Publications by authors named "Kim Jones"

113 Publications

Cannabis for medical purposes: A cross-sectional analysis of health care professionals' knowledge.

J Am Assoc Nurse Pract 2021 Mar 19. Epub 2021 Mar 19.

Department of Neurology, Oregon Health & Science University, Portland, Oregon Portland VA Health Care System, Portland, Oregon.

Background: Legalization of cannabis use and the evidence base supporting both risks and benefits of cannabinoids are expanding, but our understanding of health care professionals' (HCPs) knowledge about cannabis for medical purposes is limited. Understanding of the knowledge base and knowledge gaps about medical cannabis use is critical to advanced practice registered nurses (APRNs) because they are increasingly called on to manage patients taking multiple drugs, including prescribed and unprescribed cannabis and prescription cannabinoids.

Purpose: The purpose of this study was to examine HCPs' knowledge of clinical cannabis, including laws and regulations; risks and harms; pharmacology; and effects on pain, multiple sclerosis spasticity, and seizures as assessed with written tests before an in-person, continuing medical education program.

Methods: Total scores and differences among professions and topics were compared.

Results: A total of 178 of the 226 program attendees completed the test (79%) (107 [47%] physicians, 30 [13%] APRNs, and 18 [8%] registered nurses). The mean test score was 63.2% (SD = 12.7%) without significant differences among professions (F(3, 174) = 1.53; p = .21) but with significant differences among topics (χ2(7, 1068) = 201.13; p < .001). The score was lowest for effects on seizures (43.8%) and with scores below 70% for all other areas except laws and regulations (85.7%).

Implications For Practice: There are substantial gaps in HCPs' knowledge about the clinical effects of cannabis, especially about risks and harms, pharmacology, and the effects on pain, multiple sclerosis spasticity, and seizures. Further education may help HCPs to understand the risks and benefits of cannabis and cannabinoids across conditions.
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http://dx.doi.org/10.1097/JXX.0000000000000590DOI Listing
March 2021

Dietary Patterns in Runners with Gastrointestinal Disorders.

Nutrients 2021 Jan 29;13(2). Epub 2021 Jan 29.

Health and Physical Education, Mount Royal University, Calgary, AB T3E 6K6, Canada.

Individuals with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and reflux frequently experience gastrointestinal symptoms (GIS), potentially enhanced by high-intensity running. Food avoidances, food choices, and GIS in runners with IBS/IBD ( = 53) and reflux ( = 37) were evaluated using a reliability and validity tested questionnaire. Comparisons to a control group of runners ( = 375) were made using a Fisher's Exact test. Runners with IBS/IBD experienced the greatest amount of exercise-induced GIS followed by those with reflux. Commonly reported GIS were stomach pain/cramps (77%; 53%), bloating (52%; 50%), intestinal pain/cramps (58%; 33%), and diarrhea (58%; 39%) in IBS/IBD and reflux groups respectively. In the pre-race meal, those with IBS/IBD frequently avoided milk products (53%), legumes (37%), and meat (31%); whereas, runners with reflux avoided milk (38%), meat (36%), and high-fibre foods (33%). When considering food choices pre-race, runners with IBS/IBD chose grains containing gluten (40%), high fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) fruits (38%), and water (38%). Runners with reflux chose water (51%), grains containing gluten (37%), and eggs (31%). In conclusion, while many runners with IBS/IBD and reflux are avoiding trigger foods in their pre-race meals, they are also consuming potentially aggravating foods, suggesting nutrition advice may be warranted.
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http://dx.doi.org/10.3390/nu13020448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912258PMC
January 2021

Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised.

Int J Environ Res Public Health 2020 12 31;18(1). Epub 2020 Dec 31.

AGORA Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain.

Fibromyalgia (FM) is a heterogeneous and complex syndrome; different studies have tried to describe subgroups of FM patients, and a 4-cluster classification based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) has been recently validated. This study aims to cross-validate this classification in a large US sample of FM patients. A pooled sample of 6280 patients was used. First, we computed a hierarchical cluster analysis (HCA) using FIQR scores at item level. Then, a latent profile analysis (LPA) served to confirm the accuracy of the taxonomy. Additionally, a cluster calculator was developed to estimate the predicted subgroup using an ordinal regression analysis. Self-reported clinical measures were used to examine the external validity of the subgroups in part of the sample. The HCA yielded a 4-subgroup distribution, which was confirmed by the LPA. Each cluster represented a different level of severity: "Mild-moderate", "moderate", "moderate-severe", and "severe". Significant differences between clusters were observed in most of the clinical measures (e.g., fatigue, sleep problems, anxiety). Interestingly, lower levels of education were associated with higher FM severity. This study corroborates a 4-cluster distribution based on FIQR scores to classify US adults with FM. The classification may have relevant clinical implications for diagnosis and treatment response.
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http://dx.doi.org/10.3390/ijerph18010247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796452PMC
December 2020

Kinetics and thermodynamics of thermal inactivation for recombinant Escherichia coli cellulases, cel12B, cel8C, and polygalacturonase, peh28; biocatalysts for biofuel precursor production.

J Biochem 2021 Feb;169(1):109-117

Department of Basic Sciences, St. Louis College of Pharmacy, St. Louis, MO 63110-1088, USA.

