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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objective of this study was to evaluate subjective symptoms from the temporomandibular system in patients with fibromyalgia. Two hundred and thirty-seven individuals with fibromyalgia affiliated to the Stockholm Rheumatologic Association were included in the study. A questionnaire about symptoms of temporomandibular disorders (TMD) was mailed and returned by 191 (81%). The participants reported frequent and severe symptoms of TMD, 94% reported local pain from the temporomandibular system with a mean duration of 12 years. The most frequent sites were the temple, temporomandibular joint and neck regions. General body pain had a significantly longer duration than TMD, which indicates that fibromyalgia starts in other parts of the body and later extends to the temporomandibular region. The severity of general pain scored significantly higher than local pain, but there was a significant positive correlation between the two conditions. High frequency, 73-78 %, of headache, facial pain and tiredness of the jaws was found and about fifty percent of the patients also complained about difficulties to open the mouth and to chew. Fibromyalgia is thus a probable cause of TMD. In conclusion this study shows that patients with fibromyalgia often suffer from symptoms of TMD, and that the intensity of the pain is correlated to general body pain. These findings indicate that fibromyalgia is one of the causes of TMD.
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PMID:Presence of orofacial pain and temporomandibular disorder in fibromyalgia. A study by questionnaire. 1090 2

Fibromyalgia (FM) is a syndrome of unknown etiology characterized by chronic wide spread pain, increased tenderness to palpation and additional symptoms such as disturbed sleep, stiffness, fatigue and psychological distress. While medication mainly focus on pain reduction, physical therapy is aimed at disease consequences such as pain, fatigue, deconditioning, muscle weakness and sleep disturbances and other disease consequences. We systematically reviewed current treatment options in the treatment of fibromyalgia. Based on evidence from randomized controlled trials cardiovascular fitness training importantly improves cardiovascular fitness, both subjective and objective measures of pain as well as subjective energy and work capacity and physical and social activities. Based on anecdotal evidence or small observational studies physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia. While there seems to be no single best treatment option, physical therapy seem to reduce disease consequences. Accordingly a multidisciplinary approach combining these therapies in a well balanced program may be the most promising strategy and is currently recommended in the treatment of fibromyalgia.
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PMID:Physical therapy in the treatment of fibromyalgia. 1102 38

A case-control study was conducted in a rural area of Achaia in western Greece to examine the risk factors of brucellosis. The participants in the study were 414 (7.5% of the whole population of the investigated municipality). The cases (n = 140) were defined by clinical symptoms and confirmed by a positive standard agglutination test (SAT). All cases have been diagnosed between January 1997 and March 1999 either by physicians of the Local Health Center or by private practitioners. Two criteria were basic to establish the disease. The first one was clinical symptoms such as fever, fatigue, arthralgia and generalized aches and the second was a titer of SAT at least 1:160. Controls (n = 274) were matched with cases for age and gender in a 1:2 ratio. Approximately collection of controls was performed among those presented to the local Health Center for other diseases. Data were collected by the same physician via a personal interview and analyzed by logistic regression models. The overall incidence of the disease in the region was found to be 1110/100,000. Taking 'no ownership of animals' and 'no contact of animals' as the reference category, the strongest risk factor was trauma during animal delivery with an odds ratio (OR): 24.3; 95% confidence interval (CI): 8.8-67.5 following by absence of stables (OR: 14.4; 95% CI: 4.7-44.1). After application of multivariate stepwise analysis the adjusted risk factors remaining in the model were the place of residence (OR: 1.8; 95% CI: 1.1-3.1), professional occupation with animals (OR: 2.4; 95% CI: 1.2-4.8), absence of stables (OR: 9.1; 95% CI: 2.2-38.7) and trauma during animal delivery (OR: 11.2; 95% CI: 3.2-39.1). Consumption of cheese from pasteurized milk or consumption of cheese matured for over 3 months was found to be a protective factor (OR: 0.27; 95% CI: 0.11-0.67). The detection of brucellosis in animals is essential for the prevention of the disease. In addition efficient preventive measures should be established in order to eliminate the disease.
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PMID:Epidemiology of human brucellosis in a rural area of north-western Peloponnese in Greece. 1280 Sep 54

The mechanisms of pain causation in fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) are still debated. We wanted to compare muscle activity and pain development during and after low-grade mental stress in FMS and SNP patients. Twenty-three women with FMS, 29 women with chronic SNP and 35 healthy women performed a stressful task lasting 60 min followed by a 30 min recovery period. We recorded surface electromyography over the trapezius, neck, temporalis and frontalis muscles. Subjects reported their pain at the corresponding locations together with the development of fatigue and perceived tension. Significant differences between FMS and SNP groups were not observed either for muscular or subjective responses. SNP patients and controls responded with more pain in the trapezius and neck regions than in the forehead, in contrast to FMS patients who had a more generalized pain response. Development of pain, tension and fatigue was not related to muscle activity for any group. We conclude that FMS and SNP patients have similar pain and electromyographic responses. The results suggest that similar pathophysiological mechanisms are involved although the responses are more generalised in FMS than in SNP patients. Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP patients compared to healthy controls, possibly a result of disease-related sensitisation in pain pathways.
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PMID:Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. 1630 Sep 74

