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Bissoto JR, Silva Júnior JURD, Alvares GP, Santos FH, Len CA. Acupuncture for pediatric chronic pain: A systematic review. J Pediatr (Rio J) 2024:S0021-7557(24)00055-X. [PMID: 38697213 DOI: 10.1016/j.jped.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population. SOURCES A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria. SUMMARY OF THE FINDINGS 2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria. CONCLUSION The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings.
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Affiliation(s)
- João Roberto Bissoto
- Departamento de Pediatria, Grupo de Reumatologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Departamento de Ortopedia e Traumatologia, Grupo de Acupuntura, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Gabrielle Pignoli Alvares
- Departamento de Psicologia, Campus Bauru, Universidade Estadual Paulista Julio de Mesquita Filho, Bauru, SP, Brazil
| | - Flávia H Santos
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Claudio Arnaldo Len
- Departamento de Pediatria, Grupo de Reumatologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Zhang H, Zhang X, Wang Y, Sun X, Li S, Zhang J, Jiao J. Effects of traditional Chinese exercises in fibromyalgia syndrome: A meta-analysis of randomized controlled trials. Complement Ther Med 2024; 80:103019. [PMID: 38211633 DOI: 10.1016/j.ctim.2024.103019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/25/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES To explore the efficacy and safety of five traditional Chinese exercises (TCEs) in patients with fibromyalgia syndrome (FMS). METHODS The PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane, CNKI, WanFang, and VIP databases were comprehensively searched for randomized controlled trials (RCTs) related to TCEs published from inception until February 2023. Standardized mean differences (SMD) and 95% confidence intervals (CI) were used to determine the combined effects of the intervention, and the Cochrane risk-of-bias assessment tool and Review 5.2 software were used to assess methodological quality. The data were extracted and analyzed by the Stata15.0 random effects model. RESULTS Nineteen RCTs including 1315 participants were included in the analysis. The studies were found to be heterogeneous (I2 =86.2, P = 0.000), and thus a random effects model was used to combine the data. The results showed that traditional Chinese exercises had potentially beneficial effects on reducing pain (SMD =-0.66,95% CI [-1.08, -0.25], P = 0.002), improving sleep (SMD = -0.35,95% CI [-0.68,0. 01], P = 0.041) and relieving depression (SMD= -0.24,95% CI [-0.47, -0.02], P = 0.034) in FMS patients. However, no significant effects were found on improved quality of life (SMD =-0.20,95% CI [-0.48,0.09], P = 0.176). CONCLUSIONS TCEs can improve pain, sleep quality and depression in patients with FMS and are safe. However, they do not improve the quality of life significantly. Further large-scale, high-quality, and multi-center RCTs are required to verify the efficacy of TCEs.
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Affiliation(s)
- Hongshi Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Xiaotu Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Yidan Wang
- Changchun University of Chinese Medicine, Changchun, China
| | - Xuefeng Sun
- Changchun University of Chinese Medicine, Changchun, China
| | - Sixuan Li
- Changchun University of Chinese Medicine, Changchun, China
| | - Jindan Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Jundong Jiao
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China.
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Lima D, Pacheco-Barrios K, Slawka E, Camargo L, Castelo-Branco L, Cardenas-Rojas A, Neto MS, Fregni F. The role of symptoms severity, heart rate, and central sensitization for predicting sleep quality in patients with fibromyalgia. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1153-1160. [PMID: 37314968 PMCID: PMC10546479 DOI: 10.1093/pm/pnad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical predictors of sleep quality in patients with fibromyalgia syndrome (FMS) are still unknown. By identifying these factors, we could raise new mechanistic hypotheses and guide management approaches. We aimed to describe the sleep quality of FMS patients and to explore the clinical and quantitative sensory testing (QST) predictors of poor sleep quality and its subcomponents. METHODS This study is a cross-sectional analysis of an ongoing clinical trial. We performed linear regression models between sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and demographic, clinical, and QST variables, controlling for age and gender. Predictors for the total PSQI score and its seven subcomponents were found using a sequential modeling approach. RESULTS We included 65 patients. The PSQI score was 12.78 ± 4.39, with 95.39% classified as poor sleepers. Sleep disturbance, use of sleep medications, and subjective sleep quality were the worst subdomains. We found poor PSQI scores were highly associated with symptom severity (FIQR score and PROMIS fatigue), pain severity, and higher depression levels, explaining up to 31% of the variance. Fatigue and depression scores also predicted the subjective sleep quality and daytime dysfunction subcomponents. Heart rate changes (surrogate of physical conditioning) predicted the sleep disturbance subcomponent. QST variables were not associated with sleep quality or its subcomponents. CONCLUSIONS Symptom severity, fatigue, pain, and depression (but no central sensitization) are the main predictors of poor sleep quality. Heart rate changes independently predicted the sleep disturbance subdomain (the most affected one in our sample), suggesting an essential role of physical conditioning in modulating sleep quality in FMS patients. This underscores the need for multidimensional treatments targeting depression and physical activity to improve the sleep quality of FMS patients.
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Affiliation(s)
- Daniel Lima
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15023, Peru
| | - Eric Slawka
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Lucas Camargo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Moacir Silva Neto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15023, Peru
- Life Checkup—Medicina Esportiva Avançada, Brasilia 70040, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
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Nascimento Leite M, Kamper SJ, O'Connell NE, Michaleff ZA, Fisher E, Viana Silva P, Williams CM, Yamato TP. Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents. Cochrane Database Syst Rev 2023; 7:CD013527. [PMID: 37439598 PMCID: PMC10339856 DOI: 10.1002/14651858.cd013527.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity. OBJECTIVES To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain. DATA COLLECTION AND ANALYSIS Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale. MAIN RESULTS We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. AUTHORS' CONCLUSIONS We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.
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Affiliation(s)
- Mariana Nascimento Leite
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Effects of an Exercise for Well-Being and Physical Training Programme on Muscle Strength, Range of Movement, Respiratory Capacity and Quality of Life in Women with Fibromyalgia: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12030774. [PMID: 36769424 PMCID: PMC9918138 DOI: 10.3390/jcm12030774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
The objective of this study was to assess the efficacy of an active exercise physiotherapy programme versus an exercise for well-being programme improving muscle strength, range of movement, respiratory capacity and quality of life of women with fibromyalgia. A randomized, assessor-blind, controlled trial was conducted. A total of 141 women diagnosed with fibromyalgia were randomized to a physiotherapy exercise group (n = 47), an exercise for well-being group (n = 47) and a control group (n = 47). The study lasted 4 weeks and the experimental groups received 45 min sessions performed twice a week on alternate days. The primary outcome measures were range of movement and muscle strength. The secondary outcome measures were respiratory capacity and quality of life. The results showed statistically significant improvements in the exercise for well-being and physiotherapy groups vs. the control group at week 5 in relation to joint range of movement (p = 0.004), muscle strength (p = 0.003) and quality of life (p = 0.002). The changes found in all the spirometry parameters seem to be associated to some of the changes in joint range of movement and muscle strength as well as quality of life. Physiotherapy and exercise for well-being improved upper limb and lower limb range of movement and the muscle strength of women with fibromyalgia.
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Suder R, DeBoth KK, Carrick A, Davis J, Farrar B. A Systematic Review of Occupational Therapy-Related Interventions for Pediatric Chronic Pain. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:61-73. [PMID: 35872657 DOI: 10.1177/15394492221110544] [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: 12/29/2022]
Abstract
Occupational therapists have distinct value providing pediatric chronic pain interventions (e.g., pain management, normalizing sensory responses, increasing participation); however, limited evidence exists. This review appraised empirical studies on occupational therapy pediatric chronic pain management. Three reviewers independently screened 2,401 titles, 250 abstracts, and 71 full-text sources for studies published in English, after 2008, and with sample sizes >10, participants <18 years, with chronic pain >3 months, and outcomes related to pain/function. Studies were assessed for risk of bias. The review included 23 studies on psychological, interprofessional, virtual/telehealth, or biomechanical management, demonstrating significant decreases in pain/disability. Most studies had high risk of bias for lack of randomization and control groups, and homogeneous sampling. The occupational therapists' role in chronic pain interventions is still unclear. Research including larger, heterogenous samples is warranted to examine occupational therapy's specific role providing pain interventions as part of a team.
