery may be needed to remove the granuloma.

Inflammation of the tubes that move sperm from the testicles (congestive epididymitis).
In rare cases, the vas deferens grows back together (recanalization), and the man becomes fertile again.

What To Think About

Advantages

Vasectomy is a permanent method of birth control. Once your semen does not contain sperm, you do not need to worry about using other birth control methods.

Vasectomy is a safer, cheaper procedure that causes fewer complications than tubal ligation in women. 1

Although vasectomy can be expensive, it is a one-time cost and is often covered by medical insurance. The cost of other methods, such as birth control pills or condoms and spermicide, is likely to be greater over time.

Disadvantages

A vasectomy does not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STDs. To protect yourself and your partner from STDs, use a condom every time you have sex.

Other considerations

If you are considering a vasectomy, be absolutely certain that you will never want to father a child. Think through whether this might change after any of the following life events:

One of your living children dies (if you are a father).

You divorce and lose custody of your children.

You have a new partner who wants children.

Your financial situation improves and you can afford another child.

Your children grow up and leave home.

A vasectomy is not usually recommended for men who are considering banking sperm in case they decide later to have children. Discuss other options with your partner and your health professional.

Surgery to reconnect the vas deferens (vasectomy reversal) is available. However, the reversal procedure is difficult. Sometimes a doctor can remove sperm from the testicle in men who have had a vasectomy or a reversal that did not work. The sperm can then be used for in vitro fertilization. Both vasectomy reversal and sperm retrieval can be expensive, may not be covered by insurance, and may not always work.

Some older studies showed a risk of prostate cancer in men who have had vasectomies. However, many years of research have found no clear evidence that vasectomy is linked to prostate cancer. 1

Some doctors or health insurance plans may require a waiting period from the time you request a vasectomy and the time the procedure is done. This time allows you to be certain about your decision.

Researchers are studying other male birth control methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy involves plugging the vas deferens and then removing the plug when birth control is no longer wanted. Hormonal methods include pills or injections that the man would use to prevent sperm production. So far, no new method has been shown to be effective enough, with low side effects, to be marketed for men.

Citations
Pollack AE, et al. (2004). Female and male sterilization. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 531–573. New York: Ardent Media.
Labrecque M, et al. (2002). Effectiveness and complications associated with 2 vasectomy occlusion techniques. Journal of Urology, 168(6): 2495–2498.
Trussell J (2004). The essentials of contraception: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 221–252. New York: Ardent Media.

Author Bets Davis, MFA; Editor Maria G. Essig, MS, ELS; Associate Editor Michele Cronen;
Associate Editor Denele Ivins; Associate Editor Pat Truman, MATC; Primary Medical Reviewer Joy Melnikow, MD, MPH – Family Medicine; Specialist Medical Reviewer Kirtly Jones, MD – Obstetrics and Gynecology. Last Updated May 22, 2008.

©2005-2009 WebMD, LLC. All rights reserved.(http://www.webmd.com/sex/birth-control/vasectomy-14387)

MAKING MEMORIES AND SOBERING THOUGHTS FOR FIBROMITES

by Jeanne Hambleton © 2007
NFA Leader Against Pain-Advocate
 
I well remember how much I enjoyed Gene Kelly’s performance in the film “Singing in the Rain”. It made me feel so good, in spite of the bad weather, and between us, I really felt like being silly, running outside in the rain and singing my head off. But as my dear late Dad would have said, “Here’s a penny. Go in the next street!” That does not say much for my voice but the thought was there.

It is odd but these days you seldom hear children singing while playing. Do they still teach singing in school – all those pomp and circumstance songs like ‘Jerusalem’, ‘Land of Hope and Glory’ to name but two? Most children seem to know, ‘You’ll never walk alone’, but I guess that is down to the football fans. I seem to think we were encouraged to sing to get some fresh air in our lungs. I even remember doing breathing exercises at school – that must have been when Adam was a lad!

It also seems as if most children do not want to play in the rain and hate to get wet. What happy childhood memories come back when you see a picture of a young child in a hooded raincoat with wellies splashing in big puddles and giggling? I would think Health & Safety and the PC (Politically Correct) Brigade would have something to say about that these days – too dangerous – the child will slip over and hurt itself.

All this talk about singing and dancing in the rain brings me nicely to a little story, which I hope you will enjoy. To be truthful I am hoping to start an epidemic of people singing and dancing in the rain and getting them washed while they are at it. We could change the words, “I’m singing and washing in the rain”. Read on and you will understand where I am coming from. Regrettably I cannot remember which fibromite sent it to me – fibro fog – but thanks.
 
