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   February 2011 eNews AlertIn this eNews:

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This eNews is available for viewing and printing in a larger size.Dear Jonnie Wright,

Commitment to a job, child or grandchild can fill you with a sense of purpose, but can it also wear you thin? a new study in this month’s Latest News looks at the impact employment and caregiver roles have on the overall health of people with fibromyalgia (FM). In general, FM patients appear to respond differently to regular commitments than people from the community who are matched for age but don’t have FM.

Troubled by joint stiffness or painful bladder? Research confirms the high prevalence of these two symptoms in FM and offers an explanation for what makes them tick. Exercise intolerance is another bothersome symptom and a recent study sheds light on why people with FM have trouble initiating an exercise program. if your treatment plan leaves you guessing about FM and wishing you had more time with your doctor, read about a new program being tested in Spain.

Hope 2011 is shaping up to be a good year!

Kristin ThorsonFibromyalgia Network EditorFibro Patients Benefit from Role CommitmentsStaying employed with fibromyalgia can obviously provide you with social support and economic rewards. however, Laura Zettel-Watson, Ph.D., states, “Middle-aged and older adults often occupy several roles simultaneously; for example, they may be employed as well as giving care to children, grandchildren, or parents.” So the question that needs answering is: how does employment and caregiving impact the overall health of people with fibromyalgia?

Read the complete article in the Latest News section of our website.

[Back to Top]Joint Stiffness Stiffness is a common symptom of fibromyalgia (FM). Typically it is worse early in the morning and then it may ease up some by midday. Yet, the joints are not swollen in fibro as they might be in patients with arthritis. however, a recent study by a team in Belgium documented the presence and degree of severity of this symptom in three different age groups of FM patients.*

As we age, we expect to get more arthritis and stiffness in the joints. this means that measurements of stiffness will be influenced by a person’s age, so the researchers looked at this symptom for three different age groups. the average age of the three groups of FM subjects were 26, 45, and 70 years. For comparison, three groups of healthy controls of similar age were also recruited for this study. all subjects had the musculoskeletal stiffness of their ankle measured by a device that moves the foot passively to both extend and flex the ankle.

All three of the FM age groups rated their ankle stiffness close to 5 on a scale of 0 to 10 (where 0 is no stiffness and 10 is worse possible stiffness). the degree of ankle stiffness measured by the device in the younger and middle-aged FM patients was more than twice that of the age-matched controls.

“The self-perceived stiffness increase in the ankle reported by younger and middle-aged FM subjects is due to changes in the elastic structures around the ankle,” state the authors of the study. “However, stiffness differences were not observed in the older FM women.” Does this mean that as patients age, they outgrow the symptom of stiffness? no. As people age, the symptom of stiffness increases. In this study, the measured stiffness in the older group of healthy controls increased significantly, leaving little difference between the controls and the older FM patients.

This study shows that the degree of joint stiffness in young to middle-aged FM patients is more than twice that of healthy controls. Joint stiffness is likely present to a greater extent in the older FM group as well, but it may not differ substantially from the degree of stiffness that healthy people get with normal aging.

* Dierick F, et al. Nature of passive musculoarticular stiffness increase of ankle in female subjects with fibromyalgia syndrome. Eur J Appl Physiol [Epub ahead of print] Feb. 6, 2011.

[Back to Top]Bladder Pain and FibroWhat does interstitial cystitis (IC) have to do with fibromyalgia (FM)? a study looking at 312 cases of women with IC sought to answer this question.* In addition, the study examined the association of IC with chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and sicca syndrome (dry eye syndrome)—conditions that overlap substantially with FM.

The symptoms of IC include bladder pain with urgency and frequency (day and night). Pain worsens with bladder filling and improves with voiding. the 312 people with IC evaluated in this study had experienced bladder symptoms for less than one year. this enabled the authors to examine the medical records for each IC patient during the preceding year to search for evidence of other non-bladder syndromes that might pre-date the onset of IC.

When the IC patient had one or two non-bladder symptoms preceding the onset of IC, allergy was most often one of the conditions that pre-dated the IC. Allergy just happened to be very common and appears coincidently with IC. however, when five or more non-bladder symptoms preceded the onset of IC, a different picture unfolded. FM, CFS, IBS, and sicca syndrome were the most common pre-existing conditions. not only do these conditions overlap with one another, pain is a prominent feature for all.

The authors present two likely hypotheses to explain their findings. one is that the onset of FM, CFS, IBS, or sicca syndrome might possibly contribute in some way to the process that triggers the development of IC. the other possibility is that each of these non-bladder syndromes and IC might be caused by a shared abnormality. Well-designed studies to follow the development of these syndromes in patients will be needed to distinguish between these two hypotheses.

* Warren JW, et al. Numbers and Types of Nonbladder Syndromes as Risk Factors for Interstitial Cystitis/Painful Bladder Syndrome. Urology 77:313-320, 2011.

[Back to Top]Moving past the Exercise HurdleLow-intensity exercise is often recommended to people with FM to help maintain physical function. Yet finding the right level of activity is often a challenge because overdoing it can easily lead to an exacerbation of FM pain. this paradox may occur due to an alteration in the way the body’s sympathetic nervous system responds to an exercise challenge in people with FM.

