Prevention Tips

To help prevent Medicare from being ripped off, you should report all suspected instances of fraud and abuse. Whenever you receive a payment notice from Medicare, review it for errors. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.

The following is a list of tips to prevent fraud:

Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your doctor or other Medicare provider.

Don't allow anyone, except appropriate medical professionals, to review your medical records or recommend services.

Don't contact your physician to request a service that you do not need.

Do be careful in accepting Medicare services that are represented as being free.

Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.

Do be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.

Do avoid a provider of health care items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.

It is in your best interest and that of all citizens to report suspected fraud. Health care fraud, whether against Medicare or private insurers, increases everyone's health care costs, much the same as shoplifting increases the costs of the food we eat and the clothes we wear. If we are to maintain and sustain our current health care system, we must work together to reduce costs.

Protect your Medicarenumber as you would a credit card number

Wednesday,

March 6, 2002 12:30 pm

See Page 3 or

Call 334-6680

for info.

12/87 Pansy May Sufferer

812 Green St.

Hometown, Bliss 00000

Merced, Calif., CFIDS/ME/FMS/MPS, Mercy Hosp. Lower Level, Staff Room, 1st Tues. each month 7 pm .

Capitol CFIDS: Medical Clinic, 3rd floor conf. room, 3160 Folsom, Sacto., 2nd Sat. of each month, noon.

Greater Sacramento FM, Cancer Center, UC Davis Med.Center, 4501 X St., Sacramento, 3th Fri. of each month, 6:00 p.m.

Tip: In most cases articles in Snail Mail are in a format designed for ease of copying. Continuations are not sprinkled through the issue. Feel free to make copies of any article that might be

important in your life.

Uphold implies extended support given to something attacked.

Advocate is to argue or vote for

Back suggests supporting by lending assistance to one failing or falling

Champion suggests publicly defending one unjustly attacked or too weak to advocate his own cause.

Help means assist. Assist does not mean that one or two do it all.

To prop is to prevent falling, collapsing, sagging or slipping by placing something under or against.

Comfort can be consolation in time of trouble or worry.

Support is the least explicit about the nature of the assistance given.

SJ CFIDS/ME/FMS Support Network begins a 16th year as of January, 2002. 15 years of trying to find the best discription of “support” that can be managed by people with CFIDS, CFS, ME, FMS. We continue to struggle with the abilitites we have. The best tool is the sharing.

Maybe I’ll see you at a meeting soon..........Vivien

The truth that many people never understand, until it is too late, is that the more you try to avoid suffering the more you suffer because smaller and more insignificant things begin to torture you in proportion to your fear of being hurt.

~Thomas Merton~

Adapted from "Fibromyalgia and Chronic Myofascial Pain: A Survival Manual edition 2, by Devin J. Starlanyl and Mary Ellen Copeland © the authors, 2001.

Please be aware that we cannot hope to put all the information from ours and several other books for patients on these

disorders. Please get additional information from one of these sources. We have listed some in the bibliography.

"Fibromyalgia (FMS) is the commonest cause of widespread pain (Bennett,1995), yet it may remain undiagnosed for a long time. Uncertainty and frequent misdiagnosis can cause considerable havoc in the lives of patients. Every expert in the field seems to have his or her own estimate of how many people actually have FMS. This confusion will remain until doctors are trained in comprehensive differential diagnosis. Most FMS patients are female, but again, experts disagree on the percentage.

Fibromyalgia Syndrome is pronounced fie-bro-my-al-jia sind-rome. The word "fibromyalgia" is a combination of the Latin roots fibro (connective tissue fibers), my (muscle), al (pain), and gia (condition of). Fibromyalgia is not a new "fad disease". For many years the medical profession called it by many different names, including "chronic rheumatism" and "fibrositis". Most physicians still lack the skills to diagnose and treat it effectively. FMS, like many other conditions, is not curable right now, but it is very treatable, and there are many ways in which you can considerably improve your health and quality of life. You may come to your doctor with symptoms that seem unrelated. They can run the gamut from mental confusion to burning feet, but are usually accompanied by an over-all flu-like feeling that impacts every aspect of your life. Each chapter in "Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, edition 2" has its own medical journal reference section at the end of the chapter. There is also instruction in how to obtain these reference materials.

The American College of Rheumatology, American Medical Association, The World Health Organization, and the National Institutes of Health have all accepted FMS as a legitimate clinical entity. If your doctor "doesn’t believe in FMS", you are going to the wrong doctor. At the Travell Focus on Pain Seminar 2000, I. Jon Russell MD, editor of the Journal of Musculoskeletal Pain, mentioned the use of the Functional MRI, which shows the brain in action. In a healthy individual, when you pressed on a tender point, there is minimal response, but in a patient with FMS, "...the result was wild. The whole brain went crazy." Something is happening in the FMS central nervous system that doesn’t happen to healthy people.

Fibromyalgia can be a source of substantial disability (Kaplan, Schmidt and Cronan, 2000). This is especially true if you have had it for a long period of time without adequate medical support. Nearly everyone with FMS exhibits reduced coordination skills and decreased endurance abilities, although some of this may be due to co-existing chronic myofascial pain (CMP). Fibromyalgia is a complex syndrome characterized by pain amplification, musculoskeletal discomfort, and systemic symptoms. In FMS, there is a generalized disturbance of the way pain is processed by the body (Morris, Cruwys and Kidd, 1998). I think the definition of FMS as widespread allodynia and hyperalgesia (Russell, 1998) describes it well. Allodynia means nonpainful sensations are translated into pain sensations. Hyperalgesia means that your pain sensations are amplified. These changes in the way your central nervous system processes pain seem to be worse if there is a physically traumatic initiating event.

You may be sensitive to odors, sounds, lights, and vibrations that others don’t even notice. The noise emitted by fluorescent lights might drive you to distraction. Your body may at times interpret touch, light, or even sound as pain. Sleep, or the lack thereof, plays a crucial role in FMS. Sleep disturbances, a swollen feeling, and exercise intolerance are significantly related to FMS (Jacobsen, Petersen and Danneskiold-Samsoe, 1993).

Besides specific tender points, the essential symptom of FMS is pain, except in the case of older patients. Seniors are more troubled by fatigue, soft-tissue swelling and depression (Yunus, Holt, Masi et al. 1988) In younger people, discomfort after minimal exercise, low-grade fever or below-normal temperature, and skin sensitivity are also common (Reiffenberger and L. H. Amundson, 1996).

Central Sensitization "It is now firmly established that a central nervous system (CNS) dysfunction is primarily responsible for the increased pain sensitivity of fibromyalgia"(Simons, Travell and Simons, 1999 p 17). There is a generalized CNS- mediated deep tissue sensitivity in FMS includes the muscles, which is why so many people mistakenly believe that it is a muscular condition. Anything that results in tissue injury, whether from more obvious physical trauma such as an auto accident or from subtler biochemical damage, can cause hypersensitivity at the site of the injury. If there is repeated or continued trauma, other areas may develop the hypersensitivity (Yaksh, Hua,. Kalcheva et al. 1999). This can lead to a state of "central sensitization", as your nervous system reacts to chronic, long-term pain in several ways.

The tendency to develop FMS may be inherited. Many mothers with FMS have children with FMS. Because psychological and familial factors were not different in children with or without FMS, this may be due to genetics (Yunus, Kahn, Rawlings, et al.1999). In 1989, Pellegrino, Waylonis and Sommer found that FMS might be inherited on an autosomal dominant basis, with a variable latent phase. This means that approximately half of the children of an FMS parent will eventually develop FMS. The sooner FMS is recognized and treated the more easily symptoms can be controlled. In Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, edition 2, there is a chapter dealing with age-related issues, infant to senior citizen, later in the book.

Fibromyalgia is not musculoskeletal disorder (Simms, 1998). It should have been called "Central Nervous System-myalgia" (New Research). That is where the dysfunction is. It has nothing to do with the fibers of your muscles. In FMS, muscle fibers are not causing the problem, although there may be cellular changes caused by biochemical FMS dysfunction. Fibromyalgia is a biochemical disorder, and these biochemicals affect the whole body. You can’t have FMS only in your back or your hands. You either have it all over or you don’t have it at all. If you have localized complaints, they are probably not caused by FMS, although FMS may be amplifying the local symptoms.

Fibromyalgia is not progressive (Wolfe, Anderson, Harkness et al.1997). If your illness is getting significantly worse with time, there is some perpetuating or aggravating factor or a co-existing condition that has not been addressed. If you identify it and deal with it thoroughly and promptly, your symptoms should ease considerably. Fibromyalgia is not a diagnosis of exclusivity. You may have co-existing conditions, such as MS, arthritis, and/or myofascial pain, and still have FMS amplification.

Fibromyalgia is not a catchall, wastebasket diagnosis. It is a specific, chronic non-degenerative, non-inflammatory syndrome. It is not a disease. Diseases have known causes and well-understood mechanisms for producing symptoms. A syndrome is a specific set of signs and symptoms that occur together are also classified as syndromes. Rheumatoid arthritis, lupus, and many other serious conditions are also syndromes.

Fibromyalgia is not the same as chronic myofascial pain (Gerwin, 1999). It is fundamentally different in an important way (Simons, Travell and Simons, 1999 p 18.) There is no such thing as a fibromyalgia trigger point. Mention of "FMS trigger points" by your doctor or physical therapist should wave a warning flag that there is a serious lack of understanding here. Trigger points (TrPs) are part of myofascial pain, not FMS, and your care provider must understand this.

Fibromyalgia is not the same as CFIDS, although they may be part of the same family of central nervous system dysfunctions. In one study, levels of substance P were determined in the cerebrospinal fluid in 15 patients with CFIDS. All values were within normal. Most patients with FM have increased substance P in the cerebrospinal fluid. The results of this study support the notion that FMS and CFIDS are different disorders in spite of overlapping symptoms (Evengard, Nilsson, Lindh, et al. 1998). Another study points out that "In FMS, there is a condition of physiological hyperarousal. In CFIDS, a blunted response, the exact opposite, occurs" (Crofford, 1998).

