Tracy M. Baker! News week

Discussion in 'Fibromyalgia Main Forum' started by Sissy123, May 27, 2003.

  1. Sissy123

    Sissy123 New Member

    Are you serious? How could you print an article about those of us that have fibro and disability? Have you been extensively educated about fibro? You seem very egotistical to me, and ignorant when it comes to the disorder. There hasn't even been enough research to give it a name. The fibro is just a list of symptoms. How much education do you have about it? I feel sorry for your patients. You know sometimes, a lot of the time, you docs feel like you are God and your ideas and thoughts go. Period. You have a lot to learn about the pain and other symptoms about fibro. I really dont want to be rude, but your article was very vague and hurtful for those of us who have lost our jobs, our homes, cars, self esteem, friends...Who would give that up for $197 a month? I had a terrific career and a lot of friends with a social life and I was althetic. That article made you sound uneducated and critical about those less fortunate than yourself. Would you please explain yourself and the proof I know you dont have about your ideas about fibro. Another thing, My father that got cancer from the boilers and chemicals to produce milk for you and your family died only 3 months after retiring, He told me "Dont you feel bad about collecting SSI because I worked my whole life for that money and will not be using it now, so you are just collecting money that I made and will never spend." How many people even make it to the age to retire and have paid in their whole lives? Where does that money go? I suppose you know that also. Your letter really hit a nerve with me and I plan to respond to the article and shed some light on the matter. How could you do that and be a Doctor? You are sworn to take care of people, not take people down. sis
  2. AnnG

    AnnG New Member

    I'm lost! Was this in the Newsweek that focused on pain? I must have missed this part of it.
  3. AnnG

    AnnG New Member

    Just read the other post. Never mind!
  4. Sissy123

    Sissy123 New Member

    I looked up the qualifications of This Doc and he doesnt have what looks like to me any qualitfications to make any judgments about fibro. I will make an inquiry to News week in a very, very nice way about the article. I would never put words in our mouths without checking with you'all first. I think the guy is a moron, so I e-mailed him and told him so, in so many words. I would like to put him in my body for just one day and hear what he has to say after that. If doctors are suppose to help you, we dont need doctors like that. He is still, by the way in the Air Force reserves. Before that he was in the Air force. We all know how pompas the military can be. I know, I was married to a military reservest. His way goes. Period. I am just so............sick of people like him. Sis
  5. Shirl

    Shirl New Member

    What issue of NewWeek is this in?? Is it with in the May 19 issue??

    I have that one, and the lady (Matallana) that explained how she felt with FM was excellent, but I did not read the whole complete article on pain. It was so much about cancer pain, that I can't handle reading it, I lost my whole family to cancer and have a 'mental' thing about reading about it, it makes me sad.

    Let me know......................

    Shalom, Shirl

  6. JaciBart

    JaciBart Member

    He is a fricking moron, he ought to just spend an hour or two with any of us.

    People like him make me sick, I would spit on him if I could, the last thing we need is people like him spouting off.

    Can you please post his email??

    Jaci
  7. Princessraye

    Princessraye New Member

    As I understand it he wrote a letter to the editor. I could be wrong. There is another thread about it on this board.
  8. Mikie

    Mikie Moderator

    He shouldn't spend a couple of hours with us; he should spend a couple of hours in our bodies so he can finally get an education, something he obviously didn't get in medical school!

    Love, Mikie
  9. baby-bear

    baby-bear New Member

    Yes I am screamimg like Madwolf said when you use all caps!!!!!!!!!!!!!!!!! I too am SO-O-O-O-O-O-O-O SICK of these type doctors. I went to one last year and he made me cry and feel like I was drug seeking and all that usual stuff we get when we go to jerks that are no-it-alls!!! They say people that serve in the armed forces and are doctors and become doctors int he armed forces usually can't make it in the real world as a doctor. Im not saying all are like that but definitely so many are. Pammy
  10. MemoryLane

    MemoryLane Member

    Guess he missed reading this issue...

    Excerpt from article:

    "Physicians should listen to the patient describe the struggle of living with fibromyalgia and attempt to ameliorate the effects of symptoms on the patient's quality of life."


