NEW INSIGHTS INTO FIBROMYALGIA pot

NEW INSIGHTS INTO FIBROMYALGIA Edited by William S. Wilke           New Insights into Fibromyalgia Edited by William S. Wilke Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published December, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org New Insights into Fibromyalgia, Edited by William S. Wilke p. cm. ISBN 978-953-307-407-8 free online editions of InTech Books and Journals can be found at www.intechopen.com   Contents  Preface IX Part 1 Pathogenesis of Fibromyalgia 1 Chapter 1 Sleep and Fibromyalgia 3 Fumiharu Togo, Akifumi Kishi and Benjamin H. Natelson Chapter 2 Central Sensitization and Descending Facilitation in Chronic Pain State 19 Emiko Senba, Keiichiro Okamoto and Hiroki Imbe Chapter 3 Animal Models of Fibromyalgia 41 Yukinori Nagakura, Hiroyuki Ito and Yasuaki Shimizu Chapter 4 Psychosocial Factors in Fibromyalgia: A Qualitative Study on Life Stories and Meanings of Living with Fibromyalgia 59 Paula J. Oliveira and Maria Emília Costa Chapter 5 The Role of Oxidative Stress and Mitochondrial Dysfunction in the Pathogenesis of Fibromyalgia 77 Mario D. Cordero, Manuel de Miguel and José Antonio Sánchez Alcázar Part 2 Definition and Diagnosis of Fibromyalgia 99 Chapter 6 The Affective-Motivational Domain of the McGill Pain Questionnaire Discriminates Between Two Distinct Fibromyalgia Patient Subgroups – A Preliminary Study Based on Self-Organizing Maps 101 Monika Salgueiro and Jon Jatsu Azkue Chapter 7 The Difficulties in Developing and Implementing Fibromyalgia Guidelines 117 M. Reed and M. Herrmann VI Contents Chapter 8 Alexithymia in Fibromyalgia Syndrome 139 Ercan Madenci and Ozlem Altindag Chapter 9 Diagnosis of Fibromyalgia Syndrome: Potential Biomarkers and Proteomic Approach 149 Federica Ciregia, Camillo Giacomelli, Laura Giusti, Antonio Lucacchini and Laura Bazzichi Part 3 Treatment of Fibromyalgia 167 Chapter 10 Mind Body Therapies in the Rehabilitation Program of Fibromyalgia Syndrome 169 Susanna Maddali Bongi and Angela Del Rosso Chapter 11 Influence of Cognitive and Affective Variables in Stress, Functional Limitation and Symptoms in Fibromyalgia 187 Lilian Velasco, Cecilia Peñacoba, Margarita Cigarán, Carmen Écija and Rafael Guerrero   Preface  I try, not always successfully, to read most of each week’s edition of The Economist. In the October 15th-21st science section a report Transporter of Delight, discusses new information about the genetic underpinning of happiness, and confirmed some of my biases about the biopsychosocial nature of fibromyalgia. The story reported that Jan- Emanuel De Neve and colleagues performed a rigorous case control study involving 1,939 adolescents (De Neve J-E et al, 2011). Genetic information was collected and correlated with a validated satisfaction questionnaire. They controlled for other important potentially causative factors including education, economic status, religiosity, and many others, and discovered a gene that regulates happiness, the same gene that is found in people with fibromyalgia. The magazine story is the genesis for this polemic. A little background Human DNA is composed of approximately 21,000 genes, distinct regions arranged in 23 pairs - one each from the mother and father. The two components of each separate gene have subtle differences of amino acid distribution, which affect their function. These slightly different functional variants of the same gene are called alleles. The gene of interest is called 5-HTTLPR and modulates serotonin concentrations in the nervous system. This gene consists of a short and long allele, based on the number of amino acid residues in their structures - the long one produces more serotonin transporter proteins, which produce more serotonin than the shorter allele. The researchers found that individuals with long alleles and those with higher serotonin concentrations in the nervous system were statistically more likely to be very satisfied with their life, compared to individuals with short alleles (p=0.012). Serotonin is a chemical, which is released