The American Fibromyalgia Syndrome=20 Association

= Research

= Education

= Patient=20 Advocacy

Volume=20 9, Issue 1- November 2002

Organizational News and Activities=20

AFSA Funds=20 its 23rd Project!

Title: A Case-Controlled Study of Proton = Spectroscopy=20 in Fibromyalgia
Principal = Investigator:=20 Patrick Wood, M.D., Louisiana State University at Shreveport = (LSU)
Award Amount: $37,450=20

Fibromyalgia has long = been=20 associated with abnormalities in the body's stress response mechanisms = and is=20 believed to be due to problems in brain function. Symptoms often surface = for the=20 first time after a stressful insult to the body that may include trauma, = infectious agents or a prolonged time of severe duress. Once symptoms = have=20 developed, stress also tends to make the symptoms worse. Researchers = have shown=20 that those parts of the body responsible for handling stress may be = overactive=20 in patients with FMS (e.g., hyperactivity of the corticotropin-releasing = hormone=20 neurons, which are believed to blunt growth hormone secretion during = exercise,=20 and a sympathetic nervous system that is pushed into hyper-drive so that = it=20 can't respond appropriately to common daily stressors). These hormonal = and=20 nervous system problems could explain many of the symptoms of FMS, = including=20 widespread pain, but the search for the root cause of this situation is=20 essential in order to better understand how to treat FMS.

The hippocampus is part = of the=20 limbic system of the brain which is best known for its role in memory = and=20 learning=97but it has many other functions. The hippocampus is also = responsible=20 for "putting the brakes" on the stress response network, to prevent it = from=20 running out of control. Ironically, the same chemicals that characterize = the=20 stress response (namely cortisol, corticotropin-releasing hormone, and=20 adrenaline) are also known to damage the hippocampus, making it less = able to do=20 its job. In addition, the hippocampus also handles pain signals by = routing them=20 from the spinal cord to the brain. Exposure of the hippocampus to stress = chemicals may therefore be associated with the development of chronic = pain, such=20 as that found in FMS and CFS patients.

Magnetic resonance = spectroscopy=20 (MRS) is a technique used to characterize the chemical content of living = tissue=20 without having to take a sample. Using this technique, researchers = Patrick B.=20 Wood, M.D., and James C. Patterson, M.D., Ph.D., at Louisiana = State=20 University Health Science Center in Shreveport, will investigate whether = or not=20 patients with FMS have a lower concentration of n-acetylaspartate, or = NAA, in=20 their hippocampus. NAA is a marker of integrity and function within the = brain,=20 and a decrease in its concentration is associated with a variety of = illnesses.=20 In fact, a short communication published in The British Journal of=20 Radiology in November of 2000 (volume 73, pages 1206-08) indicated = that=20 patients with CFS exhibited a substantial decrease in their hippocampal=20 concentration of NAA. The study only assessed seven CFS patients, but = this=20 preliminary report presents a strong case for the measurement of NAA = levels in=20 both CFS and FMS patients on a larger scale. Wood and Patterson will = also be=20 evaluating the effects of depression and anxiety in FMS patients because = they=20 may often coexist in people with chronic illnesses.

Other cerebral = metabolites will be=20 measured by MRS to provide more knowledge about FMS. Creatine (Cr) = levels are=20 predictive of the rate of cellular metabolism and choline (Cho) levels = are=20 thought to be a marker of glial cell function. Glial cells surround the = neurons=20 in the brain to assist in regulating transmissions and the transfer of=20 nutrients. Hippocampus volumes will be measured as well because a = decreased size=20 has been found in patients suffering from combat-related post-traumatic = stress=20 disorder (PTSD). People with PTSD not only have impaired memory = functions=20 similar to FMS/CFS; they also have higher than normal levels of stress = hormones=20 circulating within their brain.
If patients with FMS (and possibly = CFS) are=20 found to have a lower concentration of NAA in their hippocampus compared = to=20 those without FMS, this might explain the hyperactive stress response,=20 widespread pain, "fibro fog," and many other symptoms. Medications are = available=20 to protect the integrity of the hippocampus, but they are not prescribed = for=20 patients with FMS/CFS because there is currently no basis for their use. = However, if the NAA concentrations are low in patients, then this study = will=20 open up a new avenue of drug therapies that will enable the hippocampus = to=20 recover from its stressful environment. In addition, abnormal = concentrations of=20 NAA, Cr, or Cho in the hippocampus, as well as a smaller hippocampus = size, could=20 prove to be of benefit diagnostically for patients.
Dr. Wood is an = Assistant=20 Professor at LSU Health Science Center and also serves as co-director of = their=20 Primary Care Pain Management Clinic. He recently completed a research = fellowship=20 in Psychopharmacology and was honored as one of the nation's most = promising New=20 Investigators by the National Institutes of Mental Health (NIMH) for his = work=20 involving a novel treatment for patients with FMS. NIMH is one of the = major=20 Institutes involved in brain research. He is eager to use his special = training=20 in neuropharmacology to help identify novel drugs or potential new = classes of=20 medications that will benefit patients with FMS and CFS. Dr. Patterson = is=20 director of the neuroimaging research center at LSU and is working with = Dr. Wood=20 to bring MRS technology to the field of FMS.

