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When checking fibromyalgia, myofascial pain syndrome is grouped by medline in the same category. They are different names
for an ill defined syndrome.
Pain Physician. 2002 Oct;5(4):422-32.Click here to read Links
Tizanidine is Effective in the Treatment of Myofascial Pain Syndrome.
* Malanga GA,
* Gwynn MW,
* Smith R,
* Miller D.
Associate Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry, Newark,
NJ.
Myofascial pain syndrome (MPS) is difficult to treat. The efficacy and safety of tizanidine, an alpha2-adrenergic
agent with effects on spasticity and pain, in treating MPS was evaluated. Female subjects (n = 29) with MPS of 9 to > 52
weeks' duration and mean age 37.5 (range 20-51) years, who also had reduced pressure thresholds, were enrolled. Subjects were
titrated up to 12 mg of tizanidine over 3 weeks and maintained for 2 weeks. Sleep was assessed via visual analog scale (VAS),
pain intensity via short form McGill questionnaire including VAS, disability/level of function, and pressure threshold (tested
by algometry) at baseline, weeks 3 and 5, and 1 week after tizanidine was discontinued. Patient and physician global assessments
of treatment were reported at week 5. Twenty-four subjects completed the study. Pain intensity and disability decreased significantly
from baseline at weeks 3 and 5 and after washout (P < .001). Pressure threshold and sleep improved for all study periods
(P < .001). Tizanidine was rated as good to excellent in relieving pain by 89% of subjects and 79% of physicians. No serious
adverse events occurred. Tizanidine was effective in the treatment of MPS.
PMID: 16886022 [PubMed - in process]
Internist (Berl). 2005 Nov;46(11):1207-17.Click here to read Links
[Myofascial pain syndrome]
[Article in German]
* Forst R,
* Ingenhorst A.
Orthopadische Universitatsklinik Erlangen. raimund.forst@ortho.med.uni-erlangen.de
The myofascial pain syndrome is an autonomous clinical picture with well-defined clinical and morphological features.
The myofascial pain is initiated through trigger points in the musculature which induce a typical referred pain into a specific
body region typical for each muscle. Untreated, the myofascial pain syndrome leads to a reduced extensibility of the involved
muscle with consecutive decrease of the range of motion and development of a muscular imbalance resulting in a disturbance
of complex movement and evolution of a chronic pain disease. An early started and aimed therapy can prevent effectively the
chronification. It includes beside the local treatment of the trigger point (e. g. spray-and-stretch, infiltration, acupuncture),
the pharmacological and psychotherapy, the physiotherapy and the different procedures of the physical therapy.
PMID: 16228154 [PubMed - indexed for MEDLINE]
Curr Pain Headache Rep. 2004 Dec;8(6):463-7. Links
Myofascial pain: diagnosis and management.
* Graff-Radford SB.
The Pain Center, Cedars-Sinai Medical Center, 444 South San Vicente Blvd., #1101, Los Angeles, CA 90048, USA. graffs@cshs.org.
Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial
pain is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger
point is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise
to referred pain and tenderness. The pain quality is dull or achy and associated with autonomic changes. Myofascial pain is
poorly understood, which results too often in underdiagnosis and poor management. The pathogenesis likely has a central mechanism
with peripheral clinical manifestations. The therapy for myofascial pain requires enhancing central inhibition through pharmacology
or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and
trigger point-specific therapy.
PMID: 15509460 [PubMed - indexed for MEDLINE]
Am J Med. 1986 Sep 29;81(3A):93-8. Links
Fibrositis/fibromyalgia: a form of myofascial trigger points?
* Simons DG.
The diagnostic criteria for fibrositis and primary fibromyalgia are similar to those for myofascial pain syndromes
due to trigger points. Tender points in muscles are likely to be myofascial trigger points; nonmuscular tender points clearly
are not myofascial trigger points, but may be areas of tenderness referred from such trigger points. Myofascial trigger points
refer pain to a distance and restrict range of motion of the muscle. They are associated with a palpable taut band that exhibits
a local twitch response of the muscle, and they are responsive to treatment. Persistence of myofascial trigger points is due
to perpetuating factors that can usually be corrected. Although their number is unknown, it is likely that some patients who
are diagnosed as having fibrositis/fibromyalgia have multiple myofascial trigger points aggravated by a powerful perpetuating
factor and also have a systemic disease process independent of the myofascial trigger points. Since myofascial pain syndromes
are treatable, these patients would benefit greatly by identification and relief of the myofascial component of their pain.
