Here is some of the information I recently shared in my July newsletter. Each newsletter has a specific focus.  This month is focused on fibromyalgia and Chronic Pain information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.

Tidbits, Updates and Resources:

1.Five myths about pain that many manual therapists are sick of Hearing by Nick Ng (can be found in Massage & Fitness Magazine).

• I need an x-ray or scan to detect the source of my back pain
• Pain science doesn't apply to acute pain from an injury
• Pain science can help explain someone's pain experience
• Pain science is compatible with the tissue-plasticity model
• Psychosocial factors are only important in people experiencing ongoing or persistent pain

2.  3 steps to be an even more effective pain relief therapist by Irene Diamond--a 45 minutes video of a webcast.

STUDIES, ARTICLES, AND RESOURCES

I receive a weekly update on anything published anywhere on the internet that includes information about fibromyalgia and chronic pain. If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along: info@holistichealingarts.net

1. A study titled"Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis by Yuan, Matsutani & Marques and publish in Apr 2015 in Man Ther concluded: “myofascial release had large, positive effects on pain and medium effects on anxiety and depression in contrast with placebo…myofascial release also improves fatigue, stiffness and quality of life. Connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life: and Swedish massage does not improve outcomes.

2. In a study in Sci Rep 2016 titled “Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomized placebo-controlled trial” concluded: Five cupping treatments were more effective than usual care to improve pain intensity and quality of life. However, the effects were small and cupping was not superior to sham cupping treatments, further research is warranted.

3. In a paper by Larimer Moseley, “Reconceptualizing Pain According to Modern Pain Science, published through the University of South Australia at BodyinMind.org, he argues that “the biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a reconceptualization of what pain actually is, and how it serves our livelihood. He suggests there are four key points:

1. That pain does not provide a measure of the state of the issues
2. That pain is modulated by many factors from across somatic, psychological and social domains
3. That the relationship between pain and the state of the tissues becomes less predictable as pain persists
4. That pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger.

4. A short summary of an article by John Quintner, titled “Evolution, Stress, and Fibromyalgia” adapted from Lyon P, Cohen M, Quinter J. An evolutionary stress-response hypothesis for Chronic Widespread Pain (Fibromyalgia Syndrome). Pain Med 2011;12:1167-1178  suggests a Stress Response and Substance P response in combination may explain the disparity in symptoms and why many treatments have not been effective.

5. A follow-up article to the above reference, titled “How did fibromyalgia ever become a brain disease? Disentangling conjecture and truth, by John Quintner, debunks the Central sensitivity syndromes theories.

6. A study published in Scientific Reports titled Functional Brain Network mechanism of Hypersensitivity in Chronic Pain, and summarized by Haley Otman at Medical press, titled Does an exploding brain network cause chronic pain? suggests “as opposed to the normal process of gradually linking up different centers in the brain after a stimulus, chronic pain patients have conditions that predispose them to linking up in an abrupt, explosive manner.”

7.  A study titled “Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials", published in Biomed Res Int 2017, concludes: aerobic and muscle-strengthening exercises are the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life.

8.  A narrative article, published in Minerva Anestesiol Jan 2018, titled  "The role of cannabinoids in pain control: the good, the bad and the ugly” concluded: cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic non cancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain. Cannabinoids seem to work no better than placebo for visceral pain and conferred only modest analgesic effect in cancer pain.

9.  A study published in Turk J Med Sci Dec 2017, titled “Does fibromyalgia have an effect on hearing loss in women?” concludes: results point to a pathophysiologic link between fibromyalgia and the development of audiological abnormalities in these patients.

10.  A study published in Complement Ther Med Feb 2018 titled “Effect of whole body cryotherapy interventions on health-related quality of life in fibromyalgia patients: a randomized controlled trial” concludes: Whole body cryotherapy can be recommended as an effective clinically adjuvant approach in the improvement of health-related quality of life in fibromyalgia patients.”

Alternative Health Arena

1. A study, titled “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial", published Mar 2018 in BMJ, concludes: Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise…for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement.”

2.  A study, titled “Reiki is better than placebo and has broad potential as a complementary health therapy", published in J Evid Based Complementary Altern Med Oct 2017, concludes: found reasonably strong evidence for Reiki being more effective than placebo.”

Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The six main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, cupping and lymphatic drainage and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.

PLEASE NOTE: This is the last edition of the Fibromyalgia newsletter. This newsletter will be converted to a newsletter with a focus on chronic pain conditions rather than the narrow focus of fibromyalgia.

Excerpt:

Tips & Tidbits

1. Patients with fibromyalgia show significantly lower levels of serum vitamin D than those of a control group.
2. Here is a link to the Revised Fibromyalgia Impact Questionnaire (FIQR)

Studies, Articles, and Resources

1. A study titled “A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia” by Liptan, Mist, Wright, Arzt & Jones, published in Journal of Bodywork and Movement Therapies concluded: between-group differences in symptoms and physical function did not reach statistical significance. There were no consistent focal areas of improvement for the Swedish massage group while the MFR group reported consistent pain reductions in the neck and upper back regions. A larger randomized controlled trial is called for.

