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Araújo-Filho HG, Pereira EWM, Rezende MM, Menezes PP, Araújo AAS, Barreto RSS, Martins AOBPB, Albuquerque TR, Silva BAF, Alcantara IS, Coutinho HDM, Menezes IRA, Quintans-Júnior LJ, Quintans JSS. D-limonene exhibits superior antihyperalgesic effects in a β-cyclodextrin-complexed form in chronic musculoskeletal pain reducing Fos protein expression on spinal cord in mice. Neuroscience 2017; 358:158-169. [PMID: 28673718 DOI: 10.1016/j.neuroscience.2017.06.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/12/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Chronic musculoskeletal pain is one of the main symptoms found in Fibromyalgia with unclear etiology and limited pharmacological treatment. The aim of this study was to complex LIM in β-cyclodextrin (LIM-βCD) and then evaluate its antihyperalgesic effect in an animal model of chronic musculoskeletal pain. Differential scanning calorimetry and scanning electron microscopy was used for the characterization of the inclusion complex. Male Swiss mice were used for experimental procedures where mechanical hyperalgesia, thermal hyperalgesia, muscular strength, Fos immunofluorescence was studied after induction of hyperalgesia. Mechanism of action was also investigated through tail flick test and capsaicin-induced nociception. Endothermic events and morphological changes showed that the slurry complex method was the best method for the complexation. After induction of hyperalgesia, the oral administration of LIM-βCD (50mg/kg) significantly increased the paw withdrawal threshold compared to uncomplexed limonene. Fos immunofluorescence showed that both compounds significantly decreased the number of Fos-positive cells in the dorsal horn. In nociceptive tests, FLU was able to reverse the antinociceptive effect of LIM-βCD. After intraplantar administration of capsaicin, LIM was able to significantly decrease time to lick. LIM-βCD has antihyperalgesic action superior to its uncomplexed form, with possible action in the dorsal horn of the spinal cord. These results suggest the possible applicability of LIM, uncomplexed or complexed with βCD, in conditions such as FM and neuropathic pain, for which there are currently only limited pharmacological options.
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Affiliation(s)
- Heitor G Araújo-Filho
- Laboratory of Neuroscience and Pharmacological Assays (LANEF). Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Erik W M Pereira
- Laboratory of Neuroscience and Pharmacological Assays (LANEF). Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Marília M Rezende
- Laboratory of Neuroscience and Pharmacological Assays (LANEF). Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Paula P Menezes
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Adriano A S Araújo
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Rosana S S Barreto
- Department of Health Education, Federal University of Sergipe, Largato, SE, Brazil
| | | | - Thaís R Albuquerque
- Department of Biological Chemistry, Regional University of Crato, Crato, CE, Brazil
| | - Bruno A F Silva
- Department of Biological Chemistry, Regional University of Crato, Crato, CE, Brazil
| | - Isabel S Alcantara
- Department of Biological Chemistry, Regional University of Crato, Crato, CE, Brazil
| | | | - Irwin R A Menezes
- Department of Biological Chemistry, Regional University of Crato, Crato, CE, Brazil
| | - Lucindo J Quintans-Júnior
- Laboratory of Neuroscience and Pharmacological Assays (LANEF). Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Jullyana S S Quintans
- Laboratory of Neuroscience and Pharmacological Assays (LANEF). Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil.
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Stensson N, Ghafouri B, Gerdle B, Ghafouri N. Alterations of anti-inflammatory lipids in plasma from women with chronic widespread pain - a case control study. Lipids Health Dis 2017; 16:112. [PMID: 28606089 PMCID: PMC5469054 DOI: 10.1186/s12944-017-0505-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Chronic widespread pain conditions (CWP) such as the pain associated with fibromyalgia syndrome (FMS) are significant health problems with unclear aetiology. Although CWP and FMS can alter both central and peripheral pain mechanisms, there are no validated markers for such alterations. Pro- and anti-inflammatory components of the immune system such as cytokines and endogenous lipid mediators could serve as systemic markers of alterations in chronic pain. Lipid mediators associated with anti-inflammatory qualities – e.g., oleoylethanolamide (OEA), palmitoylethanolamide (PEA), and stearoylethanolamide (SEA) – belong to N-acylethanolamines (NAEs). Previous studies have concluded that these lipid mediators may modulate pain and inflammation via the activation of peroxisome proliferator activating receptors (PPARs) and the activation of PPARs may regulate gene transcriptional factors that control the expression of distinct cytokines. Methods This study investigates NAEs and cytokines in 17 women with CWP and 21 healthy controls. Plasma levels of the anti-inflammatory lipids OEA, PEA, and SEA, the pro-inflammatory cytokines TNF-α, IL-1β, IL-6, and IL-8, and the anti-inflammatory cytokine IL-10 were investigated. T-test of independent samples was used for group comparisons. Bivariate correlation analyses, and multivariate regression analysis were performed between lipids, cytokines, and pain intensity of the participants. Results Significantly higher levels of OEA and PEA in plasma were found in CWP. No alterations in the levels of cytokines existed and no correlations between levels of lipids and cytokines were found. Conclusions We conclude that altered levels of OEA and PEA might indicate the presence of systemic inflammation in CWP. In addition, we believe our findings contribute to the understanding of the biochemical mechanisms involved in chronic musculoskeletal pain.
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Affiliation(s)
- Niclas Stensson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Kia S, Choy E. Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology. Biomedicines 2017; 5:E20. [PMID: 28536363 PMCID: PMC5489806 DOI: 10.3390/biomedicines5020020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic condition with unknown aetiology. The pathophysiology of the disease is incompletely understood; despite advances in our knowledge with regards to abnormal central and peripheral pain processing, and hypothalamo-pituitary-adrenal dysfunction, there is no clear specific pathophysiological therapeutic target. The management of this complex condition has thus perplexed the medical community for many years, and several national and international guidelines have aimed to address this complexity. The most recent guidelines from European League Against Rheumatism (EULAR) (2016), Canadian Pain Society (2012), and The Association of the Scientific Medical Societies in Germany (AWMF) (2012) highlight the change in attitudes regarding the overall approach to FMS, but offer varying advice with regards to the use of pharmacological agents. Amitriptyline, Pregabalin and Duloxetine are used most commonly in FMS and though modestly effective, are useful adjunctive treatment to non-pharmaceutical measures.
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Affiliation(s)
- Sanam Kia
- Abertawe Bro Morgannwg University Health Board NHS Trust, Neath Port Talbot Hospital, Port Talbot, Wales SA12 7BX, UK.
| | - Ernet Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Tenovus Building, Heath Park, Cardiff CF14 4XN, UK.
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Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain. Healthcare (Basel) 2017; 5:healthcare5020022. [PMID: 28445438 PMCID: PMC5492025 DOI: 10.3390/healthcare5020022] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 12/26/2022] Open
Abstract
Limited evidence exists on how non-cancer pain (NCP) affects an individual's health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach's alpha and Mosier's alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p < 0.05). The PCS12 was strongly correlated with perceived health (r = 0.52) but weakly correlated with perceived mental health (r = 0.25). The MCS12 was moderately correlated with perceived mental health (r = 0.42) and perceived health (r = 0.33). Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89-0.90, MCS12: OR = 0.94 95%CI: 0.93-0.94). In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.
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Wåhlén K, Olausson P, Carlsson A, Ghafouri N, Gerdle B, Ghafouri B. Systemic alterations in plasma proteins from women with chronic widespread pain compared to healthy controls: a proteomic study. J Pain Res 2017; 10:797-809. [PMID: 28435317 PMCID: PMC5388344 DOI: 10.2147/jpr.s128597] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic widespread pain (CWP) is a complex pain condition that is difficult to treat. The prevalence of CWP approximates ~10% of the general population, with higher prevalence in women. Lack of understanding of molecular mechanisms has been a challenge for diagnosis and treatment of chronic pain. The aim of this study was to explore the systemic protein changes in CWP compared to those in healthy controls (CON). By applying 2-dimensional gel electrophoresis, we analyzed the protein pattern of plasma samples from women with CWP (n=16) and healthy women (n=23). The proteomic data were analyzed using multivariate statistical models, and altered proteins were identified using mass spectrometry. The proteome analysis was further validated by gel-free Western blot. Multivariate statistical data analysis of quantified proteins revealed 22 altered proteins in women with CWP, compared to CON group. Many of the identified proteins are previously known to be involved in different parts of the complement system and metabolic and inflammatory processes, e.g., complement factor B, vitamin D-binding protein, ceruloplasmin, transthyretin and alpha-2-HS-glycoprotein. These results indicate that important systemic protein differences exist between women with CWP and healthy women. Further, this study illustrates the potential use of proteomics to detect biomarkers that may provide new insights into the molecular mechanism(s) of chronic pain. However, further larger investigations are required in order to confirm these findings before it will be possible to identify proteins as potential pain biomarkers for clinical use.
