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Sanzo P, Agostino M, Fidler W, Lawrence-Dewar J, Pearson E, Zerpa C, Niccoli S, Lees SJ. Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial. Physiother Theory Pract 2024:1-16. [PMID: 38384123 DOI: 10.1080/09593985.2024.2321503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results. OBJECTIVES To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively. METHODS Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group. RESULTS There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals. CONCLUSION RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identification number NCT02760212.
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Affiliation(s)
- Paolo Sanzo
- Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada
- Medical Sciences, NOSM University - Thunder Bay Campus, Thunder Bay, Canada
| | - Martina Agostino
- Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada
| | - Wesley Fidler
- Medical Sciences, NOSM University - Thunder Bay Campus, Thunder Bay, Canada
| | - Jane Lawrence-Dewar
- Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada
| | - Erin Pearson
- Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada
| | - Carlos Zerpa
- Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada
| | - Sarah Niccoli
- Medical Sciences, NOSM University - Thunder Bay Campus, Thunder Bay, Canada
| | - Simon J Lees
- Medical Sciences, NOSM University - Thunder Bay Campus, Thunder Bay, Canada
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Izuno S, Yoshihara K, Hosoi M, Eto S, Hirabayashi N, Todani T, Gondo M, Hayaki C, Anno K, Hiwatashi A, Sudo N. Psychological characteristics associated with the brain volume of patients with fibromyalgia. Biopsychosoc Med 2023; 17:36. [PMID: 37875931 PMCID: PMC10594713 DOI: 10.1186/s13030-023-00293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
Fibromyalgia (FM) is a disease characterized by chronic widespread pain concomitant with psychiatric symptoms such as anxiety and depression. It has been reported that FM patients engage in pain catastrophizing. In this study, we investigated characteristics of the brain volume of female FM patients and the association between psychological indices and brain volume. Thirty-nine female FM patients and 25 female healthy controls (HCs) were recruited for the study, and five FM patients were excluded due to white matter lesions. The following analyses were performed: (1) T1-weighted MRI were acquired for 34 FM patients (age 41.6 ± 7.4) and 25 HCs (age 39.5 ± 7.4). SPM12 was used to compare their gray and white matter volumes. (2) Data from anxiety and depression questionnaires (State-Trait Anxiety Inventory and Hospital Anxiety and Depression Scale), the Pain Catastrophizing Scale (subscales rumination, helplessness, magnification), and MRI were acquired for 34 FM patients (age 41.6 ± 7.4). Correlation analysis was done of the psychological indices and brain volume. We found that (1) The white matter volume of the temporal pole was larger in the FM patient group than in the HC group. (2) Correlation analysis of the psychological indices and gray matter volume showed a negative correlation between trait anxiety and the amygdala. For the white matter volume, positive correlations were found between depression and the brainstem and between magnification and the postcentral gyrus. Changes in the brain volume of female FM patients may be related to anxiety, depression, and pain catastrophizing.
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Grants
- JP16K15414 Ministry of Education, Culture, Sports, Science and Technology
- JP19H03752 Ministry of Education, Culture, Sports, Science and Technology
- JP20K03417 Ministry of Education, Culture, Sports, Science and Technology
- JP19FG2001 Ministry of Health, Labour and Welfare
- JP20FC1056 Ministry of Health, Labour and Welfare
- JP19ek0610015h0003 Japan Agency for Medical Research and Development
- JP19dm0307104 Japan Agency for Medical Research and Development
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Affiliation(s)
- Satoshi Izuno
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan.
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Sanami Eto
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan
| | | | - Tae Todani
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Motoharu Gondo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Chie Hayaki
- Department of Psychosomatic Medicine, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Kozo Anno
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
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3
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Maurel S, Giménez-Llort L, Alegre-Martin J, Castro-Marrero J. Hierarchical Cluster Analysis Based on Clinical and Neuropsychological Symptoms Reveals Distinct Subgroups in Fibromyalgia: A Population-Based Cohort Study. Biomedicines 2023; 11:2867. [PMID: 37893239 PMCID: PMC10604090 DOI: 10.3390/biomedicines11102867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
Fibromyalgia (FM) is a condition characterized by musculoskeletal pain and multiple comorbidities. Our study aimed to identify four clusters of FM patients according to their core clinical symptoms and neuropsychological comorbidities to identify possible therapeutic targets in the condition. We performed a population-based cohort study on 251 adult FM patients referred to primary care according to the 2010 ACR case criteria. Patients were aggregated in clusters by a K-medians hierarchical cluster analysis based on physical and emotional symptoms and neuropsychological variables. Four different clusters were identified in the FM population. Global cluster analysis reported a four-cluster profile (cluster 1: pain, fatigue, poorer sleep quality, stiffness, anxiety/depression and disability at work; cluster 2: injustice, catastrophizing, positive affect and negative affect; cluster 3: mindfulness and acceptance; and cluster 4: surrender). The second analysis on clinical symptoms revealed three distinct subgroups (cluster 1: fatigue, poorer sleep quality, stiffness and difficulties at work; cluster 2: pain; and cluster 3: anxiety and depression). The third analysis of neuropsychological variables provided two opposed subgroups (cluster 1: those with high scores in surrender, injustice, catastrophizing and negative affect, and cluster 2: those with high scores in acceptance, positive affect and mindfulness). These empirical results support models that assume an interaction between neurobiological, psychological and social factors beyond the classical biomedical model. A detailed assessment of such risk and protective factors is critical to differentiate FM subtypes, allowing for further identification of their specific needs and designing tailored personalized therapeutic interventions.
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Affiliation(s)
- Sara Maurel
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Institut de Neurosciències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Jose Alegre-Martin
- Division of Rheumatology, Clinical Unit in ME/CFS and Long COVID, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Division of Rheumatology, Research Unit in ME/CFS and Long COVID, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Jesús Castro-Marrero
- Division of Rheumatology, Research Unit in ME/CFS and Long COVID, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Pacheco-Barrios K, Pimenta DC, Pessotto AV, Fregni F. Motor Cortex Inhibition and Facilitation Correlates with Fibromyalgia Compensatory Mechanisms and Pain: A Cross-Sectional Study. Biomedicines 2023; 11:1543. [PMID: 37371638 DOI: 10.3390/biomedicines11061543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
The role of transcranial magnetic stimulation (TMS) measures as biomarkers of fibromyalgia syndrome (FMS) phenotypes is still unclear. We aimed to determine the clinical correlates of TMS measures in FMS patients. We conducted a cross-sectional analysis that included 58 patients. We performed standardized TMS assessments, including resting motor threshold (MT), motor-evoked potential (MEP), short intracortical inhibition (SICI), and intracortical facilitation (ICF). Sociodemographic, clinical questionnaires, and quantitative sensory testing were collected from all of the patients. Univariate and multivariate linear regression models were built to explore TMS-associated factors. We found that SICI did not significantly correlate with pain levels but was associated with sleepiness, comorbidities, disease duration, and anxiety. On the other hand, ICF showed a positive correlation with pain levels and a negative correlation with body mass index (BMI). BMI was a negative effect modifier of the ICF and pain association. The clinical correlates of MT and MEP were scarce. Our results suggest that SICI and ICF metrics are potential phenotyping biomarkers in FMS related to disease compensation and levels of pain perception, respectively. The clinical translation of TMS paired-pulse protocols represents an opportunity for a mechanistic understanding of FMS and the future development of precision treatments.
