tag:blogger.com,1999:blog-74812093009249824032024-03-13T11:05:56.208-04:00Life with Enigmatic Illnesses - CFS, EDS, and moreAnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-7481209300924982403.post-39142486711917353712011-09-24T05:12:00.000-04:002011-09-24T05:12:17.816-04:00How to sum up a year like this one? My Dad passed away in February. I was shocked by the physical way in which grief strikes a person. Mentally I thought I was managing okay, not great mind you, but okay considering the circumstances, but I was utterly stunned by the ramp up (or more accurately, full-on flare) of nearly all of my symptoms (migraines, IBS, fibro pain like i just couldn't believe, neurological symptoms and falling, the list goes on, and on, and on. Spring was terribly tough, no two ways around it. In May I spent a week in an epilepsy monitoring unit... the good news is I don't have epilepsy, the bad news is I have Paroxysmal seizures which I sort of gather means they aren't so sure what's causing them. Being in the hospital, I missed the one week in spring where my magnolia bloomed. Funny how it's the little things, huh. I had so been looking forward to taking pictures this year with my new camera. And this only takes us through May. Since then? The short version, my little brother got married so there was lots of prep leading up to that straight til mid July. I thought hey, now maybe I can breathe. Before the reception was over Mom broke her wrist while she was dancing (taking the term party til you drop a little too seriously). She was too cute and in all honesty she was high on life that night. At any rate we took her to the hospital after the reception ended and she came home with us at 7am the following morning. She's been living with us ever since. Oh yeah, and vertigo has once again reared its ugly head.<br />
<br />
There's so much I need to sort through, both literally (combining two households) and metaphorically. There's a lot of "intricate" details I still need to categorize and sort - trying to connect the dots between co-existing conditions. I also need relearn how to live life within my limitations. The key word in there being LIVE. There are a lot of questions I'd like to ask fellow sufferers, but unfortunately I've been so swallowed up by just trying to get by that I haven't been able to revisit the online communities that might help provide some answers. For instance, if it wasn't for a Fibro support group online 5 years back I'm not sure when, if ever, I would have realized that I had Ehlers Danlos. I've learned not to underestimate the resource we each have the potential to be for one another. It's not just about emotional support, which is absolutely essential, but also that we are all such fascinating little walking knowledge bases with unique journeys through the wilds of chronic illness. One of the things that keeps me going is believing that what I've gone through, what I continue to go through, might hopefully ease the journey just a tiny bit for someone else. If someone can avoid even one pitfall of the panoply that inevitably accompany chronic illness, than it feels a little less like it was all for naught.AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-79858175152389287272010-11-12T15:08:00.003-05:002010-11-12T15:34:46.565-05:00Life HappensI can't believe it has been over a year since my last post, and what a year it has been. In '07 I stepped partially in to the role of caregiver for my grandmother, and soon after for my mother and father. Dad nearly died this summer after breaking his hip in spring and developing c. diff from the resulting nursing home stay. <br /><br />I've found, quite frustratingly, I can't keep up, much less meet the needs of my family or myself. I keep hitting a wall. The wall it appears is now biting back. I can only assume that my extended exertion has contributed to my continued downward spiral. At the moment I'm battling vertigo - second round, first began late June and only lasted 10 days. Of all my maladies I think vertigo is the one I'd most readily trade in. Dislocations, I can handle. IBS, POTS, CFS, EDS, depression, miserable but I handle it. Vertigo handles you, there's no two ways about it.AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com1tag:blogger.com,1999:blog-7481209300924982403.post-27660043033738739402009-09-25T12:24:00.001-04:002009-09-25T12:24:31.823-04:00Feeling Chronically Fatigued?<a href="http://abcnews.go.com/video/playerIndex?id=8664151">Feeling Chronically Fatigued?</a><br /><br /><br />AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-67166503111329860672009-08-06T16:53:00.002-04:002009-08-06T17:04:50.602-04:00New Insight on IBS<a href="http://www.prohealth.com/ME-CFS/library/showArticle.cfm?libid=14755&B1=EM080509B">A role for corticotropin-releasing factor in functional gastrointestinal disorders - Source: Current Gastroenterology Reports, Aug 2009</a><br /><br />Shared via <a href="http://addthis.com">AddThis</a>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-25365727275341463942009-04-09T12:49:00.007-04:002009-04-09T15:31:27.940-04:00Whittemore Peterson Institue - Chronic Fatigue Syndrome Cure?<div style="text-align: right;">This was taken from <a href="http://www.youtube.com/user/luminescentfeeling">luminescentfeeling's Channel</a> on YouTube<br />which has an interesting and informative collection of ME/CFS<br />videos.<br /></div><br /><br /><object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/nfLoiqf6I4o&hl=en&fs=1&color1=0x402061&color2=0x9461ca"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/nfLoiqf6I4o&hl=en&fs=1&color1=0x402061&color2=0x9461ca" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object><br /><br /><object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/zyN0QSAxpVg&hl=en&fs=1&color1=0x402061&color2=0x9461ca"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/zyN0QSAxpVg&hl=en&fs=1&color1=0x402061&color2=0x9461ca" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object><br /><br /><object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/pL3axgoD_3g&hl=en&fs=1&color1=0x402061&color2=0x9461ca"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/pL3axgoD_3g&hl=en&fs=1&color1=0x402061&color2=0x9461ca" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-78541007217811197352009-01-21T10:25:00.007-05:002009-02-09T13:43:02.537-05:00FDA Gives Milnacipran Green Light for Fibromyalgia Treatment – Third to Be Approved, After Lyrica and Cymbalta<h3 style="font-weight: normal; text-align: right;font-size:11pt;"><span style="font-style: italic;font-size:85%;" >I'm very excited about this approval. With this<br />medicine's ten year</span><span style="font-size:85%;"> </span><span style="font-style: italic;font-size:85%;" >history overseas I think it may<br />be a better first choice than Cymbalta. </span><span style="font-style: italic;font-size:85%;" >Call it<br />a hunch, I also believe this may be better<br />suited for those of us</span><span style="font-size:85%;"> </span><span style="font-style: italic;font-size:85%;" >with autonomic<br />dysfunction as well. </span><span style="font-style: italic;font-size:85%;" >More thoughts later.