Lignocellulosic biomass conversion using cellulases/polygalacturonases is a process that can be progressively influenced by several determinants involved in cellulose microfibril degradation. This article focuses on the kinetics and thermodynamics of thermal inactivation of recombinant Escherichia coli cellulases, cel12B, cel8C and a polygalacturonase, peh 28, derived from Pectobacterium carotovorum sub sp. carotovorum. Several consensus motifs conferring the enzymes' thermal stability in both cel12B and peh28 model structures have been detailed earlier, which were confirmed for the three enzymes through the current study of their thermal inactivation profiles over the 20-80°C range using the respective activities on carboxymethylcellulose and polygalacturonic acid. Kinetic constants and half-lives of thermal inactivation, inactivation energy, plus inactivation entropies, enthalpies and Gibbs free energies, revealed high stability, less conformational change and protein unfolding for cel12B and peh28 due to thermal denaturation compared to cel8C. The apparent thermal stability of peh28 and cel12B, along with their hydrolytic efficiency on a lignocellulosic biomass conversion as reported previously, makes these enzymes candidates for various industrial applications. Analysis of the Gibbs free energy values suggests that the thermal stabilities of cel12B and peh28 are entropy-controlled over the tested temperature range.
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http://dx.doi.org/10.1093/jb/mvaa097DOI Listing
February 2021

Effect of surfactants at natural and acidic pH on microbial activity and biodegradation of mixture of benzene and o-xylene.

Chemosphere 2020 Dec 2;260:127471. Epub 2020 Jul 2.

Department of Civil and Environmental Engineering, University of Houston, Houston, TX, 77004, USA.

The aim of this work was to explore the effect of lowering pH and application of surfactants (Brij 35, Tween 20 and Saponin) in increasing bioavailability and biodegradability of benzene and o-xylene (BX) as two hydrophobic VOCs in a liquid mixture. All experiments were conducted at neutral and acidic pH to evaluate the effect of population change from bacteria to fungi on the BX biodegradation. The experiments demonstrated that acclimating wastewater inoculum at pH 4 increased the fungal to bacterial ratio. An increase of 11% for benzene and 22% for o-xylene was observed at pH 4 unamended-culture as compared to pH 7. Brij 35 was chosen as the optimum surfactant which was favorable for enhancing the bioavailability of BX at pH 4. Fitting the experimental data to pseudo first-order biodegradation kinetics model showed the BX were biodegraded faster in the presence of optimum surfactant at pH 7 than pH 4.
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http://dx.doi.org/10.1016/j.chemosphere.2020.127471DOI Listing
December 2020

Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management.

Postgrad Med 2019 Apr 11;131(3):185-198. Epub 2019 Feb 11.

c School of Nursing , Linfield College , Portland , OR , USA.

Chronic pain is a common public health problem that has a detrimental impact on patient health, quality of life (QoL), and function, and poses a substantial socioeconomic burden. Evidence supports the redefinition of chronic pain as a distinct disease entity, not simply a symptom of injury or illness. Chronic pain conditions are characterized by three types of pain pathophysiology (i.e. nociceptive, neuropathic, and centralized pain/central sensitization) influenced by a cluster of coexisting psychosocial factors. Negative risk/vulnerability factors (e.g. mood or sleep disturbances) and positive resilience/protective factors (e.g. social/interpersonal relationships and active coping) interact with pain neurobiology to determine patients' unique pain experience. Viewing chronic pain through a biopsychosocial lens, instead of a purely biomedical one, clinicians need to adopt a practical integrated management approach. Thorough assessment focuses on the whole patient (not just the pain), including comorbidities, cognitive/emotional/behavioral characteristics, social environment, and QoL/functional impairment. As for other complex chronic illnesses, the treatment plan for chronic pain can be developed based on pain subtype and psychosocial profile, incorporating pharmacotherapy and self-management modalities. Preferred pharmacologic treatment of conditions primarily associated with nociception (e.g. osteoarthritis) includes acetaminophen and non-steroidal anti-inflammatory drugs, whereas preferred pharmacologic treatment of conditions primarily associated with neuropathy or central sensitization (e.g. fibromyalgia) includes tricyclic compounds, serotonin-norepinephrine reuptake inhibitors, and αδ ligands. Education, exercise, cognitive behavioral therapy, and many other non-pharmacological approaches, alone or combined with pharmacotherapy, have been shown to be effective for any type of pain, although they remain underutilized due to lack of awareness of their benefits and reimbursement obstacles.
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http://dx.doi.org/10.1080/00325481.2019.1574403DOI Listing
April 2019

Selecting US research-intensive doctoral programs in nursing: Pragmatic questions for potential applicants.

J Prof Nurs 2018 Jul - Aug;34(4):296-299. Epub 2017 Nov 10.

School of Nursing, Oregon Health & Science University. Portland, OR 97239, United States.

Nurses hoping to enter a research intensive doctoral program have a choice of program delivery modes, faculty expertise, and multiple points of entry in addition to the traditional post masters. The American Association of Colleges of Nursing (AACN) lists doctoral programs in nursing in over 300 universities in the United States (U.S.) and Puerto Rico, with most institutions offering more than one type of doctorate. For prospective students who want to maximize their likelihood of significant, sustained scientific impact, identifying research-intensive Doctor of Philosophy (PhD) programs with faculty who have a topic match is key. Embarking on a scientific career requires assessing the curricula and faculty at several institutions. The purpose of this paper is to give prospective students pragmatic guidance in selecting a U.S. research-intensive doctoral program in nursing. We provide a list of published quality indicators in PhD programs as well as potential questions to be addressed to key persons in schools.
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http://dx.doi.org/10.1016/j.profnurs.2017.11.005DOI Listing
October 2018

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

J Opioid Manag 2018 Mar-Apr;14(2):103-116

Psychology, Stony Brook University, Stony Brook, New York.

