Category Archives: Primary Fibromyalgia Syndrome

A ‘WIN WIN’ FIBROMYALGIA CONFERENCE

April 23/26 2010 South Downs Holiday Village Bracklesham Bay
By Jeanne Hambleton ©

The first ever fibromyalgia conference with a pamper weekend in the SE of England, Bracklesham Bay, last weekend (April 23/26 2010) kept it promises as a memorable weekend with eminent speakers, workshops, a range of therapies and some great evening entertainment. So successful was the event that a reunion date for the next event was fixed on the spot for another conference in 2011 on April 8/11. With this first event a sell out, bookings will be accepted on first come first booked.

Vistors hit by the delayed flights flew in from Germany, Channel Islands and Ireland at the last minute while some missed the conference stranded in Spain and the Carribbean. Some drove from Scotland, Wales and northern England to the south coast to hear leading speakers in the world of fibromyalgia.

Using all of their energy in an attempt not tomiss anything during the intensive programme during the long weekend, many admitted they expected to go home and go to bed for a few days to recover.

“But it will be worth it. We have learned so much, ” said on fibromite.

Carol from Bristol wrote and said, “I just wanted to send you a huge thank you for a great weekend. I came to the conference with my mum who is a fibromite and I have learnt so much. I never knew how complex this condition was and now appreciate the frustrations people have with a) getting the correct diagnosis at all and b) getting the correct medication. It was reassuring to see and hear for myself that there are alot of dedicated people researching and I have been completely “fired up” to a) raise awareness of this condition and b) do what I can to raise funds for research. I expect you are absolutely shattered but you should be so proud of what you achieved. I cannot thank you enough for the knowledge you have given me and I hope that I can continue to support my mum and other fibromites as a result.”

LOTZA LAUGHS
While there was lots to learn the fibromites had fun too. The Fibro Fillies Race Night had folks shouting for their horse to win and the message that came back means we had to do it again. On Saturday the Folly Pogs ‘posh frocks’ Ball and fancy dress competition with great support from the fibromites saw the Nuns from the Order of Discontent (the Irish lasses) amusing the audience. Sunday evening featured the charity auction with paintings, Elvis’ shirt, a valuable wine collection, a champagne hamper and jewellery and more, all donated by visitors, raising money for research.

Partners enjoyed deep-sea fishing with good catches, played golf, went fossil hunting and some enjoyed the workshops, while the fibromites listened to 12 keynote speakers over two days. The climax on Sunday afternoon was Question Time with 4 doctors on stage.

GREAT NEWS
One of the many ‘best’ things to come out of the Fibromyalgia Conference and Pamper Weekend, under the umbrella of FMA UK, was an announcement from Professor John Davies from Guy’s Hospital and the FM Clinics, who sadly was unable to be with us, and Professor Ernest Choy, Kings College Hospital, who was so well received the delegates want him back next time.

The announcement said, “We are pleased to announce a new NHS Fibromyalgia collaboration under the King’s Health Partners (Guys, Tommy’s and Kings NHS Hospitals). Heading this new initiative is Professor Davies and Professor Choy, who share a common objective of creating an integral clinical and research programme to advance the understanding and management of patients with Fibromyalgia.

Professor John E. Davies is Consultant Rheumatologist at Guy’s and Professor Ernest Choy is Clinical Reader in Rheumatology at KCL and Director of the Kings Musculoskeletal Clinical Trials Unit.”

The delegates received the news with cheers and expressed relief that further progress was being made in the recognition of our invisible disability – fibromyalgia.

A DATE FOR THE DIARY
In view of the enthusiasm of delegates to come back and meet the people they met this time, the 2011 event on April 8/11 2011 will be reunion with all they liked and some new speakers. All fibromites will be welcome to the residential weekend. There will be staged payments to help those on benefits to spread the cost.

Other on site activities included various workshops including Maryse Boulles’s sound therapy, Karen Henderson sharing her Bath Hospital experience following a one month stay; Gemma Kingsman from Consultaid who talked about Finding the Funds for Groups; and hygienist Jane Russell who talked about teeth and health. Sheila Green from Motorvate Chichester talked about a gym with a difference. Giselle and Ian Smith from the DWP spoke about the benefit system. Sunday saw two informal ‘Meet the Doctor’ sessions with Dr. Robert Lister and Dr. Ray Perrin. The weekend included Pilates, Tai chi, Yoga with a free pamper taster day, a shopping experience and fibromites arts and crafts. One to one pamper therapy sessions ran over two days at conference discount.

SPEAKERS PRESENTATION SUMMARIES

Most people had come to hear the specialists in the field of fibromyalgia. Everyone claimed they learned so much. Even the doctors found the experience rewarding with feedback from the fibromites worthwhile.

One fibromite said it was a ‘win win weekend’ with everyone getting a great benefit.

The following brief summaries of the hour long presentations are reported by fibromites who attended the conference and helped to provide information for this article. My grateful thanks to the following note takers as it was impossible for me to sit in and listen to any of the speakers due to other conference commitments. I just wish I had been a guest….

Group Leader of West York’s FM SG Denise Rhodes made the following comment.

“Overall, the information from the speakers was delivered with humour, sympathy and great authority. The passion with which much of the subject matter was disseminated demonstrated a level of caring far and above what I expected and definitely above the experience level of many of the GPs and consultants reported to me on the helpline and by colleagues in my group. All speakers made themselves available after their presentations and showed great interest in questions asked and gave detailed responses,” she said.

Report by Leanne Daniels from Horndean FM SG with thanks for her commitment and help during the weekend.

Professor Ernest Choy MD, FRCP is Consultant Rheumatologist at King’s College Hospital and Director of the Sir Alfred Baring Jarrod Clinical Trials Unit in the Academic Department of Rheumatology, King’s College London. He is also Director of Research and Development at King’s College Hospital in London.

Discussing the new advances in the pathophysiological management of fibromyalgia Professor Choy said it was hard to investigate pain with doctors feeling there is nothing they can identify to reach a diagnosis. Many controversies have been removed by trying not to label patients. He said MRI scans show the structure of the subject but not how the organ or tissuing was functioning. Brain functions can be seen and the magnetic properties in the brain are changed by the blood flow. Since the MRI uses magnets the brain functioning can now be seen.

Brain scans have even shown a reaction when red-hot chilli peppers are placed on the skin, with pain registered in certain areas of the brain. Pain results from a pain response and activates areas of the brain. The scan is useful as a tool to see how pain is perceived in FMS using pressure applied to the thumbnails, a sensation for pain against the pressure, can be detected. When this is applied to someone with FMS the signal to the brain can be identified to see if it correlates to the pain felt. So the pain is not just in your head.

In ‘normals’ increased pressure eventually results in pain. In someone with FMS pain is triggered in the brain much sooner. This confirms the patient was not lying.

Professor Choy confirmed there are areas in the brain where normals and those with FMS show differences. Those with FMS were found to have less activity is regions of the brain than ‘normals’.

FMS patients react differently to normals, as their brain inhibitor is not working. They do not respond well to morphine. The brain produces its own morphine-type drugs. As the inhibitor does not work the natural drug produced by the brain is also reduced.

Sleep is very important and there is a link between sleep quality and pain. Good sleep reduces pain to manageable levels but the pain may not go away. Researchers are working towards identifying the relevant pathways and how to clear them. The focus is now on research to improve sleep,

Aims in the treatment of FMS include reducing pain, improving functions, better quality of life, and allowing patients to self manage. It has been identified that FMS is a complex and herogenetic condition and not everyone with fibromyalgia is the same.

Three sub groups within FMS have been identified and this is significant enough to show that blanket or individually tailored treatment would be needed. In trials random meds are given and there have been similar observations about 3 sub groups. Drugs trialed in the USA revealed similar results with sub groups in different pathways. Some patients have more sleep disturbances, mood changes or depression. Depression can lead to poor sleep patterns and hinders the ability to cope. Researchers are trying to develop treatments suitable for each individual pathway for patients. To date there is not one magic cure but with these small steps forward it is hoped that one day there may be one drug to help all fibromites.

Professor Choy said they were trying to educate doctors on what FMS actually is, and explain to the patients’ relatives more about the pain they cannot see.

Exercise may hurt but if you do not exercise you lose muscle tone, which can make fatigue worse. It is important to push on doing gradually more each day. Best time to exercise is in the evening followed by a warm bath and bed to enhance sleep quality.

Professor Choy confirmed medical guidelines could be sent to GPs on request to FMA UK – http://www.fibromyalgia-associationuk.org/general-articles-highlights-208/271-medical-pack-html

Report by Leanne Daniels

Dr Peter Fisher Chirr, MB, FRCP, FFHom is Clinical Director and Director of Research at the Royal London Homoeopathic Hospital, London, Physician to HM Queen Elizabeth II and chaired the World Health Organization’s working group on homeopathy, whose report is due for publication soon.

Talking about fibromyalgia and homeopathy he described this as treatment of like with like. It is different from herbal medicines and is often confused with this. Homeopathic treatment is for the person not the disease. One of the conditions treated may be a bee sting with pain, swellings, relieved by cold and worse with pressure. The preparation to cure the condition would be one part of the mother tincture, and maybe 99 parts of water.

Dr Fisher reported that at the last survey in 1998 8% of the population was using homeopathic remedies with 470,000 users nationwide. This related particularly to the chronically ill. The growth in users is between 12% and 13% annually.

Clinical research on Rhus Toxicoderdron for FMS using double blinds with placebos and homeopathic pills showed 25% of FMS patients responded to treatment in just over a month. Tender Points cannot be reduced but these will respond and get worse if these points feel the condition is getting worse. Overall people did better taking the pills than those on the placebo treatment.

Dr Fisher felt a condition with normal care and homeopathic treatment would work better offering a broader package of treatment than just normal care. He said people went to the Royal Homeopathic Hospital for treatment because other treatments did not work, or gave unwanted side effects, with the majority of patients responding well and improving.

The advantage of using homeopathic treatments was you could do it yourself, based on a small number of typical symptoms, it treats the person and not the disease. There are a limited number of homeopathic remedies, compared to many medications available, and it does not need a practitioner. It also has low dilution content compared to high dilution with meds.

Dr Fisher spoke of the symptoms homeopathic remedies could help and the treatments used. Homeopathic treatment was available on the NHS but it was not easy to get. These treatments seem to work for fibromyalgia. With Choose & Book you can advise your GP you wish to be referred to the Royal Homeopathic Hospital in Great Ormond Street, London, or do it yourself on the Internet.

Denise Rhodes reported -

Professor B K Puri MA (Can tab), PhD, MB, Chirr, BSc (Hones) MathCAD, MRCPsych, DipStat, PG Cert Maths, MMath, is at Hammersmith Hospital and Imperial College London, he has carried out pioneering research work and is a world-leading neuroscience and biochemistry expert.

Professor Basant Puri asked is Fibromyalgia associated with changes in brain anatomy? Previous studies show no grey matter reduction in normal healthy patients and fibromyalgia sufferers. This is in contrast to patients with psychiatric conditions.

His very recent study tested FMS sufferers against a healthy control group and identified loss of grey matter in relation to fatigue.

The tests were carried out using very sophisticated MRI scanners at a higher level than normally used 1.5T(Teslas ) Teslas are measures of magnetic strength. His tests were carried out using 3T and a totally unbiased research method called VBM approach.

His conclusions are that there is degeneration in grey matter in areas of the brain as a result of visual stimulus overload, and problems of coordinating motor and visual tasks, along with problems with sequenced complicated actions.

Denise Rhodes wrote the following reported –

Dr Cathy Price MB BCH, DCH, FRCA, FFPMRCA is a Consultant in Pain Management, Southampton University Hospital NHS Trust and a member of the British Pain Society who has an interest in fibromyalgia said there was a need to focus on patient needs rather than on conditions.

She said pain services offers a multi-disciplinary team approach, which includes psychologists, doctors, physiotherapists, occupational therapists, pharmacists, nurses, acupuncturists and job advisors in order to improve the quality of life. Dr Price said 70% of patients at discharge report positive results as against 30% who feel that it has been of little or no benefit.

Dos and Don’ts for FM –

• Do promote balance in activities
• Manage depression
• Discuss pros and cons of therapies, treatments, and strategies.
• Don’t use opoids
• Use Pain Toolkit booklet

Useful sources for FM information:

HYPERLINK “http://www.patient” http://www.patient.co.uk and /healthyFM.htm
HYPERLINK “http://www.18weeks” http://www.18weeks website dept of health – pain

Dr Price is the clinical lead for the National Pain Audit and argues that getting information into GP surgeries, hospitals and pharmacies is vital, so anything we can do to promote FM in this way will help us all.

She emphasised how important pacing is and how it is difficult to achieve – it may take months and help is so limited. Southampton has dropped organised courses such as 6 weeks on hydrotherapy etcetera, in favour of a cafeteria approach where individuals can take bits of services according to their individual needs. She referred fibromites to ICAS an independent body who will support patients to fight their corner. She also referred us to PALS who are also very helpful.

A question was asked regarding whether the very high number of GPs who are either non-believers, or non-supporters will reduce as further training, younger doctors come into the system. She said that more training and awareness is having an effect, often via e learning – online. She also said that Dr Liam Donaldson, the Chief Medical Officer, is promoting greater awareness of the condition.


Report by Leanne Daniels

Dr Ian H Treasaden MB BS LRCP MRCS FRCPsych LLM Head of Forensic Neurosciences, Lipid Neuroscience Group, Imperial College, London.

Dr Treasaden discussed mood disorders associated with FM and the management of nutrition. He spoke about normal and abnormal depression and FMS and mood disorders. He said Charles Darwin had fibromyalgia. He wrote books about species after years of travels and would suffer a fibro flare when defending his theories.

He believed the causes included hyper exatability of the nervous system, brain functions, and altered brain waves that deal with pain. Management would include a mixture of drugs and non-drug treatments plus antidepressants. On the non-medicines he included walking and exercise, hydrotherapy, CBT (cognitive behaviour therapy) that challenges negative attitudes to symptoms, plus a multi-disciplinary approach, which is rare to find.

On mood disorders he said depression causes could be more than a low mood. Periodic low moods can improve over time without treatment. Grief can be confused with depression. The Doctor spoke about Bipolar, which had replaced the manic depressant illness.

Depression symptoms included low mood, no feelings or tears, loss of interest, socially withdrawn and no interest in hobbies or work. In severe cases that can include suicidal thoughts, low self esteem, helplessness and pessimistic, loss of appetite or even weight gain, constipation, lack of sex drive, impotence, poor sleep and paranoid.

Those with FMS and depression often have headaches, worry about their symptoms and are delusional. Management can include counselling, self help, CBT, exercise and antidepressants for 6-9 months. Omega 3 is good for depression, elevating your mood and reducing anxiety. His recommendations included medication to help sleep, exercises, brain exercises and nutritional management.

Report by Leanne Daniels

Dr Nick Avery MB BS LRCP MRCS MFHom from the Natural Practice at Winchester & Eastbourne helps patients within the Health Service benefit from complementary techniques for IBS, CFS, Eczema, Allergies, Asthma and Migraine, using homeopathy for the emotional component of the illness.

Fibromyalgia is a very common condition that is poorly served by conventional medicine. In his experience, the key features are extreme fatigue, muscle pain and emotional disturbance. Interestingly the emotional aspect is the reason why patients suffer – otherwise the illness would just be interesting! Anti-depressants do not deal with this – they can help elevate mood in some patients but they do not address specific emotions. Similarly fixing the underlying fatigue state cannot be helped by drugs, which are mainly designed to block symptoms rather than create energy.

