Thursday, December 3, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia Treatments In conventional medicine perspective

Kyle J. Norton(Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

                      Fibromyalgia

According to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

The Treatment
A. In conventional medicine perspective
FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise), and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents(27).
A.1. Non medication
1. Psychological control
According to the study by Monash University and Monash Medical Centre suggested that FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important “up-stream” process in FM mechanisms and is amenable to intervention(28).
2. Cognitive-behavioral and operant-behavioral therapy
In the study to focus on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS), found that focused on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS)(29).
3. Exercise
In the reviewing the available evidence addressing the effects of exercise on central pain modulation in patients with chronic pain showed that a dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares(30).
4. Physical therapy
Based on anecdotal evidence or small observational studies physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia(31)
5. Ozone therapy
In the study to determine the efficacy of ozone therapy in patients with fibromyalgia received 24 sessions of ozone therapy during a 12-week period, found that Significant improvement was also seen both in depression scores and in the Physical Summary Score of the SF-12. Transient meteorism after ozone therapy sessions was the most frequently reported side-effect(32).

A.2. Medications
The aim of medicine is to relieve the symptoms of the disease
In anarrative review from meta-analyses and systematic reviews published since 2005. For a few medications, findings from multiple recent trials are synthesized if a systematic review had not yet been published. Classes of medications are first reviewed, followed by an overview of four common pain disorders: neuropathic pain, low back pain, fibromyalgia and osteoarthritis, showed that stepped care approach based upon existing evidence includes (1) simple analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs); (2) tricyclic antidepressants (if neuropathic, back or fibromyalgia pain) or tramadol; (3) gabapentin, duloxetine or pregabalin if neuropathic pain; (4) cyclobenzaprine, pregabalin, duloxetine, or milnacipran for fibromyalgia; (5) topical analgesics (capsaicin, lidocaine, salicylates) if localized neuropathic or arthritic pain; and (6) opioids(33).

B. Alternative treatments
Several types of alternative medicine have some potential for future clinical research. However, due to methodological inconsistencies across studies and the small body of evidence, no firm conclusions can be made at this time. Regarding alternative treatments, acupuncture and several types of meditative practice show the most promise for future scientific investigation. Likewise, magnesium, l-carnitine, and S-adenosylmethionine are nonpharmacological supplements with the most potential for further research. Individualized treatment plans that involve several pharmacological agents and natural remedies appear promising as well.(34)
In other studies to valuate complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM), researchers found that there is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. Complementary or alternative medical (CAM) has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications)(34a)..
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Wednesday, December 2, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia: The Prevention

Kyle J. Norton(Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

                      Fibromyalgia

According to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

The Prevention and management

1. Vitamin D
Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. In a study of Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression showed that Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health(23).
2. Omega 3 fatty acid
In the study to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids, five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA), found thatthese patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported(24).
3. Caffeine
In a study of forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo, found that the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia(25).
4. Coenzyme Q10
CoQ10 treatment restored mitochondrial dysfunction and the mtDNA copy number, decreased oxidative stress, and increased mitochondrial biogenesis. The results suggest that CoQ10 could be an alternative therapeutic approach for FM(26).

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(23) http://www.ncbi.nlm.nih.gov/pubmed/16850115
(24) http://www.ncbi.nlm.nih.gov/pubmed/20090445
(25) http://www.ncbi.nlm.nih.gov/pubmed/2667860
(26) http://www.ncbi.nlm.nih.gov/pubmed/22898267
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Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine Other alternative treatment

Kyle J. Norton, Master of Nutrients
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


                         The Treatment

 B. In herbal and traditional Chinese medicine perspective
B.7. The alternative natural treatment 
Beside suggesting certain herbal medicine for treatment of osteoarthritis, modern herbal and TCM medicine doctors may also combine other natural treatment for alleviating symptoms of the disease
1. Use Ice or Heat Therapies therapy
Ice therapy such as repeated, rather than continuous, ice applications may be considered as an effective treatment for some patient with osteoarthritis(380) as it reduces swelling and pain(380), if the therapy is applied correctly to avoid side effects, and prevent possible further injury, but according to Dr. Mac Auley DC. as the therapy has shown to impair reflex activity and motor function  up to 30 following treatment.(378). The doctor also said that guidance on the duration, frequency, or length of ice treatment may be depending on the particular ice therapy, injury location, or severity(379). Heat therapy has shown to loosen tissues and relax stiff joints may also benefits to some patient of osteoartritis(381). According to the study by University of Haifa, thermal and athermal short-wave diathermyhave shown effectively for the management of knee osteoarthritis(382).