Objectives: (1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations.

Methods: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training.

Results: The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9).

Conclusions: Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.
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http://dx.doi.org/10.5055/jom.2018.0437DOI Listing
July 2018

The role of spousal relationships in fibromyalgia patients' quality of life.

Psychol Health Med 2018 09 23;23(8):987-995. Epub 2018 Feb 23.

b School of Nursing , Oregon Health & Science University , Portland , OR , USA.

Fibromyalgia (FM) is a chronic pain syndrome that includes debilitating symptoms such as widespread pain and tenderness, fatigue, and poor physical functioning. Research has shown FM patients' choice of coping style and relationship quality with their spouse can impact their mental quality of life (QoL), but no known study has examined the protective nature of relationship quality and coping behaviors on both patient physical and mental QoL in the context of chronic pain. We examined 204 patients with FM on the (a) roles of coping styles and relationship quality on patient quality of life, and (b) moderating effect of relationship quality on the association between negative coping style and patient QoL. A series of multiple regressions found patients' coping styles were not significantly associated with physical QoL, but were significantly associated with mental QoL. Patients' relationship quality with their spouse was significantly associated with mental QoL, but not physical QoL and no significant interactions with negative coping style were found. Our results emphasize the importance of coping styles and relationship quality between patients and their spouses in the context of chronic pain. Clinicians can incorporate the patient's relationship as part of a more holistic approach to care and improving outcomes.
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http://dx.doi.org/10.1080/13548506.2018.1444183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152921PMC
September 2018

Randomized Controlled Trial of Acupuncture for Women with Fibromyalgia: Group Acupuncture with Traditional Chinese Medicine Diagnosis-Based Point Selection.

Pain Med 2018 09;19(9):1862-1871

Anesthesiology and Perioperative Medicine Department, Oregon Health and Science University, Portland, Oregon, USA.

Background: Group acupuncture is a growing and cost-effective method for delivering acupuncture in the United States and is the practice model in China. However, group acupuncture has not been tested in a research setting.

Objective: To test the treatment effect of group acupuncture vs group education in persons with fibromyalgia.

Design: Random allocation two-group study with repeated measures.

Setting: Group clinic in an academic health center in Portland, Oregon.

Subjects: Women with confirmed diagnosis of fibromyalgia (American College of Radiology 1990 criteria) and moderate to severe pain levels.

Methods: Twenty treatments of a manualized acupuncture treatment based on Traditional Chinese Medicine diagnosis or group education over 10 weeks (both 900 minutes total). Weekly Revised Fibromyalgia Impact Questionnaire (FIQR) and Global Fatigue Index at baseline, five weeks, and 10 weeks and a four-week follow-up were assessed.

Results: Thirty women were recruited, with 78% reporting symptoms for longer than 10 years. The mean attendance was 810 minutes for acupuncture and 861 minutes for education. FIQR total, FIQR pain, and Global Fatigue Index all had clinically and statistically significant improvement in the group receiving acupuncture at end of treatment and four weeks post-treatment but not in participants receiving group education between groups.

Conclusions: Compared with education, group acupuncture improved global symptom impact, pain, and fatigue. Furthermore, it was a safe and well-tolerated treatment option, improving a broader proportion of patients than current pharmaceutical options.
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http://dx.doi.org/10.1093/pm/pnx322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127237PMC
September 2018

Normalizing fibromyalgia as a chronic illness.

Postgrad Med 2018 Jan 19;130(1):9-18. Epub 2017 Dec 19.

f Schools of Nursing & Medicine , Oregon Health & Science University , Portland , OR , USA.

Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.
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http://dx.doi.org/10.1080/00325481.2018.1411743DOI Listing
January 2018

A simple screening test to recognize fibromyalgia in primary care patients with chronic pain.

J Eval Clin Pract 2018 02 23;24(1):173-179. Epub 2017 Oct 23.

School of Nursing, Oregon Health and Science University, Portland, USA.

Rationale, Aims, And Objectives: Primary care providers are increasingly expected to recognize and treat fibromyalgia (FM) without significant interaction with rheumatologists. The purpose of this study was to evaluate the potential usefulness of 3 simple measures (tenderness to digital pressure, BP cuff-evoked pain, and a single patient question) as a screening test for possible FM in a patient with chronic pain.

Methods: A total of 352 patients (mean age 50 ± 16.3 years, 70% female) scheduled for routine examination in 2 primary care practices were studied. They were comprised of 52 patients (14.8%) who carried a chart diagnosis of FM, 108 (30.7%) with chronic pain but not FM, and 192 who had neither pain nor FM (54.5%). Subjects were assessed for tenderness to digital pressure at 10 locations, BP cuff-evoked pain, and a single question, "I have a persistent deep aching over most of my body" (0-10).

Results: FM patients endorsed the single deep ache question substantially more than those with chronic pain but without FM (7.4 ± 2.9 vs 3.2 ± 3.4; P < .0001) and exhibited greater bilateral digital evoked tenderness (6.1 ± 3.1 vs 2.4 ± 2.4, P < 0.0001), and BP-evoked pressure pain (132.6 mmHg ±45.5 vs 169.2 mmHg ±48.0, P < 0.0001). However, on multivariate logistic regressions, the BP cuff-evoked pain became non-significant. On further analyses, a useful screening test was provided by: (1) pain on pinching the Achilles tendon at 4 kg/pressure over 4 seconds, and (2) and positive endorsement of the question "I have a persistent deep aching over most of my body".

