Recent research suggests that alcohol consumption may affect the quality of life and the severity of symptoms associated with fibromyalgia, an affective disorder often characterized by chronic pain in widespread areas of the body, joint stiffness and depression, among other symptoms. Published in Arthritis Research and Therapy, the findings are the result of a study by a team of researchers from the Mayo Clinic (AZ, USA) and the University of Michigan (MI, USA). Although previous research has examined the relationship between alcohol consumption and the symptom severity and quality of life associated with other ailments, this is the first study to examine its affect on a chronic pain disorder.
To obtain their results, the team analyzed data on alcohol consumption provided by a total of 946 patients diagnosed with fibromyalgia. The patients were then assigned to one of four groups based on their self-reported average weekly consumption of alcoholic drinks. A total of 546 patients (58%) were assigned to the ‘none‘ group (those who consumed no alcohol); 338 (36%) were assigned to ‘low‘ (those who consumed three or fewer alcoholic drinks per week); 31 (3%) were assigned to ‘moderate‘ (those who drank between three and seven alcoholic drinks per week); and 31 (3%) were assigned to ‘heavy‘ (those who consumed more than seven alcoholic drinks per week).
Adjusting for factors such as employment status, education level, BMI and opioid use, the researchers compared the number of reported painful areas on each patient‘s body, their physical functioning, duration of work missed, ability to work and their perception of pain, as well as other health-related and social factors between members of each group. Comparing the responses, the team demonstrated that individuals in the low and moderate alcohol consumption groups reported a better physical quality of life and a lower severity of symptoms associated with fibromyalgia than those who consumed no alcohol.
Lead researcher Terry Oh (Mayo Clinic) spoke to Pain Management to discuss the implications of their work. He highlighted that the findings of this study correlate with those from previous research into rheumatoid arthritis, which “suggest that moderate alcohol consumption may decrease its severity and progression.”
However, he also clearly pointed out the limitations of the research, pointing out that the results should not be taken to mean that “everybody with fibromyalgia should start drinking.” He explained that owing to “retrospective and cross-observational nature” of their study, they could not “prove whether alcohol consumption affected symptom severity or quality of life.” As further caution, he mentioned that “alcohol abuse was found to be one of the most frequent psychiatric problems in patients with chronic pain,” and that a “significant portion of chronic pain patients had a history of alcohol abuse before the onset of their pain.” He also pointed out that the same association between symptom relief and alcohol consumption was not observed “in patients with heavy consumption.”
However, he believes the findings of this study merit further research, to better understand “the association and mechanisms” underlying the suggested association between fibromyalgia symptom severity and alcohol consumption. In future, the team may consider “assessing the relationship between GABA, alcohol consumption and fibromyalgia symptoms,” using “a prospective, randomized controlled study with a larger sample size.”
– Written by Michael Mansbridge
Source: Kim CH, Vincent A, Clauw DJ et al. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Res. Ther. 15(2), R42 (2013).
Nerve mapping technology may be useful in compressed nerve surgery. The results of a small study, announced at the American Academy of Orthopedic Surgeons Annual Meeting in Chicago (IL, USA), suggest that the use of a technique called mechanomyography (MMG) may be useful in measuring nerve function and determining if a patients nerves are compressed. Discussing the results of the study, the lead author, Stephen Bartol from Henry Ford Hospital (MI, USA) said, “Traditionally, when we operated on someone who has nerve decompression, we didn‘t know if we had done enough during the surgery at the time. It was basically wait and see after the patient recovered. With the MMG tool we can differentiate between normal and compressed nerves, and gauge the severity of the compression.” MMG detects muscle movement and is able to send a real-time alert to an operating surgeon; this allows doctors to measure the performance of a nerve during surgery. Bartol believes that this information can be used by surgeons to ensure that surgery is adequate to treat a compressed nerve while removing the need for additional surgery.
In this small study, the researchers examined the electrical threshold of stimulation of 64 nerves in 41 patients before and after decompression procedures. Before decompression surgery, it was found that 89% of nerves had a raised threshold of stimulation and that following the procedure, all 64 nerves had an improvement in MMG response. While Bartol did caution that further studies were required following this small study, the research team is hopeful that MMG may become a useful tool for assisting surgeons when making operating room decisions.
–Written by Sean Fitzpatrick
Source: Henry Ford Health System. Nerve mapping technology improves surgery for compressed nerves: www.henryford.com/body.cfm?id=46335&action=detail&ref=1835
Lower back pain is a common ailment and can require many weekly clinic visits for physical therapy resulting in many hours – an expensive commitment. Researchers from the Tel Aviv University (Tel Aviv, Israel) suggest that simple aerobic walking programs work just as well as muscle strengthening programs run by rehabilitation clinics that require specialized equipment. The aerobic program consists of walking between two- and three-times a week for 20–40 min.
Michal Katz-Leurer and Ilana Shnayderman (Tel Aviv University) have suggested a treatment option that can easily be incorporated into a daily routine and also allows sufferers of back pain to have more control over their own health.
Past research has shown that back and abdominal muscles work in the same way when people walk actively as when they undergo specific exercises that target the area. Walking is an exercise that can be carried out alone and is a simple exercise whereas the specialist exercise programs require supervision.
The study comprised researchers enrolling 52 patients diagnosed with lower back pain into a randomized controlled trial. The patients were assessed for pain levels, avoidance of daily activities and feelings of disability through questionnaires. The patients were also questioned on walking and muscle endurance.
