Caffeine Myths and Facts

From the FMS Global News Desk of Jeanne Hambleton (UK)
Courtesy of WebMD

Caffeine myth or caffeine fact? It is not always easy to know. Chances are you have some real misperceptions about caffeine. For starters, do you know the most common sources of caffeine? Well, maybe two of the sources are not too hard to name — coffee and tea leaves. But did you know kola nuts and cocoa beans are also included among the most common caffeine sources? And do you know how much caffeine content can vary from food to food? Turns out it is quite a lot actually, depending on the type and serving size of a food or beverage and how it is prepared.

Caffeine content can range from as much as 160 milligrams in some energy drinks to as little as 4 milligrams in a 1-ounce serving of chocolate-flavored syrup. Even decaffeinated coffee is not completely free of caffeine. Caffeine is also present in some over-the-counter pain relievers, cold medications, and diet pills. These products can contain as little as 16 milligrams or as much as 200 milligrams of caffeine. In fact, caffeine itself is a mild painkiller and increases the effectiveness of other pain relievers.

Want to know more? Read on. WebMD has examined some of the most common myths about caffeine and gathered the facts to shed some light on those myths.

Caffeine Myth No. 1:

Caffeine Is Addictive

This one has some truth to it, depending on what you mean by “addictive.” Caffeine is a stimulant to the central nervous system, and regular use of caffeine does cause mild physical dependence. But caffeine does not threaten your physical, social, or economic health the way addictive drugs do. (Although after seeing your monthly spending at the coffee shop, you might disagree!)

If you stop taking caffeine abruptly, you may have symptoms for a day or more, especially if you consume two or more cups of coffee a day. Symptoms of withdrawal from caffeine include:

headache
fatigue
anxiety
irritability
depressed mood
difficulty concentrating

No doubt, caffeine withdrawal can make for a few bad days. However, caffeine does not cause the severity of withdrawal or harmful drug-seeking behaviors as street drugs or alcohol. For this reason, most experts do not consider caffeine dependence an addiction.

Caffeine Myth No. 2:

Caffeine Is Likely to Cause Insomnia

Your body quickly absorbs caffeine. But it also gets rid of it quickly. Processed mainly through the liver, caffeine has a relatively short half-life. This means it takes about four to five hours, on average, to eliminate half of it from your body. After eight to 10 hours, 75% of the caffeine is gone. For most people, a cup of coffee or two in the morning would not interfere with sleep at night.

Consuming caffeine later in the day, however, can interfere with sleep. If you are like most people, your sleep would not be affected if you do not consume caffeine at least six hours before going to bed. Your sensitivity may vary, though, depending on your metabolism and the amount of caffeine you regularly consume. People who are more sensitive may not only experience insomnia but also have caffeine side effects of nervousness and gastrointestinal upset.

Caffeine Myth No. 3:

Caffeine Increases Risk for Conditions Such as Osteoporosis, Heart Disease, and Cancer

Moderate amounts of caffeine — about 300 milligrams, or three cups of coffee — apparently cause no harm in most healthy adults. Some people are more vulnerable to its effects, however. That includes such people as those who have high blood pressure or are older. Here are the facts:

Osteoporosis and caffeine

At high levels (more than 744 milligrams/day), caffeine may increase calcium and magnesium loss in urine. But recent studies suggest it does not increase your risk for bone loss, especially if you get enough calcium. You can offset the calcium lost from drinking one cup of coffee by adding just two tablespoons of milk.

However, research does show some links between caffeine and hip fracture risk in older adults. Older adults may be more sensitive to the effects of caffeine on calcium metabolism. If you are an older woman, discuss with your doctor whether you should limit your daily caffeine intake to 300 milligrams or less.

Cardiovascular disease and caffeine

A slight, temporary rise in heart rate and blood pressure is common in those who are sensitive to caffeine. But several large studies do not link caffeine to higher cholesterol, irregular heartbeats, or an increased risk of cardiovascular disease.

If you already have high blood pressure, though, have a discussion with your doctor about your caffeine intake. You may be more sensitive to its effects. Also, more research is needed to tell whether caffeine increases the risk for stroke in people with high blood pressure.

Cancer and caffeine

Reviews of 13 studies involving 20,000 people revealed no relationship between cancer and caffeine. In fact, caffeine may even have a protective effect against certain cancers.

Caffeine Myth No. 4:

Caffeine Is Harmful for Women Trying to Get Pregnant

Many studies show no links between low amounts of caffeine (a cup of coffee per day) and any of the following:

trouble conceiving
miscarriage
birth defects
premature birth
low birth rate

At the same time, for pregnant women or those attempting pregnancy, the March of Dimes suggests fewer than 200 milligrams of caffeine per day. That is largely because in limited studies, women consuming higher amounts of caffeine had an increased risk for miscarriage.

Caffeine Myth No. 5:

Caffeine Has a Dehydrating Effect

Caffeine can make you need to urinate. However, the fluid you consume in caffeinated beverages tends to offset the effects of fluid loss when you urinate. The bottom line is that although caffeine does act as a mild diuretic, studies show drinking caffeinated drinks does not actually cause dehydration.

Caffeine Myth No. 6:

Caffeine Harms Children, Who, Today, Consume Even More Than Adults

As of 2004, children ages 6 to 9 consumed about 22 milligrams of caffeine per day. However, energy drinks that contain caffeine are becoming increasingly popular.

Studies suggest that up to 300 milligrams of caffeine daily is safe for kids. But is it smart? Many kids are sensitive to caffeine, developing temporary anxiety or irritability, with a “crash” afterwards. Also, most caffeine that kids drink is in sodas, energy drinks, or sweetened teas, all of which have high sugar content. These empty calories put kids at higher risk for obesity.

Even if the caffeine itself is not harmful, caffeinated drinks are generally not good for kids.

Caffeine Myth No. 7:

Caffeine Can Help You Sober Up

Actually, research suggests that people only think caffeine helps them sober up. For example, people who drink caffeine along with alcohol think they are OK behind the wheel. But the truth is reaction time and judgment are still impaired. College kids who drink both alcohol and caffeine are actually more likely to have car accidents.

Caffeine Myth No. 8:

Caffeine Has No Health Benefits

Caffeine has few proven health benefits. But the list of caffeine’s potential benefits is interesting. Any regular coffee drinker may tell you that caffeine improves alertness, concentration, energy, clear-headedness, and feelings of sociability. You might even be the type who needs that first cup o’ Joe each morning before you say a single word. Scientific studies support these subjective findings. One French study even showed a slower decline in cognitive ability among women who consumed caffeine.

Other possible benefits include improved immune function from caffeine’s anti-inflammatory effects and help with allergic reactions due to caffeine’s ability to reduce concentrations of histamines. Some people’s asthma also appears to benefit from caffeine. These research findings are intriguing, but still need to be proven.

Limited evidence suggests caffeine may also reduce the risk of the following:

Parkinson’s disease
liver disease
colorectal cancer
type 2 diabetes

Despite its potential benefits, do not forget that high levels of caffeine may have adverse effects. More studies are needed to confirm both its benefits and potential risks.

SOURCES: International Food Information Council Foundation: “Caffeine & Health: Clarifying the Controversies.” Nutrition Action Health Letter: “Caffeine: The Good, the Bad, and the Maybe.” European Food Information Council (EUFIC): “Myths and Facts about Caffeine.” Johns Hopkins University Bayview Medical Center: “Information About Caffeine Dependence.”

©2005-2009 WebMD, LLC. All rights reserved.
(http://www.webmd.com/balance/caffeine-myths-and-facts?ecd=wnl_day_042009)

SEE: http://jeannehambleton77.wordpress.com for health issue stories

Stanford develops imaging technique to catch arthritis early in onset

From the FMS Global News Desk of Jeanne Hambleton (UK)

Courtesy of Stanford School of Medicine USA

BY BRUCE GOLDMAN

STANFORD, Calif. — You come into a doctor’s office with severe knee pain. The physician orders an MRI, which reveals substantial loss of cartilage — osteoarthritis, that is—in your knee joint.

At this point, not much can be done beyond gulping down palliatives and trying to keep your weight off the joint. But the damage may have started building as much as 20 years earlier, possibly due to a traumatic injury to the affected joint.

Just ask Garry Gold, MD, an associate professor of radiology at the Stanford University School of Medicine. Now 45, Gold sustained a knee injury 20 years ago while playing in a pickup basketball game. These days, he is starting to wish his house, currently being remodeled, did not have any stairs.

