TENDER TIMES

Inside This Issue
The Hormonal Connection
A Smile
Endometriosis
Premenstrual Syndrome
10 Ways To Know If You Have PMS (humour)
Men's Zone
Osteoporosis Strikes Many Men
Better Definitions
Fibromyalgia Q & A
Blueberry Muffins
Calcium Facts
Inner Peace
Acupuncture

Studies of oxygen consumption and exertion show that fibromyalgia patients suffer from an inability to generate adequate energy at the cellular level. This may be influenced by a decreased availability of specific hormones such as DHEA and Growth Hormone.

DHEA
Studies conducted over the last few years have shown that the hormone DHEA, dehydroepiandrosterone, seems to be effective for easing fatigue and its accompanying symptoms. Individuals with connective tissue disease and those suffering from chronic depression, show abnormally low levels of DHEA. Recent research also identifies that DHEA blood values are reduced in those experiencing fatigue, headaches, and stress-related symptoms; symptoms typically present in fibromyalgia patients as well.

DHEA is a steroid hormone which is secreted by the adrenal glands in response to a chemical stimulus from the liver. The liver hormone is called IGF-1, insulin-like growth factor-1, a byproduct of human growth hormone stimulation. Due to stress, sleep interruption, and muscle fatigue, these patients experience first a dramatic reduction in growth hormone level, then IGF-I and DHEA. With time, the blood levels and symptoms often worsens.

Since DHEA, growth hormone and IGF-1 are best known for their roles in cellular growth and repair, low levels of all three are typical in fibromyalgia patients. These patients uniformly experience a decrease in not only muscle mass, but also in physical endurance and muscle strength. Further, skeletal repair may be lowered resulting in a greater risk in the future of skeletal diseases like osteoporosis and arthritis related states. Additionally, these hormones maintain the individual's immunity. Fibromyalgia, chronic fatigue, and mixed connective tissue individuals are prone to frequent, chronic and lingering infections. They have ''colds,'' sore throats, and infections or cuts that fail to heal. Studies have been published that confirm that DHEA can stimulate the immune system and may enhance one's ability to recover from and prevent these infections. DHEA supplementation can make more IGF-1 and growth hormone available by freeing them from carrier proteins.

GROWTH HORMONE
Both in states of fibromyalgia and chronic fatigue, there has been verification that IGF-1 (Somatomedin-C) levels are abnormally low. Low levels of IGF-1 are representative of low levels of growth hormone release.

There are few conditions that trigger growth hormone release. One is during stage IV sleep and another is with exercise. In fact, reports have confirmed that exercise will temporarily improve the effects of fibromyalgia. So will repeated ''good night'' sleep and afternoon ''naps.''

Growth hormone, once released, has a profound effect on muscle tissue. Growth hormone affects not only the repair but the development of the muscle tissue itself. Dramatic new research has confirmed that growth hormone supplementation will convert type II muscle fibers into type I. Since the majority of the elderly display little energy or endurance with predominantly type II (fast twitch- no endurance) muscle fibers, rejuvenation may occur with the use of growth hormone. In a three month period of time, up to 30% of the muscle cells may convert back to type I.

The daily release of growth hormone averages about 500mcg at age 20, them declines to 200 mcg at age 40 and 25mcg at age 80.

Theories of Fibromyalgia
Standard laboratory tests of the past did not show abnormalities in persons with fibromyalgia. Physicians are now using tests that were formerly only used in clinical trials. These newer tests are revealing and confirming laboratory abnormalities in persons with fibromyalgia.

Chemical analysis of muscle tissue taken from fibromyalgia sufferers reveals that high energy phosphate may be abnormal at the spot in the muscle with the greatest tenderness when pressed.

One theory about muscle abnormalities is that muscles undergo microtrauma during normal daily activities but are repaired during the fourth stage of sleep.