    Article from: The American Family Physician
    Published by the American Academy of Family Physicians
    October 1, 2000

    Treating Fibromyalgia
    PAUL J. MILLEA, M.D., M.S., and
    RICHARD L. HOLLOWAY, PH.D.
    Medical College of Wisconsin, Milwaukee, Wisconsin


    Fibromyalgia is an extremely common chronic condition that can be challenging to manage. Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that dysregulation of the autonomic and neuroendocrine system appears to be the basis of the syndrome. The diagnosis is clinical and is characterized by widespread pain, tender points and, commonly, comorbid conditions such as chronic fatigue, insomnia and depression. Treatment is largely empiric, although experience and small clinical studies have proved the efficacy of low-dose antidepressant therapy and exercise. Other less well-studied measures, such as acupuncture, also appear to be helpful. Management relies heavily on the physician's supportive counseling skills and willingness to try novel strategies in refractory cases. (Am Fam Physician 2000;62:1575-82,1587.)



    Fibromyalgia is a rheumatologic condition characterized by spontaneous, widespread soft tissue pain, sleep disturbance, fatigue and extensively distributed areas of tenderness known as tender points. Estimates of prevalence are 3.4 percent for women and 0.5 percent for men.1


    Fibromyalgia can be perplexing to patients and physicians because of the lack of associated abnormalities on readily available diagnostic tests. Despite this, recent findings about the pathogenesis and pathophysiology of fibromyalgia have dispelled the belief that the disorder is psychosomatic. While no laboratory test can confirm fibromyalgia, most patients present with a history of widespread pain, physical findings and comorbid conditions. With experience, the disorder may be diagnosed with confidence on initial presentation or after a period of observation and minimal diagnostic testing. The family physician is ideally suited to treat fibromyalgia because its management calls for a longitudinal relationship, a willingness to try different therapeutic modalities and an understanding of the interrelationship of the biopsychosocial aspects of health.


    Pathophysiology

    While the cause of fibromyalgia remains elusive, substantial findings implicate disturbances in the neuroendocrine axis as central to its etiology.2 This is particularly true of the relationship between the neuroendocrine axis and sleep. The sleep electroencephalogram of patients with fibromyalgia indicates disturbance of the non-REM sleep phase by intrusions of alpha waves with infrequent progression to stage 3 and stage 4 sleep.3 These findings correlate with patient reports of awakening repeatedly and being "unrefreshed by sleep."4

    The stages of sleep have concomitant hormone release activity. For example, release of growth hormone occurs primarily during stage 3 and stage 4 of non-REM sleep. One third of patients with fibromyalgia have low insulin growth factor (IGF) levels, an indication of low growth hormone secretion. Furthermore, symptoms of fibromyalgia may be created by disturbing non-REM sleep.5

    Other endocrinologic and neurologic findings in patients with fibromyalgia include:

    Elevation of cerebrospinal fluid substance P levels (a neurotransmitter associated with enhanced pain perception) to three times normal levels.6

    Alteration in the hypopituitary-adrenal axis with low overall production of cortisol. This contrasts with the findings in depression, where a higher-than-normal cortisol level is found.7

    Provocation of symptoms during tilt table testing and a significant prevalence of neurally mediated hypotension.8

    These results suggest that disturbances in the autonomic and endocrine stress response systems may underlie the etiology of fibromyalgia. How these pathophysiologic processes are set in motion is not understood; however, the prevalence of premorbid physical and psychologic trauma is high in these patients.


    Diagnosis

    Fibromyalgia should be considered in any patient with musculoskeletal pain that is unrelated to a clearly defined anatomic lesion. Making the diagnosis of fibromyalgia depends on findings from the history and physical examination rather than on diagnostic testing.

    In 1990, the American College of Rheumatology (ACR) established criteria for classifying patients with fibromyalgia.9 However, failure to meet these criteria does not absolutely exclude the possibility of fibromyalgia.

    As with other rheumatologic disorders, fibromyalgia:

    Is established on the basis of clinical observations.

    Is a condition with signs and symptoms that exist on a continuum.

    Often requires observation over time to firmly establish the diagnosis.


    History

    Widespread pain is characteristic of fibromyalgia. Although not all areas may be involved simultaneously, pain may occur in the occiput, neck, shoulders, thoracic and lumbar spine, paraspinous regions, buttocks, hips, elbows and knees. A careful history will uncover additional areas of pain when the chief complaint lies in one area. It is not unusual for the most significant area of pain to shift over time.