IT’S RAINING

A little girl had been shopping with her Mom in Zellers. She must have been 6 years old, this beautiful red haired, freckle faced image of innocence. It was pouring with rain outside the store. It was the kind of rain that gushes over the top of rain gutters, so much in a hurry to hit the earth it has no time to flow down the spout. We all stood there under the awning and just outside the door of Zellers.

We waited, some patiently, others irritated because it messed up their hurried day.  I am always mesmerized by rainfall.  I got lost in the sound and sight of the heavens washing away the dirt and dust of the world. Memories of running, splashing so carefree as a child came pouring in as a welcome reprieve from the worries of my day.

The little voice was so sweet as it broke the hypnotic trance we were all caught in.
“Mom, let’s run through the rain,” she said.

 ”What?” Mom asked.

“Lets run through the rain!” she repeated.

“No, Honey. We’ll wait until it slows down a bit,” Mom replied.

This young child waited about another minute and repeated: “Mom, let’s run through the rain,”

“We’ll get soaked if we do,” Mom said.

“No, we won’t, Mom.  That’s not what you said this morning,” the young girl said as she tugged at her Mom’s arm.

“This morning?  When did I say we could run through the rain and not get wet?”

“Don’t you remember?  When you were talking to Daddy about his cancer, you said, ‘If God can get us through this, He can get us through anything!’”

The entire crowd stopped dead silent.  I swear you couldn’t hear anything but the rain.  We all stood silently.  No one came or left in the next few moments.

 Mom paused and thought for a moment about what she would say.  Now some would laugh it off and scold the child for being silly.  Some might even ignore what was said.  But this was a moment of affirmation in a young child’s life:  a time when innocent trust can be nurtured so that it will bloom into faith.

“Honey, you are absolutely right.  Let’s run through the rain.  If GOD lets us get wet, well maybe we just needed washing,” Mom said.

Then off they ran.  We all stood watching, smiling and laughing as they darted past the cars and, yes, through the puddles.  They held their shopping bags over their heads just in case.  They got soaked.  But they were followed by a few who screamed and laughed like children all the way to their cars.

And, yes, I did.  I ran.  I got wet.  I needed washing.

Circumstances or people can take away your material possessions.  They can take away your money, and they can also take away your health.  But no one can ever take away your precious memories.  So, don’t forget to make time and take the opportunities to make memories everyday.

“To everything there is a season, and a time to every purpose under the heaven.” Ecclesiastes 3:1

I hope you still take the time to run through the rain. They say it takes a minute to find a special person, an hour to appreciate them, a day to love them, but then an entire life to forget them. Share this story with the people you’ll never forget.  It’s a short message and it will let them know that you’ll never forget them.

If you don’t tell anyone, it means you’re in a hurry.  A pity! Take the time to live!!!

Keep in touch with your friends.  You never know when you’ll need each other or you no longer can keep in touch – and don’t forget to run in the rain!

FMS Global News

Fibrohugs Support

Tenderpoints Newsletter

States taking action to insure nation’s 13.3M uninsured young adults

New report finds young adults in low-income families most likely to lack coverage; raising SCHIP/Medicaid eligibility age an important solution

August 8, 2007, New York, NY—Since 2003, 16 states have enacted legislation requiring insurance companies to provide health insurance coverage to dependent young adults on their parents’ health plans beyond age 18 or 19, according to a new report from The Commonwealth Fund. While Utah has had such a law since 1994, recent legislative activity reflects states’ rising concern about the steady loss of coverage among young adults under the age of 30.

Because a majority of uninsured young adults have low incomes, extending eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP) beyond age 18 would be an important policy solution to cover this group, the authors say. The SCHIP reauthorization bill recently passed in the House of Representatives would allow states to extend coverage up to age 25. Currently, Medicaid and SCHIP coverage for children typically ends at age 19.

The report, Rite of Passage” Why Young Adults Become Uninsured and How New Policies Can Help, finds that 13.3 million young adults ages 19 to 29 were uninsured in 2005, up from 12.9 million in 2004. Young adults also continue to represent the largest age group without health insurance. Despite comprising only 17 percent of the under-65 population they account for 30 percent of the uninsured in that group. Two-fifths (41%) of uninsured young adults ages 19-29 are in families below the poverty level, and 72 percent have incomes below twice the poverty level). The analysis is based on the latest updated Census Bureau data, and is an update of a May 2006 Commonwealth Fund report.

