LIST REFERENCES LIST REFERENCES A) FIBROMYALGIA 58 D) FIBROSITIS 401 B) DEPRESSIVE DISORDER 9478 E) NEURASTHENIA 670 C) *ON A&B 2 *** *** *****AMERICAN FAMILY PHYSICIAN/GP***** 82179223 Yunus M Masi AT Calabro JJ Shah IK Primary fibromyalgia. AM FAM PHYSICIAN 1982 May; 25(5):115-21 Primary fibromyalgia is a common but often unrecognized rheumatic condition. The typical patient is a young woman who complains of diffuse aches, pains and stiffness in joints and muscles. The symptoms are affected by weather and activities. Patients sleep poorly, feel tired and are often anxious. Physical examination reveals multiple tender points without evidence of arthritis or muscle weakness. Laboratory findings are normal. Management requires a program of patient education and reassurance, analgesics, physical therapy, restful sleep and occasional injection of tender areas with lidocaine. Psychoactive drugs are frequently useful. 85303847 Coulehan JL Primary fibromyalgia. AM FAM PHYSICIAN 1985 Sep; 32(3):170-7 University of Pittsburgh School of Medicine, PA *****AMERICAN JOURNAL OF MEDICINE***** 87023096 Simons DG Fibrositis/fibromyalgia: a form of myofascial trigger points? AM J MED 1986 Sep 29; 81(3A):93-8 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. Myofascial Pain Clinic Veterans Administration Medical Center Long Beach California. 87023092 McCain GA Role of physical fitness training in the fibrositis/fibromyalgia syndrome. AM J MED 1986 Sep 29; 81(3A):73-7 Cardiovascular fitness training has been suggested as a treatment for the fibrositis/fibromyalgia syndrome. Thirty-four patients with fibrositis/fibromyalgia who met Smythe's original criteria were randomly assigned to enter either a cardiovascular fitness training program or a program consisting only of flexibility exercises. Patients met in supervised groups three times weekly for a 20-week observation period. The cardiovascular fitness group underwent gradual heart rate-elevated training using a bicycle ergometer and achieved a 29.1 +/- 24.4 percent increase in peak work capacity at 170 beats per minute (PWC-170). Patients undergoing flexibility training had a net reduction in their PWC-170 scores of 4.3 +/- 9.4 percent. Patients in the cardiovascular fitness group had statistically significant improvements in the visual analogue pain scale of current pain intensity; total myalgic scores in which pain thresholds at five fibrositic tender points selected for acceptable intra-rater and inter-rater reliability were measured using a dolorimeter; percentage total body area affected as measured by self- administered pain diagrams; and patients' and physicians' global assessment scores. Psychologic profiles as measured by Symptom Checklist-90R also improved in the cardiovascular fitness group compared with the flexibility training group. It is concluded that cardiovascular fitness training is feasible in patients with fibrositis/fibromyalgia and that such training improves subjective measurements of pain-reporting behavior. A theoretic basis for improvements in pain measurement scales and psychologic profiles is discussed in light of recent literature. Department of Medicine University Hospital London Ontario Canada. 87023087 Calabro JJ Fibromyalgia (fibrositis) in children. AM J MED 1986 Sep 29; 81(3A):57-9 The features of fibromyalgia (fibrositis) in children are similar to those in adults with the syndrome. Both juveniles and adults report diffuse musculoskeletal aches and/or stiffness with typical modulating factors. Moreover, they have no systemic manifestations, and routine laboratory studies yield normal results. On physical examination in both children and adults, multiple soft-tissue tender points are evident at characteristic, symmetric sites but with no evidence of arthritis. Department of Medicine University of Massachusetts Medical School Worcester. 87023084 Yunus MB Kalyan-Raman UP Kalyan-Raman K Masi AT Pathologic changes in muscle in primary fibromyalgia syndrome. AM J MED 1986 Sep 29; 81(3A):38-42 Primary fibromyalgia syndrome, also inappropriately called "fibrositis," is a clinically recognizable nonarticular rheumatic condition with diffuse and chronic musculoskeletal aching and stiffness, accompanied by exaggerated tenderness at characteristic sites on physical examination. Results of muscle biopsy from 12 well- defined cases of primary fibromyalgia syndrome without any history of trauma have been published recently. Light microscopic examination revealed no evidence of inflammation. Histochemical analysis demonstrated type II fiber atrophy in seven patients and the "moth- eaten" appearance of type I fibers in five patients. Electron microscopic findings were most impressive, and included myofibrillar lysis with deposition of glycogen and abnormal mitochondria, as well as subsarcolemmal accumulation of glycogen and mitochondria in all 12 patients and papillary projections of sarcolemmal membrane in 11 patients. Mechanisms of these significant muscle changes in primary fibromyalgia syndrome are uncertain but may include subclinical injury of muscle spasm. Department of Medicine University of Illinois College of Medicine Peoria 61656. 