FOUND THIS PAIN FM RESEARCH INTERESTING

Discussion in 'Fibromyalgia Main Forum' started by blondieangel, Oct 4, 2002.

  1. blondieangel

    blondieangel New Member

    10th World Congress on Pain


    --------------------------------------------------------------------------------

    BY ROBERT BENNETT, MD, FRCP, FACP, FACR
    HOSTED BY INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN

    The International Association for the Study of Pain (IASP) is an international, multidisciplinary, non-profit professional association dedicated to furthering research on pain and improving the care of patients with pain. They foster and encourage research into pain mechanisms and pain syndromes and work to improve the management of patients with acute and chronic pain by bringing together basic scientists, physicians and other health professionals of various disciplines and backgrounds who have interest in pain research and management.

    The 10th World Congress on Pain was held in San Diego, CA, Aug. 17 - 22, 2002. This is a triennial meeting organized by the International Association for the Study of Pain (IASP), the leading world body for pain researchers and clinicians. It was a truly massive and overwhelming meeting with 1788 presentations of one type or another. I do not have a precise number for the attendees, but my estimate is about 3500. They came from all over the world, and I was delighted to reacquaint with friends and colleagues from Australia, Thailand, Sweden, Germany, Denmark, Great Britain, France, Chile, Argentina, Brazil and the United States. Whether you were a physician or basic researcher there was a cornucopia of interesting papers, state-of the-art lectures and symposia. The first day was devoted to refresher courses. I took part in one of these courses devoted to rheumatic pain disorders, giving a one-hour talk on fibromyalgia. The other two speakers were from the UK: Professor Michael Doherty spoke on osteoarthritis, and Professor Bruce Kidd spoke on rheumatoid arthritis. I was gratified to learn that at least some UK rheumatologists are focusing their attention on pain mechanisms -- but as in many countries this continues to be an uphill battle. There were many sessions devoted to the basic mechanisms underlying chronic pain states such as fibromyalgia. Indeed, fibromyalgia was frequently referred to in many of these presentations as being the classic example of a “central pain state.” By this is meant that peripheral tissue causes of pain cannot be readily identified in most fibromyalgia patients and that most of the action is at the level of the spinal cord and above. The neurophysiological and biochemical basis of central sensitization is now being unraveled in minute detail. Much of this work relates to neuro chemicals and their interaction with specific receptors. This is the basis of the transmission of sensory impulses from one nerve cell to another. In order to make advances in this field one must devote a large chunk of a research career to just one very specialized topic. Needless to say, the arcane nature of this work makes it very difficult to understand unless one is an “insider.” However, understanding the detailed mechanisms of neurochemical receptor interactions will be pivotal in the creation of designer drugs for treating chronic pain, while minimizing the unwanted side effects that plague many of the currently available medications. A state-of-the-art lecture by Professor Linda Watkins from the University of Colorado in Boulder was particularly noteworthy. For the past 10 years or so she has studied glial cells. Until fairly recently glial cells were considered boring, as their only known role was to provide a skeletal type support for nerve cells of the brain and spinal cord. Prof. Watkins discovered that glial cells can be activated by infections and other stresses, and they then interact with nerve cells to produce chronic-pain states via the secretion of small proinflammatory molecules called cytokines. For instance, 90 per-cent of patients with HIV infection have chronic pain. Prof. Watkins has shown that one component of the HIV virus (gp 120) interacts with glial cells to induce a chronic pain syndrome. This of course may be of relevance to fibromyalgia patients who trace the onset of their problem to an antecedent flu-like illness. Furthermore, she has recently shown that the introduction of a cytokine called interleukin 10 into the nervous system of mice with an experimentally induced chronic pain syndrome attenuates their pain. Interestingly, interleukin 10 inhibits the actions of the pro-inflammatory cytokines. This is obviously exciting and important work that may eventually have a relevance to fibromyalgia patients; stay tuned.