The physiologic responses to a sustained contraction of the thigh muscles in FM patients were compared to the results obtained for healthy control subjects. the study led by Eva Kosek, M.D., Ph.D., of Sweden, placed particular focus on examining the role of the body’s fight-or-flight sympathetic nervous system, which is involved in regulating muscular blood flow and influencing the modulation of pain.*

During a sustained contraction lasting up to 20 minutes, the sympathetic nervous system should become activated and trigger the adrenal glands to secrete adrenaline. however, the patients with FM had reduced adrenaline levels before the start of the contracting exercise as well as during it. the sympathetic-adrenal system was hypo-active in the FM patient group, but this was not the only problem.

During exercise, the hypothalamic-pituitary-adrenal (HPA) system should also become activated to release more ACTH, a stress hormone from the pituitary. In the healthy controls, the ACTH secretion increased during the sustained contraction (as it is supposed to), but this hormone remained unchanged in the FM patients. So not only is the sympathetic nervous system under-active in FM, but the the HPA system doesn’t react to the stress of exercise the way it does in healthy control subjects. according to Kosek, these two findings could contribute to exercise intolerance in FM patients.

So what about the recommendations of low-intensity exercise for people with FM? Kosek comments that regular exercise should help restore the function of the sympathetic-adrenal system and the HPA response system. In turn this should lead to improved muscle blood flow and reduced pain. At the start of an exercise program, your body may seem exercise intolerant. however, with continued low-intensity practice, you will get over the hurdle and it should eventually become easier.

* Kadetoff D, Kosek E. Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia. J Rehabil Med 42:765-772, 2010.

[Back to Top]Adding more to Standard Care Shows BenefitA little knowledge can go a long way when it comes to alleviating symptoms related to fibromyalgia.

Researchers in Barcelona, Spain wanted to know if newly diagnosed fibromyalgia (FM) patients who participated in a program that offered management strategies beyond the “standard course of treatment” would find more symptom relief.* FM patients from the region were randomly assigned to one of two groups for treatment.

General practitioners provided one-half of the group (108 patients) with the usual care that included medication to help with treating individual symptoms. this control group was also counseled about how to perform aerobic exercise with modifications made to accommodate the physical limitations of FM.

The study group of 108 patients was also provided with the usual care. In addition, the patients were enrolled in an educational program that consisted of nine, two-hour classes. They were divided into small groups of 18 for their weekly sessions. five of the classes focused on typical symptoms, potential causes of their illness, related medical conditions they may experience, current medications available, the long-term effects of pain on their lifestyle, the benefits of regular exercise, and typical barriers they would face. Another four classes offered patients lessons in physical and mental relaxation, pain relief through distraction techniques, and stress reduction. the classes were given by four general practitioners, a rheumatologist, and a psychologist. Patients in the study group were encouraged to ask questions and discuss the issues with the speakers. They also were allowed to talk with other patients in the group, share experiences and emotions.

Patients in both groups were allowed to drop out of their program at any time over the course of the treatment plan. After nine weeks, seven patients in the study group had dropped out, while twice as many patients who were receiving standard treatment quit. overall, more than half (53%) of the study group participants felt they benefitted from the program with at least 20 percent symptom relief. only 17 percent of the control group felt they benefitted from their treatment. Specifically, the study patients reported improvements in physical function, pain, fatigue, stiffness, anxiety, depression, and the number of days they felt well.

The researchers attribute some success of the study group to the patients themselves who credit the doctors for investing their time and effort to treat them, but the “tendency to please is not likely to be the main cause of the improvement,” the published study says. “We suspect that patients’ motivation and expectations may have greater importance. our findings indicate that … education and relaxation made by an interdisciplinary team is an effective treatment for FM, at least in the short term.”

When the study ended, the authors could not predict if the improvements would be permanent. but there is no harm in continuing your own study by practicing relaxation techniques and seeking out information for a better understanding of FM and improved ways to cope with this illness.

* Luciano J et al. Effectiveness of Psychoeducational Treatment Program Implemented in General Practice for Fibromyalgia Patients: a Randomized Control Trial. Clin J Pain [Epub ahead of print] Feb 11, 2011.

[Back to Top]You Know you Have Fibro when …As submitted by our Fibromyalgia Network Facebook friends for your shared amusement:

• the microwave beeps and I look in the freezer.
• I sprayed my hair with spray deodorant instead of hair spray. both are blue spray bottles … now I wonder if I have done that before and just didn’t notice.
• I couldn’t find the bagel I was preparing for lunch when I realized I had already split it and placed in toaster.
• I notice that most things I lose end up in the freezer. now, that’s the first place I look when I’m missing something.
• I pour a cup of coffee, then I can’t find it. I pour another cup and lose that too. I pour more coffee—can’t find it. I find four cups of coffee all together. They are stone cold, the pot is empty, and I have a “caffeine headache” from a lack of coffee.
• I poured diet soda on my cereal and didn’t register anything was wrong until I took a spoonful.
• I walk around at work with a pen and paper just in case someone asks me to do something. if I don’t write it down, I might forget it by the time I get back to my desk.
• I have tried to use my work swipe card to get in the front door of my house.
• I was talking on the speaker phone to my sister. I told her I had to let the dog in and would be right back. we started talking again and she said she could hardly hear me. That’s because I was talking into the TV remote control.
• I am driving with my husband. we are deep in conversation and I have to ask … “Where were we going again?”

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