Conclusion: These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient. In the case of a positive screen, a follow-up examination is required for confirmation or refutation.
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http://dx.doi.org/10.1111/jep.12836DOI Listing
February 2018

Molecular and biochemical characterization of recombinant cel12B, cel8C, and peh28 overexpressed in and their potential in biofuel production.

Biotechnol Biofuels 2017 27;10:52. Epub 2017 Feb 27.

Department of Basic Science, St. Louis College of Pharmacy, St. Louis, MO 63110-1088 USA.

Background: The high crystallinity of cellulosic biomass myofibrils as well as the complexity of their intermolecular structure is a significant impediment for biofuel production. Cloning of -, -encoded cellulases (cel12B and cel8C) and -encoded polygalacturonase (peh28) from subsp. () was carried out in our previous study using as a host vector. The current study partially characterizes the enzymes' molecular structures as well as their catalytic performance on different substrates which can be used to improve their potential for lignocellulosic biomass conversion.

Results: β-Jelly roll topology, (α/α) antiparallel helices and right-handed β-helices were the folds identified for cel12B, cel8C, and peh28, respectively, in their corresponding protein model structures. Purifications of 17.4-, 6.2-, and 6.0-fold, compared to crude extract, were achieved for cel12B and cel8C, and peh28, respectively, using specific membrane ultrafiltrations and size-exclusion chromatography. Avicel and carboxymethyl cellulose (CMC) were substrates for cel12B, whereas for cel8C catalytic activity was only shown on CMC. The enzymes displayed significant synergy on CMC but not on Avicel when tested for 3 h at 45 °C. No observed β-glucosidase activities were identified for cel8C and cel12B when tested on -nitrophenyl-β-d-glucopyranoside. Activity stimulation of 130% was observed when a recombinant β-glucosidase from was added to cel8C and cel12B as tested for 3 h at 45 °C. Optimum temperature and pH of 45 °C and 5.4, respectively, were identified for all three enzymes using various substrates. Catalytic efficiencies (/) were calculated for cel12B and cel8C on CMC as 0.141 and 2.45 ml/mg/s respectively, at 45 °C and pH 5.0 and for peh28 on polygalacturonic acid as 4.87 ml/mg/s, at 40 °C and pH 5.0. Glucose and cellobiose were the end-products identified for cel8C, cel12B, and β-glucosidase acting together on Avicel or CMC, while galacturonic acid and other minor co-products were identified for peh28 action on pectin.

Conclusions: This study provides some insight into which parameters should be optimized when application of cel8C, cel12B, and peh28 to biomass conversion is the goal.
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http://dx.doi.org/10.1186/s13068-017-0732-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327597PMC
February 2017

Mindfulness-Based Stress Reduction for Adolescents with Functional Somatic Syndromes: A Pilot Cohort Study.

J Pediatr 2017 04 12;183:184-190. Epub 2017 Jan 12.

Department of Pediatrics; Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT.

Objective: To assess the feasibility of a mindfulness-based stress reduction (MBSR) program for adolescents with widespread chronic pain and other functional somatic symptoms and to make preliminary assessments of its clinical utility.

Study Design: Three cohorts of subjects completed an 8-week MBSR program. Child- and parent-completed measures were collected at baseline and 8 and 12 weeks later. Measures included the Functional Disability Inventory (FDI), the Fibromyalgia/Symptom Impact Questionnaire-Revised (FIQR/SIQR), the Pediatric Quality of Life Inventory, the Multidimensional Anxiety Scale (MASC2), and the Perceived Stress Scale. Subjects and parents were interviewed following the program to assess feasibility.

Results: Fifteen of 18 subjects (83%) completed the 8-week program. No adverse events occurred. Compared with baseline scores, significant changes were found in mean scores on the FDI (33% improvement, P = .026), FIQR/SIQR (26% improvement, P = .03), and MASC2 (child: 12% improvement, P = .02; parent report: 17% improvement, P = .03) at 8 weeks. MASC2 scores (child and parent) and Perceived Stress Scale scores were significantly improved at 12 weeks. More time spent doing home practice was associated with better outcomes in the FDI and FIQR/SIQR (44% and 26% improvement, respectively). Qualitative interviews indicated that subjects and parents reported social support as a benefit of the MBSR class, as well as a positive impact of MBSR on activities of daily living, and on pain and anxiety.

Conclusions: MBSR is a feasible and acceptable intervention in adolescents with functional somatic syndromes and has preliminary evidence for improving functional disability, symptom impact, and anxiety, with consistency between parent and child measures.

Trial Registration: ClinicalTrials.gov: NCT02190474.
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http://dx.doi.org/10.1016/j.jpeds.2016.12.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367961PMC
April 2017

An expert panel process to evaluate habitat restoration actions in the Columbia River estuary.

J Environ Manage 2017 Mar 19;188:337-350. Epub 2016 Dec 19.