    There was an interesting symposium titled “The Biopsychosocial Approach to Fibromyalgia and Chronic Fatigue Syndrome.” It featured three researchers with differing views as to the nature of fibromyalgia and chronic fatigue syndrome. Dr. Milton Cohen from Australia asserted that two fundamental errors have been perpetuated in contemporary research on the clinical phenomenon of widespread pain and fatigue. The first is the failure to distinguish a clinical feature from a disease process without a unifying concept. This results in circular reasoning inherent in the labels of fibromyalgia and chronic fatigue syndrome. The second major error is the failure to focus on the neurobiology of the defining clinical finding –i.e. increased pain sensitivity. Dr. Lawrence Bradley from Birmingham, AL, contested Dr. Cohen’s statement regarding the lack of research on the neurobiology of fibromyalgia and presented impressive evidence for abnormal pain processing and dysregulation of neuroendocrine function in fibromyalgia. He noted that disorders such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome had a large degree of overlap. But he also noted that not all persons with chronic fatigue syndrome showed the abnormal pain sensitivity of typical fibromyalgia patients.

    Dr. Bradley concluded that a better understanding of the natural history of these overlap syndromes, looking at genetic contributions, developmental stressors and triggering events, will be essential in unraveling the relationships of these common disorders. Dr. Peter Heuts, from the Netherlands, stated that the widespread musculoskeletal pain associative with fibromyalgia has led most investigators to consider it a rheumatological disorder. He thought it was inappropriate to test hypotheses concerning the pathophysiology and treatment of fibromyalgia using concepts appropriate for painful rheumatic diseases that are usually characterized by immunological aberrations, inflammation and degeneration. He described a rather arcane procedure that measured “iterative loops” as a useful device for posing questions concerning the etiology and treatment of fibromyalgia. The measurement of iterative loops is a framework for organizing health services data. It divides the spectrum of health information into subgroups that constitute a logical progression from quantifying the burden of illness, identifying its likely causes, measuring the efficacy and efficiency of treatment interventions, monitoring their applications and, finally, deter-mining whether the burden of illness has been reduced. He ended by saying that the measurement of iterative loops is a useful construct that contributes to the avoidance of category mistakes, as well as identifying the most appropriate questions for future research. I must admit that I had difficulty following the logic of Dr. Heuts’ arguments and take issue with his assertion that contemporary fibromyalgia research has been unduly influenced by rheumatologists applying the concepts of inflammation immunology to research into this condition. Indeed, all the rheumatology researchers that I know have been adamant that there is no immunological or inflammatory basis for fibromyalgia. Overall, this was an interesting and thought-provoking symposium featuring three researchers with interesting differences of opinion regarding the common syndromes of fibromyalgia and chronic fatigue. It should be remembered that challenging contemporary beliefs is the modus operandi for scientific discoveries and progress.

    There were 27 individual poster presentations devoted to the topic of fibromyalgia. Here I review the nine that I consider to be most relevant and understandable for patients.

    1. A study from France explored the efficacy of subcutaneous ketamine on improving pain in fibromyalgia patients. Ketamine is a class of drugs known as NMDA receptor antagonists. In high doses it is used as an anesthetic. Activation of the NMDA receptor is a critical event in the biochemistry of chronic pain states. Fifty patients received subcutaneous ketamine (up to 50 mg daily) for 10 days via an infusion pump similar to that used by diabetic patients. There was a significant improvement in pain scores in 78 percent of the subjects. At six months after discontinuation of the ketamine, 45 percent of the patients still showed improvement. This is an intriguing study but suffered from lack of a control group using a placebo.

    2. There was a fascinating study from a New York group exploring the effects of the September 11th World Trade Center disaster on symptoms of fibromyalgia. In a study prior to September 11th, this group had screened a population of 9000 women in metropolitan New York and New Jersey for fibromyalgia symptomatology and psychiatric symptoms. In February and March of 2002 they recontacted 1000 of the same women to determine whether existing symptoms had changed. Interestingly, they did not find any major changes in fibromyalgia-like symptomatology, although there was a minor increase in anxiety-related symptomatology. Interestingly, there was a significant reduction in the number of doctor visits. I asked the author of this study for her interpretation of the reduced doctors visits. She conjectured it was due to a changed perspective of their problems in the light of the devastation wreaked upon so many others.

    3. There is an ongoing controversy as to whether fibromyalgia may be set off by a whiplash injuries resulting from motor vehicle accidents. A study from Switzerland applied an objective measure of increased central nervous system sensitization (the nociceptive withdrawal reflex) to three groups of subjects; one group with whiplash, another group with fibromyalgia and a group of healthy controls. The fibromyalgia and whiplash patients, but not the healthy controls, showed unequivocal evidence of increased central nervous system sensitization. This is an important study that brings some objectivity to a controversial subject.