In persons with fibromyalgia, restorative fourth stage sleep does not occur properly. In addition, an insulin-like growth factor, secreted by the liver upon release of growth hormone by the brain, is deficient in fibromyalgia.

So, muscle repair may be delayed or defective because the fibromyalgia sufferer does not fall into a deep sleep and the insulin like growth factor that repairs the muscle during sleep is deficient.

Other theories about the cause of fibromyalgia involve physical or emotional trauma, such as a car accident or virus, physical or sexual abuse, stress, depression, or neurochemical factors acting as triggers.

Theories about the pain of fibromyalgia focus on the perception of pain and how the message of pain travels to the brain. The pain of fibromyalgia is called alldynia, which means long-standing increase in pain perception.

The pain threshold in fibromyalgia appears to be lower. This may result from a malfunctioning transmission of the pain signal in the nerves, spinal cord, and brain, thereby magnifying the pain signal so a larger amount of pain is felt than actually exists.

These are all theories about the causes of fibromyalgia. More research needs to be conducted to determine the actual cause of fibromyalgia and to provide an understanding of how it actually works.

Endometriosis is a disease affecting women in their reproductive years. It was widely undiagnosed until recently. The name, as you've probably guessed, comes from the word endometrium. The clinical definition of endometriosis is an "abnormal growth of endometrial cells." Roughly 5.5 million women throughout North America have endometriosis. Endometriosis was at one time coined "husbanditis" because the pain that characterizes endometriosis was seen as a woman's excuse to get out of her marital duties. In the past, treating women who complained of pelvic pain ranged from tranquilizers to hysterectomies. Unfortunately, many women today are still being told that their symptoms are "in their heads" when, in fact, endometriosis is a physical disease causing real physical symptoms. What happens is that endometrial tissue forms outside the uterus and in other areas of the body. This tissue then develops into small growths, or tumors. These growths are usually benign (noncancerous) and are simply a normal type of tissue in an abnormal location.

The most common location of these endometrial growths is in the pelvic region, which affects the ovaries, the fallopian tubes, the ligaments supporting the uterus, the outer surface of the uterus, and the lining of the pelvic cavity. Forty to 50 percent of the growths are in the ovaries and fallopian tubes. Sometimes the growths are found in abdominal surgery scars, on the intestines, in the rectum, and on the bladder, vagina, cervix, and vulva. Other locations include the lung, arm, thigh, and other places outside the abdomen, but these are rare.

Since these growths are in fact pieces of uterine lining, they behave like uterine lining, responding to the hormonal cycle and trying to shed every month. These growths are blind -- they can't see where they are and think they're in the uterus. This is a huge problem during menstruation; when the growths start "shedding," there's no vagina for them to pass through, so they have nowhere to go. The result is internal bleeding, degeneration of the blood and tissue shed from the growths, inflammation of the surrounding areas, and formation of scar tissue. Depending on where these growths are located, they can rupture and spread to new areas, cause intestinal bleeding or obstruction (if they're in or near the intestines), or interfere with bladder function (if they're on or near the bladder). Infertility affects about 30 to 40 percent of endometriosis sufferers, and as the disease progresses, infertility is often inevitable.

The most common symptoms of endometriosis are pain before and during periods (much worse than normal menstrual cramps), pain during or after intercourse, and heavy or irregular bleeding. Other symptoms may include fatigue, painful bowel movements with periods, lower back pain with periods, diarrhea and/or constipation with periods, dizziness, low-grade fever, frequent infections and intestinal upset with periods. If the bladder is involved, there may be painful urination and blood in the urine with periods. Irregular menstrual cycles and heavier flows are also associated with endometriosis, but women with severe endometriosis usually continue to have regular, albeit painful, periods. Some women with endometriosis may have no symptoms at all. It's important to note that the amount of pain is not necessarily related to the extent or size of the growths. If you have at least two of these symptoms during your period or even experience them chronically, you may want to get checked out for endometriosis.

The Stages of Endometriosis
(The higher the number, the more severe the endometriosis.)