Pacific Northwest National Laboratory, 1529 W. Sequim Bay Road, Sequim, WA, 98382, USA. Electronic address:

We describe a process for evaluating proposed ecosystem restoration projects intended to improve survival of juvenile salmon in the Columbia River estuary (CRE). Changes in the Columbia River basin (northwestern USA), including hydropower development, have contributed to the listing of 13 salmon stocks as endangered or threatened under the U.S. Endangered Species Act. Habitat restoration in the CRE, from Bonneville Dam to the ocean, is part of a basin-wide, legally mandated effort to mitigate federal hydropower impacts on salmon survival. An Expert Regional Technical Group (ERTG) was established in 2009 to improve and implement a process for assessing and assigning "survival benefit units" (SBUs) to restoration actions. The SBU concept assumes site-specific restoration projects will increase juvenile salmon survival during migration through the 234 km CRE. Assigned SBUs are used to inform selection of restoration projects and gauge mitigation progress. The ERTG standardized the SBU assessment process to improve its scientific integrity, repeatability, and transparency. In lieu of experimental data to quantify the survival benefits of individual restoration actions, the ERTG adopted a conceptual model composed of three assessment criteria-certainty of success, fish opportunity improvements, and habitat capacity improvements-to evaluate restoration projects. Based on these criteria, an algorithm assigned SBUs by integrating potential fish density as an indicator of salmon performance. Between 2009 and 2014, the ERTG assessed SBUs for 55 proposed projects involving a total of 181 restoration actions located across 8 of 9 reaches of the CRE, largely relying on information provided in a project template based on the conceptual model, presentations, discussions with project sponsors, and site visits. Most projects restored tidal inundation to emergent wetlands, improved riparian function, and removed invasive vegetation. The scientific relationship of geomorphic and salmonid responses to restoration actions remains the foremost concern. Although not designed to establish a broad strategy for estuary restoration, the scoring process has adaptively influenced the types, designs, and locations of restoration proposals. The ERTG process may be a useful model for others who have unique ecosystem restoration goals and share some of our common challenges.
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http://dx.doi.org/10.1016/j.jenvman.2016.11.028DOI Listing
March 2017

Mindful Yoga Pilot Study Shows Modulation of Abnormal Pain Processing in Fibromyalgia Patients.

Int J Yoga Therap 2016 Jan;26(1):93-100

1. Oregon Health & Science University, Department of Anesthesiology and Perioperative Medicine, Portland, OR.

Published findings from a randomized controlled trial have shown that Mindful Yoga training improves symptoms, functional deficits, and coping abilities in individuals with fibromyalgia and that these benefits are replicable and can be maintained 3 months post-treatment. The aim of this study was to collect pilot data in female fibromyalgia patients (n = 7) to determine if initial evidence indicates that Mindful Yoga also modulates the abnormal pain processing that characterizes fibromyalgia. Pre- and post-treatment data were obtained on quantitative sensory tests and measures of symptoms, functional deficits, and coping abilities. Separation test analyses indicated significant improvements in heat pain tolerance, pressure pain threshold, and heat pain after-sensations at post-treatment. Fibromyalgia symptoms and functional deficits also improved significantly, including physical tests of strength and balance, and pain coping strategies. These findings indicate that further investigation is warranted into the effect of Mindful Yoga on neurobiological pain processing.
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http://dx.doi.org/10.17761/1531-2054-26.1.93DOI Listing
January 2016

Promoting physical activity in fibromyalgia.

Authors:
Kim D Jones

Pain Manag 2016 May 17;6(4):321-4. Epub 2016 Jun 17.

Oregon Health & Science University, Portland, OR, USA.

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http://dx.doi.org/10.2217/pmt-2016-0018DOI Listing
May 2016

Genome-wide expression profiling in the peripheral blood of patients with fibromyalgia.

Clin Exp Rheumatol 2016 Mar-Apr;34(2 Suppl 96):S89-98. Epub 2016 Feb 12.

Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.

Objectives: Fibromyalgia (FM) is a common pain disorder characterized by nociceptive dysregulation. The basic biology of FM is poorly understood. Herein we have used agnostic gene expression as a potential probe for informing its underlying biology and the development of a proof-of-concept diagnostic gene expression signature.

Methods: We analyzed RNA expression in 70 FM patients and 70 healthy controls. The isolated RNA was amplified and hybridized to Affymetrix® Human Gene 1.1 ST Peg arrays. The data was analyzed using Partek Genomics Suite version 6.6.

Results: Fibromyalgia patients exhibited a differential expression of 421 genes (p<0.001), several relevant to pathways for pain processing, such as glutamine/glutamate signaling and axonal development. There was also an upregulation of several inflammatory pathways and downregulation of pathways related to hypersensitivity and allergy. Using rigorous diagnostic modeling strategies, we show "locked" gene signatures discovered on Training and Test cohorts, that have a mean Area Under the Curve (AUC) of 0.81 on randomized, independent external data cohorts. Lastly, we identified a subset of 10 probesets that provided a diagnostic sensitivity for FM of 95% and a specificity of 96%. We also show that the signatures for FM were very specific to FM rather than common FM comorbidities.

Conclusions: These findings provide new insights relevant to the pathogenesis of FM, and provide several testable hypotheses that warrant further exploration and also establish the foundation for a first blood-based molecular signature in FM that needs to be validated in larger cohorts of patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888802PMC
July 2016

Effect of loading types on performance characteristics of a trickle-bed bioreactor and biofilter during styrene/acetone vapor biofiltration.

J Environ Sci Health A Tox Hazard Subst Environ Eng 2016 Jul 18;51(8):669-78. Epub 2016 Apr 18.

c South Texas Environmental Institute, Texas A&M University-Kingsville , Kingsville , Texas , USA.