PMID: 3464215 [PubMed - indexed for MEDLINE]
Curr Opin Rheumatol. 1999 Mar;11(2):119-26.Click here to read Links
Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
* Buskila D.
Department of Medicine B, Soroka Medical Center, Beer Sheva, Israel.
Fibromyalgia was almost completely absent from an urban affluent population compared with poor urban and rural communities.
Seventeen percent of Gulf War veterans with soft tissue syndromes had fibromyalgia, a much higher rate than was seen in previous
studies of rheumatic disease in the military population. A state of central hyperexcitability in the nociceptive system was
reported in fibromyalgia. Altered functioning of the stress-response system has been further documented in fibromyalgia and
chronic fatigue syndrome. Administration of growth hormone to patients with fibromyalgia who have low levels of insulin-like
growth factor 1 resulted in improvement in their symptoms and tenderness. An association between chronic fatigue syndrome
and initial infections was demonstrated. A correlation between particular immunologic abnormalities and measures of disease
severity was documented in chronic fatigue syndrome. Concomitant fibromyalgia in other rheumatic diseases was a major contributor
to poor quality of life. A favorable outcome of fibromyalgia in children was reported; the majority of patients improved over
2 to 3 years of follow-up. Treatment of patients with fibromyalgia continues to be of limited success.
PMID: 10319215 [PubMed - indexed for MEDLINE]
Curr Opin Rheumatol. 1991 Apr;3(2):247-58. Links
Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
* Goldenberg DL.
Newton-Wellesley Hospital, Newton, Massachusetts.
There continues to be an emerging body of literature related to fibromyalgia and the related conditions chronic fatigue
syndrome and myofascial pain. During the past year, the most notable contributions included a large multicenter study providing
new diagnostic criteria for the classification of fibromyalgia and clinical studies describing the overlap of fibromyalgia,
chronic fatigue syndrome, and myofascial pain. Pathophysiologic studies were often preliminary and uncontrolled but the focus
of these studies on abnormal nociception, neurohormones, and muscle metabolism provides an exciting hypothesis to unify pain,
fatigue, and sleep disturbances, the primary symptoms of fibromyalgia. Unfortunately, new therapeutic trials were neither
innovative nor especially encouraging.
PMID: 2064904 [PubMed - indexed for MEDLINE] Arthritis Rheum. 2006 Nov 28;54(12):3988-3998 [Epub ahead of print]Click
here to read Links
A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment
of pain in fibromyalgia.
* Fregni F,
* Gimenes R,
* Valle AC,
* Ferreira MJ,
* Rocha RR,
* Natalle L,
* Bravo R,
* Rigonatti SP,
* Freedman SD,
* Nitsche MA,
* Pascual-Leone A,
* Boggio PS.
Harvard Medical School, Boston, Massachusetts.
OBJECTIVE: Recent evidence suggests that fibromyalgia is a disorder characterized by dysfunctional brain activity.
Because transcranial direct current stimulation (tDCS) can modulate brain activity noninvasively and can decrease pain in
patients with refractory central pain, we hypothesized that tDCS treatment would result in pain relief in patients with fibromyalgia.
METHODS: Thirty-two patients were randomized to receive sham stimulation or real tDCS with the anode centered over the primary
motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive days). A blinded evaluator
rated the patient's pain, using the visual analog scale for pain, the clinician's global impression, the patient's global
assessment, and the number of tender points. Other symptoms of fibromyalgia were evaluated using the Fibromyalgia Impact Questionnaire
and the Short Form 36 Health Survey. Safety was assessed with a battery of neuropsychological tests. To assess potential confounders,
we measured mood and anxiety changes throughout the trial. RESULTS: Anodal tDCS of the primary motor cortex induced significantly
greater pain improvement compared with sham stimulation and stimulation of the DLPFC (P < 0.0001). Although this effect
decreased after treatment ended, it was still significant after 3 weeks of followup (P = 0.004). A small positive impact on
quality of life was observed among patients who received anodal M1 stimulation. This treatment was associated with a few mild
adverse events, but the frequency of these events in the active-treatment groups was similar to that in the sham group. Cognitive
changes were similar in all 3 treatment groups. CONCLUSION: Our findings provide initial evidence of a beneficial effect of
tDCS in fibromyalgia, thus encouraging further trials.