Stage I is when your endometriosis is minimal and still very thin and "filmy," hence easier to treat.

Stage II is mild endometriosis; the endometriosis is still on the thin side but is situated more deeply into your surrounding tissues.

Stage III is moderate endometriosis; your endometriosis is denser mixed with some Stage I or Stage II symptoms.

Stage IV means severe endometriosis. In this case, the endometriosis is dense and deep, a bad combination.

Diagnosis
The only way to diagnose endometriosis is with an instrument called a laparoscope (a tubelike telescope with a light in it), used in a procedure known as laparoscopy. The procedure is a form of minor surgery. After a general anesthetic is administered, your abdomen is distended (expanded) with carbon dioxide gas to make the organs easier to see. A tiny incision is made, and a laparoscope is inserted into it. By moving the laparoscope around, your surgeon can check for any signs of endometrial tissue outside the uterus. Although your doctor can often feel the endometrial growths during a pelvic exam, and your symptoms may be telltale signs of endometriosis, no competent physician would confirm the diagnosis without performing a laparoscopy procedure. The bottom line is that if you've been told you have endometriosis, but you haven't had a laparoscopy procedure done, insist that your doctor perform one, or get a second opinion. Often, the symptoms of ovarian cancer are identical to those of endometriosis. If you've been misdiagnosed with endometriosis due to your doctor's failure to confirm it through a laparoscopy, he or she may miss an early diagnosis of ovarian cancer crucial for successful treatment.

PMS is short for premenstrual syndrome, a condition researchers suspect is a neuro-endocrinopathy. This simply means a hormone disorder originating in the brain. A woman afflicted with PMS may experience a wide variety of seemingly unrelated symptoms. For that reason, it is difficult to diagnose. There is, however, one tell-tale sign: a women with PMS usually has a cyclical pattern to her symptoms.

What Are the Symptoms of PMS?
Symptoms vary from woman to woman. They come in many combinations, ranging in severity from mild to moderate to incapacitating. The one most commonly linked to PMS include: depression, lethargy, fatigue, irritability, unexplained anger, and a sense of being out of control. Other symptoms would be migraine or other headaches, sinus problems, edema, acne, compulsive eating, craving for sweet or salty food, joint pain, clumsiness, back pain, eye problems, and weight gain. In addition, we include seizures, bowel disorders, suicidal thoughts or attempts, poor concentration, paranoia, crying, and violence. Over one hundred symptoms have been observed, with each woman reporting her own unique set. The key to identifying PMS is not a set of certain symptoms, but the cyclical timing of the symptoms each month.

What Is Typical PMS Timing?
Although it is an individual matter, there are four common patterns.

1. Symptoms appear five to seven days before the onset of the period and subside with flow.


2. Symptoms begin at ovulation (usually the fourteenth day of the cycle, or mid-cycle) and last approximately two weeks or until menstrual flow begins.


3. Symptoms begin at ovulation and last up to three weeks, until heavy flow begins or period is nearly over.


4. Symptoms appear for a few days at ovulation, then subside, then reappear several days before the flow.

A woman with PMS usually has at least five days a month free of PMS symptoms.

Who Has PMS?
Researchers claim that forty percent of women of childbearing age have premenstrual syndrome. Problems can appear at puberty or as late as menopause. The onset of PMS seems to follow some shock to the endocrine system; typically menarche (first menstruation), childbirth, tubal ligation, hysterectomy, going on or off a birth control pill, or the advent of major life stress. It appears that PMS is hereditary and that symptoms can become worse with age.

Is There a Cure?
First understand that the cause of PMS is unknown, but it can be treated. A lot is up to you, the patient. The best systems for diagnosis is to chart your own set of symptoms on a PMS symptom calendar for two months.