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Affiliation(s)
- Ryan Suder
- Cleveland Clinic Children's Hospital, Cuyahoga Falls, OH, USA
| | | | | | - Julia Davis
- Cleveland State University, Cleveland, OH, USA
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Haun JN, Alman AC, Jean-Baptiste E, Melillo C, McMahon-Grenz J, Paykel JM. Delivery of Complementary and Integrative Health Using Virtual Health Resources: A Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:851-861. [PMID: 35819410 PMCID: PMC9700349 DOI: 10.1089/jicm.2021.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Complementary and integrative health (CIH) modalities promote overall health and well-being and can be beneficial for individuals with a range of conditions. Traditionally, CIH has been delivered in person. COVID-19 created a need to identify sustainable remote delivery options to assure access to CIH while practicing public health recommendations. This scoping review maps the opportunities and challenges to remotely delivered CIH. Materials and methods: A scoping review was conducted between June 2020 and October 2020 using the following search engines: PubMed, Academic Search Premier, PsycINFO, CINAHL, Cochrane Reviews, and the Cochrane Clinical Trial Collections. Search results investigating remote CIH delivery were restricted to articles written in English, published after 1990. Results: Of the 10,884 articles identified, after review for content and methods, 330 articles were included. Most articles were randomized controlled trials (n = 170), applied mindfulness (n = 203), and targeted mental and behavioral health conditions (n = 182). Interventions were primarily delivered through mobile applications (n = 151) and web-based platforms (n = 86). Most commonly reported barriers were adherence (n = 24), resource requirements (e.g., time and space) (n = 23), and technology-related issues (n = 21). Although most studies did not report facilitators (n = 217), most commonly reported facilitators were social and technologic supports, accessibility, usability, perceptions, and rewards. Participant outcomes measured were broad and included movement (n = 88), stress (n = 68), and pain (n = 54). Intervention characteristic outcomes most often measured were satisfaction and usability (n = 5). Conclusions: This scoping literature review identified many articles addressing remote delivery of CIH, but few reporting on the implementation of remotely delivered CIH. Findings suggest remotely delivered CIH, specifically mindfulness and meditation-based modalities, is a viable treatment option for a diverse range of health conditions. Feasibility studies and larger sample sizes are recommended to strengthen the scientific evidence.
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Affiliation(s)
- Jolie N. Haun
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Amy C. Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Esther Jean-Baptiste
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Christine Melillo
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Julie McMahon-Grenz
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
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Ross E, Abulaban K, Kessler E, Cunningham N. Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review. Lupus 2022; 31:864-879. [PMID: 35442103 DOI: 10.1177/09612033221094704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE. METHODS A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results. RESULTS Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue). CONCLUSION This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.
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Affiliation(s)
- Elizabeth Ross
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Khalid Abulaban
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Elizabeth Kessler
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Natoshia Cunningham
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,Department of Family Medicine, 12268Michigan State University, East Lansing, MI, USA
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Fisher E, Villanueva G, Henschke N, Nevitt SJ, Zempsky W, Probyn K, Buckley B, Cooper TE, Sethna N, Eccleston C. Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis. Pain 2022; 163:e1-e19. [PMID: 33883536 DOI: 10.1097/j.pain.0000000000002297] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Chronic pain in childhood is an international public health problem. We conducted a systematic review and meta-analysis to provide a summary of the published evidence of pharmacological, physical, and psychological therapies for children with chronic pain conditions. We searched CENTRAL, MEDLINE, EMBASE, and PsycINFO from inception to April 2020; clinical trial registries; and other sources for randomised controlled trials or comparative observational trials. We extracted critical outcomes of pain intensity, quality of life, physical functioning, role functioning, emotional functioning, sleep, and adverse events. We assessed studies for risk of bias and certainty of the evidence using GRADE. We included 34 pharmacological (4091 participants), 25 physical therapy (1470 participants), and 63 psychological trials (5025 participants). Participants reported a range of chronic pain conditions. Most studies were assessed to have unclear or high risk of bias across multiple domains. Pharmacological, physical, and psychological therapies showed some benefit for reducing pain, posttreatment, but only physical and psychological therapies improved physical functioning. We found no benefit of any treatment modality for health-related quality of life, role functioning, emotional functioning, or sleep. Adverse events were poorly reported, particularly for psychological and physical interventions. The largest evidence base for the management of chronic pain in children supports the use of psychological therapies, followed by pharmacological and physical therapies. However, we rated most outcomes as low or very low certainty, meaning further evidence is likely to change our confidence in the estimates of effects. This protocol was registered on PROSPERO (CRD42020172451).
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Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative and Supportive Care Review Group, Oxford, United Kingdom
| | | | | | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool United Kingdom
| | - William Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
| | | | | | - Tess E Cooper
- Cochrane Kidney and Transplant, Centre for Kidney Research, Children's Hospital at Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Australia
| | - Navil Sethna
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Harvard Medical School, Boston, MA, United States
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative and Supportive Care Review Group, Oxford, United Kingdom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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10
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Bedree H, Miller SA, Buscemi J, Greenley RN, Tran ST. Using Technology to Assess Bidirectionality between Daily Pain and Physical Activity: The Role of Marginalization during Emerging Adulthood. CHILDREN-BASEL 2021; 8:children8090756. [PMID: 34572188 PMCID: PMC8472665 DOI: 10.3390/children8090756] [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: 07/15/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Emerging adulthood is often overlooked as a developmental time period critical to shaping future health outcomes. Recurrent pain is a commonly experienced health concern within this age group, particularly headaches and low back pain, and early experiences of recurrent pain are related to subsequent chronic pain and disability. Furthermore, adults from marginalized populations report more frequent and severe recurrent pain. Many studies have demonstrated the therapeutic effect of physical activity on pain relief; however, others have demonstrated that physical activity can also exacerbate pain symptoms. Therefore, the current study aimed to (1) assess a bidirectional relationship between reported pain and engagement in physical activity among an emerging adult sample (N = 265) and (2) determine whether sociodemographic factors moderate this relationship. Using longitudinal daily reported pain and ActiGraph monitor data collected over two weeks, a novel dynamic structural equation modeling approach was employed. Results indicated no significant cross-lagged relationships between pain and physical activity, and no significant moderation effects. These findings suggest that a bidirectional relationship does not exist among a diverse college sample of emerging adults even after considering sociodemographic moderators. Excellent retention and few missing data suggest that using accelerometers and daily diaries are feasible methods to collect data in this population. Sample considerations and future analytical approaches are discussed.
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Affiliation(s)
- Helen Bedree
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
- Correspondence:
| | - Steven A. Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (S.A.M.); (R.N.G.)
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (S.A.M.); (R.N.G.)
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
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11
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Hurtubise K, Blais S, Noel M, Brousselle A, Dallaire F, Rasic N, Camden C. Is It Worth It? A Comparison of an Intensive Interdisciplinary Pain Treatment and a Multimodal Treatment for Youths With Pain-related Disability. Clin J Pain 2021; 36:833-844. [PMID: 32769416 DOI: 10.1097/ajp.0000000000000869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of an intensive interdisciplinary pain treatment (IIPT) day-hospital program as compared with an outpatient multimodal treatment (MMT) for youth with chronic pain. MATERIALS AND METHODS A nonrandomized pretest posttest with control group design was used. A battery of patient-oriented measures assessing pain interference, quality of life, and depressive symptoms were completed at treatment commencement and at 3, 6, and 12 months after treatment by 44 youths enrolled in the IIPT and 138 youths engaged in the MMT, with various chronic pain conditions. Data were analyzed using longitudinal mixed-effects models. RESULTS The main outcomes were the score difference from baseline of patient-oriented measures across 3 timepoints within 12 months of intervention initiation for both treatment groups. IIPT participants demonstrated greater improvement in pain interference, as compared with MMT at 3 and 12 months. Initially, health-related quality of life scores improved similarly in both groups, but greater improvement was seen in the MMT group at 12 months. Depressive symptom scores did not improve with either intervention. Only pain interference scores reached statistically and clinically significant difference levels. DISCUSSION This study supports the benefits of specialized rehabilitation interventions, including both MMT and IIPT programs, for youths with chronic pain. The findings also suggest that IIPT might have a greater long-term effect for helping youths, in particular those with high pain interference scores.
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Affiliation(s)
- Karen Hurtubise
- Faculty of Medicine and Health Sciences, University of Sherbrooke
| | - Samuel Blais
- Faculty of Medicine and Health Sciences, University of Sherbrooke.,School of Public Administration, University of Victoria, Victoria, BC
| | - Melanie Noel
- Department of Psychology, University of Calgary.,Alberta Children's Hospital Research Institute.,Hotchkiss Brain Institute, Health Research Innovation Centre
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC
| | - Frederic Dallaire
- Faculty of Medicine and Health Sciences, University of Sherbrooke.,The University Medical Centre of Sherbrooke's Centre for Research, Sherbrooke, QC
| | - Nivez Rasic
- Department of Anesthesia & Pain Medicine, Foothills Hospital, Calgary, AB
| | - Chantal Camden
- Faculty of Medicine and Health Sciences, University of Sherbrooke.,The University Medical Centre of Sherbrooke's Centre for Research, Sherbrooke, QC.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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12
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Coles ML, Uziel Y. Juvenile primary fibromyalgia syndrome: A Review- Treatment and Prognosis. Pediatr Rheumatol Online J 2021; 19:74. [PMID: 34006290 PMCID: PMC8130260 DOI: 10.1186/s12969-021-00529-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome affecting children and adolescents. In part one of this review, we discussed the epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis of JPFS. Part two focuses on the treatment and prognosis of JPFS. Early intervention is important. The standard of care is multidisciplinary, combining various modalities-most importantly, exercise and cognitive behavioral therapy. Prognosis varies and symptoms may persist into adulthood.
