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Zhao X, Dannenberg K, Repsilber D, Gerdle B, Molander P, Hesser H. Prognostic subgroups of chronic pain patients using latent variable mixture modeling within a supervised machine learning framework. Sci Rep 2024; 14:12543. [PMID: 38822075 PMCID: PMC11143186 DOI: 10.1038/s41598-024-62542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
The present study combined a supervised machine learning framework with an unsupervised method, finite mixture modeling, to identify prognostically meaningful subgroups of diverse chronic pain patients undergoing interdisciplinary treatment. Questionnaire data collected at pre-treatment and 1-year follow up from 11,995 patients from the Swedish Quality Registry for Pain Rehabilitation were used. Indicators measuring pain characteristics, psychological aspects, and social functioning and general health status were used to form subgroups, and pain interference at follow-up was used for the selection and the performance evaluation of models. A nested cross-validation procedure was used for determining the number of classes (inner cross-validation) and the prediction accuracy of the selected model among unseen cases (outer cross-validation). A four-class solution was identified as the optimal model. Identified subgroups were separable on indicators, predictive of long-term outcomes, and related to background characteristics. Results are discussed in relation to previous clustering attempts of patients with diverse chronic pain conditions. Our analytical approach, as the first to combine mixture modeling with supervised, targeted learning, provides a promising framework that can be further extended and optimized for improving accurate prognosis in pain treatment and identifying clinically meaningful subgroups among chronic pain patients.
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Affiliation(s)
- Xiang Zhao
- School of Behavioural, Social and Legal Sciences, Örebro University, Fakultetsgatan 1, 702 81, Örebro, Sweden
| | | | - Dirk Repsilber
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Björn Gerdle
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Peter Molander
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hugo Hesser
- School of Behavioural, Social and Legal Sciences, Örebro University, Fakultetsgatan 1, 702 81, Örebro, Sweden.
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
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Fonseca Das Neves J, Serra E, Kosinski T, Maréchal V, Rollin N, Richard O, Jehel L, Rusinek S. Catastrophizing and rumination mediate the link between functional disabilities and anxiety/depression in fibromyalgia. A double-mediation model. L'ENCEPHALE 2024; 50:162-169. [PMID: 37137739 DOI: 10.1016/j.encep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
Fibromyalgia can be considered to be a model of chronic pain resulting from dysregulation of pain processing. From a psychological point of view, it is possible to consider transdiagnostic processes that would participate in both the dysregulation of pain and associated emotions. OBJECTIVE The aim of this study was to test the links that exist between the tendency to Repetitive Negative Thinking (RNT) and the anxious-depressive manifestations in fibromyalgia. More specifically, we wanted to test a double mediation model where RNT would mediate the link between pain and depression/anxiety via catastrophizing. METHOD Eighty-two patients with fibromyalgia completed a series of questionnaires evaluating their level of depression, anxiety, disability related to pain, catastrophizing as well as various measures of Repetitive Thoughts. RESULTS The results showed strong correlations between RNT levels, pain, and anxious-depressive manifestations in this population. Moreover, the links between pain and depression/anxiety were mediated by catastrophizing and RNT in serial. CONCLUSION Results support the interest of studying RNT as a transdiagnostic process in fibromyalgia pain. Considering RNT in fibromyalgia allows a better understanding of tthe links that exist between pain and emotional disorders in this population and thus to better understand the psychopathological comorbidity of fibromyalgia.
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Affiliation(s)
| | - Eric Serra
- Centre d'étude et de traitement de la douleur, Centre hospitalier universitaire Amiens-Picardie, Amiens, France; Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
| | - Thierry Kosinski
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
| | - Virginie Maréchal
- Psychiatrie de Liaison, Centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France
| | - Noémie Rollin
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France; Consultation douleur, Centre hospitalier de Soissons, Soissons, France
| | - Olivier Richard
- Centre d'étude et de traitement de la douleur, Centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - Louis Jehel
- Psychiatrie de Liaison, Centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France; Equipe MOODS-IPSOM, U1018, CESP/INSERM, 94807 Villejuif Cedex, France
| | - Stéphane Rusinek
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
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Gavilán-Carrera B, Delgado-Fernández M, Sierra-Nieto E, Acosta-Manzano P, Borges-Cosic M, Soriano-Maldonado A, Segura-Jiménez V. Sedentary time is associated with depressive symptoms and state anxiety in women with fibromyalgia. Could physical activity and fitness modify this association? The al-Ándalus project. Disabil Rehabil 2023; 45:3303-3311. [PMID: 36205555 DOI: 10.1080/09638288.2022.2122602] [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: 11/02/2021] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze the associations of total and prolonged sedentary time (ST) with depressive symptoms and state anxiety in women with fibromyalgia and whether these associations are modified by moderate-to-vigorous physical activity (MVPA) and physical fitness. METHODS This cross-sectional exploratory study included 386 women with fibromyalgia aged 51.2 ± 7.6 years. Total ST, time in prolonged bouts of ST (≥30- and ≥60-min) and MVPA were measured with triaxial accelerometry. Depressive symptoms were assessed with the "Beck Depression Inventory-second edition," state anxiety with the "State-Trait Anxiety Inventory," and physical fitness with the "Senior Fitness Test Battery." RESULTS Total and prolonged ST were directly associated with depressive symptoms (total: β = 0.19, ≥30-min bout: β = 0.15, and ≥60-min bout: β = 0.12) and odds of severe depressive symptoms (all, p < 0.001). These associations generally remained significant after adjustments for MVPA and physical fitness (all, p < 0.05). Total and prolonged ST were directly associated with state anxiety (total: β = 0.11, ≥30-min bout: β = 0.12, and ≥60-min bout: β = 0.07; all, p < 0.001). These associations were generally independent of MVPA (p < 0.05) but vanished when considering physical fitness (p > 0.05). CONCLUSIONS Higher levels of total and prolonged ST are associated with greater depressive symptoms and state anxiety in women with fibromyalgia. MVPA did not modify these associations, although physical fitness could play a protective role specially for state anxiety.IMPLICATIONS FOR REHABILITATIONReducing sedentary time and avoiding its accumulation in prolonged periods could potentially reduce depressive symptoms and state anxiety in fibromyalgia.Higher sedentary time is associated with more severe depressive symptoms even in patients who engage in moderate-to-vigorous physical activity.Higher levels of physical fitness could attenuate the negative associations of sedentary time with depressive symptoms and, specially, state anxiety."Sit less, move more and exercise to increase your fitness" could be a positive message for people with fibromyalgia in clinical settings.