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Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Danielle Carolina Pimenta
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Anne Victorio Pessotto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Laboratório de Imunohematologia e Hematologia Forense (LIM40), Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC da FMUSP), São Paulo 05403-010, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
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Krock E, Morado-Urbina CE, Menezes J, Hunt MA, Sandström A, Kadetoff D, Tour J, Verma V, Kultima K, Haglund L, Meloto CB, Diatchenko L, Kosek E, Svensson CI. Fibromyalgia patients with elevated levels of anti-satellite glia cell immunoglobulin G antibodies present with more severe symptoms. Pain 2023:00006396-990000000-00274. [PMID: 36943275 DOI: 10.1097/j.pain.0000000000002881] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/16/2022] [Indexed: 03/23/2023]
Abstract
ABSTRACT Transferring fibromyalgia patient immunoglobulin G (IgG) to mice induces pain-like behaviour, and fibromyalgia IgG binds mouse and human satellite glia cells (SGCs). These findings suggest that autoantibodies could be part of fibromyalgia pathology. However, it is unknown how frequently fibromyalgia patients have anti-SGC antibodies and how anti-SGC antibodies associate with disease severity. Here, we quantified serum or plasma anti-SGC IgG levels in 2 fibromyalgia cohorts from Sweden and Canada using an indirect immunofluorescence murine cell culture assay. Fibromyalgia serum IgG binding to human SGCs in human dorsal root ganglia tissue sections was also assessed by immunofluorescence. In the cell culture assay, anti-SGC IgG levels were increased in both fibromyalgia cohorts compared with control group. Elevated anti-SGC IgG was associated with higher levels of self-reported pain in both cohorts, and higher fibromyalgia impact questionnaire scores and increased pressure sensitivity in the Swedish cohort. Anti-SGC IgG levels were not associated with fibromyalgia duration. Swedish fibromyalgia (FM) patients were clustered into FM-severe and FM-mild groups, and the FM-severe group had elevated anti-SGC IgG compared with the FM-mild group and control group. Anti-SGC IgG levels detected in culture positively correlated with increased binding to human SGCs. Moreover, the FM-severe group had elevated IgG binding to human SGCs compared with the FM-mild and control groups. These results demonstrate that a subset of fibromyalgia patients have elevated levels of anti-SGC antibodies, and the antibodies are associated with more severe fibromyalgia symptoms. Screening fibromyalgia patients for anti-SGC antibodies could provide a path to personalized treatment options that target autoantibodies and autoantibody production.
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Affiliation(s)
- Emerson Krock
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carlos E Morado-Urbina
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joana Menezes
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matthew A Hunt
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Vivek Verma
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Kim Kultima
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lisbet Haglund
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Carolina B Meloto
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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6
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Sadr S, Mobini M, Tabarestani M, Islami Parkoohi P, Elyasi F. The frequency of psychiatric disorder co-morbidities in patients with fibromyalgia: A cross-sectional study in Iran. Nurs Open 2023. [PMID: 36947671 DOI: 10.1002/nop2.1731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/24/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
AIM This study aimed to investigate psychiatric disorders in Iranian female patients with fibromyalgia (FM). DESIGN Female patients, newly diagnosed with FM, were interviewed by a psychiatrist for psychiatric assessments during a 2-year period. METHODS The diagnosis of the psychiatric disorders was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). RESULTS In total, 159 patients with the mean age of 42.15 ± 9.89 were recruited in this study. Over 92% of the cases were also diagnosed with at least one type of psychiatric disorder. Sleep disorders (SDs, 90.57%), mood disorders (MDs, 52.83%), personality disorders (PDs, 40.25%) and anxiety disorders (ADs, 16.98%) were the most prevalent diagnoses among these patients. The logistic regression results correspondingly showed that suffering from Cluster-B PDs was associated with a higher prevalence rate of somatic symptom disorders (SSDs), with a p-value of 0.019 and an odds ratio (OR) of 2.7.
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Affiliation(s)
- Sara Sadr
- School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Mobini
- Department of Rheumatology, Diabetes Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Tabarestani
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Islami Parkoohi
- Community Medicine Specialist, Vice Chancellery for Research and Technology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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7
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Peñacoba C, Ecija C, Gutiérrez L, Catalá P. Does Pain Acceptance Contribute to Improved Functionality through Walking in Women with Fibromyalgia? Looking at Depressive Comorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5005. [PMID: 36981913 PMCID: PMC10048968 DOI: 10.3390/ijerph20065005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
In the last decade, research has pointed to physical exercise as an effective treatment in fibromyalgia patients. Some studies have highlighted the role of acceptance and commitment therapy in optimizing the benefits of exercise in patients. However, given the high comorbidity in fibromyalgia, it is necessary to value its possible influence on the effect of certain variables, such as acceptance, on the benefits of treatments, such as physical exercise. Our aim is to test the role of acceptance in the benefits of walking over functional limitation, further assessing whether this model is equally valid, considering depressive symptomatology as an additional differential diagnosis. A cross-sectional study with a convenience sample through contacting Spanish fibromyalgia associations was carried out. A total of 231 women with fibromyalgia (mean age 56.91 years) participated in the study. Data were analyzed with the Process program (Model 4, Model 58, Model 7). The results highlight the role of acceptance as a mediator between walking and functional limitation (B = -1.86, SE = 0.93, 95% CI = [-3.83, -0.15]). This model, when depression is incorporated as a moderator, is significant only in patients without depression, revealing the need for personalized treatments in fibromyalgia, considering their most prevalent comorbidity.
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Audoux CR, Estrada-Barranco C, Martínez-Pozas O, Gozalo-Pascual R, Montaño-Ocaña J, García-Jiménez D, Vicente de Frutos G, Cabezas-Yagüe E, Sánchez Romero EA. What Concept of Manual Therapy Is More Effective to Improve Health Status in Women with Fibromyalgia Syndrome? A Study Protocol with Preliminary Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1061. [PMID: 36673817 PMCID: PMC9858983 DOI: 10.3390/ijerph20021061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse musculoskeletal pain, associated with characteristic signs and symptoms such as fatigue and/or sleep and mood disorders, and whose etiology, pathogenesis and prognosis may or may not be known. There is growing evidence of manual therapy as a treatment for pain in the short and medium term, also in patients affected by FM. However, the heterogeneity of the manual therapy treatments administered are a very common clinical practice, as they are based more on the judgment or tendency of the physiotherapist, rather than on clear scientific evidence. Therefore, the aim of the present study protocol will be to determine which manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional and social) in patients with FM. METHODS a randomized controlled clinical trial with a 3-month follow-up will be carried out with 52 female patients affected by rheumatologist-diagnosed FM will be recruited and evaluated at the Asociación de Fibromialgia y Síndrome de Fatiga Crónica (AFINSYFACRO) in Móstoles, Madrid, Spain. For more details on the protocol, a pilot study was carried out using a non-probability method of judgmental or purposive sampling. Thirteen patients were also evaluated, treated and reevaluated; eight patients were assigned to the myofascial techniques approach (MTA) group and five to the Maitland's mobilization approach (MMA) group. RESULTS the preliminary results presented here are intended to show how the planned randomized controlled clinical trial will develop. Patients who received MTA had significantly improved pain and health status outcomes after treatment and at 1-month follow-up, with no significant change in those who received MMA. CONCLUSIONS the exact details of the study protocol on which the manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional, and social) in patients with FM are presented. Preliminary results show that manual therapy is effective in improving pain and health status in patients with fibromyalgia at short and medium term, with significant results in those who received MTA.
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Affiliation(s)
- Carine Romane Audoux
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Cecilia Estrada-Barranco
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Oliver Martínez-Pozas
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Rodrigo Gozalo-Pascual
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Juan Montaño-Ocaña
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
| | - David García-Jiménez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, 28668 Madrid, Spain
| | - Gonzalo Vicente de Frutos
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
| | - Elena Cabezas-Yagüe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Eleuterio A. Sánchez Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
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Bourke SL, Schlag AK, O'Sullivan SE, Nutt DJ, Finn DP. Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research. Pharmacol Ther 2022; 240:108216. [PMID: 35609718 DOI: 10.1016/j.pharmthera.2022.108216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022]
Abstract
Characterised by chronic widespread musculoskeletal pain, generalised hyperalgesia, and psychological distress, fibromyalgia (FM) is a significant unmet clinical need. The endogenous cannabinoid system plays an important role in modulating both pain and the stress response. Here, we appraise the evidence, from preclinical and clinical studies, for a role of the endocannabinoid system in FM and the therapeutic potential of targeting the endocannabinoid system. While many animal models have been used to study FM, the reserpine-induced myalgia model has emerged as perhaps the most translatable to the clinical phenotype. Inhibition of fatty acid amide hydrolase (FAAH) has shown promise in preclinical studies, ameliorating pain- and anxiety-related behaviour . Clinically, there is evidence for alterations in the endocannabinoid system in patients with FM, including single nucleotide polymorphisms and increased levels of circulating endocannabinoids and related N-acylethanolamines. Single entity cannabinoids, cannabis, and cannabis-based medicines in patients with FM show promise therapeutically but limitations in methodology and lack of longitudinal studies to assess efficacy and tolerability preclude the current recommendation for their use in patients with FM. Gaps in the literature that warrant further investigation are discussed, particularly the need for further development of animal models with high validity for the multifaceted nature of FM, balanced studies to eliminate sex-bias in preclinical research, and ultimately, better translation between preclinical and clinical research.