    4. On the same subject, a group from Seattle looked at the onset of fibromyalgia following whiplash injury. This is an ongoing NIH-funded study that aims to eventually enter 400 whiplash subjects. To date, 25 subjects have been studied, and 20 percent have developed widespread pain, and 80 percent met the tender-point criteria for a diagnosis of fibromyalgia. The authors concluded that some of the findings of fibromyalgia are common in women two to three months following whiplash injury. They suggest that part of this increased prevalence may be due to a clustering of tender points in the neck region – as expected in the soft tissue trauma following hyperextension/flexion injuries to the neck. But they also noted that the high prevalence of fibromyalgia symptomatology is probably not entirely artifactual, as 68 percent of the whiplash subjects also demonstrated tender points in other parts of the body.

    5. A psychophysical research study from Gainesville, FL, studied fibromyalgia patients and healthy controls with an objective measure of central sensitization called “temporal summation.” They asked the question as to whether central sensitization could be modified by the placebo response, fentanyl (a long-actingopioid drug) or naloxone (a drug that antagonizes the analgesic actions of opioids and the placebo response). They found that fibromyalgia patients had increased levels of central sensitization compared to healthy controls. Temporal summation was attenuated by both placebo and fentanyl to a similar degree and was not influenced by naloxone. It was concluded that central sensitization, which is thought to be a critical component of increased pain sensitivity in fibromyalgia, can be centrally modulated by both endogenous (i.e. placebo) and exogenous (i.e. fentanyl) manipulations. There is increasing evidence that one's own endogenous pain modulating apparatus, modulated by endorphins, involves the same neural pathways as opioid analgesics. Thus strategies aimed at activating a patient's own endorphin system, sch as exercise, adopting positive coping strategies and having an optimistic outlook, are important tools in the effective management of fibromyalgia.

    6. Most physicians who specialize in managing fibromyalgia patients believe that a multidisciplinary approach to treatment is an essential prerequisite for success. A Canadian group developed a 10-week program for fibromyalgia patients that included education, group support, coping skills training, physical exercise in a pool, goal-setting and daily activity diaries. Patients were seen in groups of 10 to 15. Overall, 395 patients had been analyzed at the time this study was reported. Highly significant improvements were seen in the fibromyalgia Impact Questionnaire (FIQ), a widely used out-come measure in fibromyalgia studies. Women showed greater improvements than men, and women under 40 showed the most improvement.

    7. A study from Brazil reported on the effects of acupuncture on pain and quality of life in patients with fibromyalgia. Forty-eight women with fibromyalgia were randomly allocated into two treatment groups. Group 1 received amitriptyline plus twice-weekly acupuncture sessions for three months. Group 2 received amitriptyline plus stretching and relaxation exercises twice a week. There was a significant reduction of pain intensity and improved function in both groups, but the acupuncture group had significantly better response than the other group. The authors concluded that acupuncture is an effective pool for treatment of fibromyalgia patients.

    8. A study from Salt Lake City attempted to evaluate whether fibromyalgia patients would be more susceptible to pain experience during mammography and Pap smears. A questionnaire was sent out to 100 women who were randomly selected from a database of fibromyalgia patients. Fifty-nine patients agreed to take part in the survey. They rated pain and anxiety during their last mammography and Pap smear on a scale of 0 to 10. The mean pain score was 4.32 for mammography and 2.45 for Pap smears. Mean anxiety scores were 2.33 during mammography and 2.2 during Pap smears. It was concluded that women with fibromyalgia experience a moderate amount of pain during mammography and rate mammography as significantly more painful than Pap smears. Anxiety levels were comparable between the two procedures. As pain is a deterrent to women for undergoing mammography, the authors suggested that more effective pain management during this procedure should be considered for those women susceptible to discomfort during mammography, such as fibromyalgia patients.