Many patients that Dr Avery treats suffer from underlying mitochondrial failure. Mitochondria are present in most cells of the body and this is where the ATP cycle occurs, providing the energy needed for all cellular functions. A blood test has now been developed which can identify which of the two underlying possible problems is causing the low energy state. There is a lack of raw materials to make the necessary ingredients involved in the process and some kind of block in the circuit usually from a chemical / drug or other toxic substance. The only way to treat these abnormalities is to correct the underlying nutritional problem – there is either an absorption problem or nutrients are lost – or to use some kind of ‘detox’ technique.

Neither of these treatment modalities is available from conventional practitioners – despite the fact that the condition has an underlying demonstrable biochemical explanation. The Doctor showed a scientific approach to the condition, sorting out problems with absorption, retention of nutrition and the use of a variety of treatment modalities designed to improve energy levels, pain and emotional disturbance. Much of the talk is based on 15 years’ experience of helping patients who suffer from fibromyalgia – many of whom (but not all) have done very well. He intends to concentrate on what can actually be done in the light of our current understanding.

Report by Leanne Daniels

Dr Robert Lister BSc PhD FBS C Biol. is a Director of Phyla Ltd, a health care consultancy and Director of Cubic Ltd, which develop innovative medical electronic devices. He is Chairman of the Institute of Brain Chemistry and Human Nutrition at London Metropolitan University.

Introducing Linda Horncastle Dip COT SROT, Group Leader South Bucks FM SG, Dr Lister said due to FM she had stopped work. Thanks to the Alpha-Stim she has returned to work as an Occupational Therapist.

Dr Lister spoke of a pilot study relating to chemical imbalances, which showed a 60% improvement with microcurrent stimulation, but he felt something else was going on in the brain. Many people suggested the pains were a figment of the imagination and various drugs were needed to treat the condition. He felt there as ‘faulty wiring’ on the malfunctioning connections to the nervous system although imbalances may be able to fixed there was evidence that brain stimulation can modify the signals.

Dr Lister referred to the influences we feel and the chemical receivers. But when the muscle or bone is injured the body sets up an electrical current. Electricity can affect the brain. Some elements may be faulty and disconnected but this can be changed by introducing the microcurrent. By changing the electrical status this can alter the way we behave. People with psychological disorders had purely behavioural problems and these could be improved by talking.

The brain is made up of a lot of active centres and neuroscientists were using deep brain stimulations for diseases such as Parkinsons. He made reference to CES Cranial Electric Stimulation, which produced a similar effect to deep brain stimulation at a cost of £250.

Stimulation can provide relaxation in some parts of the brain and stimulation in others. It can block pain, reduce anxiety, increase positive effects and alleviate insomnia. The stimulation can also change the concentration of chemicals, releasing more so the energy levels are increased,

Studies in the USA have helped pain, anxiety, stress, muscle tension and insomnia. In recent trials based on 500 patients the majority received between up to 99% relief of symptoms and headaches. There were moderate improvements on trials involving 2,500 patients in RSD, FMS, myofascial pain and migraines.

Talking about Linda he told her story and said she had FMS for 20 years but was now walking again thanks to the microcurrent. Dr Lister confirmed microcurrents had been used in the USA for 29 years and were safe and claimed 90% success rate. At a lower power than TENS machines the effect is cumulative where the TENS stops when you turn it off. The machines use probes and sticks.

Linda’s group had tried the microcurrent machines and reported improvements in 3 weeks. While it is not a magic cure it should be used most days and then mobility improves and fibro fog disappears. There are no side effects except perhaps some tingling.

Report by Clare Palmer ANOM

Dr Raymond Perrin DO PhD, Hon. Senior Lecturer, School of Public Health and Clinical Sciences, UCLAN, Registered Osteopath and Specialist in CFS. He spent 16 years researching medical and scientific evidence while treating CFS/ME/ Fibromyalgia patients with of the Perrin Technique.

Dr Perrin explained his treatment, based on manual drainage of toxins from the central nervous system, could relieve many of the symptoms of fibromyalgia. Some doctors treat fibromyalgia (FMS) and chronic fatigue syndrome (CFS) separately, while others think they are actually the same thing – or at least, variations of the same condition. According to the Arthritis Foundation, research shows that 50 to 70 percent of people with one diagnosis also fit the criteria for the other.

Raymond Perrin’s earlier research at the University of Salford in conjunction with the University of Manchester, coupled with the hundreds of successful clinical case studies and the latest findings in neurophysiology, has provided strong evidence that CFS involves a disturbance of the drainage of toxins from the brain and muscles? These poisons often enter body in the form of viruses, bacteria and other microbes, parasitic infection or due to environmental toxins such as pesticides. Yeasts, bacteria, viruses, parasites, pesticides and heavy metals have all been implicated in cases on Fibromyalgia.

Osteopath and bioscientist Ray Perrin, who has developed this treatment technique over the past twenty years, showed how simple measures can bring relief to the patient and explained the possible patho-physiological pathways that lead to this terribly debilitating disease. The basis of this condition being a toxic overload of the brain and spine affecting the sympathetic nervous system, can over stimulate the peripheral nerves leading to pain and muscle spasms etc.

Dr Perrin stressed that although The Perrin Technique has brought much relief to many, it is not a cure-all treatment. In cases of fibromyalgia it should be used in conjunction with other therapies such as acupuncture and hypnotherapy. Supplements of vitamins and minerals, omega 3 and 6 fatty acids and pacing are all important in the overall therapy. His best-selling book The Perrin Technique, Hammersmith Press, London, 2007, sold out with a conference discount and is available from most good book supplies.

Report by Leanne Daniels

Andrea Barr MRSS (T) is a Shiatsu teacher/Complementary Pain Specialist, interested in FM, and has lectured in Switzerland, Austria and UK. She runs Pilgrim Hospital Boston Pain Clinic, Lincs. Talking about the logical empowerment approach to pain managements, she looked at the physical symptoms of FMS.

People who eat carbohydrates may suffer from an intolerance of this substance that can also lead to many of the symptoms associated with fibromyalgia she said recommending that oats and rye should be retained but most carbohydrates should be removed from the diet.

Andrea Barr referred to emotional symptoms including questioning yourself, the pressure of time, being self critical if doing nothing, feeling stressed, concerned with details and a low level depression.

The Autonomic nervous system – or fight and flight feelings – often resulted in difficulty expressing feeling, feeling under threat, while our bodies undergo a series of dramatic changes in blood flow, digestive tract, and the muscles. Signs of flight or fight syndrome are poor sleep with an inability to shut down, tight shoulders/neck, digestive upsets, regular headaches. The fight or flight feelings can stem from childhood, long term trauma, too much activity and no calmness, and undetected stress.

Referring to rest, digest and repair Andrea Barr said the heart rate drops, blood pressure falls, respiration slows and deepens. Blood flow is re-established, the immune and lymphatic systems are supported, and you feel relaxed, calm and refreshed if you slept well.

Summarising she said the body can only repair itself during rest and digest. During fight or flight the rest does nothing for the body. Traumas and triggers can put a patient in a fight or flight condition. She described how the brain reacted during this sensation.

Resources to encourage better sleep included EFT, thought field therapy, cognitive behaviour therapy, yoga, medication and breathing, Shiatsu and cranial treatments. For more help email andrea_barr@hotmail.com or ring 01522 521 817.

Report by Denise Rhodes

Dr Nina Bailey BSc, PhD is a nutritional scientist working in dietary health and nutritional intervention in disease, with emphasis on the role of fatty acids in fibromyalgia, depression and ME. She has a DVD, which explains how to manage IBS that at least 50% of FM/CFS/Depressives/chronic headache sufferers experience.

Basically her argument is that there is no perfect dietary cure but findings show that red meat, particularly if seared/charred/barbequed produce carbonation. That produces ammonia, which leads to inflammation in the gut and is extremely bad for IBS just as many sweeteners are, such as xylotomy and sorbitol. Also insoluble fibers such as whole-wheat grains, bran, unpeeled fruit, salad greens, fried foods are in question. An expansion of this is on the http://www.drninabailey.com site. Dr Bailey said information is available on her websites http://www.igennus-hn.com, http://www.drninabailey.com and from ninabailey@aoum.org.

Report by Denise Rhodes

Dr Mageb Agour MB, BS, MRCPsych recently presented his latest research findings into sleep disorders in this area at a major international medical conference in Italy in September 2009, looked at objective sleep management.

The gold standard test is
• In a laboratory where subject is wired up to record all body functions.
• A device that looks like a watch, strapped to the wrist and used in one’s own home. This is programmed to record movement and defines when/when not asleep
• There are 5 stages of sleep with normally 3 – 4 cycles per night.
• The longer we sleep the more we dream. But dream is only achieved in stage 5 (REM)
• Stage 1 light sleep/dozing low eye movement, often slightly aware and easily aroused
• Stage 2 eye movement stops, slower brainwaves
• Stage 3 Delta waves deeper stage
• Stage 4 No eye movement or muscle activity
• Stage 5 REM breathing increases, rapid eye-movement – muscles paralyzed

Babies spend 50% of sleep time in REM but with aging there are fewer REM stages in adults.

• Primary Sleep Disorders
• Narcolepsy
• Sleep apnea
• Abnormal behaviour
• Sleepwalking/talking
• Night terrors
• Secondary Sleep Disorders
• Mental disorder
• General medical conditions
• Substance users anything from caffeine to cocaine and heroin
• Sleep and FM
• Restless leg syndrome – Periodic limb movement – involuntary (if severe may need treatment)
• Bruxism (Grinding teeth)
• Alpha wave intrusion

In Fibromites non-refreshing sleep is a result of Alpha waves intruding into Betawave stage causes REM state to leave. Remedies are to reduce mental activity before bed, avoid reading in bed or watching TV.

Melatonin is seen as a useful tool and is now available from many GPs or online.
Short term sleeping tablets and treating underlying problems. Natural remedies such as Valerian, which performs in a similar way to Oxizipan or St John’s Wort, which is often used for depression.

However, when using alternative and complementary medications it is important to check with GP and/or Pharmacist to avoid clash with prescribed medication.
Chamomile, a Fish Oils High content omega 3 vital.

Report by Leanne Daniels

Andy Pothecary MPharma (Hons), ACPP Pharmacist is a Senior Pharmacist at Worthing Hospital. Andrew’s interest in fibromyalgia began in 2004 when his wife was diagnosed with the condition. He hopes to undertake research and develop a specialist role in this area in the future.

In his Pharmacist Pick & Mix presentation Andy Pothecary spoke about Medicines Licensing in the UK explaining the Drug Company identifies promising new compound, applies for a patent, and carries out further laboratory trials. The company then applies for permission to carry out clinical trials. When completed they apply for marketing authorisation (MA). They can then sell the product within the EU.

He described the types of clinical trials a drug is submitted to.

Phase I: Pre-clinical testing, with healthy male volunteers – first time drug used in humans.
Phase II: Small-scale trial at a limited number of centers, in which the drug is used in patients with the disease.
Phase III: Larger-scale trial across many centers, with a wider range of patients
Phase IV: Post-marketing surveillance – product in use but rare or long-term side effects identified

Use of unlicensed medicines

These are medicines without a PL/MA. This might be because they are undergoing clinical trials, are to treat rare conditions, or because the MA has been withdrawn or surrendered. If unlicensed medicines are used, the prescribing doctor assumes full responsibility and liability for any adverse events that might occur.

What is “Named-patient Basis?”

Process that enables patients to be supplied with an unlicensed drug. “Named patient” means the drug is being supplied (to the hospital, pharmacy, etc) for the use of a specific patient. Depending on the drug concerned, it can be fairly simple to obtain or involve lots of form filling by doctor and pharmacy.

Off-license/off-label Medicines

When a product is granted an MA, this specifies which conditions the product can be used to treat. However the product might also be used to treat other conditions. This use is termed “off-license” or “off-label” because it is not covered by the terms of the MA. Again, this means that the prescribing doctor will assume greater responsibility and liability if anything goes wrong.

Why is this relevant?

How many medicines are currently licensed for the treatment of fibromyalgia in the UK? None! He spoke about the use of ‘old drugs’ normally prescribed for other conditions but used for fibromyalgia although these may not be licensed for this. He also described the various drugs prescribed by GPs.

Report by Denise Rhodes

Gemma Kingsman, professional fundraiser, reported on Finding the Funds – and outlined what funds are available, mainly concentrating on Awards for All, which is the National Lottery.

For large pots of money £30,000 eg can be funded for up to 3 years. Smaller pots up to £5,000 can be applied for such as sessional worker funds, equipment needs, marketing the group. She advised ringing lottery help lines for how to submit and what for. They are very helpful.

Grassroots Awards are nationally available but administered locally via a local community foundation. The cash comes from wealthy donator philanthropists and organisations. Groups applying must have a written constitution with clear and simple rules and regulations, be a not-for- profit organisation, able to identify a need in the community, which the group will serve. Can make more than one application in two categories: up to £900 and from £900 – £5.000. The following year application can be made for further cash to support further needs. The Grassroots Grant might be for rent, equipment, refreshments, and volunteer costs regarding running costs.

The Lions Clubs, Rotary Group will respond to a letter for support and the website “Guide Star” is a source of information. Many Disability sites will provide sources of funding. Her company “Consultaid” charges £35 to fill in a grant application form but she referred delegates to free help in the community.

Talking fundraising we are looking for some help from our friends. We believe we can persuade a couple of American FMS doctors to come to conference next year. But we need to pay their airfare and expenses. We may be looking at approximately £500 per doctor. If you are coming next year and are able to do a bit of fund raising towards hearing these USA doctors who are often light years ahead of us in some things FMS, we would love to shout about what you are doing and would really welcome your support. Email me jeannehambleton @ mac.com if you can help. While April 2011 is some while away we need to get in the diaries of these doctors. However small your fundraising is it will all add up. Guess what – I already have two bookings. Thanks Ann and Gina.

THANKS
Finally I would like to thank FMA UK for their great support with help and wonderful conference bags, which members have said they will carry their meetings. Without their help the delegates might have had Tesco plastic carrier bags for their conference papers. Odd everyone liked the bags but no one said anything about the paperwork we spent hours stuffing inside….

Clare Palmer’s Sunday input with doctors was also appreciated. Thanks also to Teresa White and Lorely Day (Chichester FM SG), for their great work with the tombola, raffles and auction. Thanks also to Horndean members Tracy Gibbon and Andy Andrews for their major contribution to the auction with another lady fibromite whose name sadly I did not get.

My gratitude to Pauline Dee and Leanne Daniels who spent hours at the front desk dealing with enquiries. There for the cause, Pauline and Glenna Frost but neither managed to see or hear any speaker or visit a workshop. Thanks also to Glenda Philpott and Martin for spending hours filming speakers to produce a DVD of the event. Watch this space for news of when it is available. Like most conference areas the room was dark for power points and mobile telephone quiet signals may have interfered with the recording but we live in hope.

My apologies to all those who offered help with notes and speakers. I ran out of time and just had no time to get together to work out the details. I am sorry. I am grateful to Denise Rhodes and Leanne Daniels who took notes anyway and fired them off in time for me to get this article out in reasonable time.

Thanks to Bob McKinlay and Gareth Duval for organizing the golf and Chris Crick for sorting out the deep-sea fishermen and lone fisherwoman, and to the fossil hunters who understood when we said their ‘leader’ was grounded in the Caribbean under an ash cloud.

