February 2014 References  Devin J. Starlanyl   for http://www.sover.net/~devstar

Ahmad J, Tagoe CE. 2014. Fibromyalgia and chronic widespread pain in autoimmune thyroid disease. Clin Rheumatol. [Jan 18 Epub ahead of print.] “Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10% of the population, and is a recognized cause of fibromyalgia and chronic widespread pain. Recent reports are shedding light on the mechanisms of pain generation in autoimmune thyroid disease-associated pain syndromes including the role of inflammatory mediators, small-fiber polyneuropathy, and central sensitization. The gradual elucidation of these pain pathways is allowing the rational use of pharmacotherapy in the management of chronic widespread pain in autoimmune thyroid disease.”

Bertin PM. 2014. Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report. J Med Case Rep. 8(1):21. “Liposome bupivacaine use in this morbidly obese patient undergoing laparoscopic sleeve gastrectomy provided analgesic efficacy and limited postsurgical opioids to a level comparable with her baseline opioid regimen for chronic pain. Given her complex medical history and previous issues with acute and chronic pain, we consider these results highly successful and continue to use liposome bupivacaine as part of a multimodal analgesic regimen in an effort to optimize postsurgical pain management.”

Boggero IA, Kniffin TC, de Leeuw R et al. 2014. Fatigue mediates the relationship between pain interference and distress in patients with persistent orofacial pain.  J Oral Facial Pain Headache. 28(1):38-45. “These results suggest that interventions targeted specifically at fatigue symptoms may be helpful for reducing interference and improving quality of life in patients with persistent orofacial pain.”

Calandre EP, Navajas-Rojas MA, Ballesteros J et al. 2014. Suicidal Ideation in Patients with Fibromyalgia: A Cross-Sectional Study. Pain Pract. [Jan 17 Epub ahead of print.]  “Chronic pain, sleep disturbances, and depression, which are relevant symptoms of fibromyalgia syndrome, have been demonstrated to be associated with an increased likelihood of suicidal behaviors. Mortality from suicide has been shown to be greater among patients with fibromyalgia. This study aimed to assess the prevalence of suicidal ideation among a sample of patients with fibromyalgia and to evaluate its relationship with the clinical symptomatology of fibromyalgia….Suicidal ideation was markedly associated with depression, anxiety, sleep quality, and global mental health, whereas only weak relationships were observed between suicidal ideation and both pain and general physical health.”

Converse AK, Ahlers EO, Travers EG et al. 2014. Tai chi training reduces self-report of inattention in healthy young adults. Front Hum Neurosci. 8:13. “In this study of healthy young adults, we measured the effects of training in tai chi, which involves mindful attention to the body during movement. Using a non-randomized, controlled, parallel design, students in a 15-week introductory tai chi course…and control participants…were tested for ADHD indicators and cognitive function at three points over the course of the 15-weeks. The tai chi students' self-report of attention, but not hyperactivity-impulsivity, improved compared to controls. At baseline, inattention correlated positively with reaction time variability in an affective go/no-go task across all participants, and improvements in attention correlated with reductions in reaction time variability across the tai chi students…These results converge to suggest that tai chi training may help improve attention in healthy young adults. Further studies are needed to confirm these results and to evaluate tai chi as therapy for individuals with ADHD.”

Doorenbos AZ, Gordon DB, Tauben D et al. 2013. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 14(12):1533-1538. “Findings confirm the paucity of pain education across the health sciences curriculum in a CoEPE that serves a large region of the United States. The data provide a pain curriculum blueprint that can be used to recommend added pain content tin health sciences programs across the country.”