2. Acupuncture
The most oldest form of medical treatment in traditional Chinese medicine has been known for its function in relief pain(383) and functional limitation(384) for chronic patient, including patient with moderate or severe chronic knee pain(383), peripheral joint osteoarthritis(384) and hip osteoarthritis(385) with many different techniques, such as acupuncture techniques, moxibustion, transcutaneous electrical nerve stimulation(392).
In pain management, acupuncture is found to significant reduce pain intensity, improve functional mobility and quality of life in patient with osteoarthritis (386). According to the University of York, in patient with knee osteoarthritis, in a systematic review with network meta-analysis, indicated that
acupuncture is considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term, but due to poor quality of the study(387), larger sample size and multi sample studies are necessary to confirm this claim.
Dr. Vas J. and Dr..White A said "... optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments"(388)

3. Massage Therapy
Massage therapy has been used in traditional Chinese medicine over thousands of year for treatment of osteoarthritis (OA)(392)(389), especially for OA patient for short-term pain relief(389). In a sixty-eight adults with radiographically confirmed OA, massage therapy seems to be most efficacious relief pain, stiffness, and improve physical function limitation for patient OA of the knee(390).
According to the joint study by the University Medical Center and Avans University of Applied Scienc, in a systematic review of randomised clinical trials, said that there is a evidence indicated that massage improves function in the short term compared to no treatment in people with knee arthritis(391)

4. Spa therapy
Spa therapy may be one the effective technique for treatment of lower back pain, according to some studies(392)(393)9394). In patient with rheumatoid arthritis, spa therapy showed to relief symptoms of pain, stiffness and mobility(395). According to the joint study by the  University of Siena and Spa Centre of Fonteverde Natural Spa Resort, the clinical trials conducted exhibited the support of spa therapy on pain, function and quality of life in hand OA(396), if used conjunction with the application of thermal treatments(396). In patient with knee osteoarthritis, especially in European countries, although the spa treatment is still the subject of debate, the existence of data of some clinical trials suggested a beneficial effect of spa therapy on pain, function and quality of life in knee OA if the treatment cover the duration from six to nine months(397).
In the study conducted by the University of Siena, Viale Bracci, spa therapy showed effectively in modified plasma levels of leptin and adiponectin of which are, important mediators of cartilage metabolism and related to the development of knee osteoarthritis(398)

5. Hydrotherapy
Hydrotherapy, using water for the treatment of disease has shown some beneficiary for treating pain in patient with lower back pain(399), joint hemorrhages(400) and multiple sclerosis(401). In patient with knee osteoarthritis, water therapy reduced knee pain and increased knee function in participants with knee OA as effectively as conventional based therapy(402).
In a randomized controlled trial conducted among 152 older persons with chronic symptomatic hip or knee OA by the University of Sydney, hydrotherapy or Tai Chi classes showed to enhance large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA(403).
In lower limb osteoarthritis, the study of 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA suggested that water exercise induced significantly reduction in pain and improvement in physical function of the participants after 1 year with a favourable cost--benefit outcome(404).
Unfortunately, the water gym study conducted by the Universidade Estadual Paulista Júlio Mesquita Filho, showed no beneficiary in improving symptoms of individuals with knee OA(405).

6. Tai Chi
Tai chi, an ancient form of mind-body exercise or technique used in Chinese with meditative movements that promote balance and healing of the mind and body induced mental concentration, physical balance, muscle relaxation, and relaxed breathing(406).
In chronic diseases, such as osteoarthritis, Tai Chi improve physical performance(408), such as walking distance (6MWD) and knee extensor strength and pain(408) and stiffness of patient with osteoarthritis(407) and knee osteoarthritis(408)(409).
In the assessing  the effectiveness of Tai Chi for knee osteoarthritis, conducted by Tufts University School of Medicine, Tai Chi therapy improved WOMAC pain(411) and stiffness scores, physical(411) and lower-extremity function, knee proprioception, ect., after 12, 24 and 48 weeks(410).