Fibromyalgia is not just widespread pain or achy muscles. In the general population, adults who meet the ACR definition of FMS appear to have distinct features compared to those with chronic widespread pain that do not meet those criteria (White, Speechley, Harth et al. 1999a). There are many conditions, which cause widespread pain besides FMS. CMP can cause widespread pain due to trigger point cascades, for example. Side effects of some medications can do the same. Widespread pain is also common in Lyme disease, HIV, hypothyroid and other endocrine abnormalities, and some genetic diseases (Soppi M. and E. Beneforti, 1999).

Fibromyalgia is not homogenous. The cause of muscle pain and allodynia may not be the same in all persons fulfilling the American College of Rheumatology (ACR) criteria for FMS Henriksson, 1999). Fibromyalgia seems to include patients with different pain processing mechanisms (Sorensen, Bengtsson, Ahlner, et al.1997). There are many subsets of FMS. One study has separated some subsets into meaningful categories (Eisinger, Starlanyl, Blotman, 2000), and this separation may help decide which treatment regimens are more likely to help specific patients.

Fibromyalgia is not autoimmune (Wittrup, Wiik, Danneskiold-Samsoe, 1999). The presence of antinuclear antibodies and other connective tissue disease features is similar in patients with fibromyalgia and healthy controls (Yunus, Hussey and Aldag, 1993). Some FMS patients may develop co-existing autoimmune conditions, and patients with immune conditions may develop

FMS, but this does not show a causal relationship. There is a subset of people with FMS who test positive for antinuclear antibodies (Smart, Waylonis and Hackinshaw, 1997). We don’t yet know what this means. A response to antipolymer antibodies is associated with a subset of patients with FMS (Wilson, Gluck, Tesser et al. 1999).

Fibromyalgia is not a mental illness, and must not be categorized as such. Some people with FMS also have mental illness. Some people with sniffles have mental illness too, but that doesn’t mean that sniffles are caused by mental illness. Studies have shown that the incidence of mental problems is no higher with FMS patients than with any other type of chronic pain syndrome (Goldenberg, 1989; Merskey, 1989 ). "There is now clinical evidence that FMS represents a distinct rheumatic disorder and should not be regarded as a somatic illness secondary to psychiatric disorder" (Dunne and Dunne 1995). "Psychiatric Diagnostic Interview data failed to discriminate in any major way between primary fibromyalgia syndrome (a disorder with no known organic etiology) and rheumatoid arthritis (a disorder with a known organic etiology). Therefore, these data do not support a psychopathology model as a primary explanation of the symptoms of primary fibromyalgia syndrome" (Ahles, Khan, Yunus et al. 1991).

Fibromyalgia is not infectious. Infection from many causes can start the neurochemical cascade of FMS. This does not mean that FMS itself is infectious. Both FMS and CMP can be brought on by triggers, such as stress, infections, pollution, and diet. There is a great deal of financial and other stress in dealing with a chronic illness, so it is not surprising that some partners of patients with FMS develop the same illness.

Tender points hurt where pressed, but they do not refer pain. In other words, pressing a tender point does not cause pain in some other part of the body. The examiner must use enough pressure to whiten the thumbnail, which is about 4 kg pressure. The official definition further requires that tender points must be present in all four quadrants of the body, that is, the upper right and left and lower right and left parts of your body. Tender points occur in pairs, so the pain is usually distributed equally on both sides of the body.

On the back of your body, tender points are present in the following places:

Along the spine in the neck, where the head and neck meet;

On the upper line of the shoulder, a little less than halfway from the shoulder to the neck; about three finger widths, on a diagonal, inward from the last points;

On the back fairly close to the dimples above the buttocks, a little less than halfway in toward the spine;

Below the buttocks, very close to the outside edge of the thigh, about three finger widths.

On the front of your body, tender points are present in the following places:

On the neck, just above inner edge of the collarbone;

On the neck, a little further out from the last points, about four finger widths down;

On the inner (palm) side of the lower arm, about three finger widths below the elbow crease;

On the inner side of the knee, in the fat pad.

The tender point count may decrease with proper medical treatment and self-care, but that doesn’t mean that the FMS has been cured. It simply means that you have learned to deal with the perpetuating factors and co-existing conditions and have them under control.

In FMS, we believe that there is often an initiating event that activates biochemical changes, causing a cascade of symptoms. For example, unremitting grief of six months or longer can trigger FMS. In many ways, FMS is sort of like a Survivor’s Syndrome. Cumulative trauma, protracted labor in pregnancy, open-heart surgery, and even inguinal hernia repair have all been initiating events for FMS. The start of each case of FMS probably has multiple causes (Bennett and Jacobsen,1994. Not all cases of FMS cases have a known triggering event that initiates the first obvious flare. During a flare, current symptoms become more intense, and new symptoms frequently develop.

Fibromyalgia seems to be the result of many neurotransmitter cascades (Fibromyalgia Advocate, Chapter 2). A neurotransmitter cascade is like a waterfall that starts at the top and bounces off rocks and ridges on the way down, wearing down rock, moving gravel, and changing the river as it goes. The neurotransmitter cascade can cause changes throughout your body, and many of these changes start cascades of their own. Once they get going, a combination of peripheral and central factors join in to make the changes chronic, and the result is what we call fibromyalgia. Every patient may have different "informational substances" disrupted in different ways".

Used with permission from Devin

page 7

Excerpted from "The Fibromyalgia Advocate: Getting the Support You Need to Cope with Fibromyalgia and Myofascial Pain Syndrome", by Devin J. Starlanyl, © 1998, New Harbinger All rights reserved.

Please be aware that we cannot hope to put all the information from ours and several other books for patients on these disorders. Please get additional information from one of these sources. We have listed some in the bibliography.

I will consider changing my medications, my physical therapies, and my exercise routines, but I will not consider going without Guaifenesin, nor will I take anything that might block its effect. It's too important to my well-being. It is not a cure. I must still practice sound nutrition, bodywork, mind work and the other lifestyle modifications important to the FMS&MPS Complex patient, but I feel that Guai has made a decided difference in my quality of life, and allowed me to do much more than I could have done otherwise. I want others to know that there are options.

Guaifenesin therapy was developed by Dr. R. Paul St. Amand. It is experimental. We don't know how it works. The one study done on Guaifenesin and FMS was flawed, through no fault of those who ran it (St. Amand R. P. and C. Potter. 1997. "The use of uricosuric agents in fibromyalgia: theory, practice and a rebuttal to the Oregon study of Guaifenesin treatment." Clin Bul Myofas Ther 2(4):5-17.). We simply didn't know all the variables at the time the study took place, including the importance of diet for reactive hypoglycemia for the reversal to become evident, and the need for each person to find their specific dosage for the reversal to take place.

Guaifenesin is a common over-the-counter expectorant. It has been around for about seventy years, first as guaiacum and then as guaiacolate, and for about twenty years as Guaifenesin. Guaifenesin is not a cure for FMS. It does seems to allow the kidneys to eliminate something harmful that has been stored in the body. Dr. St. Amand feels that at least part of what is eliminated is phosphates, and I agree. Oxalates may also be part of this package of unwanted stored matter that is released by Guaifenesin. Excess oxalates seem to be responsible for some of the vulvitis and vulvodynia experienced by female FMS patients.

St. Amand found that with Guaifenesin therapy, there was an increased excretion of 60 percent phosphates, 30 percent oxalates and 30 percent calcium. Although you lose excess calcium, none

of his patients has exhibited any sign of osteoporosis or calcium loss. Emphysema patients on Guaifenesin often take 2400 mg a day for many years without any side effects.

Guaifenesin is safe and even available in pediatric dosages. It is also sold in as a prescription medication available in 600 mg caplets or capsules. It is important to ensure that there are no other medications mixed in with the Guaifenesin, as there often are in cough and cold formulations.

St. Amand feels that FMS develops in a cyclical process. At first, there are times when we experience symptoms interspersed with periods where we feel ok. Sometimes we are unaware of what is happening at this stage. The periods without symptoms get shorter, the symptomatic episodes become more frequent and the symptoms worsen. This is what St. Amand calls "cycling". He believes that Guai therapy reverses this process.

Your urine and sweat may become dark and smelly as Guai takes effect. I believe that this indicates a release of wastes, excess acids and, I believe, toxins, as well as substances such as quinolinic acid, the nerve toxin produced by the kynurenine pathway of tryptophan metabolism (see Alternative Tryptophan Pathway, Chapter 5, The Fibromyalgia Advocate). This release into the bloodstream is manifested by muscle aches, headaches, and often overwhelming fatigue. This includes physical problems as well as psychological ones, including feeling depressed at times during the cycle. With the release of the wastes into the blood stream, your body can begin to process these unwanted substances, and get rid of them through the urine, feces, and sweat. Your feces may become irritating, and you may experience anal itch or soreness. This can be eased by Bag Balm, anesthetic ointment, or cortisone ointment. You may also experience burning on urination, caused by the excess acid (see Fibromyalgia and Myofascial Pain Syndrome: The Survival Manual).

After the initial flush of wastes, you will begin to go through a reverse of the cyclical process. Every once in a while you will have a period where your symptoms ease. You may then begin to experience whole days where you feel well. It is important not to overdo on these days. Your body is in a struggle to regain balance. Don't overtax it.

When you get to the point where there are clusters of good days, the contrast can be remarkable. Knowing what is happening helps you to deal with the reversal symptoms. The bad days are still bad, but you know why, and you know you are on a path to better health.

Before you begin Guaifenesin therapy, use the body chart found in The Fibromyalgia Advocate map your areas of pain. This will allow you to record any progress.

The typical regimen is to start with 300 mg twice a day. I have seen some people start gentle Guai therapy on 200 mg a day. It is important to find the dosage that works for you. This varies from

patient to patient. If, after one week, no obvious change occurs, increase the dose to 600 mg twice a day for a few weeks. Pay attention to your body. If, after this time, no sign of reversal is evident, try 600 mg three times a day. This is the dosage I am on, and have found effective for me. Each of us is different. The break up of pain areas in spite of an increase in symptoms means the stored waste matter is leaving your body.