AFSA=20 Donations Are Impacting Research Directions

As AFSA enters its ninth = year of=20 operation, the influence of your donations are widely evident. The = projects and=20 the investigators funded by AFSA are making an impact in the medical = journals,=20 at scientific meetings, and at The National Institutes of Health (NIH). = There is=20 also evidence that the results of AFSA-funded projects are catching the=20 attention of the pharmaceutical industry. Although the projects funded = by AFSA=20 are small in size, and many are designed as a stepping stone to larger=20 NIH-funded projects, here is a list of accomplishments made possible by = your=20 donations:

Eight medical journal = articles=20 describing exciting new data from projects funded by AFSA have = appeared in the=20 peer-reviewed medical literature over the past two years.

Roughly an equal = number of=20 articles pertaining to AFSA awards are either "in press" or about to = be=20 submitted for publication to provide a continuous stream of medical = journal=20 articles highly relevant to fibromyalgia patient issues.=20

Over 35 presentations = at major=20 scientific conferences were made by AFSA-funded researchers regarding = the=20 outcomes of their projects, beginning in the year 1996 when Daniel = Clauw,=20 M.D., presented two posters on autonomic dysfunction in patients = with FMS=20 and CFS.=20

At least five = AFSA-funded=20 projects helped their principal investigators obtain substantial = funding from=20 NIH and other large sources of biomedical research dollars. As more = projects=20 near completion, AFSA-funded researchers will be able to use the data = from=20 their projects to apply to NIH and other large granting institutions. = The end=20 result is that the NIH is spending more money on FMS/CFS-related = projects=20 because AFSA is increasing the number of qualified investigators with=20 substantially impressive data to procure NIH grants (typically = $200,000 per=20 year for 3-4 years).=20

Several AFSA-funded = researchers=20 have written medical science book chapters incorporating their study = findings=20 and conclusions, which further educates doctors in training and others = interested in the field.

The training of new=20 investigators in the field of FMS/CFS has occurred as part of several=20 AFSA-awards. For example, an award that was made to Laurence = Bradley,=20 Ph.D., of University of Alabama at Birmingham, to use brain SPECT = imaging=20 to show that FMS and CFS are NOT depression has also helped train = Leanne=20 Cianfrini, M.S., who is working on her Ph.D. in this field. = Serge=20 Marchand, Ph.D., and Pierre Arsenault, M.D., Ph.D., of = Canada, were=20 awarded funding by AFSA to evaluate the malfunctioning in the = inhibitory pain=20 control system in patients with FMS, as well as study the drug, = Effexor. In=20 the process, these two researchers have trained many others to help in = their=20 endeavors. Referring to this subject, Marchand says, "We are in the = process of=20 expanding our research in the field of fibromyalgia by enlarging our = group of=20 people interested in trying to understand the neurophysiological = mechanisms of=20 FMS pain.

AFSA is in the process of = putting=20 together a special issue of the "Update" to discuss every project = funded, the=20 results they produced (if completed) or a progress report (if the = project is=20 still in the works), and input from each investigator on the importance = of their=20 project, in terms of how it has enhanced (or will enhance) our = scientific=20 understanding of FMS. Based on the substantial input that we have = received from=20 AFSA-funded investigators so far, we anticipate that this special issue = will be=20 36-40 pages long. We will be mailing this issue to people who have = recently contributed to AFSA because we want donors to read first-hand = about the=20 significance of their contribution!

Every = Dollar=20 Counts!

Our financial summary for = the past=20 year (July 1, 2001 to June 30, 2002) appears in the table and pie chart = below.=20 Our financials are not complicated. That's because we are all about one=20 thing=97funding research. There are no salaries and very little = overhead. Our=20 focus, our hearts, our volunteer efforts, and your donations go strictly = to=20 finding the cause of and cure for fibromyalgia.

Finincial Summary for July 1, 2001 to = June 30,=20 2002
REVENUE &=20 SUPPORT	EXPENSES
Contributions:=20	$88,263	98.31%	Research=20 Grants:	$84,974	87.27%
Interest = &=20 Other:	$1,030	1.15%	Educational:	$7,442	7.64%
Note=20 Cards:	$488	0.54%	Operating=20 Exp:	$4,954	5.09%
Total=20 Revenue:	$89,781		Total=20 Expenses:	$97,370

A more detailed financial = report=20 will be included in the upcoming special issue, and it will soon be = posted to=20 this site as well. In the expense column, two research grants were = awarded last=20 year. One was to Luc Jasmin, M.D., Ph.D., at UC-San Francisco = ($56,925 in=20 July 2001) and the other was to Laurence Bradley, Ph.D., at the=20 University of Alabama at Birmingham ($28,049 in January of 2002). The = latest=20 project granted to Patrick Wood, M.D., at LSU ($37,450), does not appear = on=20 AFSA's expense report because the award was not made until November of = 2002. The=20 educational expense includes the cost of two AFSA Updates = to=20 describe projects funded and free information packets that we mail to = people=20 inquiring about AFSA. Operating expenses include office supplies, = telephone=20 bills, postage expense, and other operating fees. As you can see, our = overhead=20 is only 5%, meaning that 95% of all donations go to our = mission.

AFSA began raising funds = for=20 research in 1994 and awarded its first two projects in June of 1995. As = of June=20 30, 2002 (our last year-end), AFSA has raised a total of $945,701. We = have=20 funded 23 high quality projects with the money raised so far, but our = reserves=20 are dipping low. Join us in our goal to reach the million dollar mark so = that=20 more patient-relevant projects can be funded in the year to come. Send = AFSA your=20 tax-deductible donation today to keep the steady stream of progress=20 going!