Complete Medical Guide For Disease Volume XI; Fibromyalgia

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Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. Plasma tryptophan and other amino acids in primary fibromyalgia: Spinal fluid monoamines in primary fibromyalgia. Revue du Rhumatisme et des Maladies Osteo-Articulaires. Role of serotonergic and noradrenergic systems in the pathophysiology of depression and anxiety disorders.

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Not the Last Word: Fibromyalgia is Real

The effects of multidisciplinary therapy on positron emission tomography of the brain in fibromyalgia: Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Functional imaging of pain in patients with primary fibromyalgia. Executive function in chronic pain patients and healthy controls: Insular cortex is a trait marker for pain processing in fibromyalgia syndrome—blood oxygenation level-dependent functional magnetic resonance imaging study in Korea.

Clinical and Experimental Rheumatology. Cerebral blood flow alterations in pain-processing regions of patients with fibromyalgia using perfusion MR imaging. American Journal of Neuroradiology. A standardized scale to measure beliefs about controlling pain B. Evidence of dysfunctional pain inhibition in Fibromyalgia reflected in rACC during provoked pain. Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network.

Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia. Patients with pain disorder show gray-matter loss in pain-processing structures: White and gray matter abnormalities in the brain of patients with fibromyalgia: Striatal grey matter increase in patients suffering from fibromyalgia—a voxel-based morphometry study. Diffusion-weighted and diffusion tensor imaging in fibromyalgia patients: Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia.

Elevated insular glutamate in fibromyalgia is associated with experimental pain. Localized 1H-NMR spectroscopy in patients with fibromyalgia: Arthritis Research and Therapy. Quantification of pain-induced changes in cerebral blood flow by perfusion MRI. Rheumatic Disease Clinics of North America. The hypothalamic-pituitary-adrenal axis in the pathogenesis of rheumatic diseases.

Endocrinology and Metabolism Clinics of North America. Neuroendocrinologic findings in primary fibromyalgia soft tissue chronic pain syndrome and in other chronic rheumatic conditions rheumatoid arthritis, low back pain Journal of Rheumatology. Diurnal hormone variation in fibromyalgia syndrome: Neuroendocrine and hormonal perturbations and relations to the serotonergic system in fibromyalgia patients.

Scandinavian Journal of Rheumatology, Supplement. Evaluation and management of endocrine dysfunction in fibromyalgia. Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. Growth hormone perturbations in Fibromyalgia: Seminars in Arthritis and Rheumatism. A metabolic basis for fibromyalgia and its related disorders: Follicular phase hypothalamic-pituitary-gonadal axis function in women with fibromyalgia and chronic fatigue syndrome. Normal profile of sex hormones in women with primary fibromyalgia. Annales Academiae Medicae Stetinensis.

Bone turnover and hormonal perturbations in patients with fibromyalgia. Autonomic nervous system derangement in fibromyalgia syndrome and related disorders.

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Israel Medical Association Journal. Simultaneous heart rate variability and polysomnographic analyses in fibromyalgia. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. Elevated plasma levels of neuropeptide Y in female fibromyalgia patients. European Journal of Pain. Alpha sleep characteristics in fibromyalgia. Interrelations between sleep and the somatotropic axis. Higher plasma IGF-1 levels are associated with increased delta sleep in healthy older men.

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Low levels of somatomedin C in patients with the fibromyalgia syndrome: Familial aggregation in the fibromyalgia syndrome. Family study of fibromyalgia. The genetics of fibromyalgia syndrome. Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Confirmation of an association between fibromyalgia and serotonin transporter promoter region 5-HTTLPR polymorphism, and relationship to anxiety-related personality traits.

Significance of catechol-O-methyltransferase gene polymorphism in fibromyalgia syndrome. An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits.


Genetic linkage analysis of multicase families with fibromyalgia syndrome. The prevalence and clinical impact of fibromyalgia in systemic lupus erythematosus. Sleep disturbances, fibromyalgia and primary Sjogren's syndrome. Wolfe F, Michaud K. Severe rheumatoid arthritis RA , worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia.

Is there a predisposition for the development of autoimmune diseases in patients with fibromyalgia? Retrospective analysis with long term follow-up. Interrelations between fibromyalgia, thyroid autoantibodies, and depression. Pamuk ON, Cakir N. The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms.

Association between thyroid autoimmunity and fibromyalgic disease severity.

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

Antipolymer antibody reactivity in a subset of patients with fibromyalgia correlates with severity. Antipolymer antibodies in Danish fibromyalgia patients. Anti-polymer antibodies are correlated with pain and fatigue severity in patients with fibromyalgia syndrome. Medical symptoms without identified pathology: Annals of Internal Medicine.