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Affiliation(s)
- Karin Wåhlén
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Olausson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Carlsson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Gilron I, Tu D, Holden R, Towheed T, Ziegler D, Wang L, Milev R, Gray C. Innovations in the Management of Musculoskeletal Pain With Alpha-Lipoic Acid (IMPALA Trial): Study protocol for a Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Alpha-Lipoic Acid for the Treatment of Fibromyalgia Pain. JMIR Res Protoc 2017; 6:e41. [PMID: 28351829 PMCID: PMC5388826 DOI: 10.2196/resprot.7198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Fibromyalgia is a common disorder characterized by chronic widespread pain, sleep disturbance, fatigue, depression, and cognitive dysfunction, resulting in substantial disability. As current analgesics provide incomplete relief and disabling side effects that aggravate fatigue and cognitive dysfunction, there is a need for new pain treatments with better efficacy and tolerability. Alpha-lipoic acid (ALA) is an antioxidant proven effective in painful diabetic neuropathy with minimal side effects. OBJECTIVE We hypothesize that this agent will provide benefits in fibromyalgia because of several similarities with neuropathic pain and also because it does not cause sedation, fatigue, or mental-slowing. To test this, we have designed a clinical trial that will assess pain, side effects, and other outcomes in participants with fibromyalgia. METHODS Using a crossover design, 24 adults with fibromyalgia will be randomly allocated to 1 of the 2 sequences of ALA and placebo. Participants will take capsules containing ALA or placebo for 4 weeks followed by a 1-week washout followed by a second 4-week treatment and 1-week washout period. ALA (or matching placebo) capsules will be titrated to 1800 mg/day over each 4-week period. The primary outcome will be mean daily pain intensity (0-10) during week 4 of each period. Secondary outcomes, assessed during week 4 of each period, will include global improvement, adverse events, mood, and quality of life. RESULTS This trial was registered in the International Standard Randomized Controlled Trial registry March 15, 2016 (Number ISRCTN58259979), and it attained ethics approval on December 3, 2016 (Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board protocol number ANAE-287-15). The recruitment started in February 2017. CONCLUSIONS This trial will provide evidence for the efficacy of ALA in fibromyalgia. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 58259979; www.isrctn.com/ISRCTN58259979 (Archived by WebCite at http://www.webcitation.org/6og9JdiyZ).
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Affiliation(s)
- Ian Gilron
- Queen's University, Kingston, ON, Canada
| | | | | | | | - Dan Ziegler
- Heinrich Heine University, Dusseldorf, Germany
| | - Louie Wang
- Queen's University, Kingston, ON, Canada
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Palstam A, Mannerkorpi K. Work Ability in Fibromyalgia: An Update in the 21st Century. Curr Rheumatol Rev 2017; 13:180-187. [PMID: 28464770 PMCID: PMC5759171 DOI: 10.2174/1573397113666170502152955] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. People with FM also report activity limitations and impaired work ability. OBJECTIVE This article aims to compile the findings of recently published research on work ability in people with fibromyalgia, and to present how work ability is influenced by various aspects. METHODS A systematic search of the literature published from the year 2000 and onwards was conducted. Thirtyfour articles were included in the review. RESULT Symptom severity was found to influence work ability in people with FM. Physically demanding jobs and work tasks were especially troublesome and were reported to constitute higher risks pof work disability. Working people with FM seemed to hold a careful balancing act to manage the risk of overload where well-functioning strategies such as making a career change, working part-time, and developing personal skills were necessary for managing work, in the short- and long term. The support of management and colleagues enabled people with FM to manage the risk of overload at work. Treatment studies evaluating work disability as outcome in FM are scarce. None of the included studies presented any effects on measures of sick-leave or work disability compared with a control group. CONCLUSION More studies of treatment effects on outcomes related to work ability in people with FM, and more longitudinal studies to explore long-term effects of symptoms on work ability and sick leave, are needed in order to be able to plan evidence based rehabilitation to improve or maintain work ability in people with FM.
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Affiliation(s)
- Annie Palstam
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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LEUNG YINGYING, THUMBOO JULIAN. Fibromyalgia as a Contextual Factor Influencing Disease Activity Measurements in Spondyloarthritis and Psoriatic Arthritis. J Rheumatol 2016; 43:1953-1955. [DOI: 10.3899/jrheum.161156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Sickness Presenteeism Among Health Care Workers and the Effect of BMI, Cardiorespiratory Fitness, and Muscle Strength. J Occup Environ Med 2016; 57:e146-52. [PMID: 26641838 DOI: 10.1097/jom.0000000000000576] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The primary objective of this study was to assess the relationship between sickness presenteeism and body mass index (BMI), cardiorespiratory fitness (CRF), and maximal voluntary contraction (MVC). METHODS Female health care workers (n = 139) were analyzed cross-sectional as well as longitudinal after 3 and 12-month follow-up. Sickness presenteeism was assessed as a summed score using validated questions from three questionnaires: Health and Work Performance Questionnaire, Work Ability Index, and Quantity and Quality Method. CRF was assessed by a maximal cycling test and MVC from four muscle groups. RESULTS Significant relationships were found between sickness presenteeism and BMI as well as MVC both cross-sectional and as changes over 3 months. Participants with BMI more than 30 kg/m had significantly higher sickness presenteeism than those with BMI less than 25 kg/m. CONCLUSIONS This study suggests that actions that decrease BMI and increase MVC decrease the amount of sickness presenteeism.
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Ericsson A, Bremell T, Cider Å, Mannerkorpi K. Effects of exercise on fatigue and physical capacity in men with chronic widespread pain - a pilot study. BMC Sports Sci Med Rehabil 2016; 8:29. [PMID: 27602228 PMCID: PMC5011845 DOI: 10.1186/s13102-016-0054-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/23/2016] [Indexed: 12/19/2022]
Abstract
Background There is very limited knowledge about the effects of exercise on men with Chronic Widespread Pain (CWP), especially regarding fatigue. We wanted to investigate the effects of resistance exercise compared with pool exercise on multidimensional fatigue, psychological distress and physical capacity in men with CWP. Methods Thirty-four men with CWP, with a mean age of 49 (SD 8, range 26–59) years, were randomised to 12 weeks of standardised pool exercise (PE) or resistance exercise (RE). The primary outcome was the Multidimensional Fatigue Inventory (MFI-20). Depression, anxiety, isometric force, pain and health-related quality of life were also assessed. Results No significant differences were found for changes in MFI-20 between the exercise groups. The RE group improved the isometric forces of right shoulder abduction (RE: ∆2.2 SD 1.5 N, PE: ∆0.6 SD 1.2 N, p = 0.009), right knee flexion (RE: ∆50, SD 50 N, PE: ∆-17, SD 71 N, p = 0.003) and left knee flexion (RE: ∆33 SD 39, PE: ∆-9 SD 52 N, p = 0.017) compared with the PE group. The drop-out rate was 29 % in the RE group and 18 % in the PE group. Conclusions Both a resistance exercise programme and a pool exercise programme improved different dimensions of fatigue in men with CWP. There were no differences in the change in fatigue over time between the exercise groups. Resistance exercise improved isometric strength compared with pool exercise. Because different types of exercise appear to improve different aspects of health, the goals could guide the choice of treatment. Further exercise studies with larger groups are needed to gain more knowledge about the effect of exercise on fatigue in men with CWP. Trial registration ClinicalTrials.gov Identifier NCT01278641. Registration date April 2008.
