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Fibromyalgia

Research Articles

FIBROMYALGIA RESEARCH ARTICLES

Martinez-Lavin Fibromyalgia Research – August 2013

“We studied a group of patients with fibromyalgia and compared them with healthy controls. By means of portable recorders, we registered the subjects’ heartbeat for 24 hours while they followed their routine daily activities.  We found that patients with fibromyalgia have relentless hyperactivity of the sympathetic nervous system.  This abnormality was also evident during sleeping hours. In a different study, we subjected patients with fibromyalgia to a simple stress test (to stand up).  We observed a paradoxical derangement of the sympathetic nervous system response to the upright posture.  Such findings have been confirmed by other groups of investigators.”

“The results of these studies suggest that a fundamental alteration of fibromyalgia is a disordered function of the autonomic nervous system.  Patients with fibromyalgia lose the normal day/night cycles (circadian rhythms) and have a relentless sympathetic hyperactivity throughout 24 hours.  This may explain the sleeping problems that the patients have.  At the same time, such individuals have sympathetic hypo-reactivity to stress, which could explain the profound fatigue, morning stiffness and other complaints associated to low blood pressure.  This autonomic nervous system dysfunction could induce other symptoms of fibromyalgia such as irritable bowel, urinary discomfort, limb numbness, anxiety and dryness of the eyes and mouth.”

“Fibromyalgia’s defining features (chronic widespread pain and tenderness to palpation) could be explained by the mechanism known as “sympathetically maintained pain”.  After a triggering event (physical/emotional trauma, infections) relentless sympathetic hyperactivity may develop in susceptible individuals.  This hyperactivity induces excessive norepinephrine (also known as noradrenaline) secretion, that could in turn sensitize central and peripheral pain receptors and thus induce widespread pain and widespread tenderness.  Exquisite tenderness at palpation (its medical term is allodynia) is a typical sympathetically maintained pain feature.  This mechanism of pain is supported by our finding that norepinephrine (noradrenaline) injections induce pain in fibromyalgia patients.   Fibromyalgia has neuropathic pain features since it is a stimulus-independent pain state accompanied by hypersensitivity to palpation (its medical term is allodynia), and abnormal sensations such as tingling, burning, or electric-shocks.  There are important similarities between fibromyalgia and the localized painful syndrome named reflex sympathetic dystrophy.  As matter of fact we propose that fibromyalgia is a generalized form of reflex sympathetic dystrophy.  Recent evidence confirms our proposal the FM is a sympathetically maintained neuropathic pain syndrome.  There is evidence that FM patients frequently have “small fiber neuropathy”.  This type of alteration produces not only persistent pain, but also the sympathetic dysfunction seen in FM.”


 

Researchers Develop Reliable Way To Use Finger Stick Blood Sample To Detect Fibromyalgia Syndrome – July 24 2013

“Researchers have developed a reliable way to use a finger-stick blood sample to detect fibromyalgia syndrome, a complicated pain disorder that often is difficult to diagnose.”

“If it were someday made available to primary care physicians, the test could knock up to five years off of the wait for a diagnosis, researchers predict.”

“In a pilot study, the scientists used a high-powered and specialized microscope to detect the presence of small molecules in blood-spot samples from patients known to have fibromyalgia.”

“By “training” the equipment to recognize that molecular pattern, the researchers then showed that the microscope could tell the difference between fibromyalgia and two types of arthritis that share some of the same symptoms.”

“Though more analysis is needed to identify exactly which molecules are related to development of the disorder itself, the researchers say their pilot data are promising.”

“We’ve got really good evidence of a test that could be an important aid in the diagnosis of fibromyalgia patients,” said Tony Buffington, professor of veterinary clinical sciences at The Ohio State University and senior author of the study.  “We would like this to lead to an objective test for primary care doctors to use, which could produce a diagnosis as much as five years before it usually occurs.”


 

Researchers Claim ‘Breakthrough’ In Fibromyalgia Study – June 19 2013

“Researchers are touting a “breakthrough discovery” in the diagnosis of fibromyalgia – a complex and painful condition that affects millions of people around the world.”

“In a new studybeing published in Pain Medicine, the journal of the American Academy of Pain Medicine, researchers based at Albany Medical College say they may have finally found the first biological evidence of what causes fibromyalgia.”

“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” said Frank Rice, PhD, President of Integrated Tissue Dynamics LLC (Intidyn) and the senior researcher on the study.”

“In a small study of fibromyalgia patients, researchers found an “enormous increase” in sensory nerve fibers in the blood vessels of the skin on the patients’ palms.  The extra nerve fibers appear to disrupt the normal flow of blood, which may explain why many fibromyalgia patients often complain of tenderness or pain in their hands and feet.”