Chronic widespread pain and fibromyalgia: Best Practice and Research. Features of somatization predict the onset of chronic widespread pain: Prevalence of post-traumatic stress disorder in fibromyalgia patients: Psychiatric disorders in patients with fibromyalgia: The role of psychiatric disorders in fibromyalgia. Depression and pain comorbidity: Archives of Internal Medicine. Antidepressant treatment of fibromyalgia. A meta-analysis and review.

A randomized controlled trial of citalopram in the treatment of fibromyalgia. Evidence-based data on pain relief with antidepressants. The pain of fibromyalgia syndrome is due to muscle hypoperfusion induced by regional vasomotor dysregulation. Antioxidant status, lipid peroxidation and nitric oxide in fibromyalgia: Biology and therapy of fibromyalgia: Fibromyalgia, infection and vaccination: Fibromyalgia-associated hepatitis C virus infection.

British Journal of Rheumatology. Chronic Coxsackie B infection mimicking primary fibromyalgia. Fibromyalgia and parvovirus infection. Fibromyalgia in human immunodeficiency virus infection. Dinerman H, Steerc AC. Lyme disease associated with fibromyalgia. Intrathecal HIV-1 envelope glycoprotein gp induces enhanced pain states mediated by spinal cord proinflammatory cytokines. Thompson ME, Barkhuizen A. Fibromyalgia, hepatitis C infection, and the cytokine connection. Gabuzda D, Wang J. Chemokine receptors and virus entry in the central nervous system. Role of microglia in central nervous system infections.

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Harrison's Principles of Internal Medicine. Buskila D, Neumann L. Fibromyalgia syndrome FM and nonarticular tenderness in relatives of patients with FM. Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome. The efficacy and safety of milnacipran for treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial. Outcome and predictor relationships in fibromyalgia and rheumatoid arthritis: Preliminary diagnostic criteria for fibromyalgia should be partially revised: Fibromyalgia criteria and severity scales for clinical and epidemiological studies: An internet survey of 2, people with fibromyalgia.

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Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: Possible serotoninergia syndrome associated with coadministration of paroxetine tramadol. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia. Pragmatic consideration of recent randomized, placebo-controlled clinical trials for treatment of fibromyalgia. Efficacy of duloxetine in painful symptoms: Conceptual framework and item selection. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome.

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Psychopharmacologic treatment of depression in the medically III. Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain.

  • Not the Last Word: Fibromyalgia is Real.
  • Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment.
  • Aims and objectives of the pathway?

Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: On average, physicians reported that their patients with FM could be characterized with the following symptoms: Physicians reported that most of their patients had moderate to extremely severe symptom severity Patient clinical characteristics at baseline are presented in Table 2. Patients reported being diagnosed by a physician over the last 3 years with an average of six concomitant chronic medical conditions range from 0 to 25 conditions.

Of these 25 conditions, back pain On average, over half of the patients in the sample reported prior diagnoses of depression Based on cut-points of validated measures, most patients also had moderate to severe rates of insomnia The most common events associated with the onset of FM were chronic stress Concomitant diagnoses included asthma, diabetes, heart disease, back pain, depression, arthritis, rheumatoid arthritis, sleep disorder, anxiety, chronic fatigue syndrome, irritable bowel syndrome, migraine, abdominal pain, hypertension, temporomandibular joint disorder, ulcer, emphysema, systemic lupus erythematosus, neurological disorder, chronic viral illness, liver disease, interstitial cystitis, renal disease, cancer, and substance abuse.

Outpatient visits included visits to primary care physicians, specialty care, physical therapists, and nonphysician care providers e. Our findings of the annual health care resource utilization is presented as percentage followed by mean [SD] for only those that used the service: Patients experienced a high number of work limitations related to FM: Annually, patients spent A total of unique medications were prescribed specifically for FM as reported by physicians.

Patients were currently taking an average of 2. Concomitant medication use occurred in As shown in Table 3 , among 1, study patients, current medications prescribed for FM included the three FDA-approved drugs: Other antidepressants, not elsewhere classified included bupropion, mirtazapine, trazadone, and buspirone sometimes used off-label as an antidepressant. Other medications, not elsewhere classified included all remaining medications physicians reported prescribing to study patients that individually accounted for less than 1.

