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	This site features information on a variety of back pain conditions, distinguishing neuropathic from nocicpetive pain, and chronic from acute back pain. The site explains the possible causes of the conditions and how the diagnoses are made. Treatment options discussed range from non-surgical—such as acupuncture, exercise, medications, and physical therapy&mdash;to surgical

	treatments, including minimally invasive discectomy, spinal fusion surgery, and laminectomy. Each is described through a step-by-step process, with some descriptions including diagrams and illustrations. Articles like “What Treatment Is Right for You?” or “Chicken Noodle Soup for Low Back Pain,” review the latest research and provide lifestyle tips for those suffering from

	chronic back pain. Additionally, Back.com offers tools, such as the “Back Pain Tracker,” which serves as a 7-day journal that can be used to track pain.

Acute Back Pain vs. Chronic Back Pain Video

	The video housed at this site describes, in detail, the differences between acute and chronic back pain. Dr. Peter F. Ullrich, Jr.,

	reviews “the causes of chronic pain and the different ways it can be treated.” Although the site focuses mainly on spine issues, much information is dedicated to chronic back pain. Featured in the “Managing Chronic Back Pain” article are a number of tips and coping techniques, covering such topics as eating right and getting enough sleep.

	Learning some simple exercise techniques can help those who suffer from chronic back pain. This video highlights the pelvic tilt, which “strengthens the lower abdominal muscles and stretches your low  ack (lumbar spine).” The exercise requires the patient to lay on their back with knees bent and feet fl at on the fl oor. Next, he or she must “contract their abdominal muscles,

	pushing their belly button towards the fl oor and fl attening their lower back.” This should be held for five seconds and repeated 10 times. The site recommends receiving permission from a qualifi ed spine specialist before attempting the exercise.

	“The mission of the OrthoGate Project is to improve orthopedic care, education and research using Internet technologies.” In doing so, the site provides physicians with access to numerous peer-validated Internet resources, as well as news on the industry, recent literature, new products, and articles.

	Based on the popular Wikipedia model, this site allows users to view and submit pages on relevant orthopedic topics in an encyclopedic manner. As with Wikipedia, much of the information found here can be trusted, but users should be wary of the accuracy of it all, as content is user-generated. Topics range from musculoskeletal medicine to joint reconstruction. The site claims to be a “knowledge sharing portal for orthopedics and musculoskeletal health.” Physicians can also share videos, power points, talks, and more.

Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back

 A Randomized, Double-blind, Controlled Trial with a 2-year Follow-up

International Journal of Medical Sciences

 To “determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin.”

 Researchers concluded that “therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.”

Importance of Fear-avoidance Behavior in Chronic Non-specifi c Low Back Pain

 “The aim of this article is to describe the importance of fear avoidance behavior and to evaluate the immediate effect of cognitive behavioral therapy (CBT) during evaluation of patients with CLBP.”

 A physical examination of a 24-year-old female patient with CLBP, was performed. The patient exhibited “painful guarded movements over the lumbo-pelvic region, but the outcomes of her Fear-Avoidance Belief Questionnaire (FABQ) showed strong cues for psychological illness.” The patient was educated on cognitive reconstruction and “after some CBT sessions, her spine guarding pattern disappeared.” The researchers concluded that by “using biopsychosocial training, positive results in fear avoidance behavior can be achieved.”

painACTION-Back Pain: A Self-Management Website for People with Chronic Back  Pain

 “To determine whether an interactive self-management Website for people with chronic back pain would signifi cantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials.”

 The team concluded that an “online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement.”

Acupuncture Therapy for Chronic Lower Back Pain: a Systematic Review

Annals of the Royal College of Surgeons of England

 “The aim of this systematic review was to evaluate if this treatment option is justified in view of recent evidence available on the efficacy of acupuncture.”

 The researcher concluded that “NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment  option for chronic low back pain, are justified.”

Patients’ Experiences of the Impact of Chronic Back Pain on Family Life and Work

 “This study investigates how individuals experience pain and its consequences for family life and work.”

