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| March 2009 eNews Alert |
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Fibromyalgia is hard to live with, and it is equally difficult to understand the many symptoms it produces. You have probably heard over and over again, if you would just exercise regularly, you would have more energy, better function, and fewer inches around the waist. Everyone wants a toned body and this eNews Alert offers insight on what could be happening inside your muscle cells that may make it so challenging for you to achieve a high level of physical fitness. Of course, you should never give up hope because researchers are turning up positive leads that may develop into effective treatments for your daytime exhaustion and sense of muscle weakness. If you have a bed partner that snores or other noisy sleep intrusions, these factors can make your pain and daytime symptoms worse. Naturally, it is essential that you, or your spouse seek aggressive help for your sleep. |
In this eNews Alert:
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Why do your muscles feel weak yet they appear normal when examined? Could it be that you just don’t get enough quality sleep to revitalize your body each night? Or, is there something going on within the muscles and other cells of people with fibromyalgia that leaves you in a constant state of exhaustion? Although sleep is likely to be an important factor, a biochemist has identified an enzyme abnormality that might shed light on your energy drain. Read about this research before it is printed in the medical journals in the Latest News section of our website. |
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| Lack of Vitamin D Increases Opioid Need | When your pain is from head to toe, as it is with fibromyalgia (FM), it can be difficult for you and your doctor to know if some other hidden process is slowly making your pain worse. In recent years, the high incidence of vitamin deficiency in chronic pain patients has been documented in several studies. When vitamin D is deficient, intestinal absorption of dietary calcium is inadequate, and there is not enough of this mineral to form strong bones. This leads to a diffuse-type of pain in the bones and surrounding muscles ... a pain that responds poorly to treatment with anti-inflammatory medications (such as ibuprofen or Aleve) or opioids. Researchers at the Mayo Clinic in Rochester, MN, looked at 267 chronic pain patients who participated in a three-week comprehensive pain management class to compare their opioid use with their vitamin D levels.* First, the participants were grouped into inadequate and adequate vitamin D levels. Second, they were further divided into opioid users and non-opioid users. For the 52 percent prescribed an opioid, their dose and duration of opioid consumption was recorded. The chronic pain patients (many of them diagnosed with fibromyalgia and low back pain) who were deficient in vitamin D were also found to be taking twice the opioid dose than those without vitamin D deficiency. In addition, they tended to be on this class of pain relievers for a much longer period of time. And despite their higher dose of opioids, their scores on physical functioning and health perception were lower than for those patients who had sufficient vitamin D levels. The findings imply that the opioids are not working as effectively as they could because this higher-dosed group still exhibited more symptoms. If you have been on a stable dose of opioid for a while, but lately you have noticed the need to increase your dose, ask your doctor for a simple blood test to measure your vitamin D levels (best measured as 25-hydroxy-vitamin D). If you are running low, your doctor will initially prescribe high-dose vitamin D until your blood levels return to normal. Then you should continue supplementing with 1,000 to 2,000 international units (I.U.) per day. Hopefully it will ease your pain and prevent you from needing a higher and higher opioid dose. This study showed that vitamin D deficiency represented an under-recognized source of pain-related signals entering the central nervous system. In these circumstances, it makes more sense to supplement with vitamin D than to continually increase opioid dose, particularly since these medications are usually ineffective for treating diffuse bone pain. * Turner MK, et al. Pain Med 9:979-984, 2008. |
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| A Snoring Spouse May be More than a Pain | ||||||||||||||||||