The participants were split into two groups; the first were placed onto a typical muscle strengthening program used by clinics with up to three exercises a week for 6 weeks, the second group went through an aerobic walking program that lasted 6 weeks, walking up to three-times a week. Patients were started on 20 min of walking and as their endurance grew this progressed to 40 min.
Results demonstrated that both groups showed improvements in all areas of the assessment which, according to Katz-Leurer, showed that their walking program was “as effective as treatment that could have been received in the clinic.”
– Written by Priti Nagda
Sources: Shnayderman I, Katz-Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clin. Rehabil. 27(3), 207–214 (2012); American friends Tel Aviv University newsroom. Walking away from back pain: www.aftau.org/site/News2?page=NewsArticle&id=18129
The European Commission has approved a patch label amendment for the 8% capsaicin patch. There are now extended options available for pretreatment before the use of the patch. Now, prior to application of the patch, patients can ingest an oral analgesic or the area to be treated can be pretreated with topical analgesics.
The patch itself, named Qutenza® (Astellas Pharma Europe Ltd, Surrey, UK) is a cutaneous patch developed for the treatment of peripheral neuropathic pain in Europe. It is the first and only high-concentration (8%) capsaicin patch licensed for the indication.
Peripheral neuropathic pain is a difficult-to-treat condition and has a negative effect on the quality of life of the sufferer. It is most often caused by a disease or lesion to the peripheral somatosensory nervous system.
The 8% capsaicin patch has been approved for the treatment of peripheral neuropathic pain, for use in nondiabetic adults, and has been approved for use in 21 countries in Europe.
The submission to the regulatory body was supported by LIFT study data, which aimed to investigate the use of an oral analgesic as a different option of pretreatment for the capsaicin patch.
The study comprised patients that were either randomized to receive tramadol tablets (oral analgesic) or an application of lidocaine cream (topical analgesic) before the 8% capsaicin patch was applied. Patients were treated with the patch for 60 min with a follow-up period of 7 days where tolerability and pain scores were monitored. The LIFT study set the end point being defined as a patient who used the capsaicin patch for 90% of the duration that the patch was intended to be worn.
– Written by Priti Nagda
Source: Astellas Pharma Europe Ltd newsroom. European Commission approves new pre-treatment options for QUTENZA™ (8% capsaicin patch) in peripheral neuropathic pain: www.presseportal.de/pm/61801/2433374/european-commission-approves-new-pre-treatment-options-for-qutenza-tm-8-capsaicin-patch-in
Evidence has been collated by researchers at the Georgetown University Medical Center (Washington, DC, USA) that suggest war veterans suffering from Gulf War illness (GWI) undergo physical changes in their brains that are not seen in individuals without the condition. Brain scans of 31 veterans with GWI were compared with the brain scans of 20 control subjects. The scans of the GWI-suffering veterans showed abnormalities in nerve fiber bundles connecting areas of the brain engaging in the processing of fatigue and pain.
This research provides the potential to further the understanding of the inexplicable medical symptoms that were reported by more than a quarter of the 697,000 veterans who were sent to combat in the Persian Gulf War of 1990–1991. The symptoms encompassing GWI range from mild to severe and debilitating including headache, widespread pain and fatigue, as well as gastrointestinal and cognitive dysfunctions.
Researchers have yet to definitively link a single causative agent or an underlying mechanism to GWI, even though the veterans were exposed to toxic chemicals, nerve agents and pesticides during their deployment.
The research produced by the scientists working at Georgetown University Medical Center is the first to demonstrate that veterans have significant axonal damage compared with unaffected individuals. In particular, damage to the right inferior fronto–occipital fasciculus was found to significantly correlate with the severity of tenderness, pain and fatigue.
The lead author of the study, Rakib Rayhan (Georgetown University Medical Center), explains how this damage can explain what is seen in veterans, “This tract of axons links cortical gray matter regions involved in fatigue, pain, emotional and reward processing. This bundle also supports activity in the ventral attention network, which searches for unexpected signals in the surrounding environment that may be inappropriately interpreted as causing pain or being dangerous. Altered function in this tract may explain the increased vigilance and distractibility observed in veterans.”
Researchers used diffusion tensor imaging (a form of functional MRI) which works by examining water diffusion patterns in the brain in order to seek changes in the integrity of white matter – which is not seen in regular MRI scans. James Baraniuk (Georgetown University Medical Center), the senior investigator on the study, explains the impact these scans have on their understanding of GWI, “While we can‘t exactly tell how this tract is affected at the molecular level – the scans tell us these axons are not working in the normal fashion.” Rayhan explains that “The changes appear distinct from multiple sclerosis, major depression, Alzheimer‘s disease and other neurodegenerative diseases,” and that “pain and fatigue are perceptions, just like other sensory input, and [GWI] could be due to extensive damage to the structures that facilitate them.”
The results are preliminary and need to be replicated, but the study authors are encouraged by the outcome, as it is the first time a potential biomarker for GWI may exist and there is also a chance of possible therapeutic avenues aimed at regenerating the damaged neurons.
The study also highlights the plight of the veterans plagued with the condition, “Some of the veterans we studied feel pain when doing something as simple as putting on a shirt. Now we have something to tell them about why their lives have been so greatly affected.”
– Written by Priti Nagda
Sources: Rayhan RU, Stevens BW, Timbol CR et al. Increased brain white matter axial diffusivity associated with fatigue, pain and hyperalgesia in Gulf War illness. PLoS ONE 8(3), e58493 (2013); Georgetown University Medical Center. Researchers link gulf war illness to physical changes in brain fibers that process pain: http://explore.georgetown.edu/news/?ID=69591&PageTemplateID=295