 The results demonstrated that there were emergent themes, such as relationships with spouses and partners (n=7), children/parents (n=6), other family and friends (n=7), and with work-related issues (n=11). “Patients expressed anxiety about how their pain affected and other family members, regret at losing full work capacity and worry about fi nancial consequences.”

Telehealth Outreach for Chronic Back Pain

 This double blind, randomized, six- month clinical trial will evaluate the  effectiveness of using telephone-delivered therapy on patients with chronic low back pain of non-neoplastic origin.

Efficacy of Antidepressants in Chronic Back Pain

 “This 12 week placebo controlled clinical trial tests the individual and combined effects of an antidepressant medication and cognitive behavioral therapy for chronic

	Developed from the venom of cobra snakes, this over-the-counter medicine releases its fangs on low back pain, shoulder pain, cramps, migraine, and more. Direct your patients to the offi cial site to learn about potential side effects, directions on how to properly use the medication, history of the creation of the product, and more. Visitors can also watch a video featuring an interview on the product featured on the TV show, “The Balancing Act.” appearing on Lifetime. The product is sold as a topical gel or an oral spray.

Cobratoxin Inhibits Pain-evoked Discharge of Neurons in Thalamic Parafascicular

	Nucleus in Rats: Involvement of Cholinergic and Serotonergic Systems

 To “investigate the inhibitory effect of cobratoxin (CTX) on pain-evoked discharge of neurons in thalamic parafascicular nucleus (Pf) of rats.” It also “analyzed some of the mechanisms involved in this effect.”

 Researchers concluded that CTX “has a dose-dependent inhibitory effect on pain-evoked discharges of Pf neurons.” The results confi rmed “electrophysiologically the antinocicpetive actions of CTX.” They also found that CTX “has a longer duration compared to morphine.”

Articles

Cover Story

A collection of links and resources from across the web focused on one specific condition. These resource range from useful websites to clinical trials. 

Net Guide: Chronic Back Pain

	More than 200 years have passed since the discovery of morphine in 1804  (

). Although the management of pain has come a long way—incorporting new technologies and featuring more diverse pharmacologic solutions&mdash;the price of seeking relief still comes with many of the same consequences, mainly in the form of addiction. Now, more than ever, with easy access to pain medication and higher prescribing rates due to the recognition of pain as a specific medical subfi eld, the problem of addiction is growing, leaving physicians and biochemical researchers looking for solutions. Within the last decade, they’ve been turning to natural compounds and investigating the phenomena of pain at the cellular level, in an attempt to develop new classes of non-addictive pain medications. But, the road hasn’t been easy.

	In 2008, the industry was abuzz with news of a new development in the understanding of pain sensation involving nerve growth factor (NGF; 

). Pfizer developed tanezumab, which had been shown to be effective in an initial study of patients suffering from osteoarthritis (OA) of the knee. The drug stood out as a non-addictive biologic agent; tanezumab is a humanized monoclonal antibody for NGF, which plays an essential role in nerve cell growth and maintenance. In the event of an injury, the level of NGF rises in the body and creates pain sensation. The drug was designed to act against NGF to prevent the increase in pain sensation during injury or in certain diseases.

	Tanezumab was in phase III clinical trials for osteoarthritis when it was abruptly halted by the FDA in June 2010 due to “reports that patients’ conditions worsened and led to joint replacements” (http://hcp.lv/cb9MNg). The drug was also being tested by Pfizer in separate trials for diabetic peripheral neuropathy and lower back pain. Drug companies Regeneron Pharmaceuticals and Ortho-McNeil-Janssen Pharmaceuticals have their own similar formulations in the works, but information was yet to be released on their progress at writing. Regeneron’s product, REGN-475, had completed phase II testing with results that indicated it had produced signifi cant improvements in patients with knee OA (

), while Ortho-McNeil-Janssen’s product, JNJ-42160443, is being used in a study that is currently recruiting patients with OA (

	Looking for solutions based on the body’s natural mechanisms may be the “next big thing” in research on a new class of biological pain relievers, but the latest developments with tanezumab indicate that much more needs to be uncovered (

	Found deep on the ocean floor among coral reefs are a group of marine creatures known for their intricately decorated shells and their toxic, immobilizing venoms (