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Affiliation(s)
- Maya Levy Coles
- grid.415250.70000 0001 0325 0791Department of Pediatrics, Meir Medical Center, Pediatric Rheumatology Unit, Kfar Saba, Israel
| | - Yosef Uziel
- Department of Pediatrics, Meir Medical Center, Pediatric Rheumatology Unit, Kfar Saba, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Masquelier E, D'haeyere J. Physical activity in the treatment of fibromyalgia. Joint Bone Spine 2021; 88:105202. [PMID: 33962033 DOI: 10.1016/j.jbspin.2021.105202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents.
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Affiliation(s)
- Etienne Masquelier
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium; Institute of NeuroScience (IoNS), Université catholique de Louvain, Louvain, Belgium.
| | - Jacques D'haeyere
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium
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14
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Kashikar-Zuck S, Briggs MS, Bout-Tabaku S, Connelly M, Daffin M, Guite J, Ittenbach R, Logan DE, Lynch-Jordan AM, Myer GD, Ounpuu S, Peugh J, Schikler K, Sugimoto D, Stinson JN, Ting TV, Thomas S, Williams SE, Zempsky W. Randomized clinical trial of Fibromyalgia Integrative Training (FIT teens) for adolescents with juvenile fibromyalgia - Study design and protocol. Contemp Clin Trials 2021; 103:106321. [PMID: 33618033 PMCID: PMC8089039 DOI: 10.1016/j.cct.2021.106321] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Juvenile-onset fibromyalgia (JFM) is a chronic debilitating pain condition that negatively impacts physical, social and academic functioning. Cognitive-behavioral therapy (CBT) is beneficial in reducing functional disability among adolescents with JFM but has only a modest impact on pain reduction and does not improve physical exercise participation. This randomized controlled trial (RCT) aims to test whether a novel intervention that combines CBT with specialized neuromuscular exercise training (the Fibromyalgia Integrative Training program for Teens "FIT Teens") is superior to CBT alone or a graded aerobic exercise (GAE) program. DESIGN/METHODS This 3-arm multi-site RCT will examine the efficacy of the FIT Teens intervention in reducing functional disability (primary outcome) and pain intensity (secondary outcome), relative to CBT or GAE. All interventions are 8-weeks (16 sessions) in duration and are delivered in small groups of 4-6 adolescents with JFM. A total of 420 participants are anticipated to be enrolled across seven sites with approximately equal allocation to each treatment arm. Functional disability and average pain intensity in the past week will be assessed at baseline, post-treatment and at 3-, 6-, 9- and 12-month follow-up. The 3-month follow-up is the primary endpoint to evaluate treatment efficacy; longitudinal assessments will determine maintenance of treatment gains. Changes in coping, fear of movement, biomechanical changes and physical fitness will also be evaluated. CONCLUSIONS This multi-site RCT is designed to evaluate whether the combined FIT Teens intervention will have significantly greater effects on disability and pain reduction than CBT or GAE alone for youth with JFM. Clinical trials.gov registration: NCT03268421.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Matthew S Briggs
- Sports Medicine Research Institute, and Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sharon Bout-Tabaku
- Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
| | - Mark Connelly
- Division of Developmental and Behavioral Sciences, Children's Mercy Hospital, Kansas City, KS, USA
| | - Morgan Daffin
- Department of Pediatrics, University of Louisville, School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Jessica Guite
- Department of Pediatrics and Nursing, University of Connecticut, Hartford, CT, USA
| | - Richard Ittenbach
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deirdre E Logan
- Division of Pain Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anne M Lynch-Jordan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory D Myer
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Sylvia Ounpuu
- Center for Motion Analysis, Connecticut Children's Medical Center, Department of Orthopedic Surgery, University of Connecticut School of Medicine, Hartford, CT, USA
| | - James Peugh
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kenneth Schikler
- Department of Pediatrics, University of Louisville, School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Dai Sugimoto
- Sport Sciences, Waseda University, Tokyo, Japan; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracy V Ting
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Staci Thomas
- Division of Sports Medicine, SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara E Williams
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William Zempsky
- Department of Pediatrics and Nursing, University of Connecticut, Hartford, CT, USA; Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
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15
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Sticking to It: A Scoping Review of Adherence to Exercise Therapy Interventions in Children and Adolescents With Musculoskeletal Conditions. J Orthop Sports Phys Ther 2020; 50:503-515. [PMID: 32741327 DOI: 10.2519/jospt.2020.9715] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify and categorize barriers, facilitators, and strategies to boost exercise therapy adherence in youth with musculoskeletal conditions to inform research and clinical practice. STUDY DESIGN Scoping review. LITERATURE SEARCH We searched MEDLINE, CINAHL, SPORTDiscus, Scopus, PEDro, and ProQuest from inception to October 1, 2019. STUDY SELECTION CRITERIA Studies written in English, with original data featuring an adherence barrier, facilitator, or boosting strategy for exercise therapy in youth (age, 19 years or younger) with musculoskeletal conditions, were included. DATA SYNTHESIS Arksey and O'Malley's framework and the PRISMA Extension for Scoping Reviews guided data synthesis. Study quality was assessed with the Mixed Methods Appraisal Tool. Descriptive consolidation included study and sample characteristics, exercise therapy details, and adherence measurement specifics. Inductive thematic analysis of adherence barriers, facilitators, and boosting strategies followed Braun and Clarke's 6-step guide. RESULTS Of 5705 potentially relevant records, 41 studies, representing 2020 participants (64% girls; age range, 2-19 years) with 12 different musculoskeletal conditions and multiple exercise therapy interventions, were included. Despite poor reporting of adherence concepts, time constraints, physical environment (eg, location), and negative exercise experiences were commonly identified barriers. Social support and positive exercise experiences were frequently identified facilitators. Reinforcement, exercise program modification, and education were recurring boosting strategies, despite being infrequent barriers or facilitators. CONCLUSION A diversity of barriers to and facilitators of exercise therapy for youth with musculoskeletal conditions were identified. Efforts to link adherence-boosting strategies to an individual's needs should be considered. Making exercise enjoyable, social, and convenient may be important to maximizing adherence in this population. J Orthop Sports Phys Ther 2020;50(9):503-515. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9715.
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16
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Lillo S. Medicina física y rehabilitación en el dolor crónico pediátrico. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Castelo-Branco L, Uygur Kucukseymen E, Duarte D, El-Hagrassy MM, Bonin Pinto C, Gunduz ME, Cardenas-Rojas A, Pacheco-Barrios K, Yang Y, Gonzalez-Mego P, Estudillo-Guerra A, Candido-Santos L, Mesia-Toledo I, Rafferty H, Caumo W, Fregni F. Optimised transcranial direct current stimulation (tDCS) for fibromyalgia-targeting the endogenous pain control system: a randomised, double-blind, factorial clinical trial protocol. BMJ Open 2019; 9:e032710. [PMID: 31672712 PMCID: PMC6830717 DOI: 10.1136/bmjopen-2019-032710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is a common debilitating condition with limited therapeutic options. Medications have low efficacy and are often associated with adverse effects. Given that FM is associated with a defective endogenous pain control system and central sensitisation, combining interventions such as transcranial direct current stimulation (tDCS) and aerobic exercise (AE) to modulate pain-processing circuits may enhance pain control. METHODS AND ANALYSIS A prospective, randomised (1:1:1:1), placebo-controlled, double-blind, factorial clinical trial will test the hypothesis that optimised tDCS (16 anodal tDCS sessions combined with AE) can restore of the pain endogenous control system. Participants with FM (n=148) will undergo a conditioning exercise period and be randomly allocated to one of four groups: (1) active tDCS and AE, (2) sham tDCS and AE, (3) active tDCS and non-aerobic exercise (nAE) or (4) sham tDCS and nAE. Pain inhibitory activity will be assessed using conditioned pain modulation (CPM) and temporal slow pain summation (TSPS)-primary outcomes. Secondary outcomes will include the following assessments: Transcranial magnetic stimulation and electroencephalography as cortical markers of pain inhibitory control and thalamocortical circuits; secondary clinical outcomes on pain, FM, quality of life, sleep and depression. Finally, the relationship between the two main mechanistic targets in this study-CPM and TSPS-and changes in secondary clinical outcomes will be tested. The change in the primary efficacy endpoint, CPM and TSPS, from baseline to week 4 of stimulation will be tested with a mixed linear model and adjusted for important demographic variables. ETHICS AND DISSEMINATION This study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare under the protocol number 2017P002524. Informed consent will be obtained from participants. Study findings will be reported in conferences and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER NCT03371225.