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Affiliation(s)
- Anna Ericsson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Bremell
- Institute of Medicine, Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Cider
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Stensson N, Ghafouri B, Ghafouri N, Gerdle B. High levels of endogenous lipid mediators (N-acylethanolamines) in women with chronic widespread pain during acute tissue trauma. Mol Pain 2016; 12:12/0/1744806916662886. [PMID: 27531672 PMCID: PMC5010217 DOI: 10.1177/1744806916662886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022] Open
Abstract
Although chronic widespread musculoskeletal pain is a significant health problem, the molecular mechanisms involved in developing and maintaining chronic widespread musculoskeletal pain are poorly understood. Central sensitization mechanisms maintained by stimuli from peripheral tissues such as muscle have been suggested. Lipid mediators with anti-inflammatory characteristics such as endogenous ligands of peroxisome proliferator activating receptor-α, oleoylethanolamide, and palmitoylethanolamide are suggested to regulate nociceptive transmission from peripheral locations on route towards the central nervous system. This case–control study investigates the levels of anti-inflammatory lipids in microdialysis samples collected during the first 2 h after microdialysis probe insertion and explores the association of these lipids with different pain characteristics in women with chronic widespread musculoskeletal pain (n = 17) and female healthy controls (n = 19). The levels of oleoylethanolamide, palmitoylethanolamide, and stearoylethanolamide were determined. During sampling of dialysate, pain ratings were conducted using a numeric rating scale. Pain thresholds were registered from upper and lower parts of the body. Oleoylethanolamide and stearoylethanolamide levels were significantly higher (p ≤ 0.05) in chronic widespread musculoskeletal pain at all time points. Numeric rating scale correlated with levels of stearoylethanolamide in chronic widespread musculoskeletal pain. Higher levels of lipid mediators could reflect an altered tissue reactivity in response to microdialysis probe insertion in chronic widespread musculoskeletal pain.
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Affiliation(s)
- Niclas Stensson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ericsson A, Palstam A, Larsson A, Löfgren M, Bileviciute-Ljungar I, Bjersing J, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther 2016; 18:176. [PMID: 27473164 PMCID: PMC4967304 DOI: 10.1186/s13075-016-1073-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/06/2016] [Indexed: 01/03/2023] Open
Abstract
Background Fibromyalgia (FM) affects approximately 1–3 % of the general population. Fatigue limits the work ability and social life of patients with FM. A few studies of physical exercise have included measures of fatigue in FM, indicating that exercise can decrease fatigue levels. There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM. The present study is a sub-study of a multicenter randomized controlled trial in women with FM. The purpose of the present sub-study was to examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM, and to investigate predictors of the potential change in fatigue. Methods A total of 130 women with FM (age 22–64 years) were included in this assessor-blinded randomized controlled multicenter trial examining the effects of person-centered progressive resistance exercise compared with an active control group. The intervention was performed twice a week for 15 weeks. Outcomes were five dimensions of fatigue measured with the Multidimensional Fatigue Inventory (MFI-20). Information about background was collected and the women also completed several health-related questionnaires. Multiple linear stepwise regression was used to analyze predictors of change in fatigue in the total population. Results A higher improvement was found at the post-treatment examination for change in the resistance exercise group, as compared to change in the active control group in the MFI-20 subscale of physical fatigue (resistance group Δ –1.7, SD 4.3, controls Δ 0.0, SD 2.7, p = 0.013), with an effect size of 0.33. Sleep efficiency was the strongest predictor of change in the MFI-20 subscale general fatigue (beta = −0.54, p = 0.031, R2 = 0.05). Participating in resistance exercise (beta = 1.90, p = 0.010) and working fewer hours per week (beta = 0.84, p = 0.005) were independent significant predictors of change in physical fatigue (R2 = 0.14). Conclusions Person-centered progressive resistance exercise improved physical fatigue in women with FM when compared to an active control group. Trial registration ClinicalTrials.gov NCT01226784. Registered 21 October 2010.
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Affiliation(s)
- Anna Ericsson
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden.
| | - Annie Palstam
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anette Larsson
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden
| | - Monika Löfgren
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Stockholm, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Stockholm, Stockholm, Sweden
| | - Jan Bjersing
- Institute of Medicine, Department of Rheumatology and Inflammation research, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Division of Community Medicine, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Center, Anesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden
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Hammond A, Freeman K. Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clin Rehabil 2016; 20:835-46. [PMID: 17008336 DOI: 10.1177/0269215506072173] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effects of a community patient education -exercise programme, using a cognitive-behavioural approach, for people with fibromyalgia. Design: A randomized, parallel group trial with assessments at 0, 4 and 8 months. Setting: Community leisure centres. Subjects: People with fibromyalgia ( n=183) attending a rheumatology outpatient department at a large district general hospital. Interventions: Participants were randomized to a patient education-exercise group ( n=97) or relaxation (attention control) group ( n=86). Main measures: The Fibromyalgia Impact Questionnaire (0-80; lower score means better health). Secondary outcomes included: the Arthritis Self-Efficacy Scale(pain and other symptoms subscales: 1 -10 scale; higher scores mean greater self-efficacy) and self-reported improvement. Results: Fifty participants withdrew or were unable to attend and 133 completed and returned baseline questionnaires: patient education group ( n=71); relaxation group ( n=62); 120/133 participants were women. Average age was 48. 53 (SD 10.89) years. Follow-up ranged between 73 and 82% of questionnaires returned. At four months, there was a difference in average changes in total Fibromyalgia ImpactQuestionnaire scores between the two groups: patient education group -3.38 (SD 9.35); relaxation group 0.3 (SD 8.85); P=0.02. Arthritis Self-Efficacy Scale scores were significantly higher in the patient education group: pain 0.59 (SD 1.45)compared to the relaxation group’s -0.12 (SD 1.22); P=0.003; other symptoms (patient education group 0.72 (SD 1.33); relaxation group 0.03 (SD 1.16); P=0.002). At eight months these differences were no longer apparent. Forty-seven per cent in the patient education group self-reported improvement compared with 13% in the relaxation group (ϰ=13.65; P=0.0001). Conclusion: Short-term improvements resulted from the education -exercise programme but were not sustained. Appropriate selection may improve efficacy.
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Affiliation(s)
- Alison Hammond
- Rheumatology Department, Derbyshire Royal Infirmary, Derby, UK.
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65
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Ericsson A, Mannerkorpi K. How to manage fatigue in fibromyalgia: nonpharmacological options. Pain Manag 2016; 6:331-8. [PMID: 27297077 DOI: 10.2217/pmt-2016-0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this article is to suggest recommendations for the management of fatigue in fibromyalgia (FM) by reviewing and compiling findings of nonpharmacological treatment for fatigue in patients with FM. The management of fatigue in FM should incorporate regular physical exercise maintained for a longer period of time, which contributes to improved general health and facilitates coping with fatigue and other symptoms. The evidence is still low and the effect of exercise on fatigue in FM needs to be further studied. Patients with FM appear to benefit from general sleep hygiene advice and also need to develop individual strategies to manage the complex factors in everyday life that may be related to fatigue.
