Category Archives: Oxford

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!

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Fibrohugs Support

Tenderpoints Newsletter

Dear Editor,

This year we are helping to support the mission of the Arthritis Foundation by raising money and participating in the Arthritis Walk.

Our team Looking Good is walking in honor of Nancy Clay, BSN RN. She has taught us through experience and expertise. In addition Nancy has brought resources and speakers to us to help us learn how to help ourselves positively while living with our illnesses. We will be walking together at Freedom Park in Morganton, NC on September 22, 2007. Registration at 9:00am and walk at 10:00am. We’d love to have you join us!

Did you know that arthritis is the nation’s leading cause of disability and affects 66 million people? One in three adults and 300,000 children have arthritis or chronic joint pain, costing the U.S. economy more than $86.2 billion annually.

We have decided to make a difference. We are committed to raising $_ 1000_ to help prevent, control and cure arthritis. You can also make a difference by joining our team and walking with us or by donating funds to help us reach our goal. If you’d like to donate, please make your check out to the Arthritis Foundation and mail it to me at 118 Torrence Cir. NW, Lenoir, NC. Please note Looking Good Team on the for line. Thank you in advance for your support! Please call Lindy 828 754 2064 or Nancy for information.

Sincerely,

Looking Good Team Captain

Lindy Wilcox

“Love bears all things.” ICor.13:7
“God is good! All the time!”

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Fibromyalgia Support

Opioids for managing chronic non-malignant pain: safe and effective prescribing.

Kahan M, Srivastava A, Wilson L, Mailis-Gagnon A, Midmer D.
Addiction Medical Service, St Joseph’s Health Centre, Toronto, Ontario, Canada. kahanm@stjoe.on.ca

OBJECTIVE: To review the evidence on safe and effective prescribing of opioids for chronic non-malignant pain.

QUALITY OF EVIDENCE: MEDLINE was searched using the terms “opioid effectiveness” and “adverse effects.” There is strong evidence that opioids are effective for both nociceptive and neuropathic pain, but limited evidence that they are effective for pain disorder. There is little information on their effectiveness at high doses or on the adverse effects of high doses.

MAIN MESSAGE: Opioids should be initiated after an adequate trial of acetaminophen or nonsteroidal anti-inflammatory drugs for nociceptive pain and of tricyclic antidepressants or anticonvulsants for neuropathic pain. Patients should be asked to sign treatment agreements and to give informed consent to treatment. Patients should experience a graded analgesic response with each dose increase. Titrate doses of immediate-release opioids slowly upward until pain reduction is achieved, and then switch patients to controlled-release opioids. Most patients with chronic non-malignant pain can be managed with<300 mg/d of morphine (or equivalent).

CONCLUSION: Opioids are safe and effective for managing chronic pain.

PMID: 17279219 [PubMed - indexed for MEDLINE]

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Prevalence of Interpersonal Abuse in Primary Care Patients Prescribed Opioids for Chronic Pain.

Balousek S, Plane MB, Fleming M.

Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

BACKGROUND: Interpersonal abuse is associated with clinical problems including chronic pain disorders. OBJECTIVES: The objective of this study is to describe 30-day and lifetime prevalence of emotional, physical, and sexual abuse found in men and women prescribed opioids for chronic pain.

DESIGN: Cross-sectional interview is the design of this study.

PARTICIPANTS: Patients, 1,009, currently prescribed opioids for chronic noncancer pain. They were recruited from the practices of 235 Family Physicians and Internists in Wisconsin. The most common pain diagnoses were arthritis, low back pain, headache, and fibromyalgia/myofascial pain.

MEASUREMENT: Data for this secondary analysis on rates of interpersonal abuse were based on 3 questions from the Addiction Severity Index (ASI) regarding 30-day and lifetime emotional, physical, and sexual abuse.

