Drug Screens Show High Degree of Noncompliance

Drug Screens Show High Degree of Noncompliance

By Kristina Fiore, Staff Writer, MedPage Today

Published: April 27, 2012


The majority of patients whose doctors order a urine screen to monitor prescription drug use — usually pain meds, central nervous system agents, and amphetamines — are not using them as prescribed, a report from one of the nation’s largest diagnostic laboratories showed.

An analysis of almost 76,000 urine screens from 2011 found that in 63% of cases results did not match up with what the doctor was looking for, researchers from Quest Diagnostics found.

In 60% of those mismatches, the screen picked up drugs other than those that had been ordered, or contained additional drugs, suggesting that many patients are using drugs in “potentially dangerous combinations.”

In the other 40%, no drug was detected at all. Such noncompliance could indicate financial constraints, the researchers noted, or drug diversion.

Inconsistent results were not confined to one drug class. They showed up in 50% of patients on central nervous system agents, 48% of those on amphetamines, and 44% of those on pain medications.

But the researchers found that the inconsistencies diminished slightly on follow-up screens. Among the 6,858 patients who had repeat testing about a month later, inconsistency rates fell to 55%, they reported.

Given the nation’s persistent prescription painkiller abuse problems, the researchers said their findings “support medical recommendations that physicians perform routine urine testing to monitor prescription drug misuse” — although Quest Diagnostics would clearly benefit from an uptick in urinalysis.

Indeed, one limit of the study is that the sample may be biased because physicians may have selected those for sampling whom they suspected had a high likelihood of misuse to begin with.

Still, some organizations have recommended regular urine screens for patients on chronic opioid therapy, including Group Health Cooperative in Washington state, which has been aggressive about curbing prescription opioid abuse.

The analysis was supported and performed by Quest Diagnostics.




Pain Relief With PAP Injections May Last 100 Times Longer Than a Traditional Acupuncture Treatment

Pain Relief With PAP Injections May Last 100 Times Longer Than a Traditional Acupuncture Treatment

n an article published in the April 23 online edition of Molecular Pain, UNC researchers describe how exploiting the molecular mechanism behind acupuncture resulted in six-day pain relief in animal models. They call this new therapeutic approach PAPupuncture.

Principal investigator Mark J. Zylka, PhD, associate professor in the Department of Cell and Molecular Physiology and the UNC Neuroscience Center, said this is a promising study that moves his lab’s work with prostatic acid phosphatase, known as PAP, towards translational research.

Several years ago, Zylka and members of his lab documented how injecting PAP into the spine eased chronic pain for up to three days in rodents. The only problem was PAP’s delivery.

“Spinal injections are invasive and must be performed in a clinical setting, and hence are typically reserved for patients with excruciating pain,” said Zylka. Though he had never received acupuncture or researched traditional Chinese medicine, Zylka said recent research showing how acupuncture relieved pain caught his eye.

“When an acupuncture needle is inserted into an acupuncture point and stimulated, nucleotides are released. These nucleotides are then converted into adenosine,” said Zylka. Adenosine has antinociceptive properties, meaning adenosine can decrease the body’s sensitivity to pain. The release of adenosine offers pain relief, but for most acupuncture patients that relief typically lasts for a few hours.

“We knew that PAP makes adenosine and lasts for days following spinal injection, so we wondered what would happen if we injected PAP into an acupuncture point?” Zylka said. “Can we mimic the pain relief that occurs with acupuncture, but have it last longer?”

To find out, Zylka and his lab injected PAP into the popliteal fossa, the soft tissue area behind the knee. This also happens to be the location of the Weizhong acupuncture point. Remarkably, they saw that pain relief lasted 100 times longer than a traditional acupuncture treatment. What’s more, by avoiding the spine the researchers could increase the dose of PAP. A single injection was also effective at reducing symptoms associated with inflammatory pain and neuropathic pain.

“Pinning down the mechanisms behind acupuncture, at least in animal models, was critical,” said Zylka. “Once you know what chemicals are involved, you can exploit the mechanism, as we did in our study.”

The next step for PAP will be refining the protein for use in human trials. UNC has licensed the use of PAP for pain treatment to Aerial BioPharma, a Morrisville, N.C.-based biopharmaceutical company.

Zylka said PAP could be applicable to any area where regional anesthesia is performed to treat pain. And PAP has the potential to last longer than a single injection of local anesthetic — the class of drugs used in regional anesthesia.