</span><span style="font-size:85%;"><br /></span><span style="font-style: italic;font-size:85%;" >-Ann Enigma</span><br /></h3><br /> January 15, 2009<br /><br /><p>The drug milnacipran (to be marketed under the brand name Savella™) received FDA approval as a prescription treatment for symptoms of fibromyalgia (FM) on January 14, 2009 – and reportedly will be available in U.S. pharmacies by March.<br /><br />Milnacipran – a selective serotonin and norepinephrine dual reuptake inhibitor (SSNRI) developed as an antidepressant – has been tested in multiple trials for ability to demonstrate concurrent improvement in FM pain, physical function, and overall impression of change (global assessment).<br /><br /><strong>Trials Measured “Global” Symptom Status</strong><br />Generally, more trial subjects taking milnacipran than subjects taking placebo reported “at least a 30% reduction in pain from baseline and also rated themselves as ‘very much improved’ or ‘much improved’ in the global assessment,” according to a release by the drug’s developer, Cypress Bioscience (San Diego), and Forest Labs (New York), which owns the rights to milnacipran in the U.S. and Canada.<br /><br />Milnacipran “is the only product approved for the management of fibromyalgia that used this complete responder analysis as its primary endpoint,” observes Cypress Bioscience CEO Jay D. Kranzler, MD, PhD.<br /><br />“The introduction of Savella is important because it is the first drug approved to treat the symptoms of fibromyalgia using a composite responder analysis,” notes fibromyalgia pain specialist and researcher Dr. Daniel Clauw, Professor of Anesthesiology and Medicine (Rheumatology) at the University of Michigan, Ann Arbor.<br /><br /><strong>May Address “Abnormalities in Certain Brain Neurotransmitters”</strong><br />“Although the exact mechanism by which Savella improves the symptoms of Fibromyalgia is unknown, some researchers believe that abnormalities in certain brain neurotransmitters may be central to fibromyalgia," the news release states. "Savella blocks the reuptake of both norepinephrine and serotonin, with greater selectivity for the inhibition of norepinephrine reuptake in vitro. This may be the mechanism by which Savella acts to improve the symptoms of fibromyalgia.”<br /><br />As with all potent drugs, milnacipran is not without potential side effects and contra-indications, as detailed in the Cypress Bioscience/Forest Labs news release under <a href="http://www.frx.com/news/PressRelease.aspx?ID=1244788">“Important Safety Information.”</a></p><br /><span style="font-size:8;"><span style="font-size:100%;">Copyright © 2009 ProHealth, Inc. </span><br /></span>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-47248848487268396352008-11-17T16:46:00.005-05:002009-01-12T11:07:16.074-05:00"Gulf War Syndrome" is real, report finds<div id="doc"><div style="text-align: right;"> <span style="font-style: italic;">It's astonishing to me how long it's taken for illnesses like these to be<br />legitimized. I suppose </span><span style="font-style: italic;">I will just try to content myself with the<br />fact they have been and not concentrate on the </span><span style="font-style: italic;">suffering<br />and ridicule that victims of Enigmatic Illness have faced.</span><br /><span style="font-style: italic;">Remember only half this battle has been won, </span><br /><span style="font-style: italic;">the other half is finding adequate care.</span><br /></div><div style="text-align: right;" class="hd">-AnnEnigma<br /><br /><a href="http://news.yahoo.com/;_ylt=AnRC.JPdmPX8iKBcgV__0dtg.3QA" class="logo"> </a> </div> <div class="bd"> <img src="http://l.yimg.com/us.yimg.com/p/us/news/editorial/4/3f/43f4f72f01edf7dbd46ddf932e12c5f8.jpeg" alt="" class="provider" /> <div class="byline"> <cite class="vcard"> By Andy Sullivan <span class="fn org">Andy Sullivan</span></cite><abbr title="2008-11-17T12:33:54-0800" class="recenttimedate"></abbr> </div><!-- end .byline --> <p>WASHINGTON (Reuters) – A report released Monday concluded that "<span class="yshortcuts" id="lw_1226958217_0">Gulf War Syndrome</span>" is a legitimate condition suffered by more than 175,000 U.S. war veterans who were exposed to chemical toxins in the 1991 <span class="yshortcuts" id="lw_1226958217_1">Gulf War</span>.</p> <p> The congressionally mandated report could help veterans who have battled the government for treatment of a wide range of unexplained neurological illnesses, from brain cancer to <span class="yshortcuts" id="lw_1226958217_2">multiple sclerosis</span>.</p> <p> The Research Advisory Committee on <span class="yshortcuts" id="lw_1226958217_3">Gulf War Veterans' Illnesses</span> concluded that Gulf War Syndrome is a physical condition distinct from the mental "shell shock" suffered by veterans in other wars. Some earlier studies had concluded it was not a distinct illness.</p> <p> "Scientific evidence leaves no question that <span class="yshortcuts" id="lw_1226958217_4">Gulf War illness</span> is a real condition with real causes and serious consequences for affected veterans," said the committee, which has been looking into the problem since 2002.</p> <p> The committee, composed of independent scientists and veterans, said Congress should boost funding for research on <span class="yshortcuts" id="lw_1226958217_5">Gulf War veterans' health</span> to at least $60 million per year.</p> <p> "This is a national obligation, made especially urgent by the many years that <span class="yshortcuts" id="lw_1226958217_6">Gulf War veterans</span> have waited for answers and assistance," the committee said.</p> <p> Congress set up the committee in 1998, but the <span class="yshortcuts" id="lw_1226958217_7">U.S. Veterans Administration</span> did not appoint anyone to serve on it until 2002.</p> <p> Gulf War Syndrome affects at least one-fourth of the 700,000 U.S. troops who served in the 1991 effort to drive Iraq out of <span class="yshortcuts" id="lw_1226958217_8">Kuwait</span>, or between 175,000 and 210,000 veterans in all, the report found. Few have seen their symptoms improve over the past 17 years, the report said.</p> <p> Symptoms include persistent headaches, widespread pain, cognitive difficulties, unexplained fatigue, skin rashes, chronic diarrhea and digestive and respiratory problems.</p> <p> Many Gulf War veterans suffering these symptoms say they met with skepticism when seeking treatment.</p> <p> The panel found two possible causes: a drug given to troops to protect against nerve gas, known as <span class="yshortcuts" id="lw_1226958217_9">pyridostigmine bromide</span>, and pesticides that were used heavily during the war.</p> <p> The panel said other possible causes could not be ruled out, including extensive exposure to smoke from oil-well fires and low-level exposure to sarin gas when captured Iraqi stocks were destroyed.