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Affiliation(s)
- Stephanie L Bourke
- Pharmacology and Therapeutics, School of Medicine, Centre for Pain Research and Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | - Anne Katrin Schlag
- Drug Science, St. Peters House, Wood Street, London, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
| | | | - David J Nutt
- Drug Science, St. Peters House, Wood Street, London, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Centre for Pain Research and Galway Neuroscience Centre, National University of Ireland, Galway, Ireland.
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10
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Ramasawmy P, Khalid S, Petzke F, Antal A. Pain reduction in fibromyalgia syndrome through pairing transcranial direct current stimulation and mindfulness meditation: A randomized, double-blinded, sham-controlled pilot clinical trial. Front Med (Lausanne) 2022; 9:908133. [PMID: 36314032 PMCID: PMC9596988 DOI: 10.3389/fmed.2022.908133] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background This double-blinded, randomized and sham-controlled pilot clinical trial aimed to investigate the preliminary clinical efficacy and feasibility of combining mindfulness meditation (MM) and transcranial direct current stimulation (tDCS) for pain and associated symptoms in patients with fibromyalgia syndrome (FMS). Methods Included FMS patients (age: 33 to 70) were randomized to three different groups to receive either ten daily sessions of anodal tDCS over the left primary motor cortex paired with MM for 20 min (active + MM, n = 10), sham tDCS combined with MM (sham + MM, n = 10) or no intervention (NoT, n = 10). Patients in the bimodal therapy groups received a week of training in MM prior to the stimulation. Participants reported pain intensity, the primary outcome, by filling in a pain diary daily throughout the whole study. They were also evaluated for quality of life, pressure pain sensitivity, psychological wellbeing, sleep quality and sleep quantity. Assessments were performed at three time points (baseline, immediately after treatment and one-month follow-up). Results Participants in the active + MM group did not exhibit reduced pain intensity following the bimodal therapy compared to controls. Patients in active group demonstrated clinically meaningful and significantly higher quality of life following the therapeutic intervention than other groups. There was no significant difference among groups regarding pressure pain sensitivity, sleep parameters and psychological scales. The combined treatment was well tolerated among participants, with no serious adverse effects. Conclusion This study was the first to pair these two effective non-pharmacological therapies for pain management in FMS. In the light of an underpowered sample size, repetitive anodal tDCS combined with MM did not improve pain or FMS-associated symptoms. However, patients in the active + MM group reported higher quality of life than the control groups. Studies with more participants and longer follow-ups are required to confirm our findings. Clinical trial registration [www.drks.de], identifier [DRKS00023490].
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Affiliation(s)
- Perianen Ramasawmy
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Sarah Khalid
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Frank Petzke
- Department of Anesthesiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
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Lepping RJ, McMillan ML, Chadwick AL, Mansour ZM, Martin LE, Gustafson KM. Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:953118. [PMID: 36185772 PMCID: PMC9521378 DOI: 10.3389/fpain.2022.953118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Abstract
Purpose To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,*Correspondence: Rebecca J. Lepping
| | - Miranda L. McMillan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zaid M. Mansour
- Department of Physical and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Laura E. Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States,Department for McMillan and Chadwick, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Cáceres‐Matos R, Gil‐García E, López‐Millán JM, Martínez‐Navas Á, Peña I, Cabrera‐León A. Profiles of adult people in a Spanish sample with chronic pain: Cluster analysis. J Adv Nurs 2022; 78:2837-2848. [PMID: 35285540 PMCID: PMC9540400 DOI: 10.1111/jan.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
AIM To establish groups of people with chronic non-cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. BACKGROUND Knowing the profiles of people who suffer from chronic non-cancer pain could make it possible to direct their treatment and to detect associated risks. DESIGN A cross-sectional study. METHODS A sample of 395 people with chronic non-cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. RESULTS Two groups were identified: lower level of impairment due to pain, characterized by being 45-65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. CONCLUSIONS Age, chronic non-cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. IMPACT These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person.
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Affiliation(s)
- Rocío Cáceres‐Matos
- Nursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversity of SevilleSevilleSpain
| | - Eugenia Gil‐García
- Nursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversity of SevilleSevilleSpain
| | | | | | - Isaac Peña
- Pain Department of the Virgen del Rocío University HospitalSevilleSpain
| | - Andrés Cabrera‐León
- Andalusian School of Public HealthGranadaSpain
- Biomedical Research Networking Centre on Public Health and Epidemiology (CIBERESP, Spanish Acronym)MadridSpain
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Weng HJ, Pham QTT, Chang CW, Tsai TF. Druggable Targets and Compounds with Both Antinociceptive and Antipruritic Effects. Pharmaceuticals (Basel) 2022; 15:892. [PMID: 35890193 PMCID: PMC9318852 DOI: 10.3390/ph15070892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022] Open
Abstract
Pain and itch are both important manifestations of various disorders, such as herpes zoster, atopic dermatitis, and psoriasis. Growing evidence suggests that both sensations have shared mediators, overlapping neural circuitry, and similarities in sensitization processes. In fact, pain and itch coexist in some disorders. Determining pharmaceutical agents and targets for treating pain and itch concurrently is of scientific and clinical relevance. Here we review the neurobiology of pain and itch and discuss the pharmaceutical targets as well as novel compounds effective for the concurrent treatment of these sensations.
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Affiliation(s)
- Hao-Jui Weng
- Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan;
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Quoc Thao Trang Pham
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Chia-Wei Chang
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei 100225, Taiwan
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ÇİFTÇİ B, ÖKE D. Fear of COVID-19: reflections on disease severity, sleep and anxiety in fibromyalgia patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1089198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: This study aimed to assess the effects of COVID- 19 fear and anxiety on disease severity, pain, sleep quality and health-related quality of life in fibromyalgia patients.
Material and Method: Sixty-four patients with diagnosis fibromyalgia and sixty-five healthy volunteers over 18 years of age were enrolled in the study. Sociodemographic features were evaluated. Fibromyalgia Impact Questionnaire (FIQ), Short Form 36 (SF-36), Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale(OCS), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants.
Results: The mean values of CAS, FIQ, PSQI, and BDI were found to be higher in the fibromyalgia group than the control group (p
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Affiliation(s)
- Betül ÇİFTÇİ
- Kırklareli Üniversitesi Sağlık Bilimleri Fakültesi Fizyoterapi ve Rehabilitasyon Bölümü
| | - Deniz ÖKE
- İstanbul Gaziosmanpaşa Eğitim ve Araştırma Hastanesi Fiziksel Tıp ve Rehabilitasyon Bölümü
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15
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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16
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Objective Diagnosis of Fibromyalgia Using Neuroretinal Evaluation and Artificial Intelligence. Int J Clin Health Psychol 2022; 22:100294. [PMID: 35281771 PMCID: PMC8873600 DOI: 10.1016/j.ijchp.2022.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background/Objective This study aims to identify objective biomarkers of fibromyalgia (FM) by applying artificial intelligence algorithms to structural data on the neuroretina obtained using swept-source optical coherence tomography (SS-OCT). Method The study cohort comprised 29 FM patients and 32 control subjects. The thicknesses of complete retina, 3 retinal layers [ganglion cell layer (GCL+), GCL++ (between the inner limiting membrane and the inner nuclear layer boundaries) and retinal nerve fiber layer (RNFL)] and choroid in 9 areas around the macula were obtained using SS-OCT. Discriminant capacity was evaluated using the area under the curve (AUC) and the Relief algorithm. A diagnostic aid system with an automatic classifier was implemented. Results No significant difference (p ≥ .660) was found anywhere in the choroid. In the RNFL, a significant difference was found in the inner inferior region (p = .010). In the GCL+, GCL++ layers and complete retina, a significant difference was found in the 4 regions defining the inner ring: temporal, superior, nasal and inferior. Applying an ensemble RUSBoosted tree classifier to the features with greatest discriminant capacity achieved accuracy = .82 and AUC = .82. Conclusions This study identifies a potential novel objective and non-invasive biomarker of FM based on retina analysis using SS-OCT.