“When it comes to pain management, there is a clear need for new approaches that last for longer periods of time,” said Julie Hurt, PhD, a postdoctoral fellow in Zylka’s lab.

Zylka co-authored the paper with Hurt. The research was undertaken at UNC and was supported by the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health.

Story Source:

The above story is reprinted from materials provided byUniversity of North Carolina at Chapel Hill School of Medicine, via Newswise.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Julie K Hurt, Mark J Zylka. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic painMolecular Pain, 2012; 8 (1): 28 DOI: 10.1186/1744-8069-8-28
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Change in attitude may ease chronic pain by aiding sleep, study suggests

Change in Attitude May Ease Chronic Pain by Aiding Sleep, Study Suggests

ScienceDaily (Apr. 26, 2012) — Chronic pain sufferers who learn to dwell less on their ailments may sleep better and experience less day-to-day pain, according to results of research conducted on 214 people with chronic face and jaw pain.

We have found that people who ruminate about their pain and have more negative thoughts about their pain don’t sleep as well, and the result is they feel more pain,” says Luis F. Buenaver, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of a study published online in the journal Pain. “If cognitive behavioral therapy can help people change the way they think about their pain, they might end that vicious cycle and feel better without sleeping pills or pain medicine.”

Buenaver and his colleagues say the study highlights the function of a major neurological pathway linking negative thinking about pain to increased pain through disturbed sleep. Buenaver says roughly 80 percent of people with chronic pain experience sleep disturbances, and previous studies have shown that people whose sleep patterns are altered are more sensitive to pain. It is also known, he says, that those who focus frequently on their pain and think more negatively about their pain report more debilitating pain. Such “pain catastrophizing,” he adds, has been found to be a more robust predictor of worse pain and pain-related disability than depression, anxiety or neuroticism.

For the study, researchers recruited 214 people with myofascial temporomandibular disorder, or TMD, serious facial and jaw pain believed to be stress-related in many cases. The participants were mostly white and female, with an average age of 34 years. Each participant underwent a dental exam to confirm TMD, then filled out questionnaires assessing sleep quality, depression, pain levels and emotional responses to pain, including whether they ruminate or exaggerate it.

Researchers found a direct correlation between negative thinking about pain and poor sleep, as well as with worse pain in the TMD patients.

Buenaver says sleeping pills and painkillers can help, but these pain patients may benefit just as much, if not more, from cognitive behavioral therapy. He says the same may be true of people who suffer from other stress-related ailments without a clear underlying pathology, including fibromyalgia, irritable bowel syndrome and some headaches, neck and back pain.

“It may sound simple, but you can change the way you feel by changing the way you think,” Buenaver said.

He and his colleagues currently are studying whether older adults with arthritis and insomnia can benefit from cognitive behavioral therapy for insomnia.

The research is supported by grants from the National Institutes of Health.

Other Hopkins researchers contributing to the study include Mpepera Simango; Jennifer A. Haythornthwaite, Ph.D.; and Michael T. Smith, Ph.D.


Story Source:

The above story is reprinted from materials provided byJohns Hopkins Medicine, via Newswise.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Luis F. Buenaver, Phillip J. Quartana, Edward G. Grace, Eleni Sarlani, Mpepera Simango, Robert R. Edwards, Jennifer A. Haythornthwaite, Michael T. Smith. Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: The mediating role of sleep disturbance.Pain, 2012; DOI: 10.1016/j.pain.2012.01.023
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Dating doesn’t have to be a disaster

Dating doesn’t have to be a disaster

By Tammy Worth

Dating can be difficult under the best circumstances. For the approximately 1 million people in the United States dealing with Crohn’s disease or ulcerative colitis, it can seem extra daunting.

Inflammatory bowel disease (IBD) can be painful, unpleasant, and inconvenient at times (having to know the location of every bathroom is tedious at best). But it doesn’t mean you should forgo dating altogether.

Following are 10 tips to help navigate the choppy waters of dating and aid in integrating a partner into your life.

Bring your A-game

If your symptoms are erratic because you are having a flare-up, dating might be the last thing on your mind.

It’s OK to wait until you feel you can put energy into the experience.

“When you go on a date, you want to bring your A-game, feel confident, and be able to engage with the person,” says Liz Bryan, a 29-year-old with Crohn’s living in Washington, D.C. “When you are having a flare, you are not focused on the other person. It may be worth getting it under control before putting yourself out there.”