</p> <p> The U.S. government has spent roughly $440 million on <span class="yshortcuts" id="lw_1226958217_10">Gulf War health research</span> since 1994, but spending has declined in recent years and often is not focused on improving veterans' health, the committee said.</p> <p> The report further highlighted inadequacies in the medical care veterans have received from their government.</p> <p> A 2007 investigation by the Washington Post found combat veterans in the current <span class="yshortcuts" id="lw_1226958217_11">Iraq war</span> faced rodent-infested housing and bureaucratic hurdles as they sought treatment at the <span class="yshortcuts" id="lw_1226958217_12">Walter Reed Army Medical Center</span>, the flagship military hospital in Washington D.C..</p> <p> (Editing by David Storey)</p> </div> <div class="ft"> <p> Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.<br /></p> </div> </div> <div class="mod ad ad_footer"> <div class="bd"> <div id="copyright"><cite>Copyright © 2008 Yahoo! Inc. All rights reserved.</cite></div> <!--http://us.ard.yahoo.com/SIG=14vrsd5gt/M=289534.12510369.12863962.12123427/D=news/S=7666528:FOOT2/Y=YAHOO/EXP=1226965473/L=kZ.nyGKIRlgA1OAERA7rnA3EGO9VlUkh5cEABwtU/B=hYyiAkWTSRk-/J=1226958273494733/A=5304694/R=4/*--> <!-- SpaceID=7666528 loc=FR01 noad --> </div></div><noscript></noscript> <!-- fe26.story.media.ac4.yahoo.com compressed/chunked Mon Nov 17 13:44:33 PST 2008 -->AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-35998714204765179522008-11-04T16:04:00.002-05:002008-11-04T16:08:21.252-05:00Fibromyalgia a ‘Real Disease,’ Study Shows<div class="subhead_fmt">Researchers Say People With Fibromyalgia Have Abnormalities of Blood Flow in the Brain</div> <div class="author_fmt"> By Caroline Wilbert<br />WebMD Health News</div> <div class="reviewedBy_fmt"> Reviewed by <a onclick="return sl(this,'','prog-lnk');" href="http://www.webmd.com/louise-chang">Louise Chang, MD</a></div> <div class="clearBoth_fmt"> </div> <p>Nov. 3, 2008 -- A new brain scan study concludes that <a href="http://www.webmd.com/fibromyalgia/default.htm" onclick="return sl(this,'','embd-lnk');">fibromyalgia</a> is related to abnormalities of blood flow in the brain.</p> <p xalan="http://xml.apache.org/xalan">"Fibromyalgia may be related to a global dysfunction of cerebral pain-processing," study author Eric Guedj, MD, of Centre Hospitalo-Universitaire de la Timone, in Marseille, France, says in a news release. "This study demonstrates that these patients exhibit modifications of brain perfusion not found in healthy subjects and reinforces the idea that fibromyalgia is a 'real disease/disorder.'"</p> <p>Fibromyalgia is a chronic disorder characterized by widespread <a onclick="return sl(this,'','embd-lnk');" chronic_id="" crosslinkid="31334" directive="friendlyurl" externalid="7B22B590819540BA" href="http://www.webmd.com/pain-management/guide/pain-management-myofascial-pain-syndrome-muscle-pain" keywordid="23108" keywordsetid="5945" object_type="" path="/webmdhttp://www.webmd.com/pain-management/guide/pain-management-myofascial-pain-syndrome-muscle-pain">muscle pain</a> and <a href="http://www.webmd.com/a-to-z-guides/weakness-and-fatigue-topic-overview" onclick="return sl(this,'','embd-lnk');">fatigue</a>. It affects 2%-4% of people, mostly women. It has been called the "invisible syndrome" because it can't be diagnosed based on a lab test or X-ray.</p> <p>For this study, researchers took brain scans on 20 women with fibromyalgia and 10 women without the condition. Participants also answered questions to assess measures of pain, disability, anxiety, and <a href="http://www.webmd.com/depression/default.htm" onclick="return sl(this,'','embd-lnk');">depression</a>.</p> <p>The brain imaging technique, called single photon emission computed tomography (SPECT), is able to detect functional abnormalities in the brain.</p> <p>Past imaging studies of patients with fibromyalgia had shown abnormalities in cerebral blood flow, also called brain perfusion. In some areas of the brain, blood flow was below normal, and in some areas, it was above normal. In this study, by using whole-brain scans on the participants, researchers were able to analyze how perfusion in each area of the brain related to measures of pain, disability, anxiety, and depression.</p> <p>Researchers confirmed that patients with fibromyalgia exhibited brain perfusion abnormalities in comparison to the healthy participants. These abnormalities corresponded with the severity of the disease. An increase in blood flow was found in areas of the brain involved in sensing pain and a decrease was found within an area thought to be involved in emotional responses to pain.</p> <p>There seemed to be no relationship between these abnormalities and presence of depression or anxiety. "We found that these functional abnormalities were independent of anxiety and depression status," Guedj says in a news release.</p> <div class="sources_fmt"> <div style="" id="sourceText_fmt"> <citations xalan="http://xml.apache.org/xalan"> <p>SOURCES:<br />Guedj, E. <i>Journal of Nuclear Medicine</i>, 2008; vol 49: pp 1798-1803.<br />News release, Society of Nuclear Medicine.<br />American College of Rheumatology web site.<br />© 2008 WebMD, LLC. All rights reserved.</p> </citations> </div> </div>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-13833862250532253752008-06-09T10:31:00.006-04:002008-06-09T10:53:35.985-04:00a song of CFS and invisible illness<div style="text-align: right;"><span style="font-style: italic;font-size:85%;" >in a recent comment<a href="http://cinderbridge.blogspot.com/"> </a></span><span style="font-style: italic;font-size:85%;" ><a href="http://cinderbridge.blogspot.com/"> </a><a href="http://cinderbridge.blogspot.com/" onclick="" rel="nofollow">cinderkeys</a><a href="http://cinderbridge.blogspot.com/"> </a>let me know about a song she'd written. i was quite touched by the depth of the emotion conveyed about the everyday of invisible illness, CFS in particular. With her permission... here are the lyrics (link to her myspace and the song below): </span><span style="font-size:85%;"><br /></span></div><br /><span style="font-style: italic;">Copyright 2006 Susan Wenger</span><br /><span style="font-style: italic;">Band name: Cinder Bridge</span><br /><br /><span style="font-weight: bold;">EVERYBODY KNOWS ABOUT ME</span><br /><br />Here I am again<br />Sitting by the window<br />In my small apartment on the second floor<br />Keep myself occupied<br />By looking at the traffic<br />As if I've lost the right to ask for more<br /><br />My body feels like it's<br />Moving underwater<br />As I lift a cup of coffee to my face<br />I think about the things<br />I'd like to try and do today<br />But somewhere in the middle lose my place<br /><br />Thick fog hazy brown<br />The two-ton weights that pull me down<br />They don't exist if no one else can see<br />Everybody knows about<br />The failings of the down and out<br />And everybody knows about me<br /><br />I had a