Objective. To investigate the metabolic and functional status of muscles of fibromyalgia (FM) patients, using P-31 magnetic resonance spectroscopy (MRS). Methods. Twelve patients with FM and 11 healthy subjects were studied. Clinical status was assessed by questionnaire. Biochemical status of muscle was evaluated with P-31 MRS by determining concentrations of inorganic phosphate (Pi), phosphocreatine (PCr), ATP, and phosphodiesters during rest and exercise. Functional status was evaluated from the PCr/Pi ratio, phosphorylation potential (PP), and total oxidative ca-Results. Patients with FM reported greater difficulty in performing activities of daily living as well as increased pain, fatigue, and weakness compared with controls. MRS measurements showed that patients had significantly lower than normal PCr and ATP levels (P < 0.004) and PCr/Pi ratios (P < 0.04) in the quadriceps muscles during rest. Values for PP and V, , , also were significantly reduced during rest and exercise. Conclusion. P-31 MRS provides objective evidence for metabolic abnormalities consistent with weakness and fatigue in patients with FM. Noninvasive P-31 MRS may be useful in assessing clinical status and evaluating the effectiveness of treatment regimens in FM. pacity (VInaJ. Fibromyalgia (FM) is a syndrome of unknown cause and poorly understood pathophysiology, with an estimated prevalence as high as 10% in one population study (1). Although levels of serum muscle enzymes and electromyography findings are normal in FM patients, histologic studies indicate the presence of abnormalities in the morphology of muscle fibers (2 3). These abnormalities include the presence of ragged red fibers (4) and swelling of capillary endothelial cells (5-7). Abnormal distribution of oxygenation in the trapezius muscle of FM patients as measured with an oxygen-sensitive electrode has been reported (S), and this finding is consistent with other observations reported by Bennett et al, who found that the blood flow in the exercising muscles of FM patients was significantly lower than in age-and sex-matched controls (9). Decreased levels of the high-energy phosphate compounds ATP and phos-phocreatine (PCr) have been observed in muscle biopsy samples from patients with FM (4). The technique of P-31 magnetic resonance ypec-troscopy (MRS) has been shown to be useful in the evaluation of a number of muscle diseases, including glycogen phosphorylase deficiency (lo), mitochondria1 myopathies (11,12) and dermatomyositis (DM) (13,14), Recent P-31 MRS studies in FM investigated both resting and exercising muscles by evaluation of PCr/ inorganic phosphate (PCr/Pi) ratios (15-19), but no defect was found. However, it is critical to determine the absolute levels of Pi, PCr, and ATP, since ratios of these compounds can be normal while the actual concentrations of compounds are reduced (20). In the present study, we used P-31 MRS to quantitate levels of Pi, PCr, and ATP and their relevant ratios in the muscles of clinically characterized FM patients (21). The metabolic ab...

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This study examines extent of agreement between oncologists' and cancer patients' reports of current cancer status. Participants with history of cancer were given a comprehensive geriatric assessment in which they were asked whether they had cancer at the present time. This was compared to cancer status concurrently recorded by their physicians in the chart. 75.5% of patients whose physicians reported 'no evidence of disease' (NED) reported that they currently had cancer. 30% of them were anxious and 27% were depressed. Among patients for whom both the patient and physician reported no cancer, only 12.5% were anxious and 7% depressed. Compared to patients with concordant responses, those who discrepantly reported they had cancer had significantly more comorbid illnesses, medications, and pain, and lower levels of social, emotional, and physical functioning. Moreover, equal levels of distress and dysfunction were found between those who reported cancer but had NED and those who reported cancer and did have active disease by physician notation. Although conclusions about cause and effect are limited due to study design, findings suggest that some patients might suffer unnecessarily from lack of understanding about current disease status. These findings also suggest the need for improved physician-patient communication and symptom recognition/management.