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Affiliation(s)
- Anna Ericsson
- University of Gothenburg, Sahlgrenska Academy, Institution of Neuroscience & Physiology - Section of Health & Rehabilitation, Physiotherapy, Göteborg, Sweden.,Närhälsan Research & Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Kaisa Mannerkorpi
- University of Gothenburg, Sahlgrenska Academy, Institution of Neuroscience & Physiology - Section of Health & Rehabilitation, Physiotherapy, Göteborg, Sweden
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66
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Musculoskeletal pain in patients with chronic kidney disease. Nefrologia 2016; 36:433-40. [PMID: 27267921 DOI: 10.1016/j.nefro.2016.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 02/16/2016] [Accepted: 03/25/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain (CMP) is a very common symptom in patients with chronic kidney disease (CKD), and is associated with a significant deterioration in quality of life. AIMS To determine the prevalence and clinical characteristics associated with CMP in patients with advanced CKD not on dialysis, and to analyse their relation with other uraemic symptoms and their prognosis significance. MATERIAL AND METHODS Cross-sectional study to analyse the uraemic symptoms of an unselected cohort of patients with CKD stage 4-5 pre-dialysis. In order to characterise patients with CMP, demographic and anthropometric data were collected, as well as data on comorbidities and kidney function. In addition, inflammatory parameters, uric parameters, bone mineral metabolism including 25-hydroxycholecalciferol (25-OHCC), creatine kinase and drugs of potential interest including allopurinol, statins and erythropoiesis-stimulating agents were recorded. RESULTS The study group consisted of 1169 patients (mean age 65±15 years, 54% male). A total of 38% of patients complained of CMP, and this symptom was more prevalent in women than in men (49 vs. 28%; P<.0001). Muscle weakness, pruritus, muscle cramps, ecchymosis, insomnia, oedema and dyspnoea were the most common symptoms associated with CMP. There were no significant associations between serum levels of creatine kinase, 25-OHCC, treatment with allopurinol, statins or erythropoiesis-stimulating agents and CMP. The female gender, elderly age, obesity, comorbidity (mainly diabetes, heart failure or COPD), and elevated levels of inflammatory markers (C-reactive protein and non-neutrophilic leukocytes) were the best determinants of CMP. While patients with CMP showed a worse survival rate, a multivariate analysis adjusted for demographic data ruled out the independent association of CMP with mortality. CONCLUSIONS CMP is highly prevalent in patients with advanced CKD and is associated with other common symptoms of chronic uraemia. As with the general population, elderly age, the female gender, obesity and some comorbid conditions are the best determinants of CMP. Increased inflammatory markers commonly observed in patients with CMP may have a relevant role in its pathogenesis.
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67
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Palstam A, Larsson A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, Gerdle B, Kosek E, Mannerkorpi K. Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial. Arthritis Res Ther 2016; 18:116. [PMID: 27209068 PMCID: PMC4875714 DOI: 10.1186/s13075-016-1007-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/28/2016] [Indexed: 01/24/2023] Open
Abstract
Background Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant’s ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program. Methods A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability. Results Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R2 = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R2 = 32, p = 0.025 and R2 = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R2 = 19, p = 0.001). Conclusion The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise. The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784.
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Affiliation(s)
- Annie Palstam
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anette Larsson
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden
| | - Monika Löfgren
- Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, SE-141 04, Sweden
| | - Jan Bjersing
- Sahlgrenska University Hospital, Rheumatology, Göteborg, Sweden
| | - Indre Bileviciute-Ljungar
- Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Centre, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Center, Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden
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68
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Lacasse A, Bourgault P, Choinière M. Fibromyalgia-related costs and loss of productivity: a substantial societal burden. BMC Musculoskelet Disord 2016; 17:168. [PMID: 27084363 PMCID: PMC4833946 DOI: 10.1186/s12891-016-1027-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/08/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study aimed at describing pain-related health care resource use, direct costs, and productivity loss among patients suffering from fibromyalgia syndrome (FMS). METHODS A cost-of-illness study with a sample of 57 adults having a diagnosis of FMS was conducted in the province of Quebec (Canada). Data regarding FMS-related direct costs and productivity loss from paid and unpaid work over a three-month period were collected using a standardized structured telephone interview protocol. Direct costs were valued in 2009 Canadian dollars using a societal perspective. RESULTS Results showed that average direct costs over a three-month period added up to $951 per patient (SD: $710), which could be translated in a mean annual cost of $3804. The purchase of prescribed medications led to the highest costs (mean: $329, SD: $321), followed by consultations to health care professionals other than physicians (mean: $129, SD: $222) and physicians consultations (mean: $98, SD: $116). Results further showed a high economic burden for patients themselves, aside from costs covered by public or private insurers. Among the subsample of participants who had a paid job (45.6%), an average of 5.6 days (SD: 13.2) were lost due to pain during the past three months. Among those who were not employed (54.4%), an average of 25.1 days in household productivity (SD: 24.8) were lost. CONCLUSIONS FMS is associated with a substantial socioeconomic burden. Further research is clearly needed to improve the management of this type of disorder and make better decisions regarding resource allocation.
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Affiliation(s)
- Anaïs Lacasse
- />Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec Canada
| | - Patricia Bourgault
- />Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec Canada
- />École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Manon Choinière
- />Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, Québec Canada
- />Centre de recherche du Centre hospitalier de l’Université de Montréal, Tour Saint-Antoine 850, rue Saint-Denis, Bureau S03-428, Montréal, Québec Canada
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69
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Johannessen EC, Reiten HS, Løvaas H, Maeland S, Juul-Kristensen B. Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type. Disabil Rehabil 2016; 38:1382-90. [DOI: 10.3109/09638288.2015.1102336] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Helle Sundnes Reiten
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | | | - Silje Maeland
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Birgit Juul-Kristensen
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Abstract
OBJECTIVES To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. METHODS A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ≤0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. RESULTS Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. DISCUSSION The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.
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71
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Loster JE, Osiewicz MA, Groch M, Ryniewicz W, Wieczorek A. The Prevalence of TMD in Polish Young Adults. J Prosthodont 2015; 26:284-288. [PMID: 26646470 DOI: 10.1111/jopr.12414] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The prevalence of temporomandibular disorders (TMD) in the general Polish population has not yet been thoroughly investigated. The aim of this study was to determine how frequently Polish young adults demonstrated the signs and symptoms of TMD, and how often they were aware of these. MATERIALS AND METHODS The study involved 260 volunteers of approximately 18 years of age (and with an F:M ratio of 2.8), who had completed the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire in its internationally accepted Polish version. The volunteers were students from three randomly selected high schools in Kraków, Poland. Following the clinical examinations, all participants received none or one or more of the RDC/TMD axis I diagnoses on one or both sides: muscle disorders (group I), disk displacements (group II), arthralgia, osteoarthritis, and osteoarthrosis (group III). Classification on RDC/TMD axis II involved pain-related impairment (Graded Chronic Pain Severity, from 0: no TMD pain in the prior 6 months, to IV: high disability-severely limiting), depression, and somatization levels (normal, moderate, severe). RESULTS On the RDC/TMD axis I, 69 (26.5%) of the participants received one or more of the possible diagnoses. Awareness of TMD was present in 20 (7.7%) people from that group, in the form of self-complaints. The difference between females and males was statistically significant (p = 0.0013). On the RDC/TMD axis II assessment, a diagnosis of pain, depression, or somatization was given in 38 (14.6%) cases from that group. CONCLUSION Muscle disorders were most frequently diagnosed in the group of Polish young adults, and the prevalence of the disease did not differ across similar groups of young people.
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Affiliation(s)
- Jolanta E Loster
- Department of Prosthodontics, Institute of Dentistry, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Magdalena A Osiewicz
- Department of Integrated Dentistry, Institute of Dentistry, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Magdalena Groch
- Department of Prosthodontics, Institute of Dentistry, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Wojciech Ryniewicz
- Department of Prosthodontics, Institute of Dentistry, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Aneta Wieczorek
- Department of Prosthodontics, Institute of Dentistry, Collegium Medicum, Jagiellonian University, Kraków, Poland
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Karlsson B, Burell G, Anderberg UM, Svärdsudd K. Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial. Scand J Pain 2015; 9:11-21. [DOI: 10.1016/j.sjpain.2015.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/26/2015] [Indexed: 10/23/2022]
Abstract
Abstract
Background and aims
Stress has been pointed out as an important influential factor in the development and maintaining of the fibromyalgia syndrome (FMS) . Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.
Methods
48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (n = 24) and a waitlist control group (n = 24) . When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-Åsberg Depression rating scale – self-reported. Primary outcome was the MPI-1 dimension ‘life control’, secondary outcomes were the MPI-1 dimensions ‘interference’, ‘affective distress’ and ‘support from spouses or significant others’, the various MPI-2 dimensions, the ‘general activity level’ in the MPI-3 dimension, and ‘vital exhaustion’, ‘stress behaviour’, and ‘depression’. The only tertiary outcome was the MPI-1 dimension ‘pain severity’.
Results
In the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions ‘life control’, ‘interference from pain’, ‘affective distress’, ‘support from spouses or significant others’, and ‘distracting responses’ and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the ‘vital exhaustion’ and ‘stress behaviour’. ‘Pain severity’ was rated higher after the intervention.