A 2:1 (w/w) mixture of styrene (STY) and acetone (AC) was subjected to lab-scale biofiltration under varied loading in both a trickle bed reactor (TBR) and biofilter (BF) to investigate substrate interactions and determine the limits of biofiltration efficiency of typical binary air pollutant mixtures containing both hydrophobic and polar components. A comparison of the STY/AC mixture degradation in the TBR and BF revealed higher pollutant removal efficiencies and degradation rates in the TBR, with the pollutant concentrations increasing up to the overloading limit. The maximum styrene degradation rates were 12 and 8 gc m(-3) h(-1) for the TBR and BF, respectively. However, the order of performance switched in favor of the BF when the loading was conducted by increasing air flow rate while keeping the inlet styrene concentration (Cin) constant in contrast to loading by increasing Cin. This switch may be due to a drastic difference in the effective surface area between these two reactors, so the biofilter becomes the reactor of choice when the rate-limiting step switches from biochemical processes to mass transfer by changing the loading mode. The presence of acetone in the mixture decreased the efficiency of styrene degradation and its degradation rate at high loadings. When the overloading was lifted by lowering the pollutant inlet concentrations, short-term back-stripping of both substrates in both reactors into the outlet air was observed, with a subsequent gradual recovery taking several hours and days in the BF and TBR, respectively. Removal of excess biomass from the TBR significantly improved the reactor performance. Identification of the cultivable strains, which was performed on Day 763 of continuous operation, showed the presence of 7 G(-) bacteria, 2 G(+) bacteria and 4 fungi. Flies and larvae of Lycoriella nigripes survived half a year of the biofilter operation by feeding on the biofilm resulting in the maintenance of a nearly constant pressure drop.
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http://dx.doi.org/10.1080/10934529.2016.1159882DOI Listing
July 2016

A possible neural mechanism for photosensitivity in chronic pain.

Pain 2016 Apr;157(4):868-878

Departments of Neurological Surgery, and Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA School of Nursing, Oregon Health & Science University, Portland, OR, USA Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA.

Patients with functional pain disorders often complain of generalized sensory hypersensitivity, finding sounds, smells, or even everyday light aversive. The neural basis for this aversion is unknown, but it cannot be attributed to a general increase in cortical sensory processing. Here, we quantified the threshold for aversion to light in patients with fibromyalgia, a pain disorder thought to reflect dysregulation of pain-modulating systems in the brain. These individuals expressed discomfort at light levels substantially lower than that of healthy control subjects. Complementary studies in lightly anesthetized rat demonstrated that a subset of identified pain-modulating neurons in the rostral ventromedial medulla unexpectedly responds to light. Approximately half of the pain-facilitating "ON-cells" and pain-inhibiting "OFF-cells" sampled exhibited a change in firing with light exposure, shifting the system to a pronociceptive state with the activation of ON-cells and suppression of OFF-cell firing. The change in neuronal firing did not require a trigeminal or posterior thalamic relay, but it was blocked by the inactivation of the olivary pretectal nucleus. Light exposure also resulted in a measurable but modest decrease in the threshold for heat-evoked paw withdrawal, as would be expected with engagement of this pain-modulating circuitry. These data demonstrate integration of information about light intensity with somatic input at the level of single pain-modulating neurons in the brain stem of the rat under basal conditions. Taken together, our findings in rodents and humans provide a novel mechanism for abnormal photosensitivity and suggest that light has the potential to engage pain-modulating systems such that normally innocuous inputs are perceived as aversive or even painful.
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http://dx.doi.org/10.1097/j.pain.0000000000000450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794405PMC
April 2016

Recommendations for resistance training in patients with fibromyalgia.

Authors:
Kim Dupree Jones

Arthritis Res Ther 2015 Sep 17;17:258. Epub 2015 Sep 17.

Oregon Health & Science University, School of Nursing, Mail Code SN-ORD, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.

It may seem counter-intuitive to purposely stress muscle in patients who have muscle pain. However, a growing body of evidence challenges the assumption that resistance (strength) training worsens muscle pain in people with fibromyalgia (FM). In fact, the latest evidence indicates that when resistance training is tailored to individual needs, people with FM can obtain worthwhile improvements in FM severity. Clinicians need a deeper understanding of how resistance training helps people with FM, so as to prescribe more specific, personalized resistance training to their patients.
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http://dx.doi.org/10.1186/s13075-015-0782-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574136PMC
September 2015

Pelvic Floor and Urinary Distress in Women with Fibromyalgia.

Pain Manag Nurs 2015 Dec 8;16(6):834-40. Epub 2015 Aug 8.

Department of Urogynecology, Oregon Health & Science University, Portland, Oregon.

Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p < .001) and PUF total 16.54 ± 7 (r = .36, p < .001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.
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http://dx.doi.org/10.1016/j.pmn.2015.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571646PMC
December 2015

A two-stage combined trickle bed reactor/biofilter for treatment of styrene/acetone vapor mixtures.

J Environ Sci Health A Tox Hazard Subst Environ Eng 2015 ;50(11):1148-59

a Department of Biotechnology, Prague University of Chemistry and Technology , Prague , Czech Republic.