7. Yoga
An ancient form of medical technique originated from India, is become a popular multimodal mind-body exercise in the Western world for promoted flexibility, strength, endurance, and balance(412). According to the study by the University of Minnesota, Minneapolis (CC, JFW), Yoga 45 to 90 mins per session for 6 to 12 wks, reduced pain, stiffness, and swelling, inpatient with osteoarthritis of the knees(413) or osteoarthritis but the study showed an inconclusive outcome on physical function and psychosocial well-being(412).

8. Chiropractic
 Chiropractic is one the alternative therapy for diagnosis and treatment of Musculoskeletal disorders (MSDs), including osteoarthritis. It is one the primary care of hip osteoarthritis in Denmark(425)
According to the Cleveland Chiropractic College, chiropractic increased range of motion, improved balance and gait speed, and decreased disability after a 12-week course in a 70 year old geriatric patient with left hip pain, a history of repetitive falls, poor balance, myofascial dysfunction, and hip osteoarthritis(424) of that may contribute to a conservative management options for patient with hip osteoarthritis(426).
Chiropractic management showed to decreased WOMAC scores and increases in hip range of motion in patient of hip osteoarthritis, according to the study by Autralia(427) and may provide a short-term benefit to relieve hip pain for patients with hip osteoarthritis waiting for hip surgery(428), according to the report of Scandinavian College of Chiropractic. 
Used in conjunction with heat, chiropractic spinal manipulation,showed more effective for the treatment of low back pain in patient of osteoarthritis (OA) in comparison of the application of moist heat or chiropractic spinal manipulation alone(429).

9. Chinese Herbal Bath Therapy
Chinese herbal bath therapy (CHBT) has been used traditionally for its effects on analgesics and anti-inflammation against pain, especially for patient with knee osteoarthritis(495). According to the joint study by  reviewed of a total of 529 abstracts identified from 7 English
and Chinese databases conducted by the Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Tufts University and Tufts University School of Medicine, the therapy effectively reduced pain, improved physical performance, and wellness in comparison to  standard western treatment with little or no adverse effects(496).