PMID: 17133529 [PubMed - as supplied by publisher] Psychol Health Med. 2006 Nov;11(4):498-506. Links
Differential efficacy of a cognitive - behavioral intervention versus pharmacological treatment in the management
of fibromyalgic syndrome.
* Garcia J,
* Simon MA,
* Duran M,
* Canceller J,
* Aneiros FJ.
Department of Psychology, University of A Coruna, Spain.
Given that studies about the differential efficacy of existing treatments in fibromyalgia syndrome are scarce, the
aim of this study was to compare the differential efficacy of a cognitive - behavioral and a pharmacological therapy on fibromyalgia.
Using a randomized controlled clinical trial, 28 fibromyalgic patients were assigned to one of following experimental conditions:
(a) pharmacological treatment (i.e., cyclobenzaprine), (b) cognitive - behavioral intervention (i.e., stress inoculation training),
(c) combined pharmacological and cognitive - behavioral treatment and (d) no treatment. The results show the superiority of
cognitive - behavioral intervention to reduce the severity of fibromyalgia both at the end of the treatment and at follow-up.
We conclude that cognitive - behavioral interventions must be considered a primary treatment of fibromyalgia syndrome.
PMID: 17129925 [PubMed - in process] Nat Clin Pract Rheumatol. 2006 Dec;2(12):671-8.Click here to read Links
Mechanisms of Disease: genetics of fibromyalgia.
* Ablin JN,
* Cohen H,
* Buskila D.
Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizman Street, Tel Aviv 64239,
Israel. ajacob@post.tau.ac.il
Fibromyalgia is characterized by widespread pain and tenderness, and has a significant familial component. The etiology
of fibromyalgia remains unclear, but genetic factors seem to have a significant role, and are influenced by environmental
factors. Research over the past two decades has demonstrated that genetic polymorphisms in the serotoninergic, dopaminergic
and catecholaminergic systems of pain transmission and processing are involved in the etiology of fibromyalgia, but additional
candidates continue to emerge. Fibromyalgia is thought to belong to the group of affective spectrum disorders, which include
related psychiatric and medical disorders. As the concept of affective spectrum disorders continues to evolve, progress in
the understanding of the genetic basis of related functional disorders, such as irritable bowel syndrome and post-traumatic-stress
disorder, is aiding our understanding of the genetic basis of fibromyalgia.
PMID: 17133252 [PubMed - in process]
Arch Intern Med. 2000 Jan 24;160(2):221-7.Click here to read Links
Comment in:
Arch Intern Med. 2000 Aug 14-28;160(15):2398, 2401.
Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder.
* Aaron LA,
* Burke MM,
* Buchwald D.
Department of Medicine, University of Washington, Seattle, USA. laaron@u.washington.edu
BACKGROUND: Patients with chronic fatigue syndrome (CFS), fibromyalgia (FM), and temporomandibular disorder (TMD)
share many clinical illness features such as myalgia, fatigue, sleep disturbances, and impairment in ability to perform activities
of daily living as a consequence of these symptoms. A growing literature suggests that a variety of comorbid illnesses also
may commonly coexist in these patients, including irritable bowel syndrome, chronic tension-type headache, and interstitial
cystitis. OBJECTIVE: To describe the frequency of 10 clinical conditions among patients with CFS, FM, and TMD compared with
healthy controls with respect to past diagnoses, degree to which they manifested symptoms for each condition as determined
by expert-based criteria, and published diagnostic criteria. METHODS: Patients diagnosed as having CFS, FM, and TMD by their
physicians were recruited from hospital-based clinics. Healthy control subjects from a dermatology clinic were enrolled as
a comparison group. All subjects completed a 138-item symptom checklist and underwent a brief physical examination performed
by the project physicians. RESULTS: With little exception, patients reported few past diagnoses of the 10 clinical conditions
beyond their referring diagnosis of CFS, FM, or TMD. In contrast, patients were more likely than controls to meet lifetime
symptom and diagnostic criteria for many of the conditions, including CFS, FM, irritable bowel syndrome, multiple chemical
sensitivities, and headache. Lifetime rates of irritable bowel syndrome were particularly striking in the patient groups (CFS,
92%; FM, 77%; TMD, 64%) compared with controls (18%) (P<.001). Individual symptom analysis revealed that patients with
CFS, FM, and TMD share common symptoms, including generalized pain sensitivity, sleep and concentration difficulties, bowel
complaints, and headache. However, several symptoms also distinguished the patient groups. CONCLUSIONS: This study provides
preliminary evidence that patients with CFS, FM, and TMD share key symptoms. It also is apparent that other localized and
systemic conditions may frequently co-occur with CFS, FM, and TMD. Future research that seeks to identify the temporal relationships
and other pathophysiologic mechanism(s) linking CFS, FM, and TMD will likely advance our understanding and treatment of these
chronic, recurrent conditions.