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Affiliation(s)
- Luis Castelo-Branco
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Uygur Kucukseymen
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dante Duarte
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mirret M El-Hagrassy
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Camila Bonin Pinto
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammed Enes Gunduz
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yiling Yang
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anayali Estudillo-Guerra
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ludmilla Candido-Santos
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ines Mesia-Toledo
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haley Rafferty
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolnei Caumo
- Laboratory of Pain & Neuromodulation, Hospital de Clinicas de Porto Alegre da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Kichline T, Cushing CC. A systematic review and quantitative analysis on the impact of aerobic exercise on pain intensity in children with chronic pain. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1531756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tiffany Kichline
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Christopher C. Cushing
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
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19
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Caes L, Fisher E, Clinch J, Eccleston C. Current Evidence-Based Interdisciplinary Treatment Options for Pediatric Musculoskeletal Pain. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018; 4:223-234. [PMID: 30148046 PMCID: PMC6096755 DOI: 10.1007/s40674-018-0101-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review the prevalence of pediatric chronic musculoskeletal pain, the clinical need, the evidence for pharmacological, psychological, physical and, complementary approaches to pain management, and the possible future development of interdisciplinary and distance care. RECENT FINDINGS We summarize the Cochrane Systematic Reviews on pharmacological interventions, which show a lack of evidence to support or refute the use of all classes of medication for the management of pain. The trials for NSAIDs did not show any superiority over comparators, nor did those of anti-depressants, and there are no trials for paracetamol, or of opioid medications. There are studies of psychological interventions which show promise and increasing support for physical therapy. The optimal approach remains an intensive interdisciplinary programmatic treatment, although this service is not available to most. SUMMARY 1. Given the absence of evidence, a program of trials is now urgently required to establish the evidence base for analgesics that are widely prescribed for children and adolescents with chronic musculoskeletal pain. 2. Until that evidence becomes available, medicine review is an essential task in this population. 3. We need more examples and efficacy evaluations of intensive interdisciplinary interventions for chronic pain management, described in detail so that researchers and clinicians can unpack possible active treatment components. 4. Online treatments are likely to be critical in the future. We need to determine which aspects of treatment for which children and adolescents can be effectively delivered in this way, which will help reduce the burden of the large number of patients needing support from a small number of experts.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
| | - Jacqui Clinch
- Bristol Royal Children’s Hospital, University of Bristol and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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20
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Dean DJ, Bryan AD, Newberry R, Gupta T, Carol E, Mittal VA. A Supervised Exercise Intervention for Youth at Risk for Psychosis: An Open-Label Pilot Study. J Clin Psychiatry 2017; 78:e1167-e1173. [PMID: 29178684 PMCID: PMC5995728 DOI: 10.4088/jcp.16m11365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/05/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A rapidly accumulating body of research suggests that exercise can improve symptoms and well-being in patients suffering from psychosis. Exercise may also promote neurogenesis in the hippocampus, a structure that plays an important role in the pathophysiology of psychosis. To date, there has not been an intervention focused on exercise prior to the onset of psychosis, a critical time for prevention of more serious illness. METHODS In this pilot study, 12 young adults at ultrahigh risk (UHR) for psychosis were enrolled in a 12-week open-label exercise intervention. Participants were randomly assigned to exercise 2 or 3 times each week and exercised between 65% and 85% of maximum oxygen capacity (Vo2max) for 30 minutes each session under the supervision of an exercise physiologist. Positive and negative symptoms, social and role functioning, performance on neurocognitive tests, cardiovascular fitness, and hippocampal structure and functional connectivity were evaluated before and after the trial. RESULTS A total of 9 participants completed the exercise intervention. Participants showed improved positive and negative symptoms and social and role functioning; improvement in multiple areas of cognition; and increased functional connectivity between the left hippocampus and occipital cortex after 12 weeks of exercise. CONCLUSIONS The results of this study suggest that exercise interventions are feasible in a UHR sample and may promote improvement in clinical, social, and cognitive domains as well as changes to brain function in regions impacted by the development of psychosis. These findings set the stage for an ongoing phase 2 randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02155699.
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Affiliation(s)
- Derek J Dean
- University of Colorado at Boulder, Department of Psychology and Neuroscience, Center for Neuroscience, 345 UCB, Boulder, CO 80309-0345.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Raeana Newberry
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Emily Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Department of Psychiatry, Northwestern University, Chicago, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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21
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Abstract
Presently, evidence for the efficacy of medications for the treatment of juvenile fibromyalgia syndrome (JFMS) is limited. While there are medications approved by the US Food and Drug Administration (duloxetine, milnacipran and pregabalin) for adults with fibromyalgia syndrome, there are none for the treatment of JFMS. A variety of medications have been prescribed for the treatment of JFMS, including (but not limited to) non-opioid analgesics, opioids, anticonvulsants, antidepressants, and muscle relaxants. Psychological therapies, most prominently cognitive behavioral therapy, are the most evidenced-based treatment modalities for JFMS. A multidisciplinary approach, combining pharmacological, behavioral and exercise-based modalities is currently the standard of care for JFMS. In the future, more stringent randomized, controlled trials with longer follow-up periods are needed in order to determine the long-term efficacy and safety of medications in the treatment of JFMS. Additionally, improved recognition of JFMS will allow for better patient recruitment to permit for adequately powered study designs.
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Affiliation(s)
- Sabrina Gmuca
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 10101 Colket, 3501 Civic Center Blvd, Philadelphia, PA, 19104-3820, USA
| | - David D Sherry
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 10101 Colket, 3501 Civic Center Blvd, Philadelphia, PA, 19104-3820, USA.
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22
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Tran ST, Guite JW, Pantaleao A, Pfeiffer M, Myer GD, Sil S, Thomas SM, Ting TV, Williams SE, Edelheit B, Ounpuu S, Rodriguez-MacClintic J, Zemel L, Zempsky W, Kashikar-Zuck S. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care Res (Hoboken) 2017; 69:413-420. [PMID: 27331358 DOI: 10.1002/acr.22946] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/13/2016] [Accepted: 05/31/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) is effective in reducing disability among youth with juvenile fibromyalgia (FM); however, engagement in moderate to vigorous physical activity remains poor, even after CBT. The purpose of this study was to evaluate the feasibility and preliminary outcomes of an innovative program combining CBT with specialized neuromuscular exercise: the Fibromyalgia Integrative Training for Teens (FIT Teens) program. METHODS Adolescents with juvenile FM (n = 22, all female, ages 12-18 years) from 2 urban children's hospitals participated in the 8-week FIT Teens intervention. Participants completed measures of pain intensity, functional disability, depressive symptoms, pain catastrophizing, fear of movement, and readiness to change at baseline and after the intervention. RESULTS The feasibility of the intervention across 2 sites was documented, including high retention rates (80%). Participants showed significant decreases in functional disability (P < 0.05), depression (P < 0.001), fear of movement (P < 0.01), and pain catastrophizing (P < 0.001) from pre- to postintervention. Results of the readiness to change measure indicated a significant decrease in precontemplation (P < 0.01) and increase in action/maintenance scores (P < 0.001). All results demonstrated medium to large effect sizes. CONCLUSION Adolescents with juvenile FM reported significant improvements in physical function and reduced fear of movement following the intervention. Improvement in physical function was achieved in a shorter time frame than in a prior trial of CBT without an exercise component. Further work is needed to compare the FIT Teens program with existing approaches and determine whether objective changes in exercise participation are achieved.
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Affiliation(s)
| | - Jessica W Guite
- Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford
| | | | - Megan Pfeiffer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gregory D Myer
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Pennsylvania, Philadelphia, and The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - Soumitri Sil
- Emory University School of Medicine, Children's Healthcare of Atlanta, and Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
| | - Staci M Thomas
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tracy V Ting
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sara E Williams
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Barbara Edelheit
- Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford
| | - Sylvia Ounpuu
- Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford
| | | | - Lawrence Zemel
- Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford
| | - William Zempsky
- Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford
| | - Susmita Kashikar-Zuck
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Sawynok J, Lynch ME. Qigong and Fibromyalgia circa 2017. MEDICINES 2017; 4:medicines4020037. [PMID: 28930252 PMCID: PMC5590073 DOI: 10.3390/medicines4020037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/09/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
Qigong is an internal art practice with a long history in China. It is currently characterized as meditative movement (or as movement-based embodied contemplative practice), but is also considered as complementary and alternative exercise or mind–body therapy. There are now six controlled trials and nine other reports on the effects of qigong in fibromyalgia. Outcomes are related to amount of practice so it is important to consider this factor in overview analyses. If one considers the 4 trials (201 subjects) that involve diligent practice (30–45 min daily, 6–8 weeks), there are consistent benefits in pain, sleep, impact, and physical and mental function following the regimen, with benefits maintained at 4–6 months. Effect sizes are consistently in the large range. There are also reports of even more extensive practice of qigong for 1–3 years, even up to a decade, indicating marked benefits in other health areas beyond core domains for fibromyalgia. While the latter reports involve a limited number of subjects and represent a self-selected population, the marked health benefits that occur are noteworthy. Qigong merits further study as a complementary practice for those with fibromyalgia. Current treatment guidelines do not consider amount of practice, and usually make indeterminate recommendations.