87023081 Smythe H Tender points: evolution of concepts of the fibrositis/fibromyalgia syndrome. AM J MED 1986 Sep 29; 81(3A):2-6 The association of chronic pain, exhaustion, and multiple somatic complaints with apparent physical good health and long survival has a long history. The syndrome was called by many names including neuresthenia, rheumatism, and invalidism. When skeletal pain and stiffness were prominent, many observers recorded the existence of sites of tenderness and sometimes of areas of induration. The work of Lewis and Kellgren provided an experimentally reproducible method of study of the phenomena of referred pain and referred tenderness, which led to hypotheses about the nature of many of these syndromes, which were unfortunately too numerous and often contradictory. More recently, it has been learned that the sites of tenderness are precisely predictable in location and, under some circumstances, experimentally inducible. They are unknown to the patient and, therefore, due to mechanisms other than distortions of interpretation. The association with a variety of forms of sleep disturbance was discovered. These events have permitted the rapid evolution of controlled, numerical studies of these associations, which are reviewed briefly in this article. Wellesley Hospital Toronto Canada. 87023080 Masi AT Yunus MB Concepts of illness in populations as applied to fibromyalgia syndromes. AM J MED 1986 Sep 29; 81(3A):19-25 Fibromyalgia syndromes are common noninflammatory, painful musculoskeletal disorders that vary in the extent and intensity of involvement. The biologic gradient of musculoskeletal pain varies from no or few symptoms and tender points in the majority of persons to generalized fibromyalgia with multiple tender points. Standardized criteria are needed in order to categorize different strata of the biologic gradient of fibromyalgia syndromes and differentiate them from other conditions. Both the sensitivity and specificity of criteria should be high. The course and prognosis of fibromyalgia syndromes are not yet known. Limited clinical data suggest three basic patterns: remitting-intermittent; fluctuating-continuing; and progressive. However, course patterns need to be derived scientifically. Multiple host and environmental factors seem to contribute to the onset and course of fibromyalgia syndromes, and these require definition. Generalized fibromyalgia syndromes share many constitutional manifestations with other common functional disorders, e.g., irritable bowel syndrome and tension headache syndrome, which suggest common underlying psychoneurophysiologic mechanisms in a subset of patients. Progress made in fibromyalgia research will find application in many dysfunctional syndromes without obvious organ pathology. Department of Medicine University of Illinois College of Medicine Peoria 61656. 87023079 Bennett RM Current issues concerning management of the fibrositis/fibromyalgia syndrome. AM J MED 1986 Sep 29; 81(3A):15-8 The fibrositis/fibromyalgia syndrome is one of the commonest forms of musculoskeletal pain seen in clinical practice. It is diagnosed on the basis of widespread pain accompanied by the physical finding of multiple tender points in remarkably reproducible locations. Accompanying the pain are two symptoms commonly associated with the "systemic" rheumatic disorders, namely morning stiffness and easy fatigability. Unlike the classical rheumatic diseases, however, fibrositis is not responsive to anti-inflammatory medications, including corticosteroids. Current therapeutic strategies, which are only partly successful, are aimed at modifying those factors that seemingly influence the severity and course of the condition; such afferent features include sleep disturbance, overuse syndromes, mechanical stress, psychic stress, and other causes of chronic pain. Major unresolved issues center around the assessment of functional disability in fibrositis and the apparent relationship to trauma in some patients. Until more is known about the underlying pathogenesis of this common condition, significant progress will be thwarted. Division of Arthritis and Rheumatic Diseases Oregon Health Sciences University Portland 97201. 