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Query: UMLS:C0016053 (fibromyalgia)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors sought to determine whether the self-report questionnaire developed by L.F. Callahan and T. Pincus is of use for the diagnosis of fibromyalgia when severe and/or chronic pain raises doubts as to an inflammatory rheumatic disease. This questionnaire evaluates the ratio between pain severity assessed on a visual analog scale and impairment of activities of daily living. High values suggest fibromyalgia, whereas low values occur in rheumatoid arthritis patients. The French translation of the questionnaire was completed by 15 fibromyalgia patients and 22 patients with inflammatory arthritic syndrome of whom 15 had rheumatoid arthritis. Mean pain/impairment ratio was 5.85 +/- 0.68 (SEM) in the fibromyalgia group versus 3.01 +/- 0.38 in the inflammatory rheumatism group. This difference was highly significant (p = 0.001 by Student's t test). The rheumatoid arthritis subgroup was also significantly different from the fibromyalgia group (p = 0.003). These findings are very similar to those reported by Callahan and Pincus. Our data confirm the value of this simple self-evaluation tool. In practice, ratios greater than 5 suggest fibromyalgia whereas ratios under 3 support the diagnosis of rheumatoid arthritis.
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PMID:[Value of the self-evaluation of functional and painful disorders for the differentiation between fibromyalgia and inflammatory rheumatic diseases]. 814 49

Chronic fatigue syndrome (CFS) as currently defined overlaps with other syndromes including chronic pain, fibromyalgia, anxiety and depression. It also resembles historical descriptions of neurasthenia. The role of psychological (cognitive) and behavioural therapies in CFS is examined. There are both pragmatic and theoretical arguments for their application to CFS. It is pragmatic to target obvious and treatable factors including inactivity and depression. A theoretical model in which psychological, physiological and social factors interact offers a plausible rationale for such treatment but is not yet empirically proven. While there is evidence for the efficacy of this type of therapy in related syndromes, the evidence in CFS is inconclusive. A randomized controlled trial of combined cognitive and behavioural therapy currently in progress is described. Initial results suggest that most patients receiving cognitive behaviour therapy improve, especially in terms of functional impairment. It remains to be seen whether this therapy will prove to be more effective than standard general practitioner care. In the meantime cognitive behaviour therapy offers a pragmatic and rational therapy for patients with CFS.
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PMID:Non-pharmacological approaches to treatment. 849 Nov 4

Chronic pain of unknown aetiology, and characterized by cutaneous trigger points, has been coined the skinache syndrome. The treatment of the skinache syndrome was evaluated in 94 patients by two independent methods 2 years after treatment. After one subcutaneous injection of lidocaine 68% of the patients were cured. The pain recurred in 27 patients having suffered for an average of 2 years. Surgical removal of the cutaneous trigger points cured 77% of the latter patients. The odds ratio of success of surgical treatment versus all other treatments combined was 101.3. The skinache syndrome requires a precise clinical investigation. Even when the origin of the pain in tendons, muscle and adipose tissue is excluded, the skinache syndrome remains a common, debilitating disorder. In contrast to fibromyalgia, the skinache syndrome has a simple and effective cure.
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PMID:The skinache syndrome. 853 46

Syndromes characterized by chronic pain and fatigue have been described in the medical literature for centuries. Fibromyalgia is the term currently used to describe this symptom complex, and considerable research has been performed in the last decade to delineate the epidemiology, pathophysiology, and genesis of this entity. Although fibromyalgia is defined by its musculoskeletal features, it is clear that there are a large number of non-musculoskeletal symptoms, such that we now understand that there is considerable overlap with allied conditions such as the chronic fatigue syndrome, migraine and tension headaches, irritable bowel syndrome, and affective disorders. This article will review our current state of knowledge regarding fibromyalgia and these allied conditions, and present a unifying hypothesis that describes both the pathophysiology of symptoms and the genesis of these disorders.
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PMID:The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia. 858 67

The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. Data sources include MEDLINE searches in English, relevant reference books and textbooks, my personal database and library, as well as personal clinical experience. I discuss these data with regard to the pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with the use of tricyclic antidepressants. Additional information is given on drug selection and dosage titration. Much emphasis is placed on the fact that while tricyclic antidepressants play a major role in the management of fibromyalgia and other chronic pain syndromes, lifestyle alterations (eg. physical reconditioning and exercise), as well as behavior modification, are also vital to a successful outcome in management.
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PMID:A guide to the understanding and use of tricyclic antidepressants in the overall management of fibromyalgia and other chronic pain syndromes. 863 90

The relation between reported chronic pain and clinical findings was studied by comparing survey data six months before and eighteen months after a clinical examination. Studied individuals (n = 165) were randomly selected from subsamples of an initial survey (n = 1806) to a general population. Among individuals reporting chronic pain 85% were assessed to have chronic pain at the examination. Diagnoses were found in 22% of examined pain individuals. Myofascial pain syndrome and myalgia were the most common findings. Compared with located neck-shoulder pain, widespread pain had a greater impact on the individual, a worse prognosis regarding pain duration and working capacity, and revealed a raised serum urate level of unclear significance. Although no specific cause of pain is found in individuals with widespread pain it is important to identify and treat this group due to the great effects on functional capacity and the worse prognosis.
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PMID:Characteristics of subjects with chronic pain, in relation to local and widespread pain report. A prospective study of symptoms, clinical findings and blood tests in subgroups of a geographically defined population. 866 57