PMID: 10647761 [PubMed - indexed for MEDLINE]
Psychol Med. 2001 Nov;31(8):1331-45. Links
The neuroendocrinology of chronic fatigue syndrome and fibromyalgia.
* Parker AJ,
* Wessely S,
* Cleare AJ.
Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and the Institute of Psychiatry,
London.
BACKGROUND: Disturbance of the HPA axis may be important in the pathophysiology of chronic fatigue syndrome (CFS)
and fibromyalgia. Symptoms may be due to: (1) low circulating cortisol; (2) disturbance of central neurotransmitters; or (3)
disturbance of the relationship between cortisol and central neurotransmitter function. Accumulating evidence of the complex
relationship between cortisol and 5-HT function, make some form of hypothesis (3) most likely. We review the methodology and
results of studies of the HPA and other neuroendocrine axes in CFS. METHOD: Medline, Embase and Psychlit were searched using
the Cochrane Collaboration strategy. A search was also performed on the King's College CFS database, which includes over 3000
relevant references, and a citation analysis was run on the key paper (Demitrack et al. 1991). RESULTS: One-third of the studies
reporting baseline cortisol found it to be significantly low, usually in one-third of patients. Methodological differences
may account for some of the varying results. More consistent is the finding of reduced HPA function, and enhanced 5-HT function
on neuroendocrine challenge tests. The opioid system, and arginine vasopressin (AVP) may also be abnormal, though the growth
hormone (GH) axis appears to be intact, in CFS. CONCLUSIONS: The significance of these changes, remains unclear. We have little
understanding of how neuroendocrine changes relate to the experience of symptoms, and it is unclear whether these changes
are primary, or secondary to behavioural changes in sleep or exercise. Longitudinal studies of populations at risk for CFS
will help to resolve these issues.
PMID: 11722149 [PubMed - indexed for MEDLINE]
Soc Sci Med. 2006 Dec;63(11):2962-73. Epub 2006 Sep 1.Click here to read Links
Creating meaning in fibromyalgia syndrome.
* Madden S,
* Sim J.
Oxford Brookes University, Oxford, UK; Keele University, UK. smadden@brookes.ac.uk
Gaining a diagnosis is considered to legitimate a person's illness, to both the self and the wider social world, while
also giving hope that treatments, and possibly a cure, will be found. A further function of diagnosis from the patient's perspective
is to give meaning to the illness experience, which is often uncertain and confusing. To do so, a diagnosis must itself have
meaning. This paper explores the creation of meaning in a medically unexplained disorder, fibromyalgia syndrome (FMS). Semi-structured
interviews, in which the diagnostic process was explored, were conducted with 17 people diagnosed with FMS in the United Kingdom,
selected from a hospital database (16 women, 1 man). Documentary analysis was also undertaken on information available from
support groups and health professionals. Although initially an acceptable diagnosis to sufferers, FMS was viewed as a mysterious
label, which provided no meaning at the time of diagnosis. The sought information was accessed in an attempt to resolve its
meaninglessness, but this proved problematic due to the ambiguous definition of FMS within the medical and support group literature,
the invisible nature of the illness, and the lack of an environment where these uncertainties could be openly discussed. Informants
varied in the degree of longer-term acceptance of a diagnosis of FMS, in relation to the concordance they achieved between
the diagnosis and their experience of illness.
PMID: 16949713 [PubMed - in process]
Int J Immunopathol Pharmacol. 2006 Jan-Mar;19(1):5-10. Links
Fibromyalgia--new concepts of pathogenesis and treatment.