good job had some good friends<br />Had a life I could look forward to<br />When I woke up each day<br />And then the fog rolled in<br />Consumed them one by one<br />'til there was nothing left for it to take away<br /><br />Sometimes I count it as a victory<br />When I manage<br />Just to drag my aching body out of bed<br />The doctors, mystified<br />Could not produce an answer<br />So they told me it was all in my head<br /><br />'cause if I wanted to<br />I could shake this yuppie flu<br />Straighten out and set myself free<br />Anyone can clearly see<br />We all choose our own destiny<br />And everybody knows about me<br /><br />Does it make it easier for you<br />To think there must be something I could do<br />Rise like a phoenix from the ashes of this solitary world<br /><br />So I remain here<br />Sitting by the window<br />Watching all the people with their lives to live<br />I would give anything<br />To go outside and join them<br />But today I don't have anything to give<br /><br />And still they have no doubt<br />I'm looking for an easy out<br />And this is what I wanted secretly<br />Everyone will have their say<br />They shake their heads<br />They walk away<br />And everybody knows about me<br />Everybody knows about me<br />Everybody knows about me<br /><br /><br /><span style="font-style: italic;">To take a listen head to </span><a style="font-style: italic;" href="http://myspace.com/cinderbridge" rel="nofollow">myspace.com/cinderbridge</a><br /><br /><span style="font-style: italic;">(If it doesn't start playing immediately, click the "Everybody Knows About Me" link.)</span><br /><br /><span style="font-style: italic;">In Susan's own words, "My aim in writing "Everybody Knows About Me" was twofold. First, I wanted people with CFIDS or similar invisible illnesses to feel they weren't alone -- that not everyone believes it's just hypochondria or laziness. Second, I wanted to make nonsufferers understand why it's silly to believe that CFIDS/other invisible illnesses are just hypochondria or laziness."</span>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com1tag:blogger.com,1999:blog-7481209300924982403.post-41818907996713474092008-06-09T09:41:00.007-04:002008-06-09T10:22:48.223-04:00Epilepsy Drugs to Get Suicide Warnings, FDA Confirms<div class="story_meta"><div style="text-align: right; font-style: italic;"><span style="font-size:100%;">so many of these drugs are used off label to treat "pain conditions" and other "enigmatic illnesses" so i'm posting this here - AnnEnigma<br /></span></div><br />From newsinferno.com<br />Date Published: Friday, June 6th, 2008</div> <!-- AddThis Bookmark Post Button BEGIN --><!-- AddThis Bookmark Post Button END --><br />US regulators are very close to finalizing new suicide warnings for 11 <a href="http://www.yourlawyer.com/topics/overview/epilepsy_drugs">epilepsy drugs</a>, The Wall Street Journal reported today. This past January, the Food & Drug Administration (FDA) issued an Early Communication announcing a safety review of the epilepsy drugs after a study showed they increased patients’ risk of suicidal thoughts and behavior. <p class="MsoNormal">The 11 epilepsy drugs slated for a new suicide warning are:</p> <ul><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=carbamazepine&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=carbamazepine&SearchType=BasicSearch">Carbamazepine</a> (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)</li><li class="MsoNormal">Felbamate (marketed as Felbatol)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020235&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020235&SearchType=BasicSearch">Gabapentin</a> (marketed as Neurontin)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020241&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020241&SearchType=BasicSearch">Lamotrigine</a> (marketed as Lamictal)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021035&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021035&SearchType=BasicSearch">Levetiracetam</a> (marketed as Keppra)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021014&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021014&SearchType=BasicSearch">Oxcarbazepine</a> (marketed as Trileptal)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021446&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=021446&SearchType=BasicSearch">Pregabalin</a> (marketed as Lyrica)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=gabitril&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=gabitril&SearchType=BasicSearch">Tiagabine</a> (marketed as Gabitril)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020505&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=020505&SearchType=BasicSearch">Topiramate</a> (marketed as Topamax)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=018723&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=018723&SearchType=BasicSearch">Valproate</a> (marketed as Depakote, Depakote ER, Depakene, Depacon)</li><li class="MsoNormal"><a title="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=zonegran&SearchType=BasicSearch" href="http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&searchTerm=zonegran&SearchType=BasicSearch">Zonisamide</a> (marketed as Zonegran)</li></ul> <p class="MsoNormal">In addition to treating epilepsy, the anti-seizure medications are used for a variety of other illnesses, including migraines, certain nerve-pain disorders, and psychiatric diseases such as bipolar disorder that themselves carry a risk of suicide.</p> <p style="margin-bottom: 10pt;" class="MsoNormal">The FDA began investigating if epilepsy drugs posed any suicide risk in 2005. In doing so, the FDA analyzed almost 200 studies of 11 anti-seizure drugs, some that have been on the market for decades. The studies tracked almost 28,000 people given epilepsy medications and another 16,000 given dummy pills.</p> <p style="margin-bottom: 10pt;" class="MsoNormal">According to the FDA, 0.43 percent of drug-treated patients experienced suicidal thoughts or behavior, compared with 0.22 percent of placebo-takers. The higher risk of suicidal thoughts and behaviors was observed at one week after starting a drug and continued to at least 24 weeks. The results were generally consistent among all the different drug products studied and were seen in all demographic subgroups. Overall, four people in the drug-treated groups committed suicide, and none in the placebo groups. For every 1,000 patients, about two more patients taking epilepsy drugs experienced suicidal thoughts than those who took placebo.</p> <p style="margin-bottom: 10pt;" class="MsoNormal">In an interview with The Wall Street Journal, Russell Katz, director the FDA’s neuropharmacological drug division confirmed the suicide warnings are coming. “We are working on the labeling changes that we want to get to the companies,” he said. An FDA advisory panel is slated to take up the issue of epilepsy drugs and suicide on July 10, but the Journal speculated the new warnings could come even sooner than that.