by neurons and governs the magnitude of neural activity. Low serotonin concentrations in the central nervous system is causally linked to affective disorders (Thieme K et al, 2004; Abeles AM et al, 2007). This same alteration of the serotonergic system is a crucial factor underlying the severity and pathogenesis of FMS (Russell IJ et al 1992; Stahl SM et al, 2009). Familial aggregation occurs in fibromyalgia. For example, among 533 first degree relatives of 78 fibromyalgia patients compared to 272 first degree relatives of 40 X Preface rheumatoid arthritis patients, the odds ratio for having fibromyalgia was 8.5 in fibromyalgia relatives versus the rheumatoid arthritis relatives (Arnold LM et al, 2004). Others have demonstrated an increased frequency of the short allele of the serotonin transporter gene 5-HTTLPR in fibromyalgia (Offenbacher M et al, 1999). In the general population, the short allele confers vulnerability to a spectrum of illnesses including anxiety disorder, depression, and bipolar disorder (Lucki I, 1998). Furthermore, increased amygdala activation to environmental stresses such as facial expression, proven by functional magnetic resonance imaging (Hariri AR et al, 2006), and other methods (Munafo MR et al, 2008) has been linked to this same allele. The amygdala is responsible for negative interpretation of environmental stimuli; increased activation equals higher “fear factor”. Next piece, temperament In 1993, C. Robert Cloninger postulated that temperament, which can be best understood as automatic emotional responses to situations in society by an individual, might be primarily due to inheritance (Cloninger CR et al, 1993). He constructed a model of four descriptive personality dimensions, which included novelty seeking, harm avoidance, reward dependency and persistence. People with harm avoidance were described as having “ pessimistic worry in anticipation of future problems, fear of uncertainty, shyness of strangers and rapid fatigability.” Those with novelty seeking were curious, disorganized, quick-tempered and impulsive. Reward dependence traits include sensitivity and a need for societal contact. Not surprisingly, people with the persistence trait were described as industrious and hard working. He suggested that all of our personalities are a mixture of these traits, and in some individuals, one or another trait dominates. He further predicted that each of these traits was due to different genes which were intimately related to brain chemistry metabolism. Harm avoidance was related to serotonin pathways, novelty seeking to dopamine pathways, and the last two to norepinephrine pathways. Research since 1992 has shown that these relationships are a bit more complicated, but the general concept is largely confirmed. Of significance, a recent publication has shown a higher frequency of both the short 5-HTTLPR allele and harm avoidance temperament trait in patients with fibromyalgia compared to controls (Cohan H et al, 2002). The genetic plus side At this point, I have associated unhappiness, 5-HTTPR short allele, harm avoidance due to amygdala activation, low central nervous system serotonin with fibromyalgia. This relationship makes sense. In the medical and in psychology and economic literature, people with harm avoidance are prone to increased situational fear responses, depression, and low self direction, as well as fibromyalgia (Celikel FC et al, 2009; Glazer Y et al, 2010). However, they are also more likely to be creative, more spiritual, more likely to participate in the arts (Bachner-Melman R et al, 2005), and [...]