We currently recommend the following: getting enough rest, exercising each day, and eliminating salt, sugar, caffeine, and alcohol. In addition, many recommend vitamin therapy, especially the B vitamins. Many PMS sufferers report transient hypoglycemia (low blood sugar). Almost all benefit from eating six small meals a day, rather than three regular meals.

Coping With PMS
For women who suspect premenstrual syndrome there are several ways of coping that don't require a doctor's prescription:

• Chart your symptoms.
  Finding out whether or not you are a victim of PMS can make you feel better. If you are a victim, knowing that you are not alone and understanding that the disorder is biochemical and not psychological can provide enormous relief.



• Eat frequently and properly.
  Good nutrition, with reduced fats and increased complex carbohydrates, important throughout your cycle but even more so after ovulation, when it is especially vital to keep blood sugar on an even keel. The change in hormone levels then alters your biochemistry, making you more susceptible to low blood sugar reactions, such as irritability, migraine, panic, tears, angry outbursts. Never go for more than four or five hours without food, a snack at bedtime may help, too.



• Exercise regularly.
  Half-hour aerobic workouts, in which you increase your pulse and work up a sweat, are good mood elevators. You should exercise three times a week all month.



• Cut down on salt.
  Since salt holds water, reducing salt intake should reduce bloating. In addition to not adding salt to your food, cook with less and avoid high-sodium foods.



• Take vitamin supplements.
  The B vitamins, especially B6, are known to reduce bloating and have an antidepressant effect, and they seem to help control carbohydrate cravings. Suggested beginning dosage is a B-complex, containing 50 milligrams of B6 daily, building up to 200 to 500 milligrams in a few months. Since B's are water soluble, you will excrete what you don't need.



• Add bran to your diet.
  Some women become constipated during premenstrual time and for the first few days of their period. Bran will bind water to itself and aid elimination.



• Cut down on caffeine.
  This includes not only coffee, but tea, cola, diet sodas, and chocolate, as well. A group of substances (xanthines) in these encourages breast cysts: Women who reduce intake of xanthines may find breasts are less tender during the premenstrual stage.



• Reduce stress if possible.
  Take things easy just before your period. If you're working, try to schedule important meetings and deadlines for another time of the month; at home, don't plan a dinner party for ten or invite your cousin and her four kids for the weekend. Set aside some time to nap, listen to music, read, or go for a walk.

Diet Rules
Eat six times a day: three meals a day with a mid-morning snack, a mid-afternoon snack, and a snack before bedtime. You should not eat any more food, however than you have previously. Now, just eat small meals. We suggest that women who do not want to lose weight restrict daily intake to 1,500 calories and women who need to lose weight limit themselves to 1,000 calories a day.

Recommendations:

1. Restrict red meat to 3 ounces a day and total protein to four ounces in a 1,000 calorie diet or seven ounces in a 1,500 calories diet. For protein eat fish, poultry and whole grains. Eggs, cheese, milk, yogurt and butter should be limited.
2. Increase complex carbohydrates (whole grains, vegetables, cereals).
3. Reduce refined sugar to as little as possible - candy, chocolate, cake, pie, pastries and ice cream are to be avoided. Eat fresh fruit as a treat.
4. Polyunsaturated fats are to be avoided.
5. Salt - the smaller amount the better. Soft drinks have lots of salt.
6. No caffeine (coffee, tea, cola, chocolate) - decaffeinated coffee is ok.
7. Eat lots of leafy green vegetables, grains, cereals.
8. No alcohol.
9. No fast foods.
10. Eat all the fruit and veggies that you want.

1. Everyone around you has an attitude problem.



2. You're adding chocolate chips to your cheese omelet.



3. The dryer has shrunk every last pair of your jeans.



4. Your husband is suddenly agreeing to everything you say.



5. You're using your cellular phone to dial up every bumper sticker that says, "How's my driving?"



6. Everyone's head looks like an invitation to batting practice.



7. You're convinced there's a God and he's male.



8. You're counting down the days until menopause.



9. You're sure that everyone is scheming to drive you crazy.



10. The ibuprofen bottle you bought yesterday is already empty.

Dr. John Morley, director of geriatric medicine at St. Louis University, says "For years I've been telling doctors that testosterone levels decrease 10 per cent every 10 years. And that by age 40, about 40 per cent of men suffer from relative impotence. But until recently, physicians refused to acknowledge it."