    9. A study from the UK evaluated the use of a new antidepressant drug called Reboxitine in a study of patients with fibromyalgia and neuropathic pain. Reboxitine is a class of drugs that selectively inhibits the reuptake of noradrenaline. Thus its mode of action is somewhat similar to that of fluoxetine (Prozac), but it inhibits noradrenaline reuptake rather than serotonin reuptake. One of the mechanisms whereby the brain can control the relay of pain impulses upward from the spinal cord is via a descending pathway from the midbrain, which uses noradrenaline as a neurotransmitter. Thus it was conjectured that Reboxitine would modulate pain via this descending noradrenaline system. Twenty-five women with fibromyalgia and 14 with neuropathic pain (nerve pain arising from conditions such as diabetes or shingles) were included in the study. Eight (32%) of the fibromyalgia patients had a very significant reduction in pain intensity, and six elected to continue with camp Reboxitine after the trial ended. Six (43%) patients in the neuropathic pain group reported significant pain reduction, but only one wished to continueusing Reboxitine after the study ended. The reason for not continuing with the medication after the end of the study was the side effects of insomnia and agitation. However, in some patients the sense of agitation was interpreted as a feeling of increased energy, which was particularly welcome in some fibromyalgia patients. This study did not contain a placebo control group and thus the specificity of the Reboxitine effect cannot be assessed.

    Overall the 10th World and Congress on Pain was a stimulating and somewhat exhausting experience. As is often the case with large international conferences, one was subjected to intense information overload. However, I came away with a sense of awe at the magnitude and quality of the research being done worldwide to reduce the burden of chronic pain. As a fibromyalgia researcher, I was gratified to see that the diagnostic term “fibromyalgia” is being used increasingly by pain researchers who often refer to it has a “classical example of central sensitization.” As a rheumatologist, I am increasingly impressed that fibromyalgia is primarily a neurological disorder that presents as a musculoskeletal pain syndrome. Having said that, I believe that rheumatologists will continue to be the major specialty to treat fibromyalgia, as the correct diagnosis of musculoskeletal pain is complex, and, furthermore, there is often an overlap of fibromyalgia with chronic rheumatic problems such as osteoarthritis, lupus, and rheumatoid arthritis. Interestingly, neurologists seem to be one of the last holdouts in accepting the fibromyalgia concept. Hopefully that will change over the next few years before the next World Congress on Pain, which will be held in Sydney, Australia, in August 2005.




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  2. blondieangel

    blondieangel New Member

    10th World Congress on Pain


    --------------------------------------------------------------------------------

    BY ROBERT BENNETT, MD, FRCP, FACP, FACR
    HOSTED BY INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN

    The International Association for the Study of Pain (IASP) is an international, multidisciplinary, non-profit professional association dedicated to furthering research on pain and improving the care of patients with pain. They foster and encourage research into pain mechanisms and pain syndromes and work to improve the management of patients with acute and chronic pain by bringing together basic scientists, physicians and other health professionals of various disciplines and backgrounds who have interest in pain research and management.

    The 10th World Congress on Pain was held in San Diego, CA, Aug. 17 - 22, 2002. This is a triennial meeting organized by the International Association for the Study of Pain (IASP), the leading world body for pain researchers and clinicians. It was a truly massive and overwhelming meeting with 1788 presentations of one type or another. I do not have a precise number for the attendees, but my estimate is about 3500. They came from all over the world, and I was delighted to reacquaint with friends and colleagues from Australia, Thailand, Sweden, Germany, Denmark, Great Britain, France, Chile, Argentina, Brazil and the United States. Whether you were a physician or basic researcher there was a cornucopia of interesting papers, state-of the-art lectures and symposia. The first day was devoted to refresher courses. I took part in one of these courses devoted to rheumatic pain disorders, giving a one-hour talk on fibromyalgia. The other two speakers were from the UK: Professor Michael Doherty spoke on osteoarthritis, and Professor Bruce Kidd spoke on rheumatoid arthritis. I was gratified to learn that at least some UK rheumatologists are focusing their attention on pain mechanisms -- but as in many countries this continues to be an uphill battle. There were many sessions devoted to the basic mechanisms underlying chronic pain states such as fibromyalgia. Indeed, fibromyalgia was frequently referred to in many of these presentations as being the classic example of a “central pain state.” By this is meant that peripheral tissue causes of pain cannot be readily identified in most fibromyalgia patients and that most of the action is at the level of the spinal cord and above. The neurophysiological and biochemical basis of central sensitization is now being unraveled in minute detail. Much of this work relates to neuro chemicals and their interaction with specific receptors. This is the basis of the transmission of sensory impulses from one nerve cell to another. In order to make advances in this field one must devote a large chunk of a research career to just one very specialized topic. Needless to say, the arcane nature of this work makes it very difficult to understand unless one is an “insider.” However, understanding the detailed mechanisms of neurochemical receptor interactions will be pivotal in the creation of designer drugs for treating chronic pain, while minimizing the unwanted side effects that plague many of the currently available medications. A state-of-the-art lecture by Professor Linda Watkins from the University of Colorado in Boulder was particularly noteworthy. For the past 10 years or so she has studied glial cells. Until fairly recently glial cells were considered boring, as their only known role was to provide a skeletal type support for nerve cells of the brain and spinal cord. Prof. Watkins discovered that glial cells can be activated by infections and other stresses, and they then interact with nerve cells to produce chronic-pain states via the secretion of small proinflammatory molecules called cytokines. For instance, 90 per-cent of patients with HIV infection have chronic pain. Prof. Watkins has shown that one component of the HIV virus (gp 120) interacts with glial cells to induce a chronic pain syndrome. This of course may be of relevance to fibromyalgia patients who trace the onset of their problem to an antecedent flu-like illness. Furthermore, she has recently shown that the introduction of a cytokine called interleukin 10 into the nervous system of mice with an experimentally induced chronic pain syndrome attenuates their pain. Interestingly, interleukin 10 inhibits the actions of the pro-inflammatory cytokines. This is obviously exciting and important work that may eventually have a relevance to fibromyalgia patients; stay tuned.