Gold, who has been diagnosed with osteoarthritis, is working with an imaging technology called sodium MRI to diagnose osteoarthritis as long as decades before the onset of physical symptoms. That may spawn new therapies that could possibly have blocked his disease before it put an end to his basketball days.

Gold is collecting young athletes who have suffered damage to the anterior cruciate ligament, or ACL, in their knee—an injury afflicting several hundred thousand people annually in the United States alone. This knee insult is especially common among female athletes.

“A good fraction of the Stanford women’s basketball and soccer teams either have torn their ACL sometime in the past or will tear it while they are still at Stanford,” Gold said. Even when the initial ligament lesion is repaired surgically, victims remain at almost doubled risk for symptomatic osteoarthritis in the injured knee a decade or two down the road, compared with uninjured people.

MRI now in routine use works by pulsing the area to be observed with electromagnetic energy, at a frequency that preferentially excites the protons in water molecules. As the protons settle back to a relaxed state, they send out an electromagnetic burst of their own, which can be picked up by sensors in the apparatus. Because cartilage has lots of water compared with nearby bone, it shows up on a computer-generated image of the region.

But while standard MRI gives a reasonable display of overall cartilage structure, it does not tell a diagnostician much about the quality of that cartilage.

“If you look into a big house and you see that it is standing up,” Gold said, “you may assume it is going to be safe in the event of an earthquake. But without closer inspection, you do not know much about the integrity of the structure.”

If standard MRI is akin to a view of standing timber in the house, the version Gold is using, called sodium MRI, enables the visualization of dry rot infecting and weakening the wood.

A key structural material in cartilage, called glycosaminoglycan, occurs in a complex with sodium, an elemental metal that has its own set of excitation and relaxation frequencies and is more restricted to cartilage than water is.

Sodium MRI has been around for years, but until recently it could not be used in clinical settings. For one thing, the magnets employed to excite sodium atoms were too puny, making crisp resolution possible only with tiny creatures such as mice.

Gold and his colleague Brian Hargreaves, PhD, assistant professor of radiology, have designed improved magnets and software to scale up the technology for human application.

They are on the right track, said Ari Borthakur, a University of Pennsylvania scientist who is not involved in Gold’s research but has done pioneering work with sodium MRI since writing his PhD thesis on it some years ago.

“Everything his lab has developed is going to be applicable in the clinics,” said Borthakur. “As America ages, we are expecting to see a huge increase in osteoarthritis, and any technique that could be used for its early diagnosis, or that could help developing therapies for curing it, or even slowing the progression of cartilage loss, would be tremendous.”

Gold and Hargreaves’ project is being conducted with funding from the National Institutes of Health and GlaxoSmithKline, an international pharmaceutical company. Neither researcher owns stock in, or receives consulting fees from, the company.

Working with Hargreaves, Gold has imaged the knees of about a dozen volunteers who have suffered a recent ACL injury. In every case so far, significant losses of glycosaminoglycan can be glimpsed under sodium MRI scanning, despite the absence of any sign of damage to cartilage observed with standard MRI. Almost invariably, sodium MRI scans of the injured knee—but not of the other, uninjured one—reveal glycosaminoglycan deficits within three years of the injury, potentially enabling a vastly accelerated diagnosis.

This ought to speed the development of new therapies, and radically lower the cost of doing so, Gold said. The idea is to be able to use glycosaminoglycan loss as a “surrogate marker” of impending osteoarthritis, much as high LDL levels are used to flag people at risk of heart disease—perhaps years before actual symptoms of heart disease manifest. While not everybody with elevated LDL develops cardiovascular disease, this marker has been sufficiently predictive of that condition that regulatory authorities routinely approve drugs based on their ability to lower LDL.

Catching osteoarthritis during its stealth phase may spur clinical trials that would be prohibitively time-consuming and costly if standard MRI were employed, because of the huge lag from the time of an ACL injury until the time cartilage deterioration can be detected by that old method.

With sodium MRI, cohorts of treated vs. untreated at-risk patients could be imaged over time to see if, within a few years of the injury, a drug or a lifestyle change is reducing or arresting the loss of glycosaminoglycan from the ligament. Once promising drugs or lifestyle changes are identified, they could then be administered to at-risk patients long before symptoms surface, Gold said.

As for Gold himself, he has yet to see what his own damaged knee looks like under sodium MRI. The 6-foot-6 once-avid amateur basketball center’s knee is too big for even his improved new experimental apparatus to fit. It’s probably too late for any kind of imaging to do Gold much good now, anyway. He already knows he’s got arthritis. “I don’t even want to look,” he said.

The Stanford University School of Medicine consistently ranks among the nation’s top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

(http://med.stanford.edu/news_releases/2009/january/sodium.html)

SEE: http://jeannehambleton77.wordpress.com for more health issue stories

Fear Keeps Many From Fighting RA Pain

From the FMS Global and UK News Desk of Jeanne Hambleton

Courtesy of WebMD.com
By Bill Hendrick – WebMD Health News- Reviewed by Louise Chang, MD

March 25, 2009 — Many people with rheumatoid arthritis may have barriers that hinder optimal management of their pain, a study suggests.

Barriers to pain reduction, Canadian researchers say, include fear of medication side effects, fear of drug interactions, worry about drug addiction, concerns that the effects of medication might mask the disease, and aversion to taking too many pills.

McGill University scientists studied 60 patients with rheumatoid arthritis, all of whom were being treated by specialists. Of the rheumatoid arthritis sufferers, 53% described their pain as moderate to severe.

Forty-seven percent reported that pain was mild or absent. And 65% of all patients, including about half of those with moderate to severe pain, were satisfied with current methods to control suffering, the researchers report in the March issue of The Journal of Pain.

Although 87% of the patients reported that they expected to have “some” pain to “much” pain from their rheumatoid arthritis, only 13% didn’t expect any pain or only slight pain.

The researchers, led by Mary-Ann Fitzcharles, MD, of Montreal General Hospital at McGill University, were interested in the potential barriers to reducing pain that kept some people hurting.

The top barriers to optimal pain management found in the study participants included:

Worry of medication side effects (80%)

Not wanting to take “too many pills” (63%)

Worry about medication interactions (57%)

Worry of addiction (35%)

The researchers found that more than half of the patients had at least three barriers.

The researchers conclude that people with rheumatoid arthritis should be questioned vigorously about their pain, and that clinicians should explore potential barriers to effective pain control.

News release, McGill University.
Fitzcharles, M. The Journal of Pain, March 2009; vol 10: pp 300-305.
© 2009 WebMD, LLC. All rights reserved.
(http://www.webmd.com/rheumatoid-arthritis/news/20090325/is-fear-keeping-you-from-fighting-ra-pain?ecd=wnl_cbp_040209)

Hand Exercises Aid Rheumatoid Arthritis

Muscle-strengthening exercises may ease pain and help individuals with RA improve their quality of life

By Gina Shaw -WebMD the Magazine – Feature Reviewed by Michael W. Smith, MD

For 25 years, New Yorker Carol Solomon, 69, ran a knitting store. In 2006, a few years into retirement, she was diagnosed with rheumatoid arthritis (RA) in both hands.

“I have movement in my thumb and in my pointer finger, but my other three fingers are pretty stiff,” she says. Solomon did not want to give up the knitting and sewing she loves, so she sought help from her doctor and physical therapists at New York’s Hospital for Special Surgery.

There is a saying about exercise and RA: Use it, but do not abuse it.

“Studies have shown that strengthening the muscles around the joints leads to overall improved function and better quality of life,” says Heather Williams, DPT, a physical therapist in the Hospital for Special Surgery’s Joint Mobility Center.

“Patients can be afraid to exercise those joints because of pain, but they really benefit from strengthening exercises.”

RA is an autoimmune disease in which the body attacks its own tissues. It is a chronic disease, but when diagnosed and treated early with a combination of medication and physical therapy, joint damage can be limited.

When it affects the hands or wrists, like Solomon’s, some helpful exercises include squeezing small exercise balls or putting the hand out flat, palm up, and bending each finger one by one into the palm. Take it slowly, advises the physical therapist. She says Solomon should try three sets of five repetitions of each exercise instead of 10 or 12 reps — and then work up to more as she builds her strength.

People with RA go through phases called “flare-ups,” with extremely swollen and painful joints, and then “subacute” phases when the disease is less active. Modifying activity depending on what phase you are in is important, says Theodore Fields, MD, clinical director of the Gosden-Robinson Early Arthritis Center at New York’s Hospital for Special Surgery.