Duschek S, Werner NS, Limbert N et al. 2014. Attentional Bias toward Negative Information in Patients with Fibromyalgia Syndrome. Pain Med. [Jan 21 Epub ahead of print.] “In addition to central nervous sensitization, affect dysregulation constitutes an important factor in the pathogenesis of fibromyalgia syndrome (FMS). The present study is concerned with emotional influences on information processing in FMS. The hypothesis of attentional bias, i.e., selective processing of negatively connoted stimuli, was tested….Twenty-seven female FMS patients and 34 healthy women undertook an emotional modification of the Stroop task. Subjects had to decide whether the colors of positive, negative, and neutral adjectives accorded with color words presented in black. Attentional bias was defined as delay in color naming of emotional words relative to neutral words. Affective and anxiety disorders, pain severity, as well as medication were considered as possible factors mediating the expected interference….Patients showed marked attentional bias, manifested in a greater response delay due to negative words compared with the control group. Among the clinical features, pain severity was most closely associated with the extent of the interference. While depression played only a subordinate role, anxiety and medication were without effect….The study provides evidence of emotionally driven selective attention in FMS. Attentional bias to negative information may play an important role in the vicious circle between negative affective state and pain augmentation. In the management of FMS pain, strategies aiming at conscious direction of attention may be helpful, e.g., imagery techniques or mindfulness training.”

Faro M, Saez-Francas N, Castro-Marrero J et al. 2014. [Impact of fibromyalgia in the chronic fatigue syndrome.] Med Clin (Barc). [Jan 2 Epub ahead of print.] [Article in Spanish] “Different studies have showed association of the chronic fatigue syndrome (CFS) with other pathologies, including fibromyalgia (FM)….We included 980 CFS patients (mean age: 48±9 years; 91% women). Fibromyalgia was present in 528 patients (54%). The level of fatigue… and pain … was higher in FM patients. Patients with CFS and FM had more prevalence of sleep-related phenomena. The percentage of patients and the degree of severity of cognitive symptoms, neurological and autonomic dysfunction was higher in FM patients…. FM patients scored higher on the fatigue impact scale … and showed worse results in the quality of life questionnaire….FM (patients have) co-morbidity (with) worse clinical parameters, fatigue and the perception of quality of life (than) in CFS patients.”

Fikree A, Grahame R, Aktar R et al. 2014. A Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients with Gastrointestinal Symptoms. Clin Gastroenterol Hepatol. [Jan 15 Epub ahead of print.] “Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors. JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations.”

Garrido-Maraver J, Cordero MD, Oropesa-Avila M et al. 2014. Clinical applications of coenzyme Q. Front Biosci (Landmark Ed). 19:619-33. “Coenzyme Q (Co Q or ubiquinone) was known for its key role in mitochondrial bioenergetics as electron and proton carrier; later studies demonstrated its presence in other cellular membranes and in blood plasma, and extensively investigated its antioxidant role. These two functions constitute the basis for supporting the clinical indication of Co Q. Furthermore, recent data indicate that Co Q affects expression of genes involved in human cell signaling, metabolism and transport and some of the effects of Co Q supplementation may be due to this property. Co Q deficiencies are due to autosomal recessive mutations, mitochondrial diseases, ageing-related oxidative stress and carcinogenesis processes, and also a secondary effect of statin treatment. Many neurodegenerative disorders, diabetes, cancer, fibromyalgia, muscular and cardiovascular diseases have been associated with low Co Q   levels. Co Q treatment does not cause serious adverse effects in humans and new formulations have been developed that increase Co Q absorption and tissue distribution. Oral Co Q treatment is a frequent mitochondrial energizer and antioxidant strategy in many diseases that may provide a significant symptomatic benefit.”

Gerwin R. 2013. Are peripheral pain generators important in fibromyalgia and chronic widespread pain?  Pain Medicine. 14:777-778. “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.”

Giannoccaro MP, Donadio V, Incensi A et al. 2013. Small nerve fiber involvement in patients referred for fibromyalgia. Muscle Nerve. [Dec 28 Epub ahead of print.] “Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain often accompanied by other symptoms suggestive of neuropathic pain. We evaluated patients for small fiber neuropathy (SFN) who were referred for fibromyalgia (FM). Methods: We studied 20 consecutive subjects with primary FM. Patients underwent neurological examination, nerve conduction studies, and skin biopsies from distal leg and thigh. Results: Electrodiagnostic studies were normal in all patients. SFN was diagnosed in 6 patients by reduced epidermal nerve fiber density. These patients also showed abnormalities of both adrenergic and cholinergic fibers….A subset of FM subjects have SFN, which may contribute to their sensory and autonomic symptoms. Skin biopsy should be considered in the diagnostic work-up of FM.” 