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Affiliation(s)
- Blanca Gavilán-Carrera
- Departamento de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Manuel Delgado-Fernández
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Eugenio Sierra-Nieto
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | - Pedro Acosta-Manzano
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Milkana Borges-Cosic
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Víctor Segura-Jiménez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- Hospital Universitario Virgen de las Nieves, Granada, Spain
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Haider S, Janowski AJ, Lesnak JB, Hayashi K, Dailey DL, Chimenti R, Frey-Law LA, Sluka KA, Berardi G. A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study. Pain 2023; 164:385-401. [PMID: 36006296 PMCID: PMC9797623 DOI: 10.1097/j.pain.0000000000002711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.
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Affiliation(s)
- Saman Haider
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Adam J. Janowski
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kazuhiro Hayashi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Dana L. Dailey
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803
| | - Ruth Chimenti
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Laura A. Frey-Law
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
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Creed F. The risk factors for self-reported fibromyalgia with and without multiple somatic symptoms: The Lifelines cohort study. J Psychosom Res 2022; 155:110745. [PMID: 35123251 DOI: 10.1016/j.jpsychores.2022.110745] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The numerous risk factors for fibromyalgia reflect its heterogeneous nature. This study assessed whether the predictors of fibromyalgia onset vary according to number of prior somatic symptoms. METHODS The prospective, population-based Lifelines cohort study included 138,617 adults without fibromyalgia or marked muscle pain. At baseline socio-demographic status, physical and psychiatric disorders, psycho-social and behavioural variables were assessed as potential predictors. At follow-up (mean 2.4 years later) new onsets of fibromyalgia were recorded by self-report. The predictors of new onsets of self-reported fibromyalgia were assessed using logistic regression with interaction terms between key variables and number of somatic symptoms. RESULTS At follow-up 679 (0.5%) participants reported new onset fibromyalgia. The strongest predictors were: female sex, rheumatoid and osteo-arthritis, IBS, impaired sleep, migraine, few years of education and impairment by bodily pain. Interaction terms with somatic symptoms were significant for years of education, low income, rheumatoid arthritis and no. of analgesics; these were predictors only for fibromyalgia with few somatic symptoms. Participants with multiple somatic symptoms had a higher number of predictors than those with few somatic symptoms. CONCLUSION This study suggests that people developing self-reported fibromyalgia with multiple pre-existing somatic symptoms have a high risk factor load reflecting risk factors for both fibromyalgia and multiple somatic symptoms. Self-reported fibromyalgia with few somatic symptoms has fewer predictors which may be specific to fibromyalgia. Future research could usefully study whether different pathophysiological mechanisms occur when fibromyalgia is preceded by high or low number of somatic symptoms.
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Affiliation(s)
- Francis Creed
- Emeritus Professor of Psychological Medicine, Psychology and Mental Health, University of Manchester, UK.
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Radunović G, Veličković Z, Rašić M, Janjić S, Marković V, Radovanović S. Assessment of gait in patients with fibromyalgia during motor and cognitive dual task walking: a cross-sectional study. Adv Rheumatol 2021; 61:53. [PMID: 34446109 DOI: 10.1186/s42358-021-00212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to assess gait pattern of patients diagnosed with fibromyalgia (FM) while performing demanding motor and/or cognitive dual tasks while walking. Further, idea was to explore possible correlations of dual task gait pattern alterations to patients' functional status and presence or absence of clinical symptoms associated with FM. METHODS Twenty-four female FM patients and 24 healthy female subjects performed a basic walking task, a dual motor, a dual mental (cognitive) and a combined, dual motor and cognitive task simultaneously. Quantitative spatial (stride length) and temporal (cycle time, swing time and double support time) gait parameters were measured using GAITRite walkway system and their variability was assessed. Patients underwent clinical examination including assessment of functional status, pain and fatigue level, psychiatric and cognitive manifestations. RESULTS The motor, cognitive and combined dual tasks affect gait performance in FM patients. Difference in tasks between FM and healthy subjects was found as double support time prolongation. Comparison of tasks showing that cycle time in FM was longer than controls and stride length was shorter in patients for all conditions, while no changes were found in any of the gait parameters variability. Further, mental/cognitive dual tasks had a larger effect than motor tasks. Correlations were also found between depression and functional status of the patients and the gait parameters. CONCLUSIONS Gait is affected in FM patients while dual task walking. No changes in stride-to-stride variability point that patients preserve stability in complex walking situations. Analysis of gait may provide additional information for the FM identification based on presence of clinical features and cognitive status. Correlation of dual task gait alterations with occurrence of clinical symptoms and influence of cognitive changes on gait pattern could additionally define FM subgroups.