“When you have a significant flare-up, the joints need more rest.”

Whatever kind of exercise you do, be sure to discuss your exercise plan with a physical therapist who understands RA.

“Have your physical therapist work out a home-exercise program that fits your needs and respects the joints you have trouble with,” says Fields.

Solomon knows her knitting needles will never fly like they used to, but she has started to work with yarn again and can even sew with a needle and thread, an impossible feat when she first was diagnosed.

“I am just seeing what I can do every day, and trying to adjust the way I do things to give myself as much function as possible,” she says.

Hand Exercise for Rheumatoid Arthritis

The Exercise:
Fill an empty box with small items such as nuts, screws, and bolts. Reach in and, handful by handful, pick the screws and bolts out of one box, place them in your other hand, and place in a second box.

The Benefit:
This exercise helps strengthen muscles around joints for improved finger mobility and helps prevent future joint damage.

Originally published in the September/October 2007 issue of WebMD the Magazine. © 2007 WebMD, Inc. All rights reserved.
(http://www.webmd.com/rheumatoid-arthritis/features/hand-exercises-aid-rheumatoid-arthritis?ecd=wnl_cbp_040209)

Nuclear Medicine: New World of Diagnosing and Treating Illness

From the FMS Global News Desk of Jeanne Hambleton

Courtesy of the Society of Nuclear Medicine – Advancing Molecular Imaging and Therapy
(https://interactive.snm.org/)

IMAGES THE BODY’S BIOLOGICAL PROCESSES

Nuclear medicine is a medical specialty that uses very small amounts of radioactive materials (radiopharmaceuticals) to diagnose, guide management and treat disease. Most nuclear medicine procedures are molecular imaging procedures that use radioactive substances. Molecular imaging procedures are highly effective, safe and painless diagnostic imaging and treatment tools that present physicians with a detailed view of what is going on inside an individual’s body at the cellular level.

Molecular imaging/nuclear medicine specialists can safely, effectively and painlessly determine if certain organs, such as the heart, brain, kidneys, liver, thyroid and lungs, are working properly. A molecular imaging/nuclear medicine procedure commonly used in diagnosing and guiding treatment of cancer patients is PET/CT scanning (see also “PET/CT Scanning: Get the Facts” – see below).

When very small amounts of radioactive materials are introduced into the body by injection, swallowing or inhalation, specific body organs can be targeted. These trace radiopharmaceuticals are detected by special cameras that work with computers to provide pictures of an area of the body, offering information about an organ’s physiology or function. The presence of disease is determined based on biological or molecular changes, rather than changes in anatomy. Radiopharmaceuticals go directly to the organ being targeted and are also used as treatment for hyperthyroidism, certain types of cancer such as thyroid and lymphoma, blood imbalances and pain relief for certain types of bone cancer.

Improves Patient Care

Today, molecular imaging and nuclear medicine offer procedures that are essential in many medical specialties, from pediatrics to cardiology to neurology to oncology. Molecular imaging and nuclear medicine procedures are an invaluable way to gather medical information that would otherwise be unavailable, require surgery or necessitate more expensive diagnostic tests.

These commonly performed biological imaging procedures are an integral part of patient care, identifying abnormalities very early in the progression of a disease-often before medical problems are apparent with other diagnostic tests. Early detection allows a disease to be treated when there may be a more successful prognosis.

Helps in Diagnosis and Treatment

In 2007, an estimated 16 million patients received nuclear medicine procedures in over 7,300 hospital and non-hospital sites in the United States, or approximately 68,000 patients daily (http://www.imvinfo.com). Nearly all hospitals-in addition to many clinics and private doctors’ offices-perform nuclear medicine tests and scans. Safe, effective, painless and commonly performed procedures include positron emission tomography (PET) scans to diagnose and monitor treatment in cancer, cardiac stress tests to analyze heart function, bone scans for orthopedic injuries and lung scans for blood clots.

More than 100 different nuclear medicine imaging procedures are available, and every major organ system can be imaged. Nuclear medicine procedures are used in the diagnosis and evaluation of treatment of:

Neurological diseases
Alzheimer’s disease and dementias
Seizure disorders
Coronary artery disease
Many types of cancer
Endocrine diseases
Thyroid
Parathyroid
Adrenal
Gastrointestinal diseases
Stomach
Liver and gallbladder
Genitourinary diseases
Kidneys
Bladder
Testicles
Pulmonary diseases
Bone diseases
Trauma
Infections

SNM and Nuclear Medicine

SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today’s medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated.

SNM’s more than 17,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit http://www.snm.org.

WHAT IS NUCLEAR MEDICINE?

Nuclear medicine specialists use safe, painless, and cost-effective techniques to image the body and treat disease. Nuclear medicine imaging is unique, because it provides doctors with information about both structure and function. It is a way to gather medical information that would otherwise be unavailable, require surgery, or necessitate more expensive diagnostic tests. Nuclear medicine imaging procedures often identify abnormalities very early in the progress of a disease – long before many medical problems are apparent with other diagnostic tests.

Nuclear medicine uses very small amounts of radioactive materials (radiopharmaceuticals) to diagnose and treat disease. In imaging, the radiopharmaceuticals are detected by special types of cameras that work with computers to provide very precise pictures about the area of the body being imaged. In treatment, the radiopharmaceuticals go directly to the organ being treated. The amount of radiation in a typical nuclear imaging procedure is comparable with that received during a diagnostic x-ray, and the amount received in a typical treatment procedure is kept within safe limits.

Today, nuclear medicine offers procedures that are essential in many medical specialties, from pediatrics to cardiology to psychiatry. New and innovative nuclear medicine treatments that target and pinpoint molecular levels within the body are revolutionizing our understanding of and approach to a range of diseases and conditions.

Would you like to know more about Nuclear Medicine? The SNM has two versions of our What Is Nuclear Medicine brochure available for download and bulk purchase. One is for General Educational Purposes and the second brochure is geared for Patients.

To download the Patients Brochure log on to
http://interactive.snm.org/docs/whatisnucmed2.pdf

© 2009 SNM. All rights reserved
(http://interactive.snm.org/index.cfm?PageID=3106&RPID=#URL.PageID%23)

WHAT IS PET?

Positron Emission Tomography (PET) is a major diagnostic imaging modality used predominantly in determining the presence and severity of cancers, neurological conditions, and cardiovascular disease. It is currently the most effective way to check for cancer recurrences, and it offers significant advantages over other forms of imaging such as CT or MRI scans in detecting disease in many patients. In 2005, an estimated 1,129,900 clinical PET patient studies were performed at 1,725 sites around the country. If you’re interested in learning how a PET scan can benefit you and need additional information, talk with your local health care provider or referring physician. At the end of this page are links to other sites with PET information too.

PET images demonstrate the chemistry of organs and other tissues such as tumors. A radiopharmaceutical, such as FDG (fluorodeoxyglucose), which includes both sugar (glucose) and a radionuclide (a radioactive element) that gives off signals, is injected into the patient, and its emissions are measured by a PET scanner.

A PET scanner consists of an array of detectors that surround the patient. Using the gamma ray signals given off by the injected radionuclide, PET measures the amount of metabolic activity at a site in the body and a computer reassembles the signals into images. Cancer cells have higher metabolic rates than normal cells, so they show up as denser areas on a PET scan. PET is useful in diagnosing certain cardiovascular and neurological diseases because it highlights areas with increased, diminished or no metabolic activity, thereby pinpointing problems.

Cancer and PET

PET is considered particularly effective in identifying whether cancer is present or not, if it has spread, if it is responding to treatment, and if a person is cancer free after treatment. Cancers for which PET is considered particularly effective include lung, head and neck, colorectal, esophageal, lymphoma, melanoma, breast, thyroid, cervical, pancreatic, and brain as well as other less-frequently occurring cancers.

Early Detection:

Because PET images biochemical activity, it can accurately characterize a tumor as benign or malignant, thereby avoiding surgical biopsy when the PET scan is negative. Conversely, because a PET scan images the entire body, confirmation of distant metastasis can alter treatment plans in certain cases from surgical intervention to chemotherapy.

Staging of Cancer: PET is extremely sensitive in determining the full extent of disease, especially in lymphoma, malignant melanoma, breast, lung, colon and cervical cancers. Confirmation of metastatic disease allows the physician and patient to more accurately decide how to proceed with the patient’s management.