</p> <p style="margin-bottom: 10pt;" class="MsoNormal">At least one drug maker, Pfizer Inc., is less than pleased at this development. Pfizer disputed the FDA’s analysis in a forum this week sponsored by the Epilepsy Study Consortium in New York. Pfizer especially disputes the inclusion of Lyrica - one of the company’s biggest growth drivers -on the FDA’s warning list. Pfizer said that Lyrica accounted for only 6.3% of the total 142 suicidal events cited by the FDA analysis. But the FDA is sticking to its guns, and the new suicide warning will apply to all 11 epilepsy drugs.</p> <p style="margin-bottom: 10pt;" class="MsoNormal">Most other epilepsy drug makers are resigned to the label changes, according to the Journal. GlaxoSmithKline, the maker of Lamictal, approached the FDA this year to volunteer changes regarding possible suicidal-behavior risks. Other drug makers may have chosen not to challenge the FDA on suicide warnings because their medications are no longer as lucrative as they once were, as patents on many epilepsy drugs have, or are close to, expiring.</p>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-76639004251005207722008-05-22T10:36:00.000-04:002008-05-22T10:39:31.814-04:00A handy response to all the unsolicited "helpful suggestions"<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.sickhumorpostcards.com/clip.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px;" src="http://www.sickhumorpostcards.com/clip.gif" alt="" border="0" /></a>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com1tag:blogger.com,1999:blog-7481209300924982403.post-11926495567744793372008-05-06T23:39:00.004-04:002008-06-09T10:24:08.494-04:00'Seven genetic types of ME' found<div class="logo"> <img src="http://newsvote.bbc.co.uk/nol/shared/img/printer_friendly/news_logo.gif" alt="BBC NEWS" width="163" height="34" /> </div> <div class="headline"><br /></div> <p> <b> Geneticists have identified a biological basis for seven different subtypes of chronic fatigue syndrome. </b> </p><p> The researchers from St George's Hospital, University of London, hope the work could lead to a blood test to distinguish between the forms. </p><p> Campaigners hope it will help counter the opinion, which remains in some quarters of the medical profession, that it is a psychological condition. </p><p> The research findings are to be presented to a conference in Cambridge. </p><div class="bo"> <p> </p></div> <div class="ibox"> <table> <tbody><tr> <td width="5"> <br /></td> <td class="fact"> <!--Smva--> <b> It's a hard illness to get a handle on, so a clinical test would be the single best way forward for everyone </b> <br /> <!--Emva--> <!--Smva--> Neil Abbot, ME Research UK <!--Emva--> </td> </tr> </tbody></table> </div> <div class="bo"> <p> Chronic fatigue syndrome (CFS), also known as ME, is a condition with a diverse range of symptoms but particularly characterised by profound muscle fatigue after physical exertion. </p><p> In its most extreme form, CFS/ME leaves sufferers bed-ridden. There is currently no diagnostic test or cure. </p><p> It affects around one in 200 people. </p><p> <b> 'Biologically meaningful' </b> </p><p> The St George's study looked at 55 patients from the US and UK with the condition, and carried out a genetic analysis of them and 75 healthy blood donors. </p><p> It identified the seven distinct subtypes of CFS/ME identified by a specific genetic pattern. </p><p> These were linked to specific symptoms. </p><p> Type one had the worst anxiety and depression levels, along with poor sleep and high pain levels. </p><p> Type two was characterised by significant post-exercise fatigue and joint and muscle pains, while type three was the mildest form of the disease. </p><p> The research identified type four as linked to moderate levels of body pain and sleep problems, with type five having stomach complaints and the most marked muscle weakness. </p><p> Type six was specifically connected to fatigue, and type seven had the most severe symptoms including pain, swollen glands and headaches. </p><p> Type four and type six were the most common forms of the condition. </p><p> Dr Jonathan Kerr, who led the St George's research, said: "We must now determine what these sub-types represent, as they appear to be biologically meaningful, and discover their natural history and possibilities for treatment." </p><p> Neil Abbot, of ME Research UK, which is organising the conference along with the Irish ME Trust, said: "The discovery of a 'thumb-print' for the illness would be the single greatest advance that could be made because, at the moment, diagnosis is on the basis of a set of vague symptoms association with other illnesses. </p><p> "It's a hard illness to get a handle on, so a clinical test would be the single best way forward for everyone." </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p></div> <div class="footer"> Story from BBC NEWS:<br />http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7378440.stm<br /><br />Published: 2008/05/05 23:02:16 GMT<br /><br />© BBC MMVIII<br /></div>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com2tag:blogger.com,1999:blog-7481209300924982403.post-1162860526235418062008-01-18T15:29:00.002-05:002008-06-09T10:27:16.483-04:00Are YOU Bendy Too?<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.arc.org.uk/arthinfo/patpubs/6019/images/6019_1.gif"><img style="cursor: pointer; width: 473px;" src="http://www.arc.org.uk/arthinfo/patpubs/6019/images/6019_1.gif" alt="" border="0" /></a><br /><img src="file:///C:/DOCUME%7E1/x/LOCALS%7E1/Temp/moz-screenshot-7.jpg" alt="" /><img src="file:///C:/DOCUME%7E1/x/LOCALS%7E1/Temp/moz-screenshot-8.jpg" alt="" /><br /><br />It took me 9 years before I realized how big a role my hypermobility was playing in my health. It was that discovery which finally led to my recent diagnosis of Ehlers-Danlos Syndrome (it's a collagen disorder of several different variations )<br /><br />The drawing above, the Beighton Score, is what a medical professional will use to rate your "bendiness", tho it's not the be all and end all on the subject.<br /><br />more on the subject soon...AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com2tag:blogger.com,1999:blog-7481209300924982403.post-15680859890241605892008-01-16T12:39:00.003-05:002008-05-22T09:37:36.807-04:00CFS/FMS RULES OF ETIQUETTEPERSONAL HYGIENE<br />1. Decisions about which body part to wash depend on which doctor you're seeing today, i.e., face/ears for the ENT; feet for the podiatrist; arms for blood tests; etc...<br />2. Proper use of toiletries can forestall bathing for several days. However, if you live alone, deodorant is a waste of good money.<br />3. Read labels carefully. Ever notice how much the can of room freshener resembles the can of deodorant?<br />4. Remember to warn your spouse before kissing if you've just taken your herbal remedies, since your breath now smells like grass.<br /><br />IN THE KITCHEN<br />1. If you can't remember what it is you're cooking in the pot, whatever it is, it can probably use more salt.