Researchers are working to determine exactly how individuals with fibromyalgia (FM) perceive pain. One of the problems believed to be associated with FM is a difference in the way FM patients interpret and process pain signals. This difference may lead to increased pain sensitivity. Understanding this difference will help researchers create new medicines and ways to treat FM.

The relationship between FM and family history is also being studied. Research is being performed to determine if a gene or genes predispose a person to FM. Researchers are also investigating whether FM is more common in patients with other existing conditions or characteristics. This will help us to understand FM better and point to other risk factors for FM.

Fibromyalgia patients often have erratic and irregular sleep patterns. A current trial is researching the efficacy of EEG biofeedback (brain electricity) on the reduction of FM symptoms.

Research is also being done on kainic acid (this acid is similar to an amino acid agonist). A single injection of this to the vagus nerve (one of the nerves in the brain that supplies nerve fibers to the organs of the chest and the abdomen) was found to enhance long-term pain sensitivity. The researchers can't say how closely the syndrome they have created in the lab rats mimics FM, but comparing what is happening in their model to what is happening in FM should give them important information about both. The eventual goal is to use the model not only to better understand chronic pain in patients with FM, but also to develop new treatments for FM.

Growth hormone therapy, though very expensive for most patients, was shown in one study to reduce symptoms and improve quality of life without significant side effects. As persons with FM may not make enough growth hormone when they exercise, pyridostigmine (Mestinon) is currently being studied to determine if the medication can stimulate production of growth hormone. It is thought that increasing growth hormone to a normal level may improve the symptoms of FM.

Many herbal dietary supplements are considered safe when used as directed, with no serious side effects reported. But problems with herbal products have been identified. It's important to tell your doctor what supplements you use, to avoid interactions with any prescription drugs you may need to take.

Herbal supplements contain biologically active compounds that should not be considered safe just because they are sold over the counter or come from "natural" sources such as plants. When trying a new herbal supplement, always ask your doctor or pharmacist whether there are known safety issues associated with the herbal supplement, especially interactions with other medications.

A fundamental problem in assessing either the efficacy or the side effects of herbal products is the lack of strict manufacturing quality standards, allowing substantial variability of products between different manufacturers and even between different batches of one product from the same manufacturer. As a consequence, firm conclusions on these compounds are difficult to reach.

Be especially cautious before going in for surgery. Some herbal remedies appear to increase the risk of bleeding. Others may interfere with drugs commonly used before, during, and after surgery, including anesthetics. It is probably most reasonable to stop taking any dietary supplements at least a week before surgery, to give them time to "wash out" of your system.

Here are some of the more popular herbal remedies thought to interact with certain prescription drugs.

• blood thinner warfarin (Coumadin®)
• antiplatelet drugs such as clopidogrel (Plavix®)

• antiviral drug Invirase®
• anti-rejection drug cyclosporine
• cardiac drug digoxin
• blood thinner Coumadin®
• antidepressants
• some cancer medications

We all know that our memories are less than what they used to be before we developed FM and CFS/ME. But did you know that many of the drugs you take can have an adverse effect on your memory? Some of the medications that may cause memory loss include:

• Atarax/Vistaril® (hydroxyzine)
• Ativan® (prazepam)
• BuSpar® (buspirone)
• Butisol Sodium® (butabarbital)
• Centrax® (prazepam)
• Compazine® (prochlorperazine)
• Dalmane® (flurazepam)
• Doriden® (glutethimide)
• Elavil® (amitriptyline)
• Halcion® (triazolam)
• Haldol® (haloperidol)
• Klonopin® (clonazepam)
• Librium® (chlordiazepoxide)
• Luminal Sodium® (phenobarbital)

• Mellaril® (thioridazine)
• Miltown® (meprobamate)
• Navane® (thiothixene)
• Nembutal® (pentobarbital)
• Noctec® (chloral hydrate)
• Noludar® (methyprylon)
• Prolixin (fluphenazine)
• Restoril® (temazepam)
• Serax® (oxazepam)
• Stelazine® (trifluo perazine)
• Thorazine® (chlorpromazine)
• Tranxene® (clorazepate)
• Valium® (diazepam)
• Xanax® (alprazolam)

If you are on one of the above medications and feel that you are having difficulty with your memory, then consult your physician. The medication may be at least partially responsible for your memory difficulties. We all have different tolerance levels to different substances. What might be toxic for you may be an adequate dose for another. It may not be necessary for you to stop taking the medication. A simple adjustment in your prescription may prove to greatly reduce its side effects.

Chronic pain is another condition that can greatly influence your memory functioning. When you are in pain, endorphins are released that can interfere with the neurotransmitters that guide memory. With pain, your attention tends to be on the pain and not on your environment.

The Internet has been flooded with email warnings to avoid freezing water in plastic bottles so as not to get exposed to carcinogenic dioxins. Dr. Rolf Halden, PhD, PE, Ass. Prof., Dept. of Envtl. Health Sciences, Johns Hopkins Bloomberg School of Public Health, answers questions about dioxins in the food supply and the risks associated with drinking water from plastic bottles and cooking with plastics.