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17
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Haddad HW, Mallepalli NR, Scheinuk JE, Bhargava P, Cornett EM, Urits I, Kaye AD. The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review. Pain Ther 2021; 10:827-848. [PMID: 33909266 PMCID: PMC8586285 DOI: 10.1007/s40122-021-00266-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The multifaceted clinical presentation of fibromyalgia (FM) supports the modern understanding of the disorder as a more global condition than one simply affecting pain sensation. The main pharmacologic therapies used clinically include anti-epileptics and anti-depressants. Conservative treatment options include exercise, myofascial release, psychotherapy, and nutrient supplementation. METHODS Narrative review. RESULTS Nutrient supplementation is a broadly investigated treatment modality as numerous deficiencies have been linked to FM. Additionally, a proposed link between gut microbiome patterns and chronic pain syndromes has led to studies investigating probiotics as a possible treatment. Despite positive results, much of the current evidence regarding this topic is of poor quality, with variable study designs, limited sample sizes, and lack of control groups. CONCLUSIONS The etiology of FM is complex, and has shown to be multi-factorial with genetics and environmental exposures lending influence into its development. Preliminary results are promising, however, much of the existing evidence regarding diet supplementation is of poor quality. Further, more robust studies are needed to fully elucidate the potential of this alternative therapeutic option.
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Affiliation(s)
| | - Nikita Reddy Mallepalli
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
| | - John Emerson Scheinuk
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
| | - Pranav Bhargava
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
- Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA
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Vicente Altabás MJ, Satué Palacián M, Cordón Ciordia B, Vilades Palomar E, Fernández Velasco D, Tello Roger Á, Garcia-Martín E. Neurorretina as an objective potential method for fibromyalgia diagnosis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:569-570. [PMID: 34756277 DOI: 10.1016/j.oftale.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M J Vicente Altabás
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain
| | - M Satué Palacián
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain; RETICS: Red temática de investigación en salud de las patologías oculares, Madrid, Spain
| | - B Cordón Ciordia
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain
| | - E Vilades Palomar
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain
| | - D Fernández Velasco
- Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain
| | - Á Tello Roger
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain
| | - E Garcia-Martín
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, Spain; RETICS: Red temática de investigación en salud de las patologías oculares, Madrid, Spain.
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Gilam G, Cramer EM, Webber KA, Ziadni MS, Kao MC, Mackey SC. Classifying chronic pain using multidimensional pain-agnostic symptom assessments and clustering analysis. SCIENCE ADVANCES 2021; 7:eabj0320. [PMID: 34516888 PMCID: PMC8442889 DOI: 10.1126/sciadv.abj0320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 05/26/2023]
Abstract
Chronic pain conditions present in various forms, yet all feature symptomatic impairments in physical, mental, and social domains. Rather than assessing symptoms as manifestations of illness, we used them to develop a chronic pain classification system. A cohort of real-world treatment-seeking patients completed a multidimensional patient-reported registry as part of a routine initial evaluation in a multidisciplinary academic pain clinic. We applied hierarchical clustering on a training subset of 11,448 patients using nine pain-agnostic symptoms. We then validated a three-cluster solution reflecting a graded scale of severity across all symptoms and eight independent pain-specific measures in additional subsets of 3817 and 1273 patients. Negative affect–related factors were key determinants of cluster assignment. The smallest subset included follow-up assessments that were predicted by baseline cluster assignment. Findings provide a cost-effective classification system that promises to improve clinical care and alleviate suffering by providing putative markers for personalized diagnosis and prognosis.
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Affiliation(s)
- Gadi Gilam
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eric M. Cramer
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kenneth A. Webber
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maisa S. Ziadni
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ming-Chih Kao
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C. Mackey
- Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Radunović G, Veličković Z, Rašić M, Janjić S, Marković V, Radovanović S. Assessment of gait in patients with fibromyalgia during motor and cognitive dual task walking: a cross-sectional study. Adv Rheumatol 2021; 61:53. [PMID: 34446109 DOI: 10.1186/s42358-021-00212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to assess gait pattern of patients diagnosed with fibromyalgia (FM) while performing demanding motor and/or cognitive dual tasks while walking. Further, idea was to explore possible correlations of dual task gait pattern alterations to patients' functional status and presence or absence of clinical symptoms associated with FM. METHODS Twenty-four female FM patients and 24 healthy female subjects performed a basic walking task, a dual motor, a dual mental (cognitive) and a combined, dual motor and cognitive task simultaneously. Quantitative spatial (stride length) and temporal (cycle time, swing time and double support time) gait parameters were measured using GAITRite walkway system and their variability was assessed. Patients underwent clinical examination including assessment of functional status, pain and fatigue level, psychiatric and cognitive manifestations. RESULTS The motor, cognitive and combined dual tasks affect gait performance in FM patients. Difference in tasks between FM and healthy subjects was found as double support time prolongation. Comparison of tasks showing that cycle time in FM was longer than controls and stride length was shorter in patients for all conditions, while no changes were found in any of the gait parameters variability. Further, mental/cognitive dual tasks had a larger effect than motor tasks. Correlations were also found between depression and functional status of the patients and the gait parameters. CONCLUSIONS Gait is affected in FM patients while dual task walking. No changes in stride-to-stride variability point that patients preserve stability in complex walking situations. Analysis of gait may provide additional information for the FM identification based on presence of clinical features and cognitive status. Correlation of dual task gait alterations with occurrence of clinical symptoms and influence of cognitive changes on gait pattern could additionally define FM subgroups.
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Affiliation(s)
- Goran Radunović
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Zoran Veličković
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Melanija Rašić
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Saša Janjić
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Vladana Marković
- Neurology Clinic, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, Serbia
| | - Saša Radovanović
- Institute for Medical Research, University of Belgrade, Dr Subotića 4, 11129, Belgrade, Serbia.
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21
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Vicente Altabás MJ, Satué Palacián M, Cordón Ciordia B, Vilades Palomar E, Fernández Velasco D, Tello Roger Á, Garcia-Martín E. Neurorretina as an objective potential method for fibromyalgia diagnosis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(21)00162-3. [PMID: 34419318 DOI: 10.1016/j.oftal.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M J Vicente Altabás
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España
| | - M Satué Palacián
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España; RETICS: Red temática de investigación en salud de las patologías oculares, Madrid, España
| | - B Cordón Ciordia
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España
| | - E Vilades Palomar
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España
| | - D Fernández Velasco
- Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España
| | - Á Tello Roger
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España
| | - E Garcia-Martín
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación e innovación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria Aragon (IIS Aragon), Universidad de Zaragoza, Zaragoza, España; RETICS: Red temática de investigación en salud de las patologías oculares, Madrid, España.
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22
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Cordón B, Orduna-Hospital E, Viladés E, Garcia-Martin E, Garcia-Campayo J, Puebla-Guedea M, Polo V, Larrosa JM, Pablo LE, Vicente MJ, Satue M. Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life. Curr Eye Res 2021; 47:143-153. [PMID: 34213409 DOI: 10.1080/02713683.2021.1951301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life. METHODS Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive and biological). RESULTS : Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed. CONCLUSIONS Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.
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Affiliation(s)
- B Cordón
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Orduna-Hospital
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Viladés
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Garcia-Martin
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J Garcia-Campayo
- Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain).,Psychiatry Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - M Puebla-Guedea
- Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain)
| | - V Polo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J M Larrosa
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - L E Pablo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M J Vicente
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M Satue
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
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23
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Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain. SPANISH JOURNAL OF PSYCHOLOGY 2021; 24:e33. [PMID: 34002687 DOI: 10.1017/sjp.2021.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks' λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks' λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.
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24
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Gaynor SM, Bortsov A, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, Diatchenko L, Nackley A, Tchivileva IE, Whitehead W, Alonso AA, Buchheit TE, Boortz-Marx RL, Liedtke W, Park JJ, Maixner W, Smith SB. Phenotypic profile clustering pragmatically identifies diagnostically and mechanistically informative subgroups of chronic pain patients. Pain 2021; 162:1528-1538. [PMID: 33259458 PMCID: PMC8049946 DOI: 10.1097/j.pain.0000000000002153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
ABSTRACT Traditional classification and prognostic approaches for chronic pain conditions focus primarily on anatomically based clinical characteristics not based on underlying biopsychosocial factors contributing to perception of clinical pain and future pain trajectories. Using a supervised clustering approach in a cohort of temporomandibular disorder cases and controls from the Orofacial Pain: Prospective Evaluation and Risk Assessment study, we recently developed and validated a rapid algorithm (ROPA) to pragmatically classify chronic pain patients into 3 groups that differed in clinical pain report, biopsychosocial profiles, functional limitations, and comorbid conditions. The present aim was to examine the generalizability of this clustering procedure in 2 additional cohorts: a cohort of patients with chronic overlapping pain conditions (Complex Persistent Pain Conditions study) and a real-world clinical population of patients seeking treatment at duke innovative pain therapies. In each cohort, we applied a ROPA for cluster prediction, which requires only 4 input variables: pressure pain threshold and anxiety, depression, and somatization scales. In both complex persistent pain condition and duke innovative pain therapies, we distinguished 3 clusters, including one with more severe clinical characteristics and psychological distress. We observed strong concordance with observed cluster solutions, indicating the ROPA method allows for reliable subtyping of clinical populations with minimal patient burden. The ROPA clustering algorithm represents a rapid and valid stratification tool independent of anatomic diagnosis. ROPA holds promise in classifying patients based on pathophysiological mechanisms rather than structural or anatomical diagnoses. As such, this method of classifying patients will facilitate personalized pain medicine for patients with chronic pain.