Amitriptyline is a tricyclic antidepressant agent which also has analgesic properties. Whether its analgesic effects are linked to its mood-altering activity or attributable to a discrete pharmacological action (or a combination of both) is unknown. Clinical trials demonstrate that oral amitriptyline achieves at least a good or moderate response in up to two-thirds of patients with post-herpetic neuralgia and three-quarters of patients with painful diabetic neuropathy, neurogenic pain syndromes that are often unresponsive to narcotic analgesics. Amitriptyline has also demonstrated efficacy in heterogeneous groups of patients with chronic non-malignant pain. Other possible areas of use for amitriptyline are in patients with fibromyalgia or as an adjuvant for uncontrolled cancer pain, although evidence for the latter application is limited. Adverse events resulting from the antimuscarinic activity of amitriptyline (primarily dry mouth and sedation) are commonly reported, even at the low dosages used for the control of pain. Low starting doses and careful dosage titration may help to minimise these effects. Orthostatic hypotension and tachycardia, sometimes associated with tricyclic antidepressant agents, may also pose a problem in the elderly. In summary, amitriptyline has a valuable place in the treatment of chronic pain conditions that affect the elderly provided that the drug is used judiciously to minimise adverse effects. Importantly, amitriptyline remains the best studied of the antidepressant agents in post-herpetic neuralgia and diabetic neuropathy and is an important and effective treatment option in these syndromes.
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PMID:Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. 873 30

Patients with a chronic pain syndrome often suffer from sleep disturbance. As both symptoms are frequent in the fibromyalgia syndrome, these patients in particular have been examined in this regard. No clear polysomnographic evaluation of the subjectively experienced sleep disturbance in these patients has been done so far. Therefore, we recorded the sleep EEG of 13 patients with a fibromyalgia syndrome in order to objectively characterize their sleep. Furthermore, we were interested in the relationship between the sleep alterations and pain intensity. In a subsequent placebo-controlled study based on pathophysiological considerations, we attempted to beneficially influence the sleep disturbance and the pain syndrome with the 5-HT2-receptor antagonist ketanserine, as this system has been proved to play a major role in the regulation of both sleep and pain. The results of our studies in patients with fibromyalgia show that the alteration of sleep is mainly characterized by a disturbance of sleep continuity associated with the experience of pain intensity. The application of 5-HT-receptor-antagonists may be a new strategy for the common treatment of sleep disturbance and the pain syndrome which needs to be evaluated in further studies. Duration of the patients' illness seems to be a predictive value in relation to intensity of the symptoms and the therapeutic outcome.
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PMID:[Sleep disorders in chronic pain and generalized tendomyopathy]. 884

A number of studies have reported abnormalities in the muscles of fibromyalgia patients. The early studies, some of which indicated morphologic abnormalities, had major problems with patient selection and lacked adequate control groups. More recent studies of morphology have shown only nonspecific or mild changes, perhaps consistent with subtle metabolic abnormalities, especially at tender point sites. Studies of muscle metabolism, however, particularly the more rigorous studies using MR spectroscopy, have failed to confirm abnormalities in muscle metabolism, both at tender and nontender point locations. The abnormalities detected in earlier studies appear to have been confounded by subtle metabolic changes resulting from muscle deconditioning. Studies of muscle blood flow also demonstrate abnormalities that can be explained by deconditioning alone. Studies of muscle strength that show differences between patients and controls can be explained by lack of voluntary effort. A popular theory of the genesis of pain in fibromyalgia syndrome was that excessive muscle tension led to increased excitability of nociceptors in muscle leading to muscle hypertension and chronic pain. Furthermore, defective sympathetic control was proposed to result in disturbed microcirculation and nociceptor excitation. In aggregate, however, studies using EMG techniques show no evidence of excessive muscle tension or defective sympathetic nervous function. Therefore, although muscular pain has been a central feature of fibromyalgia syndrome, controlled studies of muscle fail to support a convincing role for muscle in the pathophysiology of the condition. Muscle tenderness in fibromyalgia cannot be explained on the basis of primary muscle abnormalities, either structural or functional. Future pathophysiologic studies in fibromyalgia should focus on central mechanisms.
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PMID:Is there muscle pathology in fibromyalgia syndrome? 886 Jul 98

There are three realities that need to be understood by both clinicians and patients: (1) fibromyalgia is a complex chronic pain condition and current treatment is palliative rather than curative; (2) the major aim of treatment is to improve function, not abolish pain; and (3) a cycle of chronic pain, stress, and psychological arousal often generates a set of secondary symptoms. These secondary symptoms provide a positive feedback loop that is amenable to modification by cognitive-behavioral techniques. Multidisciplinary group treatment programs are especially suited to such techniques; their aim should be to maximize subsequent clinician-patient interactions. Thus, a current concept of optimal management is a blend of multidisciplinary group therapy and individualized clinician-based treatment.
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PMID:Multidisciplinary group programs to treat fibromyalgia patients. 886 Aug 3


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