<br />2. Do not toss that cold cup of coffee into the dryer or set the iron in the refrigerator to cool off, no matter how good an idea it may seem at the time.<br />3. When your husband tells you "Don't worry about dinner, just throw some frozen chicken in the oven and forget it", DON'T forget it.<br />4. When everything INCLUDING the can opener is dirty, it may be time to wash some dishes.<br />5. It's bad manners to fall asleep at the table, especially in the food.<br />6. If you're having a bad day, there's nothing better than pizza and quiet.<br /><br />DRIVING ETIQUETTE<br />1. Always place a Post-It Note on the dashboard telling you where you're going. And when you get there, place another on the dashboard that says HOME.<br />2. Never relieve yourself from a moving vehicle, especially when driving.<br />3. Always carry an electronic homing device in your car and with you so you can find your car in the parking lot.<br /><br />TIPS FOR ALL OCCASIONS<br />1. If you have to vacuum the bed, it's time to change the sheets.<br />2. If you take the dog for a walk, make sure he brings you back.<br />3. Nevermind about taking one day at a time. Just stick to one thing at a time.<br />4. Try to spend at least 45 minutes each morning doing one get-up.<br />5. Work at learning something new every day, like sitting up, for example...<br />6. Remember to breathe when napping. It's unnerving to wake up and see vultures staring at you.<br />7. Learn to understand your "body language":<br />Joints - "I ache! It's going to rain!"<br />Stomach - "You're getting me upset!"<br />Nose - "Oh, oh, I'm getting a cold!"<br />Head - "Stop it, all of you! I'm getting a migraine!"AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com1tag:blogger.com,1999:blog-7481209300924982403.post-75730795052899557782008-01-16T11:46:00.003-05:002008-06-09T10:25:01.490-04:00The Burden of Proof Rests Heavier on Misunderstood Illnesses.<span style="font-weight: bold;"><br /></span>Here at a time when the FDA is finally approving drugs for the treatment of fibromyalgia (Lyrica being the first so far) the media pipes up with the, "Is It Real?" question again - some outlets more politely than others e.g. the recent <a href="http://www.nytimes.com/2008/01/14/health/14pain.html">New York Times article</a> - I won't even bother to link to the other articles in that vein which have been quite a bit more <span style="font-style: italic;">insulting</span>. Feeding a portion of this latest rash of articles is the fact that Dr. Frederick Wolfe, who had originally "discovered" fibro in the early 90's has now decided it's a psychosomatic illness.<br /><br />I'm of two minds about the situation. The reality of the condition I don't feel is in question. The fact that doctors allow it to be the final diagnosis and cease looking any deeper I feel is a problem.<br /><br />Having been diagnosed with fibro and CFS a decade ago, I'm angry it took me 10 years to get the more accurate diagnosis of Ehlers-Danlos. There are a portion of doctors treating Fibromyalgia (and to be fair, CFS) as a wastebasket diagnosis. Can't figure it out? Blood work odd but not overtly dangerous? Fibromyalgia!<br /><br />Do I believe this collections of symptoms labeled Fibromyalgia exist? Absolutely! Do I believe that once that diagnosis is received it's the end of the diagnostic road. Emphatically NO! There are subsets within both Fibromyalgia and CFS, and until a larger portion of the medical community starts taking a serious look at that effective treatment and true respect of these illnesses are a ways off I fear.AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-91624634433664059222008-01-15T12:31:00.002-05:002008-05-22T09:41:53.705-04:00ah the frustration. i managed to get locked out of blogger.com (how many people can do that?) by getting crossovers with my google account and another email. as a relatively computer literate individual i can't believe it took 5 months to straighten that out. some days i really wish computers would quit "simplifying" my life for me [sigh].<sigh></sigh>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-73086486472695669582007-08-13T09:41:00.002-04:002008-06-09T10:26:00.411-04:00You're your own best advocate!<a href="http://www.thelupuslady.com/">The Lupus Lady's Autoimmune Disease Support</a> site has an interesting collection of conditions (tho I'm not sure I'd classify them all as strictly autoimmune conditions) many of which are found coexisting with conditions like Fibro or CFS. She's got fact sheets for some conditions and links to amazon.com for others but I'm putting it out there as a nice jumping off point for those that feel there's more to their condition than what's been diagnosed by their doc(s) so far.<br /><br />Which brings me to a rant I must get off my chest then I promise no more rants for a good long while (too many blogs full 'o rant out there already).<br /><br />I'm 35. I've been sick since I was a toddler! That's way too many hours (days, months, years?) wasted in doctors waiting rooms, and way too much of what's left of life consumed by illness in the meantime. When someone is dealing with an Enigmatic Illness it often takes years, sometimes decades before they're diagnosed. In the meantime you're called crazy or dosed with half the anti-depressants under the sun - unfortunately that's not an either/or as often as it's, "You're nuts, take these pills", especially if the patient is a girl/woman. See, that lets the doctor feel like he's off the hook and then he gets to walk away with a sense of, "Hey, solved that one...NEXT!" If I hadn't kept pushing, and kept researching, and kept talking I'd doubtless still be waiting for a diagnosis and may never have found out about Ehlers-Danlos Syndrome.<br /><br />A favorite quote of mine is by Ralph Waldo Emerson: Knowledge is the antidote to fear. As chronically ill people some of the biggest favors we can do for ourselves regarding our health care is to <span style="font-weight: bold;"><span style="font-size:130%;">educate ourselves</span>, </span>keep up-to-date on the latest developments, and <span style="font-size:130%;"><span style="font-weight: bold;">talk </span><span style="font-size:100%;">to one another</span></span>. It was in an online support group for Fibromyalgia that I found out about EDS, I went on to research the daylights out of EDS, and finally found a geneticist and genetic counselor within driving distance - all online!<br /><br />Thank God for the internet!