Fibromyalgia: abstracts 2002

The abstracts in this collection are intended to provide doctors and other health professionals with a convenient overview of trends in research on fibromyalgia published in medical journals in the year 2005. The studies were selected from the extensive literature on fibromyalgia so as to cover a wide range of subjects in limited space. The following studies were published in the period January through March, 2005, and abstracts will be added to this selection at intervals during the year. Similar collections of abstracts produced annually from 1999 on can be found on the web-site of the National Fibromyalgia Partnership: The abstracts are arranged in alphabetical order by lead author. ________________________________________ Hypothalamic-pituitary-adrenal and autonomic nervous system
functioning in fibromyalgia

In general, there seems to be a reduction in some neuroendocrine and autonomic
nervous system (ANS) responses to applied stresses in individuals who have
fibromyalgia. This article presents an overview and discussion of these findings
with respect to the role of the ANS and the neuroendocrine system in the
response to stress, with emphasis on the hypothalamic-pituitary-adrenal axis
and the possible implication for fibromyalgia.
Rheum Dis Clin North Am. 2005 Feb; 31(1):187–202, xi
Akkasilpa S, Goldman D, Magder LS, Petri M
Number of fibromyalgia tender points is associated with
health status in patients with systemic lupus erythematosus

OBJECTIVE: To ascertain the association between fibromyalgia (FM) tender points (TP) and health status in patients with systemic lupus erythematosus (SLE). METHODS: We performed a cross-sectional study of 173 SLE patients enrolled in the Hopkins Lupus Cohort. Patients were examined for FM TP and asked to complete the Health Assessment Questionnaire (HAQ) at the same visit. RESULTS: We found 38.2% of patients had no TP, 44.5% had 1-10 TP, and 17.3% had > or = 11 TP. No significant association was found between the number of FM TP and age, sex, race, or level of education. The mean score of the HAQ was 1.3 +/- 0.4. There were significant associations between FM TP and HAQ (no TP Fibromyalgia Abstracts: March 2005 1.1 +/- 0.3, 1-10 TP 1.4 +/- 0.4, > or = 11 TP 1.6 +/- 0.6; p = 0.0001).
CONCLUSION: A strong association between the number of FM TP and health
status was found in patients with SLE. The number of TP, and not just the
presence/absence of FM, is associated with health status in SLE.

J Rheumatol. 2005 Jan;32(1):48–50 Blanco LE, de Serres FJ, Fernandez-Bustillo E, Kassam DA, Arbesu D, Rodriguez C, Torre JC Alpha1-Antitrypsin and fibromyalgia: new data in favour of
the inflammatory hypothesis of fibromyalgia

Alpha1-Antitrypsin (AAT) circulates in high serum concentrations, and impreg-
nates most body tissues. AAT has a broad anti-inflammatory spectrum, and
modulates most inflammatory reactions occurring in human body. Recently, a
possible relationship between AAT deficiency (AAT-D) and fibromyalgia (FM)
has been raised, with the finding that intravenous infusions of purified human
AAT efficiently controlled FM symptoms in two patients with severe hereditary
AAT-D. On the other hand, functional magnetic resonance imaging has detected a
significant greater activity in pain sensitive areas of the brain in patients with FM,
in response to cutaneous stimuli, providing further evidence for a physiological
explanation for FM pain. In recent studies abnormal profiles of inflammation
markers in serum and biopsies have been found in FM patients. Since most of
these inflammation mediators can be inhibited by AAT, these observations would
suggest that at least a subset of the FM syndrome could be related to an
inflammatory process, possibly due to an imbalance between inflammatory
and anti-inflammatory substances, in the soft body tissues.
Future directions
of research would be: (1) to develop epidemiological studies to determine the
gene frequency of AAT deficiency alleles in FM patients; (2) implementation of a
double-blind placebo-controlled clinical trial to determine the specific role of
AAT augmentation therapy in AAT-D patients with FM; (3) identification of
specific laboratory markers for diagnostic and clinical evaluation purposes in FM;
(4) application of the newest medical imaging techniques for diagnosis; and (5)
identification of genetic, familial, and environmental risk factors suspected to par-
ticipate in the FM syndrome development.
Med Hypotheses. 2005;64(4):759–69 Boonen A, van den Heuvel R, van Tubergen A, Goossens M, Severens JL, van der Heijde D, van der Linden S Large differences in cost of illness and wellbeing between
patients with fibromyalgia, chronic low back pain,
or ankylosing spondylitis