... Bombardier C & Kith P (1994) Sleep Disorders in Patients With Chronic Fatigue Clinical Infectious Diseases, Vol.18 Suppl 1, (January 1994), ISSN 1058-4838 12 New Insights into Fibromyalgia Burns J.W.; Crofford L.J & Chervin R.D (2008) Sleep Stage Dynamics in Fibromyalgia Patients and Controls Sleep Medicine, Vol.9, No.6, (August 2008), ISSN 1389-9457 Carley D.W.; Applebaum R.; Basner R.C.; Onal E & Lopata... P.; Campbell S.M.; Abeles M.; Clark P et al (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia Report of the Multicenter Criteria Committee Arthritis and Rheumatism, Vol.33, No.2, (February 1990), ISSN 0004-3591 18 New Insights into Fibromyalgia Yassouridis A.; Steiger A.; Klinger A & Fahrmeir L (1999) Modelling and Exploring Human Sleep With Event History... Furthermore, FM pain is diffuse and multifocal, lacks a distinct spatial localization, often waxes and wanes and is frequently migratory in nature These features have led to the hypothesis that hyperexcitability of the 20 New Insights into Fibromyalgia central nervous system or dysfunction of the central inhibitory system may exist in these patients Central hyperexcitability could explain exaggerated pain and... sleep in the night following exercise in healthy people (Horne & Staff, 1983) To our knowledge, only our study (Togo et al., 2010) has compared sleep in CFS patients before and after exercise 8 New Insights into Fibromyalgia Exertion is a particularly interesting thing to study in CFS because a disabling and characteristic feature of CFS patients is that even minimal exertion produces a dramatic worsening... even cases not showing any statistical differences in normal sleep parameters between healthy controls and FM or CFS patients (Afari & Buchwald, 2003; Chervin et al., 2009; Fischler, 1999; 10 New Insights into Fibromyalgia Reeves et al., 2006) In our study (Togo et al., 2008), after excluding patients with diagnosable sleep disorders, such as sleep-disturbed breathing and leg movement disorders, patients... transporter 5-HTTLPR: involvement in smoking behavior J Genetics 2011; 90:179-185 Wolfe F, Rasker JJ: The Symptom Intensity Scale, fibromyalgia, and the meaning of fibromyalgia- like symptoms J Rheumatol 2006; 33: 2291-2299 XV Part 1 Pathogenesis of Fibromyalgia 1 Sleep and Fibromyalgia Fumiharu Togo1, Akifumi Kishi2 and Benjamin H Natelson3 1Educational Physiology Laboratory, Graduate School of Education,... Press, ISBN 978-0931092756, Seattle, USA Lashley F.R (2003) A Review of Sleep in Selected Immune and Autoimmune Disorders Holistic Nursing Practice, Vol.17, No.2, (March 2003), ISSN 0887-9311 14 New Insights into Fibromyalgia Le Bon O.; Fischler B.; Hoffmann G.; Murphy J.R.; De Meirleir K.; Cluydts R & Pelc I (2000) How Significant Are Primary Sleep Disorders and Sleepiness in the Chronic Fatigue Syndrome?... of Standardized Terminology, Techniques and Scoring System for Sleep States of Human Subjects US Government Printing Office, National Institute of Health Publication, Washington (DC), USA 16 New Insights into Fibromyalgia Reeves W.C.; Heim C.; Maloney E.M.; Youngblood L.S.; Unger E.R.; Decker M.J.; Jones J.F & Rye D.B (2006) Sleep Characteristics of Persons With Chronic Fatigue Syndrome and Non-Fatigued... in healthy controls Over the course of the many decades, sleep researchers have used simple descriptive statistics to characterize and summarize sleep architecture While this methodology has 4 New Insights into Fibromyalgia been extremely useful in defining the abnormalities that currently constitute sleep pathology, this approach does not explain specific patient complaints of disturbed and unrefreshing... healthy individuals (Horne & Shackell, 1991; Scheuler et al., 1983; Shaver et al., 1997) and in patients with disorders such as rheumatoid arthritis and CFS (Moldofsky et al., 1983; 1988) 6 New Insights into Fibromyalgia A task force of the American Sleep Disorders Association has defined a cortical arousal (American Sleep Disorders Association, 1992) as a return to alpha or fast frequency EEG activity, . NEW INSIGHTS INTO FIBROMYALGIA Edited by William S. Wilke           New Insights into Fibromyalgia Edited by William S. Wilke . www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org New Insights into Fibromyalgia, Edited by William S. Wilke p. cm. ISBN 978-953-307-407-8 free online. Intensity Scale, fibromyalgia, and the meaning of fibromyalgia- like symptoms. J Rheumatol 2006; 33: 2291-2299 Part 1 Pathogenesis of Fibromyalgia 1 Sleep and Fibromyalgia Fumiharu