There is no "Guaifenesin" or "fibromyalgia" diet. It is important those of you with co-existing reactive hypoglycemia to follow a low carbohydrate diet if you want to feel better during Guaifenesin therapy. I have found the Zone diet helpful (see "Reactive Hypoglycemia", and "Books and Tapes"). A strict low carbohydrate diet is a must for those who are overweight as well as hypoglycemic

SALICYLATE BLOCKING EFFECT

The effect of Guaifenesin therapy can be blocked by salicylates. Dr. St. Amand explains what happens in this way: "All cells have little garages called "receptors." They are each unique for

certain chemicals and hormones. To work, any medication must have the ability to enter and park in the garage in order to signal the cell to do a certain job.

Guaifenesin parks in receptors to get the kidney cells to do the work you need done. Unfortunately, salicylates are a much better fit for that garage and the valet will park salicylates in preference to anything else. When Guaifenesin arrives in the parking lot, there are no available garage spaces. Thus no signal is given for our desired effect."

The effects of a Guaifenesin blocking agent may last about 24 hours. Salicylates are found in some medications and topical creams, for example some muscle rub products and sunscreens. It is also present and often hidden in a great array of cosmetics, some ultrasound gels, mouthwashes and herbal preparations. Everyone on Guaifenesin should avoid obvious sources of salicylates such as aspirin and other blatant salicylates (Diflunsal, Methyl salicylate, Trisalicylate), plant extracts (aloe, licorice, pycnogenol, St. John's Wort, ginko, quercetin etc).

Each person seems to have a different sensitivity to the Guai blocking effect of certain salicylates, If you've found your proper dosage and suddenly the cycling stops and your symptoms worsen, check out secondary sources such as camphor, almond oil, coconut oil, lauric acid, etc. I've seen this happen to me and to others, and we've always been able to track down the offending salicylate and eliminate it, with a subsequent return to improvement. These setbacks and subsequent resolutions are yet another indication to me that we are on the right track with Guai.

Only phosphate is known to decrease ATP formation when it accumulates in the mitochondrial matrix. The mitochondria are the body's energy factories, and ours are polluting badly. Low ATP has been found in people with FMS (Park J. H., P. Phothimat, C. T. Oates, M. Hernanz-Schulman and N. J. Olsen. 1998. "Use of P-31 magnetic resonance spectroscopy to detect metabolic

abnormalities in muscles of patients with fibromyalgia." Arth Rheum 41(3):406-413; Eisinger, Plantamura and Ayavou 1994). ATP is essential to almost all cellular functions.

Both Dr. St. Amand and I suspect a lowered pH is at least part of the FMS problem. The pH is a measure of the acid/base balance of the body. Low pH indicates acid. Dr. St. Amand used his

observational skills and deductive logic to theorize what is happening in our cells. Sherlock Holmes would have been proud.

At 300 mg Guaifenesin twice a day, Dr. St. Amand found that about 20% of his patients reverse--and this reversal is often swift and strong. About 70% patients reverse at 600 mg twice a day. The rest of us need a stronger dosage. Once your symptoms are made distinctly worse by a given dose, that is probably the proper dose for you. Just remember, your body has a limited capacity for clearing out the debris. Give it the time it needs, and be gentle with yourself when you begin Guaifenesin therapy.

If your symptoms have been relieved, it may be time to see if you can do without your other medications, one at a time. Talk to your doctor about this. Once this has been done, and if your

symptoms don't return, you may want to try to drop the Guaifenesin dosage. Do this gradually. According to Dr. St. Amand, some people cut back a half pill at a time and wait about three months or so before they cut back another half pill. People are reluctant to jeopardize their hard-won health. You have cut down too far when the symptoms return, so just resume what dosage you were on when you had no symptoms. This is your maintenance dose.

To join the Guaifenesin support group in the Internet, send an email to the following address:

LISTSERV@MAELSTROM.STJOHNS.EDU

with the message: SUB GUAI-SUPPORT Your full name

Your doctor may contact Dr. St. Amand at the following:

R. Paul St. Amand, M.D.

4560 Admiralty Way, Suite 355

Marina del Rey, CA 90292

310-577-7510

For the full details on Guaifenesin therapy, plus a lot of information on fibromyalgia, read the book "What Your Doctor May Not Tell You About Fibromyalgia" by R. Paul St. Amand and Claudia Craig Marek. Visit Dr. St. Amand's website at: Guaidoc.com

Used with permission from Devin

News in the World of Myofascial Pain

Life has been tough for those of us with myofascial pain syndrome. We have too often been met with doctors who “don’t believe in” MPS. We have been hampered by the lack of a scientifically credible and understandable cause for this condition., and an officially recognized set of diagnostic criteria. This resulted in a lack of training of physicians and therapists. The insurance companies and the Social Security Administration made our lives even more difficult. This is about to change.

We now have facts that cannot be disputed. At last we have proof that myofascial pain caused by trigger points is a true disease. We know what creates a trigger point, what it is, and many of the ways it can cause us pain and other symptoms. We know what causes those taut bands that constrict our muscles, and we know why our muscles become so tight that they hurt.

A myofascial trigger point is a localized area starving for oxygen. It creates an increased local energy demand. This local energy crisis releases neuroreactive biochemicals which sensitize nearby nerves. The sensitized nerves initiate the motor, sensory, and autonomic effects of myofascial trigger points by acting on the central nervous system. Muscles with trigger points are muscles in a constant state of energy crisis.

Myofascial trigger points can be identified and documented electrophysiologically by characteristic spontaneous electrical activity (SEA). They may also be identified histologically (which means that the structure of the cells have changed) by contraction knots-- the lumps and bumps we know only too well. Both of these phenomenon seem to result from excessive release of the neurotransmitter acetylcholine (ACh) from the nerve terminal of the motor endplate (the complex end formation of the nerve).

We now have objective confirmation of electromyographic imaging of a myofascial trigger point. There are also ultrasound imaging of local twitch responses of trigger points, and biopsies of myofascial trigger points that show contraction knots and giant rounded muscle fibers. To quote from this article, "The endplate dysfunction characteristic of MTrPs involves both the nerve terminal and the postjunctional muscle fiber. This relationship identifies MTrPs as a neuromuscular disease." Simons DG. 1999. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskeletal Pain 7(1-2):111-120.

A MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of ACh in an abnormal endplate. The pathogenesis of myofascial trigger points appears to involve serious disturbance of the nerve ending and contractile mechanism at multiple dysfunctional endplates. Doctor Hong has even formed a theory concerning fibromyalgia tender points. Hong, C-Z. 1999. Current research on myofascial trigger points-pathophysiological studies. J Musculoskeletal Pain 7(1-2):121-129.

Please ask your librarian to obtain these articles through Interlibrary loan, and give them to your doctor. Don’t forget to keep copies for yourselves.

For more information on this issue of the Journal of Musculoskeletal Pain go to Journal of Musculoskeletal Pain from Haworth Medical Press

How To Use The http://www.sover.net/~devstar/index.htm Website

1) Begin by reading the site. Start with the diagnostic, which will help you discover if fibromyalgia and/or chronic myofascial pain and/or reactive hypoglycemia (insulin resistance) may be a factor in your life. It will help pinpoint some of your symptoms sources, and will also give you suggestions and guidelines.

2) Identify and deal with the perpetuating factors. This should help decrease your symptom load, and is necessary before any therapy "holds".

3) Copy the referenced data sheets for your medical care team.

4) Do read the physicians' data sheets--they may hold the answers to your questions.

5) Feel free to access the physicians' bibliography and see all the medical journal articles being written. Your reference librarian will help you get articles you need through the Interlibrary Loan.

