Fibromyalgia and Chronic Fatigue Syndrome

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ME(Myalgic Encephalomyelitis) & Chronic Fatigue Syndrome (and Fibromyalgia )
    (Over one million Americans experience ME/CFS symptoms
)

NEW

March 2018:

Feb 21 2018 105 Studies found for: Recruiting, Not yet recruiting, Available Studies | fibromyalgia

2018, June: Around $4 million funding for 5 years study of “Molecular and Single Cell Immunology of ME/CFS
Interesting listening to the video of Mark Davis -- T Cells either reacting to a pathogen
or to the body's own proteins( as in MS, Lupus, Rheumatoid Arthritis, Type 1 Diabetes....) .

 immunology and molecular biology

June 2018: no results found in COMPLETED trials WITH RESULTS advanced search of https://clinicaltrials.gov for " guaifenesin Fibromyalgia " or "guaifenesin ME/CFS".
But 98 results for "guaifenesin"  alone. (in search box "Intervention/treatment:").
 It appears that ADs promoting  guaifenesin  for Fibromyalgia is a scam ! (Guaifenesin is used to help clear mucus or phlegm from the chest when you have congestion from a cold or flu.)

May 2018 three main uses of lactate in the body:

  1. It's a major fuel source,
  2. it's the major material to support blood sugar level and
  3. it's a powerful signal for metabolic adaptation to stress.

Apr 2018: Epstein-Barr virus linked to seven serious diseases

Apr 2018: NY State creates website on Myalgic Encephalomyelitis ("Chronic Fatigue Syndrome")

The US CDC's ME/CFS webpage

The Solve ME/CFS Inititiative Webinars

MEAction #MEAction is an international network of patients

MassCFIDS The Massachusetts CFIDS/ME & FM Association

UK ME Association

Research Centers:

a new grant of $2.1 million from the National Institutes of Health (NIH) in America. searching for disease biomarkers,

Objectively measuring ME/CFS ( avoid activity that creates an oxygen deficit. Not Aerobic activity but  Anaerobic activity instead. Where anaerobic means activity ( not high activity) lasting no longer than 2 minutes followed by at least 6 minutes of complete rest. )

Can CFS be cured by never exceeding your ENERGY THRESHOLD and DAILY LIMIT ?

Mast Cell Activation May Underlie 'Chronic Fatigue Syndrome' Mar 2018

Chronic Fatigue Syndrome -- A Roadmap for Testing and Treatment

Feb 2018 Lady Gaga cancels remainder of world tour due to 'severe pain' from fibromyalgia

Dec 27, 2016 Fuel Shortage: Norwegian Study Expands on Energy Problem in Chronic Fatigue Syndrome (ME/CFS)

Scientists reveal new avenue for drug treatment in neuropathic pain

  1. Lyrica, a medicine used to treat patients with seizures, pain from shingles, and nerve painfrom diabetesand spinal cord injuries, is offering new hope to those living with the pain of fibromyalgia.

  2. Duloxetine (Cymbalta) is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).

  3. Savella is the third medication approved to help manage fibromyalgia.

 
Feb 21 2018: 76 Studies found for: Completed Studies | Studies With Results | fibromyalgia
  • magnetic therapy -- Mean Change in 3-recording Average of the Subjects Daily Pain Rating on the 0-10 Numeric Pain Intensity Scale. Resonator A  -3.69 , Inactive Resonator -1.97
  • (Oral) Ketotifen  -- <placebo wins -- Change From Baseline in Weekly Average Pain Score-- Ketotifen  Placebo 
  • Eslicarbazepine Acetate -- placebo wins (mostly)

  • pregabalin (Lyrica)

     Proportion of Patient Global Impression Change (PGIC)
    at Week 15  
    [Units: Percentage of participants]
     Pregabalin   Placebo 
    Participants Analyzed  [Units: Participants]  49   44 
    Very much improved   16.3   2.3 
    Much improved   36.7   27.3 
    Minimally improved   22.4   27.3 
    No change   18.4   38.6 
    Minimally worse   6.1   2.3 
    Much worse   0   2.3 
    Very much worse   0   0 
  • Pregabalin  --placebo wins