87023078 The fibrositis/fibromyalgia syndrome. Current issues and perspectives. December 13-14, 1985, San Francisco, California. AM J MED 1986 Sep 29; 81(3A):1-115 *****AMERICAN JOURNAL OF PSYCHIATRY***** 86266113 Hale AA Stern SL Wongsam PE Fibromyalgia in a woman with bipolar disorder, manic phase [letter] AM J PSYCHIATRY 1986 Aug; 143(8):1064 86239764 Tariot PN Yocum D Kalin NH Psychiatric disorders in fibromyalgia [letter] AM J PSYCHIATRY 1986 Jun; 143(6):812-3 85146344 Hudson JI Hudson MS Pliner LF Goldenberg DL Pope HG Jr Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. AM J PSYCHIATRY 1985 Apr; 142(4):441-6 Fibromyalgia is a form of nonarticular rheumatism characterized by diffuse musculoskeletal pain. To investigate the relationship between fibromyalgia and major affective disorder, the authors evaluated 31 patients with fibromyalgia and 14 patients with rheumatoid arthritis for rates of current or past major affective disorder and family history of major affective disorder. Both the rate of major affective disorder and the familial prevalence of major affective disorder were significantly higher in the fibromyalgia patients than the rheumatoid arthritis patients. The results suggest that fibromyalgia may be related to major affective disorder. Department of Psychiatry Harvard Medical School Boston, Mass *****ARTHRITIS AND RHEUMATISM***** 85022881 Ahles TA Yunus MB Riley SD Bradley JM Masi AT Psychological factors associated with primary fibromyalgia syndrome. ARTHRITIS RHEUM 1984 Oct; 27(10):1101-6 Forty-five ambulatory patients with primary fibromyalgia syndrome (PFS), 30 with rheumatoid arthritis, and 32 normal controls were administered 3 psychological tests: the Minnesota Multiphasic Personality Inventory (MMPI), the Life Events Inventory, and the Assertiveness-Aggressiveness Inventory. The PFS patients scored significantly higher on 8 MMPI scales when compared with the normal control group and on 4 MMPI scales when compared with the rheumatoid arthritis group. Further subgrouping of PFS patients according to MMPI scores showed that only 31% were "psychologically disturbed," 33% had a typical chronic pain profile, and 36% were within the normal range. The PFS patients scored higher than the rheumatoid arthritis and normal control groups on the Life Events Inventory but not the Assertiveness-Aggressiveness Inventory. 88049838 Buchwald D Goldenberg DL Sullivan JL Komaroff AL The "chronic, active Epstein-Barr virus infection" syndrome and primary fibromyalgia. ARTHRITIS RHEUM 1987 Oct; 30(10):1132-6 Fifty patients with primary fibromyalgia who had been followed in an academic rheumatology practice frequently reported symptoms thought to be typical of "chronic Epstein-Barr virus infection," but not of fibromyalgia: recurrent sore throat (54%), recurrent rash (47%), chronic cough (40%), recurrent adenopathy (33%), and recurrent low- grade fevers (28%). In 55% of the patients, illness had begun suddenly, with what seemed to be a viral syndrome. Antibody titers to Epstein-Barr virus in the patients with fibromyalgia, however, were not significantly different from those in age- and sex-matched "healthy" and "unhealthy" control subjects. Department of Medicine Brigham and Women's Hospital Boston MA 02115. 87100315 Felson DT Goldenberg DL The natural history of fibromyalgia. ARTHRITIS RHEUM 1986 Dec; 29(12):1522-6 The natural history of fibromyalgia was studied in 39 treated patients. All patients were surveyed by interviews conducted in 1983 (at an average of 1.3 years after diagnosis), in 1984, and again in 1985. Throughout the survey period, more than 60% of patients had moderate to severe continuing symptoms, and almost all took medications regularly to control symptoms. Younger patients (P = 0.02), those with less severe symptoms at the initial survey (P = 0.005), and those with isolated Raynaud's phenomenon (P = 0.04) were more likely to be doing well 2 years later, although symptom remission was usually transitory. Boston University Multipurpose Arthritis Center Massachusetts. 87048997 Goldenberg DL Felson DT Dinerman H A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. ARTHRITIS RHEUM 1986 Nov; 29(11):1371-7 Sixty-two patients with fibromyalgia were randomly assigned to receive 25 mg of amitriptyline at night, 500 mg of naproxen twice daily, both amitriptyline and naproxen, or placebo in a 6-week, double-blind trial. Amitriptyline was associated with significant improvement in all outcome parameters, including patient and physician global assessments, patient pain, sleep difficulties, fatigue on awakening, and tender point score. Patients taking the combined naproxen-amitriptyline regimen experienced minor, but not significant, improvement in pain when compared with patients who took amitriptyline alone. Amitriptyline, or amitriptyline and naproxen, is an effective therapeutic regimen for patients with fibromyalgia. Multipurpose Arthritis Center Boston University School of Medicine MA 02118. 