fatigue syndrome: new concepts in treatment.
Curr Pharm Des. 2008;14(13):1274-94.
Gur A, Oktayoglu P.
Department of Physical Medicine and Rehabilitation, Medical Faculty,
Dicle University, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr
PMID: 18537652
Fibromyalgia (FM) and chronic fatigue syndrome (CFS) are poorly
understood disorders that share similar demographic and clinical
characteristics. The etiology and pathophysiology of these diseases
remain unclear. Because of the similarities between both disorders it
was suggested that they share a common pathophysiological mechanisms,
namely, central nervous system (CNS) dysfunction.
Current hypotheses center on atypical sensory processing in the CNS
and dysfunction of skeletal muscle nociception and the
hypothalamic-pituitary-adrenal (HPA) axis. Researches suggest that
the (CNS) is primarily involved in both disorders in regard to the
pain, fatigue and sleep disturbances. Many patients experience
difficulty with concentration and memory and many others have mood
disturbance, including depression and anxiety. Although fibromyalgia
is common and associated with substantial morbidity and disability,
there are no US Food and Drug Administration (FDA)-approved
treatments except pregabalin.
Recent pharmacological treatment studies about fibromyalgia have
focused on selective serotonin and norepinephrine (NE) reuptake
inhibitors, which enhance serotonin and NE neurotransmission in the
descending pain pathways and lack many of the adverse side effects
associated with tricyclic medications.
CFS is a descriptive term used to define a recognisable pattern of
symptoms that cannot be attributed to any alternative condition. The
symptoms are currently believed to be the result of disturbed brain
function. To date, no pharmacological agent has been reliably shown
to be effective treatment for CFS. Management strategies are
therefore primarily directed at relief of symptoms and minimising
impediments to recovery.
This chapter presents data demonstrating CFS, abnormal pain
processing and autonomic nervous system (ANS) dysfunction in FM and CFS and concludes by reviewing the new concepts in treatments in CFS and FM.
Japanese studies report neurotropin beneficial for FM pain relief
Case report illustrates this unusual Japanese drug's potential as a safe analgesic for FM; the NIH has launched an important trial in the U.S. with Dr. Clauw.
UK researchers find vitamin D deficiency prevalent in FM patients
They consider FM & arthritis patients "at high risk" of this deficiency, recommend improved screening & management guidelines.
Low levels of magnesium & zinc associated with FM pain, fatigue levels
Levels of one correlate with number of tender points; and levels of the other with fatigue severity. But which comes first, symptom or deficiency?
Study measured metabolic dysfunction of hippocampus in FM
Efficacy of neurotropin in fibromyalgia: a case report.
Pain Med. 2008 May-Jun;9(4):460-3.
Toda K, Tobimatsu Y.
Department of Rehabilitation, Hiroshima Prefectural Rehabilitation
Center, Saijyou, Higashi-Hiroshima, Japan. goutattack@yahoo.co.jp
PMID: 18489636
Fibromyalgia is a refractory disorder that often necessitates
long-term treatment. A 45-year-old woman has suffered from a stiff
neck for 27 years and severe widespread pain for 4 years. Her visual
analog scale (VAS), global-VAS, self-rating depression scale (SDS),
and face scale were 48, 38, 42, and 15, respectively. She met the
American College of Rheumatology 1990 criteria for the classification
of fibromyalgia.
Four tablets of Neurotropin (NT) per day alone were administered, and
her pain was gradually alleviated over 3 weeks. Her heavy sensation
of the body and morning stiffness had almost disappeared 5 months
later. Her VAS was 40 after 6 months, but the subjective pain
decreased to half that at the initial visit. Her global-VAS, SDS, and
face scale were 0, 35, and 8, respectively. No adverse effects were observed.
NT, a nonprotein extract from the inflamed skin of rabbits inoculated
with vaccinia virus, is a commonly prescribed analgesic drug for
chronic pain in Japan. One of the advantages of NT is its few and
slight adverse effects. Because NT does not suppress the synthesis of
prostaglandin, NT does not cause digestive ulcers. Recent studies
suggest that the analgesic mechanism of NT is due to the activation
of a descending pain inhibitory system in the brain.
Two open studies have shown the efficacy of NT for fibromyalgia. In
order to determine whether NT is effective for fibromyalgia, a rigid
clinical study, such as a double-blinded, placebo-controlled study, is needed.
The relationship between serum trace element levels and clinical
parameters in patients with fibromyalgia.
Rheumatol Int. 2008 May 22. [Epub ahead of print]
Sendur OF, Tastaban E, Turan Y, Ulman C.
Department of Physical Medicine and Rehabilitation, Adnan Menderes
University Medicine School Hospital, Aydin, Turkey.
PMID: 18496697
We examined the association between serum trace elements and clinical
findings such as number of sensitive tender points, severity of
fatigue and functional status in patients with fibromyalgia (FM).
Thirty-two patients diagnosed as having FM according to the ACR 1990
criteria and 32 normal healthy controls (NHC) were included in this
study. The demographic data, disease duration, number of tender
points and accompanying symptoms (fatigue, sleep disorders, headache,
paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud's
phenomena) of the patients were noted. Visual analog scale (10 cm)
was implemented to estimate daily severity of pain and fatigue.
Fibromyalgia impact questionnaire was used for functional assessment.
Serum selenium (mug/dL) and serum zinc (mug/dL) levels were measured
by atomic absorption spectrometer. Serum magnesium (mmol/L) level was
measured by the original kits of Abbott Aeroset auto-analyzer.
The mean age of patients in FM group and NHC were calculated as 42.9
(SD = 7.7) years and 41.3 (SD = 9.7) years, respectively. Serum
levels of zinc (P = 0.001) and magnesium (P = 0.002) were
significantly decreased by FM groups, whereas there was no
considerable difference with selenium levels of both groups (P >
0.05). Association between serum zinc level and number of tender
points (P = 0.008) and that between fatigue and magnesium level (P =
0.003) was found as meaningful.
According to the results of this study, it was asserted that serum
magnesium and zinc levels may play an important role in the
pathophysiology of FM.
Commentary on the EULAR recommendations for the management of fibromyalgia
Nature Clinical Practice Rheumatology, Published online: 17 June 2008
| doi:10.1038/ncprheum0840
Daniel J Clauw
Correspondence 24 Frank Lloyd Wright Drive, P.O. Box 385, Ann Arbor,
MI 48106, USA, Email: dclauw@med.umich.edu
PMID: 18560385
Received 3 March 2008 | Accepted 28 April 2008
[This article has no abstract so the journal provided the first
paragraph of the full text.]
The EULAR evidence-based recommendations for the management of
fibromyalgia syndrome offer an excellent overview of the studies in
fibromyalgia published to date.1 The authors painstakingly evaluated
all the clinical trials performed in fibromyalgia, and, using only
those studies of sufficient quality, developed a series of
evidence-based recommendations for the assessment and treatment of
this condition.Their recommendations concerning pharmacological
interventions are nicely augmented and complemented by sensible
expert opinion on the overall therapeutic approach to fibromyalgia
and the use of nonpharmacological treatments. The overall message of
the manuscript is appropriate and well described: fibromyalgia is an
eminently treatable disease, and a multidisciplinary approach that
utilizes both pharmacological and nonpharmacological therapies is
optimal for most patients.
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