Gollwitzer H, Opitz G, Gerdesmeyer L et al. 2014. [Greater trochanteric pain syndrome.] Orthopade. 43(1):105-118. [Article in German] Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases.

Gordon DB, Loeser JD, Tauben D et al. 2013. Development of the KnowPain-12 Pain Management Knowledge Survey. Clin J Pain. [Oct 16 Epub ahead of print.] “The purpose of this study was to develop a brief knowledge survey about chronic non-cancer pain that could be used as a reliable and valid measure of a provider's pain management knowledge…. This study used a cross-sectional study design. A group of pain experts used a systematic consensus approach to reduce the previously validated KnowPain-50 to 12 questions (2 items per original six domains). A purposive sampling of pain specialists and health professionals generated from public lists and pain societies was invited to complete the KnowPain-12 online survey. Between April 4 and September 16, 2012, 846 respondents completed the survey…..Respondents included registered nurses (34%), physicians (23%), advanced practice registered nurses (14%), and other allied health professionals and students. Twenty-six percent of the total sample self-identified as "pain specialist". Pain specialists selected the most correct response to the knowledge assessment items more often than did those who did not identify as pain specialists, with the exception of one item. KnowPain-12 demonstrated adequate internal consistency reliability…. Total scores across all 12 items were significantly higher….among pain specialists compared to respondents who did not self-identify as pain specialists…..The psychometric properties of the KnowPain-12 support its potential as an instrument for measuring provider pain management knowledge. The ability to assess pain management knowledge with a brief measure will be useful for developing future research studies and specific pain management knowledge intervention approaches for health care providers.”

Hall D, Jones S, Iverson D. 2011. Disease awareness advertising - women's intentions following exposure. Aust Fam Physician. 40(3):143-147. “In Australia, where direct to consumer advertising of prescription medicines is prohibited, pharmaceutical companies can sponsor disease awareness advertising targeting consumers. This study examined the impact of disease awareness advertising exposure on older women's reported behavioral intentions….Women were approached in a shopping centre and randomly assigned mock advertisements for two health conditions. Disease information and sponsors were manipulated….Two hundred and forty-one women responded to 466 advertisements. Almost half reported an intention to ask their doctor for a prescription or referral as a result of seeing the advertisement, but more reported they would talk to their doctor and ask about treatments and tests. Participants were more likely to report an intention to ask for prescriptions if they perceived the health condition to be severe and themselves susceptible or if they had viewed advertisements containing limited information on the disease….Disease awareness advertising may stimulate demand for prescription medicine products. This has serious implications for general practitioners and regulators.” [Australia sets a fine example for the rest of the world in this, as in other areas such as gun control. Now if we would only follow. DJS]

Huang CY, Chen YL, Li AH et al. 2014. Minocycline, a microglial inhibitor, blocks spinal CCL2-induced heat hyperalgesia and augmentation of glutamatergic transmission in substantia gelatinosa neurons. Neuroinflammation. 11(1):7. This study in rats found that injecting minocycline, a specific inhibitor of microglial activation, provided pain relief in rats with induced central sensitization. 

Johnston SS, Udall M, Alvir J et al. 2014. Characteristics, Treatment, and Health Care Expenditures of Medicare Supplemental-Insured Patients with Painful Diabetic Peripheral Neuropathy, Post-Herpetic Neuralgia, or Fibromyalgia. Pain Med. [Jan 16 Epub ahead of print.] “Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009….The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased….The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients.”

Laniosz V, Wetter DA, Godar DA. 2014. Dermatologic manifestations of fibromyalgia. Clin Rheumatol. [Jan 14 Epub ahead of print.] “Among these (over 800) Mayo Clinic fibromyalgia patients, various dermatologic conditions and cutaneous problems were identified, including hyperhidrosis in 270 (32.0 %), burning sensation of the skin or mucous membranes in 29 (3.4 %), and various unusual cutaneous sensations in 14 (1.7 %). Pruritus without identified cause was noted by 28 patients (3.3 %), with another 16 patients (1.9 %) reporting neurotic excoriations, prurigo nodules, or lichen simplex chronicus. Some form of dermatitis other than neurodermatitis was found in 77 patients (9.1 %). Patients with fibromyalgia may have skin-related symptoms associated with their fibromyalgia. No single dermatologic diagnosis appears to be overrepresented in this population, with the exception of a subjective increase in sweating.”