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Affiliation(s)
- Goran Radunović
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Zoran Veličković
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Melanija Rašić
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Saša Janjić
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Resavska 69, Belgrade, Serbia
| | - Vladana Marković
- Neurology Clinic, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, Serbia
| | - Saša Radovanović
- Institute for Medical Research, University of Belgrade, Dr Subotića 4, 11129, Belgrade, Serbia.
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Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain. SPANISH JOURNAL OF PSYCHOLOGY 2021; 24:e33. [PMID: 34002687 DOI: 10.1017/sjp.2021.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks' λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks' λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.
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Salaffi F, Di Carlo M, Bazzichi L, Atzeni F, Govoni M, Biasi G, Di Franco M, Mozzani F, Gremese E, Dagna L, Batticciotto A, Fischetti F, Giacomelli R, Guiducci S, Guggino G, Bentivegna M, Gerli R, Salvarani C, Bajocchi G, Ghini M, Iannone F, Giorgi V, Farah S, Cirillo M, Bonazza S, Barbagli S, Gioia C, Santilli D, Capacci A, Cavalli G, Carubbi F, Nacci F, Riccucci I, Sinigaglia L, Masullo M, Polizzi BM, Cutolo M, Sarzi-Puttini P. Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients. Rheumatology (Oxford) 2021; 60:728-736. [PMID: 32793982 DOI: 10.1093/rheumatology/keaa355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. METHODS Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'-which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. RESULTS The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th-75th percentiles) were respectively 61.16 (41.16-77.00), 27.00 (19.00-32.00) and 19.0 (13.00-24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0-23 for remission, 24-40 for mild disease, 41-63 for moderate disease, 64-82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0-12 for remission, 13-20 for mild disease, 21-28 for moderate disease, 29-33 for severe disease and >33 for very severe disease; PDS: 0-5 for remission, 6-15 for mild disease, 16-20 for moderate disease, 21-25 for severe disease and >25 for very severe disease. CONCLUSIONS Disease severity cut-offs can represent an important improvement in interpreting FM.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | | | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Marcello Govoni
- Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Manuela Di Franco
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences Rheumatology Unit- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Flavio Mozzani
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elisa Gremese
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo - Fondazione Macchi, Varese, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Giuliana Guggino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Bentivegna
- Integrated Reference Center of Rheumatology, ASP 7, Scicli Hospital, Ragusa, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Carlo Salvarani
- University of Modena and Reggio Emilia, Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia, Italy
| | - Marco Ghini
- Rheumatology Unit, Azienda USL di Modena, Modena, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transpantations, University of Bari, Bari, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan State University School of Medicine, Milan, Italy
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Mariateresa Cirillo
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Sara Bonazza
- Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Stefano Barbagli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Chiara Gioia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences Rheumatology Unit- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Annunziata Capacci
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Carubbi
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Francesca Nacci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Maurizio Masullo
- Ministry of Health, General Directorate of Health Care, Rome, Italy
| | | | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino, University of Genova, Genova, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan State University School of Medicine, Milan, Italy
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Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010247. [PMID: 33396279 PMCID: PMC7796452 DOI: 10.3390/ijerph18010247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023]
Abstract
Fibromyalgia (FM) is a heterogeneous and complex syndrome; different studies have tried to describe subgroups of FM patients, and a 4-cluster classification based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) has been recently validated. This study aims to cross-validate this classification in a large US sample of FM patients. A pooled sample of 6280 patients was used. First, we computed a hierarchical cluster analysis (HCA) using FIQR scores at item level. Then, a latent profile analysis (LPA) served to confirm the accuracy of the taxonomy. Additionally, a cluster calculator was developed to estimate the predicted subgroup using an ordinal regression analysis. Self-reported clinical measures were used to examine the external validity of the subgroups in part of the sample. The HCA yielded a 4-subgroup distribution, which was confirmed by the LPA. Each cluster represented a different level of severity: “Mild–moderate”, “moderate”, “moderate–severe”, and “severe”. Significant differences between clusters were observed in most of the clinical measures (e.g., fatigue, sleep problems, anxiety). Interestingly, lower levels of education were associated with higher FM severity. This study corroborates a 4-cluster distribution based on FIQR scores to classify US adults with FM. The classification may have relevant clinical implications for diagnosis and treatment response.
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10
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Ordóñez-Carrasco JL, Sánchez-Castelló M, Calandre EP, Cuadrado-Guirado I, Rojas-Tejada AJ. Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010209. [PMID: 33396651 PMCID: PMC7795109 DOI: 10.3390/ijerph18010209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.