Andropause questionnaire:
So how do you tell if you're suffering from the andropause?

1. Do you have decreased interest in sex?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment in life?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Has there been a decreased ability to play a sport?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

What are options?
Men who answer "yes" to questions 1 or 7, or to any three questions, may be suffering from the andropause and low testosterone levels. Morley suggests that men who fail this test in all probability require testosterone.
He uses the test strictly as a screening procedure -- appropriate candidates are checked for bioavailable testosterone in their blood and, if it's low, testosterone replacement therapy (TRT) is suggested.

Does the treatment have a downside?
Since its discovery, doctors have worried that the use of testosterone might trigger enlargement of the prostate gland, or even worse, cause prostatic cancer. In fact, experts agree that testosterone could cause an undersized prostate gland to enlarge, but only to its normal size. They found no supportive evidence that testosterone causes prostatic malignancy.

Is therapy safe?
Dr. Malcolm Carruthers of London, England, has claimed for years that it's safe to use testosterone therapy. He admits testosterone can increase the growth of an existing cancer, but does not initiate one. In fact, giving testosterone may even result in earlier diagnosis of cancer as patients receiving the treatment are examined more frequently. Prior to starting testosterone therapy, men must have a general examination, including a rectal examination, and PSA test to rule out prostatic cancer.
Dr. Alvaro Morales, professor of urology at Queen's University, Kingston, Ontario, says it's prudent to prescribe Andriol, an oral form of testosterone available in Canada, for a trial period of three months. If Andriol has no clinical effect, it should be stopped. Should there be improvement, it can be continued.

The big question is, how many men will opt for treatment?
Judging by the example set by women, there won't be a stampede to the doctor's door (only 15 per cent of menopausal women use hormone replacement therapy). Men have not insignificant obstacles to overcome. First, if they fail the Morley test, many will simply refuse to accept the results or will be too embarrassed to seek medical attention. Even if they do opt for treatment, finding a physician willing to prescribe Andriol is another matter entirely -- most physicians know little about andropause.

Testosterone for heart, bones
But men and their doctors have to acknowledge it isn't only the libido that can be affected by the andropause. Researchers claim that low levels of testosterone also trigger cardiovascular disease and osteoporosis.
Morales says: "There's no question that men lose bone as they age. Moreover, giving testosterone can increase bone density in the lumbar spine and hips, but to a greater degree in the spine. There's also evidence that a low blood testosterone level is a risk factor for cardiovascular disease, and that the use of testosterone can help prevent heart disease."

But how does testosterone decrease the risk of myocardial infarction?
Several years ago, Dr. Philip Sarrel, professor of gynecology at Yale University, discovered that estrogen dilates coronary vessels while progesterone constricts them. And he shocked doctors by presenting cases in which he believed the use of progesterone had caused either a heart attack or stroke.
Dr. D. Crook (a London, England cardiologist), stunned the world congress with similar evidence. His studies show that testosterone also dilates coronary arteries. This has interesting implications. For instance, when heart attack patients are admitted to an emergency room they're routinely given medication to dilate blocked coronary arteries. This evidence suggests that, in future, patients may also receive an intravenous injection of testosterone for the same reason.
Researchers at the congress also announced good news about the effect of testosterone on lipid metabolism. Dr. Roland Tremblay, an internationally respected Quebec endocrinologist, reported that testosterone has a positive effect on blood lipids. Studies show it lowers blood cholesterol and decreases low-density lipoproteins (the bad cholesterol), increases high-density lipoproteins (the good cholesterol), and decreases triglycerides.