). For centuries, these creatures have preyed on fish, worms, and

	crustaceans, but now their dangerous venoms, known to have a severe sedative effect, are also helping people suffering with pain. Researchers like Bruce Livett, a University of Melbourne biochemist, began studying the analgesic effects of these conotoxins several decades ago (

	Conotoxins work by targeting certain receptors and sensory nerves, but unlike opioids, don’t travel through the central nervous system. Conotoxins consist of neuroactive protein fragments, or conopeptides. Currently, Prialt (ziconotide), a synthetic omega-conotoxin, is available and FDAapproved to treat severe to intractable nerve pain (

). Ziconotide “inhibits presynaptic voltage-gated calcium channels and neurotransmission across nerve synapses” (

). The drug works by binding to the N-type calcium channel receptor, located on pain fibers within the spinal cord, and produces an “analgesic effect by inhibiting the firing of sensory fibers entering the dorsal laminar of the spinal grey matter.” Essentially, it prevents sensory fibers from shooting messages of pain to the brain, preventing the sensation.

	In a blog post on the introduction of ziconotide to the market, Lawrence M. Kamhi, MD, wrote, “in intrathecal ziconotide we appear to have the first of a new class of neuropeptide pharmaceuticals with potent pain-relieving proper-ties and a relatively

	safe profi le free from addictive properties and depression of consciousness and respiration” (

). The drug must be administered intrathecally, which may knock off some points in ease of use, but appears to be a viable option for

	addiction-free pain medication. Kamhi wrote that he fi rst became familiar with conotoxins through meeting Frank Mari, MD, associate professor, Florida Atlantic University. Mari is an expert in marine biology and biotechnology and has performed

	extensive research on conotoxins. Mari’s research mostly focuses on discovering new types of conotoxins and characterizing them, or uncovering their particular sequence, he says. What he fi nds interesting about studying cone snails and conotoxins is not just that each particular animal has its own unique venom, but that the research encompasses marine biology, intricate aspects of neuroscience, and the study of the central nervous system and the brain. “Basically, these conotoxins are molecular tools that can be used from many points of view and they are markers even within the field of studying venom and toxins,” he says, adding that the study of conotoxins has the potential to make a large impact on the fi eld of pain medicine.

	“Pain is an interesting fi eld, because there are all kinds of pain.” Ziconitide is an exemplary drug from many points of view, notes Mari, particularly, because it is the first drug of marine origin; it is a peptide that targets calcium channels; and it has to be administered intrathecally.

	Whereas the last point may not be ideal for patients, since they would have to have a pump surgically installed, he says the drug has garnered enough interest to warrant a spot on the market. “So, the next challenge is to fi nd a conotoxin or a conotoxin analogue that can be administered orally and there is signifi cant progress towards that,” says Mari. There are a few barriers that stand in the way of producing orally administered conotoxins, however. Most of the targets of conotoxins are in the brain, and “peptides like conotoxins usually do not go across the blood brain barrier very well.” Work is currently being done on producing orally viable conotoxins, he says, which will no doubt be “the next generation of conotoxins in terms of treatment of pain.”

	Another conopeptide pain drug is currently in clinical trials in Australia; pharmaceutical company Zenome has developed Xen2174, which belongs to the chi-conopeptides and targets the norepinephrine transporter. In addition to pain treatment, conotoxins are being studied for the treatment of Alzheimer’s disease, multiple sclerosis, addiction, and Parkinson’s disease.

	By studying chili peppers and their capsaicins, researchers at the University of Texas Health Science Center at San Antonio were able to discover a family of “endogenous capsaicins” in humans and develop two drugs designed to treat pain manifestation (

	Lead researcher Kenneth M. Hargreaves, PhD, professor and chair, Endodontics, UT Health Science Center at San Antonio, and colleagues discovered these endogenous capsaicins while studying the receptor known as transient potential vanilloid 1 (TRPV1), typically activated in the presence of injury or high heat. Chili peppers contain capsaicins that can cause a painful sensation by activating TRPV1 in humans; natural “endogenous capsaicins” are formed by pain cells in response to high heat or injury, his team discovered.