Patients with end-stage heart failure have a trajectory of illness characterized by an overall gradual decline in function punctuated by periods of symptom exacerbation followed by a return nearly to their baseline. These exacerbations are not predictable. Death may come suddenly and unexpectedly for each patient, even though predictive models can draw an accurate survival curve by averaging the experience of a substantial number of people with heart failure. Heart failure patients often have treatable symptoms, such as dyspnea, fatigue, and generalized pain. In this article, we explain the trajectory of patients with heart failure, illustrate the importance of advance care planning for these patients, discuss the impact of choices to use or forgo new technologies, and suggest ways to improve the care system. Only by reexamining our health care spending priorities can we create a sustainable care system that allows patients to live both long and comfortably, reaching a balance that serves them and their communities well.
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PMID:Trajectory of end-stage heart failure: the influence of technology and implications for policy change. 1648 73

A 23-year-old single female patient developed constitutional manifestations in the form of fever, weight loss, anorexia, malaise, fatigue, and generalized aches in January 1995, 2 weeks after an attack of German measles. This was followed by painful, reddish, macular skin lesions over both legs which healed by dark pigmentation (leucocytoclastic vasculitis), mononeuritis multiplex, and Raynaud's phenomena of both hands and feet. Angiography of lower limbs was done to visualize the arterial tree of both lower limbs and revealed typical beading of distal arterial branches, a diagnosis compatible with polyarteritis nodosa (PAN). At that time, the patient received prednisone (45 mg/day) and azatioprin (100 mg/day) and responded well to treatment. In a second presentation in June 2005, the patient developed sudden attack of loss of vision in her left eye. Ophthalmological examination of the patient revealed evidence of left central retinal artery occlusion, ischemic optic neuropathy. The patient received methyl prednisolone, 1 g IV infusion, daily infusion for three consecutive days followed by oral prednisolone, 30 mg/day. The patient received pulse cyclophosphamide IV infusion (0.6 g/m2) on the fourth day. One week after receiving therapy, the patient progressed from having light perception to counting of fingers from a distance of 1 m.
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PMID:A case of polyarteritis nodosa complicated by left central retinal artery occlusion, ischemic optic neuropathy, and retinal vasculitis. 1657 92

Fibromyalgia and myofascial pain syndromes are terms used to describe a constellation of complaints ranging from generalized aches to specific tender trigger points often accompanied by fatigue, depression, and sleep disturbances. In the past 5 years, research has been directed primarily at determining the pathophysiology of fibromyalgia and myofascial pain syndromes and the treatment of patients' comorbidities to alleviate their symptomatology. Controversy exists as to whether fibromyalgia and myofascial pain syndromes represent a specific pathology or are merely terms to describe clinical conditions that provide patients with the reassurance that their symptoms are real and help clinicians with therapeutic direction. In the occupational health setting, this uncertainty can lead to significant difficulty in determining short- and long-term disability and assigning culpability to an individual's work environment.
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PMID:Fibromyalgia and myofascial pain syndromes and the workers' compensation environment: an update. 1664 62

Fibromyalgia is characterized by chronic widespread pain and the presence of tender points, often accompanied by several non-specific symptoms, such as fatigue, depressive mood, and sleep disturbances. The apparent overlap between fibromyalgia and other syndromes, such as chronic fatigue and irritable bowel, is not sufficient cause to consider all these syndromes as manifestations of a single syndrome. Fibromyalgia is a multifaceted problem. Central afferent pain amplification and perhaps also impaired descending pain inhibition are supposed to underlie widespread pain. Neuroendocrine perturbations, sleep disturbances, health beliefs, mood disorder, and physical deconditioning play a role in the modulation and perseverance of pain and other symptoms. It is extremely difficult to mitigate chronic generalized pain and to deal with other symptoms in fibromyalgia. A uniform intervention strategy is missing. Essential in the tailored management of fibromyalgia are an enhancement of functional capacities and quality of life, and the symptomatic treatment of individual symptoms such as pain, distress, and sleep disturbances. Rather than analysing monotherapy per se, the objective in future evaluations should be to try to find the combined pharmacological or non-pharmacological treatment of choice for specific subgroups of patients.
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PMID:Fibromyalgia: diagnosis, pathogenesis, and treatment. 1701 42

Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear. A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems. This article reviews the current and emerging literature about the pathophysiology and neurobiology of chronic widespread -musculoskeletal pain. Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.
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PMID:Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain. 1876 38

Chronic fatigue and nonrestorative sleep are prominent features of fibromyalgia (FM). It has been reported that these patients have alpha-wave intrusion during nonrapid eye movement (NREM) sleep (stages 2,3,4). Although alpha-NREM sleep has been noted in patients with other rheumatic disorders, a paucity of controlled data limits the interpretation of these reports. To determine the specificity of alphaNREM sleep, FM patients were compared with pain-free controls and with patients with generalized musculoskeletal pain without evidence of FM. There were no statistically significant differences in alpha-NREM percentages among the three groups. However, nearly half of all "pain" subjects (FM and generalized pain controls) had alpha-NREM percentages above the maximum value found in the painfree control group, and the mean percentage of alpha-NREM approached significance when pain-free controls were compared with all pain patients (FM plus generalized pain controls). These results provide additional evidence that alpha-NREM sleep may be a more generalized marker for chronic pain rather than a specific anomaly in patients with FM. Therefore, at present, sleep studies, although possibly of value in identifying factors associated with FM, should not be used in an attempt to either confirm or exclude a diagnosis ofFM in patients with generalized nonarticular pain.
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PMID:Controlled study of sleep parameters in patients with fibromyalgia. 1907 56


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