    There was an interesting symposium titled “The Biopsychosocial Approach to Fibromyalgia and Chronic Fatigue Syndrome.” It featured three researchers with differing views as to the nature of fibromyalgia and chronic fatigue syndrome. Dr. Milton Cohen from Australia asserted that two fundamental errors have been perpetuated in contemporary research on the clinical phenomenon of widespread pain and fatigue. The first is the failure to distinguish a clinical feature from a disease process without a unifying concept. This results in circular reasoning inherent in the labels of fibromyalgia and chronic fatigue syndrome. The second major error is the failure to focus on the neurobiology of the defining clinical finding –i.e. increased pain sensitivity. Dr. Lawrence Bradley from Birmingham, AL, contested Dr. Cohen’s statement regarding the lack of research on the neurobiology of fibromyalgia and presented impressive evidence for abnormal pain processing and dysregulation of neuroendocrine function in fibromyalgia. He noted that disorders such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome had a large degree of overlap. But he also noted that not all persons with chronic fatigue syndrome showed the abnormal pain sensitivity of typical fibromyalgia patients.

    Dr. Bradley concluded that a better understanding of the natural history of these overlap syndromes, looking at genetic contributions, developmental stressors and triggering events, will be essential in unraveling the relationships of these common disorders. Dr. Peter Heuts, from the Netherlands, stated that the widespread musculoskeletal pain associative with fibromyalgia has led most investigators to consider it a rheumatological disorder. He thought it was inappropriate to test hypotheses concerning the pathophysiology and treatment of fibromyalgia using concepts appropriate for painful rheumatic diseases that are usually characterized by immunological aberrations, inflammation and degeneration. He described a rather arcane procedure that measured “iterative loops” as a useful device for posing questions concerning the etiology and treatment of fibromyalgia. The measurement of iterative loops is a framework for organizing health services data. It divides the spectrum of health information into subgroups that constitute a logical progression from quantifying the burden of illness, identifying its likely causes, measuring the efficacy and efficiency of treatment interventions, monitoring their applications and, finally, deter-mining whether the burden of illness has been reduced. He ended by saying that the measurement of iterative loops is a useful construct that contributes to the avoidance of category mistakes, as well as identifying the most appropriate questions for future research. I must admit that I had difficulty following the logic of Dr. Heuts’ arguments and take issue with his assertion that contemporary fibromyalgia research has been unduly influenced by rheumatologists applying the concepts of inflammation immunology to research into this condition. Indeed, all the rheumatology researchers that I know have been adamant that there is no immunological or inflammatory basis for fibromyalgia. Overall, this was an interesting and thought-provoking symposium featuring three researchers with interesting differences of opinion regarding the common syndromes of fibromyalgia and chronic fatigue. It should be remembered that challenging contemporary beliefs is the modus operandi for scientific discoveries and progress.

    There were 27 individual poster presentations devoted to the topic of fibromyalgia. Here I review the nine that I consider to be most relevant and understandable for patients.