Question: What do you make of this recent email warning that claims dioxins can be released by freezing water in plastic bottles?

Answer: This is an urban legend. There are no dioxins in plastics. In addition, freezing actually works against the release of chemicals. Chemicals do not diffuse as readily in cold temperatures, which would limit chemical release if there were dioxins in plastic, and we don't think there are.

Question: So it's okay for people to drink out of plastic water bottles?

Answer: First, people should be more concerned about the quality of the water they are drinking rather than the container it's coming from. Many people do not feel comfortable drinking tap water, so they buy water in plastic bottles instead. The truth is that city water is much more highly regulated and monitored for quality. Bottled water is not. It can legally contain many things we would not tolerate in municipal drinking water.

Having said this, there is another group of chemicals, called phthalates that are sometimes added to plastics to make them flexible and less brittle. Phthalates are environmental contaminants that can exhibit hormone-like behavior by acting as endocrine disrupters in humans and animals. If you heat up plastics, you could increase the leaching of phthalates from the containers into water and food.

Question: What about cooking with plastics?

Answer: In general, whenever you heat something you increase the likelihood of pulling chemicals out. Chemicals can be released from plastic packaging materials like the kinds used in some microwave meals. Some plastic drinking straws say on the label "not for hot beverages." Most people think the warning is because someone might be burned. If you put that plastic straw into a boiling cup of hot coffee, you basically have a hot water extraction going on, where the chemicals in the plastic straw are being extracted into your nice cup of coffee. We use the same process in the lab to extract chemicals from materials we want to analyze.

If you are cooking with plastics or using plastic utensils, the best thing to do is to follow the directions and only use plastics that are specifically meant for cooking. Inert containers are best, for example heat-resistant glass, ceramics and good old stainless steel.

Microwave ovens can play an important role at mealtime, but special care must be taken when cooking or reheating meat, poultry, fish, and eggs to make sure they are prepared safely. Microwave ovens can cook unevenly and leave "cold spots," where harmful bacteria can survive. For this reason, it is important to use the following safe microwaving tips to prevent food borne illness.

Microwave Oven Cooking

• Arrange food items evenly in a covered dish and add some liquid if needed. Cover the dish with a lid or plastic wrap; loosen or vent the lid or wrap to let steam escape. The moist heat that is created will help destroy harmful bacteria and ensure uniform cooking. Cooking bags also provide safe, even cooking.


• Do not cook large cuts of meat on high power (100%). Large cuts of meat should be cooked on medium power (50%) for longer periods. This allows heat to reach the center without overcooking outer areas.


• Stir or rotate food midway through the microwaving time to eliminate cold spots where harmful bacteria can survive, and for more even cooking.


• When partially cooking food in the microwave oven to finish cooking on the grill or in a conventional oven, it is important to transfer the microwaved food to the other heat source immediately. Never partially cook food and store it for later use.


• Use a food thermometer or the oven's temperature probe to verify the food has reached a safe minimum internal temperature. Cooking times may vary because ovens vary in power and efficiency. Always allow standing time, which completes the cooking, before checking the internal temperature with a food thermometer.


• Cook foods to the following safe minimum internal temperatures:
  • Beef, veal, and lamb steaks, roasts, and chops may be cooked to 145 °F
  • All cuts of pork to 160 °F
  • Ground beef, veal and lamb to 160 °F
  • Egg dishes, casseroles to 160 °F
  • Leftovers to 165 °F
  • Stuffed poultry is not recommended. Cook stuffing separately to 165 °F
  • All poultry should reach a safe minimum internal temperature of 165 °F


• Cooking whole, stuffed poultry in a microwave oven is not recommended. The stuffing might not reach the temperature needed to destroy harmful bacteria.

Microwave Defrosting

• Remove food from packaging before defrosting. Do not use foam trays and plastic wraps because they are not heat stable at high temperatures. Melting or warping may cause harmful chemicals to migrate into food.


• Cook meat, poultry, egg casseroles, and fish immediately after defrosting in the microwave oven because some areas of the frozen food may begin to cook during the defrosting time. Do not hold partially cooked food to use later.


• Cover foods with a lid or a microwave-safe plastic wrap to hold in moisture and provide safe, even heating.


• Heat ready-to-eat foods such as hot dogs, luncheon meats, fully cooked ham, and leftovers until steaming hot.


• After reheating foods in the microwave oven, allow standing time. Then, use a clean food thermometer to check that food has reached 165 °F.

Containers & Wraps

• Only use cookware that is specially manufactured for use in the microwave oven. Glass, ceramic containers, and all plastics should be labeled for microwave oven use.


• Plastic storage containers such as margarine tubs, take-out containers, whipped topping bowls, and other one-time use containers should not be used in microwave ovens. These containers can warp or melt, possibly causing harmful chemicals to migrate into the food.