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Affiliation(s)
- Jorge L. Ordóñez-Carrasco
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
- Correspondence:
| | - María Sánchez-Castelló
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
| | - Elena P. Calandre
- Instituto de Neurociencias “F. Oloriz”, University of Granada, 18013 Granada, Spain;
| | - Isabel Cuadrado-Guirado
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
| | - Antonio J. Rojas-Tejada
- Department of Psychology, University of Almería, 04120 Almería, Spain; (M.S.-C.); (I.C.-G.); (A.J.R.-T.)
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11
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Abstract
Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2-5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria. Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature. Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.
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Affiliation(s)
- Kevin Hackshaw
- Division Chief of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Dell Medical School, the University of Texas , Austin, TX, USA
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12
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Gonzalez B, Novo R, Peres R. Personality and psychopathology heterogeneity in MMPI‐2 and health‐related features in fibromyalgia patients. Scand J Psychol 2020; 62:203-210. [DOI: 10.1111/sjop.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bárbara Gonzalez
- HEI‐Lab: Digital Human‐Environment Interactions Lab Universidade Lusófona de Humanidades e Tecnologias Lisbon Portugal
| | - Rosa Novo
- CICPSI, Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Rodrigo Peres
- Instituto de Psicologia Universidade Federal de Uberlândia Uberlândia Brazil
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13
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Alciati A, Atzeni F, Caldirola D, Perna G, Sarzi-Puttini P. The Co-Morbidity between Bipolar and Panic Disorder in Fibromyalgia Syndrome. J Clin Med 2020; 9:jcm9113619. [PMID: 33182759 PMCID: PMC7697979 DOI: 10.3390/jcm9113619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
About half of the patients with fibromyalgia (FM) had a lifetime major depression episode and one third had a panic disorder (PD). Because the co-morbidity between bipolar disorder (BD) and PD marks a specific subtype of BD we aimed to investigate if co-morbid BD/PD (comBD/PD) occurs more frequently than the single disorder in FM patients and evaluate the clinical significance and timing of this co-morbidity. Further, we explored the role of co-morbid subthreshold BD and PD. In 118 patients with FM, lifetime threshold and sub-threshold mood disorders and PD were diagnosed with Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR) Clinical Interview. Demographic and clinical variables were compared in co-morbid BD/PD (comBD/PD) and not co-morbid BD/PD (nocomBD/PD) subgroups. The co-morbidity BD/PD was seen in 46.6% of FM patients and in 68.6% when patients with minor bipolar (MinBD) and sub-threshold panic were included. These rates are higher than those of the general population and BD outpatients. There were no statistically significant differences between threshold and sub-threshold comBD/PD and nocom-BD/PD subgroups in demographic and clinical parameters. In the majority of patients (78.2%), the onset of comBD/PD preceded or was contemporary with FM. These findings support the hypothesis that comBD/PD is related to the development of FM in a subgroup of patients.
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Affiliation(s)
- Alessandra Alciati
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, Albese con Cassano, via Roma 16, 22032 Como, Italy; (D.C.); (G.P.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve, Emanuele-Milan, Italy
- Correspondence:
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Via Consolare Valeria 1, 98100 Messina, Italy;
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, Albese con Cassano, via Roma 16, 22032 Como, Italy; (D.C.); (G.P.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve, Emanuele-Milan, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, Albese con Cassano, via Roma 16, 22032 Como, Italy; (D.C.); (G.P.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve, Emanuele-Milan, Italy
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL 33136-1015, USA
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157 Milan, Italy;
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14
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Estévez-López F, Rodriguez-Ayllon M, Soriano-Maldonado A, Acosta-Manzano P, Segura-Jiménez V, Álvarez-Gallardo IC, Pulido-Martos M, Herrador-Colmenero M, Geenen R, Carbonell-Baeza A, Delgado-Fernández M. Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Ándalus Project. PAIN MEDICINE 2020; 20:2506-2515. [PMID: 30698774 DOI: 10.1093/pm/pny304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association. DESIGN Cross-sectional study in 420 women with fibromyalgia. SETTING Fibromyalgia associations from southern Spain. METHODS Physical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses. RESULTS Physical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P < 0.001). Negative affect was independently associated with general fatigue, physical fatigue, reduced motivation, and mental fatigue (all P ≤ 0.04). The interaction of overall physical fitness and positive affect was related to general fatigue and physical fatigue (all P ≤ 0.02). Women with fibromyalgia with higher levels of overall physical fitness and positive affect showed the lowest general fatigue and physical fatigue. CONCLUSIONS In women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.