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Affiliation(s)
- Jana Sawynok
- Departments of Pharmacology, Anesthesiology and Pain Management, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Mary E Lynch
- Departments of Anesthesiology, Pain Management and Perioperative Medicine, Psychiatry, Pharmacology, Dalhousie University and QEII Health Sciences Centre, Halifax, NS B3H 2Y9, Canada.
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Physical activity for paediatric rheumatic diseases: standing up against old paradigms. Nat Rev Rheumatol 2017; 13:368-379. [DOI: 10.1038/nrrheum.2017.75] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Black WR, Kashikar-Zuck S. Exercise interventions for juvenile fibromyalgia: current state and recent advancements. Pain Manag 2017; 7:143-148. [PMID: 28152647 DOI: 10.2217/pmt-2016-0066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- William R Black
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kashikar-Zuck S, King C, Ting TV, Arnold LM. Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome? Curr Rheumatol Rep 2016; 18:19. [PMID: 26984803 DOI: 10.1007/s11926-016-0569-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
While a majority of research has focused on adult fibromyalgia (FM), recent evidence has provided insights into the presence and impact of FM in children and adolescents. Commonly referred as juvenile fibromyalgia (JFM), youths, particularly adolescent girls, present with persistent widespread pain and cardinal symptoms observed in adult FM. A majority of youth with JFM continue to experience symptoms into adulthood, which highlights the importance of early recognition and intervention. Some differences are observed between adult and juvenile-onset FM syndrome with regard to comorbidities (e.g., joint hypermobility is common in JFM). Psychological comorbidities are common but less severe in JFM. Compared to adult FM, approved pharmacological treatments for JFM are lacking, but non-pharmacologic approaches (e.g., cognitive-behavioral therapy and exercise) show promise. A number of conceptual issues still remain including (1) directly comparing similarities and differences in symptoms and (2) identifying shared and unique mechanisms underlying FM in adults and youths.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA.
| | - Christopher King
- Department of Pediatric Anesthesia, MLC 7031, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
| | - Tracy V Ting
- Division of Pediatric Rheumatology, MLC 4010, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
| | - Lesley M Arnold
- Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
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Maia MM, Gualano B, Sá-Pinto AL, Sallum AM, Pereira RM, Len CA, Terreri MT, Barbosa CM, Roschel H, Silva CA. Juvenile fibromyalgia syndrome: Blunted heart rate response and cardiac autonomic dysfunction at diagnosis. Semin Arthritis Rheum 2016; 46:338-343. [DOI: 10.1016/j.semarthrit.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/28/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
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Masterson-Algar P, Burton CR, Rycroft-Malone J. Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research. BMJ Open 2016; 6:e013002. [PMID: 28186944 PMCID: PMC5129134 DOI: 10.1136/bmjopen-2016-013002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/23/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To systematically review how process evaluations are currently designed, what methodologies are used and how are they developed alongside or within neurological rehabilitation trials. METHODS This mixed-methods systematic review had two evidence streams: stream I, studies reporting process evaluations alongside neurorehabilitation trials research and stream II, methodological guidance on process evaluation design and methodology. A search strategy was designed for each evidence stream. Data regarding process evaluation core concepts and design issues were extracted using a bespoke template. Evidence from both streams was analysed separately and then synthesised in a final overarching synthesis proposing a number of recommendations for future research. RESULTS A total of 124 process evaluation studies, reporting on 106 interventions, were included in stream I evidence. 30 studies were included as stream II evidence. Synthesis 1 produced 9 themes, and synthesis 2 identified a total of 8 recommendations for process evaluation research. The overall synthesis resulted in 57 'synthesis recommendations' about process evaluation methodology grouped into 9 research areas, including the use of theory, the investigation of context, intervention staff characteristics and the delivery of the trial intervention. CONCLUSIONS There remains no consensus regarding process evaluation terminology within the neurological rehabilitation field. There is a need for process evaluations to address the nature and influence of context over time. Process evaluations should clearly describe what intervention staff bring to a trial, including skills and experience prior to joining the research. Process evaluations should monitor intervention staff's learning effects and the possible impact that these may have on trial outcomes.
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A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia. Clin J Pain 2016; 32:70-81. [PMID: 25724022 DOI: 10.1097/ajp.0000000000000221] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive-behavior therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention--Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols. MATERIALS AND METHODS Participants were 17 adolescent females (aged 12 to 18 y) with JFM. Of these, 11 completed the 8-week (16 sessions) FIT Teens program in a small-group format with 3 to 4 patients per group. Patients provided detailed qualitative feedback via individual semistructured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained. RESULTS The intervention was found to be feasible, well tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial. DISCUSSION Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.
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Arnold LM, Schikler KN, Bateman L, Khan T, Pauer L, Bhadra-Brown P, Clair A, Chew ML, Scavone J. Safety and efficacy of pregabalin in adolescents with fibromyalgia: a randomized, double-blind, placebo-controlled trial and a 6-month open-label extension study. Pediatr Rheumatol Online J 2016; 14:46. [PMID: 27475753 PMCID: PMC4967327 DOI: 10.1186/s12969-016-0106-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a common pain condition characterized by widespread musculoskeletal pain and tenderness. Pregabalin is an approved treatment for adults in the United States, but there are no approved treatments for adolescents with FM. METHODS This was a 15-week, randomized, double-blind, placebo-controlled study and 6-month open-label safety trial of flexible-dose pregabalin (75-450 mg/day) for the treatment of adolescents (12-17 years) with FM. Primary outcome was change in mean pain score at endpoint (scored from 0-10, with 24-h recall). Secondary outcomes included global assessments and measures of pain, sleep, and FM impact. RESULTS A total of 107 subjects were randomized to treatment (54 pregabalin, 53 placebo) and 80 completed the study (44 pregabalin, 36 placebo). Improvement in mean pain score at endpoint with pregabalin versus placebo was not statistically significant, treatment difference (95 % CI), -0.66 (-1.51, 0.18), P = 0.121. There were significant improvements with pregabalin versus placebo in secondary outcomes of change in pain score by week (P < 0.05 for 10 of 15 weeks); change in pain score at week 15 (1-week recall), treatment difference (95 % CI), -0.87 (-1.68, -0.05), P = 0.037; and patient global impression of change, 53.1 % versus 29.5 % very much or much improved (P = 0.013). Trends toward improvement with pregabalin in other secondary outcomes measuring pain, sleep, and FM impact were not significant. Safety was consistent with the known profile of pregabalin in adults with FM. CONCLUSION Pregabalin did not significantly improve the mean pain score in adolescents with FM. There were significant improvements in secondary outcomes measuring pain and impression of change. TRIAL REGISTRATIONS NCT01020474 ; NCT01020526 .
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Affiliation(s)
- Lesley M. Arnold
- University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219 USA
| | - Kenneth N. Schikler
- University of Louisville School of Medicine, Kosair Children’s Hospital, Louisville, KY USA
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Ting TV, Barnett K, Lynch-Jordan A, Whitacre C, Henrickson M, Kashikar-Zuck S. 2010 American College of Rheumatology Adult Fibromyalgia Criteria for Use in an Adolescent Female Population with Juvenile Fibromyalgia. J Pediatr 2016; 169:181-7.e1. [PMID: 26545727 PMCID: PMC7675923 DOI: 10.1016/j.jpeds.2015.10.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/27/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the utility of the 2010 American College of Rheumatology (ACR) adult fibromyalgia criteria for use in adolescents with juvenile fibromyalgia (JFM). STUDY DESIGN Participants included 47 adolescent girls diagnosed with JFM (mean age = 15.3 years) and 48 age- and sex-matched adolescents (mean age = 15.0 years) with localized chronic pain (eg, headaches or abdominal pain). A trained examiner administered the Widespread Pain Index and Symptom Severity measures and also completed a manual tender point exam. Clinicians completed a form indicating the presence of active JFM per Yunus and Masi (1985) criteria, the only available and most commonly used measure for JFM. Criterion validity analysis was performed as well as t tests comparing symptoms between JFM and controls. RESULTS With the Yunus and Masi criteria used as the gold standard, the 2010 ACR fibromyalgia criteria showed a sensitivity of 89.4% and specificity of 87.5%. CONCLUSION The 2010 ACR measure appears to be a valuable tool for the identification of JFM. However, a slight modification to the 2010 ACR measure and inclusion of a clinical exam is recommended.