Also thanks to Tony Ede (FMS SAS) and Simon Stuart (Worthing & Ferring FM SG) for taking care of projectors, laptops and power points and making it happen. Gratitude to Bill Craven and friends for the race night. I am grateful to fibromites Karen Henderson who did a workshop and sorry Sam Piggott had a flare. Also thanks to Alan Perry for the photographs of the FollyPogs Ball he has donated and to Nene Valley FM SG who donated £63 to the research fund.

Thanks also to all the speakers who gave their time without reservation, those who ran workshops, the exhibitors, and the pamper therapists. Your support was appreciated by everyone.

I also appreciate those who understood how much work was involved and have volunteered to ‘take a section’ of the conference for next year. Great news and thanks.

South Downs Holiday Village Management, staff and the Head Chef did all they could to make us comfortable. The dining room and kitchen staff were all exceptional and patiently dealt with our special diets. They were more attentive than some expensive hotels I have stayed at giving freely of their usual time off. Well done and hope your company appreciates your high standard of care. We fibromites were really grateful to everyone on site for making us very very welcome.

Finally my gratitude must also go to Sarah, my ‘rock’ that did everything pamper for us and my husband Arthur who worked with me who wrote databases, was tolerant to list bookings and payments and the endless mails. Forgive me if I have missed anyone. I am a fibromite and I do forget. And a huge thanks to those who came. You helped to make the weekend memorable for us. Without your support none of this would have happened. THANK YOU Jeanne

EUROPEAN NETWORK of FIBROMYALGIA ASSOCIATIONS

From the News Desk of Jeanne Hambleton

PRESS RELEASE -28.01.2009

 

The European Medicines Agency (EMEA) are to  have a consultation with a delegation from the European Network of Fibromyalgia Associations (ENFA) in an attempt to understand the need for medical treatments for fibromyalgia in Europe.


Brussels –
Following an invitation by the EMEA, the European Network of Fibromyalgia Associations (ENFA) has agreed to attend a consultation meeting with EMEA, where ENFA representatives will share their knowledge and experiences related to the disease of Fibromyalgia that some 14 million Europeans are suffering from.  One of the biggest challenges that the patients have been facing is the lack of officially recognized medical treatment options in the European Union whereas there are three drugs in the United States of America approved by the Food and Drug Administration: Cymbalta from Eli Lilly, Lyrica from Pfizer and recently authorised Savella from Forest & Cypress.

 

The European Declaration 69/2008 on Fibromyalgia that has been recently adopted by the European Parliament, symbolizing the awareness raised around Fibromyalgia, calls for actions on specific issues from European Institutions to improve healthcare surrounding the disease, e.g. investment in research and provision of better diagnosis and treatment.  In addition, the European Health Commissioner Ms. Vassiliou’s remarks (E-6262/08EN) on the treatment of Fibromyalgia demonstrates encouraging willingness of the European Commission to address various concerns laid out in the Declaration on Fibromyalgia.

“We hope that this new drive on Fibromyalgia awareness will bring the end to the impasse of medical treatment for Fibromyalgia patients in the EU”, said Mr. Robert Boelhouwer, President of ENFA. 

Fibromyalgia is a complex disease with a variety of symptoms in addition to the defining symptom – chronic widespread pain. It is estimated that 14 million people in Europe suffer from fibromyalgia and the condition is more prevalent with women (87%).  Fibromyalgia imposes large economic burdens on society as well as on affected individuals. The debilitating symptoms often result in lost work days, lost income and disability payments. Due to lack of awareness, on average patients in Europe see 3-4 physicians and take multiple medications over the course of several years before they receive a diagnosis of Fibromyalgia.

Mr. Boelhouwer said, “Increasing awareness of Fibromyalgia among healthcare professionals and patients will bring enormous benefits to patients, healthcare providers and the society in general by managing the burden of the disease.” he continues, “Having this in mind, ENFA welcomes the proactive role that both the European Parliament and the European Commission have taken up in raising the awareness of Fibromyalgia.”

 

 

Contact:  European Network of Fibromyalgia Associations (ENFA)

Mr. Robert Boelhouwer President of ENFA

contact@enfa-europe.eu  - www.enfa-europe.eu


 About ENFA

ENFA is a network of patient association and support groups working in close consultation with the national association in the relevant country. Our joint missions are to conquer the myths and misunderstandings around Fibromyalgia. The network will help collectively push forward the boundaries which currently exist in understanding, experiencing and treatment of Fibromyalgia. Our main goal is to see fibromyalgia receiving the recognition it deserves across Europe as an illness in its own right.


 

 

Declaration of the European Parliament on fibromyalgia (1.26.2.)

From the News Desk of Jeanne Hambleton 

 
Bulletin EU 1/2-2009 - Health and consumer protection (2/3) PROVISIONAL VERSION

1.26.2. Declaration of the European Parliament on fibromyalgia.

Adopted by the European Parliament on 13 January. Parliament called on the Council and the Commission to:

  • develop a Community strategy on fibromyalgia in order to recognise this condition as a disease;
     
  • help raise awareness of the condition and facilitate access to information for health professionals and patients, by supporting EU and national awareness campaigns;
     
  • encourage Member States to improve access to diagnosis and treatment;
     
  • facilitate research on fibromyalgia through the work programmes of the seventh framework programme for research and technological development and future research programmes;
     
  • facilitate the development of programmes for collecting data on fibromyalgia.
  • Fibromyalgia Circle of Care Initiative

    FROM THE DESK OF JEANNE HAMBLETON UK NFA LEADER AGAINST PAIN

    October 25, 2008 08:00 AM Eastern Daylight Time
    Johns Hopkins and National Fibromyalgia Association Launch Fibromyalgia Educational Initiative to Bridge Chasm in Diagnosis and Care

      Collaborative Program Shifts Paradigm with Evidence-Based Platform to Educate Providers on Fibromyalgia Management

    SAN FRANCISCO–(BUSINESS WIRE)–The Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing and the National Fibromyalgia Association announced today the launch of the Fibromyalgia Circle of Care Initiative at the ACR/ARHP Annual Scientific Meeting, October 24-29, 2008 in San Francisco. The outcomes-based educational initiative will educate providers about the disease state and the latest therapeutic options; thus, driving accurate and early diagnosis of fibromyalgia for the ten million U.S. citizens impacted by this disorder.

    The multi-interventional series of educational activities is open to primary care physicians (PCPs), rheumatologists, psychiatrists, pain management specialists, nurses (RNs), nurse practitioners (NPs) and physician assistants (PAs). The program is designed to educate providers on disease state awareness, diagnosis, impact of early diagnosis and referral, and multidisciplinary care. Additionally, the initiative will share the latest therapeutic options and strategies, as well as review clinical trials that assess newer therapies for fibromyalgia.

    “Many fibromyalgia patients see an average of four physicians—over a duration of five to eight years after the onset of the disease—before an accurate diagnosis of fibromyalgia is achieved. This represents five to eight years of underdiagnosis, misdiagnosis and inappropriate treatment of the patient,” said Victor Marrow, Ph.D., Executive Director, Office of Funded Programs/CME Johns Hopkins School of Medicine. “The Fibromyalgia Circle of Care Initiative will result in improved patient care by minimizing the lack of awareness among physicians which has been responsible for the inability or reluctance to accurately diagnose, contributing to the fragmentation of care.”

    The Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing and the National Fibromyalgia Association are collaborating on this unique program to improve fibromyalgia patient outcomes. The integrated educational activities will deliver:

    Practical and interactive case-related content
    Summaries of clinical data and recommendations on how to implement management strategies into the provider’s practice
    Updates on clinical practice guidelines and recommendations
    Evidence-based outcomes
    Patient communication content and materials
    Treatment adherence and compliance strategies
    “The Fibromyalgia Circle of Care Initiative is unique in its collaboration among healthcare organizations and leaders to raise awareness of the disease state through an interactive program that effectively drives provider participation and implementation of evidence-based lessons within their own practice,” said Lynne Matallana, President and Founder, National Fibromyalgia Association. “After completion of this program, participants will be fully prepared to use the tools and lessons learned to positively and tangibly impact the quality of life of these patients.”

    With fibromyalgia affecting up to ten million people in the United States, or up to six percent of patients seen in general medical practices, the impact to the U.S. economy is significant. According to a 2003 study by I. Jon Russell, et al., healthcare costs range from $12-$14 billion per year and account for a loss of one to two percent of the nation’s overall productivity. The study also found that total annual costs for fibromyalgia claimants were more than twice as high as the costs for the typical insurance beneficiary. Furthermore, the prevalence of disability among employees with fibromyalgia was twice as high as compared to all employees. Lastly, for every dollar spent on fibromyalgia-specific claims, employers spent approximately $50-$100 on additional direct and indirect costs.

    For more information or to register to participate in the Fibromyalgia Circle of Care Initiative, e-mail info@circleofcare.md.

    ABOUT THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE

    In July 2008, U.S. News & World Report ranked the Johns Hopkins Hospital #1 among American hospitals for the 18th consecutive year. In 2006, the Johns Hopkins Office of CME received “Accreditation with Commendation” for six years, the highest ranking issued by the ACCME. Hopkins CME has been recognized as a center for “Best Practices” and as a resource to ACCME-accredited providers. For more information, please visit http://www.hopkinscme.edu or contact Victor Marrow, Ph.D., Executive Director, CME’s Office of Funded Programs at vmarrow@jhmi.edu.

    ABOUT THE INSTITUTE FOR JOHNS HOPKINS NURSING

    The Institute for Johns Hopkins Nursing designs and delivers leading-edge continuing education for nurses. The Institute accesses the expertise of faculty and nurses from both the Johns Hopkins University School of Nursing and Johns Hopkins Hospital, including over 2,500 highly skilled clinicians in 10 clinical and countless subspecialty areas who are also world-renowned researchers and educators. For more information please visit http://www.ijhn.jhmi.edu.

    ABOUT THE NATIONAL FIBROMYALGIA ASSOCIATION

    The National Fibromyalgia Association (NFA) is a nonprofit 501(c)(3) organization whose mission is to develop and execute programs dedicated to improving the quality of life for people affected by fibromyalgia. The NFA publishes a quarterly magazine, Fibromyalgia AWARE, and hosts an award-winning website at http://www.FMaware.org.

    Contacts
    Amendola Communications for MJ Consulting Group
    Kate Donlon, 619-876-2654
    kdonlon@ACmarketingPR.com
    or
    Jan Shulman, 480-664-8412, ext. 12
    jshulman@ACmarketingPR.com

    Permalink: http://www.businesswire.com/news/biospace/20081025005016/en

    NEW DATA ON THERAPIES FOR PAIN AND INFLAMMATION FROM PFIZER

    By Jeanne Hambleton © Fibromite NFA Leader Against Pain

    While I am a great believer in positive thinking, I have to accept that medication can be the only way that allows some people to live with pain and this impossible invisible condition called fibromyalgia. From this point of view I must say I am pleased that the drug companies are continuing to find ways of easing our pain and hopefully one day will find a cure.
    This morning I received a press release from Pfizer who are working to help those of us with fibromyalgia and arthritic problems. I wanted to share this with you and the full report is listed below.

    Having read this one of my greatest hopes is that the UK medical authorities will, in the near future, give its blessing to Lyrica, Cymbalata and now Esreboxetine.

    Let us hope if these new drugs are approved in the UK that there will be no ‘post code lottery’ by the NHS for the prescription of these medications. Currently British fibromites are victims of the lack of approval of any specific fibromyalgia drugs. While American patients are able to gain relief from the new drugs, it seems the UK fibromites must suffer in silence.

    In recent years I have read and signed numerous epetitions appealing to the Prime Minister Gordon Brown to bring some relief to those of us with fibromyalgia. The epetitions have asked for research, better education of doctors and specialists, fibromyalgia clinics and much more – but all have met with lame excuses. This has nothing to do with the current financial crisis. We have been writing to Prime Ministers – Tony Blair and Gordon Brown -for years. What do we have to do to get attention – camp out in our wheelchairs outside the Houses of Parliament? We might get more press coverage that way!

    I am not surprised that Guy Fawkes chose to blow up the Houses of Parliament on November 5 if this was the only way he could get the attention of those working inside that building. Maybe we need a fictional Gun Powder Plot to enlighten the Government and spur the MPs into allocating funds for research to find a cure for fibromyalgia. But it does appear that nothing seems to stir those in the ‘corridors of power’.

    A little correction here – according to Hansard and TheyWorkforYou on October 14 Dr John Pugh MP (Shadow Minister, Treasury; Southport, Liberal Democrat) is reported to have said, “…I was recently approached by someone in my constituency who suffered from a disease called Fibromyalgia, which had to be explained to me. That person found that there was wholesale ignorance of the disease in all parts of the NHS and many parts had been accessed about the condition.”

    Hooray for John Pugh. Shall we all write to our MPs and talk about the ‘F’ word? You do know I mean F for fibromyalgia, I hope! I am not into writing about politics but for goodness sake if someone wants to win the next election they should become our champion – do something about the plight and despair of the fibromites. That should get them at least 2 million votes plus their families and friends. I wonder why are we treated as second class citizens? Just because we have an invisible disability it does not mean we have no feelings and do not deserve some respect. What do you say?

    As a matter of interest something like 10 years ago the public were ignorant about ME. Today everyone has heard of it? We must spread the ‘F’ word – fibromyalgia. I have banned the other ‘F’ word in my house. Now we all say ‘fibromyalgia’ when we lose our temper and burst into fits of laughter.

    Results from Clinical Trials Show Promise for Innovative Therapies in Rheumatoid Arthritis and Osteoarthritis Pain and Fibromyalgia

    SAN FRANCISCO–(BUSINESS WIRE)–Pfizer will present data on three investigational compounds that represent potential new mechanisms for targeting pain and inflammation. These data will highlight tanezumab, a molecule designed to target nerve growth factor, a key pain mediator; CP-690,550, a JAK-inhibitor that suppresses immune-related inflammatory response; and esreboxetine, a highly-selective norepinephrine reuptake inhibitor which plays a role in controlling the activity of this important neurotransmitter. These data will be presented at the 2008 American College of Rheumatology Scientific Meeting in San Francisco, California.

    “Pfizer has an established track record of bringing innovative therapies to patients suffering with pain and inflammation,” said Martin Mackay, Ph.D., president, Pfizer Global Research and Development. “Data to be presented at ACR confirm our clinical approaches in developing these three compounds – CP-690,550, esreboxetine and tanezumab – as potential new medicines to provide relief from these serious medical conditions.”

    Fibromyalgia

    Pfizer is a pioneer in the study of fibromyalgia, investing many years of research into treatment options for this complex pain condition. In June 2007, Lyrica (pregabalin) CV became the first FDA-approved treatment for the management of fibromyalgia. Data supporting that approval showed Lyrica patients experienced significant reduction in pain as early as week one in some patients.
    While widespread pain is the cornerstone of fibromyalgia, the condition is also characterized by other hallmark symptoms such as fatigue and difficulty concentrating.

    Data presented at ACR will highlight the results of a phase 2 proof of concept study with esreboxetine, a highly selective norepinephrine reuptake inhibitor in a fibromyalgia population.
    Data from this study showed that esreboxetine may be effective in relieving in key fibromyalgia symptoms, including pain, function and fatigue and was generally well tolerated. In the study, 43 percent of patients receiving esreboxetine reported their condition was much improved or very much improved as compared to 23 percent of placebo-treated patients.