Plan the timing and location

Keep it short and sweet when you first start dating. It’s a good idea to choose something not terribly active and where bathrooms are available—a movie instead of apple picking, for instance.

Bryan selects restaurants carefully. “No steakhouses or Asian foods,” she says. “I also found I couldn’t go out for drinks anymore; alcohol was the Bad News Bears for me.”

She leaves time between work and a date so she can go home and “take care of my business.” That way she’s comfortable when she goes out and can stay out a bit longer.

Be prepared

Frank Sileo, a psychologist in Ridgewood, N.J., who has Crohn’s disease, says preparation helps avoid problems. He recommends taking a “Crohn’s kit” with toilet paper, seat covers, spray or wipes, and a change of clothes.

If you are going somewhere new, call ahead and make sure there are restrooms. (A website and app called Sit or Squat may help you find a toilet in your area.)

And finally, carrying a medical card saying you need to use a bathroom immediately may help you gain access in shops and restaurants. You can get these from the Foundation for Clinical Research in Inflammatory Bowel Disease.

When to disclose?

There is no rule about the best time to tell someone you have IBD. “Crohn’s is difficult to talk about,” Sileo says. “It’s not like saying, ‘I’m asthmatic and need an inhaler.’ It’s not dinner conversation.”

Some people tell early, before they get too involved. Others wait a bit longer, until they are more comfortable with the person.

Sileo recommends skipping the graphic details, at least early on. Just tell them you have a gastrointestinal disease that causes stomach pain and distress. And having a sense of humor about it helps, he says.

Don’t take it personally

“If someone judges you and stops dating you because of it, that’s not someone you want to be with,” Bryan says. Telling people about it can ease tension and allow a partner to ask questions about the condition.

“If anything, getting it out there helps,” she says. “The more open I am with it and the way it makes me feel, the more understanding people around me are. I may feel horrible sometimes, but I still want to have an active life.”

Educate your partner

Many people have never heard of IBD and will need some basic facts.

Sileo recommends telling them it’s not fatal or contagious, but it limits you in certain respects. With probiotic products such as Activia and Align, people understand and are relatively comfortable with the idea of stomach distress, he says.

“When a person is listening to you tell them about it and they hear you have a sense of comfort with it, saying, ‘This is what it is, how I manage it, and how I live my life,’ it sends a message to the them about how to react and they will follow your cues.”

Be patient

Don’t expect people to be understanding or supportive right away, says Andrew Tubesing, an author and support-group leader from St. Paul, Minn., who has a type of inflammatory bowel disease called indeterminate colitis.

When Tubesing was diagnosed, he and his wife were shocked and spent a lot of time adjusting and educating themselves about IBD. “When you do decide to tell a partner, they are going to go through that same process.”

People need time to adjust. “Give them space and time to go work through the process,” he says

Know your body

Bryan knows her body; she knows what foods to avoid and what can happen if she doesn’t abstain.

And she avoids eating before a date because she doesn’t want to take chances. If she has been dating someone for a short period of time—even someone she really likes—she won’t stay overnight.

“Mornings are not good at all for me and it can be so embarrassing to get caught in that situation,” she says. “You have to know what situations you are willing to put yourself in and what is unacceptable.”

Refrain from intimacy

People with IBD may need to take a step back from intimacy once in a while. “There’s an incontrovertible truth that it is difficult to feel sexy when you have diarrhea,” Tubesing says.

And certain medications, such as prednisone, don’t help. The drug can cause weight to balloon or lower testosterone—which can be a mood killer.

Tubesing suggests finding other ways to show someone you care if you have a flare-up. “The key is to figure out what that is and do what you can to keep that flame going—even if it may just be a pilot light,” he says.

Know when to let go

Everyone hates rejection and ending relationships. But particularly when you have a condition like IBD, you need to make sure you’re dating the right person.

“Make sure they have empathy because they may have to be a caretaker for you, understanding of you when you are late to events because you are on the toilet, or have to cancel because you feel sick,” Sileo says.

“They have to be OK with it and supportive in the waves that come with it,” Bryan says. “You have to find someone who can take the journey with you


Changing a few simple aspects

Changing a few simple aspects of your lifestyle can put you in better control of your pain. Here are nine things that make chronic pain worse.