Conclusions
Cognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.
Implications
FMS is a disorder with great therapeutic challenges. Total abolishment of pain symptoms is extremely difficult or impossible to achieve. Thus, the development of individual strategies for coping with pain is essential to reduce its impact on daily life. Since stress may worsen the pain experience, coping with stress might be a promising route to accomplishing that goal. In evaluations of interventions for pain it is important to monitor the effect on behaviour responses to pain and not only ratings of pain itself.
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Affiliation(s)
- Bo Karlsson
- Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden
| | - Gunilla Burell
- Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden
| | - Ulla-Maria Anderberg
- Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden
| | - Kurt Svärdsudd
- Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden
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Montesó-Curto P, García-Martínez M, Gómez-Martínez C, Ferré-Almo S, Panisello-Chavarria ML, Genís SR, Mateu Gil ML, Cubí Guillén MT, Colás LS, Usach TS, Herrero AS, Ferré-Grau C. Effectiveness of Three Types of Interventions in Patients with Fibromyalgia in a Region of Southern Catalonia. Pain Manag Nurs 2015; 16:642-52. [PMID: 26104223 DOI: 10.1016/j.pmn.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
Abstract
Several pharmacological and nonpharmacological treatments can be used to alleviate the symptoms of fibromyalgia, although none of them are completely effective at present. In this study, we analyzed the effectiveness of different therapies in three groups of people diagnosed with fibromyalgia. The sample for this randomized controlled trial was made up of 66 people diagnosed with fibromyalgia in southern Catalonia. In turn, this sample was divided into three groups of 22 participants each, who were treated with: i) cervical infiltration with botulinum toxin, ii) group problem-solving therapy, or iii) both therapies. The variables recorded were quality of life, suicidal thoughts, perception of pain, quality of sleep, and satisfaction. Female patients composed 96.9% (n = 64) of the study sample. Satisfaction with the infiltration was 5.1 ± 2.7 points, while in group problem-solving therapy it was 6.6 ± 3.2. Self-perceived health in the infiltration group (p = .016) and the therapy group (p = .001) improved after the intervention took place. The risk of suicide decreased in the both treatments/groups (p = .049). Pain was reduced by 31.8% with infiltration, 13.6% with therapy, and 22.7% with both treatments. Anxiety/depression decreased by 45% with therapy, 36.3% with infiltration, and 36.3% with both treatments. The results also showed that the use of both treatments significantly reduces suicidal thoughts (p = .049). In conclusion, this study showed the complexity of reducing chronic pain and increasing the quality of life of people with fibromyalgia.
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Affiliation(s)
- Pilar Montesó-Curto
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain.
| | | | | | - Sandra Ferré-Almo
- Department of Anesthesiology, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | | | - Sara Romaguera Genís
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | - Maria Luisa Mateu Gil
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | | | - Lidia Sarrió Colás
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | - Teresa Salvadó Usach
- Pathology Department, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, Spain
| | | | - Carme Ferré-Grau
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
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Larsson A, Palstam A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia--a randomized controlled trial. Arthritis Res Ther 2015; 17:161. [PMID: 26084281 PMCID: PMC4489359 DOI: 10.1186/s13075-015-0679-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/10/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Muscle strength in women with FM is reduced compared to healthy women. The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength, health status, and current pain intensity in women with FM. Methods A total of 130 women with FM (age 22–64 years, symptom duration 0–35 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group. A person-centred model of exercise was used to support the participants’ self-confidence for management of exercise because of known risks of activity-induced pain in FM. The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists. Primary outcome measure was isometric knee-extension force (Steve Strong®), secondary outcome measures were health status (FIQ total score), current pain intensity (VAS), 6MWT, isometric elbow-flexion force, hand-grip force, health related quality of life, pain disability, pain acceptance, fear avoidance beliefs, and patient global impression of change (PGIC). Outcomes were assessed at baseline and immediately after the intervention. Long-term follow up comprised the self-reported questionnaires only and was conducted after 13–18 months. Between-group and within-group differences were calculated using non-parametric statistics. Results Significant improvements were found for isometric knee-extension force (p = 0.010), health status (p = 0.038), current pain intensity (p = 0.033), 6MWT (p = 0.003), isometric elbow flexion force (p = 0.02), pain disability (p = 0.005), and pain acceptance (p = 0.043) in the resistance exercise group (n = 56) when compared to the control group (n = 49). PGIC differed significantly (p = 0.001) in favor of the resistance exercise group at post-treatment examinations. No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported questionnaires from baseline to 13–18 months. Conclusions Person-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM, improving muscle strength, health status, and current pain intensity when assessed immediately after the intervention. Trial registration ClinicalTrials.gov identification number: NCT01226784, Oct 21, 2010.
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Affiliation(s)
- Anette Larsson
- Institute of Medicine, Department of Rheumatology and Inflammation research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan Box 480, 405 30, Göteborg, Sweden. .,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden.
| | - Annie Palstam
- Institute of Medicine, Department of Rheumatology and Inflammation research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan Box 480, 405 30, Göteborg, Sweden. .,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden.
| | - Monika Löfgren
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Jan Bjersing
- Sahlgrenska University Hospital, Rheumatology, Göteborg, Sweden.
| | | | - Björn Gerdle
- Department of Pain and Rehabilitation Center, Linköping University, Linköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Kaisa Mannerkorpi
- Institute of Medicine, Department of Rheumatology and Inflammation research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan Box 480, 405 30, Göteborg, Sweden. .,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden. .,Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Bourgault P, Lacasse A, Marchand S, Courtemanche-Harel R, Charest J, Gaumond I, Barcellos de Souza J, Choinière M. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS One 2015; 10:e0126324. [PMID: 25978402 PMCID: PMC4433106 DOI: 10.1371/journal.pone.0126324] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluated the efficacy of the PASSAGE Program, a structured multicomponent interdisciplinary group intervention for the self-management of FMS. METHODS A mixed-methods randomized controlled trial (intervention (INT) vs. waitlist (WL)) was conducted with patients suffering from FMS. Data were collected at baseline (T0), at the end of the intervention (T1), and 3 months later (T2). The primary outcome was change in pain intensity (0-10). Secondary outcomes were fibromyalgia severity, pain interference, sleep quality, pain coping strategies, depression, health-related quality of life, patient global impression of change (PGIC), and perceived pain relief. Qualitative group interviews with a subset of patients were also conducted. Complete data from T0 to T2 were available for 43 patients. RESULTS The intervention had a statistically significant impact on the three PGIC measures. At the end of the PASSAGE Program, the percentages of patients who perceived overall improvement in their pain levels, functioning and quality of life were significantly higher in the INT Group (73%, 55%, 77% respectively) than in the WL Group (8%, 12%, 20%). The same differences were observed 3 months post-intervention (Intervention group: 62%, 43%, 38% vs Waitlist Group: 13%, 13%, 9%). The proportion of patients who reported ≥ 50% pain relief was also significantly higher in the INT Group at the end of the intervention (36% vs 12%) and 3 months post-intervention (33% vs 4%). Results of the qualitative analysis were in line with the quantitative findings regarding the efficacy of the intervention. The improvement, however, was not reflected in the primary outcome and other secondary outcome measures. CONCLUSION The PASSAGE Program was effective in helping FMS patients gain a sense of control over their symptoms. We suggest including PGIC in future clinical trials on FMS as they appear to capture important aspects of the patients' experience. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number Register ISRCTN14526380.