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References
(430) Herbal medicines for the treatment of osteoarthritis: a systematic review by L. Long, K. Soeken 1 and E. Ernst(Rheumatology)
(431) Ginger compress therapy for adults with osteoarthritis by Therkleson T1.(PubMed)
(432) Effects of a ginger extract on knee pain in patients with osteoarthritis by Altman RD1, Marcussen KC.(PubMed)
(433) Efficacy and Safety of White Willow Bark (Salix alba) Extracts by Shara M1, Stohs SJ2.(PubMed)
(434) Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritisor back pain by Uehleke B1, Müller J, Stange R, Kelber O, Melzer J.(PubMed)
(435) Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials by Biegert C1, Wagner I, Lüdtke R, Kötter I, Lohmüller C, Günaydin I, Taxis K, Heide L.(PubMed)
(436) Willow bark extract, a useful alternative for the treatment of osteoarthritis: comment on the editorial by Marcus and Suarez-Almazor by Chrubasik S, Pollak S, Black A.(PubMed)
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(438) STINGING NETTLE CREAM FOR OSTFOARTHRITIS  by Keith Rayburn, MD; Eric Fleischbein, PharmD; Jessica Song, PharmD; Blaine Allen, RN; Mary Kundert, PharmD; Charles Leiter, PharmD; Thomas Bush, MD(Research letter)
(439) Stinging nettle cream for osteoarthritis by Rayburn K1, Fleischbein E, Song J, Allen B, Kundert M, Leiter C, Bush T.(PubMed)
(440) Phytalgic, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial by Jacquet A1, Girodet PO, Pariente A, Forest K, Mallet L, Moore N.(PubMed)
(441) Is Phytalgic(R) a goldmine for osteoarthritis patients or is there something fishy about this nutraceutical? A summary of findings and risk-of-bias assessment by Christensen R, Bliddal H.(PubMed)
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(443) The use of glucosamine, devil's claw (Harpagophytum procumbens), and acupuncture as complementary and alternative treatments for osteoarthritis by Sanders M1, Grundmann O.(PubMed)
(444) Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: a review of efficacy and safety by Brien S1, Lewith GT, McGregor G.(PubMed)
(445) [Devil's claw extract as an example of the effectiveness of herbal analgesics].[Article in German] by Chrubasik S1.(PubMed)
(446) A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain by Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC.(PubMed)
(447) Alteration of anti-inflammatory activity of Harpagophytum procumbens (devil's claw) extract after external metabolic activation with S9 mix by Hostanska K1, Melzer J, Rostock M, Suter A, Saller R.(PubMed)
(448) A review of the efficacy and safety of devil's claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis by Denner SS1.(PubMed)
(449) Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis by Rains C1, Bryson HM.(PubMed)
(450) Green tea polyphenol treatment is chondroprotective, anti-inflammatory and palliative in a mouse post-traumaticosteoarthritis model by Leong DJ, Choudhury M, Hanstein R, Hirsh DM, Kim SJ, Majeska RJ, Schaffler MB, Hardin JA, Spray DC, Goldring MB, Cobelli NJ, Sun HB.(PubMed)
(451) Antioxidant and pro-apoptotic effects of marine-derived, multi-mineral aquamin supplemented with a pine bark extract, Enzogenol, and a green tea extract, Sunphenon. by O'Callaghan YC1, Drummond E, O'Gorman DM, O'Brien NM.(PubMed)
(452) Epigallocatechin-3-gallate reduces inflammation induced by calcium pyrophosphate crystals in vitro by Oliviero F1, Sfriso P, Scanu A, Fiocco U, Spinella P, Punzi L.(PubMed)
(453) Epigallocatechin-3-gallate selectively inhibits interleukin-1beta-induced activation of mitogen activated protein kinase subgroup c-Jun N-terminal kinase in human osteoarthritis chondrocytes. by Singh R1, Ahmed S, Malemud CJ, Goldberg VM, Haqqi TM.(PubMed)
(454) Dietary polyphenols and mechanisms of osteoarthritis by Shen CL1, Smith BJ, Lo DF, Chyu MC, Dunn DM, Chen CH, Kwun IS.(PubMed)
(455) Green tea: a new option for the prevention or control of osteoarthritis by Katiyar SK, Raman C.(PubMed)
(456) Epigallocatechin-3-gallate selectively inhibits interleukin-1beta-induced activation of mitogen activated protein kinase subgroup c-Jun N-terminal kinase in human osteoarthritis chondrocytes by Singh R1, Ahmed S, Malemud CJ, Goldberg VM, Haqqi TM.(PubMed)
(457) Popular #Herbs - Turmeric (Curcuma longa) by Kyle J. Norton
(458) Role of Curcumin in Common Musculoskeletal Disorders: a Review of Current Laboratory, Translational, and Clinical Data by Peddada KV1, Peddada KV2, Shukla SK3, Mishra A3, Verma V4.(PubMed)
(459) Evaluation of the protective effects of curcuminoid (curcumin and bisdemethoxycurcumin)-loaded liposomes against bone turnover in a cell-based model of osteoarthritis by Yeh CC1, Su YH2, Lin YJ2, Chen PJ2, Shi CS3, Chen CN2, Chang HI2.(PubMed)
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(462) Cat's claw (Uncaria tomentosa) by Kyle J. Norton
(463) Effect of a Herbal-Leucine mix on the IL-1β-induced cartilage degradation and inflammatory gene expression in human chondrocytes by Akhtar N1, Miller MJ, Haqqi TM.(PubMed)
(464) Cat's claw: an Amazonian vine decreases inflammation in osteoarthritis by Hardin SR1.(PubMed)
(465) Efficacy and safety of freeze-dried cat's claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis by Piscoya J1, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJ, Sandoval M.(PubMed)
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(467) Popular #Herbs - Bromelain by Kyle J. Norton
(468) A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain by Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC.(PubMed)
(469) Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs by Klein G1, Kullich W, Schnitker J, Schwann H.(PubMed)
(470) Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies by Brien S, Lewith G, Walker A, Hicks SM, Middleton D.(PubMed)
(471) Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study by Akhtar NM1, Naseer R, Farooqi AZ, Aziz W, Nazir M.(PubMed)
(472) Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview by M. Z. Siddiqui(PMC)
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(474) FlexiQule (Boswellia extract) in the supplementary management of osteoarthritis: a supplement registry by Belcaro G1, Dugall M, Luzzi R, Ledda A, Pellegrini L, Cesarone MR, Hosoi M, Errichi M, Francis S, Cornelli U.(PubMed)
(475) Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis by Kizhakkedath R1.(PubMed)
(476) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial by Kimmatkar N1, Thawani V, Hingorani L, Khiyani R.(PubMed)
(477) Popular Herbs - Ginkgo biloba by Kyle J. Norton
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(481) Inhibitory effects of EGb761 on the expression of matrix metalloproteinases (MMPs) and cartilage matrix destruction by Wang X1, Zhao X, Tang S.(PubMed)
(482) EGb761 inhibits inflammatory responses in human chondrocytes and shows chondroprotection in osteoarthritic rat knee by Chen YJ1, Tsai KS, Chiu CY, Yang TH, Lin TH, Fu WM, Chen CF, Yang RS, Liu SH.(PubMed)
(483) Phytodolor--effects and efficacy of a herbal medicine by Gundermann KJ1, Müller J.(PubMed)
(484) Phytodolor® in musculoskeletal disorders: re-analysis and meta-analysis by Uehleke B1, Brignoli R, Rostock M, Saller R, Melzer J.(PubMed)
(485) Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews.
Soeken KL1.(PubMed)
(486) EFFECT OF A PROPRIETARY HERBAL MEDICINE ON THE RELIEF OF CHRONIC ARTHRITIC PAIN: A DOUBLE-BLIND STUDY by S. Y. MILLS, R. K. JACOBY*, M. CHACKSFIELD and M. WILLOUGHBY(Rheumatology)
(487) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study by Mills SY1, Jacoby RK, Chacksfield M, Willoughby M.(PubMed)
(488) [Gitadyl versus ibuprofen in patients with osteoarthrosis. The result of a double-blind, randomized cross-over study].[Article in Danish]by Ryttig K1, Schlamowitz PV, Warnøe O, Wilstrup F.(PubMed)
(489) Gitadyl versus ibuprofen in patients with osteoarthritis: a double-blind, randomized, cross-over study of clinical efficacy and effects on platelets and PMNs by Mieszczak CI1, Kharazmi A, Rein J, Winther K.(PubMed)
(490) [Gitadyl versus ibuprofen].[Article in Danish] by [No authors listed](PubMed)
(491) Danshen prevents articular cartilage degeneration via antioxidation in rabbits with osteoarthritis by Bai B1, Li Y2.(PubMed)
(492) Veterinary Herbal Medicine By Susan G. Wynn, Barbara Fougère, page 349.
(493) Dan Shen (Salvia miltiorrhiza) in Medicine: Volume 2. Pharmacology ..., Volume 2 edited by Xijun Yan 