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Affiliation(s)
- Tracy V. Ting
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Anne Lynch-Jordan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH;,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Catharine Whitacre
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Henrickson
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH;,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Goulart R, Pessoa C, Junior IL. Aspectos psicológicos da síndrome da fibromialgia juvenil: revisão de literatura. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Del Rosso A, Maddali-Bongi S. Mind body therapies in rehabilitation of patients with rheumatic diseases. Complement Ther Clin Pract 2015; 22:80-6. [PMID: 26850811 DOI: 10.1016/j.ctcp.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/29/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
Mind body therapies (MBT) share a global approach involving both mental and physical dimensions, and focus on relationship between brain, mind, body and behavior and their effects on health and disease. MBT include concentration based therapies and movement based therapies, comprising traditional Oriental practices and somatic techniques. The greatest part of rheumatic diseases have a chronic course, leading to progressive damages at musculoskeletal system and causing physical problems, psychological and social concerns. Thus, rheumatic patients need to be treated with a multidisciplinary approach integrating pharmacological therapies and rehabilitation techniques, that not should only aim to reduce the progression of damages at musculoskeletal system. Thus, MBT, using an overall approach, could be useful in taking care of the overall health of the patients with chronic rheumatic diseases. This review will deal with different MBT and with their effects in the most common chronic rheumatic diseases (Rheumatoid Arthritis, Ankylosing Spondylitis, Fibromyalgia Syndrome).
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Affiliation(s)
- Angela Del Rosso
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy.
| | - Susanna Maddali-Bongi
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy.
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34
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Managing Chronic Pain in Children and Adolescents: A Clinical Review. PM R 2015; 7:S295-S315. [DOI: 10.1016/j.pmrj.2015.09.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/19/2022]
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Effect of traditional Chinese exercise on the quality of life and depression for chronic diseases: a meta-analysis of randomised trials. Sci Rep 2015; 5:15913. [PMID: 26525282 PMCID: PMC4630632 DOI: 10.1038/srep15913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023] Open
Abstract
Traditional Chinese exercise (TCE) has many uses in the prevention and treatment of chronic diseases. However, there is no consensus regarding the benefit of TCE for chronic diseases. Our objective is to examine the effect of TCE on the quality of life and depression for chronic diseases by performing a meta-analysis of randomized controlled trials (RCTs). We only cover published RCTs. The outcome measures included quality of life and depression. Sixty articles with a total of 4311 patients were included. The pooling revealed that TCE could improve the SF-36 physical function subscale in the short term [SMD (95% CI) = 0.35 (0.13, 0.56), P = 0.002] and mid-term [SMD (95% CI) = 0.49 (0.12, 0.85), P = 0.009], GHQ [SMD (95% CI) = −0.68 (−1.26, −0.09), P = 0.02], the Center for Epidemiologic Studies depression scale in the short term [SMD (95% CI) = −0.86 (−1.42, −0.31), P = 0.002] and mid-term [SMD (95% CI) = −0.41 (−0.64, −0.18), P < 0.001]. The meta-analysis of RCT demonstrates that TCE can significantly improve the quality of life and depression of patients with chronic diseases. These findings provide useful information for patients with chronic diseases as well as for medical staff.
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Goulart R, Pessoa C, Lombardi I. Psychological aspects of juvenile fibromyalgia syndrome: a literature review. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:69-74. [PMID: 27267336 DOI: 10.1016/j.rbre.2015.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 07/17/2015] [Indexed: 10/22/2022] Open
Abstract
Juvenile fibromyalgia syndrome (JFMS) is a non-inflammatory chronic pain condition that occurs mainly in girls aged 9-15 years. JFMS is characterized by constant widespread pain in different parts of the body, poor sleep quality, daytime sleepiness and an altered mood. Concomitant psychological and organic factors result in a diminished capacity to cope with pain. The quality of life of individuals with chronic pain and their caregivers is severely restricted and the occurrence of symptoms of anxiety and depression is common in this population. The aim of the present study was to perform a systematic review of the literature on psychosocial factors related to JFMS. The findings reveal differences in opinion between patients and family members regarding the effect of the condition, as mothers tend to classify JFMS as more severe than the patients themselves. Individuals with JFMS seem to share the same personality traits and there seems to be a type of family environment that is favorable to the occurrence of this condition. Psychological and functional aspects should be treated with methods that can help patients and family members alter their coping strategies regarding day-to-day problems, attenuate the dysfunctional consequences of pain and fatigue and diminish the risk of catastrophizing that individuals submitted to constant pain develop in relation to their surrounding environment.
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Affiliation(s)
- Rubens Goulart
- Post-Graduate Interdisciplinary Program in Health Sciences, Universidade Federal de São Paulo, Santos, SP, Brazil.
| | - Cinthia Pessoa
- Rehabilitation and Physiotherapy Service, Prefeitura Municipal de Santos, Santos, SP, Brazil
| | - Império Lombardi
- The Human Movement Sciences Department, Universidade Federal de São Paulo, Santos, SP, Brazil
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Abstract
OBJECTIVE To assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy. STUDY DESIGN Children with fibromyalgia seen at a tertiary care hospital were treated with 5-6 hours of intensive PT/OT daily and at least 4 hours of psychosocial services weekly. All medications used for fibromyalgia were discontinued. Children underwent standardized testing, including a visual analog scale for pain; the Bruininks-Oseretsky Test of Motor Performance, Second Edition; the Bruce treadmill protocol; the Functional Disability Inventory; the Pain Stages of Change Questionnaire, adolescent version; and the Pediatric Quality of Life Inventory, Teen Report, at 3 time points: at program entry, at the end of the intensive program, and 1 year after the end of the program. RESULTS Sixty-four children (median age, 16 years; 95% Caucasian; 94% female; median duration of symptoms, 21 months) were studied. The mean pain score decreased significantly from program entry to the end of the program (from 66 of 100 to 25 of 100; P = .001). At the 1-year follow-up, 33% reported no pain. All measures of function on the Bruininks-Oseretsky Test of Motor Performance, Second Edition improved significantly and remained at that level or continued to improve over the subsequent year. The mean Bruce treadmill protocol time first increased from 588 seconds to 801 seconds (P < .001) and then dropped to 750 seconds (P = .005), which is at the 90th percentile for age and sex. All Pain Stages of Change Questionnaire, adolescent version subset scores improved significantly initially and were stable or improved at 1 year, as did the Pediatric Quality of Life Inventory, Teen Report total score. CONCLUSION Children with fibromyalgia can be successfully treated without medications with a very intensive PT/OT and psychotherapy program. They have significantly improved pain and function by subject report and objective measures of function.
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Arnold LM, Bateman L, Palmer RH, Lin Y. Preliminary experience using milnacipran in patients with juvenile fibromyalgia: lessons from a clinical trial program. Pediatr Rheumatol Online J 2015; 13:27. [PMID: 26112278 PMCID: PMC4480575 DOI: 10.1186/s12969-015-0025-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/11/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are no approved medications for juvenile fibromyalgia (JFM), a disorder that is often under-diagnosed. The effects of milnacipran, a drug approved for the management of fibromyalgia (FM) in adults, was assessed in a clinical trial program for JFM. METHODS Patients, ages 13-17 years who met the Yunus and Masi criteria for JFM and/or 1990 American College of Rheumatology criteria for FM, were enrolled in a responder-enriched, randomized withdrawal trial. After receiving open-label milnacipran (8 weeks), patients with ≥50 % improvement in pain underwent double-blind randomization (1:2) to either placebo or continuing treatment with milnacipran (8 weeks). All patients, including those who did not meet the randomization criteria for double-blind withdrawal, were allowed to enter an extension study with open-label milnacipran (up to 52 weeks). The primary endpoint was loss of therapeutic response (LTR) during the double-blind period. Additional outcome measures included the Patient Global Impression of Severity (PGIS), Pediatric Quality of Life Inventory (PedsQL: Generic Core Scales, Multidimensional Fatigue Scale), and Multidimensional Anxiety Scale for Children (MASC). Safety assessments included adverse events (AEs), vital signs, electrocardiograms, and laboratory tests. RESULTS The milnacipran program was terminated early due to low enrollment. Because only 20 patients were randomized into the double-blind withdrawal period, statistical analyses were not conducted for the LTR endpoint. However, 116 patients entered the open-label period of the initial study and 57 participated in the open-label extension study. Their experience provides preliminary information about the use of milnacipran in JFM patients. During both open-label periods, there were mean improvements in pain severity, PGIC, PedsQL, and MASC scores. No unexpected safety issues were detected. The most commonly reported treatment-emergent AEs were nausea, headache, vomiting, and dizziness. Mean increases in heart rate and blood pressure were observed, and were consistent with the AE profile in adults with FM. CONCLUSIONS The open-label findings provide preliminary evidence that milnacipran may improve symptoms of JFM, with a safety and tolerability profile that is consistent with the experience in adult FM patients. Future trial designs for JFM should consider the relatively low recognition of this condition compared to adult FM and the difficulties with enrollment. TRIAL REGISTRATION NCT01328002 ; NCT01331109.