    The most common side effects compared to placebo were constipation, insomnia, dry mouth, headache and nausea. The proportion of patients who discontinued as a result of adverse events was 8.2 percent in the esreboxetine group and 2.3 percent in the placebo treatment group.
    Fibromyalgia has been recognized by the professional community for over 30 years as a common, chronic widespread pain condition and is now thought to affect up to six million Americans. Recent evidence suggests a neurological basis to fibromyalgia, as demonstrated by brain scans and altered levels of certain neurotransmitters.

    Rheumatoid Arthritis

    Data is being presented from several clinical trials studying CP-690,550, an oral medication that inhibits the Janus Kinase enzyme (JAK). This enzyme plays a major role in controlling the activation and proliferation of white blood cells, key elements of the immune system, which play a major role in rheumatoid arthritis (RA). CP-690,550 has shown encouraging results for the treatment of rheumatoid arthritis at doses that don’t appear to be associated with excessive immune suppression.

    Investigators will present interim results from a late-breaking Phase 2B study evaluating the activity of CP-690,550 in combination with methotrexate, the most commonly-used RA treatment. Approximately 60 percent of patients on doses at or above 3 mg of CP-690,550 responded to treatment as compared to 37.7 percent on placebo. These data confirm and extend the promising data seen in an earlier phase 2A study to this longer, 12 week study, and to patients who are already taking methotrexate to treat their rheumatoid arthritis.

    Also being presented is a pharmacokinetic drug interaction study which showed that CP-690,550 and methotrexate can be co-administered without dose adjustment. In addition, preliminary results from an open label extension study will be presented.

    In these studies, the most commonly reported adverse events were nausea, headache, dizziness, disorientation, hot flushes, urinary tract infections, diarrhea and liver function tests. Larger and longer phase 3 studies are expected to start in 2009 to help further define the benefits and risks of CP-690,550 as a potential treatment for rheumatoid arthritis.

    According to the Arthritis Foundation, 1.3 million Americans live with rheumatoid arthritis, a type of arthritis that can be severe, debilitating, deforming and even shorten life.

    Osteoarthritis Pain

    Pfizer continues to research new ways of treating osteoarthritis pain. Two studies to be presented highlight a new compound in development and new data for Celebrex (celecoxib) in the treatment of osteoarthritis pain.

    Results from a Phase 2 study exploring the safety and efficacy of tanezumab, a novel biologic designed to block nerve growth factor, show that treatment once every eight weeks may significantly decrease pain in patients suffering from moderate to severe osteoarthritis pain in the knee. In the trial, approximately 75 percent of patients in both the tanezumab 100 and 200 μg/kg treatment groups experienced a 50 percent reduction in knee pain as compared to 26 percent of patients in the placebo group. In the study, the most common adverse events associated with tanezumab include headache, upper respiratory tract infection, paresthesia (abnormal sensations), hypoesthesia (decreased sensations) and arthralgia (joint aches).

    Another late-breaking study evaluated continuous use of daily Celebrex treatment over a 22-week period compared to intermittent use of the medicine in preventing spontaneous OA flares. The study showed that continuous use resulted in 42 percent fewer OA flare episodes than the intermittent use. The results from the study also demonstrated that there were no significant differences in overall adverse events between the intermittent and continuous use groups.

    According to the Arthritis Foundation, osteoarthritis affects 27 million Americans. Recent data show that one in two Americans are at risk for knee osteoarthritis over their lifetime. Loss of joint function as a result of osteoarthritis is a major cause of work disability.

    About Celebrex

    CELEBREX is indicated for the relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis in adults and ankylosing spondylitis, and for the management of acute pain in adults.

    Cardiovascular Risk
    All prescription NSAIDS, including CELEBREX, may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs may have a similar risk. This risk may increase with duration of use. Patients with CV disease or risk factors for CV disease may be at greater risk.

    All prescription NSAIDs, including CELEBREX, are contraindicated for the treatment of perioperative pain in coronary artery bypass graft surgery.

    Gastrointestinal Risk

    All prescription NSAIDs, including CELEBREX, cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.

    About Lyrica

    LYRICA is indicated for the management of Fibromyalgia, neuropathic pain associated with Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, and as adjunctive therapy for adults with Partial Onset Seizures. There have been post-marketing reports of angioedema and hypersensitivity. Treatment with Lyrica may cause dizziness, somnolence, peripheral edema or blurred vision. Other most common adverse events include dry mouth, weight gain, constipation, euphoric mood, balance disorder, increased appetite and thinking abnormally.

    About Pfizer’s Investor Briefing at ACR (American College of Rheumatology)
    On Tuesday, October 28 at 6:00 p.m. PCT, Pfizer will host a briefing for analysts and investors to review data presented at the meeting on candidates in Pfizer’s pain and inflammation portfolio

    SHIRLEY GOODNEST AND MARCY

    by Jeanne Hambleton © 2008
    NFA Leader Against Pain – International Advocate

    This little story was sent to me by a fibromite who described the tale as charming. I do agree with her. In a world full or woes and wars, this is story of pure innocence that is quite heartening. Enjoy.

    A mom was concerned about her kindergarten son walking to school since he did not want his mother to walk with him.
     
    She had an idea of how to handle it.  She asked her good friend if she would follow him to school, staying at a distance so he would not notice her.  

    The friend said since she was up early with her toddler anyway, it would be a good way for them to get some exercise, so she agreed.  

    The next school day, the friend and her little girl set out following Timmy as he walked to school with another neighborhood boy he knew.  She did this for the whole week.

    As the boys walked along, kicking stones and chatting, Timmy’s little friend noticed the same lady following them.  

    Finally he said to Timmy, “Have you noticed that lady following us to school all week?
    Do you know her?”
     
    Timmy nonchalantly replied, “Yes, I know who she is.”
     
    The friend said, “Well, who is she?”
     
    “That’s just Shirley Goodnest and her daughter Marcy,” replied Timmy.
     
    “Shirley Goodnest?  Who’s the heck is she and why is she following us?” asked his friend.
     
    “Well,” Timmy explained, “every night my Mom has me say the 23rd Psalm with my prayers ‘cause she worries about me so much.  And in the Psalm, it says, ‘Shirley Goodnest and Marcy shall follow me all the days of my life’, so I guess I’ll just have to get used to it!”
     
    May Shirley Goodnest and Marcy be with you today and always?

    FMS Global News

    Fibrohohugs Support

    Tenderpoints Newsletter

    CONGO’S BILL AND THE RACE AGAINST TIME

    by Jeanne Hambleton  © 2008
    NFA Leader Against Pain-Advocate  

    A committee of the New Jersey Senate has considered a new bill called Congo’s Law and there are hopes that Congo, the German Shepherd dog, will no longer be under sentence of death.

    See original story: Congo gets world wide support

    Congo was put on “death row” last June as a vicious dog after protecting his mistress, a female dog and three puppies, from an alleged attack with rake by a gardening contractor. When news of her fate reached the Internet animal activists and dog lovers all over the world signed petitions and sent emails to the Judge in Princeton, home of Congo, to save the dog’s life.

    This week thanks to a friend, Anne Soden, who lives in Princeton and took part in one of the demonstrations to save Congo, I can bring you news that an American Assemblyman called Neil M Cohen from the New Jersey Senate has proposed a Bill to save the life of Congo, the German Shepherd dog sentenced to death. Thanks Anne.

    Neil Cohen is quoted as saying,”Congo’s case underscores the need for the state to modernize the law that deals with dog attacks so it is fair for the owners and the animals.”

    Congo’s Bill would revise state animal control law provisions that are alleged to be archaic and barbaric, by making it more difficult to label a dog vicious or to put an animal down.

    But a USA website (http://abbyK9.blogspot.com) which shows a picture of two of the James children with Congo, adds a cautious note to say, “Please note that Congo being returned to his family is only temporary while the case goes through the appeal. Congo could still be put to sleep for protecting her family. So please, keep contacting the governor’s office to have this matter put to rest once and for all. The calls and emails are helping!” Details of who and where to write or email appear later in this story.

    NEW JERSEY SENATE

    In December Congo’s Bill, that would immediately change the state’s vicious dog laws, made its first passage through the Senate.

    The New Jersey Assemblyman Neil Cohen, who took this action, is an avid defender of the rights of animals and has sponsored several measures to ensure the humane treatment of animals. He has met Congo and his owners, the James family, at their home in Princeton to raise awareness of his legislation and the dog’s potential fate. Neil Cohen says that under current law the only defense for a dog declared vicious is if the dog has been provoked and acted in defense to protect itself, its offspring, its owner or a family member of the owner.

    “The nature of a dog is to protect those around them,” said the Assemblyman. “It’s outrageous that Congo may have been provoked into attacking and this fact is being ignored by authorities.”

    A lawyer for Congo’s owners has argued that Congo was provoked when the dog mauled a landscaper on June 5 outside a home in Princeton Township. Neil Cohen’s bill (A-4597) will clarify and revise the current vicious dog law to make it more equitable.

    The bill would take into consideration provocation by treating a dog provoked to attack differently than an unprovoked dog that caused bodily injury to a person or domestic animal during an attack.

    The Assemblyman said the bill would define striking, grabbing, poking and prodding as threatening actions and behaviors that could incite a dog to defend itself, its offspring or its owner or the owner’s family. The legislation would raise the bar for declaring a dog as vicious. It would require a dog to be found vicious beyond a reasonable doubt — the same standard used for humans charged with a crime. The measure also would give municipal courts an alternative to humanely destroying a vicious dog by giving the owner the option to comply with precautions for keeping a potentially dangerous dog.

    During the disposition and appeals process, the bill would allow an owner to keep their dog as long as they complied with current law’s precautions for keeping a potentially dangerous dog. Precautions for owners keeping a dog deemed potentially dangerous include posting signs on their property and minimizing a dog’s potential threat to people and other animals. The bill also would allow an owner and owner’s family to visit their dog during times when their dog might be impounded. The bill would establish a three-month statute of limitations for animal control officer to seize and impound alleged vicious or potentially dangerous dogs.

    Neil Cohen said the vicious dog law has not been amended since 1994 and it is long overdue for an update. He hoped his legislation would be fast tracked into law to save the life of Congo.

    Congo was ruled vicious by Princeton Township Municipal Judge Russell Annich, Jr., who also ordered that the dog be put down. The judge’s decision has since been stayed and a state Superior Court Judge has allowed the dog to return to his home, pending appeal, with numerous restrictions, including that he is muzzled and kept in a fenced area.

    The fate of Congo created a public debate that has lead to more telephone calls, emails, letters and faxes to Governor Jon S. Corzine’s office than any other issue since the governor took office.

    The Bill was carried by a vote of 5 to 0. It now heads to the Assembly Speaker who may or may not decide to post it for a vote by the full Assembly.

    ON LINE SUPPORT

    Broadcaster Warren Eckstein from Santa Monica, California, an internationally known pet and animal expert, has been carrying news of Congo’s Bill on his website.

    On December 19 Warren wrote that the New Jersey Assembly Agriculture and Natural Resources Committee today released legislation Assembly Deputy Speaker Neil M. Cohen crafted that would immediately change the state’s vicious dog laws.

    It was also reported – you will be pleased to hear – from Warren’s website that Congo and his partner Lucia are so happy to be back together.

    Elizabeth James on Warren’s website wrote, “I think the appeal could take months but we are optimistic. God willing, New Jersey Assemblyman Neil Cohen’s proposal of Congo’s Law will go through and that will be the first line of defense. We are still receiving mail and email from well wishers and supporters all around the globe! Thank you for all the support and we will keep you posted as we progress.”

    On another local website for Asbury Park Press, APP.com for Jersey for comments, blogs and shares, Tom Baldwin of Gannett State Bureau reported Assemblyman Neil Cohen, a professed dog-lover, is quoted as saying under this bill Congo gets saved and the bill gives municipal judges needed latitude to deal with dog-bite cases.

    Tom Baldwin continues and I smiled, “The story connects hot-issue circuitry. Mix the gentility of leafy, enlightened Princeton with the dog-lovers and the immigration debate — the landscaper is reported to have been an illegal from Honduras — and the story quickly won global appeal.
    “Locally, not since a whale swam up the Delaware River to freshwater Trenton in April 2005 has an animal story grabbed headlines, aside from some reported coyote attacks and New Jersey’s enduring debate over whether to allow hunters shoot black bears.”
    And finally Abby K 9 tells us the way to get Congo’s ruling reversed, hopefully, is to contact New Jersey governor Jim Corzine. His office is taking calls (and counting them) to support overturning the death sentence for Congo the German Shepherd.

    The governor’s office can be contacted at Office of the Governor, PO Box 001,Trenton, NJ 08625. Calling is preferred, (609-292-6000) but you can also email them through the website.

    http://www.nj.gov/cgi-bin/governor/govmail/govmail_1.pl

    Choose “Law & Public Safety” on the drop-down menu and on the next page, choose “Pardons & Clemency”. It only takes a few seconds to call – they are interested in the number of callers, not what you have to say – and it does not take much longer to email. Assemblyman Cohen telephone number is (908) 624-0880.

    CONGO’S BILL
    The following includes a statement from the Bill outlining the relevant details of Congo’s Bill.

    On December 17 Senate Bill No. 3019 (A.4597) was introduced for the 212th Legislature. The synopsis said it revises vicious and potentially dangerous dog law; designated Congo’s Law.

    The final Statement in the Act concerning vicious and potentially dangerous dogs and designated as Congo’s Law, and amending and supplementing P.L.1989, c.307.
    enacted by the Senate and General Assembly of the State of New Jersey said,

    “This bill clarifies and revises several provisions of the State law that address vicious and potentially dangerous dogs.  It is designated as Congo’s Law in recognition of Congo, a dog in Princeton, New Jersey, that was declared a vicious dog and subject to an order to be euthanized when, by many accounts, it was protecting its owner and the owner’s family members when a landscaping crew, against the owner’s instructions, came onto the owner’s property.

    “Specifically, the bill defines the terms ‘provoked’ and ‘unprovoked.’  Whether a dog is provoked or not is currently the only defense under the law to prevent a dog from being declared vicious when it is acting in defense of itself, its offspring, its owner, or a family member of its owner.  Also, under current law, if a municipal court declares a dog to be vicious, it must be humanely destroyed.  This bill provides the municipal court an alternative to humanely destroying a dog that is declared vicious.

    “Under the bill, the court may, for equitable reasons, choose an alternative to destroying the dog if the alternative is sufficient to protect the public and is at least as protective and restrictive as the precautions required for keeping a potentially dangerous dog.  The bill allows for an owner to keep the dog pending disposition of the case and any appeals if the owner agrees to comply with those precautions.  The precautions include posting certain signs on the property and minimizing the dog’s contact and threat to people and other animals in specific ways. 

    “In addition, the bill authorizes the court to modify certain requirements for potentially dangerous dogs, and vicious dogs that remain with their owners, to be reasonable, affordable and appropriate to the owner’s circumstances. The bill further provides for visitation by the owner and the owner’s family during any impoundment that is required.

    “Furthermore, the bill raises the burden of proof in most cases for finding a dog to be vicious or potentially dangerous to beyond a reasonable doubt, instead of by clear and convincing evidence.  The municipal burden of proof for demonstrating that a dog was not provoked or that the injury was not accidental would be by clear and convincing evidence.  The bill clarifies under the law’s hearing provisions to provide that a hearing on whether the dog is vicious or potentially dangerous will be held unless the owner agrees to relinquish ownership of the dog. 