Missed diagnosis
Another interesting message came out of Geneva -- that diagnosis of male menopause is often missed. In fact, some physicians were prescribing antidepressant medication such as Prozac, when what was actually needed was long-term testosterone therapy. Future research will demonstrate how the use of testosterone will prevent heart attacks, fractured hips and collapsed vertebra. In the meantime, selling the benefits of testosterone replacement therapy to men isn't easy. Unlike women, men are more apt to see a doctor to be repaired, rather than to seek prevention. Consequently, too many men suffer prematurely from diseases that are largely preventable

Almost as many men as women suffer from osteoporosis according to startling new evidence from a Canadian study. Moreover, men with the degenerative bone condition often don't realize they have it, according to Dr. Wojciech Olszynski. He's director of the Saskatoon Osteoporosis Centre and taking part in the Canadian Multi Centre Osteoporosis Study (CaMos)

"We found the old concept of how many men are suffering osteoporosis is wrong. We are looking at numbers almost identical to women. We are surprised to see that 25 to 27 per cent of all men and women over age 50 have some deformities in the spine. We are talking every fourth person. There's no question that osteoporosis of the spine is coming in much higher numbers than we had expected."

"And for men, it's a significantly higher number than expected or estimated before. In American studies, they are already saying that the old concept of one in four women and one in eight men should be changed to one in four women, one in five men. We cannot find any other reason in men for fragility of the bone and susceptibility to fractures, so the only definitive diagnosis is osteoporosis," says Dr. Olszynski.

Men suffer fractures
Moreover, Dr. Olszynski says many of the spinal deformities he finds are fractures men don't even remember.
"They are working on the farm, for example, and they have a back pain. They consider this almost part of their life. They say-oh, I lifted something, I had back pain for two, three weeks, then everything was better, so I didn't bother going to the doctor," he says.

He and medical colleagues in centres across Canada are doing interviews, x-rays and ultra-sounds of almost 10 thousand Canadians for CaMos. The study began five years ago and has just been extended for another three years. The work is under the supervision of McGill University and Montreal General Hospital. Funding comes from the Medical Research Council of Canada and several drug companies.

Other centres for research include Halifax, Quebec City, Toronto, Saskatoon, Calgary, Edmonton and Vancouver. The multi-year study is providing an extensive database of information.

Hip fracture deaths
Dr. Olszynski says assessing a person's risk for getting osteoporosis and prevention are critical health issues. Often, the disease is not recognized until the person falls and fragile bones, often the hip, fracture.
A lot of people die within a year of hip fractures and the complications," he says. And according to the Osteoporosis Society of Canada, men are more likely to die after a hip fracture than women.

Effective drug treatment
In some controlled clinical trials of men with osteoporosis, treatment with a class of drugs called bisphosphonates increased bone density. Dr. Olszynski has had similar results.
"I've used all the biphosphonate medications for some time, and they work great. The main way they work is to slow down the bone turnover or re-absorption. We just don't know why they work. The mechanism seems to be different in men than in women," he says.
These drugs are also prescribed for women with osteoporosis. For women, estrogen replacement hormones are sometimes prescribed as a prevention against osteoporosis. It has been suggested that a parallel prevention for men might be treatment with the male hormone testosterone.

Male hormone risk
"Men have a gradual drop in hormone levels as they grow older. Women have this drastic drop in a few years with menopause and no estrogen available. Of course this concept makes hormone replacement therapy for men very attractive - only it doesn't work," says Dr. Olszynski.
According to the International Bone and Mineral Society, there are no studies demonstrating the testosterone replacement reduces the risk of bone fracture. Nor are there studies about the long-term safety of testosterone treatments.

"It is still under study. With testosterone, there is the potential of side effects with the prostate gland. We still debate that, and a lot of medical people say there is potential for problems," says Dr. Olszynski.
"There is now a lot of controversy about how good hormone replacement therapy (HRT) really is for women. And we don't know. It's a problem. There is the extreme view that HRT may not be good for anything.
This year, the Osteoporosis Society of Canada is finishing new guidelines for osteoporosis. So we will be delivering evidence based on more than 60 thousand medical papers..