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Affiliation(s)
- Sheila M. Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Eric Bair
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
- Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain; Department of Anesthesia, School of Medicine, School of Dentistry, McGill University, Montréal, Quebec, Canada
| | - Andrea Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - Inna E. Tchivileva
- Center for Pain Research and Innovation, Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William Whitehead
- Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aurelio A. Alonso
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Thomas E. Buchheit
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Anesthesiology Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Richard L. Boortz-Marx
- Pain Medicine Division, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Wolfgang Liedtke
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jongbae J. Park
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Shad B. Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
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25
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Rehm S, Sachau J, Hellriegel J, Forstenpointner J, Børsting Jacobsen H, Harten P, Gierthmühlen J, Baron R. Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep 2021; 6:e901. [PMID: 33718743 PMCID: PMC7952123 DOI: 10.1097/pr9.0000000000000901] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Sensory abnormalities through quantitative sensory testing in fibromyalgia were not substantially influenced by psychological comorbidities. A significant subgroup showed signs of central sensitization, influenced by pain intensity. Introduction: Patients suffering from fibromyalgia syndrome (FMS) are heterogenous. They often present with sensory abnormalities and comorbidities. Objectives: We aimed to answer the following questions: (1) Is there a specific somatosensory profile in our patient cohort? (2) Can we detect subgroups characterized by a specific combination of sensory and psychological features? and (3) Do psychological parameters influence sensory signs? Methods: In 87 patients with FMS quantitative sensory testing was performed on the hand and evaluated in combination with questionnaire results regarding pain, psychological comorbidities, sleep, and functionality. Results: Patients presented different somatosensory patterns, but no specific subgroups regarding sensory signs and psychological features were detected. Hypersensitivity for noxious mechanical and thermal stimuli and hyposensitivity for nonnoxious mechanical stimuli were the most prominent features. Thirty-one percent of patients showed signs of central sensitization as indicated by abnormally increased pinprick hyperalgesia or dynamic mechanical allodynia. Central sensitization was associated with higher pain intensities (P < 0.001). Only a small influence of psychiatric comorbidities on mechanical pain sensitivity (P = 0.044) and vibration detection (P = 0.028) was found, which was partly associated with high pain intensities. A small subgroup of patients (11.4%) demonstrated thermal hyposensitivity (loss of small-fiber function). Conclusion: Patients with FMS showed various somatosensory abnormalities. These were not significantly influenced by psychological comorbidities. Signs for central sensitization were detected in about one-third of patients and associated with higher pain intensities. This supports the notion of central sensitization being a major pathophysiological mechanism in FMS, whereas small-fiber loss may be less important.
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Affiliation(s)
- Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jana Hellriegel
- Division of Psychiatry, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.,Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Mind-Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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26
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Coles ML, Weissmann R, Uziel Y. Juvenile primary Fibromyalgia Syndrome: epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis. Pediatr Rheumatol Online J 2021; 19:22. [PMID: 33648522 PMCID: PMC7923821 DOI: 10.1186/s12969-021-00493-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
Juvenile primary fibromyalgia syndrome (JPFS) is a chronic, musculoskeletal pain syndrome affecting children and adolescents, most commonly adolescent girls. The syndrome has a multifactorial etiology, with altered central pain processing playing an important role. The hallmark symptom is severe, widespread musculoskeletal pain. Other symptoms include sleep and mood disturbances, headaches, stiffness, and subjective joint swelling. Physical examination can reveal multiple tender points. The diagnosis is clinical, with defined criteria. Early diagnosis and intervention are important. In this part of the review, we discuss the epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis of JPFS. Part two will focus on treatment and prognosis.
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Affiliation(s)
- Maya Levy Coles
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., 44281, Kfar Saba, Israel
| | - Rotem Weissmann
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., 44281, Kfar Saba, Israel
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
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27
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wideman TH. A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain-Related Outcomes. Pain Pract 2021; 21:523-535. [PMID: 33316140 DOI: 10.1111/papr.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Risk constructs based on psychological risk factors (eg, pain catastrophizing, PC) and sensitization risk factors (eg, pressure pain threshold, PPT) are important in research and clinical practice. Most research looks at individual constructs but does not consider how different constructs might interact within the same individual. An evaluation of the cumulative impact of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological (PC) and sensitization (PPT) risk factors on pain-related outcomes (activity avoidance, pain severity, and disability) considering covariates. METHODS We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis, who completed all measures of this study. Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability, and pain severity). Subgroups were constructed by dichotomizing of PC and PPT scores, resulting in four groups: (1) low catastrophizing and low sensitivity (N = 26), (2) high catastrophizing and low sensitivity (N = 27), (3) low catastrophizing and high sensitivity (N = 25), and (4) high catastrophizing and high sensitivity (N = 31). RESULTS One-way analysis of variance (ANOVA) revealed significant group differences (P < 0.05, η2 = 0.08 to 0.14) in all outcomes of this study (except functional avoidance), and post hoc analysis indicated the significant differences are between group 1 and 4. A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = 0.8 to 1). The group 2 and 3 (one risk dimension groups: either high-PC or high-PPT) represent 47% of the total participants. CONCLUSIONS The study suggests both higher level of PC and pressure sensitivity have a cumulative impact on risk screening for pain-related outcomes, considering gender in functional avoidance (task-related outcome). A clinical presentation with high-PC (one dimension of risk) is not associated with high-PPT (another dimension of risk). This finding has important clinical and theoretical implications.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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28
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Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo JV, Karp BI, Merideth MA, Shah JP. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study. Eur J Pain 2021; 25:831-840. [PMID: 33326662 DOI: 10.1002/ejp.1713] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/12/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. OBJECTIVE Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain. METHODS Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. RESULTS All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). CONCLUSIONS Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. SIGNIFICANCE Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
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Affiliation(s)
- Vy T Phan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hannah K Tandon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- Biostatistics & Clinical Epidemiology Service, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Barbara I Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Melissa A Merideth
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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29
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Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010247. [PMID: 33396279 PMCID: PMC7796452 DOI: 10.3390/ijerph18010247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023]
Abstract
Fibromyalgia (FM) is a heterogeneous and complex syndrome; different studies have tried to describe subgroups of FM patients, and a 4-cluster classification based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) has been recently validated. This study aims to cross-validate this classification in a large US sample of FM patients. A pooled sample of 6280 patients was used. First, we computed a hierarchical cluster analysis (HCA) using FIQR scores at item level. Then, a latent profile analysis (LPA) served to confirm the accuracy of the taxonomy. Additionally, a cluster calculator was developed to estimate the predicted subgroup using an ordinal regression analysis. Self-reported clinical measures were used to examine the external validity of the subgroups in part of the sample. The HCA yielded a 4-subgroup distribution, which was confirmed by the LPA. Each cluster represented a different level of severity: “Mild–moderate”, “moderate”, “moderate–severe”, and “severe”. Significant differences between clusters were observed in most of the clinical measures (e.g., fatigue, sleep problems, anxiety). Interestingly, lower levels of education were associated with higher FM severity. This study corroborates a 4-cluster distribution based on FIQR scores to classify US adults with FM. The classification may have relevant clinical implications for diagnosis and treatment response.
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Ordóñez-Carrasco JL, Sánchez-Castelló M, Calandre EP, Cuadrado-Guirado I, Rojas-Tejada AJ. Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010209. [PMID: 33396651 PMCID: PMC7795109 DOI: 10.3390/ijerph18010209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.
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Affiliation(s)
- Jorge L. Ordóñez-Carrasco
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
- Correspondence:
| | - María Sánchez-Castelló
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
| | - Elena P. Calandre
- Instituto de Neurociencias “F. Oloriz”, University of Granada, 18013 Granada, Spain;
| | - Isabel Cuadrado-Guirado
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
| | - Antonio J. Rojas-Tejada
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
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Variability in experimental pain studies: nuisance or opportunity? Br J Anaesth 2020; 126:e61-e64. [PMID: 33341221 DOI: 10.1016/j.bja.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
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Abstract
Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2-5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria. Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature. Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.