86295923 Bengtsson A Henriksson KG Larsson J Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. ARTHRITIS RHEUM 1986 Jul; 29(7):817-21 Muscle energy metabolism was studied by chemical analysis of biopsy samples from: 1) trigger points in the trapezius muscle from 15 patients with primary fibromyalgia (PF), 2) nonpainful, anterior tibial muscle from 6 patients with PF, and 3) the trapezius muscle from 8 healthy controls. We found a decrease in the levels of adenosine triphosphate, adenosine diphosphate, and phosphoryl creatine, and an increase in the levels of adenosine monophosphate and creatine, in the trapezius muscles from the patients. These findings support the notion that the pain in patients with PF is of muscular origin. Department of Internal Medicine University Hospital Linkoping, Sweden 86242358 Leavitt F Katz RS Golden HE Glickman PB Layfer LF Comparison of pain properties in fibromyalgia patients and rheumatoid arthritis patients. ARTHRITIS RHEUM 1986 Jun; 29(6):775-81 Pain properties of 50 fibromyalgia patients were examined and compared with pain properties of 50 rheumatoid arthritis patients. In both fibromyalgia and rheumatoid arthritis, pain was bilateral, involved multiple sites, and was of equal intensity (60.8 versus 58.7, respectively, on a scale of 100). Fibromyalgia pain, however, was less localized to the joints and suggested greater spatial diffusion. It involved more kinds of pain experiences (radiating, steady, spreading, spasms, gnawing, unlocalized, pricking, crushing, shooting, pressing, splitting, cramping, nagging, and pins and needles), and was dispersed over larger areas of the body. The anatomic sites best for discrimination between patients with fibromyalgia and patients with rheumatoid arthritis were the lower back, thigh, abdomen, head, and hips for fibromyalgia, and wrist, foot, and fingers for rheumatoid arthritis. The traditional clinical description of aching and stiffness does not appear to accurately describe the complexity of the fibromyalgia pain syndrome. Department of Psychology and Social Sciences Rush Medical College Rush Presbyterian-St. Luke's Medical Center Chicago, IL 60612 86186981 Calabro JJ Perry RF Juvenile primary fibromyalgia syndrome [letter] ARTHRITIS RHEUM 1986 Mar; 29(3):452-3 85251862 Wallace DJ Immunofluorescence and fibromyalgia [letter] ARTHRITIS RHEUM 1985 Jul; 28(7):836-7 85122013 Yunus MB Masi AT Juvenile primary fibromyalgia syndrome. A clinical study of thirty- three patients and matched normal controls. ARTHRITIS RHEUM 1985 Feb; 28(2):138-45 Primary fibromyalgia syndrome (PFS) is a common and characteristic rheumatologic condition manifested by diffuse musculoskeletal aches, pains, and stiffness frequently modulated by various factors, e.g., weather, physical activity, sleep quality, and anxiety/stress, and accompanied by discrete tender points at typical soft tissue sites. Although well-recognized in adults, this entity has not been reported separately in juveniles. This study documents PFS in 33 juveniles who presented at age 17 or younger and compares their findings with those in age- and sex-matched normal control subjects. As in adult PFS patients, associated non-musculoskeletal symptoms were common, including fatigue, poor sleep, anxiety/stress, headaches, and paresthesias. Physical examination revealed multiple tender points at characteristic soft tissue sites and no objective evidence of arthritis. Routine laboratory test results were normal or negative. Juvenile PFS is often misdiagnosed. Recognition of this common rheumatologic condition in juveniles is important in order to avoid unwarranted investigations and improper management. Department of Medicine University of Illinois College of Medicine Peoria, IL *****JOURNAL OF RHEUMATOLOGY***** 85107877 Wolfe F Cathey MA Kleinheksel SM Fibrositis (Fibromyalgia) in rheumatoid arthritis. J RHEUMATOL 1984 Dec; 11(6):814-8 We studied demographic socioeconomic and clinical characteristics of 38 patients with fibrositis (fibromyalgia) that occurred in association with rheumatoid arthritis (RAFIB) and 242 patients with rheumatoid arthritis (RA) alone. Fewer RAFIB patients were married (57.1%), and most (97.4%) were women. No statistically significant differences in income, medical expenditures or other demographic variables were identified. All measures of function, pain, disease activity and psychological status were more abnormal in RAFIB patients. The clinical characteristics that best differentiated RAFIB and RA patients were pain, depression, anxiety and erythrocyte sedimentation rate, in logistic and stepwise regression models. Evaluation of disease severity markers, including radiographic erosions and frequency of total joint replacement, suggested that disease severity in RAFIB and RA is similar. Arthritis Center Wichita KS 85107876 Kalyan-Raman UP Kalyan-Raman K Yunus MB Masi AT Muscle pathology in primary fibromyalgia syndrome: a light microscopic, histochemical and ultrastructural study. J RHEUMATOL 1984 Dec; 11(6):808-13 Upper medial trapezius muscle biopsy was obtained from 12 primary fibromyalgia syndrome (PFS) patients (age 17 to 40 years) and studied with histochemistry, light and electron microscopy (EM). No evidence of inflammation was found in any case. Significant histochemical abnormalities were Type II fiber atrophy in 7 and moth-eaten appearance of Type I fibers in 5. EM revealed segmental muscle fiber necrosis with lipid and glycogen deposition as well as subsarcolemmal mitochondrial accumulation in all cases. Papillary projections of sarcolemmal membrane were seen in 11 patients. These observations in 12 PFS cases without obvious muscle trauma indicate