Fibromyalgia Abstracts: March 2005 OBJECTIVE: To compare the cost of illness of three musculoskeletal conditions in
relation to general wellbeing. METHODS: Patients with fibromyalgia, chronic low
back pain (CLBP), and ankylosing spondylitis who were referred to a specialist
and participated in three randomised trials completed a cost diary for the duration
of the study, comprising direct medical and non-medical resource utilisation and
inability to perform paid and unpaid work. Patients rated perceived wellbeing (0-
100) at baseline. Univariate differences in costs between the groups were estim-
ated by bootstrapping. Regression analyses assessed which variables, in addition
to the condition, contributed to costs and wellbeing. RESULTS: 70 patients with
fibromyalgia, 110 with chronic low back pain, and 111 with ankylosing spon-
dylitis provided data for the cost analyses. Average annual disease-related total
societal costs per patient were 7813 euro for fibromyalgia, 8533 euro for CLBP,
and 3205 euro for ankylosing spondylitis. Total costs were higher for fibro-
myalgia and CLBP than for ankylosing spondylitis, mainly because of cost of
formal and informal care, aids and adaptations, and work days lost. Wellbeing
was lower in fibromyalgia (mean, 48) and low back pain (mean, 42) than in
ankylosing spondylitis (mean, 67). No variables other than diagnostic group con-
tributed to differences in costs or wellbeing. CONCLUSIONS: In patients under
the care of a specialist, there were marked differences in costs and wellbeing
between those with fibromyalgia or CLBP and those with ankylosing
In particular, direct non-medical costs and productivity costs were
higher in fibromyalgia and CLBP.
Ann Rheum Dis. 2005 Mar;64(3):396–402. Epub 2004 Jul 22 Julien N, Goffaux P, Arsenault P, Marchand S Widespread pain in fibromyalgia is related to a deficit of
endogenous pain inhibition

A deficit of endogenous pain inhibitory systems has been suggested to contribute to some chronic pain conditions, one of them being fibromyalgia. The aim of the investigation was to test whether endogenous pain inhibitory systems were activated by a spatial summation procedure in 30 fibromyalgia, 30 chronic low back pain, and 30 healthy volunteers who participated in a cross-over trial (two sessions). Each session consisted of visual analog scale ratings of pain during the immersion of different surfaces of the arm in circulating noxious cold (12 degrees C) water. The arm was arbitrarily divided into eight segments from the fingertips to the shoulder. One session was ascending (from the fingertips to the shoulder) and the other was descending (from the shoulder to the fingertips); they included eight consecutive 2-min immersions separated by 5-min resting periods. For healthy and low back pain subjects, pain was perceived differently during the ascending and descending sessions (P=0.0001). The descending session resulted in lower pain intensity and unpleasantness. This lowering of the perception curve seems to be due to a full recruitment of inhibitory systems at the beginning of the Fibromyalgia Abstracts: March 2005 descending session as opposed to a gradual recruitment during the ascending
session. For fibromyalgia subjects, no significant differences were found between
the increasing and decreasing sessions (P>0.05). These data support a deficit of
endogenous pain inhibitory systems in fibromyalgia but not in chronic low
back pain. The treatments proposed for fibromyalgia patients should aim at
stimulating the activity of those endogenous systems.