Used with permission from Devin

~~~***~~~

page 10

Martha's way #1: Stuff a miniature marshmallow in the bottom of a sugar cone to prevent ice cream drips.

My way: Just suck the ice cream out of the bottom of the cone, for Pete's sake, you are probably lying on the couch with your feet up eating it anyway.

Martha's way #2: Use a meat baster to "squeeze" your pancake batter onto the hot griddle and you'll get perfectly shaped pancakes every time.

My way: Buy the precooked kind you nuke in the microwave for 30 seconds. The hard part is getting them out of the plastic bag.

Martha's way #3: To keep potatoes from budding, place an apple in the bag with the potatoes.

My way: Buy Hungry Jack mashed potato mix and keep it in the pantry for up to a year.

Martha's way #4: To prevent egg shells from cracking, add a pinch of salt to the water before hard boiling.

My way: Who cares if they crack, aren't you going to take the shells off anyway?

Martha's way #5: To get the most juice out of fresh lemons, bring them to room temperature and roll them under your palm against the kitchen counter before squeezing.

My way: Sleep with the lemons in between the mattress and box springs.

Martha's way #6: To easily remove burnt-on food from your skillet, simply add a drop or two of dish soap and enough water to cover bottom of pan, and bring to a boil on stovetop.

My way: Eat at Chili's every night and avoid cooking.

Martha's way #7: Spray your Tupperware with nonstick cooking spray before pouring in tomato based sauces and there won't be any stains.

My way: Feed your garbage disposal and there won't be any leftovers.

Martha's way #8: When a cake recipe calls for flouring the baking pan, use a bit of the dry cake mix instead and there won't be any white mess on the outside of the cake.

My way: Go to the bakery. They'll even decorate it for you.

Martha's way #9: If you accidentally over salt a dish while it's still cooking, drop in a peeled potato and it will absorb the excess salt for an instant "fix me up"

My way: If you over salt a dish while you are cooking, that's too darn bad. My motto: I made it and you will eat it and I don't care how bad it tastes.

Martha's way #10: Wrap celery in aluminum foil when putting in the refrigerator and it will keep for weeks.

My way: Celery? Never heard of the stuff.

Martha's way #11: Brush some beaten egg white over pie crust before baking to yield a beautiful glossy finish.

My way: The Mrs. Smith frozen pie directions do not include brushing egg whites over the crust and so I don't do it.

Martha's way #12: Place a slice of apple in hardened brown sugar to soften it.

My Way: Brown sugar is supposed to be "soft"?

Martha's way #13: When boiling corn on the cob, add a pinch of sugar to help bring out the corn's natural sweetness.

My Way: The only kind of corn I buy comes in a can.

Martha's way #14: To determine whether an egg is fresh, immerse it in a pan of cool, salted water. If it sinks, it is fresh, but if it rises to the surface, throw it away.

My way: Eat, cook, or use the egg anyway. If you feel bad later, you will know it wasn't fresh.

Martha's way #15: Cure for headaches: Take a lime, cut it in half and rub it on your forehead. The throbbing will go away.

My way: Martha, dear, the only reason this works is because you can't rub a lime on your forehead without getting lime juice in your eye, and then the problem isn't the headache anymore, it is because you are now blind.

Martha's way #16: If you have a problem opening jars: Try using latex dishwashing gloves. They give a non slip grip that makes opening jars easy.

My way: Go ask the very cute neighbor to do it.

Martha's way #17: Potatoes will take food stains off your fingers. Just slice and rub raw potato on the stains and rinse with water.

My way: Mashed potatoes will now be replacing the anti-bacterial soap in the handy dispenser next to my sink.

Martha's way #18: Now look what you can do with Alka

Seltzer. Clean a toilet. Drop in two Alka-Seltzer tablets, wait twenty minutes, brush and flush. The citric acid and effervescent action clean vitreous china. Clean a vase. To remove a stain from the bottom of a glass vase or cruet, fill with water and drop in two Alka-Seltzer tablets. Polish jewelry. Drop two Alka-Seltzer tablets into a glass of water and immerse the jewelry for two minutes. Clean a thermos bottle. Fill the bottle with water,

drop in four Alka-Seltzer tablets, and let soak for an hour (or longer, if necessary).

My way: Put your jewelry, vases, and thermos in the toilet. Add some Alka-Seltzer and you have solved a whole bunch of problems at once.

***

Media: Survey Press Release

FOR IMMEDIATE RELEASE

CONTACT: Renée M. Brehio

The CFIDS Association of America

704-364-0466

rmbrehio@cfids.org

- Lack of Test to Detect the Illness Remains Greatest Barrier to Diagnosis -

CHARLOTTE, NC, November 13, 2001 - Thirteen years after a group of scientists coined the term chronic fatigue syndrome (CFS) to describe a mysterious medical condition, many medical professionals are acknowledging it as a seriously disabling condition in need of treatment, concluded a survey released today by The Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America.

Three-quarters of medical professionals responding to the survey believe that CFS, also known as CFIDS, is as or more disabling than other chronic diseases such as lupus, multiple sclerosis or rheumatoid arthritis. But despite the severe nature of the illness, diagnosis remains problematic. Half of the survey respondents cited the lack of a proven diagnostic test to be the greatest barrier to accurately identifying CFS. Thirty-five percent feel lack of a known cause of the illness is a barrier to diagnosis and 31% feel there is not enough basic knowledge about CFS among the medical community.

Currently, health care practitioners are using a number of different methods to diagnose CFS. Almost three-quarters (72%) rely on exclusion of other common causes for symptoms; 68% use a patient history; and 25% use laboratory tests. Practitioners also rely on documenting the presence of symptoms other than fatigue. When respondents were asked what one symptom other than fatigue made them more likely to suspect CFS, or without which they would not make a diagnosis, the most common answer was post-exertional malaise (incapacitating fatigue lasting more than 24 hours after physical or mental exertion).

Lack of basic knowledge among practitioners and the absence of a diagnostic test means that more research and awareness of CFS is needed. Seventy-seven percent of the medical professionals surveyed felt that the amount of available professional education about CFS is not adequate. In addition, a large majority of respondents (87%) indicated that there should be more funding for research on the illness.

These survey findings confirm that CFS is increasingly recognized as a serious, debilitating illness and medical professionals still lack the core knowledge and tests they need to diagnosis CFS quickly and accurately," stated Kim Kenney, President and Chief Executive Officer of The CFIDS Association of America. "Much has been learned about CFS, but it is now very apparent that there is still a great need for research and education in the medical community."

The four-page survey was mailed to 8,100 medical professionals around the country, with a total of 865* completed surveys returned. The medical professionals polled came from a variety of disciplines including internal medicine, family/general practice, psychiatry/psychology, neurology, nursing and medical research.

About CFS (or CFIDS) CFS is a serious and complex illness that affects many different body systems. There is no known cause. It is characterized by incapacitating fatigue (experienced as profound exhaustion and extremely poor stamina), neurological problems and numerous other symptoms. CFS can

be severely debilitating and can last for many years. CFS is often misdiagnosed because it can resemble other disorders including mononucleosis, multiple sclerosis, fibromyalgia, Lyme disease, post-polio syndrome, and autoimmune diseases such as lupus. CFS is also known as myalgic encephalomyelitis (ME).

About The CFIDS Association of America

The CFIDS Association of America is the nation's leading organization working to conquer CFS. Since 1987, the Association has invested nearly $12 million in education, public policy, and research programs in its efforts to bring an end to the suffering caused by the illness. For more information on The CFIDS Association of America or CFS, please call 1-800-442-3437 or visit www.cfids.org.

75% of survey respondents believe that CFS, also known as CFIDS, is at least as disabling (53%) or more disabling (22%) than other chronic diseases such as lupus, multiple sclerosis or rheumatoid arthritis. According to half of the respondents, lack of a diagnostic test is the greatest barrier to accurately diagnosing CFS. 35% feel the greatest barrier is lack of a known cause and 31% said it is due to lack of knowledge about CFS in the medical community.*

68% of physicians surveyed said they use patient history to arrive at a CFS diagnosis.

72% exclude other common causes for symptoms, 10% use diagnostic procedures such as tilt table testing and 25% rely on lab tests.

69% of respondents answered that it is possible to make a diagnosis in children 12 and over, while only 18% believe you can diagnose CFS in children age 5 to 12.

No one cause was cited by a majority of respondents as the primary cause of CFS. The largest group, 37%, believe the primary cause of CFS is immune dysfunction, while an almost equal number, 33%, said that the cause is unknown.

83% cited impaired memory or concentration as the most common non-fatigue related symptom in CFS patients.

40% said there was a symptom other than fatigue that made them more likely to suspect CFIDS or without which they would not make a diagnosis. The most common answer was post-exertional malaise, which is incapacitating fatigue lasting more than 24 hours after physical or mental exhaustion.

In terms of treatment, the largest percentage of respondents (69%) counsel patients on making lifestyle adjustments, while smaller percentages also prescribe treatments for the various symptoms of CFS such as antidepressants, sleep aids, nutritional supplements, pain medication, immune modulators, antivirals or antibiotics and cardiovascular or blood pressure drugs.

77% of the medical professionals feel that the amount of professional education about CFS is not adequate and that more is needed.

87% of respondents indicated a need for more funding for CFS research.

Approximately half of the respondents (57%) feel the general public is not very well informed about CFS. 11% thought that the public is somewhat informed and 0% feel that the public is well informed. 32% actually feel the public is somewhat to very misinformed about CFS.

*(Note: some statistics equal more than 100% due to multiple answers provided by respondents)

~~~~~~***~~~~~~

Canada, as most are aware, has a socialized medical system that has one benefit that can be used by those in the United States: the price ofmedication is controlled.

Prices in Canada can be from 30% to 1000% less than the same medications in the United States. Prescriptions for a three-month supply, including shipping charges, can often be less than a one-month supply in the United States, although not all medications have this drastic a price difference.

Canadian Prescription Drugs works with a group of pharmacies that process the prescriptions that are written by physicians in the United States and medication can be sent directly to the patient as long as a valid U.S. prescription is used.

For those patients struggling with a chronic illness, costly medication is not always covered by their insurance plans. More information is available by calling 1-877-966-0567 (toll free) or going to the website:

The National CFIDS Foundation, Inc. is an all volunteer group that derives no financial gain from alerting people to this information.

Gail Kansky, National CFIDS Foundation, Inc.

103 Aletha Rd.

Needham, MA 02392-3931

781-449-3535

http://www.NCF-NET.org

January 15, 2002...Dr. Michael Lawson MD FRACP will tell us “everything we always wanted to know” about IRRITABLE BOWEL SYNDROME. He will discuss medications used to treat IBS and tips for coping with IBS problems.

February 15, 2002...Dr. Steven Natzel, upper cervical Chiropractor, will present a computer imaging program used to diagnose back problems. His topic: Something you Cannot Live Without.

March 15, 2002...Dr. Scott Fishman MD, head of the Pain Management Center at UCD will talk about various medications and techniques to handle pain. There will be a Q & A session.

Meetings are held at the UCD Cancer Center, 45th and “X” St., Sacramento, 3rd Friday of each month, 6:30 to 8:30 p.m.

All family members, friends and medical providers are welcome to attend meetings.

***

by Paula Kurtzweil

November-December 1999

You don't have to look far to find a health product that's totally bogus--or a consumer who's totally unsuspecting. Promotions for fraudulent products show up daily in newspaper and magazine ads and TV "infomercials." They accompany products sold in stores, on the Internet, and through mail-order catalogs. They're passed along by word-of-mouth.

And consumers respond, spending billions of dollars a year on fraudulent health products, according to Stephen Barrett, M.D., head of Quackwatch Inc., a nonprofit corporation that combats health fraud. Hoping to find a cure for what ails them, improve their well-being, or just look better, consumers often fall victim to products and devices that do nothing more than cheat them out of their money, steer them away from useful, proven treatments, and possibly do more bodily harm than good.

"There's a lot of money to be made," says Bob Gatling, director of the program operations staff in the Food and Drug Administration's Center for Devices and Radiological Health. "People want to believe there's something that can cure them."

FDA describes health fraud as "articles of unproven effectiveness that are promoted to improve health, well being or appearance." The articles can be drugs, devices, foods, or cosmetics for human or animal use.