definite but nonspecific muscle changes which we suspect are secondary to chronic muscle spasm and ischemia of unknown etiology. Department of Pathology University of Illinois College of Medicine at Peoria 84114697 Yunus MB Fibromyalgia syndrome: a need for uniform classification [editorial] J RHEUMATOL 1983 Dec; 10(6):841-4 88035892 Ferraccioli G Ghirelli L Scita F Nolli M Mozzani M Fontana S Scorsonelli M Tridenti A De Risio C EMG-biofeedback training in fibromyalgia syndrome. J RHEUMATOL 1987 Aug; 14(4):820-5 Fifteen patients with fibromyalgia syndrome were given EMG-BFB (biofeedback) training sessions because of persistent aches after one year of monthly courses of NSAID. A long-lasting clinical benefit was observed in 56%. The improvement was found in those without overt psychopathological disturbances. In fact, a subgroup of clinically depressed patients responded poorly. Our findings were confirmed in a controlled study. Six patients were allocated into "true EMG-BFB" and 6 into "false EMG-BFB" treatment in a blinded fashion. The rheumatological assessment revealed a significant improvement in most of the variables only in the "true EMG-BFB" group. Psychiatry Department University Hospital of Parma Italy. 87036677 Molony RR MacPeek DM Schiffman PL Frank M Neubauer JA Schwartzberg M Seibold JR Sleep, sleep apnea and the fibromyalgia syndrome. J RHEUMATOL 1986 Aug; 13(4):797-800 A patient who presented with primary fibromyalgia syndrome (PFS) was found to have sleep apnea. Since frequent wakening and nonrestorative sleep are prominent clinical complaints in both disorders, we hypothesized an etiologic relationship. A subsequent clinical survey of 11 additional sleep apneics revealed that 3 (27%) fulfilled proposed criteria for PFS. This was significantly greater than local and literature reported studies of nonrheumatologic patients and was comparable to reported prevalence of fibromyalgia in rheumatologic referral populations. A blinded sleep physiology study of 7 patients with PFS revealed a significantly increased percentage of transitional sleep and increased frequency of miniarousals/h, but no significant evidence of occult sleep apnea compared to matched normal controls. The frequent arousals of sleep apnea may be associated with fibromyalgia in some patients but do not explain the sleep disorder of PFS. Department of Medicine UMDNJ-Rutgers Medical School New Brunswick. 86254121 Dinerman H Goldenberg DL Felson DT A prospective evaluation of 118 patients with the fibromyalgia syndrome: prevalence of Raynaud's phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction. J RHEUMATOL 1986 Apr; 13(2):368-73 One hundred eighteen consecutive patients with fibromyalgia were evaluated prospectively. Immunoglobulin deposits at the dermal- epidermal junction were found in only 4 of 36 patients. Twelve patients (14%) had at least one positive antinuclear antibody (ANA) test. Eight patients (7%) had at least one low C3. Thirty-five patients (30%) has a history of Raynaud's phenomenon and 22 (18%) had sicca symptoms, defined as symptomatic dry eyes and mouth and a positive Schirmer test. The 35 patients with Raynaud's phenomenon had a significantly higher prevalence of sicca symptoms, positive ANA or low C3 compared to the 83 patients who did not have Raynaud's phenomenon. Thus, a subset of patients with fibromyalgia may have features suggestive of a systemic connective tissue disorder. Multipurpose Arthritis Center Boston University School of Medicine MA 02118 86199948 Yunus MB Denko CW Masi AT Serum beta-endorphin in primary fibromyalgia syndrome: a controlled study. J RHEUMATOL 1986 Feb; 13(1):183-6 Serum beta-endorphin was assayed without knowledge of study subject category in 44 consecutive patients with primary fibromyalgia syndrome, 3 patients with rheumatoid arthritis (RA), and 30 normal controls, all females. Mean serum beta-endorphin levels were 81 +/- 28 pg/ml in patients with fibromyalgia, whereas those in normal controls and patients with RA were 73 +/- 17 pg/mg and 73 +/- 18 pg/ml, respectively. These differences were not statistically significant. Serum beta-endorphin levels did not correlate with relevant clinical variables in either fibromyalgia or RA groups. Department of Medicine University of Illinois College of Medicine Peoria 61656 86143574 Alonso-Ruiz A de la Hoz-Martinez A Zea-Mendoza AC Fibromyalgia syndrome as a late complication of toxic-oil syndrome [letter] J RHEUMATOL 1985 Dec; 12(6):1207-8 85160594 Yonker RA Panush RS Idiopathic eosinophilic myositis with preexisting fibromyalgia. J RHEUMATOL 1985 Feb; 12(1):165-7 Idiopathic eosinophilic myositis is a rare entity. Only 6 other cases have been reported in the literature. We report a patient with degenerative joint disease and fibromyalgia who subsequently developed eosinophilic myositis over a tender trigger area. Department of Medicine College of Medicine University of Florida, Gainesville 32610 *****JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION***** 