 

Objective Evidence That Small-Fiber Polyneuropathy Underlies Some Illnesses Currently Labeled As Fibromyalgia – June 5 2013

Abstract

“Fibromyalgia is a common, disabling syndrome that includes chronic widespread pain plus diverse additional symptoms.  No specific objective abnormalities have been identified, which precludes definitive testing, disease-modifying treatments, and identification of causes.  In contrast, small-fiber polyneuropathy (SFPN), despite causing similar symptoms, is definitionally a disease caused by the dysfunction and degeneration of peripheral small-fiber neurons.  SFPN has established causes, some diagnosable and definitively treatable, eg, diabetes.  To evaluate the hypothesis that some patients labeled as having fibromyalgia have unrecognized SFPN that is causing the symptoms of illness, we analyzed SFPN-associated symptoms, signs and pathological and physiological markers in 27 patients with fibromyalgia and in 30 matched normal controls.”


 

Low-Dose Naltrexone For The Treatment Of Fibromyalgia: Findings Of A Small, Randomized, Double-Blind, Placebo-Controlled, Counterbalanced, Crossover Trial Assessing Daily Pain Levels – February 2013

OBJECTIVE:

“To determine whether low dosages (4.5 mg/day) of naltrexone reduce fibromyalgia severity as compared with the nonspecific effects of placebo. In this replication and extension study of a previous clinical trial, we tested the impact of low-dose naltrexone on daily self-reported pain. Secondary outcomes included general satisfaction with life, positive mood, sleep quality, and fatigue.”

METHODS:

“Thirty-one women with fibromyalgia participated in the randomized, double-blind, placebo-controlled, counterbalanced, crossover study. During the active drug phase, participants received 4.5 mg of oral naltrexone daily. An intensive longitudinal design was used to measure daily levels of pain.”

RESULTS:

“When contrasting the condition end points, we observed a significantly greater reduction of baseline pain in those taking low-dose naltrexone than in those taking placebo (28.8% reduction versus 18.0% reduction; P = 0.016). Low-dose naltrexone was also associated with improved general satisfaction with life (P = 0.045) and with improved mood (P = 0.039), but not improved fatigue or sleep. Thirty-two percent of participants met the criteria for response (defined as a significant reduction in pain plus a significant reduction in either fatigue or sleep problems) during low-dose naltrexone therapy, as contrasted with an 11% response rate during placebo therapy (P = 0.05). Low-dose naltrexone was rated equally tolerable as placebo, and no serious side effects were reported.”

CONCLUSION:

“The preliminary evidence continues to show that low-dose naltrexone has a specific and clinically beneficial impact on fibromyalgia pain. The medication is widely available, inexpensive, safe, and well-tolerated. Parallel-group randomized controlled trials are needed to fully determine the efficacy of the medication.”


 

A Randomized, Double-Blind, Placebo-Controlled Trial Of Pramipexole, A Dopamine Agonist, In Patients With Fibromyalgia Receiving Concomitant Medications – August 2005

OBJECTIVE:

“To assess the efficacy and safety of pramipexole, a dopamine 3 receptor agonist, in patients with fibromyalgia.”

METHODS:

“In this 14-week, single-center, double-blind, placebo-controlled, parallel-group, escalating-dose trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo) to receive 4.5 mg of pramipexole or placebo orally every evening. The primary outcome was improvement in the pain score (10-cm visual analog scale [VAS]) at 14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain improvement scale, the tender point score, the 17-question Hamilton Depression Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities and disability were not excluded. Stable dosages of concomitant medications, including analgesics, were allowed.”

RESULTS:

“Compared with the placebo group, patients receiving pramipexole experienced gradual and more significant improvement in measures of pain, fatigue, function, and global status. At 14 weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the placebo arm (treatment difference -1.77 cm). Forty-two percent of patients receiving pramipexole and 14% of those receiving placebo achieved > or =50% decrease in pain. Secondary outcomes favoring pramipexole over placebo included the total FIQ score (treatment difference -9.57) and the percentages of improvement in function (22% versus 0%), fatigue (29% versus 7%), and global (38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes showed a better trend for pramipexole treatment than for placebo, but failed to reach statistical significance, including improvement in the tender point score (51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%), the BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end points showed a better trend for the placebo arm. The most common adverse events associated with pramipexole were transient anxiety and weight loss. No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole.”

CONCLUSION:

“In a subset of patients with fibromyalgia, approximately 50% of whom required narcotic analgesia and/or were disabled, treatment with pramipexole improved scores on assessments of pain, fatigue, function, and global status, and was safe and well-tolerated.”


 

Yoga Boosts Stress-Busting Hormone, Reduces Pain, Study Finds – July 27 2011

“A new study finds that practicing yoga reduces the physical and psychological symptoms of chronic pain in women with fibromyalgia.  The study is the first to look at the effects of yoga on cortisol levels in women with fibromyalgia.  Participants’ saliva revealed elevated levels of total cortisol foll…”

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