RESULTS: Forty-seven percent of women and 22% of men reported a history of lifetime physical abuse. Thirty -five percent of women and 10% of men reported lifetime sexual abuse. Binary logistic regression identified the following variables associated with lifetime physical abuse: female gender (RR 2.81, CI 2.01-3.94), age 31-50 (RR1.77, CI 1.30-2.41), Caucasian (RR1.67, CI 1.19-2.35), increased psychiatric symptoms as measured by the ASI (RR 2.14, CI 1.56-2.94), and lifetime suicide attempts (RR 3.98, CI 2.76-5.74).
CONCLUSIONS: This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.

PMID: 17641933 [PubMed - as supplied by publisher]

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SOUNDING OFF ABOUT FIBROMYALGIA AWARENESS WEEK

By Jeanne Hambleton© UK Fibromite

I know I am always going on about raising awareness and fibromyalgia and this is especially important as far as the UK Government is concerned. Although we have E Petitions allegedly for the eyes of the Prime Minister, asking for support for various aspects of fibromyalgia, I have my doubts as to whether these will actually achieved any funding for research or recognition for FM – oh me of little faith.

Two of the 4 E Petitions about fibromyalgia on the No.10 Downing Street website will end this month (August) and as a supporter I am hoping to receive comments from the No.10 Downing Street web team (almost certainly not the Prime Minister). I feel sure the Prime Minister does not have time to read all the E Petitions – too busy with his politics. I almost have the impression the E Petitions were designed to save the postman delivering hundred and hundreds of letters which someone has to open and read, although rumour has it the idea of E Petitions was thought to be a bad idea.

As a matter of interest my new E Petition is to help replace those that are about to expire and can be found at the following website. It only takes a minute to do and you will feel go you have supported us. PLEASE would you please sign? I need 1000 signatures before it will be considered – 2000 would be nice. Tell your friends and family PLEASE. I am not on commission!

http://petitions.pm.gov.uk/FIBROFUNDING/

But my reason for writing is other ways to raising awareness during Fibromyalgia Awareness Week.

For us here in the UK and possibly the world over, the 8th to 15th September is Fibromyalgia Awareness Week. We do still of course have another annual event on 12th May – World Fibromyalgia Awareness Day. If you did nothing on that day to further the cause, now is your big chance.

Yes you have guessed it. I am going to talk about doing your bit for this FM Week. Raising funds would be a plus but raising awareness is far more important. Not sure about you, but I am pig sick of people looking at me and saying, “Fibro what?” If you listen carefully you can hear them thinking, “Poor girl – I wonder how long she has to live?”

If you are going to dismiss that thought be sure to tell them, we may not die from FM but as sure as eggs are eggs we will live with the pain for the rest of our lives or until someone finds a cure. (That is why you are signing the E Petition!)

What can you do? I have made several suggestions below with varying amounts of effort, so no excuses please.

NOT TOO HARD WITH FAMILY HELP
Find everything you have in your home that refers to fibromyalgia and invite your friends and neighbours to a need-to-know coffee morning, or afternoon tea and cake (if you don’t do mornings!) You can talk about each item connected with FM, or ask how the last 10 years has been for each of your visitors. When it is your turn you can recall what you used to do and how disabled you are now. Remind them it is an invisible disability and although you look so well you feel so awful.
Keep it bright and light with a few funny fibro stories. This event could even provide you with a few fit helpers for the future if you stage a fund raising event for FM to help your local Support Group.

ARMCHAIR EFFORT
If life is a struggle and a coffee morning is all too much, you could start your own letter writing campaign. Here in the UK you could write to your MP or in the States try your Senator? The MP’s address will be in your local telephone book. If you cannot find it ring the local paper. If you are feeling inspired you could write to the Prime Minister himself – Gordon Brown PM, 10, Downing Street, London, SW1A2AA, or email his assistant james.bowler@hm-treasury.gsi.gov.uk. David Cameron can be reached at camerond@parliament.uk. I am guessing here but I would think that Sir Menzies Campbell could be reached using campbellm@parliament.uk

The mail address of most MPs is their surname followed by the initial and the address – for example the Health Minister Alan Johnson MP – his address is johnsona@parliament.uk.