    “The bill further requires the notice to the owner to inform the owner of the potential consequences of not replying to the notice within seven days.  Under current law and the bill, if the owner does not reply within seven days of the notice, or if the owner relinquishes ownership of the dog, the dog may be humanely destroyed.  The bill eliminates the requirement to tattoo a potentially dangerous dog.

    “The bill also modifies the provision under current law concerning liability insurance for potentially dangerous dogs.  The bill allows the court to order this insurance for potentially dangerous dogs, and if applicable, vicious dogs, if it is available.  Furthermore, the court is directed to determine a sufficient and reasonable amount of coverage and a reasonable cost for that coverage; and the insurance company is directed to notify the municipality of the coverage and any lapsing of the policy, if the company can lawfully do so.

    “Finally, the bill provides additional protections for the public by authorizing municipalities, if a municipality chooses to do so, to establish procedures for recording and investigating complaints about, and requiring appropriate notice to the public concerning, dogs within the jurisdiction of the municipality that are reported to exhibit menacing, threatening, or other aggressive behavior that may lead to injury to a person or a domestic animal, or that have injured a person but have not been the subject of an action pursuant to the State vicious and potentially dangerous dog law.  The municipality must establish these procedures and requirements by ordinance and it is authorized to require an owner of a dog subject to complaints to post signs or take other action determined necessary by the municipality for the protection of the public.

    “With Assembly Floor Amendments
    (Proposed By Assemblyman Cohen) ADOPTED: DECEMBER 13, 2007
     
    These amendments:
          (1) make changes to the definition of “provoked” in the bill;
          (2) remove certain time limitations by which certain actions may be taken in section 2 of the bill; and
          (3) change the municipal burden of proof with respect to whether the dog was not provoked or that the injury was not accidental from beyond a reasonable doubt to by clear and convincing evidence.

    Clause 15 states – This act shall take effect immediately, and shall apply to all pending cases and cases in the process of being adjudicated as of the date of enactment of this act, and to any dogs under court order for humane destruction as of January 1, 2007 but which have not been destroyed as of the date of enactment of this act.

    The Bill must now go before the Full Assembly.

    See Also: http://fmsglobalnews.wordpress.com/2007/12/02/congo-on-doggie-death-row-gets-worldwide-support-and-tv-publicity-for-his-reprieve/

    A committee of the New Jersey Senate has considered a new bill called Congo’s Law and there are hopes that Congo, the German Shepherd dog, will no longer be under sentence of death.

    Congo was put on “death row” last June as a vicious dog after protecting his mistress, a female dog and three puppies, from an alleged attack with rake by a gardening contractor. When news of his fate reached the Internet animal activists and dog lovers all over the world signed petitions and sent emails to the Judge in Princeton, home of Congo, to save the dog’s life.

    This week thanks to a friend, Anne Soden, who lives in Princeton and took part in one of the demonstration to save Congo, I can bring you news that an American Assemblyman called Neil M Cohen from the New Jersey Senate has proposed a Bill to save the life of Congo, the German Shepherd dog sentenced to death. Thanks Anne.

    Neil Cohen is quoted as saying,”Congo’s case underscores the need for the state to modernize the law that deals with dog attacks so it is fair for the owners and the animals.”

    Congo’s Bill would revise state animal control law provisions that are alleged to be archaic and barbaric, by making it more difficult to label a dog vicious or to put an animal down.

    But a USA website (http://abbyK9.blogspot.com) which shows a picture of two of the James children with Congo, adds a cautious note to say, “Please note that Congo being returned to his family is only temporary while the case goes through the appeal. Congo could still be put to sleep for protecting his family. So please, keep contacting the governor’s office to have this matter put to rest once and for all. The calls and emails are helping!” Details of who and where to write or email appear later in this story.

    NEW JERSEY SENATE

    In December Congo’s Bill, that would immediately change the state’s vicious dog laws, made its first passage through the Senate.

    The New Jersey Assemblyman Neil Cohen, who took this action, is an avid defender of the rights of animal and has sponsored several measures to ensure the humane treatment of animals. He has met Congo and his owners, the James family, at their home in Princeton to raise awareness of his legislation and the dog’s potential fate. Neil Cohen says that under current law the only defense for a dog declared vicious is if the dog has been provoked and acted in defense to protect itself, its offspring, its owner or a family member of the owner.

    “The nature of a dog is to protect those around them,” said the Assemblyman. “It’s outrageous that Congo may have been provoked into attacking and this fact is being ignored by authorities.”

    A lawyer for Congo’s owners has argued that Congo was provoked when the dog mauled a landscaper on June 5 outside a home in Princeton Township. Neil Cohen’s bill (A-4597) will clarify and revise the current vicious dog law to make it more equitable.

    The bill would take into consideration provocation by treating a dog provoked to attack differently than an unprovoked dog that caused bodily injury to a person or domestic animal during an attack.

    The Assemblyman said the bill would define striking, grabbing, poking and prodding as threatening actions and behaviors that could incite a dog to defend itself, its offspring or its owner or the owner’s family. The legislation would raise the bar for declaring a dog as vicious. It would require a dog to be found vicious beyond a reasonable doubt — the same standard used for humans charged with a crime. The measure also would give municipal courts an alternative to humanely destroying a vicious dog by giving the owner the option to comply with precautions for keeping a potentially dangerous dog.

    During the disposition and appeals process, the bill would allow an owner to keep their dog as long as they complied with current law’s precautions for keeping a potentially dangerous dog. Precautions for owners keeping a dog deemed potentially dangerous include posting signs on their property and minimizing a dog’s potential threat to people and other animals. The bill also would allow an owner and owner’s family to visit their dog during times when their dog might be impounded. The bill would establish a three-month statute of limitations for animal control officer to seize and impound alleged vicious or potentially dangerous dogs.

    Neil Cohen said the vicious dog law has not been amended since 1994 and it is long overdue for an update. He hoped his legislation would be fast tracked into law to save the life of the Congo.

    Congo was ruled vicious by Princeton Township Municipal Judge Russell Annich, Jr., who also ordered that the dog be put down. The judge’s decision has since been stayed and a state Superior Court Judge has allowed the dog to return to his home, pending appeal, with numerous restrictions, including that he is muzzled and kept in a fenced area.

    The fate of Congo created a public debate that has lead to more telephone calls, emails, letters and faxes to Governor Jon S. Corzine’s office than any other issue since the governor took office.

    The Bill was carried by a vote of 5 to 0. It now heads to the Assembly Speaker who may or may not decide to post it for a vote by the full Assembly.

    ON LINE SUPPORT

    Broadcaster Warren Eckstein from Santa Monica, California, an internationally known pet and animal expert, has been carrying news of Congo’s Bill on his website.

    On December 19 Warren wrote that the New Jersey Assembly Agriculture and Natural Resources Committee today released legislation Assembly Deputy Speaker Neil M. Cohen crafted that would immediately change the state’s vicious dog laws.

    It was also reported – you will be pleased to hear – from Warren’s website that Congo and his partner Lucia are so happy to be back together.

    Elizabeth James on Warren’s website wrote, “I think the appeal could take months but we are optimistic. God willing, New Jersey Assemblyman Neil Cohen’s proposal of Congo’s Law will go through and that will be the first line of defense. We are still receiving mail and email from well wishers and supporters all around the globe! Thank you for all the support and we will keep you posted as we progress.”

    On another local website for Asbury Park Press, APP.com for Jersey for comments, blogs and shares, Tom Baldwin of Gannett State Bureau reported Assemblyman Neil Cohen, a professed dog-lover, is quoted as saying under this bill Congo gets saved and the bill gives municipal judges needed latitude to deal with dog-bite cases.

    Tom Baldwin continues and I smiled, “The story connects hot-issue circuitry. Mix the gentility of leafy, enlightened Princeton with the dog-lovers and the immigration debate — the landscaper is reported to have been an illegal from Honduras — and the story quickly won global appeal.
    “Locally, not since a whale swam up the Delaware River to freshwater Trenton in April 2005 has an animal story grabbed headlines, aside from some reported coyote attacks and New Jersey’s enduring debate over whether to allow hunters shoot black bears.”
    And finally Abby K 9 tells us the way to get Congo’s ruling reversed, hopefully, is to contact New Jersey governor Jim Corzine. His office is taking calls (and counting them) to support overturning the death sentence for Congo the German Shepherd.

    The governor’s office can be contacted at Office of the Governor, PO Box 001,Trenton, NJ 08625. Calling is preferred, (609-292-6000) but you can also email them through the website.

    http://www.nj.gov/cgi-bin/governor/govmail/govmail_1.pl

    Choose “Law & Public Safety” on the drop-down menu and on the next page, choose “Pardons & Clemency”. It only takes a few seconds to call – they are interested in the number of callers, not what you have to say – and it does not take much longer to email. Assemblyman Cohen telephone number is (908) 624-0880.

    CONGO’S BILL
    The following includes a statement from the Bill outlining the relevant details of Congo’s Bill.

    On December 17 Senate Bill No. 3019 (A.4597) was introduced for the 212th Legislature. The synopsis said it revises vicious and potentially dangerous dog law; designated Congo’s Law.

    The final Statement in the Act concerning vicious and potentially dangerous dogs and designated as Congo’s Law, and amending and supplementing P.L.1989, c.307.
    enacted by the Senate and General Assembly of the State of New Jersey said,

    “This bill clarifies and revises several provisions of the State law that address vicious and potentially dangerous dogs.  It is designated as Congo’s Law in recognition of Congo, a dog in Princeton, New Jersey, that was declared a vicious dog and subject to an order to be euthanized when, by many accounts, it was protecting its owner and the owner’s family members when a landscaping crew, against the owner’s instructions, came onto the owner’s property.

    “Specifically, the bill defines the terms ‘provoked’ and ‘unprovoked.’  Whether a dog is provoked or not is currently the only defense under the law to prevent a dog from being declared vicious when it is acting in defense of itself, its offspring, its owner, or a family member of its owner.  Also, under current law, if a municipal court declares a dog to be vicious, it must be humanely destroyed.  This bill provides the municipal court an alternative to humanely destroying a dog that is declared vicious.

    “Under the bill, the court may, for equitable reasons, choose an alternative to destroying the dog if the alternative is sufficient to protect the public and is at least as protective and restrictive as the precautions required for keeping a potentially dangerous dog.  The bill allows for an owner to keep the dog pending disposition of the case and any appeals if the owner agrees to comply with those precautions.  The precautions include posting certain signs on the property and minimizing the dog’s contact and threat to people and other animals in specific ways. 

    “In addition, the bill authorizes the court to modify certain requirements for potentially dangerous dogs, and vicious dogs that remain with their owners, to be reasonable, affordable and appropriate to the owner’s circumstances. The bill further provides for visitation by the owner and the owner’s family during any impoundment that is required.

    “Furthermore, the bill raises the burden of proof in most cases for finding a dog to be vicious or potentially dangerous to beyond a reasonable doubt, instead of by clear and convincing evidence.  The municipal burden of proof for demonstrating that a dog was not provoked or that the injury was not accidental would be by clear and convincing evidence.  The bill clarifies under the law’s hearing provisions to provide that a hearing on whether the dog is vicious or potentially dangerous will be held unless the owner agrees to relinquish ownership of the dog. 

    “The bill further requires the notice to the owner to inform the owner of the potential consequences of not replying to the notice within seven days.  Under current law and the bill, if the owner does not reply within seven days of the notice, or if the owner relinquishes ownership of the dog, the dog may be humanely destroyed.  The bill eliminates the requirement to tattoo a potentially dangerous dog.

    “The bill also modifies the provision under current law concerning liability insurance for potentially dangerous dogs.  The bill allows the court to order this insurance for potentially dangerous dogs, and if applicable, vicious dogs, if it is available.  Furthermore, the court is directed to determine a sufficient and reasonable amount of coverage and a reasonable cost for that coverage; and the insurance company is directed to notify the municipality of the coverage and any lapsing of the policy, if the company can lawfully do so.

    “Finally, the bill provides additional protections for the public by authorizing municipalities, if a municipality chooses to do so, to establish procedures for recording and investigating complaints about, and requiring appropriate notice to the public concerning, dogs within the jurisdiction of the municipality that are reported to exhibit menacing, threatening, or other aggressive behavior that may lead to injury to a person or a domestic animal, or that have injured a person but have not been the subject of an action pursuant to the State vicious and potentially dangerous dog law.  The municipality must establish these procedures and requirements by ordinance and it is authorized to require an owner of a dog subject to complaints to post signs or take other action determined necessary by the municipality for the protection of the public.

    “With Assembly Floor Amendments
    (Proposed By Assemblyman Cohen) ADOPTED: DECEMBER 13, 2007
     
    These amendments:
          (1) make changes to the definition of “provoked” in the bill;
          (2) remove certain time limitations by which certain actions may be taken in section 2 of the bill; and
          (3) change the municipal burden of proof with respect to whether the dog was not provoked or that the injury was not accidental from beyond a reasonable doubt to by clear and convincing evidence.

    Clause 15 states – This act shall take effect immediately, and shall apply to all pending cases and cases in the process of being adjudicated as of the date of enactment of this act, and to any dogs under court order for humane destruction as of January 1, 2007 but which have not been destroyed as of the date of enactment of this act.

    The Bill must now go before the Full Assembly.

    by Jeanne Hambleton  © 2008
    NFA Leader Against Pain-Advocate  

    A committee of the New Jersey Senate has considered a new bill called Congo’s Law and there are hopes that Congo, the German Shepherd dog, will no longer be under sentence of death.

    Congo was put on “death row” last June as a vicious dog after protecting his mistress, a female dog and three puppies, from an alleged attack with rake by a gardening contractor. When news of his fate reached the Internet animal activists and dog lovers all over the world signed petitions and sent emails to the Judge in Princeton, home of Congo, to save the dog’s life.

    This week thanks to a friend, Anne Soden, who lives in Princeton and took part in one of the demonstration to save Congo, I can bring you news that an American Assemblyman called Neil M Cohen from the New Jersey Senate has proposed a Bill to save the life of Congo, the German Shepherd dog sentenced to death. Thanks Anne.

    Neil Cohen is quoted as saying,”Congo’s case underscores the need for the state to modernize the law that deals with dog attacks so it is fair for the owners and the animals.”

    Congo’s Bill would revise state animal control law provisions that are alleged to be archaic and barbaric, by making it more difficult to label a dog vicious or to put an animal down.

    But a USA website (http://abbyK9.blogspot.com) which shows a picture of two of the James children with Congo, adds a cautious note to say, “Please note that Congo being returned to his family is only temporary while the case goes through the appeal. Congo could still be put to sleep for protecting his family. So please, keep contacting the governor’s office to have this matter put to rest once and for all. The calls and emails are helping!” Details of who and where to write or email appear later in this story.

    NEW JERSEY SENATE

    In December Congo’s Bill, that would immediately change the state’s vicious dog laws, made its first passage through the Senate.

    The New Jersey Assemblyman Neil Cohen, who took this action, is an avid defender of the rights of animal and has sponsored several measures to ensure the humane treatment of animals. He has met Congo and his owners, the James family, at their home in Princeton to raise awareness of his legislation and the dog’s potential fate. Neil Cohen says that under current law the only defense for a dog declared vicious is if the dog has been provoked and acted in defense to protect itself, its offspring, its owner or a family member of the owner.

    “The nature of a dog is to protect those around them,” said the Assemblyman. “It’s outrageous that Congo may have been provoked into attacking and this fact is being ignored by authorities.”