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Affiliation(s)
- Patricia Bourgault
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Anaïs Lacasse
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Serge Marchand
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de neurochirurgie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roxanne Courtemanche-Harel
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jacques Charest
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Isabelle Gaumond
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Juliana Barcellos de Souza
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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Lisboa LL, Sonehara E, Oliveira KCAND, Andrade SCD, Azevedo GD. Efeito da cinesioterapia na qualidade de vida, função sexual e sintomas climatéricos em mulheres com fibromialgia. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:209-15. [DOI: 10.1016/j.rbr.2014.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 10/23/2022] Open
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Dailey DL, Keffala VJ, Sluka KA. Do cognitive and physical fatigue tasks enhance pain, cognitive fatigue, and physical fatigue in people with fibromyalgia? Arthritis Care Res (Hoboken) 2015; 67:288-96. [PMID: 25074583 DOI: 10.1002/acr.22417] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 07/22/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Fibromyalgia is a condition characterized by chronic widespread muscle pain and fatigue. The primary objective of this study was to determine if pain, perceived cognitive fatigue, and perceived physical fatigue were enhanced in participants with fibromyalgia compared to healthy controls during a cognitive fatigue task, a physical fatigue task, and a dual fatigue task. METHODS In total, 24 people with fibromyalgia and 33 healthy controls completed pain, fatigue, and function measures. A cognitive fatigue task (Controlled Oral Word Association Test) and physical fatigue task (Valpar peg test) were done individually and combined for a dual fatigue task. Resting pain, perceived cognitive fatigue, and perceived physical fatigue were assessed during each task using visual analog scales. Function was assessed with shoulder range of motion and grip. RESULTS People with fibromyalgia had significantly higher increases in pain, cognitive fatigue, and physical fatigue when compared to healthy controls after completion of a cognitive fatigue task, a physical fatigue task, or a dual fatigue task (P < 0.01) with the exception of perceived cognitive fatigue during the cognitive fatigue task. People with fibromyalgia performed equivalently on measures of physical performance and cognitive performance on the physical and cognitive fatigue tasks, respectively. CONCLUSION These data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue, and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation.
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78
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015. [PMID: 25731853 DOI: 10.1007/s00420–015–1036-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Pain in more than one site is common in working populations. We aimed to characterise combined pain (pain in the upper and lower body) and to evaluate whether the prevalence of combined pain is positively related to combined occupational mechanical exposures to the upper and lower body and to high psychosocial job strain. METHODS This cross-sectional study was based on questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. The study included 14,081 men and 20,173 women. Occupational exposures were assessed by job exposure matrices. We analysed the prevalence of pain limited to the upper body, pain limited to the lower body, and combined pain in relation to occupational exposures using Poisson regression. RESULTS During the last year, 23.2 % of the men and 33.9 % of the women reported combined pain, which was characterised by somatisation, illness worrying, and low SF-36 scores. For men, the adjusted prevalence ratio for combined pain was 1.51 [95 % confidence interval (95 % CI) 1.40-1.64] in relation to exposures limited to the upper body and 2.24 (95 % CI 2.11-2.39) in relation to combined exposures. For women, the corresponding adjusted prevalence ratios were 1.56 (95 % CI 1.50-1.63) and 1.55 (95 % CI 1.50-1.61). High job strain was related to pain among men, only. CONCLUSION Combined pain may in part be explained by local effects of occupational mechanical exposures acting at more than one site.
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Affiliation(s)
- Tine Gjedde Sommer
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Nørrebrogade 44, building 2C, 8000, Aarhus C, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015; 88:1099-110. [DOI: 10.1007/s00420-015-1036-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Trigger points: an anatomical substratum. BIOMED RESEARCH INTERNATIONAL 2015; 2015:623287. [PMID: 25811029 PMCID: PMC4355109 DOI: 10.1155/2015/623287] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/25/2015] [Indexed: 12/23/2022]
Abstract
This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTrPs). Although anatomoclinical correlations represent a major feature of MTrP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTrP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Seven points are described, four of which are motor points: in all cases, these locations corresponded to clinically described MTrPs. The four points were common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MTrP is useful to achieve a better understanding of the anatomical correlation of MTrP and the physiopathology of these disorders and may provide a scientific basis for their treatment, rendering useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.
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Canela C, Schleifer R, Jeger J, Ebner G, Seifritz E, Liebrenz M. Die invalidenversicherungsrechtliche Begutachtung in der Schweiz vor dem Hintergrund der letzten Gesetzesrevision und neueren Rechtsprechung. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2015. [DOI: 10.1007/s11757-014-0302-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ericsson A, Nyström C, Mannerkorpi K. Psychometric properties of the Stress and Crisis Inventory (SCI-93) in females with fibromyalgia and chronic widespread pain. Nord J Psychiatry 2015; 69:28-34. [PMID: 24848785 DOI: 10.3109/08039488.2014.915580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fibromyalgia (FM) and chronic widespread pain (CWP) are commonly associated with symptoms such as fatigue, stiffness, tension, exhaustion and psychological distress. Research on biological markers of the degree of stress symptoms has been conducted for decades. However, biological markers do not offer sufficient information for clinical practice, and thus, validated rating scales are still the best assessment option. The Stress and Crisis Inventory-93 (SCI-93) was designed to assess the severity of symptoms that are primarily related to the autonomous nervous system. OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the SCI-93 with regard to known-group validity, internal consistency and test-retest reliability. METHODS The study included 166 women with FM or CWP in addition to 157 age-matched healthy women. The test-retest reliability was investigated in 40 women with FM. RESULTS A one-factor solution was chosen, which explained 53% of the total variance; Cronbach's alpha was 0.98. The group of patients with FM and CWP showed significantly higher SCI-93 total scores than the healthy reference group (mean = 76.4 ± 24.9 vs. mean = 24.9 ± 21.3; P < 0.001), supporting known-group validity. In the test-retest reliability study, the intra class correlation for the SCI-93 total score was 0.95. CONCLUSIONS The SCI-93 demonstrated satisfactory known-group validity and test-retest reliability. The instrument appears to reflect well the severity of autonomous symptoms.
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Affiliation(s)
- Anna Ericsson
- Anna Ericsson, P.T., Ph.D., Institute of Medicine, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden , and Research Development & Education Centre Fyrbodal, Primary Health Care , Sweden
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83
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Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study. Clin J Pain 2014; 30:391-8. [PMID: 23887345 DOI: 10.1097/ajp.0b013e3182a0dd06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care. METHODS A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression. RESULTS A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability. DISCUSSION The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years.
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84
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Mundal I, Gråwe RW, Bjørngaard JH, Linaker OM, Fors EA. Prevalence and long-term predictors of persistent chronic widespread pain in the general population in an 11-year prospective study: the HUNT study. BMC Musculoskelet Disord 2014; 15:213. [PMID: 24951013 PMCID: PMC4089927 DOI: 10.1186/1471-2474-15-213] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 06/10/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic widespread pain (CWP) is common and associated with prominent negative consequences. The aim of this study was to assess the prevalence of persistent CWP in an 11-year prospective cohort study in the general population, and to examine anxiety, depression, alcohol use, poor sleep, body mass index (BMI) and chronic disease, along with demographic, lifestyle and other health-related variables as possible predictors for the assumed CWP persistence. METHODS CWP was defined as having pain at three or more predefined sites (involving the trunk and upper and lower limbs) for at least three months in the last year. We used a Norwegian general population cohort of 28,367 individuals who responded to both the second (1995-1997) and the third (2006-2008) waves of the Nord-Trøndelag Health Study (HUNT2 and HUNT3, respectively). Data were analysed with logistic regression models. RESULTS CWP prevalence in HUNT2 was 17%. Of those reporting CWP in HUNT2, 53% still reported CWP at follow-up in HUNT3. Adjusted analyses revealed that depression and alcohol consumption were not substantially associated with the 11-year prospective CWP outcome. Poor sleep, obesity and chronic disease predicted persistent CWP, and being male and/or 60 years or older was protective. CONCLUSIONS This cohort study revealed that nearly half of the participants with baseline CWP resolved from CWP 11 years later. Among those whose CWP did not resolve, obesity, sleeping problems and chronic disease predicted CWP persistence, while aging and male sex was protective. Anxiety, mixed anxiety and depression, former smoking, and overweight were weakly associated, while depression, moderate exercise, and alcohol use were not associated with persistent CWP.