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Affiliation(s)
- Lesley M. Arnold
- Women’s Health Research Program, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219 USA
| | - Lucinda Bateman
- Fatigue Consultation Clinic, 1002 E. South Temple Street, Suite 408, Salt Lake City, UT, 84102, USA.
| | - Robert H. Palmer
- Forest Research Institute, an affiliate of Actavis, Inc., Harborside Financial Center, Plaza V, Suite 1900, Jersey City, NJ 07311 USA
| | - Yuhua Lin
- Forest Research Institute, an affiliate of Actavis, Inc., Harborside Financial Center, Plaza V, Suite 1900, Jersey City, NJ, 07311, USA.
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Sánchez-Rodríguez E, Miró J. The Assessment of Fatigue in Children With Chronic Pain. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2015. [DOI: 10.1027/1015-5759/a000208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to review the options that are available for assessing fatigue in children and adolescents with chronic pain problems, analyze the psychometric properties of all the instruments and provide health professionals with key information on which to base decisions about their use. A literature search was conducted using PsycINFO, MEDLINE, CINAHL, ERIC, and Scopus databases and the Cochrane Library between 1934 and January 2013 in order to identify all the studies that have evaluated fatigue in these populations. A total of 936 articles were retrieved, of which 24 were relevant. Of these 10 fatigue-related questionnaires were subject to specific content analysis. Only five of them evaluated fatigue in children with chronic pain, and just two had made a specific analysis of their psychometric characteristics. Most measures have been developed with a multidimensional approach of fatigue in mind. Psychometric information is missing for many questionnaires. On the basis of evidence-based assessment (EBA) criteria none of the questionnaires retrieved can be considered to be well-established measures that can be used in children with chronic pain.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain – ALGOS
- Research Center for Behavior Assessment (CRAMC)
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili
| | - Jordi Miró
- Unit for the Study and Treatment of Pain – ALGOS
- Research Center for Behavior Assessment (CRAMC)
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Tarragona, Catalonia, Spain
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Qigong and fibromyalgia: randomized controlled trials and beyond. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:379715. [PMID: 25477991 PMCID: PMC4247977 DOI: 10.1155/2014/379715] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/25/2014] [Indexed: 11/18/2022]
Abstract
Introduction. Qigong is currently considered as meditative movement, mindful exercise, or complementary exercise and is being explored for relief of symptoms in fibromyalgia. Aim. This narrative review summarizes randomized controlled trials, as well as additional studies, of qigong published to the end of 2013 and discusses relevant methodological issues. Results. Controlled trials indicate regular qigong practice (daily, 6–8 weeks) produces improvements in core domains for fibromyalgia (pain, sleep, impact, and physical and mental function) that are maintained at 4–6 months compared to wait-list subjects or baselines. Comparisons with active controls show little difference, but compared to baseline there are significant and comparable effects in both groups. Open-label studies provide information that supports benefit but remain exploratory. An extension trial and case studies involving extended practice (daily, 6–12 months) indicate marked benefits but are limited by the number of participants. Benefit appears to be related to amount of practice. Conclusions. There is considerable potential for qigong to be a useful complementary practice for the management of fibromyalgia. However, there are unique methodological challenges, and exploration of its clinical potential will need to focus on pragmatic issues and consider a spectrum of trial designs. Mechanistic considerations need to consider both system-wide and more specific effects.
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Sawynok J, Lynch M. Qualitative analysis of a controlled trial of qigong for fibromyalgia: advancing understanding of an emerging health practice. J Altern Complement Med 2014; 20:606-17. [PMID: 25072523 DOI: 10.1089/acm.2013.0348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A randomized controlled trial (RCT) and an extension trial of qigong (Chaoyi Fanhuan qigong [CFQ]) in patients with fibromyalgia were recently completed. In the present study, a qualitative analysis of comments from the RCT was undertaken using motivation and amount of practice to determine whether initial experiences provided information relevant to outcomes. INTERVENTION Participants in the RCT received instruction in qigong (level 1 CFQ), practiced 45 min/day for 8 weeks and continued practice to 6 months; open-ended qualitative comments on experiences were invited at 8 weeks and 4 and 6 months. Extension trial participants received further instruction (level 2 CFQ) and practiced regularly for 8 weeks-6 months. Comments from the original RCT were considered as narratives for the extension trial subgroup (n=20) and thematically, according to amount of practice, for all participants who completed the RCT (n=73). RESULTS Narrative comments from the RCT for those who completed the extension trial (n=13) and those who withdrew from that trial (n=7) were considered separately. Participants reporting benefits within the first 8 weeks were more likely to maintain practice and report continued benefits at 4-6 months than those who withdrew from the trial. Thematic comments for all who completed the RCT (n=73) were considered in relation to amount of practice (per protocol, intermediate, minimal). Participants who practiced per protocol during the initial 8 weeks (≥5 hours/wk) were more likely to maintain practice over 4-6 months and to report beneficial health effects from qigong. CONCLUSIONS This retrospective qualitative analysis of information collected in an RCT of qigong for fibromyalgia indicates that favorable initial experiences with the practice over 8 weeks predispose to continued practice and more health effects. Future individual trials and meta-analyses of qigong will need to attend to the amount, and potentially quality, of practice undertaken in considering trial outcomes.
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Affiliation(s)
- Jana Sawynok
- 1 Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia, Canada
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42
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Buskila D, Ablin JN. Treating juvenile fibromyalgia: cognitive-behavioral therapy, exercise and pharmacotherapy. Pain Manag 2014; 3:323-4. [PMID: 24654862 DOI: 10.2217/pmt.13.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dan Buskila
- Department of Medicine H, Soroka Medical Center & Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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43
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Lee C, Crawford C, Schoomaker E. Movement Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S40-53. [DOI: 10.1111/pme.12411] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rabbitts JA, Holley AL, Karlson CW, Palermo TM. Bidirectional associations between pain and physical activity in adolescents. Clin J Pain 2014; 30:251-8. [PMID: 23669450 PMCID: PMC3766388 DOI: 10.1097/ajp.0b013e31829550c6] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives were to: (1) examine temporal relationships between pain and activity in youth, specifically, whether physical activity affects pain intensity and whether intensity of pain affects subsequent physical activity levels on a daily basis, and (2) examine clinical predictors of this relationship. METHODS Participants were 119 adolescents (59 with chronic pain and 60 healthy) aged 12 to 18 years, 71% female. Adolescents completed 10 days of actigraphic monitoring of physical activity and daily electronic diary recordings of pain intensity, medication use, sleep quality, and mood. Linear mixed models assessed daily associations among physical activity and pain. Daily mean (average count/min) and peak (highest daily level) activity were used for analyses. Medication use, sleep quality, and mood ratings were included as covariates, and age, sex, and body mass index percentile were adjusted for. RESULTS Higher pain intensity was associated with lower peak physical activity levels on the next day (t641=-2.25, P=0.03) and greater medication use predicted lower mean physical activity levels the same day (t641=-2.10, P=0.04). Higher mean physical activity levels predicted lower pain intensity ratings at the end of the day (t705=-2.92, P=0.004), but only in adolescents with chronic pain. DISCUSSION Youth experiencing high pain intensity limit their physical activity level on a day-to-day basis. Activity was related to subsequent pain intensity, and may represent an important focus in chronic pain treatment. Further study of the effect of medications on subsequent activity is needed.