    A lawyer for Congo’s owners has argued that Congo was provoked when the dog mauled a landscaper on June 5 outside a home in Princeton Township. Neil Cohen’s bill (A-4597) will clarify and revise the current vicious dog law to make it more equitable.

    The bill would take into consideration provocation by treating a dog provoked to attack differently than an unprovoked dog that caused bodily injury to a person or domestic animal during an attack.

    The Assemblyman said the bill would define striking, grabbing, poking and prodding as threatening actions and behaviors that could incite a dog to defend itself, its offspring or its owner or the owner’s family. The legislation would raise the bar for declaring a dog as vicious. It would require a dog to be found vicious beyond a reasonable doubt — the same standard used for humans charged with a crime. The measure also would give municipal courts an alternative to humanely destroying a vicious dog by giving the owner the option to comply with precautions for keeping a potentially dangerous dog.

    During the disposition and appeals process, the bill would allow an owner to keep their dog as long as they complied with current law’s precautions for keeping a potentially dangerous dog. Precautions for owners keeping a dog deemed potentially dangerous include posting signs on their property and minimizing a dog’s potential threat to people and other animals. The bill also would allow an owner and owner’s family to visit their dog during times when their dog might be impounded. The bill would establish a three-month statute of limitations for animal control officer to
    seize and impound alleged vicious or potentially dangerous dogs.

    Neil Cohen said the vicious dog law has not been amended since 1994 and it is long overdue for an update. He hoped his legislation would be fast tracked into law to save the life of the Congo.

    Congo was ruled vicious by Princeton Township Municipal Judge Russell Annich, Jr., who also ordered that the dog be put down. The judge’s decision has since been stayed and a state Superior Court Judge has allowed the dog to return to his home, pending appeal, with numerous restrictions, including that he is muzzled and kept in a fenced area.

    The fate of Congo created a public debate that has lead to more telephone calls, emails, letters and faxes to Governor Jon S. Corzine’s office than any other issue since the governor took office.

    The Bill was carried by a vote of 5 to 0. It now heads to the Assembly Speaker who may or may not decide to post it for a vote by the full Assembly.

    ON LINE SUPPORT

    Broadcaster Warren Eckstein from Santa Monica, California, an internationally known pet and animal expert, has been carrying news of Congo’s Bill on his website.

    (http://wareneckstein.com)

    On December 19 Warren wrote that the New Jersey Assembly Agriculture and Natural Resources Committee today released legislation Assembly Deputy Speaker Neil M. Cohen crafted that would immediately change the state’s vicious dog laws.

    It was also reported – you will be pleased to hear – from Warren’s website that Congo and his partner Lucia are so happy to be back together.

    Elizabeth James on Warren’s website wrote, “I think the appeal could take months but we are optimistic. God willing, New Jersey Assemblyman Neil Cohen’s proposal of Congo’s Law will go through and that will be the first line of defense. We are still receiving mail and email from well wishers and supporters all around the globe! Thank you for all the support and we will keep you posted as we progress.”

    On another local website for Asbury Park Press, APP.com for Jersey for comments, blogs and shares, Tom Baldwin of Gannett State Bureau reported Assemblyman Neil Cohen, a professed dog-lover, is quoted as saying under this bill Congo gets saved and the bill gives municipal judges needed latitude to deal with dog-bite cases.

    Tom Baldwin continues and I smiled, “The story connects hot-issue circuitry. Mix the gentility of leafy, enlightened Princeton with the dog-lovers and the immigration debate — the landscaper is reported to have been an illegal from Honduras — and the story quickly won global appeal.
    “Locally, not since a whale swam up the Delaware River to freshwater Trenton in April 2005 has an animal story grabbed headlines, aside from some reported coyote attacks and New Jersey’s enduring debate over whether to allow hunters shoot black bears.”
    And finally Abby K 9 tells us the way to get Congo’s ruling reversed, hopefully, is to contact New Jersey governor Jim Corzine. His office is taking calls (and counting them) to support overturning the death sentence for Congo the German Shepherd.

    The governor’s office can be contacted at Office of the Governor, PO Box 001,Trenton, NJ 08625. Calling is preferred, (609-292-6000) but you can also email them through the website.

    http://www.nj.gov/cgi-bin/governor/govmail/govmail_1.pl

    Choose “Law & Public Safety” on the drop-down menu and on the next page, choose “Pardons & Clemency”. It only takes a few seconds to call – they are interested in the number of callers, not what you have to say – and it does not take much longer to email. Assemblyman Cohen telephone number is (908) 624-0880.

    CONGO’S BILL
    The following includes a statement from the Bill outlining the relevant details of Congo’s Bill.

    On December 17 Senate Bill No. 3019 (A.4597) was introduced for the 212th Legislature. The synopsis said it revises vicious and potentially dangerous dog law; designated Congo’s Law.

    The final Statement in the Act concerning vicious and potentially dangerous dogs and designated as Congo’s Law, and amending and supplementing P.L.1989, c.307.
    enacted by the Senate and General Assembly of the State of New Jersey said,

    “This bill clarifies and revises several provisions of the State law that address vicious and potentially dangerous dogs.  It is designated as Congo’s Law in recognition of Congo, a dog in Princeton, New Jersey, that was declared a vicious dog and subject to an order to be euthanized when, by many accounts, it was protecting its owner and the owner’s family members when a landscaping crew, against the owner’s instructions, came onto the owner’s property.

    “Specifically, the bill defines the terms ‘provoked’ and ‘unprovoked.’  Whether a dog is provoked or not is currently the only defense under the law to prevent a dog from being declared vicious when it is acting in defense of itself, its offspring, its owner, or a family member of its owner.  Also, under current law, if a municipal court declares a dog to be vicious, it must be humanely destroyed.  This bill provides the municipal court an alternative to humanely destroying a dog that is declared vicious.

    “Under the bill, the court may, for equitable reasons, choose an alternative to destroying the dog if the alternative is sufficient to protect the public and is at least as protective and restrictive as the precautions required for keeping a potentially dangerous dog.  The bill allows for an owner to keep the dog pending disposition of the case and any appeals if the owner agrees to comply with those precautions.  The precautions include posting certain signs on the property and minimizing the dog’s contact and threat to people and other animals in specific ways. 

    “In addition, the bill authorizes the court to modify certain requirements for potentially dangerous dogs, and vicious dogs that remain with their owners, to be reasonable, affordable and appropriate to the owner’s circumstances. The bill further provides for visitation by the owner and the owner’s family during any impoundment that is required.

    “Furthermore, the bill raises the burden of proof in most cases for finding a dog to be vicious or potentially dangerous to beyond a reasonable doubt, instead of by clear and convincing evidence.  The municipal burden of proof for demonstrating that a dog was not provoked or that the injury was not accidental would be by clear and convincing evidence.  The bill clarifies under the law’s hearing provisions to provide that a hearing on whether the dog is vicious or potentially dangerous will be held unless the owner agrees to relinquish ownership of the dog. 

    “The bill further requires the notice to the owner to inform the owner of the potential consequences of not replying to the notice within seven days.  Under current law and the bill, if the owner does not reply within seven days of the notice, or if the owner relinquishes ownership of the dog, the dog may be humanely destroyed.  The bill eliminates the requirement to tattoo a potentially dangerous dog.

    “The bill also modifies the provision under current law concerning liability insurance for potentially dangerous dogs.  The bill allows the court to order this insurance for potentially dangerous dogs, and if applicable, vicious dogs, if it is available.  Furthermore, the court is directed to determine a sufficient and reasonable amount of coverage and a reasonable cost for that coverage; and the insurance company is directed to notify the municipality of the coverage and any lapsing of the policy, if the company can lawfully do so.

    “Finally, the bill provides additional protections for the public by authorizing municipalities, if a municipality chooses to do so, to establish procedures for recording and investigating complaints about, and requiring appropriate notice to the public concerning, dogs within the jurisdiction of the municipality that are reported to exhibit menacing, threatening, or other aggressive behavior that may lead to injury to a person or a domestic animal, or that have injured a person but have not been the subject of an action pursuant to the State vicious and potentially dangerous dog law.  The municipality must establish these procedures and requirements by ordinance and it is authorized to require an owner of a dog subject to complaints to post signs or take other action determined necessary by the municipality for the protection of the public.

    “With Assembly Floor Amendments
    (Proposed By Assemblyman Cohen) ADOPTED: DECEMBER 13, 2007
     
    These amendments:
          (1) make changes to the definition of “provoked” in the bill;
          (2) remove certain time limitations by which certain actions may be taken in section 2 of the bill; and
          (3) change the municipal burden of proof with respect to whether the dog was not provoked or that the injury was not accidental from beyond a reasonable doubt to by clear and convincing evidence.

    Clause 15 states – This act shall take effect immediately, and shall apply to all pending cases and cases in the process of being adjudicated as of the date of enactment of this act, and to any dogs under court order for humane destruction as of January 1, 2007 but which have not been destroyed as of the date of enactment of this act.

    The Bill must now go before the Full Assembly.

    See Also: http://www.ipetitions.com/petition/savecongo/

    GROWING SUPPORT FOR FIBROMITE AHEAD OF HER TIME

    by Jeanne Hambleton © 2007
    NFA Leader Against Pain-Advocate

    You may remember the story about Linda Allen, a UK fibromite who in spite of being severely disabled with this invisible disability has been raising FMS awareness among medical students. Her gracious offer to help anyone willing to follow her example and spread the word has resulted in a flurry of emails, mostly from the USA and Canada.

    While Linda and I are both willing to help, advise and encourage anyone from anywhere to pick up the gauntlet and run with it by talking to medical students, it is surprising that so few UK sufferers have written. It is here that we believe many GPs are still blinkered as far as diagnosing fibromyalgia is concerned.

    For some long time those with this awful syndrome have been telling me that their doctor suggests it is all in their head. Trust me I am a fibromite – you are not imagining the aches, pains, chronic fatigue, sleeplessness, cognitive problems and many of the other nasties that cohabit with fibromyalgia. These ARE the symptoms.

    All this time I have been thinking that in Canada and the USA, where there are so many knowledgeable experts in this field, fibromites were being recognised and diagnosed far more quickly than the years it takes here in the UK.

    The moral behind this thinking is, we have a huge worldwide job to raise awareness about fibromyalgia, not only in the UK but just about everywhere. With this is mind it is even more important that you contact your local health authority or training hospital and offer to be interviewed by medical students and answer questions about your fibromyalgia and any other dispositions you may have living with your FMS. I hope they will jump at the opportunity. If they do not, tell us and we will name and shame them.

    I often hear fibromites say, “It is so good to be able to share my problems, pains and concerns with someone,” – here is the golden opportunity – and you can talk about yourself and your health and you could be helping to find cure. Some of those young doctors may decide to specialise in this field. Whatever they do they will have an inside knowledge of fibromyalgia and be able to recognise FMS albeit in their own surgery, in accident and emergency clinic, or a hospital ward.

    If you can do this it would be a giant step for fibromyalgia and would encourage more research as the world hears about the pain we suffer. It really is up to you – Linda and I cannot do it alone.

    LINDA’S ANSWERS

    Linda has asked me to thank everyone who has written to her like most families with young children she has struggling to get ready for Christmas with all the trimmings to delight her young son. Linda is making a great effort to reply to you as soon as she can.

    We are delighted with the support so far and hope details of these emails will encourage you to go further with raising awareness.

    Jane wrote, “One minute you are pleased that there is someone out there that has fibro then you feel bad that someone must hurt like you do”. 

    Bambi sent an email saying, “You are my inspiration! I just read about you in an email I receive from Tenderpoints. I meant what I said.”

    Bambi who lives in the States and suffers with fibromyalgia, rheumatoid arthritis, Lupus, chronic pain syndrome, and has undergone a number of operations, is taking “a variety of med’s and still going through the motions of trying to find what works best for me.” She writes about her journey through medications and diagnosis leading to the sad and frustrating times that so many FM sufferers go through.

    Regardless of her pain she writes, “When I was reading about you, all I kept thinking was that I’ve found my mentor! You see, I am a 44 year old, mother of 2, wife of 22 yrs……. for too many years I have been battling the stigma’s of living with chronic pain. I won’t go into an entire boring full biography about myself! Let me just tell you briefly, I’m an ex-dancer…jazz, ballet, that kind of dancer! HA!…..most people assume with a name like ‘Bambi’, it’s another kind of dance I used to do!   I’m a freelance artist, who on a good day is lucky enough to work on sketching, painting, or some kind of inspiration I may have. I have a positive outlook the majority of the time.

    “I say it this way because I feel it’s important to allow yourself to have those days that are bad, let your body heal itself, rest, etc. We have earned the right to every now and then have a little ‘bitch’ session. I think it is healthy to vent every now and then! I also feel though it is our fault we have what we have, we have to learn to accept what we can’t help, (not give into it though!) It is not anyone else’s fault that we feel bad, so why should they have to suffer too. I try to keep a good sense of humor, a smile even when I hurt….I can be in pain but still be glad I have my family.

    (Hi Bambi I am the writer with FMS and it is not your fault. It is now thought to be genetic and if you ask your parents and grand parents you may find some have suffered very bad arthritis, rheumatism or fibrositis. If we have the gene it only takes a trauma or stress for an A type personality – workaholic – to trigger the fibromyalgia. I write this as a patient with no medical training, but this is what I have heard from medical experts. However I do agree you should not take your suffering out on other people and a positive outlook is so very important. Jeanne)

    “Anyway, my point is that, through out this entire “journey” of chronic pain, I figured there is someway I can help, so other people don’t have to go through what I have had to endure! I admire what you and your Doctor are doing and would love to do the same!….I know, I apologize, I could have said this at the beginning, in one sentence!”
    Bambi signed her email with “peace, laughter & miracles”.

    Linda told her, “You have to have a sense of humour to survive being fibromyalgic…. life is for living is what I say and I refuse to sit in a chair and rock for the next 50 years!! I am not into feeling sorry for myself at all. It is counter productive and I am with you on the positive attitude thing, you have got to have this or you will go under. So you sound like an ideal candidate for doing what I am doing, chatting to medical students on an informal basis and educating them about ourselves, our condition and the whole shebang we go through for a diagnosis, treatment, support and help. Think about it, you’d be fab!!”

    Catherine from somewhere in New York who read Linda’s story in Tenderpoints (from Fibrohugs) thanked her so very much for what she is doing for all FMS patients around the world.

    She wrote, “I see a rheumatologist at a teaching hospital here in upstate New York, and I think I shall print this for him.  He always wants to learn and I wonder if I would ever have your strength.  Even if I didn’t, your story may be just what I need.”
    Catherine signs herself a partner in FMS/CFIDS.

    Karen has had FMS for seven years and writes, “When I read about what your doing, I thought that this lady is doing exactly what I have been wanting to do for years now. And I go for treatment for the perfect place for it. That is Oklahoma University Research Hospital. We call it OU for short. But my thinking has always been that this is such a complex disease that you would have to be a teacher just to discuss it, because 15 minutes with your GP just doesn’t get it.

    “And only someone with this disease can tell you in detail anything about it and it takes a long time to do that because there is so much to tell. I would love to share my knowledge with some soon to be Doctors. This is where I know you will understand that we know a lot more than they do about FMS because we were forced to learn about what was wrong with us because nobody could tell us. All I ever heard was, ‘I am sorry for you but I can’t help you and good luck. Hope you don’t end up in a wheel chair.’