<br /><br />The internet has become our great equalizer. If we can't find <span style="font-style: italic;">it </span>on the internet there's a good chance we can find <span style="font-style: italic;">a book about <span style="font-weight: bold;">it</span></span><span style="font-weight: bold;"> </span>on the internet. With such a fantastic resource at our fingertips I truly believe we can become our own best health care advocates if we're willing to. And if/when we can't, we need to ask for help from those around us (I'm still working on that asking for help part. :o)AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-7201368194421400622007-07-31T13:34:00.000-04:002007-07-31T16:54:31.690-04:00Articles & SuchThe idea to collect all the useful articles I've come across regarding all these conditions has been percolating for a while now. This seems like as good a time and place to start as any :)<br /><br />Brand new from Medscape: <span style="font-weight: bold;"><a href="http://www.medscape.com/viewarticle/560409">Multidimensional Approach Recommended for Fibromyalgia Treatment</a>. </span>Good article with some helpful recommendations. I think I'll end up adding a commentary to the recommendations eventually. Copied the article for those who don't have a Medscape membership.<br /><div style="font-weight: bold;"><img src="http://images.medscape.com/pi/global/ornaments/spacer.gif" alt="" height="10" width="1" /></div> <!-- Title --> <div style="font-weight: bold;" class="title"> Multidimensional Approach Recommended for Fibromyalgia Treatment <span class="cmetag">CME/CE</span> </div> <p> </p> <b>News Author: Laurie Barclay, MD<br />CME Author: Désirée Lie, MD, MSEd</b><br /> <p> <b>Release Date: July 26, 2007</b><b style="color: rgb(153, 0, 0);"> </b> </p><p>July 26, 2007 — Management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and other treatment, according to a review published in the July 15 issue of <i>American Family Physician</i>.</p><p>"Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points," write Sangita Chakrabarty, MD, MSPH, and Roger Zoorob, MD, MPH, from Meharry Medical College in Nashville, Tennessee. "It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Nearly 2 percent of the general population in the United States suffers from fibromyalgia, with females of middle age being at increased risk."</p><p>Criteria for diagnosis of fibromyalgia are those issued by the American College of Rheumatology (ACR) in 1990. These include widespread pain with a minimum duration of 3 months and the presence of 11 or more tender points at 18 specific anatomic sites.</p><p>Conditions that should be considered in the differential diagnosis of fibromyalgia include myofascial pain syndrome, chronic fatigue syndrome, and hypothyroidism. Furthermore, these conditions may also be present in patients with fibromyalgia, which renders the diagnosis more difficult.</p><p>In recent years, recognition, understanding, and diagnosis of fibromyalgia have improved. Despite the absence of well-established treatment recommendations, the authors suggest that a multidimensional approach can be effective.</p><p>Specific treatment recommendations are as follows:</p><ul><li>Suggested treatment modalities include patient education, cognitive behavior therapy, exercise, physical therapy, and pharmacotherapy (level of recommendation, A, based on 5 randomized controlled trials).<br /><br /></li><li>Antidepressant medications may alleviate pain and improve sleep quality and global well-being in patients with fibromyalgia (level of recommendation, B, based on few randomized controlled trials).<br /><br /></li><li>Cyclobenzaprine, 10 to 30 mg at bedtime, may decrease pain and improve sleep quality in patients with fibromyalgia (level of recommendation, A, based on systematic review of randomized controlled trials).<br /><br /></li><li>Aerobic exercise training may ameliorate fibromyalgia symptoms (level of recommendation, A, based on systematic review of randomized controlled trials).</li></ul><p>Fibromyalgia treatments for which there is strong evidence of effectiveness include amitriptyline, 25 to 50 mg at bedtime; cyclobenzaprine, 10 to 30 mg at bedtime; cardiovascular aerobic conditioning exercise; cognitive behavioral therapy; multidisciplinary therapy as discussed earlier; and patient education, which may take place in a group format using lectures, written materials, and demonstrations.</p><p>Fibromyalgia treatments for which there is moderate evidence of effectiveness include the dual-reuptake inhibitors duloxetine, venlafaxine, and fluoxetine, at doses of 20 to 80 mg at bedtime, either alone or in combination with a tricyclic antidepressant. Other pharmacotherapies backed by moderate evidence of effectiveness include pregabalin and tramadol, 200 to 300 mg daily, either alone or in combination with acetaminophen.</p><p>Nonpharmacologic therapies with moderate evidence of effectiveness in fibromyalgia are acupuncture, balneotherapy, biofeedback, hypnotherapy, and strength training.</p><p>Evidence to support the use of chiropractic therapy, electrotherapy, manual and massage therapy, or ultrasonography in patients with fibromyalgia is weak. Evidence to justify the use of corticosteroids, melatonin, nonsteroidal anti-inflammatory drugs, opioids, thyroid hormone, flexibility exercises, and injections of tender or trigger points is altogether lacking.</p><p>"The effectiveness of acupuncture and biofeedback has been supported by some studies," the authors conclude. "Serum levels of substance P and serotonin were significantly elevated after acupuncture treatment, suggesting possible mechanisms in pain relief. Although their effectiveness has not been proven by controlled trials, other treatment modalities employed include chiropractic therapy, yoga, tai chi, massage therapy, magnetic therapy, and tender-point injections."</p><p>The authors have disclosed no relevant financial relationships.</p><p>In an accompanying editorial, Christine N. Huynh, MD, from Virginia Commonwealth University School of Medicine in Richmond, and colleagues note that clinicians have often felt frustrated when faced with a patient with fibromyalgia because of the dearth of evidence and consensus.</p><p>However, this review, an earlier systematic review in 2004 of treatment options, and the 2005 consensus guidelines from the American Pain Society assist in the definition and management of fibromyalgia. The 1990 ACR diagnostic criteria are also clinically useful, with the caveat that fibromyalgia can be diagnosed even if the ACR's tender point criteria are not met, provided the history is highly suggestive.</p><p>"Now that there is an evidence- and consensus-based practical approach to the diagnosis and management of fibromyalgia, a higher quality of care can be provided to patients with this syndrome," Dr. Huynh and colleagues write. "Screening for disorders that may initiate or exacerbate symptoms of fibromyalgia is critical. If comorbid disorders are not identified early and treated appropriately, therapies that target fibromyalgia only as a primary disorder may be ineffective."</p><p>The editorial also highlights the controversy regarding the usefulness of opioids in fibromyalgia management, as well as the paucity of evidence supporting their use and the potential for opioid-induced hyperalgesia.