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Affiliation(s)
- Kevin Hackshaw
- Division Chief of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Dell Medical School, the University of Texas , Austin, TX, USA
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Gonzalez B, Novo R, Peres R. Personality and psychopathology heterogeneity in MMPI‐2 and health‐related features in fibromyalgia patients. Scand J Psychol 2020; 62:203-210. [DOI: 10.1111/sjop.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bárbara Gonzalez
- HEI‐Lab: Digital Human‐Environment Interactions Lab Universidade Lusófona de Humanidades e Tecnologias Lisbon Portugal
| | - Rosa Novo
- CICPSI, Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Rodrigo Peres
- Instituto de Psicologia Universidade Federal de Uberlândia Uberlândia Brazil
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Sahar K, Thomas SA, Clarke SP. Adjustment to fibromyalgia: The role of domain‐specific self‐efficacy and acceptance. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karan Sahar
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
| | - Shirley A. Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
| | - Simon P. Clarke
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK,
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Central Sensitivity Is Associated with Poor Recovery of Pain: Prediction, Cluster, and Decision Tree Analyses. Pain Res Manag 2020; 2020:8844219. [PMID: 33178373 PMCID: PMC7647749 DOI: 10.1155/2020/8844219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.
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Hazra S, Venkataraman S, Handa G, Yadav SL, Wadhwa S, Singh U, Kochhar KP, Deepak KK, Sarkar K. A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia. Front Neurosci 2020; 14:788. [PMID: 32848561 PMCID: PMC7417433 DOI: 10.3389/fnins.2020.00788] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiology of fibromyalgia is supposedly an interplay between central nervous system hyper-responsiveness, autonomic dysfunction, and peripheral pain. In this cross-sectional study, the objective was to assess central sensitization and autonomic activity in patients with fibromyalgia compared with control. Fifty adults diagnosed with fibromyalgia by the modified American College of Rheumatology 2010 criteria and an equal number of age- and sex-matched controls participated in the study in an urban tertiary care hospital. Central sensitization was assessed by history and by evidence of increased prefrontal cortical activity as measured by cortical oxygenation using functional near-infrared spectroscopy. Autonomic activity was assessed by heart rate variability, electrodermal activity, and deep breathing test in three physiological states: rest, sympathetic stress (cold pressor test), and deep breathing. Mann–Whitney U-test, paired t-test, Wilcoxon test, and Friedman test with Bonferroni a priori were used to analyze the data. Cortical activity was significantly higher in the fibromyalgia group than control. There was no significant difference in autonomic activity between the fibromyalgia and control groups. In the fibromyalgia group, variable degrees of sympathetic hyperactivity and normal parasympathetic activity were observed. Central sensitization may be playing a primary role in the pathophysiology of generalized pain in fibromyalgia.
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Affiliation(s)
- Sandipan Hazra
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Gita Handa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - S L Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Wadhwa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - U Singh
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - K P Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - K K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kaushik Sarkar
- Department of Electronics and Communication Engineering, Narula Institute of Technology, Kolkata, India
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Davies AF, Hill P, Fay D, Dee A, Locher C. Body Reprogramming: Reframing the Fibromyalgia narrative and providing an integrative therapeutic model. Health Psychol Open 2020; 7:2055102920971494. [PMID: 35186312 PMCID: PMC8851147 DOI: 10.1177/2055102920971494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We propose a theory known as the Hyland model to help conceptualise
Fibromyalgia within a complex adaptive control system. A fundamental
assumption is that symptom generating mechanisms are causally
connected, forming a network that has emergent properties. An illness
narrative has been developed which has a ‘goodness of fit’ with the
lived experience of those with Fibromyalgia. The theory guides
management within the clinical setting and incorporates current
evidence-based therapeutic strategies, within a multi-modal
intervention described as ‘Body Reprogramming’. This intervention
focuses on non-pharmacological and lifestyle-based considerations. The
theoretical framework also helps explain why modest therapeutic
effects are gained from current pharmacological options.
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Affiliation(s)
| | - Patrick Hill
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - Annily Dee
- University Hospitals Plymouth NHS Trust, UK
| | - Cosima Locher
- Harvard Medical School, USA.,University of Plymouth, UK.,University of Basel, Switzerland
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Zdebik N, Zdebik A, Bogusławska J, Przeździecka-Dołyk J, Turno-Kręcicka A. Fibromyalgia syndrome and the eye-A review. Surv Ophthalmol 2020; 66:132-137. [PMID: 32512032 DOI: 10.1016/j.survophthal.2020.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
Fibromyalgia is a chronic, widespread pain syndrome of unclear etiology characterized by fatigue, sleeping problems, cognitive disorders, somatic complaints, and severe pain in parts of the body at the time of physical activity, with no laboratory findings specific to the disease or diagnostic tests. Fibromyalgia can be associated with ocular symptoms (foreign body sensation, irritation) and visual disturbances (blurred vision), coexisting with dry eye syndrome and reduced corneal sensitivity. Cases of scleritis, including the necrotizing form, accompanying fibromyalgia have been reported. Changes in the eye may contribute to the pathogenesis of fibromyalgia. Research shows the choroid to be significantly thinner in patients with fibromyalgia, revealing changes in optic disc perfusion and a decreased retinal nerve fiber layer thickness. There are also thin corneal stromal nerves with diminished sub-basal plexus nerve density. Pathological changes and functional abnormalities of small nerve fibers are observed in patients with fibromyalgia. Corneal confocal bio-microscopy is a new noninvasive method to evaluate small nerve fiber morphology, serving as an alternative for skin biopsies, and reveals new possibilities in diagnostics and finding innovative therapies for this disease. Fibromyalgia remains a challenge for ophthalmologists, and further studies are required to evaluate ocular involvement. It may be that future diagnostic criteria for fibromyalgia will contain ophthalmic examination modalities. Observed ocular changes and their pathomechanisms may constitute new targets for therapy to improve the quality of life of patients with fibromyalgia.
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Affiliation(s)
- Natalia Zdebik
- University of Wrocław, Clinic of Ophthalmology, Wrocław, Poland
| | - Alexander Zdebik
- Carl-Thiem-Klinikum, Klinik für Dermatologie und Allergologie, Cottbus, Germany.
| | - Joanna Bogusławska
- Provincial Specialist Hospital in Wrocław, Clinic of Ophthalmology, Wrocław, Poland
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Izquierdo-Alventosa R, Inglés M, Cortés-Amador S, Gimeno-Mallench L, Chirivella-Garrido J, Kropotov J, Serra-Añó P. Low-Intensity Physical Exercise Improves Pain Catastrophizing and Other Psychological and Physical Aspects in Women with Fibromyalgia: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103634. [PMID: 32455853 PMCID: PMC7277480 DOI: 10.3390/ijerph17103634] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain and other physical and psychological features. In this study, we aimed to analyze the effect of a low-intensity physical exercise (PE) program, combining endurance training and coordination, on psychological aspects (i.e., pain catastrophizing, anxiety, depression, stress), pain perception (i.e., pain acceptance, pressure pain threshold (PPT), and quality of life and physical conditioning (i.e., self-perceived functional capacity, endurance and functional capacity, power and velocity) in women with FM. For this purpose, a randomized controlled trial was carried out. Thirty-two women with FM were randomly allocated to a PE group (PEG, n = 16), performing an eight-week low-intensity PE program and a control group (CG, n = 16). Pain catastrophizing, anxiety, depression, stress, pain acceptance, PPT, quality of life, self-perceived functional capacity, endurance and functional capacity, power, and velocity were assessed before and after the intervention. We observed a significant improvement in all studied variables in the PEG after the intervention (p < 0.05). In contrast, the CG showed no improvements in any variable, which further displayed poorer values for PPT (p < 0.05). In conclusion, a low-intensity combined PE program, including endurance training and coordination, improves psychological variables, pain perception, quality of life, and physical conditioning in women with FM.