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Tuesday, December 1, 2015

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine Topical Remedy and Electrostimulation

Kyle J. Norton, Master of Nutrients
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                        The Treatment

B. In herbal  and traditional Chinese medicine perspective
5. Topical Remedy
5.1. Topical Ginger 
Ginger, one of the herbal medicine used as cooking spice and best known for its treatment in warming the stomach, use as topical remedy, it has been found to consist the potential for treatment of osteoarthritis, according to Dr. Therkleson T., in the study of 20 adults with moderate to severe osteoarthritis(414). On a self-report arthritis Health Assessment Questionnaire, topical ginger  showed to relief osteoarthritic symptoms, in both  body physiological recordings and pain scale(415).
The Edith Cowan University, in the study of a self-treatment using the ginger patch for a further 24 week, showed that ginger treatment relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis(416).

5.2. Capsaicin cream
Topical Capsaicin cream used for treatment of soft tissue with a pharmaceutical name of Finalgon®(420), may be effective for treatment of osteoarthritis in dependent to its concentration.
In a randomized, single-blind, 28-day study conducted by Research Testing Laboratories, capsaicin cream (0.25%) applied twice daily, showed to relieve severity of osteoartghritic pain with side effect of burning sensation(419).
Civamide cream produced by Winston Pharmaceuticals, approved by FDA, civamide cream is a cis-isomer of capsaicin topical medication used for treatment of osteoarthritis of the knee and other neuropathic pain(417). In the study by Northwestern University Feinberg School of Medicine, in patients with OA of the knee, civamide cream 0.075% or a lower dose of civamide cream, 0.01% effectively in relieve pain and improve physical functions(418).