87312052 Painful questions about fibromyalgia [letter] JAMA 1987 Sep 18; 258(11):1476-7 87199154 Bennett RM Fibromyalgia [editorial] JAMA 1987 May 22-29; 257(20):2802-3 87199147 Goldenberg DL Fibromyalgia syndrome. An emerging but controversial condition. JAMA 1987 May 22-29; 257(20):2782-7 The clinical manifestations, laboratory findings, and treatment results of 118 patients with fibromyalgia followed up by one investigator were compared with those of other recent reports. The history of this syndrome and recent efforts to establish diagnostic criteria and to understand underlying pathophysiologic mechanisms were studied. A practical, noninvasive office-based evaluation and conservative treatment approach were developed, determined by an understanding of the natural history of this common but controversial disorder. Department of Medicine Boston University School of Medicine MA 02118. *****LANCET***** 83087566 Henriksson KG Bengtsson A Larsson J Lindstrom F Thornell LE Muscle biopsy findings of possible diagnostic importance in primary fibromyalgia (fibrositis, myofascial syndrome) [letter] LANCET 1982 Dec 18; 2(8312):1395 *****MOUNT SINAI JOURNAL OF MEDICINE***** 84219478 Wallace DJ Fibromyalgia: unusual historical aspects and new pathogenic insights. MT SINAI J MED (NY) 1984 Apr; 51(2):124-31 *****NEW ZEALAND MEDICAL JOURNAL***** 82220821 Anderson G Fibromyalgia and the biomedical model [letter] NZ MED J 1982 Apr 14; 95(705):243 82196176 Fisk JW Fibromyalgia [letter] NZ MED J 1982 Feb 10; 95(701):91-2 82149282 Treadwell BL Fibromyalgia or the fibrositis syndrome: a new look. NZ MED J 1981 Dec 23; 94(698):457-9 82058730 Jacks DA Fibromyalgia [letter] NZ MED J 1981 Sep 23; 94(692):237 82058716 Treadwell BJ Fibromyalgia [letter] NZ MED J 1981 Aug 26; 94(690):157-8 *****POSTGRADUATE MEDICINE***** 87041159 Hench PK Mitler MM Fibromyalgia. 2. Management guidelines and research findings. POSTGRAD MED 1986 Nov 15; 80(7):57-64, 69 Treatment of fibromyalgia includes various forms of therapy-- physical, behavioral, psychological, and pharmacologic. No drug therapy has proved uniformly successful, but some drugs provide temporary relief from pain. After an initial therapy program has been established, patients can assume the major responsibility for management. Research studies aimed at defining the cause of fibromyalgia have linked it to sleep disorders, neurogenic mediators, immune mechanisms, muscle disease, and psychological disturbances. Division of Rheumatology Scripps Clinic and Research Foundation La Jolla CA 92037. 87041158 Hench PK Mitler MM Fibromyalgia. 1. Review of a common rheumatologic syndrome. POSTGRAD MED 1986 Nov 15; 80(7):47-56 Fibromyalgia is a nonarticular rheumatic syndrome of unknown cause characterized by diffuse musculoskeletal aching, pain and stiffness, easy fatigability, multiple discreet tender points, emotional distress, and often, light and restless sleep with intensification of symptoms upon awakening. Symptoms are modulated by environmental, physiologic, and psychological factors. Generally, findings from laboratory tests and roentgenograms are normal. In primary fibromyalgia, no underlying rheumatic or other systemic organic disease is present. Secondary fibromyalgia is a manifestation of underlying disease. Division of Rheumatology Scripps Clinic and Research Foundation La Jolla California. 87016705 Waxman J Zatzkis SM Fibromyalgia and menopause. Examination of the relationship. POSTGRAD MED 1986 Sep 15; 80(4):165-7, 170-1 Women predominate at all ages among patients diagnosed as having primary fibromyalgia. Of 100 patients reviewed, the average age at onset of fibromyalgia was 46. Of 65 patients in whom menopause occurred before diagnosis of fibromyalgia, the average age at menopause was 42, and most of these women had menopause related to surgery and insufficient estrogen therapy. Estrogen deficit is, thus, a prominent promoting factor in the majority of fibromyalgia patients and is likely to have an effect on sleep, mood, and anxiety state. These emotional responses may subsequently be somatized as pain. Therefore, estrogen therapy should be added to the treatment armamentarium for fibromyalgia in selected patients. Department of Internal Medicine Ochsner Clinic New Orleans. *****SCANDINAVIAN JOURNAL OF RHEUMATOLOGY***** 87094056 Bengtsson A Henriksson KG Jorfeldt L Kagedal B Lennmarken C Lindstrom F Primary fibromyalgia. A clinical and laboratory study of 55 patients. SCAND J RHEUMATOL 1986; 15(3):340-7 The clinical symptoms of 55 patients with primary fibromyalgia (PF) were studied and compared with 30 patients with rheumatoid arthritis (RA). The PF patients expressed a more intense feeling of illness than did the RA patients. Stiffness occurred just as often in PF as in RA. Trigger points occurred less frequently in RA patients. Muscular fatigue appeared to be one of the most disabling symptoms in PF. Neurophysiological studies indicated that the fatigue was at least partly of central origin. Ischemic forearm exercise test gave no evidence of impaired glycogenolysis. Laboratory investigation revealed normal 25-hydroxyvitamin D, cobalamin, folate, estrogen, testosterone, and myoglobin in the PF patients. Department of Internal Medicine University Hospital Linkoping Sweden. 