If your partner’s snoring is keeping you awake, it may be adding to your daytime symptoms. In a small study, Anna Karla Alves Smith, Ph.D., and a team of sleep researchers at the Universidade Federal de São Paulo, Brazil, determined that wives of men with obstructive sleep apnea (OSA) experienced more pain, distress, and impaired sleep than women whose husbands did not snore.1 But this information is not terribly new. Previous studies have shown that unhappy spouses and higher divorce rates tend to go hand in hand with bed partners who snore, gasp, make choking sounds, interrupt sleep, or cause their spouse to worry about the abnormal breathing.2 Research also shows that when OSA patients are treated with continuous positive airway pressure (CPAP), bed partners describe better sleep, and improvements in tiredness, anxiety, and quality of life. These studies link CPAP treatment with the improvement of the spouses’ symptoms.3 However, what makes this Brazilian study unique is that the wives of the OSA patients reported more pain and sleep problems than wives of healthy sleeping spouses even when they were separated from their snoring husbands and studied in a sleep laboratory. “To the best of our knowledge this is the first study to demonstrate that bed partners of OSA patients have a higher frequency of fibromyalgia clinical symptoms and sleep repercussions confirmed by polysomnography,” stated Smith in the study. She believes the data corroborates previous findings that report “a greater prevalence of musculoskeletal pain in bed partners of patients with OSA.” For the study, Smith assembled 17 wives of husbands who were obstructive sleep apnea patients and 17 wives of healthy sleepers who were matched for age, menopausal status, and body mass index. All the wives spent at least half their nights sleeping with their spouse and considered themselves in stable relationships (married at least seven years). Each woman filled out numerous questionnaires that assessed their daily lives, pain, fatigue, anxiety, and quality of life. They spent one night to acclimate in the sleep lab followed by a second that included an all-night polysomnography. Wives of OSA patients reported their sleep to be lighter and not as deep as the control wives. The polysomnography confirmed this by measuring significantly more awake episodes throughout the night. Although not as prominent, the sleep study also showed that OSA wives tended to spend more time in a lighter sleep level and less time in deep-level sleep. Other significant measures reported by OSA wives included lower pain thresholds, more tender points, higher distress levels, and poorer sleep and quality of life scores. Overall, 10 percent of the OSA wives met the criteria for fibromyalgia in terms of widespread chronic pain and at least 11 tender points, compared to 2 percent of the control wives. While more studies need to be done, Smith believes the long-term effects of the OSA sleeper may contribute to the spouses’ development of musculoskeletal pain, sleep and behavioral impairments. The most popular coping strategy adopted by the OSA wives in the study was to sleep in another room. 1. Smith AKA, et al. Sleep Med, March 18 [Epub ahead of print] 2009. |
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| Facial Pain and Sleep | ||||||||||||||||||
When your jaw or facial muscles are sore, laying your head on a pillow to fall asleep at night can be painful. The same goes for headaches and tight neck muscles that are often associated with facial pain. One would suspect that this situation would hinder your sleep or make the pain worse. A study described in the January 2009 issue of the Fibromyalgia Network Journal showed that randomly interrupting the sleep of healthy people severely crippled the ability of their pain-fighting system.1 In fact, after four nights of disrupted sleep, these otherwise healthy, young individuals developed muscular aches and pains. But how do the findings in healthy people relate to those with chronic pain and naturally occurring impairments in sleep? This question was asked by Michael T. Smith, Ph.D., and his research team at Johns Hopkins University in Baltimore, MD, who looked at the link between pain and sleep in a group of patients diagnosed with temporomandibular disorder (TMD) of muscular origin.2 Although TMD is not fibromyalgia, most of you can probably relate to the jaw, facial, and head pain associated with TMD. Smith tested the effectiveness of the pain-fighting system, called the diffuse noxious inhibitory control (DNIC) system, and correlated it with the results from an overnight sleep study for 53 TMD patients. The DNIC operates on the basis that a pain stimulus will minimize the impact of additional stimuli by pouring out opioids and other pain relievers. Stimulating the DNIC system is usually done by having the subject place their hand in ice-cold water. This will lead to a 35 percent increase (at least temporarily) in the pain threshold of pain-free, healthy sleepers. The ability of the DNIC system to raise each TMD subject’s pain threshold was tested several times throughout the study using the standard ice-cold water stimulus. Patients also underwent an overnight sleep study to determine their sleep efficiency ... it is a percentage of the amount of time a person is asleep during the eight-hour period that they are in bed. Based on the sleep evaluation, Smith divided the TMD patients into three groups: good, fair, and poor sleep efficiency. Those in the good sleep efficiency group had a normal functioning DNIC (i.e., their pain thresholds increased 35 percent with the cold stimulus). The DNIC of the “fair” group produced a 25 percent increase in pain threshold, and the DNIC of the poor sleepers only generated a 15 percent increase in pain threshold. “These findings suggest that better sleep continuity is associated with improved pain inhibition (i.e., a higher DNIC score),” writes Smith. He adds that a less-effective DNIC may serve as a risk factor for the development or promotion of chronic pain. If this study can be replicated in other chronic pain populations, “these findings would appear to support aggressive efforts to treat insomnia.” Although it has not yet been shown that improving sleep leads to beneficial changes in the DNIC system, it’s a logical treatment approach that has not been formally tested in people with TMD or fibromyalgia. 1. Smith MT, et al. SLEEP 30:494-505, 2007. |