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Affiliation(s)
- Fernando Estévez-López
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Northern Ireland, UK.,Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - María Rodriguez-Ayllon
- PROmoting FITness and Health Through Physical Activity (PROFITH) Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | | | - Manuel Pulido-Martos
- Department of Psychology, Faculty of Humanities and Sciences of Education, University of Jaén, Jaén, Spain
| | - Manuel Herrador-Colmenero
- PROmoting FITness and Health Through Physical Activity (PROFITH) Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Rinie Geenen
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ana Carbonell-Baeza
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
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15
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Muller V, Chan F, Iwanaga K, Wu JR, Chen X, Lee B, Tao J, Rumrill P, Bezyak J. An Empirically Derived Taxonomy of Biopsychosocial Factors of Adjustment to Fibromyalgia: Results of a Multivariate Analysis. REHABILITATION COUNSELING BULLETIN 2020. [DOI: 10.1177/0034355220925157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Fibromyalgia (FM) is a lifelong central nervous system disorder that is precipitated by a range of biological, psycho-cognitive, and social factors. The aims of this exploratory study were to (a) identify biopsychosocial and cognitive factors that may affect an individual’s response to FM, (b) determine whether individuals with FM can be grouped into homogeneous subgroups based on biopsychosocial factors associated with response to FM, and (c) compare subgroup differences in health outcomes and life satisfaction. This study included 302 participants with FM. Principal components analysis yielded three sets of biopsychosocial factors that may affect response to FM (i.e., protective, cognitive-affective, and physical factors). Based on these three factors, a cluster analysis was performed, which produced three homogeneous subgroups: (a) the moderate amount of problems group, (b) the least amount of problems group, and (c) the many problems group. Analysis of variance (ANOVA) results indicated that these three subgroups differed significantly in terms of health outcomes and life satisfaction. The findings of this study broaden the existing literature related to understanding FM from a multidimensional symptom response perspective and contribute to the development and validation of biopsychosocial interventions for people with FM.
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Affiliation(s)
- Veronica Muller
- Hunter College, The City University of New York, New York City, USA
| | - Fong Chan
- University of Wisconsin–Madison, USA
| | | | - Jia-Rung Wu
- Northeastern Illinois University, Chicago, USA
| | | | | | - Jing Tao
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | | | - Jill Bezyak
- University of Northern Colorado, Greeley, USA
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16
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Santos E Campos MA, Párraga‐Montilla JA, Aragón‐Vela J, Latorre‐Román PA. Effects of a functional training program in patients with fibromyalgia: A 9‐year prospective longitudinal cohort study. Scand J Med Sci Sports 2020; 30:904-913. [DOI: 10.1111/sms.13640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/03/2020] [Accepted: 02/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
| | | | - Jerónimo Aragón‐Vela
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhague Denmark
| | - Pedro A. Latorre‐Román
- Department of Didactics of Music, Plastic and Corporal Expression University of Jaén Jaén Spain
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17
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Climent‐Sanz C, Gea‐Sánchez M, Moreno‐Casbas MT, Blanco‐Blanco J, García‐Martínez E, Valenzuela‐Pascual F. A web‐based therapeutic patient education intervention for pain and sleep for women with fibromyalgia: A sequential exploratory mixed‐methods research protocol. J Adv Nurs 2020; 76:1425-1435. [DOI: 10.1111/jan.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Carolina Climent‐Sanz
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Montserrat Gea‐Sánchez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - María T. Moreno‐Casbas
- Instituto de Salud Carlos III Nursing and Healthcare Research Unit (Investen‐isciii) Madrid Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid Spain
| | - Joan Blanco‐Blanco
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Ester García‐Martínez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Fran Valenzuela‐Pascual
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
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18
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Álvarez-Gallardo IC, Estévez-López F, Torres-Aguilar XC, Segura-Jiménez V, Borges-Cosic M, Soriano-Maldonado A, Camiletti-Moirón D, García-Rodríguez IC, Munguía-Izquierdo D, Sierras-Robles Á, Delgado-Fernández M, Girela-Rejón MJ. Physical activity, sedentary behaviour, physical fitness, and cognitive performance in women with fibromyalgia who engage in reproductive and productive work: the al-Ándalus project. Clin Rheumatol 2019; 38:3585-3593. [PMID: 31468225 DOI: 10.1007/s10067-019-04750-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/06/2019] [Accepted: 08/12/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION/OBJECTIVES Reproductive labour refers to activities and tasks directed at caregiving and domestic roles, such as cleaning, cooking, and childcare. Productive labour refers to activities that involve economic remuneration. The aim of the present study was to analyse physical activity, sedentary behaviour, physical fitness, and cognitive performance in women with fibromyalgia who engaged, or did not engage, in productive work. METHOD This cross-sectional study comprised 276 women with fibromyalgia from Andalusia (southern of Spain). Levels of physical activity (light, moderate, and vigorous) and sedentary behaviour were measured by an accelerometer. Physical fitness and cognitive performance were measured with a battery of performance-based tests. RESULTS More hours/week of homemaker-related tasks were associated with higher time spend in light physical activity and lower sedentary behaviour (P < 0.001 and P < 0.05, respectively). Furthermore, in comparison with those who only engaged in reproductive labour, women with fibromyalgia who engaged in productive work showed lower levels of sedentary behaviour and higher levels of light and moderate physical activity, physical fitness (except muscular strength), and cognitive performance (all, P < 0.05). CONCLUSIONS Altogether, our findings suggest that productive work is consistently related to better physical and cognitive functioning in women with fibromyalgia. If future research corroborates causality of our findings, then, to maintain women with fibromyalgia engaging in productive work may be strived for not only because of societal or economic reasons but also for better health. However, we should keep in mind that people with fibromyalgia have a chronic condition, and therefore, adaptations at the workplace are imperative.Key Points• Women with fibromyalgia, who spend more time in reproductive labour, have higher levels of light physical activity and lower sedentary behaviour; however, it is associated with poorer general health (as lower physical fitness or cognitive performance).• Household tasks are often seen as a responsibility associated with the gender roles that women with fibromyalgia perform, despite the feelings of incapacity they cause. Policies focused on reducing reproductive labour demands for fibromyalgia patients (i.e. social help on housework or childcare) might facilitate the inclusion of daily active behaviours.• People with fibromyalgia who engage in productive work seem to have better health outcomes than those who have not; however, we cannot forget that adaptations and flexibility at the workplace are imperative.