Question :
My wife was diagnosed with fibromyalgia approximately 7 months ago. Since then we have had usual problems with finding a doctor with knowledge about her condition. We have finally found a psychologist & an internal medicine physician. I have brought home a lot of information from various sites off the internet regarding conditions & treatments for our own knowledge. However, I haven't been able to find much information on dietary needs or proper diet for patients with the condition.
Answer :
Fibromyalgia, which simply means sore/achey muscles and connective tissues, can have many different underlying causes or predisposing factors. As a result it is hard to give recommendations which are generically applicable to all fibromyalgia patients. Having said that I would suggest a diet low in sugar and processed foods. Stay away from hydrogenated oils specifically and high amounts of fat in general. On the "more of" side I encourage the use of organic foods and more vegetables and whole grains. Many fibromyalgia patients don't digest and absorb very well so the use of digestive enzymes with meals may be beneficial. Usually supplementation with calcium and magnesium and MSM (methyl sulfonyl methane) are also helpful. For more indivualized recommendations on foods to avoid it may be helpful to have food allergy testing done.
- Milton Hammerly, M.D., Medical Director of Complementary and
Alternative Medicine, Centura, Private Practice, Aurora,
CO 80011. -

Acupuncture in general and electroacupuncture in particular has an excellent track record in treatment of pain. One of the leading experts in use of acupuncture in pain relief is Dr. P. Baldry after asserting categorically that acupuncture is certainly the treatment of choice for dealing with Myofascial Pain Syndrome or trigger point problems.

Dr. Baldry states: "The pain in Fibromyalgia, which would seem to be due to some as yet unidentified noxious substance in the circulation giving rise to neural hyperactivity at tender points and trigger points takes a protracted course and it is only possible by means of acupuncture to suppress this neural hyperactivity for short periods."

As is clear there are other ways, however if acupuncture is used for Fibromyalgia Baldry believes that it is necessary to repeat treatment every 2 to 3 weeks for months or even years, which he regards as unsatisfactory, "but nevertheless some patients insist that it improves the quality of their lives."

Relief from pain for weeks on end and an enhanced quality of life would seem quite a desirable objective, perhaps helping ease the pain burden while more fundamental approaches are dealing with constitutional and causative issues.

A Swiss research team in Geneva has examined the effectiveness of electro-acupuncture in treating Fibromyalgia. Seventy patients(54 women) who all met the American College of Rheumatology criteria for Fibromyalgia received either sham acupuncture ("wrong" points used) or the real thing. Various methods were used for patients to record their level of symptom activity and the amount of medication they used before and after treatment. Sleep quality, morning stiffness and pain were all monitored.

Over a three week period the electroacupuncture treatment was administered with only the doctor giving the treatment knowing whether or not the needles were being placed correctly and whether the amount and type of electrical current being passed through the needles was correct. Seven out of the eight measurements showed that only the acupuncture group and not the placebo (dummy acupuncture) group had benefits (as in all such studies a few minor improvements are always noted in the dummy or placebo group, but these were only slight).

The acupuncture group, after treatment, required far more pressure on tender points to produce pain while use of pain killing medication was virtually halved as was these patient's assessment of regional pain levels. There was also a significant increase in quality of sleep. The length of time morning stiffness was experienced only improved a small amount.

Around 25% of the treated group did not improve significantly while all the others showed a remarkable amount of improvement with some having almost complete relief of all symptoms. The duration of the improvement was noted to be "several weeks" in most patients which seems to be in line with Dr. Baldry's observation of it being necessary to repeat treatment every few weeks.

The fact that there are virtually no side effects from electroacupuncture make it attractive when compared with pain killing and/or antidepressant medication.

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