Loeser JD, Cahana A. 2013. Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business. Clin J Pain. 29(4):31-316. “The world of health care and the world of business have fundamentally different ethical standards.  In the past decades, business principles have progressively invaded medical territories, leading to often unanticipated consequences for both patient and providers. Multidisciplinary pain management has been shown to be more effective than all other forms of health care for chronic pain patient; yet, fewer and fewer multidisciplinary pain management facilities are available in the United States.…We call for increased pin educational experiences for all types of health care providers and the separation of business concepts from pain-related health care.”  “Despite the talk about evidence-based medicine…the primary driving force behind changes in health care has become economics. …Chronic pain management has not done well in such an environment….chronic pain patients suffer from this more than most other patient groups.”

Loggia ML, Berna C Kim J et al. 2014. Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis Rheumatol. 66(1):203-12. “Patients exhibited less robust activation during both anticipation of pain and anticipation of relief within regions of the brain commonly thought to be involved in sensory, affective, cognitive, and pain-modulatory processes. In healthy controls, direct searches and region-of-interest analyses of the ventral tegmental area revealed a pattern of activity compatible with the encoding of punishment signals: activation during anticipation of pain and pain stimulation, but deactivation during anticipation of pain relief. In FM patients, however, activity in the ventral tegmental area during periods of pain and periods of anticipation (of both pain and relief) was dramatically reduced or abolished….FM patients exhibit disrupted brain responses to reward/punishment. The ventral tegmental area is a source of reward-linked dopaminergic/γ-aminobutyric acid-releasing (GABAergic) neurotransmission in the brain, and our observations are compatible with reports of altered dopaminergic/GABAergic neurotransmission in FM. Reduced reward/punishment signaling in FM may be related to the augmented central processing of pain and reduced efficacy of opioid treatments in these patients.”

McInnis OA, Matheson K, Anisman H. 2014. Living with the unexplained: Coping, distress, and depression among women with chronic fatigue syndrome (CFS) and/or fibromyalgia compared to an autoimmune disorder.  Anxiety Stress Coping. [Jan 30 Epub ahead of print.] “Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress…. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia.”

Nakamura I, Nishioka K, Usui C et al. An Epidemiological Internet Survey of Fibromyalgia and Chronic Pain in Japan. Arthritis Care Res (Hoboken). [Jan 8 Epub ahead of print.] “Because FM usually presents with more severe and more widely distributed pain, as well as more non-painful symptoms than CP, our results suggest that FM is a different clinical phenotype of CP.”

Sturgeon JA, Yeung EW, Zautra AJ. 2014. Respiratory Sinus Arrhythmia: a Marker of Resilience to Pain Induction. Int J Behav Med. [Jan 14 Epub ahead of print.] There may be significant individual differences in physiological regulatory responses to the experience of pain and stress. Respiratory sinus arrhythmia is a physiological indicator that may have implications for efficient physiological responses to pain and stress….Fifty-nine women (33 with fibromyalgia and 26 healthy controls) were exposed to repeated thermal pain stimuli and were asked to rate their feelings of fatigue after each block of thermal pain exposures….Self-reported fatigue affect increased during pain induction, but greater respiratory sinus arrhythmia predicted less-pronounced increases in fatigue affect across induction trials. Respiratory sinus arrhythmia appears to be a promising indicator of physiological resilience to pain, predicting an attenuated effect of repeated pain exposure on self-reported fatigue. Implications of efficient regulation of pain, fatigue, and long-term physical health are discussed.

Sullivan MD, Cahana A, Derbyshire S et al. 2013. What does it mean to call chronic pain a brain disease?  J Pain. 14(4):317-322. “When considering the significance of neuroimaging results, it is important to remember that “disease” is a concept that arises out of clinical medicine, not laboratory science. Following Canguilhem, we believe that disease is best defined as a structural or functional change that causes disvalue to the whole organism.  It is important to be cautious in our assertions about chronic pain as a brain disease because these may have negative effects on 1) the therapeutic dialogue between clinicians and patients; 2) the social dialogue about reimbursement for pain treatments and disability due to pain; and 3) the chronic pain research agenda.... We should not see pain caused by the brain alone. Pain is not felt by the brain, but by the person….conceiving of chronic pain as a brain disease can have negative consequences for research and clinical care of patients with chronic pain.”