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Affiliation(s)
- Inmaculada C Álvarez-Gallardo
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui, s/n, 11519, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cadiz, Spain.
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Xitlali C Torres-Aguilar
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui, s/n, 11519, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cadiz, Spain
| | - Milkana Borges-Cosic
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Daniel Camiletti-Moirón
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui, s/n, 11519, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cadiz, Spain
| | | | - Diego Munguía-Izquierdo
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, University Pablo de Olavide, Seville, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging, Madrid, Spain
| | - Ángela Sierras-Robles
- Department of Physical Education, Music, and Fine Arts, University of Huelva, Huelva, Spain
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - María J Girela-Rejón
- Department of Didactic of Corporal Expression, Faculty of Education Sciences, University of Granada, Granada, Spain
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19
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Are Signs of Central Sensitization in Acute Low Back Pain a Precursor to Poor Outcome? THE JOURNAL OF PAIN 2019; 20:994-1009. [DOI: 10.1016/j.jpain.2019.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/13/2019] [Accepted: 03/02/2019] [Indexed: 12/20/2022]
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20
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Vriezekolk JE, Peters AJF, van den Ende CHM, Geenen R. Solicitous and invalidating responses are associated with health-care visits in fibromyalgia. Rheumatol Adv Pract 2019; 3:rkz008. [PMID: 31431996 PMCID: PMC6649929 DOI: 10.1093/rap/rkz008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives Health-care use in FM is substantial. Besides the severity of the disease and psychological factors, previous research suggests that the social environment can influence patients’ health-care use. In this study, we describe health-care use in patients with FM and investigate the relationship of social responses of the partner and family with health-care use. Methods Cross-sectional data of 280 patients with FM were analysed. Sociodemographic variables, health-status variables, health-care use, partner’s solicitous and punishing responses, and invalidation (i.e. discounting and lack of understanding) by family were assessed. Heath-care use was defined as the number of visits to physicians and health professionals. Associations of independent variables with health-care use were examined using univariate and hierarchical regression analyses. Results In the preceding 6 months, 99% of the patients visited at least one physician and 66% visited at least one health professional. The mean (s.d.) total health-care visits and the number of different disciplines consulted were 18.5 (17.7) and 3.6 (1.7), respectively. Being female, paid employment, having a co-morbid condition, a higher severity of FM, more partner’s solicitous responses and more invalidating responses by family were univariately associated with visits to a physician. Having a co-morbid condition, severity of FM and invalidation by family were uniquely associated with visits to a physician. No other associations were found. Conclusion Therapeutic attention to patients’ close social environment might be a useful approach to improve health-related outcomes, including health-care use, in patients with FM.
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Affiliation(s)
| | | | | | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
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21
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Taylor SJ, Steer M, Ashe SC, Furness PJ, Haywood-Small S, Lawson K. Patients' perspective of the effectiveness and acceptability of pharmacological and non-pharmacological treatments of fibromyalgia. Scand J Pain 2019; 19:167-181. [PMID: 30315738 DOI: 10.1515/sjpain-2018-0116] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023]
Abstract
Background and aims Fibromyalgia is a complex condition characterised by widespread pain, sleep disturbance, fatigue and cognitive impairment, with a global mean prevalence estimated at 2.7%. There are inconsistencies in guidelines on the treatment of fibromyalgia leading to dissatisfaction from patients and healthcare professionals. This study investigated patient-reported outcomes of pharmacological and non-pharmacological treatment usage and effectiveness with an assessment of acceptability. Methods Nine hundred and forty-one participants completed a self-administered anonymous questionnaire giving quantitative data of demographics, treatment usage and treatment outcomes. Participant-reported effectiveness and side effects were compared in the following treatment classes: analgesics, antidepressants, gabapentinoids, gastrointestinal treatments, activity interventions, dietary-based treatments, and psychological, physical and alternative therapies. Participants also reported whether they knew about or had tried different treatments. Results The results from the online survey indicated that the range of mean effectiveness ratings were similar for pharmacological and non-pharmacological treatments, whereas non-pharmacological treatments had lower side effects ratings and higher acceptability relative to pharmacological treatments. Participants were not aware of some treatment options. Conclusions The results show lower side effects ratings and higher acceptability for non-pharmacological treatments compared to pharmacological treatments despite similar effectiveness ratings. Implications This article presents results from a large online survey on fibromyalgia patient perspectives of pharmacological and non-pharmacological treatments. Results will inform healthcare professionals and patients about optimal treatments based on ratings of effectiveness, side effects and acceptability that are tailored to patient symptom profiles. Some participants were unaware of treatment options highlighting the importance of patient education allowing collaboration between patients and healthcare professionals to find optimal treatments.