2. In a study in Man Ther 2015 by Yuan, Matsutani & Marques, titled “Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis”, the authors concluded: myofascial release had large, positive effects on pain and medium effects on anxiety and depression at the end of treatment; myofascial release also improves fatigue, stiffness and quality of life; connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding stiffness, depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life; and Swedish massage does not improve outcomes.

3. In a study, published in Rheumatol Int. 2017 titled “A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial” concluded: exercises with and without connective tissue massage might be effective for decreasing pain, fatigue and sleep problem whereas increasing health status and quality of life. However, exercises with CTM might be superior in improving pain, fatigue, sleep problem, and role limitations due to physical health compared to exercise alone.

4. A study, published in J Pain Res. 2017, titled “Caffeine as an opioid analgesic adjuvant in fibromyalgia” concluded: caffeine consumption was associated with decreased pain and symptom severity in opioid users, but not in opioid nonusers, indicating caffeine may act as an opioid adjuvant in fibromyalgia-like chronic pain patients. This data suggest that caffeine consumption concomitant with opioid analgesics could provide therapeutic benefits not seen with opioids or caffeine alone.

5. A study published in Complement Ther Clin Prati in Aug 2017, titled “Effects of whole-body vibration therapy in pain, function and depression of the patients with fibromyalgia” concluded: Whole body vibration therapy is found to be effective in reducing symptoms of fibromyalgia.

6. A study published in Clin Biomech titled “Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study” concluded: Hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact on women. However, scapular kinematics did not change after the period of treatment. Although symptoms improved, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.

Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.

Excerpt:

Tips & Tidbits

1. An excellent description of fibromyalgia—published in 2012 and updated in 2013, can be found on Pain Research and Treatment, titled Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis and Treatment
2. An excellent article, published in Arthritis Research and Therapy in 2013, focused on the often forgotten aspect of fibromyalgia—Fatigue. Beyond pain in fibromyalgia: insights into the symptom of fatigue.
3. In January 2016, the biotech research company, Premier Biomedical, filed for a provisional patent for a second drug to treat fibromyalgia.
4. An article summarizing the results of a study published in Arthritis Care Research in 2015 found two distinct subgroups in fibromyalgia symptoms: those who demonstrated widespread significant pain and those who demonstrated less pain but more fatigue. It points to the need for individualized treatment protocols
5. New Headgear Device Delivers Pain Relief for Fibromyalgia and Migraine. The device has been studied for eight years with positive results and has been approved for sale as a medical device. However, it is currently only available in the European market. The PainX headgear works by either controlling perception of pain or altering the reaction to pain
6. A study looked at the relationship between fitness, fatness and cognitive function and found a definite correlation between fitness and cognitive function but no relationship between fatness and cognitive function.
7. Innovative Med Concepts announced that the Food and Drug Administration (FDA) has granted Fast Track designation to IMC-1 for the treatment of fibromyalgia. IMC-1 has successfully completed a randomized, double-blind, placebo-controlled Phase 2 study (PRID-201) in patients with fibromyalgia. The study was designed to confirm the hypothesis that latent herpes virus may have a role in fibromyalgia symptoms or recurrence. Suppression of chronic tissue-resident herpes virus, the mechanism of action of IMC-1, may significantly improve fibromyalgia-related symptoms. The company is currently working with the FDA to meet all the necessary requirements for the initiation of Phase 3 trials for IMC-1 in fibromyalgia. IMC-1 is a fixed-dose combination of famciclovir, an antiviral nucleoside analog, and celecoxib, a COX-2 inhibitor.
8. Leptin, an appetite-regulatory hormone, is also known to act as a proinflammatory adipokine. One of the effects of increased systemic leptin concentrations may be greater sensitivity to pain. Leptin appears to be a predictor of body pain both within- and between-individuals and may be a driver of generalized pain states such as fibromyalgia.
9. An article, published in 2016 in Current Molecular Medicine, focused on the association between fibromyalgia and bipolar disorder. Their conclusion: Overlapping neural circuits may underpin parallel clinical manifestations of both disorders. Fibromyalgia and BD are both characterized by functional abnormalities in the hypothalamic-pituitary-adrenal axis, higher levels of inflammatory mediators, oxidative and nitrosative stress as well as mitochondrial dysfunction. An overactivation of the kynurenine pathway in both illnesses drives tryptophan away from the production of serotonin and melatonin, leading to affective symptoms, circadian rhythm disturbances, and abnormalities in pain processing. In addition, both disorders are associated with impaired neuroplasticity (e.g., altered brain-derived neurotrophic factor signaling).

Studies, Articles, and Resources

1. A review of all studies regarding massage and fibromyalgia, published in Rheumatology International in Jul 201, found few controlled studies and those did have some flaws. However, short-term relief from pain with massage was found with all the studies and only one study found possible long term relief.
2. A study, published in Journal of Manipulative & Physiology Therapy in Feb 2009, Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial, found both MLD and CTM appear to yield improvement. However, manual lymph drainage might be preferred and have slightly more benefit.