1. Smoking

Smoking decreases the amount of oxygen that reaches your muscles — oxygen that is required for efficient muscle use. Ever tried to go all day without eating? Well, that’s what your muscles can feel like when you smoke. Smoking can also cause fatigue and lung disorders, and it can make it harder for the body to heal itself. It is best for your body if you quit smoking, especially if you have chronic pain.

2. Being a Couch Potato

A sedentary lifestyle can lead to muscle disuse syndrome. In other words, use it or lose it. Over time, muscles that are barely used lose their strength and endurance. Weak muscles are much less efficient, meaning it takes more work to do simple tasks, like taking a shower. You can avoid disuse syndrome by learning safe, effective exercises for your condition.

3. Stressing Out

Stress increases your heart rate, which makes you breathe faster and tightens your muscles. In addition to this, stress can cause agitation and anxiety, which is known to intensify feelings of pain. Practice techniques that help calm you down, such as deep breathing and relaxation. If you can reduce your stress, you can reduce some of your excessive pain.

4. Focusing on Your Pain

Your brain can only focus on so much at one time. Have you ever gotten forgotten you had a headache because you were busy? Turning your attention elsewhere decreases the amount of energy your brain can spend on your pain. Allow something else to take center stage and you can decrease your pain experience. On the other hand, giving pain your full attention means that everything else gets blocked out. Think of what you could be missing!

5. Being Non-compliant With Pain Meds

Your doctor prescribes pain meds for a reason: to decrease your pain experience. Despite this, you may be scared of addiction, or even failing a drug test. You may not like your medication side effects. Maybe you just want to detoxify your system. These concerns are perfectly normal, but consider this: quitting your pain medication cold turkey can lead to worse problems, especially if you are taking opioids or anti-convulsants. If you are interested in pursuing alternative treatment strategies, involve your doctor first.

6. Avoiding Your Doctor

Your doctor should just assume you still have pain, and everything is status quo, right? Wrong. Every day, advances in research increase our knowledge about disorders and medications. Your doctor is your number one resource. Not only can he assess how you are progressing, but he knows if something is newly available that may be better for your condition. You don’t have to see your doctor every week, but make sure to schedule routine visits to discuss your case. You may just learn something new.

7. Eating Junk Food

Refined sugar and saturated fats taste great, but they don’t give your body the fuel it needs to operate efficiently. Remember, efficient muscles use less energy, saving you effort with every move. We may hate to admit it, but most of us feel better when we eat our vegetables and drink more water. Maybe it’s time to put down that doughnut and coffee and start the day out right with some wholegrain cereal or protein-rich yogurt. Not sure where to start? Talk to your doctor, or consult a dietician. You can also find some great nutrition information right here at About.com.

8. Drinking Alcohol

Not only does alcohol decrease the rate of transmission of some kinds of nerve impulses in the brain, but it can also interact harmfully with medications. Believe it or not, these include over-the-counter painkillers. Moderate to heavy drinkers also have a greater risk of heart and lung disease. If you have chronic pain, it’s best to leave the bottle alone.



9. Overdoing It

Overdoing things on days when you feel good can have disastrous consequences. While it may be tempting to tackle your entire to-do list on a day when you have virtually no pain, you can set yourself back for several days as you recover. It is better to keep a steady level of activity from day to day — one that you know your body can handle.



Chronic Pain and Depression

Chronic Pain and Depression: Managing Pain When You’re Depressed

Living with chronic pain should be enough of a burden for anybody. But pile on depression — one of the most common problems faced by people with chronic pain — and that burden gets even heavier.

Depression can magnify pain, and make it harder to cope. The good news is that chronic pain and depression aren’t inseparable. Effective treatments can relieve depression and make chronic pain more tolerable.

Chronic Pain and Depression: A Terrible Twosome

If you have chronic pain and depression, you’ve got plenty of company. That’s because chronic pain and depression are common problems that often overlap. Depression is one of the most common psychological issues facing people who suffer from chronic pain, and it often complicates the patient’s conditions and treatment. Consider these statistics:

  • According to the American Pain Foundation, about 32 million people in the U.S. report pain lasting longer than one year.
  • From one-quarter to more than half of patients who complain of pain to their physicians are depressed.
  • On average, 65% of depressed people also complain of pain.
  • People whose pain limits their independence are especially likely to get depressed.

Because depression in patients with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctors’ visits. The result is depression, along with sleep disturbances, loss of appetite, lack of energy, and decreased physical activity which may make pain much worse.