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Affiliation(s)
- Ruth Izquierdo-Alventosa
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 València, Spain; (R.I.-A.); (S.C.-A.); (P.S.-A.)
| | - Marta Inglés
- Freshage Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES-ISCIII), Fundación Investigación del Hospital Clínico Universitario de Valencia (INCLIVA), 46010 València, Spain
- Correspondence: ; Tel.: +34-963-98-38-55
| | - Sara Cortés-Amador
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 València, Spain; (R.I.-A.); (S.C.-A.); (P.S.-A.)
| | - Lucia Gimeno-Mallench
- Freshage Research Group, Department of Physiology, Faculty of Medicine, Universitat de València, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES-ISCIII), Fundación Investigación del Hospital Clínico Universitario de Valencia (INCLIVA), 46010 València, Spain;
| | | | - Juri Kropotov
- N.P. Bechtereva Institute of Human Brain, Russian Academy of Science, 197022 St. Petersburg, Russia;
| | - Pilar Serra-Añó
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 València, Spain; (R.I.-A.); (S.C.-A.); (P.S.-A.)
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Pressure Pain Tolerance Predicts the Success of Emotional Awareness and Expression Therapy in Patients With Fibromyalgia. Clin J Pain 2020; 36:562-566. [PMID: 32271184 DOI: 10.1097/ajp.0000000000000829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quantitative sensory testing may help predict treatment responses in individuals with chronic pain. Our objective was to determine whether evoked pain sensitivity at baseline predicted preferential treatment responses to either emotional awareness and expression therapy (EAET) or cognitive behavioral therapy (CBT) in individuals with fibromyalgia (FM). METHODS This was a secondary analysis of a previous randomized clinical trial, in which individuals with FM were randomized to EAET, CBT, or Education as a control intervention. Only females who completed baseline and post-treatment assessments were analyzed (n=196). The primary outcome was change in overall clinical pain severity from pretreatment to posttreatment, and the primary predictor of interest was pressure pain tolerance at baseline. RESULTS Among patients with low pain tolerance at baseline (n=154), both EAET and CBT led to small but significant improvements in clinical pain severity (CBT mean=0.66, 95% confidence interval [0.24-1.07]; EAET mean=0.76 [0.34-1.17]). Conversely, in patients with normal pain tolerance (n=42), there was no significant improvement in clinical pain after CBT (0.13 [-0.88 to 1.14]), a small improvement after FM Education (0.81 [0.14-1.48]), but a much larger and statistically significant improvement after EAET (2.14 [1.23-3.04]). DISCUSSION Normal levels of pressure pain tolerance at baseline predicted greater improvement in clinical pain severity after EAET than CBT. Quantitative sensory testing may provide insights about individual responses to psychologically based therapies for individuals with chronic pain.
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Merante D. The mirogabalin ALDAY phase 3 program in pain associated with fibromyalgia: the lessons learned. Curr Med Res Opin 2020; 36:661-666. [PMID: 32027198 DOI: 10.1080/03007995.2020.1725744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
Aims: The main aim of this work was to identify and to share the lessons learned from the negative outcome of the mirogabalin ALDAY phase 3 clinical program in pain associated with fibromyalgia. These lessons are important to improve planning and design of future phase 3 programs in fibromyalgia.Methods: A systematic review from Cochrane Library, Medline, Embase, clinicaltrials.gov, pharmaceutical companies, and regulatory agencies' websites, was carried out starting from the development of gabapentin, the first α2δ ligand studied for the treatment of neuropathic pain and ending with the mirogabalin program.Results: Based on the outcome of the main fibromyalgia programs, several differences in design, primary endpoint choice, magnitude of placebo response, presence of an active comparator, and size of the entire clinical program were identified. This analysis focused on the negative primary results of the mirogabalin ALDAY program and found several contributing factors. Above all, the magnitude of placebo response and the unprecedented size of the program were identified. The number of study visits and procedures was also high and highly demanding on all subjects involved in ALDAY.Outcome: In terms of main lessons learned from ALDAY, the first was the need for a comprehensive patient-focused strategy to preliminarily identify the challenges of fibromyalgia based on patient perspective and study complexity. Second, there was a need for a harmonized, truly patient-centric, global regulatory guidance accepted by regulatory agencies. Third, ALDAY proved that a phase 2 proof of concept, dose ranging study is necessary before commencing any phase 3 program in fibromyalgia.
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Terol Cantero MC, Buunk AP, Cabrera V, Bernabé M, Martin-Aragón Gelabert M. Profiles of Women With Fibromyalgia and Social Comparison Processes. Front Psychol 2020; 11:440. [PMID: 32231628 PMCID: PMC7082725 DOI: 10.3389/fpsyg.2020.00440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background Due to uncertainty regarding chronic pain in Fibromyalgia (FM) patients, there has been a growing interest in social comparison and its influence on emotional responses. Aims to analyze profiles in FM patients according to pain perception, social comparison strategies and anxiety and depression. Methods The sample consisted of 131 FM outpatients (Mean age: 50.15, SD = 11.1). Two scales were used: the Social Comparison Illness Scale and the Hospital Anxiety and Depression Scale. Results Two profiles were found by cluster analysis (K-means method): one (66%) with a higher level of pain perception, anxiety and depression and greater use of upward contrast and downward identification social comparison; and another (34%) with lower levels of pain perception, anxiety and depression and greater use of upward identification and downward contrast. Conclusion These profiles underline the interest in social comparison strategies and their role in FM.
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Affiliation(s)
- M Carmen Terol Cantero
- Departamento Ciencias del Comportamiento y Salud, Facultad Ciencias Sociosanitarias, Universidad Miguel Hernández, Elche, Spain.,Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Abraham P Buunk
- Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Victor Cabrera
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
| | - Miguel Bernabé
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Maite Martin-Aragón Gelabert
- Departamento Ciencias del Comportamiento y Salud, Facultad Ciencias Sociosanitarias, Universidad Miguel Hernández, Elche, Spain
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43
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Woldeamanuel YW, Sanjanwala BM, Peretz AM, Cowan RP. Exploring Natural Clusters of Chronic Migraine Phenotypes: A Cross-Sectional Clinical Study. Sci Rep 2020; 10:2804. [PMID: 32071349 PMCID: PMC7028739 DOI: 10.1038/s41598-020-59738-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/03/2020] [Indexed: 01/03/2023] Open
Abstract
Heterogeneity in chronic migraine (CM) presents significant challenge for diagnosis, management, and clinical trials. To explore naturally occurring clusters of CM, we utilized data reduction methods on migraine-related clinical dataset. Hierarchical agglomerative clustering and principal component analyses (PCA) were conducted to identify natural clusters in 100 CM patients using 14 migraine-related clinical variables. Three major clusters were identified. Cluster I (29 patients) - the severely impacted patient featured highest levels of depression and migraine-related disability. Cluster II (28 patients) - the minimally impacted patient exhibited highest levels of self-efficacy and exercise. Cluster III (43 patients) - the moderately impacted patient showed features ranging between Cluster I and II. The first 5 principal components (PC) of the PCA explained 65% of variability. The first PC (eigenvalue 4.2) showed one major pattern of clinical features positively loaded by migraine-related disability, depression, poor sleep quality, somatic symptoms, post-traumatic stress disorder, being overweight and negatively loaded by pain self-efficacy and exercise levels. CM patients can be classified into three naturally-occurring clusters. Patients with high self-efficacy and exercise levels had lower migraine-related disability, depression, sleep quality, and somatic symptoms. These results may ultimately inform different management strategies.
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Affiliation(s)
- Yohannes W Woldeamanuel
- Stanford Headache and Facial Pain Division, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Bharati M Sanjanwala
- Stanford Headache and Facial Pain Division, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Addie M Peretz
- Stanford Headache and Facial Pain Division, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert P Cowan
- Stanford Headache and Facial Pain Division, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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López-Ruiz M, Losilla JM, Monfort J, Portell M, Gutiérrez T, Poca V, Garcia-Fructuoso F, Llorente J, Garcia-Fontanals A, Deus J. Central sensitization in knee osteoarthritis and fibromyalgia: Beyond depression and anxiety. PLoS One 2019; 14:e0225836. [PMID: 31805099 PMCID: PMC6894784 DOI: 10.1371/journal.pone.0225836] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives To determine the psychopathological profile of patients with central sensitization (CS) in a sample of knee osteoarthritis, with and without CS, and fibromyalgia, and to compare their psychopathological profiles. Methods The final sample consists of 19 patients with osteoarthritis and CS (mean 66.37 years ± 8.77), 41 osteoarthritis patients without CS (mean 66.8 ± 7.39 years), 47 fibromyalgia patients (mean 46.47 years ± 7.92) and 26 control subjects (mean 51.56 years ± 11.41). The psychopathological profile was evaluated with the Millon Multiaxial Clinical Inventory. Results The average score of MCMI-III reflect higher scores in the fibromyalgia and osteoarthritis-CS groups. Patients with osteoarthritis-CS are more likely to report larger scores in Borderline and Major Depression scales. Fibromyalgia patients are more likely to report more increased scores in Somatoform and Major Depression, versus osteoarthritis-CS group. Fibromyalgia patients versus osteoarthritis without CS are more likely to report higher scores in Schizoid, Depression, Histrionic, Sadistic, Borderline, Somatoform, Posttraumatic Stress Disorder and Major Depression scales. Discussion Patients with CS have less differences in their psychopathological profiles as well as in both osteoarthritis groups and greatest differences are obtained between the fibromyalgia and osteoarthritis without CS, so perhaps presence of CS is the key to differentiate those groups and not chronic pain. An exhaustive assessment brings more accurate psychopathological profiles, thus better psychological treatment could be applied.