  • Milnacipran  PARTICIPANTS (1) 30% reduction in pain (2)  "very much improved" and "much improved;" and (3) physical function improvement:--- Milnacipran  Placebo 56 ( out of 516 participants)

  • (Gabapentin ER)Fibromyalgia Impact: amounts to none

  • two AVACEN Widespread Pain After 4 Weeks = 8.9 [ 0 = Lowest pain score (Best Outcome)., 19 = Highest]

  • Duloxetine 60 mg -- placebo wins but Change From Baseline to 14-Week Endpoint in Fibromyalgia Impact Questionnaire :- Duloxetine 60 mg -18.41, Placebo 

  • Xyrem (Sodium Oxybate) 

 

The percentage of participants who met all 3 of the following criteria:

  • Reduction of >=20% from baseline to week 8 in both PVAS & FIQ total score and PGI-C response of "very much better" or "much better". (PGI-C is a 7 point likert scale measuring change in the participant's fibromyalgia symptoms that ranges from "very much worse" to "very much better" )

  • The PVAS ranges from 0 (no pain) to 100 (worst imaginable pain).

  • The FIQ ranges from 0 (best function) to 100 (worst function).

 Placebo   Xyrem
(Sodium Oxybate) 4.5g 
 Xyrem
(Sodium Oxybate) 6.0g 
  Participants Analyzed  [Units: Participants]  66   62   67 
  The Primary Outcome Measure Was a Composite of Changes From Baseline in Three Co-primary Self Report Measures: Pain Visual Analog Scale (PVAS, Electronic Diaries), Fibromyalgia Impact Questionnaire (FIQ), and Patient Global Impression of Change (PGI-C).  [Units: Percentage of Participants]      
  Responders   12.9   29.8   28.1 
  Non - Responders (Reduction was not >=20%)  87.1   70.2   71.9 

 Pregabalin 

Participants
Participants Analyzed   [Units: Participants]  106 
Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)    
All-causality adverse events (AEs)   102 
All-causality SAEs   3 

Change in Pain: -13.1 [0 (no pain) to 100 (worst possible pain)]

  • Duloxetine close to placebo. Duloxetine 2.79, Placebo   3.36 [ 7-point scale where a score of 1 indicates that the patient is “very much improved,” a  4  “no change,” and a 7 “very much worse.”]

  • Pregabalin  Daily pain Pregabalin -1.48, placebo -1.30 [ scores were assessed on an 11-point numerical rating scale  ranging from 0 (no pain) to 10 (worst possible pain).]
    % of Participants “Improved (Very Much Improved, Much Improved, or Minimally Improved)”: Pregabalin 70.0 , placebo 62.1

  • Saizen® (Somatropin) Growth hormone:
    --
    %
    of Participants With Less Than 11 Tender Points at Month 12 - Saizen® 53%, Placebo + Saizen®34%
    -- physical impairment, well-being, missed work, pain, fatigue, rest, stiffness, anxiety, and depression. Score ranges from 0 (best result - very well) to 100 (worst result - awful). Saizen® 52.5, Placebo + Saizen® 64.7

  • Xyrem Number of Participants Reporting Adverse Events   498  out of 560 ( 19 serious)

  • Xyrem

 Percentage of pain VAS responders. Subjects with a >= 30% reduction in pain VAS from baseline to endpoint (week 14) were considered responders; all other subjects were considered non-responders. The pain VAS ranges from 0 (no pain) to 100 (worst imaginable pain).  Placebo   Xyrem (Sodium Oxybate) 4.5g   Xyrem (Sodium Oxybate) 6.0g 
Participants Analyzed  [Units: Participants]  188   195   190 
 a Greater Than or Equal to 30% Reduction in Pain [Units: Percentage of Participants]      
Responder   20.2   35.4   35.3 
Non - Responder  ( no 30% reduction)  79.8   64.6   64.7 
  • Pregabalin   Change  Week 12 in Pain  -20.1  [0 “no pain” to 100 “worst possible pain]
  • Xyrem
   Placebo   Xyrem 4.5g   Xyrem 6.0g 
Participants Analyzed  [Units: Participants]  183   182   183 
% of Participants with a Greater Than or Equal to 30% Reduction in Pain      
Responder   27.3   46.2   39.3 
Non - Responder ( no 30% reduction)  72.7   53.8   60.7 
  • Pregabalin  ( the higher dose, 600mg, scored worse ! )