If you are using snail mail send your letter to your MP at House of Commons, London, SW1A 0AA

For information about websites, biographies and email addresses search for your MP in alphabetical order at http://www.parliament.uk/directories/directories.cfm

If you do not know who your MP is try http://www.theyworkforyou.com/ and type on your postcode. This will produce a message box, so have our message ready to cut and pate into the box.

If you think you have written a good letter to the PM, the Health Minister and your MP about your FM appealing for Government support for research to find a cure, and speed up diagnosis, including details of your life as a person with an invisible disability – the symptoms – pain 24/7, chronic fatigue, sleeplessness, cognitive problems, IBS, RLS and all the other nasties – send a copy to the Editor of your local paper. Ask him to print it with the readers’ letters, adding your own comments about what you hope the PM will agree. It is a good idea to use bullet points for the symptoms (easier to read).

Now you are on roll! Why not send a copy to your local radio station and the regional TV station? You never know they just might wonder – like everyone else – exactly what fibromyalgia means.

GOING OUT TO THE PUBLIC
If you access to lots of fibromyalgia literature you could ask your local superstore manager if you can stand near the entrance one busy afternoon and hand out literature. If you have friends you could have a table and chairs with fibromites who can talk about the syndrome and maybe encourage anyone interested to join the Group.

EDUCATING STUDENT DOCTORS
By now you should be full of confidence and really ready to go anywhere to tell your story. Contact you local PCT – Primary Care Trust (details in your local telephone book) – who are responsible for the hospitals and doctors in your area. Ask if you could talk to a class of student doctors about fibromyalgia from a patient’s perspective? You could answer their questions and help them become more knowledgeable about diagnosing FM for future patients. You would indeed be raising awareness by doing this, as so many GPs believe it is all in our head. The Fibromyalgia Association of the UK, http://www.fibromyalgia-associationuk.org, has prepared literature for the medical profession. I believe the American NFA – http://www.fmaware.org – also had medical literature for doctors.

Yes we now believe it is all in our head – but not as the GP suggests. Does your GP think it is in your imagination and that you are a mad malingerer? If so tell him it is now said that FM is due to a chemical imbalance in the brain.

My final thought would be to festoon your house or garden with balloons with a sign in the window saying “Happy Anniversary Fibromyalgia”. Someone is bound to ask you who is Fibromyalgia. Take a photograph and send it to the local paper with a caption saying you are celebration Fibromyalgia Awareness Week. I feel sure you will find this an uplifting experience and enjoy the fun. At the end of all this raising awareness you will feel you have achieved something by spreading the word – which as we know is FIBROMYALGIA.

Do write and tell me about your achievements – we can then have another go at more publicity for FM.

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Publication trends in chronic fatigue syndrome: Comparisons with fibromyalgia and fatigue: 1995-2004.

Friedberg F, Sohl S, Schmeizer B.
Department of Psychiatry and Behavioral Medicine, Stony Brook University, NY, USA.

OBJECTIVE: In order to identify publishing patterns in chronic fatigue syndrome (CFS), we compared the annual number of peer review articles for CFS, fibromyalgia (FM), and non-CFS fatigue over a recent decade (1995-2004).

METHOD: Citations were drawn from Ovid/Medline, PsychInfo, and the Journal of Chronic Fatigue Syndrome for peer review articles focusing on CFS, FM, and fatigue for each year of the decade ending in 2004. Statistics included chi-square, tests for differences in proportions, and regression-based curve estimation.

RESULTS: The frequency of CFS peer review articles did not significantly change from the first half to the second half of the decade (1995-2004). By comparison, the output of both FM and fatigue articles significantly increased (P<.0001). A quadratic model (inverted U shape; P<.02) best fit the data for CFS annual publication frequency. By comparison, exponential models best fit the data for both FM (P<.0001) and fatigue (P<.0001) citations. The highest percentage of citations (15-16%) for both CFS and FM fell within the domains of diagnosis, physiopathology, and psychology. For fatigue, almost one third (31.4%) of the citations were focused on etiology, while psychology (11.5%) and physiopathology (10.4%) articles were the next most cited. Based on first-author affiliation, CFS articles were most likely to originate in the United States (37.7%), England (31.4%), and the Netherlands (4.9%).