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Affiliation(s)
- Sophie J Taylor
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Michael Steer
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Simon C Ashe
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Penny J Furness
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Sarah Haywood-Small
- Biomolecular Sciences Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Kim Lawson
- Biomolecular Sciences Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Laroche F, Guérin J, Azoulay D, Coste J, Perrot S. La fibromyalgie en France : vécu quotidien, fardeau professionnel et prise en charge. Enquête nationale auprès de 4516 patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rhum.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire–Revised: differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes. Pain 2018; 160:908-921. [DOI: 10.1097/j.pain.0000000000001468] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Feliu-Soler A, Pérez-Aranda A, Andrés-Rodríguez L, Butjosa A, Díaz NS, Trujols J, Núñez C, Stephan-Otto C, Rozadilla-Sacanell A, Serrano-Blanco A, Kratz AL, Luciano JV. Digging into the construct of fibrofog: Psychometric properties of the Spanish version of the Multidimensional Inventory of Subjective Cognitive Impairment in patients with fibromyalgia. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/jabr.12134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Adrián Pérez-Aranda
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Laura Andrés-Rodríguez
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Anna Butjosa
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
| | | | - Joan Trujols
- Centre for Biomedical Research in Mental Health; CIBERSAM; Madrid Spain
- Addictive Behaviors Unit; Department of Psychiatry; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Christian Núñez
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
| | - Christian Stephan-Otto
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Centre for Biomedical Research in Mental Health; CIBERSAM; Madrid Spain
| | | | - Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP; Madrid Spain
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation; University of Michigan; Ann Arbor MI USA
| | - Juan V. Luciano
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
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25
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Adams LM, Turk DC. Central sensitization and the biopsychosocial approach to understanding pain. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/jabr.12125] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Leah M. Adams
- Department of Psychology; George Mason University; Fairfax VA
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine; University of Washington; Seattle WA
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26
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Homma M, Ishikawa H, Kiuchi T. Illness perceptions and negative responses from medical professionals in patients with fibromyalgia: Association with patient satisfaction and number of hospital visits. PATIENT EDUCATION AND COUNSELING 2018; 101:532-540. [PMID: 28893471 DOI: 10.1016/j.pec.2017.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine whether illness perceptions among patients with fibromyalgia and negative responses from medical professionals correlate with their satisfaction with their physicians or with their number of hospital visits. METHODS Questionnaires were sent by post to members of the Japan Fibromyalgia Support Association. Measures collected included, as independent variables, the Brief Illness Perception Questionnaire and the Illness Invalidation Inventory; and as outcomes, the Patient Satisfaction Consultation Questionnaire and the number of hospital visits. RESULTS We analyzed data from 304 patients. Multiple logistic regressions showed that perception of poor treatment control and the experience of being discounted and misunderstood by medical professionals were strongly correlated with dissatisfaction with attending physicians. Patients who perceived poor treatment control visited the hospital fewer times, while patients who reported being discounted by medical professionals visited more times. Patients' negative emotions correlated neither with patient satisfaction nor with the number of hospital visits. CONCLUSION Treatment effectiveness and the respect accorded to patients were the key factors significantly correlated both with patient satisfaction and the number of hospital visits. PRACTICE IMPLICATIONS Physicians should not emphasize only patients' negative psychological status but also should convey a respectful attitude and help patients understand their current treatment is useful.
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Affiliation(s)
- Mieko Homma
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hirono Ishikawa
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan.
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27
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Hoskin TL, Whipple MO, Nanda S, Vincent A. Longitudinal stability of fibromyalgia symptom clusters. Arthritis Res Ther 2018; 20:37. [PMID: 29486783 PMCID: PMC5830338 DOI: 10.1186/s13075-018-1532-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/01/2018] [Indexed: 01/22/2023] Open
Abstract
Background Using self-report questionnaires of key fibromyalgia symptom domains (pain, fatigue, sleep disturbance, function, stiffness, dyscognition, depression, and anxiety), we previously identified four unique symptom clusters. The purpose of this study was to examine the stability of fibromyalgia symptom clusters between baseline and 2-year follow-up. Methods Women with a diagnosis of fibromyalgia completed the Brief Pain Inventory, Profile of Mood States, Medical Outcomes Study Sleep measure, Multidimensional Fatigue Inventory, Multiple Ability Self-Report Questionnaire, Revised Fibromyalgia Impact Questionnaire, and the 36-Item Short Form Survey Instrument at baseline. Follow-up measures were completed approximately 2 years later. The hierarchical agglomerative clustering algorithm previously developed was applied; agreement between baseline and follow-up was assessed with the κ statistic. Results Among 433 participants, the mean age was 56 (range 20–85) years. The median Revised Fibromyalgia Impact Questionnaire total score was 57 (range 8–96). More than half of participants (58%) remained in the same cluster at follow-up as at baseline, which represented moderate agreement between baseline and follow-up (κ = 0.44, 95% confidence interval (CI) 0.37–0.50). Only two patients changed from high symptom intensity to low symptom intensity; similarly, only three moved from low to high. Conclusions Fibromyalgia patients classified into four unique symptom clusters based on the key domains of pain, fatigue, sleep disturbance, function, stiffness, dyscognition, depression, and anxiety showed moderate stability in cluster assignment after 2 years. Few patients moved between the two extremes of severity, and it was slightly more common to move to a lower symptom level than to worsen. Trial registration Not applicable.