    Daily pain diary 0(no pain) to 10(worst possible

     Placebo   Pregabalin
    300 mg 
     Pregabalin
    450 mg 
     Pregabalin
    600 mg 
    Participants Analyzed  [Units: Participants]  184   184   181   186 
    Change in Pain Score at Endpoint (Up to Week 14)    -0.73     -1.06    -1.29  -0.96
  • Rotigotine  close to placebo
  • Lacosamide  not much better than placebo
  •  Tramadol Hydrochloride + Acetaminophen : Pain from 53.0 day14, to 44.9 day 56 [no pain 0 to "worst possible pain 100]
  • Drug Injectafer : Change in BPI, Pain Interference :- Injectafer  -4.1, Placebo -2.3 [Brief Pain Inventory (BPI) includes front and back body diagrams, 4 pain severity items and 7 pain interference items rated on 0–10 scales (with 0 being the best outcome and 10 being the worst outcome), and a question about percentage of pain relief by analgesics. The Pain Interference Score is calculated by adding the scores for the 7 pain interference questions and then dividing by 7 to give a score out of 10.]
  • Pregabalin  Pain Score for Fibromyalgia Population at Week 6: -3.37, baseline 6.69 [0 (no pain) to 10 (worst possible pain)]
Jan 2018: 13 Trials found for: cfs | Recruiting, Not yet recruiting, Available Studies | "Fatigue"
Jan 2018: 57 Trials found for: cfs | Available, Active, not recruiting, Completed Studies | "Fatigue"
  • RESULTS: Duloxetine po 60-120 mg/day for 12 weeks. Pain Severity Score: Duloxetine: -1.6,    Placebo: -0.8 ---
     
    Patient Global Impression of Improvement: Duloxetine: 3.2 , Placebo: 3.3
  • RESULTS: Viagra Change in Fatigue Impact Scale at 6 Weeks. Viagra: -32.6 Placebo: -1.5
  • RESULTS: Effect of Carnosine Supplementation on Chronic Fatigue Syndrome Severity. Carnosine -3.8, Placebo: -2.0
Jan 2018: 240 Studies found for: Recruiting, Not yet recruiting, Available Studies | "Fatigue"

Symposium highlights new chronic fatigue syndrome research

" a disease of things that are low" there's a metabolic problem going on. ......it's a hypometabolic disease ---molecules necessary for energy production... were "very, very low,"

The citric acid cycle is needed to burn glucose, which provides energy. These very low numbers suggest that a patient cannot generate energy or another key molecule used for energy, Adenosine triphosphate (ATP), very well.

"ATP is the gasoline of the body. The molecule allows energy to be consumed in your body," he said, noting it is necessary for movements such as muscle contractions.

Something in ME/CFS patients appears to shut down these necessary processes, he said. It appears that the pathway leading up to the citric acid cycle is somehow shut.

"Scientists have some theories about why the metabolic sequence in a ME/CFS patient might turn off. ....... the switch-off mechanism could be a "danger response." ME/CFS is a metabolic state designed to protect the body during a viral infection, for example, but for some reason it doesn't get turned back on after the infection has gone away.