    Physical Examination

    Examination will reveal areas of pain on palpation but without the classic inflammatory signs of redness, swelling and heat in the joints and soft tissue. Although tender points are found in many different locations, the ACR has selected 18 sites that are more characteristic for fibromyalgia (Figure 1). To be classified with a definitive diagnosis of fibromyalgia, the patient must have tenderness on palpation at 11 of the 18 sites and a history as defined in Table 1, although patients with fewer than 11 sites still may have fibromyalgia. The number of tender points may change over time.

    Skill in palpation of tender points is critical to establishing a diagnosis of fibromyalgia. Physical findings encountered during palpation of the soft tissues include tender points, changes in skin texture, increased resting muscle tension and changes in the texture of the subcutaneous tissue.


    TABLE 1
    American College of Rheumatology Criteria for Classification of Fibromyalgia
    ------------------------------------------------------------

    Widespread pain for at least three months, defined as the presence of all of the following:

    Pain on the right and left sides of the body
    Pain above and below the waist (including shoulder and buttock pain)
    Pain in the axial skeleton (cervical, thoracic or lumbar spine, or anterior chest)

    Pain on palpation with a 4-kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites):

    Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus
    Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5-C7
    Trapezius: at the midpoint of the upper border
    Supraspinatus: above the scapular spine near the medial border
    Second rib: just lateral to the second costochondral junctions
    Lateral epicondyle: 2 cm distal to the lateral epicondyle
    Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle
    Greater trochanter: posterior to the greater trochanteric prominence
    Knee: at the medial fat pad proximal to the joint line
    ------------------------------------------------------------
    Adapted with permission from Wolfe F, Smythe HA, Yunas MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.


    Differential Diagnosis

    The diagnosis of fibromyalgia may be made based on the ACR criteria or based on the presence of the characteristic syndrome, or both. Clinicians familiar with fibromyalgia order a minimum of testing when cases appear straightforward. The thyroid-stimulating hormone level should be checked routinely because hypothyroidism can mimic the symptoms of fibromyalgia. Other diagnoses to consider include drug-induced myopathies (particularly those associated with the statin class of lipid-lowering agents), polymyalgia rheumatica and other rheumatologic syndromes.

    Myofascial pain syndrome may be confused with fibromyalgia. To complicate the situation, myofascial pain syndrome may occur in patients with fibromyalgia. Similar to fibromyalgia, myofascial pain syndrome is a condition that is diagnosed clinically. With a careful history and physical examination, the physician should be able to determine whether a patient has fibromyalgia, myofascial pain syndrome, or both. While the pain of fibromyalgia is widespread with changing areas of emphasis, myofascial pain arises from trigger points in individual muscles. The diagnosis of myofascial pain syndrome should be considered when, by history, the patient's pain pattern is limited to a particular region over time.

    The definitive differentiation between myofascial pain syndrome and fibromyalgia is made by physical examination. Myofascial pain syndrome is defined by the presence of trigger points. Unfortunately, location alone does not differentiate between trigger points and tender points because they often occur in similar locations. Distinguishing between trigger points and tender points depends on characteristic findings associated with trigger points that are found on physical examination. Trigger points are located within taut bands of muscle, whereas tender points are not. Palpation of trigger points often reproduces the pain radiation pattern experienced by the patient and can elicit a twitch in the muscle. The pain elicited on palpation of a tender point is localized to the area under palpation and does not elicit a jump or twitch. Lastly, trigger points often have a nodular texture described as similar to a pencil eraser, whereas tender points have no palpatory characteristics distinguishing them from surrounding tissue.10


    TABLE 2
    Comorbid Conditions Associated with Fibromyalgia
    ------------------------------------------------------------

    Migraine headache
    Chronic fatigue
    Irritable bowel syndrome
    Depression
    Restless legs syndrome
    Temporomandibular joint syndrome
    Myofascial pain syndrome

    ------------------------------------------------------------
    Information from Hudson JL, Goldenberg DL, Pope HG, Keck PE, Schlesinger L. Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 1992;92:363-7.


    Comorbid Conditions

    Patients with fibromyalgia often have one or more comorbid conditions (Table 211). Along with myofascial pain syndrome, the most common of these are migraine headache, irritable bowel syndrome and a history of depression and chronic fatigue.11 Although treatment for fibromyalgia may help to alleviate the symptoms of comorbid conditions, specific treatment for these comorbidities may be indicated.


