Sunday, September 24, 2023
This article is intended for primary care clinicians, rheumatologists, and other specialists who care for patients with fibromyalgia.
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Upon completion of this activity, participants will be able to:
As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this enduring material for a maximum of 0.25
AMA PRA Category 1 Credit(s)™
. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This enduring material activity, Medscape Education Clinical Briefs has been reviewed and is acceptable for up to 260 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2012. Term of approval is for 1 year from this date. Each Clinical Brief is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of each Clinical Brief. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: Total credit is subject to change based on topic selection and article length.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
AAFP Accreditation Questions
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME Released: 4/17/2013
Valid for credit through: 4/17/2014, 11:59 PM EST
processing....
Fibromyalgia (FM) is a prevalent, chronic condition associated with widespread pain, tenderness, fatigue, and cognitive and somatic symptoms. It is thought to be a central amplification disorder of pain perception resulting from neurochemical imbalances in the central nervous system.
Despite the well-known harmful effects of alcohol, findings of previous studies suggest that alcohol may have positive effects on chronic pain and rheumatoid arthritis. Thus far, however, no studies have assessed alcohol intake in patients with FM. The objective of this study by Kim and colleagues was to evaluate the relationship between alcohol consumption and FM symptom severity and quality of life (QOL).
Patients with FM who drink low or moderate amounts of alcohol have less severe symptoms than nondrinkers, and Mayo Clinic researchers suspect that alcohol's ability to raise γ-aminobutyric acid (GABA) levels might be the reason. However, the researchers note that the nondrinkers (more than half of the study population) might also have had more severe FM and avoided alcohol out of concern about possible interactions with FM treatment drugs, such as opioids.
"Our study demonstrates that low and moderate alcohol consumption was associated with lower fibromyalgia symptoms and better QOL [quality of life] compared to no alcohol consumption. The reasons for these results are unclear. Since recent studies have demonstrated that ...GABA levels are low in fibromyalgia, and alcohol is known to be a GABA-agonist, future studies should examine whether alcohol could have a salutary effect on pain and other symptoms in fibromyalgia," Chul H. Kim, MD, and colleagues reported online March 15 in Arthritis Research & Therapy. The research team was led by Terry H. Oh, MD, from the Department of Physical Medicine and Rehabilitation at the Mayo Clinic in Rochester, Minnesota.
The study included 946 patients in Mayo's Fibromyalgia Treatment Program from May 1, 2001, through April 30, 2004. All had confirmed FM and had completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Survey (SF-36).
The patients were divided into the following self-reported alcohol consumption categories: none (no drinks/week; n = 546 [58%]), low (≤3 drinks/week; n = 338 [36%]), moderate (<3 to 7 drinks/week; n = 31 [3%]), and heavy (>7 drinks/week [n = 31] 3%). These were then examined for correlation with FM-related symptoms (FIQ scores) and QOL (SF-36 scores).
Better QOL, Less Pain
Drinkers had higher education, a lower body mass index (BMI), and a lower frequency of unemployment and opioid use than nondrinkers.
After adjusting for age, employment status, educational level, BMI, and opioid use, the researchers found significant group differences in the number of tender points, FIQ total score, FIQ subscales of physical function, work missed, job ability, and pain.
"Moderate drinkers had overall lower fibromyalgia-related symptoms, and higher QOL scores than the other groups. Pairwise comparison among the four groups showed that the moderate and low alcohol drinkers had better physical QOL than nondrinkers, with significant differences for SF-36 physical functioning, pain index, and physical component summary scores," the authors wrote.
The association between low or moderate drinking, fewer FM symptoms, and better QOL held even after adjustment for social variables and BMI. This beneficial effect was not observed in heavy drinkers.
The authors concluded, "We urge caution when generalizing the findings of this study because of the relatively small number of moderate and heavy drinkers in the study. Furthermore, we do not recommend that patients with fibromyalgia start or increase drinking for their symptoms."
"GABA, an inhibitory neurotransmitter, is low in the brain in fibromyalgia, which may go some way to explain why the nervous system reaction to pain is amplified. Alcohol binds to the GABA receptor in the central nervous system which in turn may turn down pain transmission. However, the effects of alcohol may also be due to improved mood, socialization and tension, and while moderate drinkers have fewer symptoms there are still many questions about how this happens," Dr. Oh said in a press release.
The study was supported by the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research. The authors have disclosed no relevant financial relationships.
Arthritis Res Ther. 2013;15:R42. Published online March 15, 2013. Abstract