86315732 Lund N Bengtsson A Thorborg P Muscle tissue oxygen pressure in primary fibromyalgia. SCAND J RHEUMATOL 1986; 15(2):165-73 Trigger points in painful muscle are a characteristic sign in patients with primary fibromyalgia. The MDO oxygen electrode was used to evaluate oxygenation in the subcutaneous tissue and in trigger points in the trapezius and brachioradial muscles. Ten patients and 8 normal controls were studied. The results in the patients were abnormal, with scattered or slalom-slope histograms, indicating low tissue oxygenation. The controls were normal, except in one case. The conclusion is that in patients with primary fibromyalgia, the muscle oxygenation is abnormal or low, at least in the trigger point area of the muscles. Department of Anesthesiology University Hospital Linkoping, Sweden 86179698 Bengtsson A Henriksson KG Larsson J Muscle biopsy in primary fibromyalgia. Light-microscopical and histochemical findings. SCAND J RHEUMATOL 1986; 15(1):1-6 Seventy-seven muscle biopsies from 57 patients with primary fibromyalgia and 17 biopsies from 9 healthy controls were examined by routine histopathological and histochemical methods. All patients fulfilled strict diagnostic criteria. 42 biopsies from patients were deemed normal or borderline, while 35 showed discrete pathological changes (degeneration, regeneration, inflammatory infiltrates, ragged red fibres, and 'moth-eaten' fibres in muscles other than m. trapezius). Biopsies from controls were normal or borderline in 14 and showed mild focal abnormalites in 3 cases. 'Moth-eaten' fibres were found in 35 of 41 trapezius biopsies taken from patients and in 9 of 10 trapezius biopsies from controls. Ragged red fibres were found in 15 of 41 trapezius biopsies taken from patients. In the deltoid muscle, 'moth-eaten' fibres were found in 3 and ragged red fibres in 2 of 9 biopsies from patients. Frequency of type I and type II fibres and the area of muscle fibres were the same in patients as in controls. Capillary density was the same in both groups. These changes, although not sufficient to constitute a diagnostic test for PF, indicate that this condition has an organic basis. Department of Internal Medicine University Hospital Linkoping, Sweden *****SEMINARS IN ARTHRITIS AND RHEUMATISM***** 82017257 Yunus M Masi AT Calabro JJ Miller KA Feigenbaum SL Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. SEMIN ARTHRITIS RHEUM 1981 Aug; 11(1):151-71 Detailed clinical study of 50 patients with primary fibromyalgia and 50 normal matched controls has shown a characteristic syndrome. Primary fibromyalgia patients are usually females, aged 25-40 yr, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety, poor sleep, headaches, irritable bowel syndrome, subjective swelling in the articular and periarticular areas and numbness. Physical examination is characterized by presence of multiple tender points at specific sites and absence of joint swelling. Symptoms are influenced by weather and activities, as well as by time of day(worse in the morning and the evening). In contrast, symptoms of psychogenic rheumatism patients have little fluctuation, if any, and are modulated by emotional rather than physical factors. In psychogenic rheumatism, there is diffuse tenderness rather than tender points at specific sites. Laboratory tests and roentgenologic findings in primary fibromyalgia are normal or negative. Primary fibromyalgia should be suspected by the presence of its own characteristic features, and not diagnosed just by the absence of other recognizable conditions. This study has also shown that primary fibromyalgia is a poorly recognized condition. Patients were usually seen by many physicians who failed to provide a definite diagnosis despite frequent unnecessary investigations. A guideline for diagnosis of primary fibromyalgia, based upon our observations, is suggested. Management is usually gratifying in these frustrated patients. The most important aspects are a definite diagnosis, explanation of the various possible mechanisms responsible for the symptoms, and reassurance regarding the benign nature of this condition. A combination of reassurance, nonsteroidal antiinflammatory drugs, good sleep, local tender point injections, and various modes of physical therapy is successful in most cases. *** *** *****CLINICAL AND EXPERIMENTAL RHEUMATOLOGY***** 85177845 Burda CD Immunoglobulin-G deposits at the dermal-epidermal junction in secondary (traumatic) fibromyalgia syndrome [letter] CLIN EXP RHEUMATOL 1984 Apr-Jun; 2(2):195 87079079 Burda CD Cox FR Osborne P Histocompatability antigens in the fibrositis (fibromyalgia) syndrome. CLIN EXP RHEUMATOL 1986 Oct-Dec; 4(4):355-8 HLA antigen Class I (A, B, C) and II (DR) were determined