Checking for recurrences:

PET is currently considered to be the most accurate diagnostic procedure to differentiate tumor recurrences from radiation necrosis or post-surgical changes. Such an approach allows for the development of a more rational treatment plan for the patient.

Assessing the Effectiveness of Chemotherapy:

The level of tumor metabolism is compared on PET scans taken before and after a chemotherapy cycle. A successful response seen on a PET scan frequently precedes alterations in anatomy and would therefore be an earlier indicator of tumor response than that seen with other diagnostic modalities.

PET and CT or MRI

Because PET measures metabolism, as opposed to MRI or CT, which “see” structure, it can be superior to these modalities, particularly in separating tumor from benign lesions, and in differentiating malignant from non-malignant masses such as scar tissue formed from treatments like radiation therapy. PET is often used in conjunction with an MRI or CT scan through “fusion” to give a full three-dimensional view of an organ and the location of cancer within that organ. The newest PET scanners are a combination of PET and CT devices that provide the important metabolic information from PET superimposed on the high-quality anatomic information from CT.

Neurological Disease

PET’s ability to measure metabolism also has significant implications in diagnosing Alzheimer’s disease, Parkinson’s disease, epilepsy and other neurological conditions, because it can vividly illustrate areas where brain activity differs from the norm.

Alzheimer’s Diagnosis: Until recently, autopsy has been considered the only definitive test for Alzheimer’s disease (AD). Recent studies indicate that PET can supply important diagnostic information and confirm an Alzheimer’s diagnosis. When comparing a normal brain versus an AD-affected brain on a PET scan, a distinctive image appears in the area of the AD-affected brain. This pattern is seen very early in the AD course. Conventionally, the confirmation of AD is a long process of elimination that averages between two and three years of diagnostic and cognitive testing. Early diagnosis can provide the patient access to therapies, which are more effective earlier in the disease.

PET also is useful in differentiating Alzheimer’s disease from other forms of dementia disorders, such as vascular dementia, Parkinson’s disease, Huntington’s disease, etc.

Epilepsy:

PET is one of the most accurate methods available to localize areas of the brain causing epileptic seizures and to determine if surgery is a treatment option.

Cardiovascular Disease

By measuring both blood flow (perfusion) and metabolic rate within the heart, physicians using PET scans can pinpoint areas of decreased blood flow, such as those with blockages, and differentiate living muscle from damaged muscle, which has inadequate blood flow (myocardial viability). This information is particularly important in patients who have had previous myocardial infarction (heart attack) and who are being considered for a procedure such as angioplasty or coronary artery bypass surgery.

Cost & Reimbursement:

PET scan charges range from $850–$4,000, depending on the type of scan. American Insurance companies will cover the cost of many PET scans. Medicare reimburses for almost all cancers. Some indications have already been determined to be reimbursable, others are reimbursed as long as they are part of a qualified clinical trial or a clinical study to determine the effectiveness of PET in imaging specific cancers. Medicare is constantly updating reimbursements, so visit the SNM Web site to find the latest information.

History of PET

In the 1970s PET scanning was formally introduced to the medical community. At that time it was seen as an exciting new research modality that opened doors through which medical researchers could watch, study, and understand the biology of human disease.

In 1976, the radiopharmaceutical fluorine-18-2-fluoro-2-deoxyglucose (FDG), a marker of sugar metabolism with a half-life of 110 minutes, enabled tracer doses to be administered safely to the patient with low radiation exposure. The development of radiopharmaceuticals like FDG made it easier to study living beings, and set the groundwork for more in-depth research into using PET to diagnose and evaluate the effect of treatment on human disease.

To perform PET studies in the late 1970s, a large staff was needed: physicists to run the cyclotron that produces the fluorine-18 and to oversee the scanner, chemists to make the tracers such as FDG, and dedicated, specialist physicians.

During the 1980s the technology that underlies PET advanced greatly. Commercial PET scanners were developed with more precise resolution and images. As a result, many of the steps required for producing a PET scan became automated and could be performed by a trained technician and experienced physician, thereby reducing the cost and complexity of the procedure. Smaller, self-shielded cyclotrons were developed, making it possible to install cyclotrons at more locations.

Over the last several years, the major advance in this technology has been the combining of a CT scanner and a PET scanner in one device. The modern PET/CT scanner allows a study to be done in a shorter amount of time but still provides more diagnostic information.

PET Today

PET and PET/CT are widely available today. The technology is robust and provides high-quality images. Some of the earlier roadblocks to having or using a PET or PET/CT device—such as availability of particular radiopharmaceuticals—are no longer present.

Reviewed by R. Edward Coleman, MD

© 2009 SNM. All rights reserved.

Chronic Opioid Therapy Guidelines Offer Direction for Physicians

From the FMS Global News Desk of Jeanne Hambleton

Courtesy of Fibromyalgia Network – February 2009

While patients are rightfully concerned about not receiving adequate pain relief, physicians harbor fears about drug abuse, safety issues, and government oversight. New clinical guidelines for the use of chronic opioid therapy in chronic non-cancer pain patients, developed by consensus of the American Pain Society and the American Academy of Pain Medicine, may ease both patient and physician concerns.

The guidelines, published in the February issue of the Journal of Pain, offer a roadmap for physicians on how to safely prescribe opioids to patients with moderate to severe pain.* The authors specifically state that their report applies to patients with “chronic non-cancer pain conditions, including common conditions such as back pain, osteoarthritis, fibromyalgia, and headache.”

Throughout the guidelines, physicians are urged to evaluate their patients’ pain and function on a regular basis. And, if doctors are worried that a patient is abusing or misusing the prescribed opioid, they may need to reduce the time between scheduled office visits. In addition, physicians are encouraged to look at all of the available options for treating patients’ chronic pain, including the use of opioids, and it is emphasized that this class of medications will seldom provide sufficient pain control. This means that patients placed on opioids will likely need to be prescribed medications from other drug classes as well as non-drug therapies. And, physicians who do not have the skill-set to prescribe opioids need to coordinate their patients’ care with another doctor who is experienced in providing this therapy.

The American Pain Society emphasized the following three points to all its members this month:

The guidelines are comprehensive and evidenced-based to assist physicians in managing chronic opioid therapy, according to the American Pain Society President Charles Inturrisi, Ph.D

“Regular monitoring of chronic opioid therapy patients is warranted because the therapeutic benefits of these medications are not static and can be affected by changes in the underlying pain condition, coexisting disease, or in psychological or social circumstances,” said Gilbert J. Fanciullo, M.D., director of the division of pain and palliative care at Dartmouth Hitchcock Medical Center.

Cochair Perry Fine, M.D., professor of anesthesiology at the University of Utah Medical Center, added that doctors do not have to solely rely upon patient self reports. Pill counts, urine drug screening, family member or caregiver interviews, and prescription monitoring data may all be used to check for possible abuse or other opioid-related problems.

The message is clear that under most circumstances, there are reasonable ways for physicians to prescribe chronic opioid therapy for their patients in pain while emphasizing safety issues and minimizing side effects or the potential for drug misuse. The guidelines offer physicians 25 recommendations with detailed explanations on how to follow them—all to help doctors prescribe opioids to their chronic pain patients in a responsible fashion. In addition to the key points already made, here are other highlights from the published guidelines:

Clinicians may consider a trial of chronic opioid therapy (COT) for moderate to severe pain that is having an adverse impact on a patient’s function or quality of life as long as the therapeutic benefits outweigh the risks (abuse, misuse and addiction). Three different patient screening tools (questionnaires that are easy to administer) are included with the guidelines to help doctors assess potential risks associated with COT for a given patient (the SOAPP, the ORT, and the DIRE).

Before initiating a trial of COT, physicians should provide their patients with informed consent, which alerts patients to all of the potential risks associated with taking opioids. After informed consent, doctors should discuss with their patients a COT management plan that outlines the goals of therapy, expectations, monitoring requirements, etc. A sample consent form and management plan are included in the guideline.

Initial treatment with an opioid should be regarded as a therapeutic trial to determine if COT is effective. If the first opioid does not work or produces adverse side effects, other types of opioids may be tried, but patients need to keep in mind that opioids are prescribed on a trial basis.

Physicians should anticipate, identify, and track common opioid-associated side effects. Constipation is the most frequent problem, and unfortunately it does not go away or get better with continued use of the medication. With this in mind, doctors should recommend stool softeners or increased fiber intake when issuing patients an opioid prescription. Nausea or vomiting may occur but tends to diminish over a few days. If it lasts longer, doctors can prescribe a medication to treat this side effect. Sedation and clouded thinking usually goes away with continued opioid use, while reduction in sex hormones may appear down the road with COT. If a patient begins to experience a decrease in libido, sex hormones can be checked and supplemented if necessary. Other side effects may also occur, so patients and physicians need to be on the lookout for them.