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Affiliation(s)
- Jennifer A Rabbitts
- *Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA †Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
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Kashikar-Zuck S, Cunningham N, Sil S, Bromberg MH, Lynch-Jordan AM, Strotman D, Peugh J, Noll J, Ting TV, Powers SW, Lovell DJ, Arnold LM. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics 2014; 133:e592-600. [PMID: 24567017 PMCID: PMC3934334 DOI: 10.1542/peds.2013-2220] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This prospective longitudinal study examined the long-term physical and psychosocial outcomes of adolescents with juvenile-onset fibromyalgia (JFM), compared with healthy control subjects, into early adulthood. METHODS Adolescent patients with JFM initially seen at a pediatric rheumatology clinic (n = 94) and age- and gender-matched healthy control subjects (n = 33) completed online measures of demographic characteristics, pain, physical functioning, mood symptoms, and health care utilization at ∼6 years' follow-up (mean age: 21 years). A standard in-person tender-point examination was conducted. RESULTS Patients with JFM had significantly higher pain (P < .001), poorer physical function (P < .001), greater anxiety (P < .001) and depressive symptoms (P < .001), and more medical visits (P < .001)than control subjects. The majority (>80%) of JFM patients continued to experience fibromyalgia symptoms into early adulthood, and 51.1% of the JFM sample met American College of Rheumatology criteria for adult fibromyalgia at follow-up. Patients with JFM were more likely than control subjects to be married and less likely to obtain a college education. CONCLUSIONS Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | | | - Soumitri Sil
- Divisions of Behavioral Medicine and Clinical Psychology and
| | | | - Anne M. Lynch-Jordan
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Daniel Strotman
- Divisions of Behavioral Medicine and Clinical Psychology and
| | - James Peugh
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Jennie Noll
- Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Tracy V. Ting
- Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Departments of Pediatrics and
| | - Scott W. Powers
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Daniel J. Lovell
- Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Departments of Pediatrics and
| | - Lesley M. Arnold
- Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
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Kashikar-Zuck S, Ting TV. Juvenile fibromyalgia: current status of research and future developments. Nat Rev Rheumatol 2014; 10:89-96. [PMID: 24275966 PMCID: PMC4470499 DOI: 10.1038/nrrheum.2013.177] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition most commonly affecting adolescent girls. The condition is characterized by widespread musculoskeletal pain and other associated symptoms, including fatigue, nonrestorative sleep, headaches, irritable bowel symptoms, dysautonomia and mood disorders such as anxiety and/or depression. In the past few years, there has been a greater focus on understanding JFM in adolescents. Research studies have provided insight into the clinical characteristics of this condition and its effect on both short-term and long-term psychosocial and physical functioning. The importance of early and effective intervention is being recognized, as research has shown that symptoms of JFM tend to persist and do not resolve over time as was previously believed. Efforts to improve treatments for JFM are underway, and new evidence strongly points to the potential benefits of cognitive-behavioural therapy on improving mood and daily functioning. Research into pharmacotherapy and other nonpharmacological options is in progress. Advancements in the understanding of adult fibromyalgia have paved the way for future studies on diagnosis, assessment and management of JFM. This Review focuses on our current knowledge of the condition, provides an update of the latest research advances, and highlights areas for further study.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Division of Behavioural Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Centre, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Tracy V Ting
- Division of Paediatric Rheumatology, Cincinnati Children's Hospital Medical Centre, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Kashikar-Zuck S, Zafar M, Barnett KA, Aylward BS, Strotman D, Slater SK, Allen JR, LeCates SL, Kabbouche MA, Ting TV, Hershey AD, Powers SW. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain 2013; 29:1066-72. [PMID: 23446072 PMCID: PMC3675174 DOI: 10.1097/ajp.0b013e3182850544] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
SUMMARY Chronic pain in children is associated with significant negative impact on social, emotional, and school functioning. Previous studies on the impact of pain on children's functioning have primarily used mixed samples of pain conditions or single pain conditions (eg, headache and abdominal pain) with relatively small sample sizes. As a result, the similarities and differences in the impact of pain in subgroups of children with chronic pain have not been closely examined. OBJECTIVE To compare pain characteristics, quality of life, and emotional functioning among youth with pediatric chronic migraine (CM) and juvenile fibromyalgia (JFM). METHODS We combined data obtained during screening of patients for 2 relatively large intervention studies of youth (age range, 10 to 18 y) with CM (N=153) and JFM (N=151). Measures of pain intensity, quality of life (Pediatric Quality of Life; PedsQL, child and parent-proxy), depressive symptoms (Children's Depression Inventory), and anxiety symptoms (Adolescent Symptom Inventory-4-Anxiety subscale) were completed by youth and their parent. A multivariate analysis of covariance controlling for effects of age and sex was performed to examine differences in quality of life and emotional functioning between the CM and JFM groups. RESULTS Youth with JFM had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM, overall functioning was higher but school functioning was a specific area of concern. DISCUSSION Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, College of Medicine
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kimberly A. Barnett
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Brandon S. Aylward
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Daniel Strotman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Shalonda K. Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, College of Medicine
| | - Janelle R. Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Susan L. LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Marielle A. Kabbouche
- Department of Pediatrics, University of Cincinnati, College of Medicine
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Tracy V. Ting
- Department of Pediatrics, University of Cincinnati, College of Medicine
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center
| | - Andrew D. Hershey
- Department of Pediatrics, University of Cincinnati, College of Medicine
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, College of Medicine
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Verkamp EK, Flowers SR, Lynch-Jordan AM, Taylor J, Ting TV, Kashikar-Zuck S. A survey of conventional and complementary therapies used by youth with juvenile-onset fibromyalgia. Pain Manag Nurs 2013; 14:e244-e250. [PMID: 24315277 PMCID: PMC3857559 DOI: 10.1016/j.pmn.2012.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/14/2012] [Accepted: 02/14/2012] [Indexed: 11/16/2022]
Abstract
Little is known regarding treatment choices of youth diagnosed with juvenile-onset fibromyalgia (JFM) as they move into young adulthood. Additionally, there is little empirical evidence to guide youth with FM into appropriate treatment options, leading to a variety of therapies used to manage FM symptoms. The purpose of this descriptive study was to examine all therapies used by individuals with JFM as they entered young adulthood and the perceived effectiveness of these treatments. As part of a larger follow-up study, participants completed a web-based survey of all current and past treatments received for FM symptoms 2 years after their initial presentation and diagnosis at a pediatric rheumatology clinic. One hundred ten out of 118 eligible patients participated in the follow-up assessment as young adults (mean age 18.97 years; 93.6% female). A majority of participants reported use of conventional medications (e.g., antidepressants, anticonvulsants) and nondrug therapies (e.g., psychotherapy). Currently and within the past 2 years, antidepressant medications were the most commonly used to manage FM. Complementary treatments were used less often, with massage being the most popular choice. Although currently used treatments were reported as being effective, past treatments, especially medications, were viewed as being more variably effective. This is a potential reason why young adults with JFM might try more complementary and alternative approaches to managing their symptoms. More controlled studies are needed to investigate the effectiveness of these complementary methods to assist treatment providers in giving evidence-based treatment recommendations.
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Affiliation(s)
- Emily K Verkamp
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Stacy R Flowers
- Department of Psychology, Children's Medical Center of Dayton, Dayton, Ohio
| | - Anne M Lynch-Jordan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Janalee Taylor
- William S. Rowe Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tracy V Ting
- William S. Rowe Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A systematic review and meta-analysis of qigong for the fibromyalgia syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:635182. [PMID: 24288564 PMCID: PMC3833122 DOI: 10.1155/2013/635182] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/05/2013] [Indexed: 11/17/2022]
Abstract
Objectives. The fibromyalgia syndrome (FMS) is a chronic condition with only few evidence-based complementary and alternative therapies available. This paper presents a systematic review and meta-analysis of the effectiveness of Qigong for fibromyalgia syndrome. Methods. The PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, and Cambase databases were screened in December 2012 to identify randomized controlled trials comparing Qigong to control interventions. Major outcome measures were pain and quality of life; and secondary outcomes included sleep quality, fatigue, depression, and safety. Standardized mean differences (SMD) and 95% confidence intervals were calculated. Results. Seven trials were located with a total of 395 FMS patients. Analyses revealed low quality evidence for short-term improvement of pain, quality of life, and sleep quality and very low quality evidence for improvement of fatigue after Qigong for FMS, when compared to usual care. No evidence was found for superiority of Qigong compared to active treatments. No serious adverse events were reported. Discussion. This systematic review found that Qigong may be a useful approach for FMS patients. According to the quality of evidence, only a weak recommendation for Qigong can be made at this point. Further high quality RCTs are required for the conclusive judgment of its long-term effects.
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Affiliation(s)
- Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Winfried Häuser
- Department Internal Medicine I, Klinikum Saarbrücken, 66119 Saarbrücken, Germany
- Department of Psychomsomatic, Medicine and Psychotherapy, Technische Universität München, 81865 München, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
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Extension trial of qigong for fibromyalgia: a quantitative and qualitative study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:726062. [PMID: 24069054 PMCID: PMC3771469 DOI: 10.1155/2013/726062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 12/04/2022]
Abstract
This extension trial is an open-label observational trial of 20 subjects with fibromyalgia who undertook level 2 Chaoyi Fanhuan Qigong (CFQ) training following an earlier controlled trial of level 1 CFQ. Subjects practiced 60 min/day for 8 weeks and continued some daily practice for 6 months. Quantitative measures, assessed at baseline, 8 weeks, 4 and 6 months, were of pain, impact, sleep, physical and mental functions, and practice time. Qualitative comments also were recorded. Compared to baselines, CFQ practice led to significant improvements in pain, impact, sleep, and physical function in the 13 subjects (65%) who completed the trial; changes were present at 8 weeks and were maintained for the 6-month trial duration. A highly motivated subgroup of N = 5, who practiced the most, had the best outcomes in terms of end symptomology, and qualitative comments indicated health benefits in other domains as well. Qualitative comments by the remaining N = 8 trial completers and N = 7 withdrawals indicate different experiences with the practice. This extension trial indicates that diligent CFQ practice over time produces significant health gains in fibromyalgia in a subset of individuals. Future studies will need to address factors that might predispose to favourable outcomes.
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