FDA shares federal oversight of health fraud products with the Federal Trade Commission. FDA regulates safety, manufacturing and product labeling, including claims in labeling, such as package inserts and accompanying literature. FTC regulates advertising of these products.

Because of limited resources, says Joel Aronson, team leader for the nontraditional drug compliance team in FDA's Center for Drug Evaluation and Research, the agency's regulation of health fraud products is based on a priority system that depends on whether a fraudulent product poses a direct or indirect risk.

When the use of a fraudulent product results in injuries or adverse

reactions, it's a direct risk. When the product itself does not cause harm but its use may keep someone away from proven, sometimes essential, medical treatment, the risk is indirect. For example, a fraudulent product touted as a cure for diabetes might lead someone to delay or discontinue insulin injections or other proven treatments.

While FDA remains vigilant against health fraud, many fraudulent products may escape regulatory scrutiny, maintaining their hold in the marketplace for some time to lure increasing numbers of consumers into their web of deceit.

How can you avoid being scammed by a worthless product? Though health fraud marketers have become more sophisticated about selling their products, Aronson says, these charlatans often use the same old phrases and gimmicks to gain consumers' attention--and trust. You can protect yourself by learning some of their techniques.

The following products typify three fraudulent products whose claims prompted FDA to issue warning letters to the products' marketers, notifying them that their products violated federal law. Two of the products also were added to FDA's import alert list of unapproved new drugs promoted in the United States. Products under import alert are barred from entry onto the U.S. market.

Take a look at these products' promotions. They are rife with the kind of red flags to look out for when deciding whether to try a health product unknown to you.

Product No. 1:

Pure emu oil

" ... extremely beneficial in the treatment of rheumatism, arthritis ... infections ... prostate problems, ulcers ... cancer, ...heart trouble, hardening of the arteries, diabetes and more. ... "

"completely eliminating the gangrene ...

"... antibiotic, pain reliever ... ."

Be suspicious of products that claim to cure a wide range of unrelated diseases--particularly serious diseases, such as cancer and diabetes. No product can treat every disease and condition, and for many serious diseases, there are no cures, only therapies to help manage them.

Cancer, AIDS, diabetes, and other serious diseases are big draws because people with these diseases are often desperate for a cure and willing to try just about anything.

Personal Testimonials

but he is more like himself again!!!"

Personal testimonies can tip you off to health fraud because they are difficult to prove. Often, says Reynaldo Rodriguez, a compliance officer and health fraud coordinator for FDA's Dallas district office, testimonials are personal case histories that have been passed on from person to person. Or, the testimony can be completely made up.

"This is the weakest form of scientific validity," Rodriguez says. "It's just compounded hearsay."

Some patients' favorable experiences with a fraudulent product may be due more to a remission in their disease or from earlier or concurrent use of approved medical treatments, rather than use of the fraudulent product itself.

Quick Fixes

"... eliminates skin cancer in days! ..."

Be wary of talk that suggests a product can bring quick relief or provide a quick cure, especially if the disease or condition is serious. Even with proven treatments, few diseases can be treated quickly. Note also that the words "in days" can really refer to any length of time. Fraud promoters like to use ambiguous language like this to make it easier to finagle their way out of any legal action that may result.

http://www.fda.gov/fdac/features/1999/699_fraud.html

Dump undrained pineapple in pan. Spread evenly. Dump in pie filling and spread. Dump cake mix on top of this. Spread evenly. Sprinkle pecans over cake mix. Put margarine on top. Bake at 350 for 45 to 50 minutes. Serve warm or cold.

1 large can chicken, about 2 cups

(tuna, shrimp or crab may be used)

1 can cream of chicken soup

1 can cream of celery or cream of mush-

room soup

1 small can mushrooms, drained

1 small can pimientos (OPTIONAL)

(I used sliced water chestnuts, cut up, instead)

1 small can evaporated milk

1 can Chinese noodles, save some for topping

Onion powder and ground pepper to taste

Bread crumbs* (did not use 'cause noodles seemed to

suffice)

Butter

(*French’s onion toppers might be tasty tho’)

Mix all ingredients thoroughly in a large bowl, except the bread crumbs and butter. Plade in buttered oven-proof baking dish, cover with remaining noodles and dot with butter.

350º oven for 1/2 hour or until bubbling. ENJOY!!

Thanks to Terry Reese

And here’s is Roz’s Crab Mold....

a favorite at our Pot Luck Luncheons

1 6 or 8 ounce package cream cheese

1 can mushroom soup

1 envelop Knox gelatin in 3 tablespoons water

1 cup finely cut celery

3 - 4 green onions, (more is OK) finely sliced

1 can crab

1 cup shrimp (cut up)

1 jar pimentos (chopped)

or some sun dried tomatoes in olive oil

Heat soup, add the dissolved gelatin mix. Add the cream cheese, mix. Add the celery, onion, crab and shrimp, pimento (or tomatoes). Mix all.

Pour into a mold. Chill overnight. Unmold.

Try the sun dried tomatoes in olive, patted dry.

Thanks to Roz Ogletree

Dough for 8 Kuchen

1½ cups lukewarm milk

½ cup sugar

2 eggs

2 teaspoons salt

1/2 cup shortening

7 to 7½ cups flour

2 packages yeast dissolved in ½ cup warm water.

Mix ingredients using ½ the flour. Add the yeast mixture. Gradually add remaining flour. Knead. Let rise 1 to 1½ hours. Punch down. Let rise again. Roll to size of pie pans. Fill with fruit and *filling, add **streusel topping. Bake at 350º, 25-30 minutes, or until center tests done.

4 eggs

1 cup sugar

4 cups milk (mixed from powder, canned, etc.)

1 tablespoon flour or more for thickening.

Cook on top of stove over medium heat until thick. Add one teaspoon vanilla. Pour into kuchen crusts. Add fruit as desired. Add streusel topping.

½ cup brown sugar

1 cup flour

Dash cinnamon and nutmeg

Thanks to Linda Weatherbee-Green

Media contact:

Charlene D. Hill

Media Relations Manager

630.792.5175

E-mail: chill@jcaho.org

(Oakbrook Terrace, IL - December 5, 2001)

Surgeries on the wrong site, or on the wrong patient, or performance of the wrong procedure on a patient are completely preventable and should never happen, according to a special alert issued today by the Joint Commission on Accreditation of Healthcare Organizations to nearly 18,000 health care facilities nationwide.

The Joint Commission alert calls on the health care community to take specific safety steps and seeks to enlist patients to help to eliminate these tragic mistakes.

"Health care experts are unanimous in their belief that these types of errors should never happen," says Dennis S. O'Leary, M.D., president, Joint Commission. "The know-how to create systems that prevent wrong site surgeries has existed for years, yet the number of errors has not decreased. Even one wrong site surgery is one too many."

To help avoid these surgical errors, the Joint Commission encourages patients to make one basic request: ask to have the surgical site marked with a permanent marker. "This simple step really will help," Dr. O'Leary said. "And it is an important way in which patients can play an active role in improving safety."

The Joint Commission alert also recommends that health care facility staff:

Mark the surgical site - Sometimes referred to as "signing your site," doctors place their initials on the surgical site with a permanent marking pen in a way that cannot be overlooked and then actually operate through or next to the initials.

Orally verify the surgery - In the operating room just before starting the operation, each member of the surgical team should confirm that they have the correct patient, the correct surgical site and the correct procedure.

Take a 'time out' in the operating room - This gives the surgical team one last chance to double check amongst themselves about the impending procedure, check charts, and corroborate information with the patient.

"It is most important that there be cooperative openness between the surgeon and the nurses," says Tom Russell, M.D., executive director, American College of Surgeons. "The two groups must both take responsibility, and if there are questions, they should stop to be sure everyone is on the same page. No one should make assumptions."

During its on-site quality evaluations, the Joint Commission will ask accredited health care facilities how they are protecting patients from wrong site surgeries. The Joint Commission's error reporting database includes more than 150 such cases collected since 1996.

The Joint Commission first drew attention to the issue more than three years ago when it issued its first alert on the subject. The American Academy of Orthopaedic Surgeons and the New York State Department of Health have also independently issued recent recommendations on prevention of wrong site surgeries.

"Although the wrong site surgery problem has been addressed on the local level in many areas of the country, there has been no organized national effort to eliminate wrong site surgery," says S. Terry Canale, M.D., immediate past president, American Academy of Orthopaedic Surgeons.

The new warning about surgical mistakes is the latest in a series of patient safety alerts issued by the Joint Commission. Previous alerts have focused on deadly medication mix-ups, patient suicides, infant abductions and fatal falls among the elderly.

Making patient safety its top priority, the Joint Commission has established one of the nation's most comprehensive voluntary reporting systems for health care errors. The resulting database includes detailed information about the causes of the errors, and has enabled the Joint Commission to both warn health care facilities about dangers and share solutions to prevent these tragedies. The complete list and text of past issues of Sentinel Event Alert can be found on the Joint Commission's website.

http://www.jcaho.org/news

December 7, 2001

Featuring: Kim A. Snyder, Michelle Akers, Blake Edwards and Stephen Paganetti. A documentary written and directed by Kim A. Snyder. No MPAA rating (unobjectionable for all). Running time: 74 minutes.

BY ROGER EBERT

I now believe in Chronic Fatigue Syndrome. I was one of many who somehow absorbed the notion that it was an imaginary illness. I am ashamed of myself. At the Hamptons Film Festival, I met Kim A. Snyder, who was working as an assistant producer on a Jodie Foster film when she contracted CFS in 1995. For the last five years, while still battling the disease, she directed "I Remember Me," a documentary which does what the Centers for Disease Control in Atlanta shamefully failed to do: connects the dots.

Snyder begins in Lake Tahoe, where the disease struck hundreds of people. She talks to Dr. Daniel L. Peterson, who first started treating CFS patients there in 1984, has had seven who committed suicide because of the disease, and has no doubt it is real. She also talks to a spokesperson for the nearby Incline Village Visitors' Bureau, who says CFS is promoted by "quack doctors and mostly overweight women." This person succeeds in becoming the living embodiment of the real estate brokers in "Jaws," who don't want anyone to believe there's a shark.