	Hargreaves identifi ed these capsaicin-like substances as oxidized linoleic acid metabolites (OLAMs). “We found that tissue injury, or heating skin or neurons, releases OLAMs that then activate the TRPV1 receptor,” he says. “In a sense, we discovered a family of endogenous capsaicins.” Hargreaves and his team developed two new drugs designed to block the synthesis of OLAMS or the antibodies that activate them. This finding, he says, is “important since it both teaches us about how our bodies respond to injury and infl ammation and reveals potentially novel approaches for treating pain.”

	Various studies that have used TRPV1 knockout mice or TRPV1 antagonists have provided “good evidence that this receptor is involved in many diverse types of pain,” he adds. These include inflammation, cancer pain, burn pains, and other chronic pain conditions. “Therefore, drugs that block OLAMs may constitute novel approaches for pain control,” he notes. Unlike opioids, these drugs do not have a chemical addiction factor. Hargreaves and his team also published a paper last fall that demonstrated anti-OLAM antibodies signifi cantly reduce mechanical pain (“allodynia”) in rats using the CFA model of infl ammation. These drugs, however, are not currently on the market.

	Although the addictive properties of opioids are well documented, their powerful effect on pain relief cannot be discounted. That’s why researchers around the world have their sights set on developing drugs that target glial cells in an attempt to stop tolerance and dependence at the source and keep the analgesic effect of opioids intact. Among these researchers is Haroon Hameed, MD, of Johns Hopkins Hospital, who recently co-authored the article, “The effect of morphine on glial cells as a potential therapeutic target for pharmacological development of analgesic drugs,” featured in the April issue of Current Pain and Headache Reports (

	Glial cells play an important role in providing support and maintaining the healthy function of neurons in the brain. However, opioids, including morphine, tend to over-activate glial cells, which in turn begin to oppose the pain suppression properties of the drugs. Opioids not only connect with the appropriate receptors, but also to glial cell receptors, which then leads to greater tolerance and dependence, affecting the addiction factor. Researchers have been working on methods to prevent opioids from stimulating glial cells in order to deliver pain relief without the side effects of addiction.

	Experimental drugs like AV411 work to block morphine’s effects on glial cells. Hameed studied the effects of this drug and others, including, MK-801, AV333, and SLC022, in the article he co-authored. “My research in this area has been inspired by the vast possible utility of these medications for the treatment of subacute and chronic pain,” Hameed says. “Our recent article in Current Headache and Pain Reports is a good place to start understanding the role of glia in mediating many of the unwanted effects of chronic opioid use—such as reward, hyperalgesia, and tolerance&mdash;as well as the possible new roles of many glia-modifying medications that might mitigate or possibly even reverse these opioid side effects.”

	Hameed says research into the fi eld may allow for a way to “effectively treat patients with low doses of opioids” without the need to adjust for tolerance or without the “serious side effects, such as reward, dependence, and hyperalgesia.” Whereas Hameed says research into glial cells is promising, he feels it will certainly take some time “before these medications are ready to be used by patients at-large.”

	The trouble with producing on-addictive drugs The CDC reported that between 1999 and 2006, “the number of poisoning deaths in the United States nearly doubled” (

), “largely because of overdose deaths involving prescription opioid painkillers.” Yet, the use of opioid analgesics remains high because of their indisputable effectiveness on pain relief. Also, research in the production of non-addictive drugs for moderate to severe pain is complex, according to Hargreaves.

	“Progress has actually been fast due to the concerted efforts of many labs; however, the translation of these findings into clinically useful non-addictive drugs has been slow.”

	Hargreaves says he believes the major barrier to research is in having a novel mechanism, or target, for development. The ideal target would not engage the central nervous system mechanisms, since that would increase the risk of activating central dopamine systems and produce analgesic tolerance, he says. Hargreaves believes the “OLAM system satisfies at least some of these criteria.”

	For Mari, the complex process of addiction is one of the main barriers in developing non-addictive pain drugs. “Opioid receptors are responsible in great part for all of these addiction problems,” he says. “They are good pain killers, but only last very shortly; after a while, some people develop tolerance to morphine, so they no longer get analgesia from it.” The alternatives currently are slim, he says.