CONCLUSION: The output of CFS peer review articles has not increased over the past decade, while the number of FM and fatigue articles has increased substantially.

PMID: 17662750 [PubMed - in process]

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Mouse genome will help identify causes of environmental disease

Research on the DNA of 15 mouse strains commonly used in biomedical studies is expected to help scientists determine the genes related to susceptibility to environmental disease. The body of data is now publicly available in a catalog of genetic variants, which displays the data as a mouse haplotype map, a tool that separates chromosomes in to many small segments, helping researchers find genes and genetic variations in mice that may affect health and disease. The haplotype map appearing online in the July 29th issue of Nature is the first published full descriptive analysis of the “Mouse Genome Resequencing and SNP Discovery Project” conducted by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health.

“These data allow researchers to compare the genetic makeup of one mouse strain to another, and perform the necessary genetic analyses to determine why some individuals might be more susceptible to disease than another. This puts us one step closer to understanding individual susceptibility to environmental toxins in humans. We also hope that pharmaceutical companies developing new treatments for environmental diseases will find these data and this paper as a valuable resource,” said David A. Schwartz. M.D., NIEHS Director.

The paper describes in detail the laborious and technology-driven approaches that were used to identify 8.27 million high quality SNPs distributed among the genomes of 15 mouse strains. Single Nucleotide Polymorphisms, or SNPs (known as snips), are single genetic changes, or variations, that can occur in a DNA sequence.

Much of the project was conducted through a contract between the National Toxicology Program at NIEHS and Perlegen Sciences, Inc. of Mountain View Calif.

“The database of mouse genetic variation should facilitate a wide range of important biological studies, and helps demonstrate the utility of this array technology approach,” said David R. Cox, M.D., Ph.D., chief scientific officer at Perlegen Sciences, Inc.

The Perlegen scientists used C57BL/6J the first mouse strain to undergo DNA sequencing as their standard reference to conduct the re-sequencing on the four wild-derived and eleven classical mouse strains. The technology used, the oligonucleotide array, was also used to discover common DNA variation in the human genome.

The arrays looked at about 1.49 billion bases (58 percent) of the 2.57 billion base pair of their standard reference strain. The data were then used to develop the haplotype map which contains 40,898 segments.

“The data will be a valuable resource to many, including the National Toxicology Program,” Schwartz says. The National Toxicology Program (NTP) is an interagency program, headquartered at NIEHS, with the mission to coordinate, conduct and communicate toxicological research across the U.S. government.

“The NTP is looking forward to exploring the responses of these strains of mice to various environmental agents,” said John Bucher, Ph.D., the new associate director of the NTP.

Frank M. Johnson, Ph. D., an NTP research geneticist and one of the authors of the Nature paper, adds that systematically characterizing even more mouse strains for susceptibility to toxins will not only help with genetic analysis, but better position researchers to do intervention studies.

###
The data are publicly available on the National Center for Biotechnology Information Web site at http://www.ncbi.nlm.nih.gov/SNP/ and at a Web site developed by Perlegen at http://mouse.perlegen.com which allows researchers to download SNPs, genotypes, and LR-PCR primer pairs, which are currently mapped to NCBI Build 36.

In addition to the NTP and Perlegen Sciences scientists, other key collaborators on the project include researchers from the Department of Computer Science and Department of Human Genetics, University of California, Los Angeles; the Department of Computer Science and Engineering, University of California, San Diego; The Jackson Laboratory, Bar Harbor, Maine; Broad Institute of Harvard and MIT; and the Center for Human Genetic Research, Massachusetts General Hospital.