Chronic pain is often a complex condition and physicians who prescribe COT should routinely promote other therapies, such as psychotherapy (pain can be awful to cope with), physical and occupational therapies for restoring function, and other non-drug approaches in addition to prescribing other non-opioid medications. The purpose of this recommendation is to treat the whole person and improve the odds that a patient with chronic pain will achieve a more fulfilling life.

Doctors need to counsel patients prior to starting COT and continue until a stable dose is reached or if the dose is later increased as the patients’ cognitive skills may be impaired for a short period of time. If clouded thought processes do occur, driving should temporarily be avoided … so patients might want to start an opioid on a weekend when they do not have to drive. After a stable dose is reached, there is no evidence to suggest that patients on COT should be restricted from driving or engaging in most work activities.

The opioid guidelines give your doctor the “how to” advice for prescribing opioids, including sample copies of patient screening questionnaires, a consent form, management plan, and full details on how to responsibly prescribe opioids. However, they also assume that the prescribing physician is already knowledgeable about issues concerning this class of medications (i.e., the guidelines cannot possibly convert a novice into an expert on COT). Neither the patient nor physician should feel awkward about the consent and management forms, or random urine tests. Doctors who follow these guidelines should be better equipped to implement opioid therapies for their chronic pain patients (such as fibromyalgia) in a safe manner.

* Chou R, Fanciullo GJ, Fine PG, et al. J Pain 10(2):113-130, 2009.

Calling the Kettle Black
… editorial comment

By Kristin Thorson, Editor, Fibromyalgia Network

Posted: February 27, 2009

If your newspaper ran the February 8th Associated Press article “Drugmakers’ push boosts ‘murky’ ailment,” implying that the drug industry has fabricated fibromyalgia in an effort to churn a profit, you have every right to be furious!1 Controversy sells, and that was what the reporter, Matthew Perrone banked on. Perrone sought out Fred Wolfe, M.D., of Wichita, KS, because he knew from the January 14, 2008 front-page article in the New York Times that Wolfe had a track record for trashing patients with fibromyalgia and big, bad pharma as well. It is ironic, however, that Wolfe would make derogatory statements about the drug industry when he is heavily funded by six drug companies himself.

Wolfe is the director (and paid employee) of the National Data Bank for Rheumatic Diseases, a nonprofit registered as The Arthritis Research Center Foundation, Inc. Its mission is “conducting ongoing research to improve conditions for people with arthritis, fibromyalgia, lupus and other conditions.” He openly declares in his research papers, in which he is testing the effectiveness and safety of drugs for rheumatoid arthritis, that he is funded by Centocor, Aventis, Pfizer, Bristol-Myers Squibb, Amgen, and Abbott. So perhaps Wolfe’s dislike is not so much for the drug industry as it seems for fibromyalgia.

Prompted by mixed reports on increased cancer rates in people with rheumatoid arthritis (RA), Wolfe conducted an observational study on the incidence of cancer in RA patients who took the tumor necrosis factor (TNF) blocking agents Enbrel (etanercept) or Remicade (infliximab).2 His findings were derived from information in the National Data Bank (NDB) and per the NDB’s agreement with Centocor, the maker of Remicade, the drug company was allowed to review Wolfe’s manuscript prior to publication. But Wolfe does not just cater to Centocor. His NDB organization has similar contractual agreements with Bristol-Myers Squibb and Sanofi-Aventis.

Wolfe’s study contradicted earlier reports of increased cancer risks for RA patients taking Enbrel or Remicade. It also confirmed that TNF blocking drugs are linked to skin cancers, including potentially deadly melanomas. Instead of using his findings to alert the medical community that these drugs may pose a health hazard, Wolfe went on record with WebMD as stating: “The drugs, at this moment, do not seem to add any risk except for skin cancer and melanoma. This is a small overall risk and I do not think people should be concerned.” He also added that the risks did not outweigh the benefit for patients who truly need the new drugs.3

While there is no argument that people with RA deserve effective therapies, do you not think it is odd that Wolfe is the one pushing drugs on RA patients while in the recent AP article he bashes the drug industry for fabricating fibromyalgia to boost their sales? Yet he is quoted in the AP article as saying, “I think the purpose of most pharmaceutical company efforts is to do a little disease-mongering and to have people use their drugs.” Further in the article he says, “The underlying purpose here is really marketing, and they do that by sponsoring symposia and hiring physicians to give lectures and prepare materials.” Wolfe’s negative sentiments about fibromyalgia appear clear in a February 2009 report in which he writes, “Recently, regulatory authorities have approved treatments for fibromyalgia, offering some de facto support, although no proof, for fibromyalgia as a distinct disorder.”4 However, there was a time when RA had no “proof,” but that does not mean that the patients who suffered with it years ago did not have a real disease.

It is true that Wolfe was the lead author for the 1990 American College of Rheumatology criteria for fibromyalgia, but that was 18 years ago and much has changed.5 In 1990, the number of rheumatologists who were skeptical about the realness of fibromyalgia far outnumbered the believers. I should know, because I hosted an information booth on fibromyalgia at the annual rheumatology meetings throughout the 1990s, and in the early years I can attest to the ugly controversies surrounding this disease.

In 1994, Wolfe orchestrated a consensus conference (paid by the insurance industry) whose primary goal was to trivialize fibromyalgia and restrict patient care.6 Why he wanted to turn his back on fibromyalgia is still unknown, but his efforts failed. During the past eight years, the rheumatologists have rallied to increase the legitimacy of fibromyalgia by developing guidelines for improving the quality of research and for testing therapies to treat this patient population. Today, Wolfe and many of his colleagues do not see eye to eye when it comes to issues concerning fibromyalgia. At age 74, he appears to get his jollies by trash-talking fibromyalgia to headline-mongering reporters.

For all of you who were subjected to the AP story, I hope my comments help you understand the nonsensical nature of the article and that you can ignore any future reports that happen to quote Wolfe. I also want to make three additional points about the AP article:

Although Wolfe’s own nonprofit takes money from the drug companies, this does not mean that all nonprofits and organizations that help patients must do the same to stay afloat. Fibromyalgia Network and its sister organization, the American Fibromyalgia Syndrome Association (AFSA), have never received money from the pharmaceutical industry or other companies that could bias the way these two organizations operate.

Daniel Clauw, M.D., of the University of Michigan, did receive a small grant award from the National Fibromyalgia Research Association (NFRA) in Salem, OR, but the NFRA should not be confused with the National Fibromyalgia Association (NFA). NFRA does not receive money from the drugmakers.

The article implies that Clauw’s brain imaging research, which has documented many brain processing abnormalities over the past ten years, was tainted by drug money. That simply is not true because the funding for these studies came from government grants based on the merits of his proposals. “Most of us conducting research in the field of fibromyalgia were here ten years before the drug industry even took notice of this disease,” Clauw points out.

Perrone M. Associated Press © hosted by Google, Feb 8, 2009; (AP article).
Wolfe F, Michaud K. Arthritis Rheum 56(9):2886-2895, 2007.
DeNoon DJ. WebMD Health News Aug. 29, 2007; (WebMD article).
Wolfe F, Michaud K. J Rheumatol First Release Feb. 15, 2009; doi:10.3899/jrheum.080897.
Wolfe F, et al. Arthritis Rheum 33(2):160-72, 1990.
Wolfe F. J Rheumatol 23(3):534-9, 1996.

Kaufmann I, et al. Rheumatol Int [epub ahead of print] December 4, 2008.
Kaufmann I, et al. Clin Immunol 125:103-111, 2007.

(http://www.fmnetnews.com/basics-news.php#opioid)
All information on this site is copyrighted by
Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929.
This site is provided for informational purposes only. To remain unbiased, we do not accept endorsements, advertisements, or pharmaceutical industry grants. Patients should always consult their physician for medical advice and treatment.