	“Ziconotide is the fi rst major pain killer approved by the FDA in the past 25 years. So, it’s taken 25 years to come up with something that is better than morphine.” At least it’s better for certain patients, he notes, especially for those who no longer respond to morphine. “Ziconotide does not give you addiction because it works by a totally different mechanism. Basically, it’s by neuronal transmission, and all you’re doing is blocking the transmission at a level that has nothing to do with addiction.”

	Additionally, creating solutions targeted at a certain type of receptor, protein, or other biological component, without adversely affecting other biological components, is an issue, Hameed adds.

	“There is always a difficulty in producing receptor specific medications that do not also act on identical or like receptors in similar tissues. In the central nervous system, we are especially dealing with a great number of complex functions, including its perceptions and responses to internal and external stimuli in the form of immediate and adaptive responses.” Often times, opioids and other medications can unintentionally produce somatic effects, including dry mouth and constipation, and sensory effects that can alter the perception of pain, he says. “To counteract these unwanted effects, it appears that in the foreseeable future—when using opioids for acute, subacute, and chronic pain relief&mdash;we may need to use dual therapy, such as treatment with glia-modifying agents, to maximize their safety and effi cacy.”

	Whether the focus is blocking the transmission of pain signals by targeting certain substances and processes, blocking glial cells to maximize the analgesic effect of opioids, or using genomic sequencing to knockout certain players in the manifestation of pain, the research is on its way, and the goals are the same: to offer effective pain relief without the pitfalls of addiction.

More than 200 years have passed since the discovery of morphine in 1804  (http://hcp.lv/dCk9eP). Although the management of pain has come a long way-incorporting new technologies and featuring more diverse pharmacologic solutions-the price of seeking relief still comes with many of the same consequences, mainly in the form of addiction.

Addiction Be Gone! Non-addictive Pain Drugs Are on The Way

This site lays out the basics of postoperative pain, including when it can become an issue. As the site explains, when postoperative pain becomes “poorly controlled, the pain can cause increased heart and respiratory rate, anxiety, nausea and vomiting, urinary retention, and elevated adrenalin and cortisol levels, or reduced immune response and

increased risk of infection.” Send your patients here to learn about the causes and treatment options associated with this type of pain.

For a concise explanation of what to expect with postoperative pain, direct your patients to this Q&A section of Health Central. The article here explains how postoperative pain

is treated through the use of pain medications, “including opiates or narcotics, local anesthetics, and antiinflammatory medications.”

Here, patients can become well acquainted with efficient postoperative pain relief and the factors that aid in producing positive results. The site features a chart listing the advantages of “good postoperative pain relief” along with consequences of “poor postoperative care.” The site also lists common surgeries, such as lower abdominal surgery and major joint surgery, and relative expectations of when post-operative pain

Supplementing Relaxation and Music for Pain After Surgery

 To “test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain.”

 After patients “were randomized into four groups: PT, RM, a combination (PTRM), and a control,” researchers found that “RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease the pain without adding side effects.”

The Effect of Therapeutic Touch on Postoperative Patients

To evaluate the effect of therapeutic touch (TT) on “pain and behavioral markers in patients recovering from vascular surgery.”

The researchers found that “participants who received TT had a significantly lower level of pain, lower cortisol level, and higher NKC level.” They concluded that TT is a “beneficial intervention.”

Effect of Celecoxib Combined with Thoracic Epidural Analgesia on Pain After Thoracotomy

 British Journal of Anesthaesia (June 25, 2010)

 To evaluate the effect of celecoxib combined with thoracic epidural analgesia on pain following a thoracotomy.

 The team studied 40 patients “undergoing thoracotomy” through a prospective, randomized, double-blind, placebo-controlled study. Each patient was given general

anesthesia, and patient-controlled epidural analgesia was used during 48 hours after surgery. The patients either received oral celecoxib or placebo “from the evening before surgery until 48 hours after operation.” Results of the study demonstrated that the celecoxib group reported lower “postoperative pain scores at rest and during coughing.”

Effects of Guided Imagery on Postoperative Outcomes in Patients Undergoing Same-day Surgical Procedures: a Randomized, Single-blind Study

 Gonzales E, Ledesma R, McAllister D, et al

 “To evaluate the effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures.”