 

=======================
Fibromyalgia and Male Physiology: Why It's Different A 2008 study published in Neuroimage showed that men have fewer serotonin receptors (brain cells that respond to it) than women. However, the process of reuptake—which is essentially "recycling" so the neurotransmitter can be used again—may be more efficient in men.
Drugs that slow reuptake are commonly prescribed for fibromyalgia. They're called SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin-norepinephrine reuptake inhibitors. Two of the three drugs approved for this condition are SNRIs: Cymbalta (duloxetine) and Savella (milnacipran).
the vagus nerve’s neurotransmitter, how it communicates with the body, is acetylcholine, which is inhibited by various meds regularly prescribed to many of us, including: Benadryl, Xanax and various other psych and stomach meds (Google acetylcholine inhibitors for a full list).
.If you're taking vitamin D, you're probably taking too much.   Two vitamin D capsules a day (at 2000 international units each) adds up to 4000 IU—the daily limit. If you’re taking in any vitamin D at all otherwise (and you almost certainly are), you’re already over the safe dosage.  There’s no solid evidence that taking multi- or any other kind of vitamin is beneficial to your health unless you’re vitamin-deficient.
I
t’s not uncommon to have a deficiency in it. Studies can’t agree on an exact number, but around 30-40 percent of U.S. adults don’t get enough of the D from their diet and sunlight. Only a few foods contain it at all and those that do, like fatty fish or egg yolks or cheese, may be hard to eat enough of to actually get the benefit. That’s why the U.S. dairy industry started fortifying milk with it. And the trouble with sunlight (which doesn't give you vitamin D, but does trigger your body's production of it) is that it’s harmful to get too much of it. It’s better to cover up and avoid skin cancer than it is to go unprotected in an effort to get enough vitamins. Plus, the darker your skin is, the fewer UVB rays get through to produce vitamin D in the first place.
High doses have the potential to cause nausea, vomiting, constipation, and weakness.  And since too much vitamin D can lead to too much calcium, you can also wind up with kidney stones and abnormal heart rhythms.
Unless you’re getting almost no vitamin D, you’re probably fine. 
Albrecht et al:- "excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” . “This discovery provides concrete evidence of a fibromyalgia-specific pathology" http://www.science20.com/news_articles/fibromyalgia_not_all_head_its_skin_paper_concludes-114985

Are Peripheral Pain Generators Important in Fibromyalgia and Chronic Widespread Pain?

Fibromyalgia (FM) is a chronic widespread pain syndrome (CWPS) that is generally considered to be the result of a dysfunctional central pain modulating system. It is thought to importantly involve the descending pain inhibitory system.

FM is known to be associated with multimodal hypersensitivity: mechanical, thermal, visual, and auditory. It is associated with a variety of comorbid conditions including

  • irritable bowel syndrome,

  • painful bladder,

  • migraine headache, and

  • temporo-mandibular joint syndrome.

The relationship of the comorbid conditions to FM has not been clear. They can be considered to be the result of hyper-effective ascending central pain transmission resulting from deficient descending pain inhibition, or they can be considered as clinical entities in themselves, whose importance in FM lies in their acting as peripheral pain generators that enhance or initiate central sensitization, thereby contributing to chronic widespread pain.

There may, of course, be some truth in both of these concepts. The presence of peripheral pain generators that lead to central sensitization initiating or maintaining CWPS or FM remains controversial, however. This question is addressed in a masterful study by Albrecht et al. [1], published in this issue.

Albrecht et al. [1] investigated the innervation of arteriolevenule shunts (AVS) that are located deep in the dermis of hypothenar glabrous skin, an area that is often painful in FM patients. The function of these AVS, as the authors note, is to increase or decrease blood flow to glabrous skin as part of the body’s thermoregulatory mechanism.

Under thermal stress conditions, as much as 60% of the cardiac output is distributed to skin, and a high proportion of this is directed to glabrous skin. They hypothesized that FM patients may have a disorder involving the sensory and sympathetic innervation of the arterioles and AVS in glabrous skin, leading to or exacerbating the pain of FM.

They performed an immunofluorescent examination of arteriole and AVS innervation, using immunofluorescent labeling to identify unmyelinated peptidergic C fibers, lightly myelinated peptidergic Ad, and lightly myelinated non-peptidergic Ad fibers. The skin biopsies were double labeled to differentiate C fiber, Ad sensory fibers, and noradrenergic sympathetic fibers. Noradrenergic sympathetic fibers were identified by being positive for neuropeptide Y and negative for calcitonin-gene-related-peptide (CGRP). The relative proportions of sensory and sympathetic nerve innervation of arterioles and AVS and the density of innervation of arterioles and AVS were also measured.