Health Benefits of Intravenous Nutrient Therapy – Myers Cocktail

From the FMS Global News Desk of Jeanne Hambleton

Courtesy HealthNotesNewswire

By Darin Ingels, ND

EDITOR’S NOTE: While I appreciate this was written in 2003 I do know that many fibromites are regularly given the ‘Myers Cocktail’ to relieve pain. I felt the background would be interesting. However I would recommend you read the Consumer Alert written May/June 2007 on the FM Net News website (http://www.fmnetnews.com/resources-alert-product8.php) for another view point. Please do not shoot the messenger I am merely reporting what I have found. I have a good friend who has these injections from time to time and she believes they do her the world of good. See the FM Net News report. Without prejudice. JH)

Healthnotes Newswire (January 16, 2003)

Administering a vitamin and mineral formula (known as the Myers cocktail?) intravenously may be useful in treating a variety of medical problems, according to a report in Alternative Medicine Review (2002;7:389?403). Although few studies have been published on this therapy, many physicians have observed its benefit in treating migraine headaches, fatigue, allergies, heart disease, acute asthma attacks, fibromyalgia, infections, and other conditions.

The Myers cocktail was pioneered by John Myers, MD, a physician from Baltimore, Maryland, who developed this treatment more than 30 years ago. The doses of the various nutrients were subsequently modified, based on more recent information, by Alan R. Gaby, MD, the author of the report.

The vitamin-mineral combination includes magnesium, calcium, vitamin B12 (hydroxocobalamin), vitamin B6 (pyridoxine), vitamin B5 (dexpanthenol), vitamin B complex, and vitamin C. Intravenous therapy can raise blood levels of nutrients to a considerably greater extent than oral therapy can, and some doctors believe that achieving these high blood levels has therapeutic benefits in certain clinical situations. The benefits of the Myers cocktail may be due to the drug-like (pharmacological) effects of some nutrients (for example, high concentrations of vitamin C kills viruses), or to improved transport of nutrients from the blood into the cells. More research is necessary to clarify this issue.

Some physicians who use the Myers cocktail report that it is particularly useful in treating acute asthma attacks and acute migraine headaches. Relief of symptoms usually occurs within minutes of administering the concoction. It is not clear whether the benefits are due to one nutrient or to the combination of nutrients, but other studies have shown that intravenous magnesium alone can reduce the symptoms of asthma and migraines. However, the author?s observation is that the Myers cocktail is more beneficial for acute asthma attacks than is magnesium alone.

The author and other physicians have found that the Myers cocktail is also useful in treating angina, chronic fatigue syndrome, bronchitis, sinusitis, fibromyalgia, hayfever, chronic hives, narcotic withdrawal, hyperthyroidism, muscles spasms, tension headaches, and some cases of mild to moderate depression. While many people improved after the first treatment, others required several treatments to achieve the maximum benefit, suggesting this therapy may have a cumulative effect. The number of treatments needed varies by person and condition. Some individuals obtain long-lasting relief after a few treatments, while others require ongoing treatments to maintain the benefit. The risk of serious adverse reactions is said to be low and the treatment is usually well tolerated.

The most common side effect of the Myers cocktail is a sensation of warmth, particularly if the injection is given rapidly. This effect is primarily due to magnesium, although calcium may also be a contributing factor. People with low blood pressure may be more prone to this side effect than those with normal or high blood pressure. People taking digoxin (Lanoxin®) and medications that deplete potassium should be cautious in using this treatment, since giving magnesium intravenously to such individuals could induce an irregular heart beat. The Myers cocktail can be prescribed only by a medical doctor, osteopath, or, in some states, a naturopath.

Although most of the reported benefits of the Myers cocktail are anecdotal, doctors who use this treatment are convinced that it often produces results not achievable by any other means. Controlled studies are needed to verify these clinical observations.

Darin Ingels, ND, MT (ASCP), received his bachelor?s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.

Copyright © 2003 Healthnotes, Inc. All rights reserved. Healthnotes Newswire is for educational or informational purposes only, and is not intended to diagnose or provide treatment for any condition. If you have any concerns about your own health, you should always consult with a healthcare professional. Healthnotes, Inc. shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Healthnotes and the Healthnotes logo are registered trademarks of Healthnotes, Inc.

(http://www.thevitaminservice.com:healthnotes.asp%3Forg=vitaminservice&page=newswire:newswire_2003_01_16_2.cfm..webarchive)

Consumer Alerts Myers’ Cocktail
Courtesy Fibromyalgia Network

Many treatment centers for fibromyalgia are heavily promoting the use of intravenous (IV) Myers’ nutrient therapy, or what many call a modified Myers’ cocktail. The advertisements often boast that you can receive up to 60% reduction in pain and an 80% reduction in fatigue. They also claim that you will notice these symptom improvements within two days of receiving the Myers’ IV cocktail.

Myers was a physician who believed that an IV infusion of the ingredients below would help jump-start symptom improvements (especially fatigue) in people with chronic illnesses, but never published data to substantiate his theory. So why is it that treatment centers are claiming you can reap amazing improvements in pain and fatigue with the Myers’ cocktail? They are basing it on a report of seven women with fibromyalgia (and no control subjects for comparison) by Patrick Massey, M.D., Ph.D., of Elk Grove Village, IL.*

Although Massey is to be commended for trying to evaluate a nutrient treatment for fibromyalgia patients, the results of his study are being taken out of context for the promotional use of this expensive therapy ($200 – $300 a shot). Massey selected seven fibromyalgia patients who were already under his care and tried to help them with eight weekly Myers’-type IV infusions. He asked the seven patients to rate their pain and fatigue prior to the first IV, and then to rate these symptoms as a weekly average when they returned to his office for the next infusion. The seven patients knew that they were being given something new to help ease their fibromyalgia symptoms, which could understandably lead to high expectations for health improvements. This was not a blinded or placebo-controlled study.

Massey states in his report that the eight-week therapy reduced pain by 60% and fatigue by 80%. However, due to the lack of a placebo comparison group, the small number of patients in the study, the power of suggestion (the “white coat” effect because doctors often wear white lab coats), and the fact that all seven patients knew they were receiving the nutrient therapy and not a placebo, patients cannot bank on these results. The mere power of suggestion by the person in the white coat (even if it is not intended) may produce phenomenal results from a placebo or sugar pill.

In the discussion part of the report, Massey comments that the therapy is short-lived-lasting between 24 and 48 hours. Yet he provides no data to substantiate this claim. Promoters of the IV Myers’ cocktail may reference the 24-48 hour time frame to imply the speed at which patients should notice symptom improvements, but it is actually the estimated duration of the relief. If you have received IV nutrient therapies before, only to find that they do not produce long-lasting symptom benefits (if any at all), this could be the reason why. Yet, regular infusions of this nature are not practical and they are expensive (approximately $250 per infusion).

Why is the Myers’ cocktail so expensive? Any treatment approach that includes an IV is costly. The ingredients in this IV therapy are relatively cheap when taken orally as nutritional supplements. If one were to take the nutrients in the IV dose over 48 hours as an oral supplement, then the cost per month would be less than $15, as compared to four IV treatments a month totaling about $1,000. (See the third column in the table above for the daily equivalent oral doses.) Patients who are concerned that their diet is deficient in these essential nutrients have little to lose by trying this oral supplementation approach. All you need to do is purchase three supplements: 1) vitamin B complex, 2) vitamin C, and 3) magnesium. The vitamin C formula should be buffered and the magnesium should be chelated so these supplements are gentle on your stomach.

* Massey PB. Alternative Therapies 13(3):32-34, May/June 2007.

Modified Myers’ IV Formula (may provide up to 48 hours of relief) includes the following:
Magnesium chloride hexahydrate, Calcium gluconate, Vitamin C , Hydroxocobalmin (B12) , Pyridoxine hydrochloride (B6), Dexpanthenol (B5) Riboflavin (B2), Thiamine (B1), Niacinamide (B3).
Estimated Costs $250/IV Dose, $15/Month. For quantities please log on to the Fibromyalgia Network website as below.

(http://www.fmnetnews.com/resources-alert-product8.php)

All information on this site is copyrighted by Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929.
This site is provided for informational purposes only. To remain unbiased, we do not accept endorsements, advertisements, or pharmaceutical industry grants. Patients should always consult their physician for medical advice and treatment.

Chili Pepper Compound Can Bring Pain Relief

From the FMS News Desk of Jeanne Hambleton

COURTESY usnews.com Health Day – Monday March 16

Capsaicin works on nerves to ease joint discomfort, scientists say

(HealthDay News) – University of Buffalo scientists say they have found how capsaicin, the compound that gives chili peppers their fiery flavor, also works to relieve joint and muscle pain.

In a study appearing Tuesday in the journal PLoS Biology, researchers found that capsaicin flips on nerve-ending receptors that sense both pain and heat.