 The researchers studied 44 adults scheduled for head and neck procedures. The participants were “randomly assigned into 2 groups for the single-blind investigation,” with both groups received 28 minutes of privacy. The experimental group “listened to a guided imagery compact disk (CD)” and the control group patients “received no intervention.” The researchers collected data on “pain and narcotic consumption at 1- and 2- hour postoperative intervals.”

Results demonstrated that the guided imagery group experienced a significant decrease “in anxiety levels” and at two hours the group “reported less pain.” The “length of stay in PACU in the guided imagery group was an average of 9 minutes less than in the control group.”

Post-operative Pain Control Using Direct Continuous Bupivacaine Infusion After Pelvic Organ Prolapse Repair

“This prospective randomized controlled study will determine the efficacy of continuous local anesthesia at decreasing pain scores compared to patient controlled analgesia for pelvic organ prolapse procedures including posterior colporrhaphy and

Clinical Trial of Gabapentin to Improve Postoperative Pain in Surgical Patients

 This double blind, placebocontrolled study will evaluate the efficacy of  gabapentin in improving postoperative pain in surgical patients.

Effect of Oral Choline Supplementation on Postoperative Pain

 The study is designed to “test whether consuming additional choline before gynecological surgery decreases postoperative pain.”

Send your patients here to learn more about the 24-hour prescription medication for moderate to severe chronic pain. Visitors can learn more about how Ultram ER’s extended release technology delivers a lasting dose of tramadol for a total of 24-hours, how to properly take the medication, and possible side effects to look out for. There are also tips on managing pain through lifestyle changes, a checklist of questions to ask your doctor, safety information, and information for prescribers.

Effi cacy of Extended Release Tramadol for Treating Prescription Opioid Withdrawal

 “This study will determine whether two different doses of extended release tramadol can treat opioid withdrawal and whether tramadol itself produces withdrawal after it is no longer taken.”

The Discriminative Effects of Tramadol in Humans

 This study is designed to “to test whether tramadol can be used for the treatment of opioid addiction” at higher “doses than those generally used for the treatment of pain.” Researchers seek participants who are users of opioids and stimulants but not addicted to either.

Net Guide Post Operative Pain

Direct your patients to this site to review tutorials on fi bromyalgia. Visitors can choose from an interactive tutorial, a self-playing tutorial, or read the information via a text summary. Both the interactive and self-playing versions cover causes, symptoms,

treatment options, and self-care tips through more than 70 slides. The interactive version additionally requires patients to answer multiple-choice questions along the way. The site also offers access to the latest research, clinical trials, and patient handouts.

Patients can learn about the eight “Vicious Cycles that block Fibromyalgia” healing at this site. Richard Podell, MD, clinical professor, Robert Wood Johnson Medical School, maintains the site with relative information on fibromyalgia and chronic fatigue syndrome. The eight cycles include non-restorative sleep, disordered breathing rhythms, inactivity, magnesium loss, hormonal imbalances, blood-sugar instability, mind/body tension, and losing perspective; Podell offers advice and tips on avoiding these cycles.

Learning lifestyle changes and heeding the advice of medical professionals can make all the difference in living with fibromyalgia. But hearing from other patients who are managing their pain successfully certainly helps as well. Here, patients can receive lifestyle tips from their peers through reading the results of a number of patient surveys conducted by the fibromyalgia network. The surveys focus on such topics as “Managing Your Sleep,” “Employment and Income,” and “Coping with Flares.” Some surveys contain responses from as many as 5,000 members. Additionally, the site offers tips on coping, diet and exercise, and relationships, all based on research.

Debates and Directions in Fibromyalgia: Recognizing Signs and Selecting the Appropriate Paths

The objective of this activity is to help participants “improve diagnostic skills related to fibromyalgia and other forms of chronic pain” and “evaluate and address comorbidities in patients with fi bromyalgia.”

The Reality of Fibromyalgia: Pathways to Diagnosis, Therapy, and Quality of Life

This program is designed to “provide attendees with a thorough understanding of the pathology and epidemiology of fibromyalgia, FDA approved treatments for the condition, and patient management guidelines.” Upon completion, providers should be able to “better recognize and diagnose fibromyalgia, treat symptoms more effectively, and improve quality of life for patients affected by this disorder.”