    1. A study from France explored the efficacy of subcutaneous ketamine on improving pain in fibromyalgia patients. Ketamine is a class of drugs known as NMDA receptor antagonists. In high doses it is used as an anesthetic. Activation of the NMDA receptor is a critical event in the biochemistry of chronic pain states. Fifty patients received subcutaneous ketamine (up to 50 mg daily) for 10 days via an infusion pump similar to that used by diabetic patients. There was a significant improvement in pain scores in 78 percent of the subjects. At six months after discontinuation of the ketamine, 45 percent of the patients still showed improvement. This is an intriguing study but suffered from lack of a control group using a placebo.

    2. There was a fascinating study from a New York group exploring the effects of the September 11th World Trade Center disaster on symptoms of fibromyalgia. In a study prior to September 11th, this group had screened a population of 9000 women in metropolitan New York and New Jersey for fibromyalgia symptomatology and psychiatric symptoms. In February and March of 2002 they recontacted 1000 of the same women to determine whether existing symptoms had changed. Interestingly, they did not find any major changes in fibromyalgia-like symptomatology, although there was a minor increase in anxiety-related symptomatology. Interestingly, there was a significant reduction in the number of doctor visits. I asked the author of this study for her interpretation of the reduced doctors visits. She conjectured it was due to a changed perspective of their problems in the light of the devastation wreaked upon so many others.

    3. There is an ongoing controversy as to whether fibromyalgia may be set off by a whiplash injuries resulting from motor vehicle accidents. A study from Switzerland applied an objective measure of increased central nervous system sensitization (the nociceptive withdrawal reflex) to three groups of subjects; one group with whiplash, another group with fibromyalgia and a group of healthy controls. The fibromyalgia and whiplash patients, but not the healthy controls, showed unequivocal evidence of increased central nervous system sensitization. This is an important study that brings some objectivity to a controversial subject.

    4. On the same subject, a group from Seattle looked at the onset of fibromyalgia following whiplash injury. This is an ongoing NIH-funded study that aims to eventually enter 400 whiplash subjects. To date, 25 subjects have been studied, and 20 percent have developed widespread pain, and 80 percent met the tender-point criteria for a diagnosis of fibromyalgia. The authors concluded that some of the findings of fibromyalgia are common in women two to three months following whiplash injury. They suggest that part of this increased prevalence may be due to a clustering of tender points in the neck region – as expected in the soft tissue trauma following hyperextension/flexion injuries to the neck. But they also noted that the high prevalence of fibromyalgia symptomatology is probably not entirely artifactual, as 68 percent of the whiplash subjects also demonstrated tender points in other parts of the body.

    5. A psychophysical research study from Gainesville, FL, studied fibromyalgia patients and healthy controls with an objective measure of central sensitization called “temporal summation.” They asked the question as to whether central sensitization could be modified by the placebo response, fentanyl (a long-actingopioid drug) or naloxone (a drug that antagonizes the analgesic actions of opioids and the placebo response). They found that fibromyalgia patients had increased levels of central sensitization compared to healthy controls. Temporal summation was attenuated by both placebo and fentanyl to a similar degree and was not influenced by naloxone. It was concluded that central sensitization, which is thought to be a critical component of increased pain sensitivity in fibromyalgia, can be centrally modulated by both endogenous (i.e. placebo) and exogenous (i.e. fentanyl) manipulations. There is increasing evidence that one's own endogenous pain modulating apparatus, modulated by endorphins, involves the same neural pathways as opioid analgesics. Thus strategies aimed at activating a patient's own endorphin system, sch as exercise, adopting positive coping strategies and having an optimistic outlook, are important tools in the effective management of fibromyalgia.

    6. Most physicians who specialize in managing fibromyalgia patients believe that a multidisciplinary approach to treatment is an essential prerequisite for success. A Canadian group developed a 10-week program for fibromyalgia patients that included education, group support, coping skills training, physical exercise in a pool, goal-setting and daily activity diaries. Patients were seen in groups of 10 to 15. Overall, 395 patients had been analyzed at the time this study was reported. Highly significant improvements were seen in the fibromyalgia Impact Questionnaire (FIQ), a widely used out-come measure in fibromyalgia studies. Women showed greater improvements than men, and women under 40 showed the most improvement.