“The receptor acts like a gate to the neurons. When stimulated it opens, letting outside calcium enter the cells until the receptor shuts down, a process called desensitization,” study leader Feng Qin, an associate professor at the university’s School of Medicine and Biomedical Sciences, said in a news release issued by the institution.
The flood of calcium changes the levels at which the receptors detect pain signal. “In other words, the receptor had not desensitized per se, but its responsiveness range was shifted,” Qin said.

While capsaicin has been used in folk medicines for generations, knowing how it works in relation to PIP2 may lead to developing other analgesics that ease pain without first causing irritation on their own, the team said.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about capsaicin .
(http://health.usnews.com/articles/health/healthday/2009/02/25/chili-pepper-compound-can-bring-pain-relief.html)

Finding Effective Treatment for Your Chronic Pain

Studies are underway to look into the effectiveness of alternative ways of delivering pain medications

By January W. Payne

Chronic pain is a problem that—when healthcare, lost income, and lost productivity are taken into account—is estimated to cost about $100 billion in the United States each year. More than a quarter of Americans age 20 or older, or about 76.5 million people, say they’ve experienced pain that lasted longer than 24 hours, according to the American Pain Foundation—and 42 percent have endured pain lasting longer than a year. Nobody keeps good long-term national stats, but if North Carolina’s experience is any guide, the numbers are on the rise.

A just-published study in the Archives of Internal Medicine found that the prevalence of chronic low-back pain in the state more than doubled, to 10.2 percent, between 1992 and 2006. Paul J. Christo, assistant professor and director of the Multidisciplinary Pain Fellowship at the Johns Hopkins University School of Medicine, calls undiagnosed, untreated, or undertreated pain a “significant public-health problem.”

Chronic pain encompasses a multitude of ills, from back pain, headaches, neck pain, and conditions like arthritis and fibromyalgia to pain that develops as a result of cancer treatment and lingers for months or even years. Low-back pain, migraines, and joint pain (particularly in the knees) are among the most common complaints, according to the National Center for Health Statistics. knee pains,

Still, while it may have different origins, chronic pain “can be viewed as an illness in its own right because of its effect on function,” says Russell Portenoy, chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City.

Studies have shown that some people with chronic pain have brain abnormalities, though the connection between that and pain is not well understood. One recent study, for instance, showed that women with fibromyalgia had blood flow abnormalities in a region of the brain known to discriminate the intensity of pain that were not observed on CT scans done in healthy women.

Another study showed that chronic pain may harm the wiring of the brain, as demonstrated on functional MRIs. Chronic pain may also be caused by a problem with the “fight or flight” response, Christo says. “We believe that in certain pain conditions . . . the stress response can worsen pain because that stress response releases a chemical called noroepinephrine. . . . And noroepinephrine binds to certain receptors in the body that trigger pain.”

“Pain is essentially an alarm system that is designed to grab your attention, and when it works properly, it signals harm or healing,” says Scott Fishman, professor and chief of the division of pain medicine at the University of California-Davis School of Medicine. When the body heals, the pain should dissipate, but “the nervous system can become injured,” Fishman says. “That’s when the symptom of pain becomes the disease of chronic pain.”

Finding relief can take quite an effort, since the causes are often not immediately clear and there is not a sure-fire treatment. The battle can require a team of experts, so the multidisciplinary pain clinics or pain management programs that have sprouted up at hospitals, rehab centers, and in free-standing facilities over the past decade or so may be of particular help.

The clinics provide an all-in-one setting for care that, in addition to pain management specialists who may be trained as neurologists, psychiatrists, physiatrists, or anesthesiologists, may include physical therapists, family and vocational counselors, and massage therapists, for example. (The American Chronic Pain Association offers advice on selecting a pain clinic.)

After a full assessment, tailored treatment may include medications from anti-inflammatory drugs to antidepressants to opioids. Since commonly prescribed opioid medications such as oxycodone, fentanyl, and morphine can cause addiction, the American Pain Society and the American Academy of Pain Medicine have just released the first comprehensive clinical practice guidelines to help physicians make treatment decisions.

The guidelines, published in the Journal of Pain, suggest that physicians regularly assess people taking long-term opioids and do periodic drug screenings of patients who are considered to be at risk for abuse or addiction. Meanwhile, the Food and Drug Administration announced plans this month to require the brand-name and generic makers of morphine, oxycodone, fentanyl, and methadone to assist with a plan to reduce the risks associated with the drugs.

Other treatment options include injections of steroids or other medications, nerve blocks that interrupt pain signals, physical therapy, alternative therapies, and psychological interventions such as cognitive behavioral therapy, biofeedback, and guided imagery and other relaxation techniques. Acupuncture, which some people with pain find helpful, is thought to ease pain by raising the level of endorphins in the body, Christo says. “Endorphins are sort of like opioids. . . . They are natural pain relievers,” he says.

“They are released when the body experiences pain—when you sprain your ankle, cut your finger, in response to injury.” Still, research offers conflicting conclusions about the pain-relieving effects of acupuncture. A review of 13 studies published last month in British Medical Journal found that acupuncture offered only a small level of pain relief for people with low-back pain, migraines, knee osteoarthritis, and postoperative pain.

Jennifer Phillips, 41, of Providence Forge, Va., saw 54 doctors before the fibromyalgia that caused her pain was diagnosed in 1996. Finally, after seeing an internist whose nurse had fibromyalgia, she found a routine that works for her: a combination of proper sleep (achieved, in part, using the tricylic antidepressant amitriptyline), daily supplements of vitamins, magnesium, and potassium, plenty of water, and a low-carb diet.

The search is on for greater relief. Studies are underway to look into the safety and effectiveness of alternative ways of delivering pain medications, such as an inhaled form of fentanyl that would get the drug into the patient’s system more quickly. For older people who have fractures of the spine, vertebroplasty and kyphotlasty—two minimally invasive techniques in which bone cement is injected into the collapsed bone in the spine—can result in “significant pain reduction,”

Christo says. In the ongoing debate over how best to handle back pain, a study just published in the Journal of the American Academy of Orthopaedic Surgeons finds that the most effective way to treat most degenerative disc disease cases is to combine physical therapy and anti-inflammatory medications, rather than having surgery.
While it may seem counterintuitive, people with chronic pain should try to get exercise. Experts say it is important to keep moving, both for the usual cardiovascular reasons and in order to avoid muscle atrophy. A supervised, individually designed exercise program, incorporating stretching or strengthening, may improve pain and functioning in people with chronic low-back pain, according to a 2005 study published in Annals of Internal Medicine.

A physical therapist or personal trainer can offer the necessary advice. In fact, staying in bed for more than a day or two can make back pain worse, according to the National Library of Medicine’s MedlinePlus.

Jeff Nance of Indianapolis, whose chronic pain is caused by degenerative disc disease and spinal stenosis of his lower back, recalls that he barely wanted to leave his home three years ago. Then he discovered the Meridian Health Group pain clinic in Indianapolis. Now he is working full time again, and he recently participated in an annual bike ride across the state of Indiana. Nance goes back to the clinic every few months for a check of his medications, and he sees a psychologist a couple of times a month.

“What we try to do is really recognize that people can have pain for all kinds of reasons, [and we] find as many of those causes as possible and treat them in the most specific fashion as possible,” says Michael Clark, associate professor and director of the Chronic Pain Treatment Program in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Hospital. “Ultimately, you’d like to get somebody well.”

(http://health.usnews.com/articles/health/pain/2009/02/10//finding-effective-treatment-for-your-chronic-pain.html?loomia_ow=t0:a41:g2:r2:c0.160667:b22273524&s_cid=loomia:chili-pepper-compound)

Copyright © 2009 U.S.News & World Report LP All rights reserved.

Disability Equality

From the Fibromyalgia News Desk of Jeanne Hambleton

Courtesy News Distribution Service for Government and Public Sector
Department for Innovation, Universities and Skills (National)

The Government has highlighted progress towards achieving its ambition of equality for disabled people by 2025 with the publication of a series of reports from 11 Secretaries of State, the Office for Disability Issues’ (ODI) annual report and additional research about the Disability Equality Duty.

The reports by the 11 Secretaries of State are the first of their kind. They identify progress towards disability equality made by each department and where there are still issues to address. They also show how departments and public bodies will work strategically to introduce mechanisms for change. The ODI has produced an overview of the Secretary of State reports, highlighting key findings from each.