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Affiliation(s)
- Ingunn Mundal
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
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85
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Abstract
SUMMARY Fibromyalgia is a clinical syndrome with a widely heterogeneous presentation that can present significant difficulty in diagnosis and management. It is becoming clear that patients with fibromyalgia experience pain at a higher intensity than normal healthy individuals, and that the difference in their experience of pain is likely secondary to abnormalities in central pain processing rather than dysfunction in the peripheral tissues. However, the exact cause of these abnormalities remains unclear. What we do know is that fibromyalgia syndrome is a complex condition that requires a unique, well-coordinated and multidisciplinary approach to treatment with the understanding that it is not a disease that can be cured, but rather a clinical syndrome that can be managed. The goal of this article is to review our current understanding of the etiology, pathophysiology and diagnosis of fibromyalgia syndrome as well as to review the evidence for current treatment strategies. While we do not provide any novel research, where available, the results of published meta-analyses are summarized as are some original studies. This article also discusses the new preliminary diagnostic criteria for fibromyalgia syndrome, which was proposed by Wolfe et al. in 2010. It is the opinion of the senior author of this paper that, while these criteria are proposed with good intentions and are likely to be helpful in the area of clinical and epidemiological research, in the clinical setting they are likely to add more confusion than clarity and lead to an increased diagnosis of fibromyalgia syndrome at a time when few physicians are interested in and willing to properly care for these individuals. Many of the patients who would be diagnosed under the new criteria are likely to be sidelined, poorly served and treated inappropriately and excessively, adding stress to an already over-burdened healthcare system. The senior author of this paper warns that caution should be undertaken before widespread use of these proposed criteria is implemented in the clinical setting.
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Affiliation(s)
- Deven Karvelas
- Rehabilitation Medicine Professionals, SC, Milwaukee, WI, USA
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86
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Giacomelli C, Talarico R, Bombardieri S, Bazzichi L. The interaction between autoimmune diseases and fibromyalgia: risk, disease course and management. Expert Rev Clin Immunol 2014; 9:1069-76. [DOI: 10.1586/1744666x.2013.849440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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87
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Ullrich A, Hauer J, Farin E. Communication preferences in patients with fibromyalgia syndrome: descriptive results and patient characteristics as predictors. Patient Prefer Adherence 2014; 8:135-45. [PMID: 24520192 PMCID: PMC3917950 DOI: 10.2147/ppa.s53474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Communication with patients with fibromyalgia syndrome (FMS) is often considered difficult. The primary objective of this explorative study was to describe the communication preferences of FMS patients in comparison with other chronic diseases, and the secondary objective was to identify patient-related predictors of those communication preferences. METHODS A total of 256 FMS patients were asked to fill out the KOPRA [(Kommunikationspraeferenzen), communication preferences of patients with chronic illness] questionnaire at the beginning of their rehabilitation, answering questions about their communication preferences. The KOPRA's descriptive parameters were calculated and compared with other diagnosis groups. In order to include as many influencing factors as possible, data on patient-related sociodemographic, medical, pain impact and psychologic variables were gathered. A hierarchical regression analysis with four steps was performed to identify patient-related predictors of patients' communication preferences. RESULTS FMS patients consider an open and patient-centered communication style to be especially important. Emotionally supportive communication and communication about personal circumstances are important for FMS patients, but the preferences of individual patients vary widely. FMS patients reveal higher values in all the subdimensions of communication preferences compared with patients with low back pain or chronic ischemic heart disease. Only a few variables appear to predict patient communication preferences. The explained variance ranged from 3.1% to 9.7%. Psychologic variables have been identified as predictors in conjunction with all communication preferences. CONCLUSION Health care providers who communicate with FMS patients should employ an open and patient-centered communication style, and affective communication components should be adapted to accommodate each patient.
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Affiliation(s)
- Antje Ullrich
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
- Correspondence: Antje Ullrich, Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Engelbergerstr. 21, D-79106 Freiburg, Germany, Tel +49 761 270 74870, Fax +49 761 270 73310, Email
| | - Johannes Hauer
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
| | - Erik Farin
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
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88
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Frey-Law LA, Lee JE, Wittry AM, Melyon M. Pain rating schema: three distinct subgroups of individuals emerge when rating mild, moderate, and severe pain. J Pain Res 2013; 7:13-23. [PMID: 24379696 PMCID: PMC3873848 DOI: 10.2147/jpr.s52556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background While the validity of pain assessment has been well documented, the underlying schema (ie, organized, preconceived ideas) of how individuals interpret numerical pain ratings is not well understood. This study’s objectives were to examine numerical pain intensity ratings, from (0 to 10 cm on the visual analog scale [VAS]) across multiple severities of commonly experienced acute pain conditions to determine whether the ratings differed between these pain conditions and/or between individuals. Methods A community sample (N=365, 66% female) rated their anticipated pain intensity (VAS) for threshold, mild, moderate, severe, and tolerance level, using several common pain conditions: headache, toothache, joint injury, delayed-onset muscle soreness, burns, and “general pain.” Results Cluster analysis revealed three subgroups of individuals, suggesting three types of underlying pain rating schema: 1) Low Rating subgroup (low VAS pain intensity ratings across all the pain severity categories); 2) Low/High Rating subgroup (low VAS pain intensity rating for mild, but high VAS pain intensity rating for severe pain); and 3) High Rating subgroup (high VAS pain intensity ratings across all the pain severity categories). Overall, differences between pain conditions were small: muscle soreness pain intensity was consistently rated lower than the other pain types across severities. The highest pain ratings varied between joint injury and general pain, depending on severity level. No effects of sex or current experience of pain were noted. Conclusion The results indicate that: 1) three distinct pain schemas were present in this community-based sample, indicating significant variation in how pain scales are utilized and/or interpreted between clusters of individuals; 2) pain ratings vary by condition, but these differences are minor; and 3) pain rating schemas are not significantly different between males and females or between individuals with and without current pain.
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Affiliation(s)
- Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA
| | - Jennifer E Lee
- Mount Mercy University, Department of Psychology, Cedar Rapids, IA, USA ; College of Nursing, The University of Iowa, IA, USA
| | - Alex M Wittry
- Department of Emergency Medicine, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Gerhardt A, Hartmann M, Blumenstiel K, Tesarz J, Eich W. The Prevalence Rate and the Role of the Spatial Extent of Pain in Nonspecific Chronic Back Pain-A Population-Based Study in the South-West of Germany. PAIN MEDICINE 2013; 15:1200-10. [DOI: 10.1111/pme.12286] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andreas Gerhardt
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg
| | - Klaus Blumenstiel
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg
- Department of Psychosomatic Medicine and Psychotherapy; Fürst-Stirum-Hospital; Bruchsal Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg
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Martín J, Torre F, Padierna A, Aguirre U, González N, Matellanes B, Quintana JM. Interdisciplinary treatment of patients with fibromyalgia: improvement of their health-related quality of life. Pain Pract 2013; 14:721-31. [PMID: 24279638 DOI: 10.1111/papr.12134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/16/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess whether an interdisciplinary intervention is more effective than usual care for improving the health-related quality of life (HRQoL) among patients with fibromyalgia (FM), and to identify variables that were predictors of improvement in HRQoL. METHODS In a randomized controlled clinical trial carried out on an outpatient basis in a hospital pain management unit, 153 patients with FM were randomly allocated to an experimental group (EG) or a control group (CG). Participants completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6 months after the intervention. The EG received an interdisciplinary treatment (12 sessions for 6 weeks) which consisted of coordinated psychological, medical, educational, and physiotherapeutic interventions while the CG received standard-of-care pharmacologic treatment. Descriptive statistics, ANOVA, Chi square and Fisher tests and generalized linear models were used for data analysis. RESULTS Six months after the intervention, statistically significant improvements in HRQoL were observed in physical functioning (P = 0.01), pain (P = 0.03) and total FIQ score (P = 0.04) in the EG compared to the CG. The number of physical illnesses was identified as a predictor for improvement. CONCLUSIONS This interdisciplinary intervention has shown effectiveness in improving the HRQoL of this sample of patients with FM. The number of physical illnesses was identified as a predictor of that improvement.