Pain. 2005 Mar;114(1–2):295–302
Antidepressants and antiepileptic drugs for
chronic non-cancer pain

The development of newer classes of antidepressants and second-generation anti-
epileptic drugs has created unprecedented opportunities for the treatment of
chronic pain. These drugs modulate pain transmission by interacting with specific
neurotransmitters and ion channels. The actions of antidepressants and anti-
epileptic drugs differ in neuropathic and non-neuropathic pain, and agents within
each medication class have varying degrees of efficacy. Tricyclic antidepressants
(e.g., amitriptyline, nortriptyline, desipramine) and certain novel antidepressants
(i.e., bupropion, venlafaxine, duloxetine) are effective in the treatment of
neuropathic pain. The analgesic effect of these drugs is independent of their
antidepressant effect and appears strongest in agents with mixed-receptor or
predominantly noradrenergic activity, rather than serotoninergic activity.

First-generation antiepileptic drugs (i.e., carbamazepine, phenytoin) and second-
generation antiepileptic drugs (e.g., gabapentin, pregabalin) are effective in the
treatment of neuropathic pain. The efficacy of antidepressants and antiepileptic
drugs in the treatment of neuropathic pain is comparable; tolerability also is
comparable, but safety and side effect profiles differ. Tricyclic antidepressants are
the most cost-effective agents, but second-generation antiepileptic drugs are
associated with fewer safety concerns in elderly patients. Tricyclic antidepressants
have documented (although limited) efficacy in the treatment of fibromyalgia and
chronic low back pain. Recent evidence suggests that duloxetine and
pregabalin have modest efficacy in patients with fibromyalgia.

Am Fam Physician. 2005 Feb 1; 71(3):483–90
Mannerkorpi K
Exercise in fibromyalgia
PURPOSE OF REVIEW: Several studies have indicated that physical exercise is beneficial for patients with fibromyalgia. The aim of this article is to review the recent literature relating to exercise in fibromyalgia, specifically articles published Fibromyalgia Abstracts: March 2005 between September 2003 and September 2004, to highlight developments in the
field. RECENT FINDINGS: Previous studies indicate that aerobic exercise per-
formed at adequate intensity for an individual can improve function, symptoms,
and well-being. A recent study of aerobic exercise showed that training in
sedentary women with fibromyalgia using short bouts of exercise produces
improvements in health outcomes. A study of aerobic walking resulted in
improvements in physical function, symptoms, and distress. Two studies of low-
intensity pool exercise reported a positive impact on fibromyalgia symptoms and
distress. Two studies of qigong movement therapy were reported, one indicating
improvements in symptoms and the other in movement harmony, indicating that
this mode of exercise needs to be evaluated further. SUMMARY: The recent
studies support existing literature on the benefits of exercise for patients with
fibromyalgia. The outcomes appear to be related to the program design and the
characteristics of the populations studied. As the patients with fibromyalgia
form a heterogeneous population, more research is required to identify the
characteristics of patients who benefit from specific modes of exercise.
Moreover, long-term planning is needed to motivate the patients to continue
regular exercise
. Informing patients about the benefits of exercise and adjusting
the exercise intensity to individual limitations enhances adherence. The social
support gained by exercising in groups also enhances adherence to exercise.
Curr Opin Rheumatol. 2005 Mar; 17(2):190–4 Morf S, Amann-Vesti B, Forster A, Franzeck UK, Koppensteiner R, Uebelhart D, Sprott H Microcirculation abnormalities in patients with fibromyalgia—
measured by capillary microscopy and laser fluxmetry