Also, the ODI annual report shows continuing work towards improving life chances for disabled people, including:

* £35 million committed to improving childcare provision for disabled children over the next three years

* An increase over the past year in the number of accessible buses, trains and stations
* Cross-government initiatives to improve recording and prosecution of disability-related hate crime

* A 20 per cent increase in the Disabled Facilities Grant in 2009, with a further six per cent scheduled for 2010

•A 60 per cent increase in disabled students’ allowances in the last year

The ODI has also published research on Disability Equality Duty implementation more generally across England, showing a growing awareness of disability equality issues and the value of involving disabled people in the development of Disability Equality Schemes.

Jonathan Shaw, Minister for Disabled People, said: “This shows real progress towards realising our vision of disability equality by 2025 and reflects the hard work of many people across government. The Secretary of State reports are the first of their kind and illustrate the Government’s commitment to ensuring disabled people have the same chances in life as everyone else.”

Stephen Martin, Director of the Office for Disability Issues said: “These reports underscore the importance of proactively addressing the barriers that still keep many disabled people from reaching their full potential and realising their hopes, dreams and aspirations. We have made a lot of progress, but there is still much to be done. The ODI looks forward to continuing to work effectively with all of our partners in government and others to make the vision of equality by 2025 a reality.”

* The Office for Disability Issues was established in 2005 following a recommendation in the Improving the Life Chances of Disabled People report. It is a cross-government unit that works with all departments to help maintain the shared commitment to improving opportunities and outcomes for disabled people. http://www.odi.gov.uk.
nvisible disability

(https://nds.coi.gov.uk/content/detail.asp?ReleaseID=386304&NewsAreaID=2&NavigatedFromSearch=True)

Fibromyalgia Research News

From the Fibromyalgia FMS Global News Desk of Jeanne Hambleton

A service of the U.S. National Library of Medicine – NCBI – http://www.pubmed.gov
and the National Institutes of Health

Multidisciplinary care and stepwise treatment for fibromyalgia
J Clin Psychiatry. 2009 Feb 9;69(12):e35.

Arnold LM, Bradley LA, Clauw DJ, Glass JM, Goldenberg DL.
Division of Women’s Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, sleep abnormalities, and common comorbidity with psychiatric and medical disorders. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Sensitive and appropriate methods of diagnosis and an integrated treatment plan including proper patient education, aerobic exercise, and cognitive-behavioral therapy have been shown effective in alleviating fibromyalgic symptoms. The development of a comprehensive, multidisciplinary disease management strategy is a difficult but essential challenge facing clinicians treating patients with fibromyalgia. Copyright 2008 Physicians Postgraduate Press, Inc.

PMID: 19203485 [PubMed - in process] Courtesy of NCBI & PubMed

Assessing and diagnosing fibromyalgia in the clinical setting
J Clin Psychiatry. 2008 Nov 6;69(11):e33.

Clauw DJ.
Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

Fibromyalgia is a common and disabling condition that may be difficult to assess and diagnose owing to its wide range of symptoms and common comorbidities. The most common symptoms of fibromyalgia include widespread pain over the whole body, pain at specific tender points, fatigue, memory and other cognitive problems, sleep and mood disturbances, and impaired functioning. Accurately diagnosing fibromyalgia may require diagnostic testing and physical examinations such as tender points examinations; however, patients with longstanding symptoms may be diagnosed according to a symptom-based fibromyalgia criteria checklist. This activity provides a sample assessment and diagnosis in a clinical situation. Copyright 2008 Physicians Postgraduate Press, Inc.

PMID: 19200425 [PubMed - in process] Courtesy of NCBI & PubMed

Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions
Clin Rheumatol. 2009 Jan 27. [Epub ahead of print]

Okifuji A, Bradshaw DH, Olson C

Pain Research and Management Center, Department of Anesthesiology, University of Utah, 615 Arapeen Drive, Suite 200, Salt Lake City, UT, 84108, USA, akiko.okifuji@hsc.utah.edu.

The aim of this study was to investigate the associations between obesity and fibromyalgia syndrome (FMS). This study was conducted at the University of Utah Pain Management and Research Center, Salt Lake City, Utah. Thirty-eight FMS patients were included in this study. Neuroendocrine indices (catecholamines, cortisol, C-reactive protein [CRP], and interleukin-6), symptom measures (Fibromyalgia Impact Questionnaire), sleep indices (Actigraph), and physical functioning (treadmill testing) were measured. Body mass index (BMI) provided the primary indicator of obesity. Approximately 50% of the patients were obese and an additional 21% were overweight. Strong positive associations were found between BMI and levels of IL-6 (r = 0.52) and epinephrine (r = 0.54), and somewhat weaker associations with cortisol (r = 0.32) and CRP (r = 0.37). BMI was also related to maximal heart rate (r = 0.33) and inversely related to distance walked (r = -0.41). BMI was associated with disturbed sleep: total sleep time (r = -0.56) and sleep efficiency (r = -0.44). No associations between self-reported symptoms and BMI were found. This study provides preliminary evidence suggesting that obesity plays a role in FMS-related dysfunction.

PMID: 19172342 [PubMed - as supplied by publisher] Courtesy of NCBI & PubMed

Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study
Clin Rheumatol. 2009 Jan 24. [Epub ahead of print]

Pamuk ON, Dönmez S, Cakir N.

The objective was to determine the relationship between symptoms of fibromyalgia (FM) and early menopause and hysterectomy. We included 115 postmenopausal patients with FM (mean age 54.6 +/- 7.6) and 67 rheumatoid arthritis (RA) patients (mean age 55.5 +/- 9) into our study. All patients were questioned about the severity of their symptoms of FM, anxiety, and depression by using a visual analog scale and FM impact questionnaire. Patients’ history of menopause and hysterectomy were recorded. Menopause ( 0.05). FM-related symptoms started in 30 patients (26.1%) with FM with menopause or within the first postmenopausal year. When the clinical features of FM patients whose symptoms started within the first menopausal year were compared to other FM patients; it was observed that the frequency of early menopause was higher in the former group (p = 0.048). Duke anxiety and depression score was higher in patients with hysterectomy whose FM symptoms started within the first year of post-hysterectomy than other FM patients (9.1 +/- 2.7 vs. 6.7 +/- 2.7, p = 0.022). Early menopause and hysterectomy may be one of the factors contributing to the development of FM.

PMID: 19169621 [PubMed - as supplied by publisher] Courtesy of NCBI & PubMed

Gene therapy promising for rheumatoid arthritis

From the News Desk of Jeanne Hambleton 

           Monday, February 9, 2009

NEW YORK (Reuters) –- Researchers have successfully used gene therapy to substantially reduce joint pain in two patients with rheumatoid arthritis (RA).    These data “provide the first documented, clinical evidence that local gene therapy can provide symptomatic relief in human RA,” Dr. Christopher H. Evans and co-investigators report in the February issue of Human Gene Therapy.  RA develops when, for unknown reasons, the body’s immune system turns against itself, causing joints to become swollen and inflamed. If the disease is inadequately controlled, the tissues of the joint are eventually destroyed. There is no cure for RA, which is estimated to affect more than 2 million individuals in the U.S. alone.  “RA is an extremely painful condition affecting multiple joints throughout the body. Arthritis is a good target for (gene therapy) because the joint is a closed space into which we can inject genes,” Evans, from Harvard Medical School in Boston, noted in a written statement.  Prior studies have shown that the molecule interleukin-1 plays a key role in the breakdown of cartilage in patients with arthritis. In the current study, tissue was removed from the knuckle joints of two patients with severe RA and a harmless virus was inserted into the tissue cells, in order to serve as a “vector” to shuttle a gene that blocks action of the interleukin-1 protein to the joint. After being placed in culture to grow and replicate, the cells were injected back into the afflicted joints.  One patient who received gene therapy in two joints experienced an 85 percent reduction in pain in one joint within 1 day, and both joints were pain-free from 1 week onward. “Remarkably,” the researchers report, joints receiving the therapy were protected from flares that occurred during the study period.  The second patient also responded to gene therapy, with a 70 percent reduction in pain between weeks 2 and 3.  “Existing treatments for rheumatoid arthritis are costly and need to be administered regularly,” said Evans, adding that in addition to risk of side effects, not all patients respond well. “This paper provides us with the first real evidence that painful symptoms can indeed be lessened through gene therapy.”  Ongoing work will focus on the use of gene therapy for the treatment of osteoarthritis, by far the most common type of arthritis, as well as rheumatoid arthritis, Evans noted.

Courtesy of  The Tehran Times  (http://www.tehrantimes.com/index_View.asp?code=188744)   Info@tehrantimes.com