Document Detail

A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia.
MedLine Citation:
PMID:  18240245     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A subset of fibromyalgia (FM) patients have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 (IGF-1) axis, as evidenced by low serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that pyridostigmine (PYD) improves the acute response of GH to exercise in FM patients. The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms. METHODS: FM patients were randomized to 1 of the following 4 groups: PYD plus exercise, PYD plus diet recall but no exercise, placebo plus exercise, and placebo plus diet recall but no exercise. The primary outcome measures were the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. Secondary outcome measures were the total score on the Fibromyalgia Impact Questionnaire (FIQ) and FIQ VAS scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) and physical fitness (lower body strength/endurance, upper and lower body flexibility, balance, and time on the treadmill). RESULTS: A total of 165 FM patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated. CONCLUSION: Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms. However, PYD did improve anxiety and sleep, and exercise improved fatigue and fitness. We speculate that PYD may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study.
K D Jones; C S Burckhardt; A A Deodhar; N A Perrin; G C Hanson; R M Bennett
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  58     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-25     Completed Date:  2008-04-07     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  612-22     Citation Subset:  AIM; IM    
Oregon Health & Science University School of Nursing, Portland 97239, USA.
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MeSH Terms
Anxiety / therapy
Cholinesterase Inhibitors / administration & dosage*,  adverse effects
Combined Modality Therapy
Fatigue / rehabilitation
Fibromyalgia / drug therapy*,  psychology
Hypothalamo-Hypophyseal System / physiology
Insulin-Like Growth Factor I / metabolism
Middle Aged
Patient Compliance
Physical Fitness
Pyridostigmine Bromide / administration & dosage*,  adverse effects
Quality of Life
Treatment Outcome
Vagus Nerve / physiology
Grant Support
5R01-NR-8150-4/NR/NINR NIH HHS; M01-RR-000334/RR/NCRR NIH HHS; R01 NR008150-04/NR/NINR NIH HHS
Reg. No./Substance:
0/Cholinesterase Inhibitors; 101-26-8/Pyridostigmine Bromide; 67763-96-6/Insulin-Like Growth Factor I
Comment In:
Aust J Physiother. 2008;54(3):219   [PMID:  18833687 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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