“Chronic pain and depression go hand in hand,” says Steven Feinberg, MD, adjunct associate clinical professor at Stanford University School of Medicine. “You almost have to assume a person with chronic pain is depressed and begin there.”

Chronic Pain and Depression: A Vicious Cycle

Pain provokes an emotional response in everyone. Anxiety, irritability, and agitation — all these are normal feelings when we’re hurting. Normally, as pain subsides, so does the stressful response.

But what if the pain doesn’t go away? Over time, the constantly activated stress response can cause multiple problems associated with depression. Those problems can include:

  • chronic anxiety
  • confused thinking
  • fatigue
  • irritability
  • sleep disturbances
  • weight gain or loss

Some of the overlap between depression and chronic pain can be explained by biology. Depression and chronic pain share some of the same neurotransmitters — the chemical messengers traveling between nerves. They also share some of the same nerve pathways.

The impact of chronic pain on a person’s life overall also contributes to depression.

“The real pain comes from the losses” caused by chronic pain, according to Feinberg. “Losing a job, losing respect as a functional person, loss of sexual relations, all these make people depressed.”

Once depression sets in, it magnifies the pain that is already there. “Depression adds a double whammy to chronic pain by reducing the ability to cope,” says Beverly E. Thorn, professor of psychology at the University of Alabama and author of the book Cognitive Therapy for Chronic Pain.

Research has compared people with chronic pain and depression to those who only suffer chronic pain. Those with chronic pain and depression:

  • report more intense pain
  • feel less control of their lives
  • use more unhealthy coping strategies

Because chronic pain and depression are so intertwined, depression and chronic pain are often treated together. In fact, some treatments can improve both chronic pain and depression.


Treating Chronic Pain and Depression: A “Whole-Life” Approach

Chronic pain and depression can affect a person’s entire life. Consequently, an ideal treatment approach addresses all the areas of one’s life affected by chronic pain and depression.

Because of the connection between chronic pain and depression, it makes sense that their treatments overlap.


The fact that chronic pain and depression involve the same nerves and neurotransmitters means that antidepressants can be used to improve both chronic pain and depression.

“People hate to hear, ‘it’s all in your head.’ But the reality is, the experience of pain is in your head,” says Feinberg. “Antidepressants work on the brain to reduce the perception of pain.”

Tricyclic antidepressants have abundant evidence of effectiveness. However, because of side effects their use is often limited. Some newer antidepressants are prescribed by doctors to treat certain painful chronic syndromes and seem to work well with fewer side effects.

Physical Activity

Many people with chronic pain avoid exercise. “They can’t differentiate chronic pain from the ‘good hurt’ of exercise,” says Feinberg. But, the less you do, the more out of shape you become. That means you have a higher risk of injury and worsened pain.

The key is to break this cycle. “We now know that gentle, regular physical activity is a crucial part of managing chronic pain,” says Thorn. Everyone with chronic pain can and should do some kind of exercise. Consult with a physician to design an exercise plan that’s safe and effective for you.

Exercise is also proven to help depression. “Physical activity releases the same kind of brain chemicals that antidepressant medications release — [it’s] a natural antidepressant,” says Thorn.

Mental and Spiritual Health

Chronic pain affects your ability to live, work, and play the way you’re used to. This can change how you see yourself — sometimes for the worse.

“When somebody begins to take on the identity of a ‘disabled chronic pain patient,’ there is a real concern that they have sunk into the pain and become a victim,” says Thorn.

Fighting this process is a critical aspect of treatment. “People with chronic pain end up sitting around,” which leads to feeling passive, says Feinberg. “The best thing is for people to get busy, take control.”

Working with a health care provider who refuses to see you as a helpless victim is part of the formula for success. The goal is to replace the victim identity with one of a “well person with pain,” according to Thorn.

Treating Chronic Pain and Depression: Cognitive Therapy for Chronic Pain

Is there such a thing as “mind over matter”? Can you “think” your way out of feeling pain?

It may be hard to believe, but research clearly shows that for ordinary people, certain kinds of mental training truly improve chronic pain.


One approach is cognitive therapy. In cognitive therapy, a person learns to notice the negative “automatic thoughts” that surround the experience of chronic pain. These thoughts are often distortions of reality. Cognitive therapy can teach a person how to change these thought patterns and improve the experience of pain.