in a small group of fibrositis (fibromyalgia) patients and normal controls. Sixty-seven percent of fibrositis patients had DR4 versus 30% of normal controls. There was also an increased relative risk (4.5). No statitical significance of other Class I and II antigens in fibrositis was found. Department of Medicine Schumpert Medical Center Shreveport Louisiana. *****COMPREHENSIVE THERAPY***** 84284045 Yunus MB Primary fibromyalgia syndrome: current concepts. COMPR THER 1984 Aug; 10(8):21-8 PFS is a characteristic and clinically recognizable rheumatologic syndrome. It is a very common condition, but only recently has investigational interest grown in this interesting syndrome. PFS should be diagnosed by its own characteristic features and not merely by excluding other conditions. Pathophysiology of PFS is not well understood at this time and needs further study. Sleep EEG studies in PFS have revealed disturbed non-REM sleep, and normal volunteers deprived of non-REM sleep develop many features of non-REM sleep develop many features of PFS, including musculoskeletal aching, tenderness, and fatigue. Psychologic studies have shown that only a subset of PFS patients have shown that only a subset of PFS patients are significantly disturbed as determined by MMPI scores, and PFS patients as a group are more stressed than RA patients and normal controls as measured by Holmes-Rahe Life Events Inventory. It appears that chronic anxiety-stress causes muscle spasm that can be appreciated clinically in some patients and indirectly, possibly by electron microscopic findings of muscle biopsy. Likely role of other factors, e.g., constitutional, trauma, posture, and weather are also discussed. Biochemical transmitters of pain remain to be studied in PFS. Lack of a specific physical or laboratory finding should not deter acceptance of PFS as an entity, since such specific findings are absent in other similar and well-accepted conditions, e.g., irritable bowel syndrome, with which PFS shares many other common features, including muscle tenderness and spasm. PFS is different from psychogenic pain, and any implication by a physician that it is "all in the head" is certain to perpetuate chronic pain and disability.(ABSTRACT TRUNCATED AT 250 WORDS) 87029170 Sheon RP Regional myofascial pain and the fibrositis syndrome (fibromyalgia). COMPR THER 1986 Sep; 12(9):42-52 Medical College of Ohio at Toledo. *****HAREFUAH***** 86248963 Landau M Sigal M Alfisi S Weiner P [Primary fibromyalgia syndrome--a psychosocial analysis] HAREFUAH 1986 Mar 2; 110(5):227-30 (Published in HEBREW) *****IMJ. ILLINOIS MEDICAL JOURNAL***** 85130463 Layfer L Fibromyalgia (fibrositis). IMJ 1985 Feb; 167(2):131-2 *****IOWA MEDICINE***** 84034409 Menadue MC Kothari MK Primary fibromyalgia: a review and update. J IOWA MED SOC 1983 Aug; 73(8):314-5 *****JOURNAL OF INTERNATIONAL MEDICAL RESEARCH***** 87276854 Caruso I Sarzi Puttini PC Boccassini L Santandrea S Locati M Volpato R Montrone F Benvenuti C Beretta A Double-blind study of dothiepin versus placebo in the treatment of primary fibromyalgia syndrome. J INT MED RES 1987 May-Jun; 15(3):154-9 A double-blind study comparing the efficacy and tolerability of dothiepin with that of placebo in the treatment of primary fibromyalgia syndrome was carried out. Dothiepin was shown to improve significantly the condition of patients with primary fibromyalgia syndrome and there was a significant difference between dothiepin and placebo in all the clinical variables measured. Only mild and transient side-effects were reported. Further controlled studies are required to define the effects of dothiepin on fibromyalgia. Rheumatology Service L. Sacco Hospital Milan Italy. *****ORTHOPEDIC NURSING***** 87230481 Smeltzer KJ Fibromyalgia: the frustration of diagnosis and management. ORTHOP NURS 1987 May-Jun; 6(3):28-31 *****PAIN***** 87230435 Ahles TA Yunus MB Masi AT Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome. PAIN 1987 Apr; 29(1):105-11 The responses of 45 primary fibromyalgia syndrome (PFS) patients, 29 rheumatoid arthritis (RA) patients and 31 healthy non-pain controls (NC) on the Zung Self-Rating Depression scale were compared. No difference between the PFS and RA groups was found, although the former has no known organic pathology, unlike the latter. Therefore, the hypothesis that the presentation of chronic pain in the absence of a known organic pathology is a variant of 'depressive disease' was not supported in the case of PFS. However, a subgroup of PFS (28.6%) and RA (31.0%) patients appeared to be experiencing significant depressive symptomatology. Department of Psychiatry and Behavioral Medicine University of Illinois College of Medicine Peoria. Connect Time = 12.63 Minutes Connect Time Charge @ $16.00/HR 3.37 Communications Charge @ 6.00/HR 1.26 Search Element @ .10 .50 Reference Print @ .10 5.80 Title Scan @ .05 1.10 Abstract Display @ .10 .10 Abstract Print @ .10 3.50 Total Search Cost $ 15.63 Printing done. Please Deactivate, Then Press .