Nonpharmacologic treatment specifically for FM, as reported by physicians, was prescribed to 1, patients The most common nonpharmacologic treatments were rest Exercise included gentle walking, aerobic, pilates, strength training, stretching, and pool therapy. Counseling included sessions with Master in Social Work, psychologists, psychiatric consult, and support groups. Multivariate findings comparing the use of duloxetine, pregabalin, and milnacipran with any other medication are shown in Table 5. Medication history was one of the best predictors of the type of current medication patients were taking.

Stepwise logistic regressions models of baseline medication use: Age over 65, gender, race, body mass index, socioeconomic status, insurance status, insurance type, region receiving treatment in Puerto Rico vs other areas of the United States.


Other specialties included neurology, psychiatry, pain specialists, physical medicine, obstetrics and gynecology, and osteopathy. Use of opioids excluding tramadol , use of NSAIDs, number of medications, medication status no treatment, switching, augmenting. Physician variables were also among the best predictors of the type of current medication patients were taking. Additional variables associated with drug use varied by drug cohort. Sensitivity analyses were performed to assess the fit and robustness of models.

Logistic regression analyses were run again with the imputed data. No substantial differences were observed. Models were also run with two definitions of opioid medication use with and without tramadol included. Models reported in Table 5 exclude tramadol in the category of opioids in order to represent distinctions specified in the APS guidelines for FM. The results, including tramadol as an opioid, remained the same for models predicting use of duloxetine and milnacipran.

When tramadol was added to the opioid class, pregabalin use was significantly and negatively associated with opioid use. Additionally, when tramadol was added to the opioid class, use of other medications was no longer associated with patients over 65 years of age, but it was associated with having a lower likelihood of being privately insured. The burden of illness across a wide variety of measures was high for study patients. Most patients experienced clinically significant levels of disability, insomnia, depressive and anxiety symptoms, and cognitive problems as determined with standard cut-points for validated scales.

Although patients with FM commonly report cognitive impairments [12] , this is one of the first studies to document the severity of cognitive functioning in a naturalistic study. Overall, the study findings were fairly consistent with demographic and outcome data from populations in France and Germany [35]. Health care resource utilization reported by patients was also consistent with previously reported retrospective claims data [20—22].

Annual health care use was high, with most patients visiting outpatient facilities. Multiple treatment approaches to FM were observed in this study. Although high use of various medications has been previously reported from insurance claims data [20—22,37,38] , this study strengthens previous findings as it is the only study to provide an exhaustive list by physicians of all currently prescribed medications used to treat FM.

In contrast, drug claims reported in FM populations cannot distinguish the indication for use when multiple conditions are present. Differences may be due to methods of collecting medication data or may be due to changing standards of practice. This represents recent changes in treatment patterns when compared with the National Fibromyalgia Association's survey data, in which acetaminophen, ibuprofen, naproxen, cyclobenzaprine, amitriptyline, and aspirin were the most commonly used medications.

Treatment patterns may reflect current changes in the environment with the entry of pregabalin in June , duloxetine in June just before the start of the study , and milnacipran in March midway through the study enrollment period. Despite the lack of evidence and the potential for side effects, the literature has reported that, among internet survey respondents with FM, opioids were among the highest ranking medications for perceived helpfulness [12].

Benzodiazepenes and nonbenzodiazepene sedatives may have been prescribed more for their roles in sleep disturbances rather than in FM specifically [13,18]. Nonpharmacologic treatments were prescribed to The most frequent therapies included exercise, rest, heat modalities, and cognitive strategies e. One exception was CBT. Despite strong evidence for its efficacy [18] , CBT was administered to only 4. Less use of CBT may be related to its accessibility rather than to physician recommendations or patients' requests. Treatment patterns for duloxetine, pregabalin, and milnacipran tended to be associated with physician specialty, insurance type, and medication history.

For example, rheumatologists and other specialists were more likely to prescribe approved medicines for FM than medicines for which there was little or no evidence base for efficacy in FM, perhaps reflecting greater evidence-based knowledge about FM treatment. Surprisingly, clinical characteristics of severity of pain, depression, anxiety, disability, cognition, sleep disturbances, and fatigue were not significantly related to the current medication patterns assessed at a single point in time.

It was also of interest that, aside from age, patient demographics and socioeconomic status were not associated with treatment selection. There are some limitations to these findings. First, patients may have initiated the new agent at any time in the management cycle for FM. On average, patients reported living with FM for over 5 years. Although no significant differences were found across medication cohorts based on length of illness, these findings may not be generalizable to newly diagnosed patients, especially as new treatments have been made available.