“There are misconceptions that young adults don’t have health insurance by choice,” said Sara Collins, lead author and Assistant Vice President for the Future of Health Insurance at The Commonwealth Fund. “However, affordability and access to coverage are real barriers for many young people who lack access to employer coverage. Even the cost of basic coverage on the individual insurance market can amount to a large share of a low or moderate income. ”

States with laws requiring health plans to cover young adults on their parents’ insurance until age 25 include Colorado, Idaho, Maine, Maryland, Massachusetts, Minnesota, New Mexico, Rhode Island, Texas, Washington, and West Virginia. Delaware, Indiana, and South Dakota require coverage until age 24, New Hampshire and Utah until age 26; and New Jersey until age 30. Most of the state laws apply to all young adults but laws in Idaho, Rhode Island, and South Dakota only apply to students. Most of the laws were passed between 2005 and 2007; the Utah legislation was passed in 1994, and the Texas law in 2003.

States aren’t alone in seeking to expand coverage to young adults. Several federal level proposals, including the SCHIP reauthorization bill that recently passed in the House include provisions that would allow states to increase access to Medicaid and SCHIP up to age 25.

“State-level efforts to cover young adults—one of the largest and fastest-growing segments of the uninsured population—are very important, and it is exciting to see the momentum in this area,” said Commonwealth Fund President Karen Davis. “However, most uninsured young adults do not have access to private coverage through their parents’ plans. For these young adults, extending Medicaid and SCHIP coverage beyond age 18 can make a real difference.”

In addition to increasing Medicaid and SCHIP eligibility, the authors recommend continued efforts to expand eligibility for dependents under private coverage beyond age 18 or 19 and that states take steps to ensure that colleges and universities require and offer health insurance coverage to students.

###
The Commonwealth Fund is a private foundation working toward a high performance health system.

Music Video Of The Day

FMS Global News

Fibromyalgia Support

Source

Characteristics and healthcare costs of patients with fibromyalgia syndrome.

Berger A, Dukes E, Martin S, Edelsberg J, Oster G.
Policy Analysis, Inc. (PAI), Brookline, MA, USA.

Purpose: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice. Materials and methods: Using a US health-insurance database, we identified all patients, aged >/= 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study). Results: The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. $3291 ($13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001). Conclusions: Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.

PMID: 17655684 [PubMed - as supplied by publisher]

FMS Global News

Source

Hypothesis: The Chaos and Complexity Theory May Help our Understanding of Fibromyalgia and Similar Maladies.

Martinez-Lavin M, Infante O, Lerma C.

National Institute of Cardiology, Mexico City, Mexico.

BACKGROUND: Modern clinicians are often frustrated by their inability to understand fibromyalgia and similar maladies since these illnesses cannot be explained by the prevailing linear-reductionist medical paradigm.

OBJECTIVE: This article proposes that new concepts derived from the Complexity Theory may help understand the pathogenesis of fibromyalgia, chronic fatigue syndrome, and Gulf War syndrome.

METHODS: This hypothesis is based on the recent recognition of chaos fractals and complex systems in human physiology.

RESULTS: These nonlinear dynamics concepts offer a different perspective to the notion of homeostasis and disease. They propose that the essence of disease is dysfunction and not structural damage. Studies using novel nonlinear instruments have shown that fibromyalgia and similar maladies may be caused by the degraded performance of our main complex adaptive system. This dysfunction explains the multifaceted manifestations of these entities.

CONCLUSIONS: To understand and alleviate the suffering associated with these complex illnesses, a paradigm shift from reductionism to holism based on the Complexity Theory is suggested. This shift perceives health as resilient adaptation and some chronic illnesses as rigid dysfunction.

PMID: 17570473 [PubMed - as supplied by publisher]

1: Semin Arthritis Rheum. 2007 Jun 13; [Epub ahead of print]

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Tenderpoints

Source

Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review.

1: Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5.

Tsao JC.

Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.

PMID: 17549233 [PubMed - in process]

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Tenderpoints

Source

Gabapentin Shown Effective for Fibromyalgia Pain

FOR IMMEDIATE RELEASE
Monday, June 11, 2007

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Subscribe CONTACT:
Ray Fleming
301-496-8190

New research supported by the National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) shows that the anticonvulsant medication gabapentin, which is used for certain types of seizures, can be an effective treatment for the pain and other symptoms associated with the common, often hard-to-treat chronic pain disorder, fibromyalgia.

In the NIAMS-sponsored, randomized, double-blind clinical trial of 150 women (90 percent) and men with the condition, Lesley M. Arnold, M.D., director of the Women’s Health Research Program at the University of Cincinnati College of Medicine, and her colleagues found that those taking gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks displayed significantly less pain than those taking placebo. Patients taking gabapentin also reported significantly better sleep and less fatigue. For the majority of participants, the drug was well tolerated. The most common side effects included dizziness and sedation, which were mild to moderate in severity in most cases.