Performance of a two-stage biofiltration system was investigated for removal of styrene-acetone mixtures. High steady-state acetone loadings (above C(in)(Ac) = 0.5 g.m(-3) corresponding to the loadings > 34.5 g.m(-3).h(-1)) resulted in a significant inhibition of the system's performance in both acetone and styrene removal. This inhibition was shown to result from the acetone accumulation within the upstream trickle-bed bioreactor (TBR) circulating mineral medium, which was observed by direct chromatographic measurements. Placing a biofilter (BF) downstream to this TBR overcomes the inhibition as long as the biofilter has a sufficient bed height. A different kind of inhibition of styrene biodegradation was observed within the biofilter at very high acetone loadings (above C(in)(Ac) = 1.1 g.m(-3) or 76 g.m(-3).h(-1) loading). In addition to steady-state measurements, dynamic tests confirmed that the reactor overloading can be readily overcome, once the accumulated acetone in the TBR fluids is degraded. No sizable metabolite accumulation in the medium was observed for either TBR or BF. Analyses of the biodegradation activities of microbial isolates from the biofilm corroborated the trends observed for the two-stage biofiltration system, particularly the occurrence of an inhibition threshold by excess acetone.
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http://dx.doi.org/10.1080/10934529.2015.1047672DOI Listing
February 2016

Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia.

Explore (NY) 2015 Jul-Aug;11(4):304-9. Epub 2015 Apr 28.

Pacific University, Forest Grove, OR.

Context And Objective: A growing body of literature suggests that mindfulness techniques may be beneficial in fibromyalgia. A recent systematic review and meta-analysis of six trials indicated improvement in depressive symptoms and quality of life, calling for increased rigor and use of standardized measures in future trials. The purpose of the study was to examine the relationship between mindfulness [as measured by the Five Facet Mindfulness Questionnaire (FFMQ)] and fibromyalgia impact [as measured by the Revised Fibromyalgia Impact Questionnaire (FIQR)].

Design, Setting, And Participants: A cross-sectional survey was conducted with adults diagnosed with fibromyalgia from a national fibromyalgia advocacy foundation e-mail list.

Results: A total of 4986 respondents represented all 50 states in the United States and 30 countries. FIQR scores demonstrated moderate to severe fibromyalgia with the majority of subjects (59%) scoring ≤60. Scores on the FFMQ subscales ranged from 20.8 to 27.3, with highest scores for the observe subscale. All subscale correlations were small to moderate and indicated that more severe fibromyalgia impact was associated with less mindfulness except in the observe scale (r = .15, P > .000). No clinical or demographics explained as much variance in the FIQR total as any of the mindfulness subscales.

Conclusions: Fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions. Baseline values for the observe subscale of the FFMQ were unexpectedly high. Further research is needed to know if this may be due to non-mindful observations and should be noted when the FFMQ is used in fibromyalgia clinical trials.
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http://dx.doi.org/10.1016/j.explore.2015.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552195PMC
April 2016

Delayed Gastric Emptying Is Associated With Early and Long-term Hyperglycemia in Type 1 Diabetes Mellitus.

Gastroenterology 2015 Aug 14;149(2):330-9. Epub 2015 May 14.

Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts.

Background & Aims: After the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to show persistent benefit of prior intensive therapy on neuropathy, retinopathy, and nephropathy in type 1 diabetes mellitus (DM). The relationship between control of glycemia and gastric emptying (GE) is unclear.

Methods: We assessed GE with a (13)C-spirulina breath test and symptoms in 78 participants with type 1 diabetes at year 20 of EDIC. The relationship between delayed GE and glycated hemoglobin (HbA1c), complications of DM, and gastrointestinal symptoms were evaluated.

Results: GE was normal (37 participants; 50%), delayed (35 participants; 47%), or rapid (2 participants; 3%). The latest mean HbA1c was 7.7%. In univariate analyses, delayed GE was associated with greater DCCT baseline HbA1c and duration of DM before DCCT (P ≤ .04), greater mean HbA1c over an average of 27 years of follow-up evaluation (during DCCT-EDIC, P = .01), lower R-R variability during deep breathing (P = .03) and severe nephropathy (P = .05), and a greater composite upper gastrointestinal symptom score (P < .05). In multivariate models, retinopathy was the only complication of DM associated with delayed GE. Separately, DCCT baseline HbA1c (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3) and duration of DM (OR, 1.2; 95% CI, 1.01-1.3) before DCCT entry and mean HbA1c during DCCT-EDIC (OR, 2.2; 95% CI, 1.04-4.5) were associated independently with delayed GE.

Conclusions: In the DCCT/EDIC study, delayed GE was remarkably common and associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia. ClinicalTrials.gov numbers NCT00360815 and NCT00360893.
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http://dx.doi.org/10.1053/j.gastro.2015.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516593PMC
August 2015

Biofiltration of gasoline and diesel aliphatic hydrocarbons.

J Air Waste Manag Assoc 2015 Feb;65(2):133-44

a Institute of Chemical Technology , Prague , Czech Republic.

The ability of a biofilm to switch between the mixtures of mostly aromatic and aliphatic hydrocarbons was investigated to assess biofiltration efficiency and potential substrate interactions. A switch from gasoline, which consisted of both aliphatic and aromatic hydrocarbons, to a mixture of volatile diesel n-alkanes resulted in a significant increase in biofiltration efficiency, despite the lack of readily biodegradable aromatic hydrocarbons in the diesel mixture. This improved biofilter performance was shown to be the result of the presence of larger size (C₉-C(12)) linear alkanes in diesel, which turned out to be more degradable than their shorter-chain (C₆-C₈) homologues in gasoline. The evidence obtained from both biofiltration-based and independent microbiological tests indicated that the rate was limited by biochemical reactions, with the inhibition of shorter chain alkane biodegradation by their larger size homologues as corroborated by a significant substrate specialization along the biofilter bed. These observations were explained by the lack of specific enzymes designed for the oxidation of short-chain alkanes as opposed to their longer carbon chain homologues.
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http://dx.doi.org/10.1080/10962247.2014.980016DOI Listing
February 2015

Interest in yoga among fibromyalgia patients: an international internet survey.