6.  Electrostimulation
Use of electricity for treatment of pain, muscle dysfunction and sarcopenia can be dated back to Ancient Egyptians and later the Greeks and Romans(421). According to the Abteilung für Physikalische Medizin und Rehabilitation, transcutaneous electrostimulation may be effectively and positively in influence of pain and function, mobility, and quality of life in patients suffering from OA(422). Unfortunately, in the review of 14  trials resulting in the inclusion of 18 small trials in 813 patients, found that  electrosimulation does not offer pain relief for effective for pain relief. for patient with osteoarthritis of the knee with the relative droping out rate as high as 95%(423).

All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months


Back to General health http://kylejnorton.blogspot.ca/

Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca p/general-health.html

References
(414) Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms. by Therkleson T1.(PubMed)
(415) Ginger Therapy for Osteoarthritis: A Typical Case by Therkleson T1.(PubMed)
(416) Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms by Therkleson T1(PubMed)
(417) Zucapsaicin(Wikipedia)
(418) Civamide cream 0.075% in patients with osteoarthritis of the knee: a 12-week randomized controlled clinical trial with a longterm extension by Schnitzer TJ1, Pelletier JP, Haselwood DM, Ellison WT, Ervin JE, Gordon RD, Lisse JR, Archambault WT, Sampson AR, Fezatte HB, Phillips SB, Bernstein JE.(PubMed)
(419) High strength capsaicin cream for osteoarthritis pain: rapid onset of action and improved efficacy with twice daily dosing by Schnitzer TJ1, Posner M, Lawrence ID.(PubMed)
(420) Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain.
Chrubasik S1, Weiser T, Beime B.(PubMed)
(421) Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting by Heidland A1, Fazeli G, Klassen A, Sebekova K, Hennemann H, Bahner U, Di Iorio B.(PubMed)
(422) Osteoarthritis: physical medicine and rehabilitation--nonpharmacological management.
Stemberger R1, Kerschan-Schindl K.(PubMed)
(423) Transcutaneous electrostimulation for osteoarthritis of the knee by Rutjes AW1, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P.(PubMed)

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Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia: The Diagnosis

Kyle J. Norton(Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

                      Fibromyalgia

 According to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

                                             The Diagnosis 


In the narrative review of the literature, consensus documents by the American College of Rheumatology (ACR), evidence-based interdisciplinary German guidelines on the diagnosis and management of FMS by Klinikum Saarbrücken Internal Medicine 1 Winterberg 1 D-66119 Saarbrücken, the recommendations of a stepwise diagnostic work-up of patients with chronic widespread pain (CWP) in primary care include: Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, screening for other functional somatic symptoms and mental disorders, and referring to mental health specialists in case of mental disorder(20). Other study suggested of 4 phased diagnosis. In phase one, physicians undertook a self-assessment of their practice. Phase two of the study involved diagnosis and treatment of a virtual case vignette. The third phase consisted of analysis of the data from phase two and providing feedback from an expert rheumatologist, and the fourth phase was to complete patient report forms for five patients in their practice(21).
Here we quote the text from the study of The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgiaand Measurement of Symptom Severity by FREDERICK WOLFE,1 DANIEL J. CLAUW,2 MARY-ANN FITZCHARLES,3 DON L. GOLDENBERG,4
ROBERT S. KATZ,5 PHILIP MEASE,6 ANTHONY S. RUSSELL,7 I. JON RUSSELL,8 JOHN B. WINFIELD,9 AND MUHAMMAD B. YUNUS10
Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >7 AND SS >5) OR (WPI 3–6 AND SS >9).
Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Please note:
This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors as Provisional.This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validationbased on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.As disclosed in the manuscript, these criteria were developed with support from the study sponsor, Lilly Research Laboratories.The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participatein the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to thesubmission of the paper. The recipient of the grant was Arthritis Research Center Foundation, Inc. The authors receivedno compensation. The ACR found the criteria to be methodologically rigorous and clinically meaningful.ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse anycommercial product or service. The ACR received no compensation for its approval of these criteria(22).