</p><p>"As with any chronic pain syndrome, patients should be carefully selected for opioid therapy, and a plan should be in place for appropriate follow-up and monitoring for pain reduction, outcome improvement, side effects, and misuse," Dr. Huynh and colleagues conclude. "Physician awareness of effective nonpharmacologic and pharmacologic therapies can minimize ineffective prescribing and patient frustration associated with failure of therapy. As growing evidence from well-designed studies becomes available, physicians can confidently employ a practical and evidence-based approach to this once ill-defined syndrome."</p><p><i>Am Fam Physician</i>. 2007;76:247-254.</p><p><a href="http://www.aafp.org/afp/20070715/editorials.html" target="_blank">http://www.aafp.org/afp/20070715/editorials.html</a></p><h3>Clinical Context</h3><p>According to the authors of the current study, fibromyalgia is a chronic, nonarticular pain syndrome defined by widespread musculoskeletal pain and generalized tender points with other symptoms such as sleep disturbance, fatigue, headache, morning stiffness, paresthesia, and anxiety. Prevalence in the United States is 3.4% in women and 0.5% in men, with increasing prevalence to age 80 years and women being affected 10 times more frequently than men and familial clustering suggesting a genetic etiology.</p> <p>This is a review of clinical features, management strategies, comorbidities, and differential diagnoses associated with fibromyalgia.</p> <h3>Study Highlights</h3><ul><li>Diagnosis is not by exclusion but by using ACR 1990 criteria; it mainly depends on history and physical examination.</li><li>ACR criteria include 2 components: widespread pain above and below the waist including the axial skeleton and presence of 11 tender points among 18 specified points.</li><li>Complaints at presentation include pain at multiple sites, fatigue, poor sleep, and low back pain that may radiate to buttocks and legs.</li><li>Cognitive impairment such as memory problems, headaches, dizziness, anxiety, and depression may occur.</li><li>The Fibromyalgia Impact Questionnaire is a self-administered instrument that is useful in assessing functional abilities in daily life and outcomes of treatment. The questionnaire is available at: <a href="http://www.myalgia.com/FIQ/fiq.pdf" target="_blank">http://www.myalgia.com/FIQ/fiq.pdf</a>.</li><li>Systematic palpation at the 18 sites using a force of 8.8 lb (blanching of the examining thumbnail) is part of the physical examination for diagnosis.</li><li>Laboratory testing plays a limited role in diagnosis, and baseline tests used include complete blood count, thyroid-stimulating hormone testing, and comprehensive metabolic panel.</li><li>Triggers for symptoms include emotional stress, illness, surgery, and trauma.</li><li>Patients with higher count of tender points have been shown to have a higher incidence of childhood adverse experiences such as loss of a parent or abuse.</li><li>Comorbid conditions associated with fibromyalgia include alpha-delta sleep anomaly, altered sleep pattern with increase in stage 1 sleep, reduction in delta sleep, and sleep disruption, which also occurs with depression.</li><li>Anxiety and depression are the most common comorbidities.</li><li>Prevalence of migraines is higher than in the general population, headaches are a common complaint, and patients may also have irritable bowel syndrome and abdominal pain.</li><li>Other comorbid conditions include irritable bladder, premenstrual syndrome, restless leg syndrome, temperomandibular joint pain, noncardiac chest pain, Raynaud's phenomenon, and sicca syndrome.</li><li>The differential diagnoses for fibromyalgia include myofascial pain syndrome, chronic fatigue syndrome, hypothyroidism, metabolic and inflammatory myopathies (especially in patients taking statins), and polymyalgia rheumatica.</li><li>Pharmacologic treatment remains the mainstay of therapy.</li><li>Tricyclic antidepressants such as amitriptyline, 25 to 50 mg at bedtime, can provide analgesia and treat mood disorders.</li><li>Fluoxetine at 80 mg daily is of limited efficacy, and fluoxetine is more effective in combination with amitriptyline.</li><li>Tramadol may be used for analgesic effect for moderate to severe pain and needs to be titrated to avoid nausea and dizziness.</li><li>Cyclobenzaprine, 10 to 30 mg at bedtime, can improve sleep and reduce pain.</li><li>Pregabalin, a second generation anticonvulsant, has been shown to be effective at 450 mg daily for pain, fatigue, and improving sleep.</li><li>Other strategies of benefit include patient education, cognitive behavior therapy, and some forms of complementary and alternative medicine such as acupuncture and biofeedback.</li></ul> <h3>Pearls for Practice</h3><ul><li>Diagnosis of fibromyalgia mainly depends on history and physical examination; ACR criteria used are widespread pain above and below the waist including the axial skeleton and presence of 11 tender points among 18 specified points. At presentation, patients may complain of pain at multiple sites, fatigue, poor sleep, and low back pain.</li><li>Comorbid conditions of fibromyalgia include anxiety and depression, headache and migraine, sleep disruption, irritable bladder, premenstrual syndrome, restless leg syndrome, temperomandibular joint pain, noncardiac chest pain, Raynaud's phenomenon, and sicca syndrome. Management strategies include pharmacotherapy, cognitive behavior therapy, education, and some types of complementary medicine.</li></ul><a name="Target"></a><h3>Target Audience</h3><p>This article is intended for primary care clinicians, rheumatologists, and other specialists who care for patients with fibromyalgia.</p><span style="font-weight: bold;"><br /></span>AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0tag:blogger.com,1999:blog-7481209300924982403.post-70670002168947688152007-02-20T12:41:00.002-05:002008-06-09T10:26:40.808-04:00Something I should have started years agoI've been dealing with chronic illness for most of my life. You deal, get on with things as best you can and just aim for as close to "normal" as you can get.<br /><br />No matter what the illness, if it goes on long enough, you eventually start asking, "Why?" Why me? Is there some cosmic lesson I'm supposed to learn from this? Why does one person get to run a triathlon while I *feel* like I've run one after only having brushed my teeth.<br /><br />I've decided two things:<br />1) "Normal" has got to be the most subjective term in existence<br />2) The only meaning illness has is the meaning you give it.<br /><br />I've chosen to put my experiences with...<br /><ul><li>Chronic Fatigue Syndrome (CFS aka CFIDS)</li><li>Ehlers-Danlos Syndrome (EDS)<br /></li><li>Fibromyalgia<br /></li><li>Irritable Bowel Syndrome (IBS)<br /></li><li>Postural Orthostatic Tachycardia Syndrome (POTS)<br /></li><li>Neurally Mediated Hypotension (NMH)<br /></li></ul>...to work for anyone else sharing those conditions or the symptoms associated with them.<br /><br />To be continued...AnnEnigmahttp://www.blogger.com/profile/03457940534453781765noreply@blogger.com0