Reference: Kelly A. Frazer, Eleazar Eskin, Hyun Min Kang, Molly A. Bogue, David A. Hinds, Erica J. Beilharz, Robert V. Gupta, Julie Montgomery, Matt M. Morenzoni, Geoffrey B. Nilsen, Charit L. Pethiyagoda, Laura L. Stuve, Frank M. Johnson, Mark J. Daly, Claire M. Wade, David R. Cox. A sequence-based variation map of 8.27 million SNPs in inbred mouse strains. Nature, 2007

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

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

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Violence, stress, and somatic syndromes.

Crofford LJ.

Center for the Advancement of Women’s Health, University of Kentucky. lcrofford@uky.edu.

Syndromes characterized by pain, fatigue, mood disorder, cognitive dysfunction, and sleep disturbance have been referred to as stress-related somatic disorders by virtue of the observation that onset and exacerbation of symptoms occur with stress. These syndromes include but are not limited to fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. As with most chronic illnesses, genetic susceptibility and lifetime environmental exposures play a role in creating vulnerability to disease. Cumulative lifetime stress has been associated with a number of physiologic changes in the brain and body that reflect dysregulated hormonal and autonomic activity. Exposure to the stressor of violence is likely to create a state of vulnerability for the stress-related somatic syndromes and also to contribute to symptom expression and severity. Understanding the relationship between violence, stress, and somatic syndromes will help in clarifying the consequences of violence exposure to long-term health and health-related quality of life.

PMID: 17596347 [PubMed - in process]

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EULAR evidence based recommendations for the management of fibromyalgia syndrome.

Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskilla D, Da Silva JA, Danneskiold-Samsøe B, Dincer F, Henriksson C, Henriksson K, Kosek K, Longley K, McCarthy GM, Perrot S, Puszczewicz MJ, Sarzi-Puttini P, Silman A, Späth M, Choy EH.

King’s College London, United Kingdom.

OBJECTIVE: To develop evidence based recommendations for the management of fibromyalgia syndrome (FMS). METHODS: A multidisciplinary task force was formed representing eleven European Countries. The design of the study including search strategy, participants, interventions, outcome measures, data collection and analytical method was defined at the outset. A systematic review was undertaken with the keywords ‘fibromyalgia’, ‘treatment or management’ and ‘trial’. Studies were excluded if they did not utilise the ACR classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale (VAS) and fibromyalgia impact questionnaire (FIQ). The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. RESULTS: One hundred and forty six studies were eligible for the review. Thirty nine pharmacologic intervention studies and 59 non-pharmacologic were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and ‘other pharmacological’ and exercise, cognitive behavioural therapy, education, dietary interventions and ‘other non-pharmacological’. In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. CONCLUSION: Nine recommendations for the management of FMS were developed using a systematic review and expert consensus.

PMID: 17644548 [PubMed - as supplied by publisher]

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Fibromyalgia: a rheumatologic diagnosis?

Endresen GK.

Department of Rheumatology, The National Hospital Rikshospitalet, Forskningsvn. 2, Block B, 0027, Oslo, Norway, gerhard.endresen@rikshospitalet.no.

Fibromyalgia (FM) is a medically unexplained or functional somatic syndrome (FSS). The two classification criteria are chronic widespread pain (CWP) and the finding of 11/18 tender points (TP). FM overlaps and co-occurs with other FSSs, and auxiliary symptoms that are not included in the criteria may be clues to other FSSs. About ten FSSs include chronic fatigue syndrome, myofascial pain syndromes and irritable bowel syndrome. TP do not reflect demonstrable pathology, and are locations where everyone is generally more tender. In FM they are more tender than normal due to lowered pain threshold. High TP counts are associated with the extent of distress or unspecific somatic symptoms in the absence of chronic pain. TP lack validity and should be excluded. CWP and distress are outside the domain of rheumatology, and abnormal mechanisms in FM relate to the central nervous system, as compared to “peripheral” mechanisms studied in rheumatology. FM should not be considered as a rheumatologic condition but rather as part of a broader spectre of FSSs. Patients with FSSs should be considered and treated together across medical specialities by general physicians in primary health care.

PMID: 17641896 [PubMed - as supplied by publisher]

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