    Treatment

    Because the symptoms of fibromyalgia wax and wane, treatment (as with that of other chronic diseases) is an ongoing process rather than management of a single episode. Flare-ups often exacerbate the patient's underlying stress. Furthermore, stress can also precipitate flare-ups of fibromyalgia. Physicians should spend some time eliciting and hearing the ongoing narrative of the struggle of living with a chronic disease and attempt to ameliorate the effects of the symptoms on the patient's quality of life.

    Treatment of fibromyalgia is largely empiric. Although some frequently used approaches, such as antidepressants and exercise, have evidence to support their use, others (such as acupuncture) are less well studied. None of the therapies used in fibromyalgia are based on evidence from larger randomized, double-blind, placebo-controlled trials. This void places a premium on the physician's therapeutic creativity and supportive counseling skills.


    The therapeutic response to patients with relatively mild symptoms and no sleep disturbances may involve only identification of fibromyalgia to explain and legitimize their symptoms, along with encouragement to develop and maintain an active exercise program. Many patients will benefit from the use of low-dose antidepressants. Other patients may require more complicated regimens, which may include psychotherapy, medications, acupuncture, massage and physical therapy, to maintain function. Ideally, the practitioner will collaborate with the patient to construct a unique treatment plan consonant with the patient's circumstances.12 That plan will necessarily evolve within the context of the physician-patient relationship.


    Therapeutic Measures

    Antidepressant Agents. Although antidepressants have a lengthy history in the treatment of chronic pain syndromes, they have received only limited study in the treatment of fibromyalgia. The tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or combinations of both, produce mild to moderate improvement in symptoms. In controlled studies,1 approximately one third to one half of patients responded to pharmacologic treatment. One study13 found that while 25 mg of amitriptyline (Elavil) or 20 mg of fluoxetine (Prozac) reduced the symptoms of fibromyalgia, the combination of the two was twice as effective as either agent taken alone. The dosages used are somewhat lower than those needed to treat depression. The older agents (such as amitriptyline) can be started at a dosage of 10 mg taken daily two to three hours before bedtime. This allows the peak sedative effect to be realized while avoiding unwanted carry-over sedation on awakening. The time of administration can be adjusted depending on individual patient response.

    The dosage of antidepressant must be individualized. This is particularly true of the tricyclic agents, given their variable absorption, metabolism and excretion. Dosages should be gradually increased, not to exceed the recommended maximum for the drug. Even patients who are able to tolerate very small amounts of these medications may derive benefit from them. In these instances, doxepin elixir (Sinequan) can be started at a low dose (one drop, or 0.67 mg) and slowly titrated upward.14 Fluoxetine, an SSRI, can be started at doses in the lower range and should generally be taken in the morning.

    The use of cyclobenzaprine (Flexeril) is supported by evidence primarily from one randomized controlled trial that followed 120 patients.15 Clinically, its use has many adherents.

    There is a note of caution when using antidepressants to manage fibromyalgia: a significant portion of patients may find that their symptoms worsen while using these drugs. Symptoms must be monitored carefully as therapeutic blood levels are reached.16

    Exercise. Aerobic and strength-training activities have been associated with significant improvements in pain, tender point counts and disturbed sleep in patients with fibromyalgia.17 Unfortunately, maintenance of exercise regimens tends to be poor in patients with fibromyalgia. Strategies for improving compliance, such as having the patient work out with a companion, can be discussed with the patient.

    Acupuncture. A substantial meta-analysis of studies using acupuncture in the treatment of fibromyalgia confirms the empiric finding of medical acupuncturists that acupuncture is an extremely useful adjunctive treatment for many patients with fibromyalgia.18 While not curative, acupuncture can enhance the patient's quality of life. The frequency of acupuncture is individualized and may range from weekly visits to visits once every 10 to 12 weeks. Information about physician acupuncturists practicing in a particular area may be obtained by contacting the American Association of Medical Acupuncture, 5820 Wilshire Blvd., Ste. 500, Los Angeles, CA 90036. This information is also on their Web site.

