Gulf War Illness- Fibromyalgia Current News

Gulf War Veterans Health information on news on Fibromyalgia

Two news stories on fibromyalgia that gulf war veterans need to read, keep file copy, distribute to other ill gulf war veterans, provide copies to their doctors be it at VA or civilian, also to other health care providers. Disseminate the information on emails, postings on facebook, etc. WE will keep all educated and informed. We encourage the VA doctors to welcome this information flow in order to help save them time finding the current information that could help ill gulf war veterans. Again add your comments at www.veteranstoday.com following the article, or email me at [email protected]

1. Interaction Of Multiple Brain Networks Provides Insight Into How Pain Occurs
2. New Criteria Proposed For Diagnosing Fibromyalgia Suggests No Longer Focusing On Tender Points

1. Interaction Of Multiple Brain Networks Provides Insight Into How Pain Occurs
Main Category: Fibromyalgia

Article Date: 31 Jul 2010 – 0:00 PDT

A recent study from researchers at Massachusetts General Hospital and University of Michigan provides the first direct evidence of linkage between elevated intrinsic (resting-state) brain connectivity and spontaneous pain intensity in patients with fibromyalgia (FM). This research shows an interaction of multiple brain networks, offering greater understanding of how pain arises. Details of the study appear online and in the August issue of Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Chronic pain syndromes such as FM can cause widespread pain that varies in intensity and fluctuates over time. In addition to pain, FM patients may experience other symptoms such as fatigue, sleep disturbances, memory problems, and temperature sensitivity. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that FM affects 5 million American 18 years of age or older, occurring more often in women (80%-90%).

In the current study, Vitaly Napadow, Ph.D. and colleagues enrolled 36 female subjects -18 FM patients and 18 healthy control subjects with a mean age of 38.9 and 36.1 years of age, respectively. FM study subjects had a disease-duration of at least 1 year, self-reported pain for more than 50% of each day, and were willing to limit introduction of new medications or treatment strategies to control FM symptoms.

As a part of the study, 6 minutes of resting-state functional magnetic resonance imaging (FMRI) data from study subjects were collected. Data were analyzed using dual-regression independent components analysis – a data-driven approach for the identification of independent brain networks. Intrinsic connectivity was evaluated in multiple brain networks: the default mode network (DMN), the executive attention network (EAN), and the medial visual network (MVN), with the MVN serving as a negative control.

Prior to undergoing the MRI scan, participants were asked to rate the intensity of their FM pain on a scale of 0-10, where 0 is equivalent to “no pain present” and 10 is equivalent to “the worst pain they could imagine.” The pain scores ranged widely, from 0 to 8.1.

“Our results clearly show that individuals with FM have greater connectivity between multiple brain networks and the insular cortex, which is a brain region previously linked with evoked pain processing and hyperexcitability in FM,” said Dr. Napadow. The research team found that patients with FM had greater intrinsic connectivity within the right EAN, and between the DMN and the insular cortex – a brain region linked to evoked pain processing. “In patients with FM, our findings strongly implicate the insular cortex as being a key node in the elevated intrinsic connectivity,” added Dr. Napadow. “Patients demonstrated greater DMN connectivity to the left anterior, middle, and posterior insula.” In the right EAN, FM patients demonstrated greater intra-network connectivity within the right intraparietal sulcus (iPS). Researchers found no differences between the FM and healthy control groups for the left EAN or the MVN.

The current findings provide better understanding of the underlying brain mechanisms of clinical pain in FM and may potentially lead to markers of disease progression. Broader implications for explaining how subjective experiences such as pain arise from a complex interplay among multiple brain networks can also be derived from this study. “Our approach represents a novel step forward in finding the neural correlates of spontaneous clinical pain,” concluded Dr. Napadow. “However, our results were derived strictly from patients with FM and may not be generalized to other chronic pain states, an area we are currently evaluating for further research.”

Full Citation:
“Intrinsic Brain Connectivity in Fibromyalgia Is Associated With Chronic Pain Intensity.” Vitaly Napadow, Lauren LaCount, Kyungmo Park, Suzie As-Sanie, Daniel J. Clauw, and Richard E. Harris. Arthritis & Rheumatism; Published Online: April 6, 2010 (DOI: 10.1002/art.27497); Print Issue Date: August 2010.

Source:
Dawn Peters
Wiley-Blackwell
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2. New Criteria Proposed For Diagnosing Fibromyalgia Suggests No Longer Focusing On Tender Points
Main Category: Fibromyalgia

Article Date: 26 May 2010 – 2:00 PDT

The American College of Rheumatology (ACR) is proposing a new set of diagnostic criteria for fibromyalgia that includes common symptoms such as fatigue, sleep disturbances, and cognitive problems, as well as pain. The new criteria are published in the May issue of the ACR journal Arthritis Care & Research.

“These new criteria recognize that fibromyalgia is more than just body pain,” said Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center. “This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown.”

Routine lab tests can not detect fibromyalgia, a condition that is characterized by unexplained pain from head to toe and exhaustion. Instead, the diagnosis has been made by a tender point test, a physical exam that focuses on 18 points throughout the body. When light pressure is applied to these points, clustered around the neck, shoulder, chest, hip, knee, and elbow regions, patients with fibromyalgia feel tenderness or pain.

To meet the previous diagnostic criteria, which were established in 1990, patients must have widespread pain in all four quadrants of their body for a minimum duration of three months and experience moderate pain and tenderness at a minimum of 11 of the 18 specified tender points.

“There are numerous shortcomings with the previous criteria, which didn’t take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities,” said Katz.

According to Katz, fibromyalgia pain may fluctuate, which can affect the number of tender points, and the tender point test did not adequately measure symptom severity or the effectiveness of new treatments.

“The tender point test also has a gender bias because men may report widespread pain, but they generally aren’t as tender as women. Fibromyalgia may be under-diagnosed in both men and women because of the reliance on 11 tender points, and also due to failing to account for the other central features of the illness,” said Katz.

Additionally, due to the confusion regarding the tender point test, the authors note that most primary care doctors don’t bother to check tender points or they aren’t checking them correctly. Consequently, fibromyalgia diagnosis in practice has often been a symptom-based diagnosis. The new criteria will standardize a symptom-based diagnosis so that all doctors are using the same process.

The tender point test is being replaced with a widespread pain index and a symptom severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.

The symptom severity score is determined by rating on a scale of zero to three, three being the most pervasive, the severity of three common symptoms: fatigue, waking unrefreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.

To meet the criteria for a diagnosis of fibromyalgia a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more.

Some criteria will remain unchanged. The symptoms must have been present for at least three months, and the patient does not have a disorder that would otherwise explain the pain.

To develop and test the new criteria, researchers performed a multicenter study of 829 previously diagnosed fibromyalgia patients and a control group of rheumatic patients with non-inflammatory disorders using physician physical and interview examinations. The data were processed by the National Data Bank for Rheumatic Diseases.

The authors note the study has a number of limitations. They recommend a follow-up test in the primary care setting that includes patients with other rheumatic conditions to determine the rate of misclassification that may occur.

The study was funded by Lilly Research Laboratories. Lilly Research Laboratories did not participate in the design of the study, see the results of the study, or review the manuscript or submitted abstracts.

Rush University Medical Center, located in Chicago, Illinois, is an academic medical center that encompasses the 676-bed hospital (including Rush Children’s Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation’s top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Source: Rush University Medical Center