Hot Topics & Readers’ Notes – 12-12-12

Small fiber neuropathy in FM patients

A majority (61%) of fibromyalgia patients with neuropathic pain were found to have small fiber neuropathy, according to a recent study presented at the American College of Rheumatology Annual Meeting. Punch biopsies were performed on the legs of 56 patients who had been diagnosed with FM. Identifiable causes of the small fiber neuropathy included glucose metabolism, vitamin D deficiency, Sjogren’s syndrome and elevated erythrocyte sedimentation rate. This study suggests that, at least in a subset of FM patients, the source of their pain may be in their small nerves. Read more here. (Note: free registration on is required to read the full article.)


Explaining FM to children

When children have a chronic pain condition like fibromyalgia, it can be difficult for them to understand why they are hurting and how they can cope with the pain. Speaking to clinicians at the American Academy of Pediatrics National Conference and Exhibition, Kenneth Goldschneider, MD, of Children’s Hospital and Medical Center in Cincinnati, recommended using pictures and charts whenever possible to illustrate the multifactorial nature of their condition. When it comes to coping with the pain, he suggested that children learn to treat the pain like “selective hearing.” For example, when a child is engrossed in a video game, he often doesn’t hear his mother calling him. He said, “Activities that involve mental focus can create a selective hearing for pain.” Read more here. (Note: free registration on is required to read the full article.)


FM treatments – medication choices

A study published in the October 2012 issue of the journal Pain Medicine described the burden of illness and treatment patterns for 1700 patients with fibromyalgia. They found that the burden of illness was high – FM patients reported high annual health care use as well as numerous work limitations – and treatment patterns were highly variable. The patients studied were taking a total of 182 unique types of medications and most (77.8%) took more than one medication concurrently. Importantly, the treatments with the most evidence to support their use for FM were not always the most frequently chosen.


What FM feels like – Video

This short but very poignant little video by Dr. Kevin White – What Fibromyalgia Feels Like – not only demonstrates what FM feels like, but perhaps more importantly, what it feels like when people don’t believe you.


Reader wants more FM info

I’m a long time user and purchaser on ProHealth and a “fan” on the facebook page. For the past year it seems the emphasis of Prohealth in its postings and newsletters has shifted from the fibro community to the ME community. As a fibro patient, I’m feeling a loss of support from you guys, especially when 4 facebook posts per day are all about ME/CFS.  Just letting you know how it feels on this side of the screen. – Marcie

Thank you for sharing your concerns, Marcie.  You are correct, there does seem to have been more emphasis on ME/CFS than FM in recent months.  Part of the reason is that there has been a lot of ME/CFS news in the past year.  Too long overlooked, ME/CFS is finally getting some much-deserved attention in both medical and governmental circles.  But that doesn’t mean FM is not as important to us as ever.  In fact, I was asked to join the ProHealth team just last month in an effort to increase the volume of fibromyalgia information available on ProHealth’s Website.  My responsibilities include editing the FM HealthWatch newsletter and ensuring that the latest fibro news and research is promptly posted on the site.  I promise you I will do my best to make sure FM gets equal time and space with ME/CFS. – Karen Lee Richards     


Effect of Savella on body weight

A study was conducted to evaluate the effects of milnacipran (Savella) on body weight in patients with fibromyalgia. In three double-blind, placebo-controlled milnacipran trials from 3-12 months in length, a total of 3,458 patients lost an average of 1.5 – 2.5 lbs. In a separate three-year long open-label study, 1,227 patients had lost an average of 2.3 lbs. at 12 months but gradually returned to their baseline weight by 30 months. Nausea was the most commonly reported adverse event with milnacipran, however, nausea rates were significantly lower in patients who lost weight than in patients who did not lose weight, suggesting that nausea did not contribute to the weight loss.


Hypnosis for managing FM

Abstract: This randomized, controlled trial contrasted the effects of 5 not-standardized sessions of hypnosis over 2 months in 59 women with fibromyalgia who were randomly assigned to treatment (n?=?30) or a wait-list control group (n?=?29). Patients in the treated group were encouraged to practice self-hypnosis. Fibromyalgia Impact Questionnaire (FIQ), MOS-Sleep Scale, Multidimensional Fatigue Inventory (MFI), Cognitive Strategy Questionnaire (CSQ), and Patient Global Impression of Change (PGIC) were administered at baseline, 3 months (M3), and 6 months (M6) after inclusion. Compared to the control, the hypnosis group reported better improvement on PGIC (p = .001 at M3, p = .01 at M6) and a significant improvement in sleep and CSQ dramatization subscale (both at M6).