Int J Yoga Therap 2014;24:117-24

School of Nursing, Oregon Health & Science University, Portland, Oregon, USA.

Studies in circumscribed clinical settings have reported the adoption of yoga by many fibromyalgia (FM) patients. However, it is unclear from existing studies which types of yoga practices FM patients are typically engaging in and the extent to which they experience yoga as helpful or not. The purpose of this study was to survey FM patients in many different regions to inquire about their engagement in various yoga practices, the perceived benefits, and the obstacles to further practice. A 13-question Internet survey of persons self-identified as FM patients was conducted among subscribers to 2 electronic newsletters on the topic of FM. Respondents (N = 2543) replied from all 50 U.S. states and also from Canada, Australia, and the United Kingdom, and from more than two dozen other countries. On average, respondents were 57 years of age and 96% were female, with an average time since diagnosis of 13 years. Of these respondents, 79.8% had considered trying yoga and 57.8% had attended 1 yoga class. The respondents' classes typically focused almost exclusively on yoga poses, with minimal training in meditation, breathing techniques, or other practices. The most commonly cited benefits were reduced stiffness, relaxation, and better balance. The most frequently cited obstacles were concerns about the poses being too physically demanding and fear that the poses would cause too much pain. These findings confirm strong interest in yoga across a geographically diverse range of FM patients. However, concerns about yoga-induced pain and yoga poses being too difficult are common reasons that FM patients do not engage in yoga exercises. This study supports the need for yoga programs tailored for FM patients to include modification of poses to minimize aggravating movements and substantive training in meditation and other yoga-based coping methods to minimize pain-related fear.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587211PMC
January 2014

Postpartum transabdominal laparoscopic adrenalectomy for pheochromocytoma presenting with abruption and hypertensive emergency.

Am Surg 2015 Jan;81(1):E34-5

Department of Surgery, University of South Carolina, Columbia, South Carolina, USA.

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January 2015

Photothrombotic stroke induces persistent ipsilateral and contralateral astrogliosis in key cognitive control nuclei.

Neurochem Res 2015 Feb 11;40(2):362-71. Epub 2014 Dec 11.

School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.

While astrocytes are recognised to play a central role in repair processes following stroke, at this stage we do not have a clear understanding of how these cells are engaged during the chronic recovery phase. Accordingly, the principal aim of this study was to undertake a quantitative multi-regional investigation of astrocytes throughout the recovery process. Specifically, we have induced experimental vascular occlusion using cold-light photothrombotic occlusion of the somatosensory/motor cortex in adult male C57B6 mice. Four weeks following occlusion we collected, processed, and immunolabelled tissue using an antibody directed at the glial fibrillary acidic protein (GFAP), an astrocyte specific cytoskeletal protein marker. We investigated GFAP changes in 13 regions in both the contra- and ipsi-lateral hemispheres from control and occluded animals. Specifically, we examined the infra-limbic (A24a), pre-limbic (A25), anterior cingulate (A32), motor (M1 and M2) cortices, the forceps minor fibre tract, as well the shell of the accumbens, thalamus, cingulate cortex (A29c), hippocampus (CA1-3) and lateral hypothalamus. Tissue from occluded animals was compared against sham treated controls. We have identified that the focal occlusion produced significant astrogliosis (p < 0.05), as defined by a marked elevation in GFAP expression, within all 13 sites assessed within the ipsilateral (lesioned) hemisphere. We further observed significant increases in GFAP expression (p < 0.05) in 9 of the 13 contralesional sites examined. This work underscores that both the ipsilateral and contralesional hemispheres, at sites distal to the infarct, are very active many weeks after the initial occlusion, a finding that potentially has significant implications for understanding and improving the regeneration of the damaged brain.
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http://dx.doi.org/10.1007/s11064-014-1487-8DOI Listing
February 2015

Preliminary evidence of a blunted anti-inflammatory response to exhaustive exercise in fibromyalgia.

J Neuroimmunol 2014 Dec 18;277(1-2):160-7. Epub 2014 Oct 18.

School of Nursing, Oregon Health Science University, Portland, OR 97239, United States; School of Nursing, MGH Institute of Health Professions, Boston, MA 02129, United States. Electronic address:

Exercise intolerance, as evidenced by a worsening of pain, fatigue, and stiffness after novel exertion, is a key feature of fibromyalgia (FM). In this pilot study, we investigate whether; insufficient muscle repair processes and impaired anti-inflammatory mechanisms result in an exaggerated pro-inflammatory cytokine response to exhaustive exercise, and consequently a worsening of muscle pain, stiffness and fatigue in the days post-exercise. We measured changes in muscle pain and tenderness, fatigue, stiffness, and serum levels of neuroendocrine and inflammatory cytokine markers in 20 women with FM and 16 healthy controls (HCs) before and after exhaustive treadmill exercise. Compared to HCs, FM participants failed to mount the expected anti-inflammatory response to exercise and experienced a worsening of symptoms post-exercise. However, changes in post-exertional symptoms were not mediated by post-exertional changes in pro-inflammatory cytokine levels. Implications of these findings are discussed.
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http://dx.doi.org/10.1016/j.jneuroim.2014.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314393PMC
December 2014