“The whole idea is that your thoughts and emotions have a profound impact on how you cope” with chronic pain, says Thorn. “There’s very good evidence that cognitive therapy can reduce the overall experience of pain.”

Cognitive therapy is also a proven treatment for depression. According to Thorn, cognitive therapy “reduces symptoms of depression and anxiety” in chronic pain patients.

In one study Thorn conducted, at the end of a 10-week cognitive therapy program, “95% of patients felt their lives were improved, and 50% said they had less pain.” She also says, “Many participants also reduced their need for medications.”

Treating Chronic Pain and Depression: How to Get Started

The best way to approach managing chronic pain is to team up with a physician to create a treatment plan. When chronic pain and depression are combined, the need to work with a physician is even greater. Here’s how to get started.

  • See your primary care physician and tell her you’re interested in gaining control over your chronic pain. As you develop a plan, keep in mind that the ideal pain management plan will be multidisciplinary. That means it will address all the areas of your life affected by pain. If your physician is not trained in pain management herself, ask her to refer you to a pain specialist.
  • Empower yourself by tapping into available resources. Several reputable national organizations are devoted to helping people live full lives despite pain. See the list below for their web sites.
  • Find a cognitive therapist near you with experience in the treatment of chronic pain. You can locate one by contacting the national pain organizations or cognitive therapists’ professional groups listed below.

Living With Chronic Pain and Depression: Resources You Can Use

American Pain Foundation

Arthritis Foundation

American Chronic Pain Association

Academy of Cognitive Therapy

Association for Behavioral and Cognitive Therapies

Beck Institute for Cognitive Therapy and Research



Chronic Pain And Fibromyalgia Websites

Chronic Pain And Fibromyalgia Websites:

posted Jul 18, 2011 by stacyh502@gmail

Chronic Pain And Fibromyalgia Websites:
American Chronic Pain Association (ACPA)

http://www.theacpa.org/ –– This site’s missions is to facilitate peer support and education for individuals with chronic pain and their families so that these individuals may live more fully in spite of their pain and to raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Access checked November 14, 2005.

Arthritis Foundation

http://www.arthritis.org/ –– A consumer-oriented site, the Arthritis Foundation is the only national not-for-profit organization that supports the more than 100 types of arthritis and related conditions with advocacy, programs, services and research. Access checked November 8, 2005.

Chronic Pain Network– (CPN)

http://www.chronicpainnetwork.com/ –– Chronic Pain Network– (CPN) is a company-produced (Ligand Pharmaceuticals) national initiative of value-added programs and services providing resources for practitioners and patients to support appropriate patient pain assessment, treatment, and balanced risk management of chronic pain. Access checked November 20, 2006.

Chronic Pain Rehabilitation Program (CPRP)

http://www.vachronicpain.org/ –– Part of the James A. Haley Veterans Hospital in Tampa, Florida, the CPRP provides extensive pain management resources at their website of interest to healthcare practitioners. Access checked January 18, 2006.

Fibromyalgia Information Foundation (FIF)

http://www.myalgia.com/ –– A website offering research and treatment information from an Oregon-based foundation whose directors are Oregon Health and Science University researchers engaged in the day to day management of fibromyalgia patients. Access checked February 27, 2007.

Fibromyalgia Network

http://www.fmnetnews.com/ ––Educational materials, including an extensive quarterly newsletter containing research studies, interviews and information to provide ideas for coping and new therapies to try. Access checked November 14, 2005.

National Chronic Pain Society (NCPS)

http://www.ncps-cpr.org/ –– NCPS provides peer support groups for people with chronic pain and their families. The Society also offers current, accurate information from qualified professionals through its Chronic Pain Report (CPR), a quarterly newsletter, and multidisciplinary conferences. Access checked March 28, 2006.

National Fibromyalgia Association (NFA)

http://www.fmaware.org/ ––A nonprofit organization dedicated to informing communities about fibromyalgia through programs, a magazine and newsletter, and other awareness items. Access checked November 14, 2005.

National Fibromyalgia Partnership (NFP)

http://www.fmpartnership.org/ –– An educational organization that makes medically accurate, quality resource information concerning etiology, pathophysiology and management of fibromyalgia available to healthcare professionals and the community at-large. Access checked February 28, 2007.

National Fibromyalgia Research Association (NFRA)

http://www.nfra.net/ –– The website of an activist organization located in Salem, Oregon dedicated to education, treatment and finding a cure for fibromyalgia. Access checked February 28, 2007.