Open Access Medical Books



Edited by William S. Wilke .

232 pages .
Open Access .
ISBN 978-953-307-407-8 .

I try, not always successfully, to read most of each week’s edition of The Economist. In the October 15th-21st science section a report Transporter of Delight, discusses new information about the genetic underpinning of happiness, and confirmed some of my biases about the biopsychosocial nature of fibromyalgia. The story reported that Jan-Emanuel De Neve and colleagues performed a rigorous case control study involving 1,939 adolescents (De Neve J-E et al, 2011). Genetic information was collected and correlated with a validated satisfaction questionnaire. They controlled for other important potentially causative factors including education, economic status, religiosity, and many others, and discovered a gene that regulates happiness, the same gene that is found in people with fibromyalgia. The magazine story is the genesis for this polemic.

A little background

Human DNA is composed of approximately 21,000 genes, distinct regions arranged in 23 pairs - one each from the mother and father. The two components of each separate gene have subtle differences of amino acid distribution, which affect their function.
These slightly different functional variants of the same gene are called alleles. The gene of interest is called 5-HTTLPR and modulates serotonin concentrations in the nervous system. This gene consists of a short and long allele, based on the number of amino acid residues in their structures - the long one produces more serotonin transporter proteins, which produce more serotonin than the shorter allele. The researchers found that individuals with long alleles and those with higher serotonin concentrations in the nervous system were statistically more likely to be very satisfied with their life, compared to individuals with short alleles (p=0.012).
Serotonin is a chemical, which is released by neurons and governs the magnitude of neural activity. Low serotonin concentrations in the central nervous system is causally linked to affective disorders (Thieme K et al, 2004; Abeles AM et al, 2007). This same alteration of the serotonergic system is a crucial factor underlying the severity and pathogenesis of FMS (Russell IJ et al 1992; Stahl SM et al, 2009).
Familial aggregation occurs in fibromyalgia. For example, among 533 first degree relatives of 78 fibromyalgia patients compared to 272 first degree relatives of 40 rheumatoid arthritis patients, the odds ratio for having fibromyalgia was 8.5 in fibromyalgia relatives versus the rheumatoid arthritis relatives (Arnold LM et al, 2004). Others have demonstrated an increased frequency of the short allele of the serotonin transporter gene 5-HTTLPR in fibromyalgia (Offenbacher M et al, 1999). In the general population, the short allele confers vulnerability to a spectrum of illnesses including anxiety disorder, depression, and bipolar disorder (Lucki I, 1998).
Furthermore, increased amygdala activation to environmental stresses such as facial expression, proven by functional magnetic resonance imaging (Hariri AR et al, 2006), and other methods (Munafo MR et al, 2008) has been linked to this same allele. The amygdala is responsible for negative interpretation of environmental stimuli; increased activation equals higher “fear factor”.....

Dr. William S. Wilke, M.D.
Department of Rheumatic and Immunologic Diseases,
A50 Cleveland Clinic, Orthopedic and Rheumatologic Institute,
Cleveland, Ohio,


Part 1 Pathogenesis of Fibromyalgia .

 1 Sleep and Fibromyalgia 3 Fumiharu Togo, Akifumi Kishi and Benjamin H. Natelson

 2 Central Sensitization and Descending Facilitation in Chronic Pain State 19 Emiko Senba, Keiichiro Okamoto and Hiroki Imbe

 3 Animal Models of Fibromyalgia 41 Yukinori Nagakura, Hiroyuki Ito and Yasuaki Shimizu

 4 Psychosocial Factors in Fibromyalgia: A Qualitative Study on Life Stories and Meanings of Living with Fibromyalgia 59 Paula J. Oliveira and Maria Emília Costa

 5 The Role of Oxidative Stress and Mitochondrial Dysfunction in the Pathogenesis of Fibromyalgia 77 Mario D. Cordero, Manuel de Miguel and José Antonio Sánchez Alcázar

Part 2 Definition and Diagnosis of Fibromyalgia .

 6 The Affective-Motivational Domain of the McGill Pain Questionnaire Discriminates Between Two Distinct Fibromyalgia Patient Subgroups – A Preliminary Study Based on Self-Organizing Maps 101 Monika Salgueiro and Jon Jatsu Azkue

 7 The Difficulties in Developing and Implementing Fibromyalgia Guidelines 117 M. Reed and M. Herrmann

 8 Alexithymia in Fibromyalgia Syndrome 139 Ercan Madenci and Ozlem Altindag

 9 Diagnosis of Fibromyalgia Syndrome: Potential Biomarkers and Proteomic Approach 149 Federica Ciregia, Camillo Giacomelli, Laura Giusti, Antonio Lucacchini and Laura Bazzichi

Part 3 Treatment of Fibromyalgia .

 10 Mind Body Therapies in the Rehabilitation Program of Fibromyalgia Syndrome 169 Susanna Maddali Bongi and Angela Del Rosso

 11 Influence of Cognitive and Affective Variables in Stress, Functional Limitation and Symptoms in Fibromyalgia 187 Lilian Velasco, Cecilia Peñacoba, Margarita Cigarán, Carmen Écija and Rafael Guerrero

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Published by: Unknown - Saturday, June 15, 2013


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