Tauben DJ, Loeser JD. 2013. Pain education at the University of Washington School of Medicine. J Pain. 14(5):431-437. “There is a compelling need for implementation of new approaches to pain medicine education in both medical and other health science schools in response to the increasing evidence of inadequate and insufficient pain medicine education in both the U.S. and elsewhere. The UWSOM has recently increased pain curriculum time spent and the future practice relevance of its pain education by implementing a 4-year integrated curriculum tailored to match both the learning level and clinical experience, including most of the ISAP’s recommended content, while emphasizing the educational needs of future primary care physicians, those who are and will continue to manage the vast majority of patients seeking medical advice and treatment of both acute and chronic pain.”

Thomas K, Shankar H. 2013. Targeting myofascial taut bands by ultrasound. Curr Pain Headache Rep. 17(7):349. “A growing body of evidence…suggests that taut bands are readily visualized under ultrasound-guided exam, especially when results are correlated with elastography, multidimensional imaging, and physical exam findings such as local twitch response.”

Tutoglu A, Boyaci A, Koca I et al. 2014. Quality of life, depression, and sexual dysfunction in spouses of female patients with fibromyalgia. Rheumatol Int. [Jan 9 Epub ahead of print.] “Being a spouse of a patient with fibromyalgia might significantly interfere with quality of life and lead to a high rate of sexual dysfunction. Spouses of patients with fibromyalgia might also be investigated for sexual dysfunction and quality of life. Treatment programs for this group should be considered.”

Wepner F, Scheuer R, Schuetz-Wieser B et al. 2014. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain. 155(2):261-268. “The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.”


Whyte Ferguson L. 2014. Adult Idiopathic scoliosis: The tethered spine. J Bodyw Mov Ther. 18(1):99-111. “This article reports on an observational and treatment study using three case histories to describe common patterns of muscle and fascial asymmetry in adults with idiopathic scoliosis (IS) who have significant scoliotic curvatures that were not surgically corrected and who have chronic pain. Rather than being located in the paraspinal muscles, the myofascial trigger points (TrPs) apparently responsible for the pain were located at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in these muscles appear to tether the spine in such a way that they contribute to scoliotic curvatures. Evaluation also showed that each of these individuals had major ligamentous laxity and this may also have contributed to development of scoliotic curvatures. Treatment focused on release of TrPs found to refer pain into the spine, release of related fascia, and correction of related joint dysfunction. Treatment resulted in substantial relief of longstanding chronic pain. Treatment thus validated the diagnostic hypothesis that myofascial and fascial asymmetries were to some extent responsible for pain in adults with significant scoliotic curvatures. Treatment of these patterns of TrPs and muscle and fascial asymmetries and related joint dysfunction was also effective in relieving pain in each of these individuals after they were injured in auto accidents. Treatment of myofascial TrPs and asymmetrical fascial tension along with treatment of accompanying joint dysfunction is proposed as an effective approach to treating both chronic and acute pain in adults with scoliosis that has not been surgically corrected.”

Yun MJ, Kang DM, Lee KH et al. 2013. Multiple chemical sensitivity caused by exposure to ignition coal fumes: a case report. Ann Occup Environ Med. 25(1):32. “Since 2011, a 55-year-old woman had experienced edema, myalgia, and other symptoms when she smelled ignition coal near her workplace. She had been diagnosed with fibromyalgia syndrome (FMS) and was treated, with no improvement of symptoms. Since then, she showed the same symptoms after exposure to city gas, the smell of burning, and exhaust gas. To avoid triggering substances, she moved to a new house and used an air purifier. She quit her job in November 2012. After visiting our hospital, she underwent a differential diagnosis for FMS, chronic fatigue syndrome, and somatization disorder….She was educated about the disease and to avoid triggering substances. She received ongoing treatment for her symptoms….This case showed that symptoms began after smelling ignition coal. After that, her triggers were increased such as the smell of city gas, burning, and exhaust gas. This case is the first reported in Korea of MCS due to environmental exposure after ruling out other diseases.”

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