Previous research reported that the use of APS guideline medications tended to increase from prediagnosed and newly diagnosed to established patients with FM [36]. Second, patterns of care were found to be very diverse use of nonpharmacologic treatments was universal, and polypharmacy was quite common , thus limiting the ability to assess any individual treatment as a stand-alone therapy.

Of all patients included in the study, were female and eleven male. The average age of the patients was The assessment results revealed chronicity stages of 2 and 3 MPSS. The evaluated findings can include information obtained from the medical and care history, a psychiatric examination, consultations with specialists, a physical examination, diagnostic tests or procedures, surgical procedures, and pathological or radiological examinations. Based on the ICD, an analysis of the concomitant diseases of each patient revealed 1, additional diagnoses for all subjects, ie, an average of 6.

The additional diagnoses were coded in accordance with the German coding guidelines for diseases. These included low-back pain, low-back pain with sciatica, and spondylosis experienced at the same time as the FMS. These included obesity, diabetes mellitus, and food intolerances, such as fructose and lactose malabsorption.

Diseases of the nervous system were diagnosed times, and included headache, cervicocranial syndrome, and radiculopathy. Comprehensive standardized cost accounting was used to allocate costs to cost categories. Eight cost categories were analyzed, and their share of the total costs are shown in Figure 2. This includes the staff costs for doctors, statutory social security contributions and pension contributions, and other staff costs and fees for doctors not employed by the hospital.

Cost category 2 covers nursing-staff costs. This includes statutory social security contributions, pension contributions, and other staff costs. This covers statutory social security contributions, pension contributions, and other staff costs. Cost categories 4A and B include material costs for medicinal products, hospital-pharmacy delivery costs, and those relating to medical need for blood, packed red cells, and blood plasma.

Cost categories 6A and B cover dressings, remedies, and aids, medical and nursing consumables, and radiology and nuclear medicine, as well as laboratory services. They also cover tests in external departments, electroencephalography, electrocardiography, ultrasound, physiotherapy, disinfectants, and other medical needs.

This category accounts for the highest proportion of the cost of inpatient care. It also includes the cost of food, water, electricity, fuel, materials, cleaning products and disinfectants, linen, laundry cleaning and care, household consumables, crockery, fuel, lubricants, and garden maintenance. Moreover, maintenance cleaning and laundry cleaning by external companies, administrative services, office materials and printing, postage, Post Office box and bank fees, light freight, telephone systems and telex machines, telegrams, radio and television, travel expenses, fares, recruitment costs, consulting fees, audit, court and legal fees, contributions to organizations, hospitality, IT and organizational expenses, central administration, and central personnel management are also included.

Category 8 also includes the cost of the central printing service, central technical services, replacing durables provided fixed values were given , taxes, duties, insurance, interest and similar expenses for operating loans, depreciation of other durables, and ordinary expenditure, such as rent, leases, licenses, carriage for delivery of goods, material expenses for training and development, and renting durables.

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The distribution of average total costs on cases is shown in Figure 3. These cases were analyzed regarding secondary diagnoses. We found the following to be the most common: Additional diagnoses are shown in Figure 4 , and are coded according to the ICD Figure 4 Additional fibromyalgia-syndrome diagnoses in the cost-driving group. However, random-sample analyses showed that the number of additional diagnoses of a patient with fibromyalgia was not associated with higher costs.

There was no causal relationship between the length of stay in hospital and the number of concomitant diseases either. Instead, physical limitations, high therapy-resistant pain intensity, and progression of chronicity were more likely to have an effect. Patients with severe forms of fibromyalgia are recommended multimodal treatments in an inpatient setting.

Several previous studies have focused on the costs arising from fibromyalgia. As in other studies, women are affected much more often than men. According to our data, disease activity and physical limitations 43 are more likely to influence costs. This study includes all of the costs of inpatient care for those with a severe form of FMS. As part of a cost-of-illness study, economic data analysis and its results provide important information for health-policy makers, hospital managers, and the general public. The indication-based cost calculation can provide information for the financial risk management of an inpatient facility.

For doctors, therapists, and nurses, treatment information based on the results of the concomitant disease analysis can also be generated. Our analysis is limited by the unavailability of comparison data for standardized accounting for interdisciplinary treatment costs depending on and differentiating between intensity of FMS especially less severe or mild cases, which were excluded here according to the inclusion criteria.

Further studies should check for those and also cost related data for the elements of the treatment. In addition, further studies should look more closely at the efficacy of action taken in the context of cost causation. Comorbidity of fibromyalgia with medical and psychiatric disorders.

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