Alternative and Complementary Approaches

1. A study, published in Clinical Rehabilitation in Jan 2011, A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients, found craniosacral therapy improved medium-term pain symptoms.
2. A study published in Feb 2016 in Acupuncture Medicine, titled Acupuncture for fibromyalgia in primary care: a randomized controlled trial, found: Individualised acupuncture treatment in primary care in patients with fibromyalgia proved efficacious in terms of pain relief, compared with placebo treatment. The effect persisted at 1 year, and its side effects were mild and infrequent.

Here is a brief summary of information I recently shared in my January newsletter. Each newsletter has a specific focus.  This month is focused on fibromyalgia information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.

TIDBITS & UPDATES

Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome-Prospective Clinical Trial has shown some promising results.

Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy

A study at the Monash Alfred Psychiatry Research Centre in Australia is looking at the possibility of using Transcranial Magnetic Stimulation for treatment.

A new study shows that fibromyalgia can cause car crashes

Treatments of low dose of growth hormone show promise

Fibromyalgia Tied to Hysterectomy, Gynecologic Disease.

Study shows the incidence of fibromyalgia after acute whiplash is very low.

STUDIES, ARTICLES, and RESOURCES

Women with Fibromyalgia Have Lower Levels of Calcium, Magnesium, Iron and Manganese in Hair Mineral Analysis

Beyond pain in fibromyalgia: insights into the symptom of fatigue

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

Children with fibromyalgia experienced significant improvements in pain and function without medications after an intensive program of physical therapy (PT), occupational therapy (OT), and psychosocial services, according to a new study

A randomized, double-blind, placebo-controlled phase III trial of duloxetine in Japanese fibromyalgia patients

No unusual activity with lactic acid seen in patients with fibromyalgia, migraine

A new study analyzed multiple areas of fibromyalgia including pain, brain characteristics, and medication efficacy, which resulted in some very telling conclusions. The authors behind the new research, published in the latest issue of The Journal of Pain, had several predictions

In the Alternative Health Care Arena

Several double blind studies suggest that Melatonin might also help in combating Fibromyalgia pain.

Food intake assessment and quality of life in women with fibromyalgia

In a recent Cochrane review, which captured the most updated evidence on the topic, the researchers found that resistance training improves multidimensional function, pain, tenderness, and muscle strength in women with FM.

A new study reveals increasing activity levels helped the women reduce their pain.

Those experiencing wide-spread pain, such as caused by Fibromyalgia, have a new friend.

In a study of 2239 people with chronic widespread pain in the UK, those participants who drank a moderate amount of alcohol had less disability than those who did not drink- by a significant margin of 67%. So, what defined a moderate amount of alcohol? 1-2 drinks per day, such as 1 pint of beer, one small glass of wine or 1 shot of liquor. And, no, if a little is good, a little more is not better.

Doesn’t this press release sound like something too good to be true? Well, maybe.

The study results, published in Arthritis Care & Research, Moderate Alcohol consumption is associated with lower risk (and severity) of chronic widespread pain: Results from a UK population-based study, was initially proposed to determine if alcohol consumption was associated with a likelihood that alcohol would increase the level of disability. To the surprise of the researchers, the research found just the opposite—that moderate intake of alcohol actually decreased the disability. There are a number of flaws with the study, including confounding factors that might impact the results of the study, such as age, weight, gender, cigarette smoking, and level of isolation.

This is an example of how the media can give misleading or misunderstood information. The Press release does not include any of the weaknesses of the study but just focuses on the fun and media worthy aspects of the study.

So, should a person with widespread pain disorders, such as fibromyalgia, add a couple of drinks a day to their dietary intake? I think we need to take this information slowly and realize in moderation, some people may find alcohol in very moderate amounts can help decrease the disability of chronic pain, but for others, the risks of drinking alcohol may outweigh any benefit that might occur.

As always, when health information is splashed across the media, we need to realize that the whole story may not be sexy or fun or even interesting and so when information is the focus of the media release may not be the best information to make decisions about our health.

So, if you enjoy a drink in moderation, nothing indicates it will increase your pain. And, if you don’t choose to drink alcohol, nothing yet suggests that you should change your practices or your choices.

Citation: Macfarlane, Gary J. & Beasley, Marcus. “Moderate Alcohol Consumption is Associated with Lower Risk (and Severity) of Chronic Widespread Pain: Results from a UK Population-based Study,” Arthritis Care & Research, American College of Rheumatology at Wiley Online Library. http://onlinelibrary.wiley.com/doi/10.1002/acr.22604/abstract

Here is some of the information I recently shared in my June newsletter. Each newsletter has a specific focus.  This month is focused on fibromyalgia information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.

• Type 1: high levels of pain and severe mental and physical impairment
• Type 2: high levels of pain and several physical impairments
• Type 3: moderate levels of pain and high levels of mental impairment
• Type 4: moderate levels of pain and moderate levels of mental and physical impairment
• Type 5: Similar to the general population

3.  Following a post-market Phase 4 study evaluating LYRICA’s effectiveness as a treatment for fibromyalgia in adolescents, it has been determined that Lyrica is ineffective as a treatment in this population.