Yes, Dr. Petersen sighs, investigators from the CDC in Atlanta looked into the Lake Tahoe outbreak: "They came out here and skied and looked at a few charts." The conclusion was that Chronic Fatigue Syndrome was psychosomatic, or hysterical, or misdiagnosed. We are reminded that until the 1950s, multiple sclerosis was also considered a hysterical condition.

Snyder is an investigative journalist who does her own detective work. She identifies many earlier outbreaks with the same symptoms as CFS and goes to Punta Gorda, Fla., to visit five women who had the disease 40 years ago. Investigators visiting their community at the time concluded it was a real disease and not an imaginary condition, and said so in a report--which the women never saw. Snyder shows one woman the report on camera. She expresses her anger; this report would have informed her she was not, as many assured her, going crazy.

Snyder interviews two famous CFS sufferers: the film director Blake Edwards, who has continued to work during remissions in a 15-year struggle with the disease, and the Olympic gold medalist soccer player Michelle Akers, who walked off a field one day and collapsed. But Snyder's most touching the depressing visit is to the bedside of Stephen Paganetti, a high school senior in Connecticut. He has been on his back in bed for years. The slightest exercise exhausts him. He is fed through tubes. Determined to attend his high school graduation, he's taken there by ambulance and wheeled in on a gurney. Few of his classmates had come to see him imprisoned in his bedroom; one says "you get better--and we'll talk!" They give him a quilt they have all contributed patches to. Just what a high school kid wants for his graduation.

By the end of filming, Stephen is still suffering, and indeed less than 20 percent of CFS sufferers get better, Snyder says. The disease strikes as many women as HIV. There has been recent progress. Robert J. Suhadolnik, a biochemist at Temple University, has identified a blood enzyme that acts as a marker of CFS, after many doctors claimed it had no physical symptoms. A whistle blower at the Centers for Disease Control has revealed to government accountants that $13 million was illegally diverted from CFS study to other diseases. Yet TV comics still joke about the disease as a form of laziness. Ironic, isn't it, that Kim Snyder wasn't too lazy to make this film--while the CDC and the medical establishment are only now stirring into action.

Note: For more on Paganetti's story, visit www.cfids-me.org/cfscc/bass0498.html

Thanks to Myrna Merriman

CIRCLE ALL THAT APPLY:

I have been diagnosed by a doctor with

Post-Polio Syndrome

Today's Date ____ /____ /____

Date of Birth ____ /____/____

Gender _____ Age ______

Marital Status _____________

Years of Schooling ______

Number of Brothers/Sisters ______

Occupation _____________________

If you are NOT working now, why not? _________

_____________________________________

Where do you live? ___________________ __________________________

NO | YES I was diagnosed by a doctor as having paralytic polio. In what year? ______

NO | YES I was diagnosed by a doctor as having non-paralytic polio. In what year? ______

NO | YES Someone (maybe a family member) told me I had polio as a child. In what year? ______

NO | YES As a child I had an illness with a fever that made me very fatigued for several days. In what year? ______

If YES to any of the above:

I had a fever for ______ days I had a stiff neck for ___ days I was hospitalized for ______ days

I was living in (city)_____________

(state/province)_________ (country) _________ when I got sick.

At that time these muscles were weakened: O Neck, O Back,

O Left leg, O Right leg,

O Left arm, O Right arm

At that time these muscles were paralyzed: O Neck O Back

O Left leg, O Right leg

O Left arm. O Right arm

NO | YES Someone in my house had polio when I had these symptoms.

If YES who had polio? ______________

Who else in your family had similar symptoms at the same time? _____________________

What symptoms did they have? ____________

____________________________________

Please CIRCLE BOTH the FREQUENCY AND SEVERITY that best describe how you feel on a daily basis:

Mild fatigue:

never, sometimes, frequently, always

Moderate fatigue:

never, sometimes, frequently, always

Severe fatigue:

never, sometimes, frequently, always

Mild muscle weakness:

never, sometimes, frequently, always

Moderate muscle weakness: never, sometimes, frequently, always

Severe Muscle weakness:

never, sometimes, frequently, always

Mild Arm/leg muscle pain:

never, sometimes, frequently, always

Moderate Arm/leg muscle pain:

never, sometimes, frequently, always

Severe Arm/leg muscle pain:

never, sometimes, frequently, always

Mild Arm/leg muscle pain:

never, sometimes, frequently, always

Moderate Arm/leg muscle pain:

never, sometimes, frequently, always

Severe Arm/leg muscle pain:

never, sometimes, frequently, always

Mild joint pain

never, sometimes, frequently, always

Moderate joint pain:

never, sometimes, frequently, always

Severe joint pain:

never, sometimes, frequently, always

Mild Back/neck pain:

never, sometimes, frequently, always

Moderate Back/neck pain:

never, sometimes, frequently, always

Severe Back/neck pain:

never, sometimes, frequently, always

Mild Difficulty sleeping:

never, sometimes, frequently, always

Moderate Difficulty sleeping:

never, sometimes, frequently, always

Severe Difficulty sleeping:

never, sometimes, frequently, always

Mild Difficulty staying awake during the day:

never, sometimes, frequently, always

Moderate Difficulty staying awake during the day:

never, sometimes, frequently, always

Severe Difficulty staying awake during the day:

Mild Difficulty concentrating:

never, sometimes, frequently, always

Moderate Difficulty concentrating

never, sometimes, frequently, always

Severe Difficulty concentrating:

never, sometimes, frequently, always

Mild Difficulty focusing my attention

never, sometimes, frequently, always

Moderate Difficulty focusing my attention:

never, sometimes, frequently, always

Severe Difficulty focusing my attention:

never, sometimes, frequently, always

Mild Difficulty keeping my mind from wandering

never, sometimes, frequently, always

Moderate Difficulty keeping my mind from wandering:

never, sometimes, frequently, always

Severe Difficulty keeping my mind from wandering

never, sometimes, frequently, always

Mild Difficulty remembering information:

never, sometimes, frequently, always

Moderate Difficulty remember information:

never, sometimes, frequently, always

Severe Difficulty remembering information:

never, sometimes, frequently, always

Mild Difficulty thinking of words I want to say:

never, sometimes, frequently, always

Moderate Difficulty thinking of words I want to say:

never, sometimes, frequently, always

Severe Difficulty thinking of words I want to say

never, sometimes, frequently, always

Mild Difficulty thinking clearly:

never, sometimes, frequently, always

Moderate Difficulty thinking clearly:

never, sometimes, frequently, always

Severe Difficulty thinking clearly:

never, sometimes, frequently, always

Symptoms get worse with:

COLD EXPOSURE: NO | YES

EMOTIONAL STRESS: NO | YES

PHYSICAL OVEREXERTION: NO | YES

NO | YES The symptoms I have today came on slowly over time. ( Over how many months, years: _________ )

NO | YES The symptoms I have today began immediately after having a flu-like illness.

NO | YES The symptoms I have today began after an ACCIDENT or SURGERY (circle)

NO | YES I SNORE

NO | YES WAKE SHORT OF BREATH

NO | YES WAKE WITH MY HEART POUNDING AT NIGHT

NO | YES WAKE NOT FEELING RESTED.

NO | YES My muscles twitch or jump as I FALL asleep

NO | YES My muscles twitch or jump DURING the night.

NO | YES I have been diagnosed with a "slow" thyroid (hypothyroidism).

NO | YES I have been diagnosed with depression NO | YES I am depressed now.

CIRCLE ALL THAT APPLY: I have been diagnosed by a doctor with CFS | ME | FM | Post-Polio Syndrome.

I have FAINTED about _______ times in my life before new symptoms.

I have FAINTED about _______ times since new symptoms.

NO | YES I have had great difficulty waking up after a general anesthetic since I have had new symptoms

NO | YES I HAVEN'T HAD ANESTHETIC.

Please CIRCLE the answer that best describes how you usually think, feel or act BEFORE you had new symptoms.

If you are not working now, CIRCLE the answer that best describes how you acted when you were working.

Do YOU...

True False ... enjoy competition?

True False ... consider yourself to be "hard driving?"

True False ... set at least one deadline per day for yourself?

True False ... have a temper that's hard to

control, ("fiery)?"

True False ... set at least one deadline per week for yourself?

True False ... usually wake up in the morning NOT feeling well rested?

True False ... usually spend LESS than five days on an average vacation?

True False ... spend MORE than eight hours per week working overtime?

True False Have you taken less than one

vacation per year during the

past five years?

True False Is it very important for you

personally to get ahead in life?

TOTALLY OPTIONAL (but helpful):

Name _____________________________

E-mail ____________ Phone ____________

PLEASE return to Dr. Richard L. Bruno

151 Prospect Avenue Box 17A

Hackensack, NJ 07601 USA

or e-mail harvestctr@AOL.COM

Many thanks!

The right to have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists and other healthcare professionals.

•

The right to have your pain thoroughly assessed and promptly treated.

•

The right to be informed by your doctor about what may be causing your pain,

possible treatments, and the benefits, risks and costs of each.

•

The right to participate actively in decisions about how to manage your pain

•

The right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased.

•

The right to be referred to a pain specialist if your pain persists.

•

The right to get clear and prompt answers to your questions, take time to make decisions, and

refuse a particular type of treatment if you choose.

Although not always required by law, these are the rights you should expect, and if

necessary demand, for your pain care.

Thanks to: http://www.painfoundation.org

American Pain Foundation, 201 N. Charles Street #710, Baltimore, MD 21201

Used with permission

More than 50 million Americans suffer from chronic pain caused by various diseases and disorders, and each year another 25 million experience acute pain as a result of injury or surgery.

Although most pain can be relieved or greatly eased with proper pain management, the tragedy is that most pain goes untreated, undertreated, or improperly treated. No one should have to suffer needlessly when the knowledge and skills are available today to manage most pain.