AVS were significantly larger in the FM patients than in the controls. The increased size of the AVS correlated with increased tortuosity to some degree but more significantly to an increase in the innervation of the AVS. The overall innervation area was 4x greater in FM patient AVS than in control subjects AVS.

Peptidergic (CGRPcontaining) C-fiber sensory axons made up the largest component of the increased AVS innervation.

The CGRPcontaining vasodilatory sensory innervation was far greater in proportion to noradrenergic vasoconstrictive sympathetic innervation than the ratio of the two types of innervation was in control subjects.

In summary, the authors found that AVS in palmar glabrous skin of FM patients had increased sympathetic and sensory innervation compared to control subjects, whereas arteriole and venous innervation was normal.

This study suggests, as the authors point out that changes in blood flow and increased thermal sensitivity may each contribute to local palmar pain, a common complaint of FM patients. By so doing, they contribute to peripheral nerve sensitization which gives rise to local (peripheral) pain as well as contributing to central sensitization and central pain.

These findings contribute importantly to our concept of the nature of pain in CWPS or FM. Previous studies in this area showed that lidocaine injections into tender points in the trapezius muscle in FM patients result in decreased local tenderness, and also decreased heat hyperalgesia at points remote from the injection sites, showing that peripheral nociceptive input is important in maintaining central sensitization [2].

Myofascial trigger points were not specifically mentioned as the pain source in the trapezius muscles in that study, but subsequently, in other studies, myofascial trigger points were identified as sources of peripheral nociceptive pain that caused local tenderness [3–6].

The association and reproduction of pain in FM patients produced by stimulating peripheral nociceptive sites is suggestive, but not proof of a cause and effect relationship. It is the reduction in local and widespread pain in FM in response to treatment of the peripheral nociceptive sites that is most convincing in determining that peripheral nociceptive sites play an important role in initiating and maintaining pain [7,8]. It is unlikely that chronic changes in central pain modulation would produce the changes seen in innervation patterns of AVS.

Pain is not a simple sensation, and is rarely the result of a disorder in one system only. It is complex, involving multiple interactions. CWPS and FM cannot be considered to be solely a disorder of central pain modulation, and perhaps not even primarily so. Pain is the outcome of a complex interplay between the central modulation and peripheral pain input. That balance between inhibition and facilitation of incoming pain impulses determines the pain that we experience, as shown when descending pain modulation shifts from inhibition to facilitation following sustained isometric contraction sufficient to cause muscle nociception in FM patients [9]. The work of Albrecht et al. [1] advances our understanding of this interplay with their elegantly done study of AVS in FM patients that emphasizes the importance of peripheral pain generators in determining the clinical expression of pain. source

 
SUPPLEMENTS? like
  • Magnesium: contributes towards normal muscle function, nervous system and the reduction of tiredness & fatigue.
  • L-Glutamine: anabolic support.?
  • Probiotic Max: improves digestive health.?
  • Omega 3 Fish Oil: helps combat inflammation.?
  • Ribose: helps to restore ATP the body’s natural energy source.?
  • Fultium D or Vit D: helps the body absorb calcium.?
  • Folic Acid: helps the body produce and maintain new cells. In particular, red blood cell formation.?
  • Turmeric ?

Multivitamins, vitamin D, calcium and vitamin C, — the most common supplements, — showed no advantage in the prevention of cardiovascular disease, heart attack, stroke or premature death.
The multivitamins included A, B1, B2, B3 (niacin), B6, B9 (folic acid), C, D and E; and ß-carotene; calcium; iron; zinc; magnesium; and selenium.
It's most beneficial to rely on a healthy diet to get your fill of vitamins and minerals," Dr. Jenkins said
From a systematic review of existing data and single randomized control trials published from 2012 to 2017.

 
Feb 1st 2018 Clinical Trials GcMAF  is a vitamin protein found naturally in the body. It activates the cells responsible for tissue repair and initiating an immune response against infection and inflammation. One Study COMPLETED on  Muscle Pain, Joint Pain  What is GcMAF?    

Questions? info@MarinInfo.org