* Lucas HJ,
* Brauch CM,
* Settas L,
* Theoharides TC.
Special Clinic for FMS and CFS, Trier, Germany.
Fibromyalgia (FMS) is a debilitating disorder characterized by chronic diffuse muscle pain, fatigue, sleep disturbance,
depression and skin sensitivity. There are no genetic or biochemical markers and patients often present with other comorbid
diseases, such as migraines, interstitial cystitis and irritable bowel syndrome. Diagnosis includes the presence of 11/18
trigger points, but many patients with early symptoms might not fit this definition. Pathogenesis is still unknown, but there
has been evidence of increased corticotropin-releasing hormone (CRH) and substance P (SP) in the CSF of FMS patients, as well
as increased SP, IL-6 and IL-8 in their serum. Increased numbers of activated mast cells were also noted in skin biopsies.
The hypothesis is put forward that FMS is a neuro-immunoendocrine disorder where increased release of CRH and SP from neurons
in specific muscle sites triggers local mast cells to release proinflammatory and neurosensitizing molecules. There is no
curative treatment although low doses of tricyclic antidepressants and the serotonin-3 receptor antagonist tropisetron, are
helpful. Recent nutraceutical formulations containing the natural anti-inflammatory and mast cell inhibitory flavonoid quercetin
hold promise since they can be used together with other treatment modalities.
PMID: 16569342 [PubMed - indexed for MEDLINE]
Health Qual Life Outcomes. 2006 Sep 25;4:67.Click here to read Click here to read Links
A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005).
* Jones KD,
* Adams D,
* Winters-Stone K,
* Burckhardt CS.
School of Nursing, Oregon Health & Science University, Portland, Oregon, USA. joneskim@ohsu.edu
The purpose of this review was to: (1) locate all exercise treatment studies of fibromyalgia (FM) patients from 1988
through 2005, (2) present in tabular format the key details of each study and (3) to provide a summary and evaluation of each
study for exercise and health outcomes researchers. Exercise intervention studies in FM were retrieved through Cochrane Collaboration
Reviews and key word searches of the medical literature, conference proceedings and bibliographies. Studies were reviewed
for inclusion using a standardized process. A table summarizing subject characteristics, exercise mode, timing, duration,
frequency, intensity, attrition and outcome variables was developed. Results, conclusions and comments were made for each
study. Forty-six exercise treatment studies were found with a total of 3035 subjects. The strongest evidence was in support
of aerobic exercise a treatment prescription for fitness and symptom and improvement. In general, the greatest effect and
lowest attrition occurred in exercise programs that were of lower intensity than those of higher intensity. Exercise is a
crucial part of treatment for people with FM. Increased health and fitness, along with symptom reduction, can be expected
with exercise that is of appropriate intensity, self-modified, and symptom-limited. Exercise and health outcomes researchers
are encouraged to use the extant literature to develop effective health enhancing programs for people with FM and to target
research to as yet understudied FM subpopulations, such as children, men, older adults, ethnic minorities and those with common
comorbidities of osteoarthritis and obesity.
PMID: 16999856 [PubMed - in process]
JAMA. 2004 Nov 17;292(19):2388-95.Click here to read Links
Comment in:
J Fam Pract. 2005 Feb;54(2):105.
JAMA. 2005 Feb 16;293(7):796; author reply 796-7.
Management of fibromyalgia syndrome.
* Goldenberg DL,
* Burckhardt C,
* Crofford L.
Department of Rheumatology, Newton-Wellesley Hospital, Newton, Mass 02462, USA. dgoldenb@massmed.org
CONTEXT: The optimal management of fibromyalgia syndrome (FMS) is unclear and comprehensive evidence-based guidelines
have not been reported. OBJECTIVE: To provide up-to-date evidence-based guidelines for the optimal treatment of FMS. DATA
SOURCES, SELECTION, AND EXTRACTION: A search of all human trials (randomized controlled trials and meta-analyses of randomized
controlled trials) of FMS was made using Cochrane Collaboration Reviews (1993-2004), MEDLINE (1966-2004), CINAHL (1982-2004),
EMBASE (1988-2004), PubMed (1966-2004), Healthstar (1975-2000), Current Contents (2000-2004), Web of Science (1980-2004),
PsychInfo (1887-2004), and Science Citation Indexes (1996-2004). The literature review was performed by an interdisciplinary
panel, composed of 13 experts in various pain management disciplines, selected by the American Pain Society (APS), and supplemented
by selected literature reviews by APS staff members and the Utah Drug Information Service. A total of 505 articles were reviewed.