    Chronic Opioid Analgesic Therapy (COAT). This intervention should be reserved for patients with moderate to severe pain or significant functional impairment and for those in whom other therapies are ineffective or contraindicated. Controlled clinical trials demonstrate COAT to be safe and effective in patients with pain that is not related to cancer.19 Patients requiring intermittent relief from pain may be given appropriate dosages of oral narcotic analgesics combined with acetaminophen. Those patients needing ongoing pain relief may be prescribed controlled-release oxycodone (Roxicodone) or morphine sulfate (Duramorph). Patients receiving COAT should be informed of the possibility of dependence and should be monitored regularly.20

    Nonsteroidal Anti-Inflammatory Agents (NSAIDs). Although commonly prescribed in analgesic doses, NSAIDs have not been proved to be effective in the treatment of fibromyalgia.


    Behavior Therapies

    Patients with fibromyalgia may experience difficulty fulfilling work and social obligations because of poor symptom control. This difficulty can lead to social isolation and feelings of decreased self-efficacy. Collaborative care between family physicians and other health care professionals may provide optimal benefit for patients. Pain perception is an extremely complex phenomenon that may be modified by experience. Several behavior science approaches appear to hold benefit for fibromyalgia.

    Cognitive Behavior Training. A program21 of 20 hours of relaxation response training and movement therapy found to be effective in treating patients with low back pain included 28 patients with fibromyalgia. Patients who completed the program reported reduced pain and other symptoms, as well as improved function and general health.21

    One study22 reviewed two types of "formal self-management strategies" published from 1981 through 1996. The results tend to favor training in coping skills as being more effective than physical fitness training, but preliminary evidence suggests that combining both types of training may be more effective than either alone. As with all of the approaches to fibromyalgia, this article22(p.445) points out that "not all individuals show the same response to these programs." A program23 combining cognitive behavior strategies, physical exercise, relaxation and information about chronic pain was compared with a control program of autogenic (self-hypnosis) training only. At the end of treatment and four months later, members of the study group reported less impairment in their daily lives.23

    Hypnosis. In a controlled study of 40 patients, hypnosis improved functioning and reduced pain more than physical therapy.24


    Other Therapies

    Several therapies that are less well studied and less commonly used may be helpful in certain cases.

    Growth Hormone Therapy. Treatment with recombinant growth hormone was highly effective in reducing symptoms and improving quality of life in a small, randomized study25 involving a subset of patients with fibromyalgia and low insulin-like growth factor I levels. No significant side effects were encountered. Unfortunately, the cost of growth hormone is prohibitive for most patients.25

    Chiropractic Treatment. Following four weeks of treatment, 21 patients with fibromyalgia improved compared with control subjects receiving medication only.26

    Support Groups and Online Chat Rooms. Many patients benefit from discussing their day-to-day lives with others who are also affected by fibromyalgia. Support groups may be located through a local chapter of the Arthritis Foundation (AF). The AF address is 1330 W. Peachtree St., Atlanta, GA 30309.


    Initiating Treatment

    The goals of treatment for fibromyalgia are to control pain and improve function. These goals can be met using a variety of techniques. A reasonable and cost-effective strategy may be initiated using antidepressants and exercise. If patients do not tolerate these measures or if additional symptomatic relief is needed to maintain function, the addition of hypnosis, behavior therapy, acupuncture and/or chiropractic treatment could then be considered. If pain control or function, or both, are still poor, COAT should then be considered.

    Members of various family practice departments develop articles for "Practical Therapeutics." This article is one in a series coordinated by the Department of Family and Community Medicine at the Medical College of Wisconsin, Milwaukee. Guest editors of the series are Linda N. Meurer, M.D., M.P.H., and Douglas Bower, M.D.


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

    The Authors

    PAUL J. MILLEA, M.D., M.S.,
    is an assistant professor of family medicine at the Medical College of Wisconsin, Milwaukee. He received a master's of science in addiction studies at the University of Arizona College of Medicine, Tucson, and received his medical degree from the Medical College of Wisconsin. After serving a residency in family practice at Baylor College of Medicine, Houston, Dr. Millea completed a fellowship in family therapy at the Baylor College of Medicine and Galveston Family Institute.

    RICHARD L. HOLLOWAY, PH.D.,
    is professor and associate chair and chief of the Division of Career Development for the Department of Family and Community Medicine and associate dean for student affairs at the Medical College of Wisconsin. Dr. Holloway holds a clinical certification and license as a marriage and family therapist specializing in intergenerational family therapy. He received his doctorate from Syracuse University and completed a postdoctoral fellowship at the measurement services center at the University of Minnesota.