    7. A study from Brazil reported on the effects of acupuncture on pain and quality of life in patients with fibromyalgia. Forty-eight women with fibromyalgia were randomly allocated into two treatment groups. Group 1 received amitriptyline plus twice-weekly acupuncture sessions for three months. Group 2 received amitriptyline plus stretching and relaxation exercises twice a week. There was a significant reduction of pain intensity and improved function in both groups, but the acupuncture group had significantly better response than the other group. The authors concluded that acupuncture is an effective pool for treatment of fibromyalgia patients.

    8. A study from Salt Lake City attempted to evaluate whether fibromyalgia patients would be more susceptible to pain experience during mammography and Pap smears. A questionnaire was sent out to 100 women who were randomly selected from a database of fibromyalgia patients. Fifty-nine patients agreed to take part in the survey. They rated pain and anxiety during their last mammography and Pap smear on a scale of 0 to 10. The mean pain score was 4.32 for mammography and 2.45 for Pap smears. Mean anxiety scores were 2.33 during mammography and 2.2 during Pap smears. It was concluded that women with fibromyalgia experience a moderate amount of pain during mammography and rate mammography as significantly more painful than Pap smears. Anxiety levels were comparable between the two procedures. As pain is a deterrent to women for undergoing mammography, the authors suggested that more effective pain management during this procedure should be considered for those women susceptible to discomfort during mammography, such as fibromyalgia patients.

    9. A study from the UK evaluated the use of a new antidepressant drug called Reboxitine in a study of patients with fibromyalgia and neuropathic pain. Reboxitine is a class of drugs that selectively inhibits the reuptake of noradrenaline. Thus its mode of action is somewhat similar to that of fluoxetine (Prozac), but it inhibits noradrenaline reuptake rather than serotonin reuptake. One of the mechanisms whereby the brain can control the relay of pain impulses upward from the spinal cord is via a descending pathway from the midbrain, which uses noradrenaline as a neurotransmitter. Thus it was conjectured that Reboxitine would modulate pain via this descending noradrenaline system. Twenty-five women with fibromyalgia and 14 with neuropathic pain (nerve pain arising from conditions such as diabetes or shingles) were included in the study. Eight (32%) of the fibromyalgia patients had a very significant reduction in pain intensity, and six elected to continue with camp Reboxitine after the trial ended. Six (43%) patients in the neuropathic pain group reported significant pain reduction, but only one wished to continueusing Reboxitine after the study ended. The reason for not continuing with the medication after the end of the study was the side effects of insomnia and agitation. However, in some patients the sense of agitation was interpreted as a feeling of increased energy, which was particularly welcome in some fibromyalgia patients. This study did not contain a placebo control group and thus the specificity of the Reboxitine effect cannot be assessed.

    Overall the 10th World and Congress on Pain was a stimulating and somewhat exhausting experience. As is often the case with large international conferences, one was subjected to intense information overload. However, I came away with a sense of awe at the magnitude and quality of the research being done worldwide to reduce the burden of chronic pain. As a fibromyalgia researcher, I was gratified to see that the diagnostic term “fibromyalgia” is being used increasingly by pain researchers who often refer to it has a “classical example of central sensitization.” As a rheumatologist, I am increasingly impressed that fibromyalgia is primarily a neurological disorder that presents as a musculoskeletal pain syndrome. Having said that, I believe that rheumatologists will continue to be the major specialty to treat fibromyalgia, as the correct diagnosis of musculoskeletal pain is complex, and, furthermore, there is often an overlap of fibromyalgia with chronic rheumatic problems such as osteoarthritis, lupus, and rheumatoid arthritis. Interestingly, neurologists seem to be one of the last holdouts in accepting the fibromyalgia concept. Hopefully that will change over the next few years before the next World Congress on Pain, which will be held in Sydney, Australia, in August 2005.




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  3. G

    G New Member

    Nice to read about this and glad they are finally doing more research.

    G
  4. allhart

    allhart New Member

    thank you for posting this i read it but never saved it now here it is yeah its realy grate thanks for taking the time to post it so others can read it and my stupid but could save it
  5. Cactuslil

    Cactuslil New Member

    Praise God when I finally was able to get treatment I landed on the best this county has to offer, atleast in my situation. I live in a very "ill-unfriendly" part of south texas...but my doc has not succumbed to this unfortunate practice. I am getting a copy of this to give me in case he missed it. Thanks. CactusLil'