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Affiliation(s)
- Marina López-Ruiz
- Service of Psychiatry and Psychology, HM-Sant Jordi Clinic, Barcelona, Spain
- * E-mail:
| | - Josep Maria Losilla
- Department of Methodology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Jordi Monfort
- Rheumatology Service, Hospital del Mar, Barcelona, Spain
| | - Mariona Portell
- Department of Methodology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Teresa Gutiérrez
- Department of Clinical and Health Psychology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Violant Poca
- Rheumatology Service, Institute Ferran of Rheumatology (IFR), Barcelona, Spain
| | | | - Jone Llorente
- Rheumatology Service, Hospital del Mar, Barcelona, Spain
| | | | - Joan Deus
- Service of Psychiatry and Psychology, HM-Sant Jordi Clinic, Barcelona, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
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45
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Ellingson LD, Stegner AJ, Schwabacher IJ, Lindheimer JB, Cook DB. Catastrophizing Interferes with Cognitive Modulation of Pain in Women with Fibromyalgia. PAIN MEDICINE 2019; 19:2408-2422. [PMID: 29474665 DOI: 10.1093/pm/pny008] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Pain modulation is a critical function of the nociceptive system that includes the ability to engage descending pain control systems to maintain a functional balance between facilitation and inhibition of incoming sensory stimuli. Dysfunctional pain modulation is associated with increased risk for chronic pain and is characteristic of fibromyalgia (FM). Catastrophizing is also common in FM. However, its influence on pain modulation is poorly understood. Objective To determine the role of catastrophizing on central nervous system processing during pain modulation in FM via examining brain responses and pain sensitivity during an attention-distraction paradigm. Methods Twenty FM patients and 18 healthy controls (CO) underwent functional magnetic resonance imaging while receiving pain stimuli, administered alone and during distracting cognitive tasks. Pain ratings were assessed after each stimulus. Catastrophizing was assessed with the Pain Catastrophizing Scale (PCS). Results The ability to modulate pain during distraction varied among FM patients and was associated with catastrophizing. This was demonstrated by significant positive relationships between PCS scores and pain ratings (P < 0.05) and brain responses in the dorsolateral prefrontal cortex (P < 0.01). Relationships between catastrophizing and pain modulation did not differ between FM and CO (P > 0.05). Conclusions FM patients with higher levels of catastrophizing were less able to distract themselves from pain, indicative of catastrophizing-related impairments in pain modulation. These results suggest that the tendency to catastrophize interacts with attention-resource allocation and may represent a mechanism of chronic pain exacerbation and/or maintenance. Reducing catastrophizing may improve FM symptoms via improving central nervous system regulation of pain.
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Affiliation(s)
- Laura D Ellingson
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Isaac J Schwabacher
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
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Sensory Function and Pain Experience in Arthritis, Complex Regional Pain Syndrome, Fibromyalgia Syndrome, and Pain-Free Volunteers. Clin J Pain 2019; 35:894-900. [DOI: 10.1097/ajp.0000000000000751] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Quantitative Data for Transcutaneous Electrical Nerve Stimulation and Acupuncture Effectiveness in Treatment of Fibromyalgia Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:9684649. [PMID: 30949223 PMCID: PMC6425376 DOI: 10.1155/2019/9684649] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022]
Abstract
Aim. To evaluate the effects of acupuncture and transcutaneous electric nerve stimulation (TENS) applications on the quantitative electroencephalography (qEEG) changes and to evaluate their therapeutic effects in patients with fibromyalgia syndrome (FMS). The study included 42 patients with FMS and 21 healthy volunteers. The patients were randomly assigned to two groups (n=21 in each) to undergo either TENS or acupuncture application. In both acupuncture and TENS groups, baseline electroencephalography (EEG) recording was performed for 10 min and, then, TENS or acupuncture was performed for 20 min, followed by another 10 min EEG recording. Baseline qEEG findings of FMS patients in the TENS and acupuncture groups were similar. Delta and theta powers over the frontal region of FMS patients were lower than controls. Theta powers of right posterior region were also lower than controls. In the TENS group, after the treatment, an increase was observed in the alpha power of the left anterior region as well as a decrease in pain scores. In the acupuncture group, an increase was determined in the alpha power of the right and left posterior regions as well as a decrease in pain score after the treatment. The power of low- and moderate-frequency waves on resting EEG was decreased in the patients with FMS. Decreased pain and increased inhibitor activity were found on qEEG after TENS and acupuncture applications. In conclusion, both TENS and acupuncture applications seem to be beneficial in FMS patients.
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48
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Ozen S, Saracgil Cosar SN, Cabioglu MT, Cetin N. A Comparison of Physical Therapy Modalities Versus Acupuncture in the Treatment of Fibromyalgia Syndrome: A Pilot Study. J Altern Complement Med 2019; 25:296-304. [DOI: 10.1089/acm.2018.0330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Selin Ozen
- Department of Physical and Rehabilitation Medicine and Baskent University Faculty of Medicine, Ankara, Turkey
| | - Sacide Nur Saracgil Cosar
- Department of Physical and Rehabilitation Medicine and Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Nuri Cetin
- Department of Physical and Rehabilitation Medicine and Baskent University Faculty of Medicine, Ankara, Turkey
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49
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Kashikar-Zuck S, Cunningham N, Peugh J, Black WR, Nelson S, Lynch-Jordan AM, Pfeiffer M, Tran ST, Ting TV, Arnold LM, Carle A, Noll J, Powers SW, Lovell DJ. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain 2019; 160:433-441. [PMID: 30335681 PMCID: PMC6344278 DOI: 10.1097/j.pain.0000000000001415] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Juvenile-onset fibromyalgia (JFM) is typically diagnosed in adolescence and characterized by widespread pain and marked functional impairment. The long-term impact of JFM into adulthood is poorly understood. The objectives of this study were to describe physical and psychosocial outcomes of youth diagnosed with JFM in early adulthood (∼8-year follow-up), examine longitudinal trajectories of pain and depressive symptoms from adolescence to young adulthood, and examine the impact of pain and depressive symptoms on physical functioning over time. Participants were 97 youth with JFM enrolled in a prospective longitudinal study in which pain symptoms, and physical and psychosocial functioning were assessed at 4 time points over approximately 8 years. At the time 4 follow-up (Mage = 24.2 years), the majority continued to suffer from pain and impairment in physical, social, and psychological domains. However, trajectories of pain and emotional symptoms showed varying patterns. Longitudinal analysis using growth mixture modeling revealed 2 pain trajectories (Steady Improvement and Rapid Rebounding Improvement), whereas depressive symptoms followed 3 distinct trajectories (Low-Stable, Improving, and Worsening). Membership in the Worsening Depressive symptoms group was associated with poorer physical functioning over time (P < 0.001) compared with the Low-Stable and Improving groups. This study offers evidence that although JFM symptoms persist for most individuals, pain severity tends to decrease over time. However, depressive symptoms follow distinct trajectories that indicate subgroups of JFM. In particular, JFM patients with worsening depressive symptoms showed decreasing physical functioning and may require more intensive and consistent intervention to prevent long-term disability.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Natoshia Cunningham
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - James Peugh
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - William R. Black
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Sarah Nelson
- Department of Anesthesia, Pain and Perioperative Medicine, Boston Children’s Hospital
- Department of Psychiatry, Harvard Medical School
| | - Anne M. Lynch-Jordan
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Megan Pfeiffer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | | | - Tracy V. Ting
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Psychology, DePaul University, Chicago
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
| | - Lesley M. Arnold
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
| | - Jennie Noll
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Scott W. Powers
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
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50
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Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire–Revised: differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes. Pain 2018; 160:908-921. [DOI: 10.1097/j.pain.0000000000001468] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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