All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies


Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months

Back to General health http://kylejnorton.blogspot.ca/p/general-health.html

Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(21) http://www.ncbi.nlm.nih.gov/pubmed/23118542
(22)http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf
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Monday, November 30, 2015

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine Diet modification -The Important of Supplements

Kyle J. Norton, Master of Nutrients
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                        The Treatment

B. In herbal  and traditional Chinese medicine perspective
4. The Important of Supplements for osteoarthitis
4.1. Glucosamine
Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, is a precursor for glycosaminoglycans(194), a major component of joint cartilage(195). Treatment of glucosamine sulfate, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, or nutrients, such as antioxidants and omega-3 fatty acids showed to prevent cartilage degeneration and treat arthritis, according to study(195).

4.2. Chondroitin
Sulfated glycosaminoglycan (GAG), found in cartilage around joints in the body id a chemical composed of alternating sugars (N-acetylgalactosamine and glucuronic acid).
The chemical compound has been used as nonsteroidal anti-inflammatory drugs for treatment of osteoarthritis by it self or combination with viscosupplementation, according to study(367).
The comparison of piascledine 300 and chondroitin sulfate for treatment of knee osteoarthritis study, also insisted that  3 capsules chondroitin sulfate per day or one capsule of avocado soybean unsaponifiable (ASU) improved the WOMAC-index decreased in both groups for approx. 50% to the end of therapy(368).
According to the Birmingham VA Medical Center, chondroitin, reliefs pain for patient with knee osteoarthritis with little adverse effects when compared with control(369) and its combination  with glucosamine showed a greater effect in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis(370)(371),

4.3. Avocado soybean unsaponifiables (ASU)
 Avocado soybean unsaponifiables (ASU) is a natural vegetable extract composed of  one-third avocado oil and two-thirds soybean oil, may be used effectively for treatment of knee osteoarthritis to replace the use of analgesics and nonsteroidal antiinflammatory drugs (NSAIDs), according to the a three-month, prospective, randomized, double-blind, placebo-controlled, parallel-group trial(372).  In patients with symptomatic osteoarthritis (OA) of the knee or hip, The extract inhibited functional disability, especially for patient with hip OA(373).
According to the Erasmus University Hospital of Brussels, daily intake of 300mg or 600mg of ASU, reduced intake of NSAIDs and analgesics by more than 50% in 71% in patient aged 45 to 80 years with femoro-tibial knee osteoarthritis(374) and improved symptoms of patients with OA of the knee and hip, according to the Universities of Exeter and Plymouth, Devon(375) probably through modulating OA pathogenesis by inhibiting a number of molecules and pathways(376), such as preventing the osteoarthritic osteoblast-induced inhibition of matrix molecule production in induced cartilage repair (377).

All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies


Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months


Back to General health http://kylejnorton.blogspot.ca/


Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca p/general-health.htmlReferences
(194) Glucosamine inhibits the synthesis of glycosaminoglycan chains on vascular smooth muscle cell proteoglycans by depletion of ATP by Little PJ1, Drennon KD, Tannock LR.(PubMed)
(195) Effects of Glucosamine and Chondroitin Sulfate on Cartilage Metabolism in OA: Outlook on Other Nutrient Partners Especially Omega-3 Fatty Acid by Jörg Jerosch(PubMed)
(367) Osteoarthritis in Latin America: Study of Demographic and Clinical Characteristics in 3040 Patients by Reginato AM1, Riera H, Vera M, Torres AR, Espinosa R, Esquivel JA, Felipe OJ, Blas JR, Rillo O, Papasidero S, Souto R, Rossi C, Molina JF, Ballesteros F,Radrigan F, Guibert M, Chico A, Gil ML, Camacho W, Urioste L, Garcia AK, Iraheta I, Gutierrez CE, Duarte M, Castañeda O, Coimbra I, Muñoz Louis R, Reveille J, Quintero M; Pan-American League of Associations for Rheumatology (PANLAR) Osteoarthritis Study Group(PubMed)
(368) Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee by Pavelka K1, Coste P, Géher P, Krejci G.(PubMed)
(369) Chondroitin for osteoarthritis by Singh JA1, Noorbaloochi S, MacDonald R, Maxwell LJ.(PubMed)
(370) Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib by Hochberg MC1, Martel-Pelletier J2, Monfort J3, Möller I4, Castillo JR5, Arden N6, Berenbaum F7, Blanco FJ8, Conaghan PG9, Doménech G10, Henrotin Y11,Pap T12, Richette P13, Sawitzke A14, du Souich P15, Pelletier JP2; on behalf of the MOVES Investigation Group(PubMed)
(371) Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis by Clegg DO1, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW,Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ.(PubMed)
(372) Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial by Blotman F1, Maheu E, Wulwik A, Caspard H, Lopez A.(PubMed)
(373) Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. by Maheu E1, Mazières B, Valat JP, Loyau G, Le Loët X, Bourgeois P, Grouin JM, Rozenberg S.(PubMed)
(374) Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study by Appelboom T1, Schuermans J, Verbruggen G, Henrotin Y, Reginster JY.(PubMed)
(375) Avocado-soybean unsaponifiables (ASU) for osteoarthritis - a systematic review by Ernst E1.(PubMed)
(376) Management of Osteoarthritis with Avocado/Soybean Unsaponifiables by Christiansen BA1, Bhatti S2, Goudarzi R3, Emami S4.(PubMed)
(377) Avocado/soybean unsaponifiables prevent the inhibitory effect of osteoarthritic subchondral osteoblasts on aggrecan and type II collagen synthesis by chondrocytes by Henrotin YE1, Deberg MA, Crielaard JM, Piccardi N, Msika P, Sanchez C.(PubMed)
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Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia: The Complications