This unblinded preliminary case-control study was done to demonstrate functional
and structural changes in the microcirculation of patients with primary fibromy-
algia (FM). We studied 10 women (54.0 +/- 3.7 years of age) with FM diagnosed
in accordance with the classification criteria of the American College of Rheum-
atology, and controls in three groups (n = 10 in each group)—age-matched
women who were healthy or who had rheumatoid arthritis or systemic
scleroderma (SSc). All 40 subjects were tested within a 5-week period by the
same investigators, using two noninvasive methods, laser fluxmetry and capillary
microscopy. The FM patients were compared with the healthy controls (negative
controls) and with rheumatoid arthritis patients and SSc patients (positive
controls). FM patients had fewer capillaries in the nail fold (P < 0.001) and
significantly more capillary dilatations (P < 0.05) and irregular formations (P <
0.01) than the healthy controls. Interestingly, the peripheral blood flow in FM
patients was much less (P < 0.001) than in healthy controls but did not differ from
that of SSc patients (P = 0.73). The data suggest that functional disturbances of
Fibromyalgia Abstracts: March 2005 microcirculation are present in FM patients and that morphological
abnormalities may also influence their microcirculation.

Arthritis Res Ther. 2005; 7(2):R209–16. Epub 2004 Dec 10 Turk DC The potential of treatment matching for subgroups of patients
with chronic pain: lumping versus splitting

A large and diverse number of treatments have been shown to be effective in
reducing pain and other symptoms for a minority but statistically significant
number of patients in different chronic pain syndromes. The means by which such
different treatments achieve similar outcomes is not well understood. In this
paper, the importance of considering patient heterogeneity for those who may be
diagnosed with the same medical syndrome is discussed. The author suggests that
the lack of satisfactory treatment outcomes for the treatments of chronic
pain syndromes may be accounted for by the patient homogeneity myth
assumption that all patients with the same medical diagnosis are similar on all
important variables. The importance of subdividing (splitting) patients into
meaningful groups is described. Studies presenting data on the identification of
patient subgroups based on psychosocial and behavioral characteristics and the
reliability and validity of this approach are presented. Some initial attempts to
demonstrate the potential for matching treatments to patient subgroups are

Clin J Pain. 2005 Jan-Feb; 21(1):44–55; discussion 69–72
Werle E, Jakel HP, Muller A, Fischer H, Fiehn W, Eich W
Serum hyaluronic acid levels are elevated in arthritis patients,
but normal and not associated with clinical data in patients
with fibromyalgia syndrome

BACKGROUND: Fibromyalgia syndrome (FM) is a disease with widespread
chronic pain and many nonspecific symptoms. Hyaluronic acid (HA) is a disputed
marker for the diagnosis of FM. The aim of the study is to clarify the discrepant
results reported so far. METHODS: Serum concentrations of HA were measured
with a radiometric assay (Pharmacia & Upjohn, Sweden) in 41 patients with FM
(38 females), 48 with arthritis (35 females) and 31 control subjects (28 females).
Correlations of HA levels with clinical parameters (duration of disease, age,
gender, medication) and scores of disease severity (e.g. depression and pain) were
calculated. If appropriate, partial correlations and analysis of covariance adjusted
for confounding variables (e.g. age) were used. RESULTS: HA levels were
confirmed to be age-related in the whole study group
(r(s) = 0.54; P < 0.001)
Fibromyalgia Abstracts: March 2005 and each subgroup. Association between HA levels and gender, drug therapy,
clinical or psychometric data could not be demonstrated in patients suffering from
FM. Analyzing all study participants, HA levels were correlated with the pain
disability index (PDI) (r(tau) = 0.27; P < 0.02) and, in arthritis patients only, with
duration of disease (r(tau) = 0.82; P < 0.001). Moreover, analysis of covariance
revealed that patients with FM had normal HA values as compared with control
subjects and only patients with arthritis had significantly higher levels than both
other groups. CONCLUSIONS: The present study with a quite large cohort
including patients with arthritis and FM demonstrates that serum levels of HA in
FM are neither elevated nor associated with any relevant clinical data of this
disease and, therefore, have no diagnostic or prognostic value
Clin Lab. 2005; 51(1–2):11–9
Fibromyalgia Abstracts: March 2005


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