    “I have never written to anybody else that has this disease, but your story was the one that turned on the light. I hope to hear from you, God Bless You.”

    Mary who works in the medical profession in the States said she was given news of Linda’s story by a holistic nurse who has been helping her with pain control.
    Diagnosed with fibromyalgia after many years of ‘non-diagnoses’ she said the problem was not only an unawareness on the physicians part, but her own unwillingness to accept it because of the attitudes I have encountered for quite some time of the doctors who label FMS as a non-existent disorder.”

    Mary suggests these doctors think fibromyalgia is something, “We give patients to pacify them when they need a diagnosis”. In other words – for all the hypochondriacs out there.

    “It angers me to think about it now, because these physicians have labeled me as such and put me on anti-depressants. Now I hear behind my back from their nurses and assistants that they diagnose fibromyalgia but don’t believe it,” she said adding she was frustrated and disillusioned with medicine.

    Linda suggests the physician “desperately need educating into the severity of the condition you deal with 24/7. I could send you some information specifically for doctors to print off if you like? Maybe it would give them a kick up the butt? It couldn’t hurt to try eh?”

    Joan from Canada said she could relate to Linda’s fibromyalgia and back problems. She suggests, “I have a specialist here in Toronto who insists fibro is related to disruption of the discs in the back and neck. Certainly the activity and especially horseback riding would contribute to your fibro. I have been on long term disability for 12 years now and everything she has directed me to do has been right. We do walk a very fine line in fibro. If we do too much we will relapse. 

    “I admire the work you are doing in educating young would-be doctors and students. It is something I have wanted to do for a long, long time. I just did not know quite how to get started. 

    “I felt such a pull in my heart when I read your bio, I just wanted to share with you what I believe has helped me.  Maybe it will help you too! We are the same age. Too young to let life pass us by!” said Joan.

    Gloria who I think is also from the States offered congratulations to Linda for stepping up and adds, “I, like you, have had fibromyalgia since about the 1980′s, maybe even longer.  I was (and still am) very active, although I tire easily.  The specialty doctor that I saw at that time discovered my “trigger points” but he did not have a name for the illness.  Unfortunately, my regular GP was not the greatest.  I had a terrible flare-up about 7 or 8 years ago.  I went to my GP with a list of my symptoms.  He looked at the list, looked at me and told me that “someone who writes a list like this is mental.”  This was someone that I trusted my health with for over forty years.  I quickly changed physicians.  I started with an internist about a month later, gave the same list to him.  He took x-rays and blood work, sat for an hour asking me questions and told me to return in three weeks.  When I returned, he had all of the test results in hand.  We talked some more and he mentioned “myalgia.”  I asked him if he said fibromyalgia.  He said, “No, do you think you have that?”  I said I don’t know, but I had just heard of it.  He tested the trigger points and diagnosed me that day with fibromyalgia.  It has been a blessing to find a doctor that listens and is empathetic to the pain that FMS involves. I live with pain on a daily basis and some days are worse/better than others.”

    This is just another story which shows just how important it is to educate the medical students and the young doctors who are willing to listen.

    Jackie has such empathy with Linda she suggests, “I felt as if I were reading my life and medical condition on the page.  I have written to the FFC here in the states but have gotten no reply as of yet.  They have several centers here in the US but none are very close to me and you have to do your first visit in person, after that they do something either thru mail or something.  But it’s too hard for me to travel, as you probably know. I think my fibro was partially caused by having rheumatic fever twice as a child.  In my teens I had great pain, then they called ‘growing pains’. 

    “I like you was active even after diagnosis until I just could not do it anymore.  It hurts so bad emotionally not to be able to do what I used to do. 

    “In the past my son in law said that my house was so clean you could eat off the floors.  I am not able to do that anymore.  Nor do the things I want to do. And I agree with you that a loss can cause a real fibro flare, because I lost my youngest grandson age 16 in June.  The only way I can survive that is knowing that he is with God.

    “Thank you so much for your article.  Just having someone out there that I can  “cry” to means a lot. Now I have to go, my back is hurting so bad. Love. A sister in fibro,”

    Brenda who I think is from California (emails give little away) wrote and said,
    “Thank you for your story particularly the “letter to normals” that I have sent this on to friends and family as it sums up how I feel. I would like to help spread the word. What can I do to help?”

    Although Brenda believes her GP will not be very helpful she told Linda, “I do have an appointment with my rheumatologist in January so will ask her if I can talk to med students.”

    Brenda who labels FMS as ‘the beast’, tells Linda. “It is very difficult here to get anything prescribed for pain as people have a tendency to sue their doctor if they get addicted to the drug. I had to give my GP a letter promising him not to sue him so he would give me a script for valium so I could sleep at night as the flexeril was no longer working. Anyway I am taking 4mg at night and it has helped tremendously so far. But I am stuck with over the counter pain killers which on bad days just aren’t effective. I have bought a couple of books on fibromyagia recently and it seems there is more research money being invested as FMS is on the rise.”

    Encouraging Brenda to take up the challenge Linda replied, “I started speaking to medical students about our much misunderstood condition as they need to do ‘practice consultations’ as part of their training and speak to people who have a chronic pain condition.”

    Betty who wrote to Linda about specific enzyme based natural medication which had worked for her own for back pains, added, “Today’s doctors still have no answers as I have fibromyalgia and chronic fatigue plus the latest visit to the doctor has her looking at something called Polymyalgia. I think that is what she called it. The only thing that helps that is Prednisone and I refuse to go on steroids, so I’m hoping the blood tests come back negative for that condition. Take care… and keep the faith.”

    Replying Linda thanked Betty and is humbled by her kind words. She added the message “reaffirms my faith in humanity and for that I thank you from the bottom of my heart”.

    Having invited the world to keep in touch with us, it occurs to me that as fibromyalgia fighters we should perhaps come together as a VIRTUAL FIBROMYALGIA AWARENESS GROUP.

    This would allow us all to enjoy the successes of others and help with the few disappointments, if any, of trying to raise awareness about this rotten invisible disability. We will protect your privacy and will not divulge or print anything other than your first name and maybe the country in which you live…unless you instruct us otherwise or include your own email in the text.

    If there is enough support for the idea we thought that for membership of our elite VFAG you should have FMS, CFS/ME or be a carer for someone with these disabilities. We will do our best to print your stories – maybe not always in full and will reserve the right to edit anything which may be deemed as offensive or likely to have any legal connotation.

    I would ask you to send me your emails with information your endeavours to raise awareness with medical students or doctors, or in any other way, highlighting any publicity you have managed to achieve, with copies to both Linda and I.

    We hope you will share your triumphs with others and we will ‘move mountains’ and raise awareness. With enough support we will start our own weblog where you will be published and able to tell our friends.

    We are depending on you. Please email me at jeannehambleton@mac.com and Linda at lindajaneallen@hotmail.co.uk and with your success stories. You can also find me on
    http://jeannehambleton77.wordpress.com

    Take care. Keep well and go to it. Jeanne

    FMS Global News

    Fibrohugs Support

    Tenderpoints Newsletter

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    CO-PROXAMOL UK WITHDRAWAL DEBATE

    by Jeanne Hambleton © 2007 – Fibromite
    NFA Leader Against Pain – Advocate
    Dateline: November 2007

    (This is a long document for which I make no apologies. It has entailed much work but it is my hope that readers will be encouraged to take action. No copyright infringement is intended as this is not written for financial gain but for guidance and in the hope of some action and hopefully ‘without prejudice’.)

    The painkiller, which so many UK fibromites and millions of other people rush to take to relieve pain, co-proxamol, is scheduled to be withdrawn from general prescription from New Year’s Day. Only named patients, who have tried alternatives and failed to find relief from other drugs, will be considered by some GPs for a special prescription. It is hoped this may continued after the end of 2007 subject to the availability of stocks, as some manufacturers have already stopped producing this drug.

    As a writer and reporter I claim no medical qualifications but to help people understand the problems surrounding the distribution of co-proxamol, or lack of it, I have drawn together, from a number of sources, background information and comments from those who have a special interest in the withdrawal of co-proxamol.

    Already many patients are being told that this medication can only be prescribed under special circumstances – your GP must decide you are a suitable and trustworthy patient and that you will read and abide by the instructions. Alcohol and co-proxamol are literally a deadly combination and can be fatal. This is the reason given by the “powers that be” for withdrawing co-proxamol, which is a combination of the analgesics, dextropropoxyphene and paracetamol. There is little doubt that by the end of the year obtaining co-proxamol on prescription may be more difficult – unless things change. I am told that some years ago paracetamol faced withdrawal in a similar battle – which was won!

    HOUSE OF COMMON DEBATE

    Many people who take co-proxamol have been complaining about the withdrawal of this painkiller, which was highlighted in the House of Commons in a debate way back in 2005 following an announcement in the press early that year. The debate appears to continue with no solution in sight as we enter the final stages of withdrawal – one month away.

    In 2005 according to the Hansard report on the debates in the House, Anne Begg, Labour MP for Aberdeen South, called for an Adjournment Debate on the availability of co-proxamol. The MP said she had a personal interest as she had been prescribed these tablets for some years and took four a day. A number of her constituents who relied on the drug had contacted her about the withdrawal – hence the debate.

    Hansard reported that Anne Begg spoke about specific patients who relied heavily on co-proxamol. In some cases the painkiller was the relief that enabled patients to carry on working, sleep well and keep mobile. She related stories with which many of you will be familiar – patients being taken off co-proxamol and given alternative painkillers. Patients found they were unable to sleep well, felt unwell all the time and were unable to continue at work.

    The MP told the House that the drug was not being withdrawn because it was ineffective – those using the drug found it very effective. It was not due to side effects – patients felt it gave them less problems than alternative analgesics or other drugs. Co-proxamol had not been connected with the incidence of strokes, heart attacks or other major health problems.

    The then Secretary of State for Health had confirmed to Anne Begg, “That some people might abuse the drug and use it to commit suicide,” said the Hansard report. The Department of Health claimed between 400 and 500 suicides annually were connected with co-proxamol.

    The MP reported that all drugs carry some sort of risk, which in theory could mean practically every drug would be unavailable. Those relying on co-proxamol were upset that the drug had been singled out for withdrawal. Anne Begg said there had been a similar debate about paracetamol several years earlier and this remained controversial for a long period.

    Co-proxamol users claimed this drug was superior and that it led to a feeling of wellbeing. It was said this was due to destropropoxyphene, which is used in the medication.

    Anne Begg said GPs were recommended to prescribe paracetamol or a non-steroidal anti-inflammatory medication such as ibrufen. However ibrufen was not without risks for those with gastric problems. The alternatives went on to include a very strong analgesic, which has severe side effects to amytriptyline, a drug often prescribed for patients who have been involved in suicide attempt.

    News of the withdrawal of co-proxamol was originally announced in January 2005 but it had taken six months for this to be debated by MPs. Anne Begg claimed this was because patients who had been offered a change in prescription had taken time to discover the alternatives did not work. She made reference to informed choices and referred to other drugs effective in dealing with arthritic pains and fibromyalgia, that had been withdrawn due to other dangers to health.

    The MP said although she did not normally go against medical opinion, with co-proxamol she felt the Government should reconsider the advice of one of its committees. She expressed concern and recommended the Government should review the prescribing arrangements for co-proxamol and asked why some responsible patients should be penalized. GPs should be able to prescribe co-proxamol to a patient who was aware of the risks if misused or left accessible to others. It was suggested a change in the packaging in smaller quantities could help – this had been done with paracetamol. A strip of 10 tablets might be considered an overdose, where eight co-proxamol would be safer said Anne Begg.

    In response to a request from the press it was reported the Medicines and Healthcare products Regulatory Agency had said co-proxamol would be available to patients on their “own responsibility” subject to clinical needs. But this report did not coincide with feedback from patients said the MP.

    IN RESPONSE

    Hansard reported that the Parliamentary Under-Secretary, Department of Health, Caroline Flint said the Department had, at that stage, received 130 letters from Members of Parliament writing on behalf of their constituents.

    Caroline Flint claimed the co-proxamol decision was made after a full risk-benefit assessment, extensive public consultation and with the Committee on Safety of Medicines advice. Other specialists and experts were invited to comment including the Government’s Independent Scientific Advisory Committee on Medicine Safety. The Parliamentary Under-Secretary said co-proxamol, that was said to be very toxic, could result in an overdose from only a few tablets beyond the recommended dose. Patients could die before they arrived at hospital, as unlike paracetamol, there is no antidote for co-proxamol poisoning.

    There had been a comprehensive review in 2004 by the Committee on Safety of Medicines, said Caroline Flint and the public was invited to provide comments on the advantages and risks over a 12-week period. Hansard reported that many large organisations including healthcare professionals, patient groups and stakeholders had received letters. Having considered the evidence the CSM felt the risks outweighed the benefits and manufacturers were recommended by the MRHA to withdraw the drug over a period of 36 months – by December 2007.

    Caroline Flint reported a reduction in the amount of co-proxamol being prescribed, with the 50% of the total reduction made in the first six months following the announcement about the withdrawal. It was reported by Hansard that one doctor had decreased the number of patients using co-proxamol from over 400 to just 20 but the GP did acknowledge there was currently no acceptable option for this small minority of his patients.

    It was reported co-proxamol had been available for some 40 years and many patients who were distressed about the withdrawal, had written expressing this view. It was said co-proxamol would be available on a named basis only at the end of the withdrawal period. The MHRA will ensure GPs are aware of this and this should resolve the supply question.

    The Parliamentary Under-Secretary confirmed GPs would still be able to prescribe co-proxamol if there is a clinical need and if no satisfactory alternative could be used. There will however be a much stronger focus on “risk benefit judgment for the particular patient”.

    Caroline Flint said the Department of Health would support the decision but would accept there could be a need to allow co-proxamol to be prescribed for some patients where there was a clinical need. Responding to a question on the availability of future supplies, the MP said it would be necessary to decide about the future for the minority who are prescribed co-proxamol as the only acceptable painkiller to bring relief.

    The Parliamentary Under-Secretary hoped Arthritis Care and similar groups would feel reassured by her comments and her “acceptance of the possibility that co-proxamol will continue to be prescribed where there is a clear clinical need because alternative treatments are unsuitable”.

    She added that the Government is sensitive to the problem and accept that pain management is a complex matter.

    Hansard (the Official Report) is the edited verbatim report of proceedings in both Houses of Parliament. Reports contain Written Ministerial Statements and Written Answers. Daily Debates are published on the following website the next working day at 8 am. http://www.publications.parliament.uk/pa/pahansard.htm

    ARTHRITIS CARE

    Arthritis Care who have been opposed to the withdrawal of this drug since it was first announced, had been working with some MPs to have the issue raised in Parliament again this year.

    The Arthritis Care website believed the named patient basis only was not a satisfactory way to ensure those who need the painkiller would receive it. The charity continues to argue for a review of how best to make co-proxamol available long term.

    On their website Arthritis Care have invited those in pain, who had been transferred from co-proxamol to another drug, to contact them with comments in the efficiency of the alternative, to help further this cause. Telephone 0207 380 6547 or contact -

    Campaigns@Arthritiscare.org.uk
    WalesCampaigns@Arthritiscare.org.uk
    or ScotlandCampaigns@Arthritiscare.org.uk
    http://www.arthritiscare.org.uk/Campaigns/Currentcampaigns/Co-proxamol states

    The Arthritis Care website shows that MPs Anne Begg and Howard Stoate are working with the organisation to press for a review on the withdrawal of co-proxamol.