• Microwave plastic wraps, wax paper, cooking bags, parchment paper, and white microwave-safe paper towels should be safe to use. Do not let plastic wrap touch foods during microwaving.


• Never use thin plastic storage bags, brown paper or plastic grocery bags, newspapers, or aluminum foil in the microwave oven.

More Information

If you're interested in learning more about Food Preparation and Food Storage, along with great tasting recipes, we suggest you visit Fran's Kitchen!

A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain.

METHODS:

In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising. Mattress firmness is rated on a scale developed by the European Committee for Standardisation.

The H(s) scale starts at 1.0 (firmest) and stops at 10.0 (softest). We randomly assigned participants firm mattresses (H(s)=2.3) or medium-firm mattresses (H(s)=5.6). We did clinical assessments at baseline and at 90 days. Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability.

FINDINGS:

At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2.36 [95% CI 1.13-4.93]), pain on rising (1.93 [0.97-3.86]), and disability (2.10 [1.24-3.56]) than did patients with firm mattresses.

Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0.059), pain while lying in bed (p=0.064), and pain on rising (p=0.008) than did patients with firm mattresses.

INTERPRETATION:

A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

Many people with FM and/or CFS/ME are given antidepressants, mood stabilizers, and antipsychotics to treat their symptoms. What they don't tell you is that these medications increase weight by stimulating the appetite or slowing the body's metabolism, and that weight gain can range from minimal (a few pounds) to significant (up to 50 pounds).

If dealing with the unbearable pain and unending fatigue wasn't bad enough, now you have added weight gain to deal with. Such rapid weight gain may increase the risk of many health conditions associated with being overweight such as:

• high blood pressure
• diabetes
• heart disease
• arthritis
• some types of cancer

Be aware of the potential for weight gain and follow these strategies to head off extra pounds:

Weight Loss Strategy 1:
Weigh yourself weekly and keep a diary of your weight so you can notice small increases quickly and take steps to counter further gains. Also keep a food diary for an accurate gauge of how much you're really eating on a daily basis.

Weight Loss Strategy 2:
Avoid or limit high-calorie, high-fat foods.

Weight Loss Strategy 3:
Eat smaller portions - and smaller meals and snacks overall.

Weight Loss Strategy 4:
Don't keep large quantities of junk foods in your home. If you need to snack, choose healthy foods such as fresh fruit or vegetables or unbuttered popcorn.

Weight Loss Strategy 5:
Eat slowly. Many people eat too quickly - the brain needs about 20 minutes to recognize that the stomach is full , so if you eat too fast, you'll be apt to consume more calories than you need to satisfy your hunger.

Weight Loss Strategy 6:
Don't skip meals. Going for long periods of time without food only serves to make you hungrier in the long term and more likely to overeat once you do eat.

Weight Loss Strategy 7:
Exercise every day to counteract any extra calories you're consuming and give a boost to your metabolism. Try aerobic exercise such as walking or swimming in a pool. Even light stretching helps to burn off calories.

Weight Loss Strategy 8:
Drink frequently. Hunger is one of the symptoms of dehydration, so quench your thirst with calorie-free beverages such as water, seltzer, diet soda, and decaffeinated coffee and tea.

Weight Loss Strategy 9:
If all else fails, talk to your healthcare provider about switching to a medication that is less likely to cause weight gain or adding another one that might help avoid weight gain. NEVER stop taking your medication without discussing it with your doctor!

Personal Note
I've been taking antidepressants for 21 years. In that time I've gained well over a 100 lbs. For the last six month I've begun to follow the strategies outlined above. I'm happy to announce I've been able to lose 55 lbs, and I'm well on my way to my goal of losing 100 lbs. Trust me, if I can do this, being fully disabled with FM and CFS/ME, it might work for you too!

If you take antidepressant medication, you may wonder: Will medication change my personality or who I am?

Dr. Karen L. Swartz, Director of the Mood Disorders Clinic at Johns Hopkins, answers this important question that's on the minds of many patients.

"Antidepressant and anti anxiety medications don't alter your personality, but they may change your interactions with others. For example, depending on your initial symptoms, they may make you feel less anxious, sad, moody, irritable, or lethargic. That can help you get along with others better and be more productive and engaged in life.

The medications don't artificially make you go from sad to happy; rather, they correct the chemical imbalance that, in turn, has thrown your emotional reactions out of balance. You should still be able to experience mood changes.

Sometimes, individuals taking antidepressant medication experience a sense of numbness, apathy, or dulling of moods. This side effect is not a goal of the medication. It may mean that your depression has been partially treated and the dull mood will lift with time, or that you need to adjust your dosage.

It could also mean that this particular medication is not the right one for you, and switching to another medication might produce better results. You also may not have received the correct diagnosis: For instance, you may have been diagnosed with depression when you are actually suffering from bipolar disorder, which requires a different approach to treatment. That's why it's imperative to be aware of your moods. If you feel like you're just not yourself when you're taking a medication, be sure to discuss it with your doctor."

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