    Address correspondence to Paul J. Millea, M.D., M.S., Department of Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226

    REFERENCES

    1.Goldenberg DL. Fibromyalgia syndrome a decade later: what have we learned? Arch Intern Med 1999;159:777-85.

    2.Pillemer SR, Bradley LA, Crofford LJ, Moldofsky H, Chrousos GP. The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum 1997;40:1928-39.

    3.Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am 1989;15(1):91-103.

    4.Harding SM. Sleep in fibromyalgia patients: subjective and objective findings. Am J Med Sci 1998; 315:367-76.

    5.Lentz MJ, Landis CA, Rothermel J, Shaver JL. Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. J Rheumatol 1999;26:1586-92.

    6.Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek JE, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 1994;37:1593-601.

    7.Demitrack MA, Crofford LJ. Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 1998;840:684-97.

    8.Bou-Holaigah I, Calkins H, Flynn JA, Tunin C, Chang HC, Kan JS, et al. Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia. Clin Exp Rheumatol 1997;15:239-46.

    9.Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.

    10.Schneider MJ. Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis.
    J Manipulative Physiol Ther 1995;18:398-406.

    11.Hudson JL, Goldenberg DL, Pope HG, Keck PE, Schlesinger L. Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 1992;92:363-7.

    12.Potts MK, Silverman SL. The importance of aspects of treatment for fibromyalgia (fibrositis). Arthritis Care Res 1990;3:11-8.

    13.Goldenberg DL, Mayskiy M, Mossey C, Ruthazar R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitryptyline in the treatment of fibromyalgia. Arthritis Rheum 1996;39: 1852-9.

    14.Godfrey RG. A guide to the understanding and use of tricyclic antidepressants in the overall management of fibromyalgia and other chronic pain syndromes. Arch Intern Med 1996; 156:1047-52.

    15.Bennett RM, Gatter RA, Campbell SM, Andrews RP, Clark SR, Scarola JA. A comparison of cyclobenzaprine and placebo in the management of fibrositis. A double-blind controlled study. Arthritis Rheum 1988;31:1535-42.

    16.Jaeschke R, Adachi J, Guyatt G, Keller J, Wong B. Clinical usefulness of amitriptyline in fibromyalgia: the results of 23 N-of-1 randomized controlled trials. J Rheumatol 1991;18:447-51.

    17.Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol 1996;25:77-86.

    18.Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999;48:213-8.

    19.Caldwell JR, Hale ME, Boyd RE, Hague JM, Iwan T, Shi M, et al. Treatment of osteoarthritis pain with controlled release oxycodone or fixed combination oxycodone plus acetaminophen added to nonsteroidal anti-inflammatory drugs: a double blind, randomized, multicenter, placebo controlled trial. J Rheumatol 1999;26:862-9.

    20.Brown RL, Fleming MF, Patterson JJ. Chronic opioid analgesic therapy for chronic low back pain. J Am Board Fam Pract 1996;9:191-204.

    21.Singh BB, Berman BM, Hadhazy VA, Creamer P.
    A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med 1998;4:67-70.

    22.Sandstrom MJ, Keefe FJ. Self-management of fibromyalgia: the role of formal coping skills training and physical exercise training programs. Arthritis Care Res 1998;11:432-47.

    23.Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clin J Pain 1998;14:232-8.

    24.Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol 1991;18:72-5.

    25.Bennett RM, Clark SC, Walczyk J. A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 1998;104:227-31.

    26.Blunt KL, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1997;20:389-99.


    Copyright © 2000 by the American Academy of Family Physicians.



    [This Message was Edited on 05/28/2003]
  11. Sissy123

    Sissy123 New Member

    You should look up his name on the net and send him that report. He lives in Augusta, Ks. He may benefit, if he feels like reading it, from the report and information it contains. I know he said in short we are just whining and giving us SSI is a waste of the tax payers money! That is what p---d me off the most. Mikie, I lost my father to cancer also. He was one of the infamous Robert Courtneys victims of the diluted chemo in Research Medical Center in Kansas City, MO. Thankfully he is serving a 30 year sentence and sewing military uniforms! He requested to be a pharmasist at the prison, can you beleive that?!!! His father was a preacher, and Robert was building a 2,000.000 home in the Virgin IsLands and his own church to be a preacher down there. People never cease to amaze me. Much Love Sis