NIAMS Director Stephen I. Katz. M.D., Ph.D., remarked that “While gabapentin does not have Food and Drug Administration approval for fibromyalgia, I believe this study offers additional insight to physicians considering the drug for their fibromyalgia patients. Fibromyalgia is a debilitating condition for which current treatments are only modestly effective, so a study such as this is potentially good news for people with this common, painful condition.”

Fibromyalgia is a chronic disorder characterized by chronic, widespread muscle pain and tenderness, and is frequently accompanied by fatigue, insomnia, depression, and anxiety. It affects three million to six million Americans, mostly women, and can be disabling.

The precise cause of fibromyalgia in not known, but research suggests it is related to a problem with the central nervous system’s processing of pain. As with some other chronic pain conditions, people with fibromyalgia often develop a heightened response to stimuli, experiencing pain that would not cause problems in other people. Yet, unlike many other pain syndromes, there is no physical evidence of inflammation or central nervous system damage.

Although gabapentin has little, if any, effect on acute pain, it has shown a robust effect on pain caused by a heightened response to stimuli related to inflammation or nerve injury in animal models of chronic pain syndromes. Researchers have suspected that it might have the same effect in people with fibromyalgia. The new research, published in the April 2007 edition of Arthritis & Rheumatism, indicates the suspicions were correct.

Although the researchers cannot say with certainty how gabapentin helps reduce pain, Dr. Arnold says one possible explanation involves the binding of gabapentin to a specific subunit of voltage-gated calcium channels on neurons. “This binding reduces calcium flow into the nerve cell, which reduces the release of some signaling molecules involved in pain processing,” she says.

How gabapentin improves sleep and other symptoms is less clear, and there are probably different mechanisms involved in fibromyalgia symptoms. “Gabapentin improved sleep, which is an added benefit to patients with fibromyalgia who often report unrefreshing or disrupted sleep,” Dr. Arnold says.

What is important is that people with fibromyalgia now have a potential new treatment option for a condition with few effective treatments. “Studies like this give clinicians evidence-based information to guide their treatment of patients,” says Dr. Arnold.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’ National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at http://www.niams.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.

Arnold, LM et al. Gabapentin in the treatment of fibromyalgia; a randomized, double-blind, placebo-controlled multicenter trial. Arthritis Rheum. 2007; 56: 1336-1344.

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Tenderpoints

Source

The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial.

1: PLoS Clin Trials. 2007 May 18;2(5):e19.

The GK, Bleijenberg G, van der Meer JW.

Department of General Internal Medicine, Nijmegen Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

OBJECTIVES: It is unclear whether insulin-like growth factor (IGF) function is involved in the pathophysiology of chronic fatigue syndrome (CFS). Unpublished data and reports in patient organization newsletters suggest that Acclydine, a food supplement, could be effective in the treatment of CFS by increasing biologically active IGF1 levels. Here we aimed to measure the IGF1 and IGF binding protein (IGFBP) 3 status of CFS patients compared to age- and gender-matched neighborhood controls, and to assess the effect of Acclydine on fatigue severity, functional impairment, and biologically active IGF1 level (IGFBP3/IGF1 ratio).

DESIGN: A randomized, placebo-controlled, double-blind clinical trial. SETTING: Radboud University Nijmegen Medical Centre, The Netherlands. PARTICIPANTS: Fifty-seven adult patients who fulfilled the US Centers for Disease Control and Prevention criteria for CFS. IGF status of 22 CFS patients was compared to that of 22 healthy age- and gender-matched neighborhood control individuals.

INTERVENTION: Acclydine or placebo for 14 wk.

OUTCOME MEASURES: Outcomes were fatigue severity (Checklist Individual Strength, subscale fatigue severity [CIS-fatigue]), functional impairment (Sickness Impact Profile-8 [SIP-8]), and biologically active IGF1 serum concentrations. Analyses were on an intention-to-treat basis.

RESULTS: There was no difference in IGF status in 22 CFS patients compared to healthy age- and gender-matched control individuals. Treatment with Acclydine did not result in significant differences compared with the placebo group on any of the outcome measures: CIS-fatigue +1.1 (95% CI -4.4 to +6.5, p = 0.70), SIP-8 +59.1 (95% CI -201.7 to +319.8, p = 0.65), and IGFBP3/IGF1 ratio -0.5 (95% CI -2.8 to +1.7, p = 0.63).

CONCLUSION: We found no differences in IGF1 status in CFS patients compared to healthy matched neighborhood controls. In addition, the results of this clinical trial do not demonstrate any benefit of Acclydine over placebo in the treatment of CFS.

PMID: 17525791 [PubMed - in process]

FMS Global News

Tenderpoints

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

FMS Global News

Tenderpoints

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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