    Reporting on the current situation the campaign website states, “The MHRA anticipates that after 2007, co-proxamol will be available on a ‘named patient’ basis only, subject to stocks.

    THE BACKGROUND AND PLAN OF ACTION

    When the MRHA announced the withdrawal of co-proxamol on January 31 2005 it was stated, “A recent consultation looking at evidence for the safety and effectiveness of co-proxamol found that the benefits of the medicine did not outweigh the risks and that it should be gradually withdrawn from clinical use. Co-proxamol is associated with 300-400 intentional and accidental fatal overdoses each year.”

    It is estimated that 1.7 million GP patients each year receive 7.5 million prescriptions for co-proxamol.

    At that time the Chairman of the Committee on Safety of Medicines (CSM), Professor Gordon Duff said, “Co-proxamol will be phased out of the market place gradually to give patients time to discuss their treatment with their doctor and change to a suitable alternative. There is no need for panic or concern and if patients have been taking co-proxamol continuously for a long time they should not stop without consulting their doctor.”

    In January 2005 the Chairman of the Medicines and Healthcare products Regulatory Agency (MHRA), Sir Alasdair Breckenridge said, “Whilst the risks of co-proxamol are well known to health professionals, the latest evidence is that the measures to strengthen the labelling of co-proxamol have been ineffective in reducing the high fatality rate involving both intentional and accidental overdose. The MHRA and CSM have considered further evidence gathered during a public request for information on the risks and benefits of co-proxamol and have decided that the benefits of the continued availability of co-proxamol do not outweigh the risks and that co-proxamol should be withdrawn from the market.”

    At the same time The Times newspaper reported it had learnt and printed the following,

    “One of Britain’s most commonly used drugs is to be withdrawn over concerns about the high risk of accidental death from slight overdose and its frequent use in suicides.

    “Co-proxamol, prescribed to hundreds of thousands of Britons every year, is to be the subject of a staggered withdrawal because of evidence that it can cause death if patients exceed the maximum recommended dosage by as little as two tablets……

    “A recent study found that the medication, whose effects are increased by alcohol, was responsible for 18 per cent of all drug-related deaths and 5 per cent of all suicides. David Kelly, the Government’s weapons adviser, is believed to have taken up to three packets of co-proxamol shortly before his death in 2003.

    “Last year eight million prescriptions were issued in England and Wales for co-proxamol, which has been a mainstay in British healthcare for more than 40 years.”

    CO-PROXAMOL WEBSITE

    In March 2005 Dr Martin Kittel of Windsor launched a website about co-proxamol in which he claimed no widespread consultation had taken place and that doctors were as surprised as patients when the announcement was made.

    The Doctor suggested, “Unless something extraordinary happens, co-proxamol will be withdrawn from the market and millions of patients suffering chronic pain will have to switch to another drug.”

    The site, http://www.coproxamol.org.uk/ which was funded by the Doctor, is apparently no longer available.

    Prior to the site’s disappearance, Dr. Kittel suggested the choice of alternative drugs was very limited and many patients would be left without an equally effective pain killer or will have to take higher does of alternatives, which may lead to other complications including constipation.

    He pointed out that, “Co-proxamol by experience is just a lot more effective than other equal drugs and for many patients causes less side effects. Co-proxamol is highly cost effective and its withdrawal will not only harm patients, but also harm the health service. The NHS will pay a lot more for equally effective pain relief, strapping it of cash badly needed in fighting other diseases. Arthritis sufferers recently had to change drugs, when Cox 2 inhibitors were related to heart disease and one of them was withdrawn (Vioxx).”

    Dr. Kittel stresses the website is not funded by any drug company and he urges all co-proxamol users to write to the local councillors, parish, district and county, MPs, and MEPs, asking the Houses of Parliament for a review on the withdrawal of co-proxamol before the scheduled withdrawal at the end of 2007. The simple website he recommends identifying your MP, using only your postcode, can be found on: -
    http://www.writetothem.com/

    Alternatively your Yellow Pages telephone book (Members of Parliament – Political Organisations and Representatives) should give you your MP’s address to post a letter.

    When writing to your MP on-line, it may be helpful if you first type what you want to say off-line and then copy and paste it in the letter/message area when you enter the above website. This will save “on-line time”.

    PATIENTS’ POINTS OF VIEW

    Some time ago I looked at the Patient UK website and searched for co-proxamol. The site has since been “redeveloped” and although there are supposed to be two references to the painkiller, they were not easily available.

    http://www.patient.co.uk/

    In March one patient had written, “The situation of co-proxamol withdrawal is a very woeful one and it seems immoral and unethical to allow people to suffer by removing this medication from their lives when there is no suitable alternative to be found. This drug has been in use for many years by millions and its effects and side effects are well documented.

    “I agree that this matter is now one to be fought about at the highest level of Government possible (i.e. letters to MPs etc. – especially those who are medically trained).

    “I suggest that those users who have been taking this medication for many years with no ill effects; for whom there can be found no suitable alternative; whose quality of life is enhanced by the freedom from pain that it can bring and who are not found to be suffering from any accompanying depressive illness or disposition to drug abuse or attempting/completing suicide; and for whom there are no contradictions medically due to polypharmaceutical complications or existing medical conditions, should be given the option of doing the following:

    “Sign a document declaring that they have been fully informed about the possible risks involved in taking this particular medication and that in the event of any unfortunate consequences as a result of taking co-proxamol in the way normally prescribed by a medical practitioner, they will not hold the prescribing doctor (or the General Practice where the doctor may be working) to be legally liable.

    “This medicolegal course of action is undertaken every day in the case of people giving their consent to surgical procedures under anesthetic by signing a document permitting surgery (and the need for any further treatment if necessary whilst under anesthetic).

    “Of course, in the case of medical negligence – if found proven – there may be case for blame, thus by signing a similar document concerning one’s daily medications there would be created a situation for some thinking and debate.

    “However, I believe that this may be a suitable way around this difficult matter and am sure that many patients who are finding co-proxamol to be a life enhancing aid in the daily difficulties of chronic medical conditions causing much pain and distress, would be happy to give their consent to taking some responsibility for informed participation in their medical treatment – instead of having, as it were, the ‘rug pulled out from under them’ – for such is the effect of this draconian measure concerning the issue of prescribing co-proxamol for many years and then suddenly stopping.

    “In some cases there has not even been a gradual period of readjustment to other analgesia given – leaving patients in a worse state than before. This goes against the doctors’ ethical code of “first, do[ing] no harm.”

    “In a ‘worst case scenario’ it is possible that some patients, unable to find adequate alternative pain-relief would fall into depressive states (chronic pain can do this) and some, even, eventually resort to attempting/completing suicide – thus the declared medical objective of reducing the number of deaths from prescribing this drug might well end up causing a higher number from not prescribing it. Hardly an intelligent, desirable solution to the problem.

    “If then, as a patient you find this medication to be essential to your life, please do fight for your rights to as pain free an existence as possible and get writing to your GP practice managers and Members of Parliament.”

    TV DOCTOR ADDS HIS SUPPORT

    Dr. Hilary Jones, the GMTV medical professional, also came out in support of the battle to save co-proxamol.

    In an interview with Jim Pollard of Arthritis News, Dr. Hilary said many of his patients were asking what alternative painkillers they can use but he did not have the answer. His patients said other painkillers make them sick and were not as effective. Dr. Hilary, who had taken co-proxamol, claimed the painkiller was a safe drug.

    Like others Dr. Hilary urged those in need of co-proxamol to write to their MPs to have the decision reversed.

    The article outlining Dr. Hilary’ views on co-proxamol appeared in the August/September 2006 issue of Arthritis News.

    E-PETITION

    In September 2007 when supplies of co-proxamol seemed to suddenly become unavailable the complaints came thick and fast. To help I launched an e-petition but those who complained failed to support this. Whether a rush in the last month will have any effects, remains to be seen.

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

    It is somewhat out of date now, as it seems supplies seem to be currently available. If you feel strongly enough to launch your own e-petition asking about the future of co-proxamol, please let me know and I will sign it and mention it on my weblog.

    I did in fact submit a further e-petition but this was rejected – the web team may have thought it was too political. Nevertheless the contents of the e-petition are certainly worth reading.

    It does in fact present the perfect ‘excuse’ should a GP feel he does not wish to prescribe this painkiller for you. Had it been accepted it would have read:

    Will the Prime Minister Gordon Brown please reverse the ban on prescribing the 50 year old painkiller CO-PROXAMOL due to come into effect in December 2007 and instead make it controlled drug under Schedule 3 of the Misuse of Drugs Act 1971, before it is too late and it all becomes a shambles.

    Dr. Howard Stoate (MP Dartford) speaking in a House of Commons debate in May 2007, according to TheyWorkForYou.com and the Hansard report, suggested co-proxamol should become a controlled painkiller, as the GP would then be free to prescribe it without having to walk a legal tightrope to do so. Few GPs, if any, will wish to expose themselves to the possible threat of litigation by doing so, however strong the patient’s need for the drug. In practice, the solution amounts to a comprehensive ban he said.

    THE PRESS RELEASE

    In August 2007 I contacted the Press Office of the MHRA (Medicines and Healthcare products Regulatory Agency www.mhra.gov.uk/) and apart from a long and detailed background to the decision – an increase in the number of suicides with folk taking co-proxamol and the dangers of alcohol with this painkiller – the Press Officer wrote:

    We recognise, however, that there is a small group of patients who are likely to find it very difficult to change or where there is an identified clinical need; when alternatives appear not to be effective or suitable. For these patients, continued provision of co-proxamol through normal prescribing may continue until the cancellation of the licenses at the end of 2007. After this time there is a provision for the supply of unlicensed co-proxamol, on the responsibility of the prescriber which in effect means it will still be available, for as long as you need it, should your doctor deem it suitable for you. If you wish to go down this route may I suggest you discuss this possibility with your doctor?

    So is there light at the end of the tunnel?

    SO BE IT

    We are now on count down to December 2007 at the end of this week and understandably the big date for this month for most folk is the 25th – and on the 31st when co-proxamol is due to disappear, people will be celebrating the arrival of New Year.

    It will be interesting to see the public reaction if suddenly co-proxamol is no longer being prescribed in January.

    Try as he might, my dear GP always tell me my painkiller is being discontinued and I should use this or that…I quote MP Caroline Flint’s promises in the House of Commons saying that one manufacturer WILL continue to manufacture and supply co-proxamol. I give him my affirmation that I am a responsible fibromite and as a long-term reliable fibromite I am able to be a named patient and have co-proxamol. The dear man eventually gives in, bless him.

    I think I would be up the wall now with my 3 fractures in my pelvic bone and fractured wrist without co-proxamol…either that or I would be in the divorce courts for sure…

    I imagine many more doctors will be offering alternatives and there will come a time when it is no longer economically viable for the one remaining manufacturer to continue making co-proxomal together with the pressure from the powers that be. That is, unless we can all become named patients and are prescribed co-proxamol regardless of what we might have to sign to say we will behave responsibly and not overdose.

    It is beyond my understanding why some medical quango has not produced a suitably worded form for us to sign relieving our GPs of any responsibility legally.

    Is it not time that for those suffering with fibromyalgia, chronic fatigue, ME, arthritis and other long-term pain problems take up the challenge before it is too late?

    I believe there has been no recent mention about co-proxamol in the House since May 2007. It must be good time to write to your MP and encourage others who take this painkiller to do the same. There is a chance that you may save co-proxamol from being withdrawn from general prescription. Tell your MP about your pain and suffering – why you need this painkiller (fibromyalgia?) to be available to you – they need to know – but do not forget the message – we need a review on the withdrawal of co-proxamol, a change of policy, a U turn.

    If your MP is a member of the All Party Parliamentary Group on Fibromyalgia (APPG for FMS), ask him or her to raise this at their next meeting and to take the question of a review forward for debate. This would also apply to arthritis, ME and all long term chronic pain.

    To find the name of your MP look in your telephone book, or Yellow Pages or try TheyWorkForYou.com and search for ALL MPs.

    As of October 2007 the MPs who are members of the All Party Parliamentary Group for Fibromyalgia are: Rob Wilson (chairman); Dr Nick Palmer (vice chairman); Philip Davies (treasurer); Ian Austin (secretary).

    Members: Russell Brown, Paul Clark, Gerry Sutcliffe, Adrian Bailey, Natascha Engel,
    Rosie Cooper, Jim Devine, Ian Lucas, Andrew Dismore, Richard Burden, David Cameron,
    Robert Key, Graham Brady, Tim Boswell, Shailesh Vara, Dr Julian Lewis, Andrew Pelling,
    John Gummer, Henry Bellingham and Norman Lamb.

    I am sure you all know what to write about – co-proxamol, a review and funding desperately needed for fibromyalgia research.

    Between ourselves the email address of most MPs is their surname initial@parliament.uk – ie camerond@parliament.uk. However there are exceptions. Try this website for a lot more detail. The alphabetical list of MPs will lead you to websites, biographies and email addresses.
    http://www.parliament.uk/directories/directories.cfm

    Not wishing to sound like a wet blanket (I have never listened to a wet blanket, have you?) all MPs are generally only required to reply to correspondence from their constituents – those who voted them in locally. I have been rebuffed (knocked back) several times even with press enquiries. If they are a member of the APPG, you should mention this and stress this is why you are asking the questions – as a member of the APPG for FMS – and in the hope they will answer it – and copy your request to your own MP and let him know who else you have written to.

    It might be a good idea to copy your emails to MPs Anne Begg and Howard Stoate who have already raised questions in the House about co-proxamol. It is said Anne Begg has taken co-proxamol. Your emails will give the MPs some ammunition to raise this problem again.

    begga@parliament.uk stoateh@parliament.uk

    This Doctor is according to the website was the Vice Chairman of the APPG for Medical Research.

    ALL PARTY PARLIAMENTARY GROUP FOR FIBROMYALGIA

    May I suggest you look among the names of the members of this APPG for FMS and you will see a certain distinguished name? I understand he has been a member of this Group for a considerable time – before other commitments made big demands on his time. With enough pressure he just might help – who knows.

    Lastly as recently as October 2007 the chairman of this APPG Rob Wilson had written questions heard in the House, according to the Hansard report and TheyWorkForYou.com.

    He asked the Secretary of State for Health

    (1) what recent steps his Department has taken to raise awareness of fibromyalgia among (a) the general public and (b) health professionals;

    (2) what progress is being made in improving NHS (a) diagnosis and (b) treatment of fibromyalgia;

    (3) what recent representations he has had and received on fibromyalgia.

    Hansard source reported that Ann Keen (Parliamentary Under-Secretary (Health Services), Department of Health) had replied saying,

    • “We have made no assessment of the progress being made by the National Health Service into improving the diagnosis and treatment of fibromyalgia.

    • “We have taken no recent steps to raise awareness of fibromyalgia among the general public and health professionals.

    • “We have received three recent Downing Street e-petitions on fibromyalgia, as well as correspondence from individuals and their members of Parliament.”

    What kind of answer is that when the Government is trying to get fibromites back in the work place to reduce the benefit bills?

    One other fact to emerge from this reply is that the e-petitions are obviously reaching the Department of Health even if they appear to be ignoring them. I wonder does the PM ever see them?

    Better get writing to your MPs in double quick time, even if you are an ex-pat somewhere else in the world.

    Do let me have your comments – have you written?

    I have read and re-read this until I am seeing double – please excuse any typos – fibro fog is the culprit!

    Jeanne Hambleton © November 2007

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    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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