Kyle J. Norton(Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

                      Fibromyalgia
According to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

                           Complications

1. Negative impact in relationships
In a study was designed to survey a large community sample of adults with fibromyalgia about the impact on the spouse/partner, children and close friends, found that in addition to physical impairments that are well documented among individuals with fibromyalgia, fibromyalgia can result in a substantial negative impact on important relationships with family and close friends(13).

2. Psychological problem
According to the study by Monash University and Monash Medical Centre in comparison between FM patients and healthy individuals found significant differences in control (Perceived Control of Internal States Scale and Mastery Scale), pain, perceived stress, fatigue, confusion, and mood disturbance (all P < 0.001). There were significant associations found between both high and low levels of control on stress, mood, pain, and fatigue (P < 0.001-0.05). Strong negative correlations were present between internal control and perceived stress (P < 0.0005)(14).

3. Pain disability, depression, and pressure sensitivity differences in genders
In the study to determine the differences in pain, disability, depression, and pressure sensitivity between men and women with fibromyalgia syndrome (FMS), and to analyze the relationship between pain and pressure sensitivity in FMS, found that w determine the differences in pain, disability, depression, and pressure sensitivity between men and women with fibromyalgia syndrome (FMS), and to analyze the relationship between pain and pressure sensitivity in FMS(15).

4. Impaired functionality, and impact on the quality of life
In the study to compare depressive symptoms and stress perception between women with and without FM, in addition to investigate the relationship between those characteristics and the functionality and the impact on the quality of life of those patients, showed that in the FM group, a positive correlation was observed between the depressive symptoms and perceived stress (r = 0.54, P < 0.05), pain (r = 0.58, P < 0.01), impaired functionality (r = 0.56, P < 0.01), and impact on the quality of life (r = 0.46, P < 0.05). In this group there was also correlation between perceived stress and impaired functionality (r = 0.50;P < 0.05). Pain showed no relationship with perceived stress(16).

5. Fall risk
There were significant relationships between fall risk and NRS scores (r = 0.565), and FIQ fatigue subscores (r = 0.560) (both p < 0.05). Worse postural performance and fall risk found in the fibromyalgia patients compared to controls were related with the sleep quality in the last 24 h and level of fatigue, according to the study by Pamukkale University Medical School(17).

6. Postural control deficits
In the study to determine whether FM patients, compared to age-matched healthy controls (HCs), have differences in dynamic posturography, including sensory, motor, and limits of stability, found that that middle-aged FM patients have consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological examination. Further study is needed to determine prospective fall rates and the significance of lower-extremity MTPs. The development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training(18).

7. Infections, neoplastic and cardiovascular disease and mortality
In the study to determine whether fibromyalgia (FM) is associated with an increase in comorbidity (infections, neoplastic and cardiovascular disease) as well as with an increase in mortality, showed that despite the high comorbidity and medical resource use in FM, there is no evidence that this entity is associated with an increase in comborbidity due to cardiovascular disease or infections. The association between FM and HIV and hepatitis C virus infections suggests a possible relationship between FM and chronic viral infection. Patients with chronic generalized pain may have an increased risk of developing cancer. FM may also carry an increased risk of accidental death and death from cancer(19).




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