Clinical rheumatology
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Clinical rheumatology · Apr 2007
ReviewCentral sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome.
In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. ⋯ This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc.
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Clinical rheumatology · Apr 2007
Clinical TrialThe effect of gabapentin in earlier stage of reflex sympathetic dystrophy.
The objective of this paper is to investigate the effect of gabapentin in the earlier stage of reflex sympathetic dystrophy syndrome (RSD). Twenty-two patients diagnosed with RSD were enrolled. Initial gabapentin dosage was 600 mg/day. ⋯ Gabapentin cannot be recommended as the drug of choice, but it may be considered as one of the therapeutic alternatives in the management of pain due to RSD. We suggest that it is effective only for the pain and not for other symptoms of RSD. Serious side effects that will cause the patient to stop using the drug are rare.
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Clinical rheumatology · Apr 2007
Clinical TrialLack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients.
The effect of systemic glucocorticosteroids on the metabolism of glucose is well known; however, there are no reports on the effect of intraarticular steroids on the metabolism of glucose in diabetic patients. Controlled or near controlled diabetic patients who have self-monitoring devices for home monitoring of blood glucose with shoulder pain were offered an intraarticular crystalloid steroid injection of 35 mg of methylprednisolone acetate (MPA) at the shoulder joint after failure of pharmacological and physical therapy. Patients were asked to record blood glucose levels before and 2 h after breakfast, lunch, and supper (six times a day) every other day during 1 week before the injection and during the day of the injection, the next day and every other day for 2 weeks after the injection. ⋯ There was no significant change between the mean glucose values before and after meals after the injection compared to those before the injection, respectively, except on a few occasions only throughout the study period. Mean fructosamine level before injection was 279 micromol/l+/-49.8 compared to 275 micromol/l+/-50.9 after the injection (P=0.125). Intraarticular injection of MPA at the shoulder joint in diabetic patients with shoulder pain has no significant effect on blood glucose levels.