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Affiliation(s)
- Josune Martín
- Research Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
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91
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Fagerlund AJ, Bystad MK, Aslaksen PM. [Transcranial direct current stimulation for chronic pain]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:2266-9. [PMID: 24226334 DOI: 10.4045/tidsskr.13.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) is a non-invasive method for neuromodulation. By changing the neurons' resting membrane potential, the method can alter the activity in areas of the brain. We therefore wished to review randomised controlled trials (RCTs) that investigate the treatment effect of tDCS on chronic pain. EVIDENCE We undertook a search in PubMed with the search terms «transcranial direct current stimulation» and «pain», with «randomized controlled trial» as a filter. RESULTS Five randomised, controlled trials that used quantitative outcome measures for pain were identified. The studies focused on strongly varying groups of patients suffering from pain. The results from some of the studies showed that stimulation with the aid of tDCS led to a significantly lower level of pain, but seen as a whole, the results were not conclusive. INTERPRETATION The method should be further investigated in studies that include clearly defined groups of patients suffering from pain, as well as a larger number of participants, before implementation of the method is considered as a treatment option for chronic pain.
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92
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Ryan C, McDonough S, Kirwan J, Leveille S, Martin D. An investigation of association between chronic musculoskeletal pain and cardiovascular disease in the Health Survey for England (2008). Eur J Pain 2013; 18:740-50. [DOI: 10.1002/j.1532-2149.2013.00405.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/12/2022]
Affiliation(s)
- C.G. Ryan
- Health and Social Care Institute; Teesside University; Middlesbrough UK
| | - S. McDonough
- Institute of Nursing and Health Research; School of Health Sciences; University of Ulster; UK
| | - J.P. Kirwan
- Lerner Research Institute; Department of Pathobiology; Cleveland Clinic; USA
| | - S. Leveille
- College of Nursing and Health Sciences; University of Massachusetts Boston; USA
| | - D.J. Martin
- Health and Social Care Institute; Teesside University; Middlesbrough UK
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93
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Gilron I, Shum B, Moore RA, Wiffen PJ. Combination pharmacotherapy for the treatment of fibromyalgia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ian Gilron
- Queen's University; Departments of Anesthesiology & Perioperative Medicine & Biomedical & Molecular Sciences; 76 Stuart Street Victory 2 Pavillion Kingston ON Canada K7L 2V7
| | - Bonnie Shum
- Queens University; Anesthesiology & perioperative Medicine; 76 Stuart St Kingston ON Canada K7L 2V7
| | - R Andrew Moore
- University of Oxford; Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics); Pain Research Unit Churchill Hospital Oxford Oxfordshire UK OX3 7LE
| | - Philip J Wiffen
- University of Oxford; Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics); Pain Research Unit Churchill Hospital Oxford Oxfordshire UK OX3 7LE
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94
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Yeephu S, Suthisisang C, Suttiruksa S, Prateepavanich P, Limampai P, Russell IJ. Efficacy and safety of mirtazapine in fibromyalgia syndrome patients: a randomized placebo-controlled pilot study. Ann Pharmacother 2013; 47:921-32. [PMID: 23737510 DOI: 10.1345/aph.1r725] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data from an open-label trial suggest that mirtazapine might prove useful in treatment of fibromyalgia syndrome (FMS). OBJECTIVE To obtain preliminary efficacy data of mirtazapine for estimation of sample size requirements for a Phase 2 clinical trial in FMS. METHODS This 13-week randomized controlled trial compared the effects of mirtazapine 15 mg/day, mirtazapine 30 mg/day, and placebo in 40 patients with FMS. The primary outcomes were change in Pain Visual Analog Scale (PVAS) and proportion of pain responders (≥30% PVAS reduction). Secondary outcomes included scores from the Jenkins Sleep Scale (JSS), Patient Global Impression of Change (PGIC), Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Patient Global Assessment, and self-reported adverse events. RESULTS Significant within-group PVAS reductions from baseline were observed in all 3 groups, with the greatest improvement in the mirtazapine 30-mg group (p < 0.005); between-group difference was not significant. The proportion of pain responders did not meet significance criteria (66.67% for mirtazapine 30 mg, 50% for mirtazapine 15 mg, 41.67% for placebo). Significant within-group improvement in JSS scores was seen for mirtazapine 30 mg (p < 0.01) and mirtazapine 15 mg (p < 0.05). Between-group comparison achieved significance for JSS item 3, waking several times per night (p < 0.05). On the PGIC, 72.73% felt better with both mirtazapine dosages compared with 50% for placebo. Within-group FIQ responses indicated improvement in only mirtazapine-treated groups, whereas within-group improvement for HAM-D and Patient Global Assessment was observed in all groups. Based on our findings, the sample size requirement (80% power, 5% type I error) should be 83 per group to detect PVAS change difference between mirtazapine 30 mg and placebo. Common mirtazapine-related adverse events were increased appetite and weight gain. CONCLUSIONS Patients with FMS taking mirtazapine exhibited within-group significant improvement in most of the measured outcomes. Between-group analysis was predictably compromised by the small sample size. Mirtazapine was well tolerated. Further study with a larger sample size is likely to be useful.
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Affiliation(s)
- Suwimon Yeephu
- Faculty of Pharmacy, Department of Pharmacology, Mahidol University, Rajthevee, Bangkok, Thailand
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95
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Huang KT, Hazzard MA, Babu R, Ugiliweneza B, Grossi PM, Huh BK, Roy LA, Patil C, Boakye M, Lad SP. Insurance Disparities in the Outcomes of Spinal Cord Stimulation Surgery. Neuromodulation 2013; 16:428-34; discussion 434-5. [DOI: 10.1111/ner.12059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/14/2013] [Accepted: 03/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Kevin T. Huang
- Division of Neurosurgery; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Matthew A. Hazzard
- Division of Neurosurgery; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Ranjith Babu
- Division of Neurosurgery; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery; Center for Neurosurgical Outcomes Research; Maxine Dunitz Neurosurgical Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Peter M. Grossi
- Division of Neurosurgery; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Billy K. Huh
- Department of Anesthesia; Divison of Pain; Duke University Medical Center; Durham NC USA
| | - Lance A. Roy
- Department of Anesthesia; Divison of Pain; Duke University Medical Center; Durham NC USA
| | - Chirag Patil
- Department of Neurosurgery; Center for Neurosurgical Outcomes Research; Maxine Dunitz Neurosurgical Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Maxwell Boakye
- Department of Neurosurgery; University of Louisville; Louisville KY USA
- Department of Neurosurgery; Robley Rex VA Medical Center; Louisville KY USA
| | - Shivanand P. Lad
- Division of Neurosurgery; Department of Surgery; Duke University Medical Center; Durham NC USA
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96
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Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K, Vallejo MS. Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women. Maturitas 2013; 75:94-100. [DOI: 10.1016/j.maturitas.2013.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 01/01/2023]
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97
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Mertens VC, Goossens MEJB, Verbunt JA, Köke AJ, Smeets RJEM. Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial. Trials 2013; 14:90. [PMID: 23548195 PMCID: PMC3655830 DOI: 10.1186/1745-6215-14-90] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/13/2013] [Indexed: 11/29/2022] Open
Abstract
Background Non-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment. Methods/design Study design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment. Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program. Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each. Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment. Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored. Discussion The results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place. Trial registration Nederlands trial register NTR3065
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Affiliation(s)
- Vera-Christina Mertens
- Department of Rehabilitation Medicine, Maastricht University, School for Public Health and Primary Care, CAPHRI, PO Box 616, Maastricht, MD 6200, The Netherlands.
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Martínez-Jauand M, Sitges C, Femenia J, Cifre I, González S, Chialvo D, Montoya P. Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia. Clin Rheumatol 2013; 32:975-81. [DOI: 10.1007/s10067-013-2212-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/18/2013] [Accepted: 02/02/2013] [Indexed: 11/28/2022]
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99
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Heredia-Jimenez JM, Soto-Hermoso VM. Kinematics gait disorder in men with fibromyalgia. Rheumatol Int 2013; 34:63-5. [PMID: 23292191 DOI: 10.1007/s00296-012-2651-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 12/15/2012] [Indexed: 10/27/2022]
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100
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Castro-Sánchez AM, Matarán-Peñarrocha GA, López-Rodríguez MM, Lara-Palomo IC, Arendt-Nielsen L, Fernández-de-las-Peñas C. Gender Differences in Pain Severity, Disability, Depression, and Widespread Pressure Pain Sensitivity in Patients with Fibromyalgia Syndrome Without Comorbid Conditions. PAIN MEDICINE 2012; 13:1639-47. [DOI: 10.1111/j.1526-4637.2012.01523.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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