Fibromyalgia: Overcoming Barriers to Diagnosis & Treatment

This course is designed to help physicians recognize “fibromyalgia as a multi-system disease associated with a number of objective abnormalities, a wide range of symptoms and comorbid conditions.” Proper diagnosis of fibromyalgia and guidelines for management are also covered.

A Painful Reality: Diagnosis & Treatment of Fibromyalgia & Comorbidities

This activity focuses on “diagnostic criteria for fi bromyalgia” based on established guidelines and “common comorbidities associated with fi bromyalgia.” Participants will also learn about the role of both pharmacologic and nonpharmacologic treatment for

Self-regulatory Defi cits in Fibromyalgia and Temporomandibular Disorders

 Solberg Nes L, Carlson C, Crofford L, et al

 To evaluate the practice of self-regulating in the treatment of fibromyalgia (FM). Since research “indicates that self-regulatory strength is a limited source that can be depleted or fatigued,” the current study is “aimed at demonstrating that patients with FM and temporomandibula (TMD) are vulnerable to self regulatory fatigue as a consequence of their condition.”

 The study included 50 patients and 50 controls. Both groups were “exposed to an experimental self-regulation task followed by a persistence task.” Patients with FM

and TMD “displayed signifi cantly less capacity to persist on the subsequent task compared with controls.” Additionally, “patients exposed to low self regulatory

effort displayed similar low persistence to patients and controls exposed to high self-regulatory effort.” This indicated that patients with chronic pain conditions may suffer

Pain Response Profile of Patients with Fibromyalgia Treated with Duloxetine

 Researchers sought to evaluate the amount of time required for patients with fibromyalgia taking an initial 12-week course of treatment with duloxetine to receive minimal clinically significant improvement.

 The researchers found that at endpoint, “46.9% of patients receiving 60 mg/d, 48.6% receiving 120-mg/d, and 32.1% of those receiving placebo had greater than or equal to 30% improvement on average from baseline.”

Atypical Depression Is More Common than Melancholic in Fibromyalgia: An  Observational Cohort Study

 To “determine whether major depressive disorder (MDD) with atypical features and MDD with melancholic features occurs in a FM sample and to describe their demographic, clinical, and diagnostic characteristics.”

 The study included a sample of “76 outpatients with FM from an academic Rheumatology clinic and a community mental health practice.” Results indicated that 11.8% of the patients were euthymic, 52.6% “met diagnostic criteria for MDD with atypical features,” and “35.6% for MDD with melancholic features.” Additionally,

“atypical depression was 1.5 times more common than melancholic depression.”

Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep

 To “evaluate the relationship between Fibromyalgia Syndrome and obesity in the multiple FMS-related domains: hyperalgesia, symptoms, physical abilities, and sleep.”

 The results indicated that “obesity in FMS was associated with greater pain sensitivity, poorer sleep quality, and reduced physical strength and fl exibility.” Additionally, “obesity may aggregate FMS.” The researchers suggest that “weight

management may need to be incorporated into treatments.”

Sustained Pain Reduction Through Affective Selfawareness in Fibromyalgia: A Randomized Controlled Trial

 The “randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia.”

 The study included 45 female participants with fibromyalgia. A group of 24 participants was randomized to a “manualized ASA intervention,” while the rest were placed in a “wait-list control” group.” “The intervention began with a one-time physician consultation, followed by three weekly, two hour group sessions based upon a mind-body model of pain.” The sessions used “structured written emotional disclosure and emotional awareness exercises. “According to the results, the “affective selfawareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fi bromyalgia compared to wait-list control.”

Coping Skills Training for Adolescents with Fibromyalgia

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

 “To determine whether coping skills training, when combined with usual medical care, can reduce pain and disability in adolescents with fibromyalgia.”

July 2010

Net Guide: Chronic Back Pain

Addiction Be Gone! Non-addictive Pain Drugs Are on The Way

Net Guide Post Operative Pain

Net Guide: Fibromyalgia