Gentle hatha yoga reduced FM symptoms

Abstract: Gentle hatha yoga and reduction of fibromyalgia-related symptoms: a preliminary report.

Objectives and Methods: This study examined whether gentle Hatha yoga reduced fibromyalgia-related symptoms for a convenience sample of 10 participants ranging in age from 39 to 64 years who received yoga instruction 2 times per week for 8 weeks. Methods: Respondents completed the Fibromyalgia Impact Questionnaire 1 time per week and provided weekly journal reports regarding their health status. Pre- and post-intervention manual tender point evaluations were also conducted. Results: Findings provide evidence of association between participating in gentle Hatha yoga classes and reduced fibromyalgia-related symptoms. Conclusions: Additional randomized controlled trials with larger sample sizes and greater empirical rigor are needed to more fully understand this relationship.


 Sleep problems for FM and RA patients

Fibromyalgia and rheumatoid arthritis are pain disorders, both of which are associated with complaints of sleep disturbance, non-refreshing sleep, and daytime sleepiness and fatigue.  Since FM is thought to involve the central nervous system, while RA involves the peripheral nervous system, researchers compared subjective and objective measures of nocturnal sleep, daytime sleepiness, fatigue and pain between the two groups and a third healthy control group.  They found that women with FM have similar nocturnal sleep disturbance as those with RA, but FM patients report greater self-rated daytime sleepiness and fatigue than RA and healthy controls, which did not correspond to the relatively low level of objectively determined daytime sleepiness of FM patients. Their conclusion was that these findings suggest a generalized hyperarousal state in FM.  Read the abstract here.


FM overview: causes to treatments

A paper published in the journal Pain Research and Treatment titled, “Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis and Treatment” was based on a systematic search of the PubMed database to identify articles related to fibromyalgia published from 1904 through 2012. The stated primary purpose of the paper is “to assist orthopedic surgeons who find themselves faced with patients’ referring musculoskeletal symptoms affected by (often undiagnosed) fibromyalgia.” However, the paper does such a good job of summarizing FM – from its etiology and pathogenesis (causes, in so far as they are known) to its diagnosis and range of treatment options – that it is a valuable resource for other medical professionals and for patients as well.


Relationship status affects pain-coping ability

A study published in the October 16, 2012 issue of the Pain journal examined (1) whether daily pain-related changes in physical functioning differed between happily partnered, unhappily partnered, and unpartnered female chronic pain patients, and (2) whether affect and pain cognitions mediated the partner status effect on pain-related changes in physical functioning. Two hundred fifty-one women with chronic pain due to osteoarthritis and/or fibromyalgia took part in the study. These results indicate that happily partnered pain patients show less pain-related physical disability and more adaptive affective and cognitive responses to daily pain changes than do unhappily partnered and unpartnered patients. Living in a happy union may bolster the capacity of patients to sustain a sense of pain coping efficacy during pain episodes, which in turn, minimizes pain-related physical activity limitations.


Laser heat therapy improves pain, mobility

In order to evaluate the effects of Class IV laser therapy on pain, fibromyalgia impact, and physical function in women diagnosed with FM, 38 women with FM were randomly assigned to one of two treatment groups – laser heat therapy (LHT; n=20) or sham heat therapy (SHT; n=18). Treatment consisted of application of LHT or SHT over seven tender points located across the neck, shoulders, and back, administered by a chiropractic physician for 7 minutes. Pain, upper body flexibility and FM impact significantly improved with the laser heat therapy, while no change was observed with the sham therapy. Researchers concluded, “This study provides evidence that LHT may be a beneficial modality for women with FM in order to improve pain and upper body range of motion, ultimately reducing the impact of FM.”


Note: This information has not been evaluated by the FDA. It is general and anecdotal, and is not meant to prevent, diagnose, treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it with your professional healthcare team.

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