If left untreated, chronic pain can prevent you from having a full and meaningful life. Once your pain is under control, your body and mind will be less stressed. You'll be able to sleep better, focus on work, enjoy relationships with family and friends, and take part in social activities. If your pain has been caused by an injury or surgery, your recovery may be faster once your pain is managed.

Finding good pain care and taking control of your pain can be hard work. Learn all you can about pain and possible treatments. Be persistent, insist on your rights, and don't give up.

Many of us have beliefs about pain that are simply not true and prevent us from getting the relief we deserve. The truth is:

Pain is not something you "just have to live with." Treatments are available to relieve or lessen most pain. If untreated, pain can make other health problems worse, slow recovery, and interfere with healing. Get help right away, and don't let anyone suggest that your pain is simply "in your head."

Not all doctors know how to treat pain. Your doctor should give the same attention to your pain as to any other health problems. But many doctors have had little training in pain care. If your doctor is unable to deal with your pain effectively ask your doctor to consult with a specialist, or consider switching doctors.

Pain medications rarely cause addiction. Morphine and similar pain medications, called opioids, can be highly effective for certain conditions. Unless you have a history of substance abuse, there is little risk of addiction when these medications are properly prescribed by a doctor and taken as directed. Physical dependence-which is not to be confused with addiction-occurs in the form of withdrawal symptoms if you stop taking these medications suddenly. This usually is not a problem if you go off your medications gradually.

Most side effects from opioid pain medications can be managed. Nausea, drowsiness, itching, and most other side effects caused by morphine and similar opioid medications usually last only a few days. Constipation from these medications can usually be managed with laxatives, adequate fluid intake, and attention to diet. Ask your doctor to suggest ways that are best for you.

If you act quickly when pain starts, you can often prevent it from getting worse. Take your medications when you first begin to experience pain. If your pain does get worse, talk with your doctor. Your doctor may safely prescribe higher doses or change the prescription. Non-drug therapies such as relaxation training and others can also help give you relief.

1. Speak up! Tell your doctor or nurse that you're in pain. It is not a sign of personal weakness to tell them about your pain. Pain is a common medical problem that requires urgent attention. So don't be embarrassed or afraid to talk about it.

2. Tell your doctor or nurse where it hurts. Do you have pain in one place or several places? Does the pain seem to move around?

3. Describe how much your pain hurts. On a scale from 0 to 10, zero means no pain at all and 10 means the worst pain you can imagine. In the past week, what was the highest level of pain you felt? When did you feel it? What were you doing at the time? When did it hurt the least? How bad does it hurt right now?

4. Describe what makes your pain better or worse. Is the pain always there, or does it go away sometimes? Does the pain get worse when you move in certain ways? Do other things make it better or worse?

5. Describe what your pain feels like. Use specific words like sharp, stabbing, dull, aching, burning, shock-like, tingling, throbbing, deep, pressing, etc.

6. Explain how the pain affects your daily life. Can you sleep? Work? Exercise? Are you able to do activities with family and friends? Can you concentrate on tasks? How is your mood? Are you sad? Irritable? Depressed? Do you feel unable to cope?

7. Tell your doctor or nurse about past treatments for pain. Describe any medical treatments you've had such as medication or surgery, and mention other approaches you've tried. Have you done massage, yoga or meditation? Applied heat or cold to the painful areas? Exercised? Taken over-the-counter medications, or supplements such as vitamins, minerals, and herbal remedies? Tried other treatments? Explain what worked and what didn't.

Take control. It’s your responsibility to tell your doctor you’re in pain, take part in planning your treatment, follow your pain management plan, ask questions, and speak up if treatment isn’t working. If necessary, seek other help. Be persistent until you find what works best for you.

Set goals. Once you've found a doctor you trust, decide with your doctor on some realistic goals for things you most want to do again - for example, sleeping, working, exercising, enjoying sexual relations, etc. Begin working on the easiest goals first.

Work with your doctor or nurse to develop a pain management plan. This might include a list of medications, when to take them, and possible side effects. It might include therapies other than medication. Make sure you understand the plan and carry it out fully. If you don’t, you are less likely to get relief.

Keep a pain diary. Write down information about your level of pain at different times, how you're feeling, and what activities you're able to do or not do. Keep a record of medications you're taking or any non-drug treatments. The diary will help you see what’s working and measure progress. Bring your diary on visits to the doctor.

Ask your doctor or nurse about non-drug, non-surgical treatments. These could include relaxation therapy, exercise, massage, acupuncture, meditation, application of cold or heat, behavioral therapy, and other techniques.

Ask your doctor or nurse about ways to relax and cope with pain. The way you feel about your pain can actually affect the pain itself. Your pain may feel worse if you are stressed, depressed, or anxious.

If you have questions or concerns, speak up. If you’re worried about medications or other treatments, ask your doctor or nurse. If your treatment is not working, insist that your pain be reassessed and new treatments offered. Be polite, but be firm.

If you're going to have surgery, ask your doctor for a complete pain management plan beforehand. Ask what medications you will receive before the operation to minimize pain later, and what will be available for pain relief afterwards.

If you’re a patient in a hospital or other facility and you’re in pain, speak up. Ask a doctor or nurse for help. If you don't get help right away, ask again. If you still don't get help, ask to speak to the patient advocate or representative. Most likely the doctor or nurse will respond, but be sure to insist on effective pain care without delay.

Pace yourself. Once you experience some degree of control over your pain, don’t overdo it. Your body may be out of condition if you have been suffering pain for awhile. Take time to gradually build up to normal activity.

If you’re not satisfied with your pain care, don't give up. Does your doctor listen to you? Is your doctor able to assess and treat your pain? Are you getting adequate care? If after a reasonable time the answer is "no," find another doctor or pain care program.

If you want to learn from people in other organizations who understand particular types of pain:

For chronic pain, contact the American Chronic Pain Association at www.theacpa.org or call 1-916-632-0922.

For cancer pain, contact Cancer Care at www.cancercare.org or call 1-800-813-HOPE, or contact your local American Cancer Society office.

For a list of organizations that specialize in a particular disease or disorder, contact the American Pain Foundation at www.painfoundation.org or call 1-888-615-PAIN.

If you want to find a pain specialist:

Ask your regular doctor, if you have one, for a referral to a good pain specialist or pain clinic.

Ask family members, friends and co-workers who have suffered from pain for a recommendation.

Contact the largest local hospital or medical school in your area and ask if they have a pain team or know of a good local pain specialist or pain clinic.

If you are under a managed care program, call your representative or caseworker and ask for their list of approved pain specialists.

Call a local hospice, even though you may not need hospice care, and ask them to suggest doctors who are good at pain management.

Our consumer friendly website has information about causes, treatment options, ways to find trained specialists and peer support, and how to cope with pain. It also links to over 200 carefully selected websites on pain and related topics.

If you are unable to get access to the Internet and need more information, write to us at:

American Pain Foundation

201 N. Charles Street, Suite 710

Baltimore, MD 21201

Disclaimer: This brochure is provided for educational and informational purposes only. APF is not engaged in rendering medical advice or professional services and this information should not be used for diagnosing or treating a health problem. APF makes no representation or warranties, expressed or implied. Providing reference to other organizations does not imply that APF endorses the information or services provided by them. Those organizations are solely responsible for the information they provide.

page 24

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap --sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body

damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include

headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to

the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past

disease or injury or any visible sign of damage inside or outside the nervous system).

Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are

some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted

in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback,

and behavior modification may also be employed to treat chronic pain.

Many people with chronic pain can be helped if they understand all the causes of pain and the many

and varied steps that can be taken to undo what chronic pain has done. Scientists believe that

advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.

Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers

believe activates endorphin systems. Other experiments with acupuncture have shown that there are

higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.

Organizations

American Chronic Pain Assn (ACPA)

P.O. Box 850

Rocklin, CA 95677-0850

ACPA@pacbell.net

http://www.theacpa.org

Tel: 916-632-0922, Fax: 916-632-3208

American Council for Headache Education

19 Mantua Road

Mt. Royal, NJ 08061

achehq@talley.com

http://www.achenet.org

Tel: 856-423-0258 800-255-ACHE (255-2243) , Fax: 856-423-0082

National Headache Foundation

428 West St. James Place 2nd Floor

Chicago, IL 60614-2750

info@headaches.org

http://www.headaches.org

Tel: 773-388-6399 888-NHF-5552 (643-5552)

Fax: 773-525-7357

1. He who laughs last, thinks slowest.

2. Everyone has a photographic memory. Some just don't have film.

3. A day without sunshine is like, well, night.

4. On the other hand, you have different fingers.

5. Change is inevitable, except from a vending

machine.

6. I just got lost in thought. It was unfamiliar

territory.

7. When the chips are down, the buffalo is empty.

8. Seen it all, done it all, can't remember most of it.

9. Those who live by the sword get shot by those who don't.

10. I feel like I'm diagonally parked in a parallel universe.

11. You have the right to remain silent. Anything you say will be misquoted then used against you.

12. I wonder how much deeper the ocean would be without sponges. cost and blamed it on the cost of living.

17. Just remember... if the world didn't suck, we'd all fall off.

18. The 50-50-90 rule: Anytime you have a 50-50 chance of getting something right, there's a 90% probability you'll get it wrong.

19. It is said that if you line up all the cars in the world end to end, someone would be stupid enough to try and pass them.

20. You can't have everything, where would you put it?

21. Latest survey shows that 3 out of 4 people make up 75% of the world's population.

22. The things that come to those who wait are usually the things left by those who got there first.

23. A fine is a tax for doing wrong. A tax is a fine for doing well.

24. It was recently discovered that research causes cancer in rats.

25. Everybody lies, but it doesn't matter since nobody

listens.

26. I wished the buck stopped here, as I could use a few.

27. I started out with nothing, and I still have most of it.

28. Light travels faster than sound. This is why some people appear bright until you hear them speak.

13. Honk if you love peace and quiet.

14. Despite the cost of living, have you noticed how it re mains so popular?

15. Nothing is foolproof to a sufficiently talented fool.

16. It is hard to understand how a cemetery raised its burial

Thanks to Jolene

You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it's a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.

It is pain. In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses.