DATA SYNTHESIS: There are major limitations to the FMS literature, with many treatment trials compromised by short duration
and lack of masking. There are no medical therapies that have been specifically approved by the US Food and Drug Administration
for management of FMS. Nonetheless, current evidence suggests efficacy of low-dose tricyclic antidepressants, cardiovascular
exercise, cognitive behavioral therapy, and patient education. A number of other commonly used FMS therapies, such as trigger
point injections, have not been adequately evaluated. CONCLUSIONS: Despite the chronicity and complexity of FMS, there are
pharmacological and nonpharmacological interventions available that have clinical benefit. Based on current evidence, a stepwise
program emphasizing education, certain medications, exercise, cognitive therapy, or all 4 should be recommended.
PMID: 15547167 [PubMed - indexed for MEDLINE]
J Rheumatol. 2000 Dec;27(12):2911-8. Links
Mind-body therapies for the treatment of fibromyalgia. A systematic review.
* Hadhazy VA,
* Ezzo J,
* Creamer P,
* Berman BM.
Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, USA.
OBJECTIVE: To assess the effectiveness of mind-body therapy (MBT) for fibromyalgia syndrome (FM) by systematically
reviewing randomized/quasirandomized controlled trials using methods recommended by the Cochrane Collaboration. METHODS: Nine
electronic databases, 69 conference proceedings, and several citation lists were searched for relevant trials in any language.
Eligible trials were scored for methodological quality using a validated instrument. Information on major outcomes was extracted.
Insufficient data reporting prevented statistical pooling, therefore a best-evidence synthesis was performed. RESULTS: Thirteen
trials involving 802 subjects were included. Seven trials received a high methodological score. Compared to waiting list/treatment
as usual, there is strong evidence that MBT is more effective for self-efficacy, limited evidence for quality of life, inconclusive
evidence for all other outcomes. There is limited evidence that MBT is more effective than placebo (for pain and global improvement);
inconclusive evidence that MBT is more effective than physiotherapy, psychotherapy, or education/attention control for all
outcomes; strong evidence that moderate/high intensity exercise is more effective than MBT (for pain and function). There
is moderate evidence that MBT plus exercise (MBT+E) is more effective than waiting list/treatment as usual (for self-efficacy
and quality of life); limited evidence that MBT+E is more effective than education/attention control; inconclusive for other
outcomes. There is inconclusive evidence for MBT+E vs other active treatments for all outcomes. Longterm within-groups results
show greatest benefit for MBT+E. CONCLUSION: MBT is more effective for some clinical outcomes compared to waiting list/treatment
as usual or placebo. Compared to active treatments, results are largely inconclusive, except for moderate/high intensity exercise,
where results favor the latter. Further research needs to focus on the synergistic effects of MBT plus exercise and/or plus
antidepressants.
PMID: 11128685 [PubMed - indexed for MEDLINE]
J Gen Intern Med. 2000 Sep;15(9):659-66.Click here to read Click here to read Links
Comment in:
ACP J Club. 2001 May-Jun;134(3):85.
Treatment of fibromyalgia with antidepressants: a meta-analysis.
* O'Malley PG,
* Balden E,
* Tomkins G,
* Santoro J,
* Kroenke K,
* Jackson JL.
Division of General Internal Medicine, Walter Reed Army Medical Center Washington, DC, USA.
BACKGROUND: Fibromyalgia is a common, poorly understood musculoskeletal pain syndrome with limited therapeutic options.
OBJECTIVE: To systematically review the efficacy of antidepressants in the treatment of fibromyalgia and examine whether this
effect was independent of depression. DESIGN: Meta-analysis of English-language, randomized, placebo-controlled trials. Studies
were obtained from searching MEDLINE, EMBASE, and PSYCLIT (1966-1999), the Cochrane Library, unpublished literature, and bibliographies.
We performed independent duplicate review of each study for both inclusion and data extraction. MAIN RESULTS: Sixteen randomized,
placebo-controlled trials were identified, of which 13 were appropriate for data extraction. There were 3 classes of antidepressants
evaluated: tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials), and S-adenosylmethionine (2 trials).