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| Get Ahead of the April Journal | The April 2009 Fibromyalgia Network Journal features eye-opening insight to the processes that go on inside your brain while you are sleeping – or at least while you are trying to sleep. So when you do go to sleep, what actually sleeps? And what happens to your body if you do not sleep "normally," as most FM patients have serious difficulty sleeping. The article "The Brain that Never Fully Sleeps ... and the Body's Consequences," in the April issue discusses what can happen to your body when you experience chronic sleep disruptions. The bottom line leads to increased health risks involving weight gain, elevated blood pressure, metabolic syndrome, diabetes, and more. But there are ways you can help minimize your risk of ever developing metabolic syndrome and prevent the onset of diabetes. As a precursor to the April issue, you can get a step up by reading "Is Your Expanding Waistline Due to Metabolic Disease?," which was initially printed in the April 2007 issue of the Fibromyalgia Network Journal. The article explains that your FM appears to be disrupting the way your body uses and stores energy, leading to increased fat storage around the midriff and making you more vulnerable to developing metabolic disease. But you can learn what factors contribute to the illness and take action to fight this disease with many positive treatment options. Download a free copy of this article in PDF format today. |
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| Spread Fibromyalgia Awareness | ||||||||||||||||||
Small steps have led to great strides in fibromyalgia awareness over the years. Again this year, the Fibromyalgia Network invites each and every one of you to continue this effort by joining the Awareness Day activities on May 12 or any day you feel up to it. The Awareness campaign is designed to minimize the time and energy requirements on your part. The materials are subtle reminders that while your illness is invisible, it does exist. And all of our items are provided to you for only the cost of printing and postage. For more information, visit the Awareness page of our website at www.fmnetnews.com/awareness. Our only goal is to make it as easy as possible for you to spread awareness. We offer purple wristbands, popular ribbon-shaped car magnets, and 5.5-by-8.5 inch removable static charged decals that adhere to virtually any smooth surface including windows, doors, and walls without any sticky residue. Imprinted on all of these items is, "Fibromyalgia - It's REAL." Of course we continue to offer our colorful posters, bookmarks, and fibromyalgia pins to stir up publicity in your town.
To order Awareness items with a credit card call us toll-free at (800) 853-2929, or go to our website at www.fmnetnews.com/awareness. If you prefer to order by mail with a check or money order, an Awareness Item Order Form will be included in your April Journal. |
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| New Support Groups | ||||||||||||||||||
Fibromyalgia Network wishes to welcome 21 fibromyalgia/chronic fatigue syndrome support groups that we have added to our referral list this month. For a copy of our full, current listings, send us a self addressed, stamped envelope requesting the state referral sheet you wish to receive. For additional support group information, call our toll-free line at (800) 853-2929 or e-mail groups@fmnetnews.com. We know it can be difficult to get a new group off the ground and we wish to promote those just starting so all Members in the area can benefit. If you e-mail or call us for information about a support group in your area, please specify your location in terms of the nearest major metropolitan city. If you have been searching for a nearby support group, check our list of new groups to see if one has formed in your city. This link to new groups is temporarily available for Members of the Fibromyalgia Network only. |
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Wishing you better health ahead, Kristin Thorson & the Staff of FM Network |
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| To remain unbiased, we do not accept endorsements, advertisements, government funds, or pharmaceutical industry grants. Articles are for informational purposes only. You must consult your physician for treatment. Fibromyalgia Network ... Helping Patients Since 1988
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