In 1931, the French medical missionary Dr. Albert Schweitzer wrote, "Pain is a more terrible lord of mankind than even death itself." Today, pain has become the universal disorder, a serious and costly public health issue, and a challenge for family, friends, and health care providers who must give support to the individual suffering from the physical as well as the emotional consequences of pain.

Ancient civilizations recorded on stone tablets accounts of pain and the treatments used: pressure, heat, water, and sun. Early humans related pain to evil, magic, and demons. Relief of pain was the responsibility of sorcerers, shamans, priests, and priestesses, who used herbs, rites, and ceremonies as their treatments.

The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system have a role in producing the perception of pain. But it was not until the Middle Ages and well into the Renaissance-the 1400s and 1500s-that evidence began to accumulate in support of these theories. Leonardo da Vinci and his contemporaries came to believe that the brain was the central organ responsible for sensation. Da Vinci also developed the idea that the spinal cord transmits sensations to the brain.

In the 17th and 18th centuries, the study of the body-and the senses-continued to be a source of wonder for the world's philosophers. In 1664, the French philosopher René Descartes described what to this day is still called a "pain pathway." Descartes illustrated how particles of fire, in contact with the foot, travel to the brain and he compared pain sensation to the ringing of a bell.

In the 19th century, pain came to dwell under a new domain-science-paving the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. These drugs led to the development of aspirin, to this day the most commonly used pain reliever. Before long, anesthesia-both general and regional-was refined and applied during surgery.

"It has no future but itself," wrote the 19th century American poet Emily Dickinson, speaking about pain. As the 21st century unfolds, however, advances in pain research are creating a less grim future than that portrayed in Dickinson’s verse, a future that includes a better understanding of pain, along with greatly improved treatments to keep it in check.

The Two Faces of Pain: Acute and Chronic

What is pain? The International Association for the Study of Pain defines it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.

Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.

Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can-and often does-cause severe problems for patients.

Hundreds of pain syndromes or disorders make up the spectrum of pain. There are the most benign, fleeting sensations of pain, such as a pin prick. There is the pain of childbirth, the pain of a heart attack, and the pain that sometimes follows amputation of a limb. There is also pain accompanying cancer and the pain that follows severe trauma, such as that associated with head and spinal cord injuries. A sampling of common pain syndromes follows, listed alphabetically.

Arachnoiditis is a condition in which one of the three membranes covering the brain and spinal cord, called the arachnoid membrane, becomes inflamed. A number of causes, including infection or trauma, can result in inflammation of this membrane. Arachnoiditis can produce disabling, progressive, and even permanent pain.

Arthritis. Millions of Americans suffer from arthritic conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout. These disorders are characterized by joint pain in the extremities. Many other inflammatory diseases affect the body's soft tissues, including tendonitis and bursitis.

Back pain has become the high price paid by our modern lifestyle and is a startlingly common cause of disability for many Americans, including both active and inactive people. Back pain that spreads to the leg is called sciatica and is a very common condition (see below). Another common type of back pain is associated with the discs of the spine, the soft, spongy padding between the vertebrae (bones) that form the spine. Discs protect the spine by absorbing shock, but they tend to degenerate over time and may sometimes rupture. Spondylolisthesis is a back condition that occurs when one vertebra extends over another, causing pressure on nerves and therefore pain. Also, damage to nerve roots (see Spine Basics in the Appendix) is a serious condition, called radiculopathy, that can be extremely painful. Treatment for a damaged disc includes drugs such as painkillers, muscle relaxants, and steroids; exercise or rest, depending on the patient's condition; adequate support, such as a brace or better mattress and physical therapy. In some cases, surgery may be required to remove the damaged portion of the disc and return it to its previous condition, especially when it is pressing a nerve root. Surgical procedures include discectomy, laminectomy, or spinal fusion (see section on surgery in How is Pain Treated? for more information on these treatments).

Burn pain can be profound and poses an extreme challenge to the medical community. First-degree burns are the least severe; with third-degree burns, the skin is lost. Depending on the injury, pain accompanying burns can be excruciating, and even after the wound has healed patients may have chronic pain at the burn site.

Central pain syndrome-see "Trauma" below.

Cancer pain can accompany the growth of a tumor, the treatment of cancer, or chronic problems related to cancer's permanent effects on the body. Fortunately, most cancer pain can be treated to help minimize discomfort and stress to the patient.

Headaches affect millions of Americans. The three most common types of chronic headache are migraines, cluster headaches, and tension headaches. Each comes with its own telltale brand of pain.

Migraines are characterized by throbbing pain and sometimes by other symptoms, such as nausea and visual disturbances. Migraines are more frequent in women than men. Stress can trigger a migraine headache, and migraines can also put the sufferer at risk for stroke.

Cluster headaches are characterized by excruciating, piercing pain on one side of thehead; they occur more frequently in men than women.

Tension headaches are often described as a tight band around the head.

Head and facial pain can be agonizing, whether it results from dental problems or from disorders such as cranial neuralgia, in which one of the nerves in the face, head, or neck is inflamed. Another condition, trigeminal neuralgia (also called tic douloureux), affects the largest of the cranial nerves (see The Nervous Systems in the Appendix) and is characterized by a stabbing, shooting pain.

Muscle pain can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis. Another disabling syndrome is fibromyalgia, a disorder characterized by fatigue, stiffness, joint tenderness, and widespread muscle pain. Polymyositis, dermatomyositis, and inclusion body myositis are painful disorders characterized by muscle inflammation. They may be caused by infection or autoimmune dysfunction and are sometimes associated with connective tissue disorders, such as lupus and rheumatoid arthritis.

Myofascial pain syndromes affect sensitive areas known as trigger points, located within the body's muscles. Myofascial pain syndromes are sometimes misdiagnosed and can be debilitating. Fibromyalgia is a type of myofascial pain syndrome.

Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system (see The Nervous Systems in the Appendix). Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment. Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome (see below), which can follow injury; phantom limb and post-amputation pain (see Phantom Pain in the Appendix), which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.

Reflex sympathetic dystrophy syndrome, or RSDS, is accompanied by burning pain and hypersensitivity to temperature. Often triggered by trauma or nerve damage, RSDS causes the skin of the affected area to become characteristically shiny. In recent years, RSDS has come to be called complex regional pain syndrome (CRPS); in the past it was often calledcausalgia.

Repetitive stress injuries are muscular conditions that result from repeated motions performed in the course of normal work or other daily activities. They include: writer's cramp, which affects musicians and writers and others, compression or entrapment neuropathies, including carpal tunnel syndrome, caused by chronic overextension of the wrist and tendonitis or tenosynovitis, affecting one or more tendons.

Sciatica is a painful condition caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues down into the thighs, legs, ankles, and feet. Sciatica is characterized by pain in the buttocks and can be caused by a number of factors. Exertion, obesity, and poor posture can all cause pressure on the sciatic nerve. One common cause of sciatica is a herniated disc (see Spine Basics in the Appendix).

Shingles and other painful disorders affect the skin. Pain is a common symptom of many skin disorders, even the most common rashes. One of the most vexing neurological disorders is shingles or herpes zoster, an infection that often causes agonizing pain resistant to treatment. Prompt treatment with antiviral agents is important to arrest the infection, which if prolonged can result in an associated condition known as postherpetic neuralgia. Other painful disorders affecting the skin include: vasculitis, or inflammation of blood vessels; other infections, including herpes simplex; skin tumors and cysts, and tumors associated with neurofibromatosis, a neurogenetic disorder.

Sports injuries are common. Sprains, strains, bruises, dislocations, and fractures are all well-known words in the language of sports. Pain is another. In extreme cases, sports injuries

can take the form of costly and painful spinal cord and head injuries, which cause severe suffering and disability.

Spinal stenosis refers to a narrowing of the canal surrounding the spinal cord. The condition occurs naturally with aging. Spinal stenosis causes weakness in the legs and leg pain usually felt while the person is standing up and often relieved by sitting down.

Surgical pain may require regional or general anesthesia during the procedure and medications to control discomfort following the operation. Control of pain associated with surgery includes presurgical preparation and careful monitoring of the patient during and after the procedure.

Temporomandibular disorders are conditions in which the temporomandibular joint (the jaw) is damaged and/or the muscles used for chewing and talking become stressed, causing pain. The condition may be the result of a number of factors, such as an injury to the jaw or joint misalignment, and may give rise to a variety of symptoms, most commonly pain in the jaw, face, and/or neck muscles. Physicians reach a diagnosis by listening to the patient's description of the symptoms and by performing a simple examination of the facial muscles and the temporomandibular joint.

Trauma can occur after injuries in the home, at the workplace, during sports activities, or on the road. Any of these injuries can result in severe disability and pain. Some patients who have had an injury to the spinal cord experience intense pain ranging from tingling to burning and, commonly, both. Such patients are sensitive to hot and cold temperatures and touch. For these individuals, a touch can be perceived as intense burning, indicating abnormal signals relayed to and from the brain. This condition is called central pain syndrome or, if thedamage is in the thalamus (the brain's center for processing bodily sensations), thalamic pain syndrome. It affects as many as 100,000 Americans with multiple sclerosis, Parkinson's disease, amputated limbs, spinal cord injuries, and stroke. Their pain is severe and is extremely difficult to treat effectively. A variety of medications, including analgesics, antidepressants, anticonvulsants, and electrical stimulation, are options available to central pain patients.

Vascular disease or injury-such as vasculitis or inflammation of blood vessels, coronary artery disease, and circulatory problems-all have the potential to cause pain. Vascular pain affects millions of Americans and occurs when communication between blood vessels and nerves is interrupted. Ruptures, spasms, constriction, or obstruction of blood vessels, as well as a condition called ischemia in which blood supply to organs, tissues, or limbs is cut off, can also result in pain.

There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain. Defining pain as sharp or dull, constantor intermittent, burning or aching may give the best clues to the cause of pain. These escriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.

Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include:

Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. Information from EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage. EP tests also involve two sets of electrodes -one set for stimulating a nerve (these electrodes are attached to a limb) and a