Overall, the quality of the studies was good (mean score 5.6, scale 0-8). The odds ratio for improvement with therapy was
4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled risk difference for these studies was 0.25 (95% CI, 0.16 to
0.34), which calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1 patient to experience symptom improvement.
When the effect on individual symptoms was combined, antidepressants improved sleep, fatigue, pain, and well-being, but not
trigger points. In the 5 studies where there was adequate assessment for an effect independent of depression, only 1 study
found a correlation between symptom improvement and depression scores. Outcomes were not affected by class of agent or quality
score using meta-regression. CONCLUSION: Antidepressants are efficacious in treating many of the symptoms of fibromyalgia.
Patients were more than 4 times as likely to report overall improvement, and reported moderate reductions in individual symptoms,
particularly pain. Whether this effect is independent of depression needs further study.
PMID: 11029681 [PubMed - indexed for MEDLINE]
J Fam Pract. 1999 Mar;48(3):213-8. Links
Is acupuncture effective in the treatment of fibromyalgia?
* Berman BM,
* Ezzo J,
* Hadhazy V,
* Swyers JP.
Complementary Medicine Program, University of Maryland School of Medicine, Baltimore 21207, USA.
BACKGROUND: We conducted this study to assess the effectiveness of acupuncture in the treatment of fibromyalgia syndrome
(FMS), report any adverse effects, and generate hypotheses for future investigation. METHODS: We searched MEDLINE, EMBASE,
Manual Therapy Information System, the Cochrane registry, the University of Maryland Complementary and Alternative Medicine
in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative
Medicine databases for the key words "acupuncture" and "fibromyalgia." Conference abstracts, citation
lists, and letters supplemented the search. We selected all randomized or quasi-randomized controlled trials, or cohort studies
of patients with FMS who were treated with acupuncture. Methodologic quality, sample characteristics, type of acupuncture
treatment, and outcomes were extracted. Statistical pooling was not performed because of the differences in control groups.
RESULTS: Seven studies (3 randomized controlled trials and 4 cohort studies) were included; only one was of high methodologic
quality. The high-quality study suggests that real acupuncture is more effective than sham acupuncture for relieving pain,
increasing pain thresholds, improving global ratings, and reducing morning stiffness of FMS, but the duration of benefit following
the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related
pain. Lower-quality studies were consistent with these findings. Booster doses of acupuncture to maintain benefit once regular
treatments have stopped have been described anecdotally but not investigated in controlled trials. CONCLUSIONS: The limited
amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms
of patients with FMS. However, because this conclusion is based on a single high-quality study, further high-quality randomized
trials are needed to provide more robust data on effectiveness.
PMID: 10086765 [PubMed - indexed for MEDLINE]
Arch Phys Med Rehabil. 2001 Jul;82(7):986-92.Click here to read Links
Needling therapies in the management of myofascial trigger point pain: a systematic review.
* Cummings TM,
* White AR.
British Medical Acupuncture Society, London, England. msjc@waitrose.com
OBJECTIVE: To establish whether there is evidence for or against the efficacy of needling as a treatment approach
for myofascial trigger point pain. DATA SOURCES: PubMed, Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, AMED, and CISCOM
databases, searched from inception to July 999. STUDY SELECTION: Randomized, controlled trials in which some form of needling
therapy was used to treat myofascial pain. DATA EXTRACTION: Two reviewers independently extracted data concerning trial methods,
quality, and outcomes. DATA SYNTHESIS: Twenty-three papers were included. No trials were of sufficient quality or design to
test the efficacy of any needling technique beyond placebo in the treatment of myofascial pain. Eight of the 10 trials comparing
injection of different substances and all 7 higher quality trials found that the effect was independent of the injected substance.
All 3 trials that compared dry needling with injection found no difference in effect. CONCLUSIONS: Direct needling of myofascial
trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo
is neither supported nor refuted by the evidence from clinical trials. Any effect of these therapies is likely because of
the needle or placebo rather than the injection of either saline or active drug. Controlled trials are needed to investigate
whether needling has an effect beyond placebo on myofascial trigger point pain. Copyright 2001 by the American Congress of
Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
PMID: 11441390 [PubMed - indexed for MEDLINE]
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