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Affiliation(s)
- Tanya L Hoskin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mary O Whipple
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ann Vincent
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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28
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Bäckryd E, Persson EB, Larsson AI, Fischer MR, Gerdle B. Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study). PLoS One 2018; 13:e0192623. [PMID: 29420607 PMCID: PMC5805304 DOI: 10.1371/journal.pone.0192623] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination. DESIGN Cross-sectional, registry-based study. SETTING AND SUBJECTS Chronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015. METHODS Data from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares-discriminant analysis. RESULTS Four subgroups were identified. Group 1 was characterized by low "psychological strain", the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high "psychological strain" and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high "social distress", the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low "social distress", and high pain intensity. CONCLUSIONS The identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived "social distress" raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth B. Persson
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Marcelo Rivano Fischer
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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29
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Bartley EJ, Robinson ME, Staud R. Pain and Fatigue Variability Patterns Distinguish Subgroups of Fibromyalgia Patients. THE JOURNAL OF PAIN 2017; 19:372-381. [PMID: 29253551 DOI: 10.1016/j.jpain.2017.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
The current study examined between- and within-subject variability in pain-related symptoms as predictors of pain and fatigue, and identified patient subgroups on the basis of symptom variability characteristics. Two hundred fifty-six fibromyalgia (FM) patients completed daily diaries up to a period of 154 days and reported on symptoms of pain intensity, pain unpleasantness, fatigue, anxiety, and depressed mood. Measures of health status, quality of life, and somatic symptoms were obtained at baseline, and hierarchical linear modeling and cluster analyses were used. Significant intra- and interindividual variability in daily FM symptoms was observed. Higher levels of pain were associated with greater fluctuations in pain unpleasantness, fatigue, and depressed mood. Similar effects were observed for fatigue and individual variability in anxiety also emerged as a robust predictor. Three FM subgroups were revealed: low variability in symptoms (cluster 1), high symptom variability (cluster 2), and a mixed variability group characterized by low fluctuation in pain unpleasantness; moderate pain, fatigue, and depressed mood variability; and high anxiety variability (cluster 3). Cluster 3 exhibited lower social functioning and higher levels of pain, compared with cluster 1. These findings support the dynamic nature of FM pain and suggest the presence of FM subgroups on the basis of variation in mood and pain symptomatology. PERSPECTIVE FM patients show significant intra- and interindividual variability in pain, mood, and fatigue. Subgroups in mood and pain-related variability emerged, with phenotypic clusters differing across levels of pain intensity and social functioning. Better understanding of the processes affecting pain variability may facilitate targeted treatments for the control of pain.
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Affiliation(s)
- Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida.
| | - Michael E Robinson
- Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida
| | - Roland Staud
- Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Medicine, University of Florida, Gainesville, Florida
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30
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Estévez-López F, Segura-Jiménez V, Álvarez-Gallardo IC, Borges-Cosic M, Pulido-Martos M, Carbonell-Baeza A, Aparicio VA, Geenen R, Delgado-Fernández M. Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Ándalus project. Rheumatology (Oxford) 2017; 56:2015-2024. [PMID: 28968914 DOI: 10.1093/rheumatology/kex302] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives The aim of this study was to identify subgroups in terms of adaptation to FM and to test differences in FM severity between these subgroups. Methods The al-Ándalus project made it possible to perform a comprehensive population-based cross-sectional study in 486 FM patients including multiple assessments of modifiable (could be targeted in therapy) resilience and vulnerability factors, measured by objective and subjective assessments, related to psychological and physical function. FM severity was assessed by means of FM impact (total score of the Revised Fibromyalgia Impact Questionnaire) and distress (Polysymptomatic Distress Scale of the modified 2011 preliminary criteria for FM). Exploratory factor analysis, cluster analysis and analysis of variance were conducted. Results Factor analysis yielded eight factors: three included objective measures (declarative memory, active lifestyle and objective physical fitness) and five included subjective measures (fatigue, psychological distress, catastrophizing, resilience and subjective physical fitness). Cluster analysis based on these eight factors identified five profiles: Adapted (16%), Fit (18%), Poor performer (20%), Positive (20%) and Maladapted (26%). Most profile comparisons revealed different levels of FM severity varying from Adapted (the most favourable profile) to Maladapted (the most unfavourable profile) with Fit, Poor performer and Positive obtaining intermediate positions. Conclusions Heterogeneity of FM was shown by five clinically meaningful profiles of modifiable factors that were associated with FM severity. It is of clinical interest to examine whether these profiles are associated with FM prognosis and the effectiveness of interventions, which would enhance the development of customized interventions based on adaptation profiles in FM.
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Affiliation(s)
- Fernando Estévez-López
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Víctor Segura-Jiménez
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz
| | - Inmaculada C Álvarez-Gallardo
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz
| | - Milkana Borges-Cosic
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Manuel Pulido-Martos
- Department of Psychology, Faculty of Humanities and Sciences of Education, University of Jaén, Jaén
| | - Ana Carbonell-Baeza
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz
| | - Virginia A Aparicio
- Department of Physiology, Faculty of Pharmacy, Faculty of Sport Sciences, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Rinie Geenen
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
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31
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Hadlandsmyth K, Dailey DL, Rakel BA, Zimmerman MB, Vance CG, Merriwether EN, Chimenti RL, Geasland KM, Crofford LJ, Sluka KA. Somatic symptom presentations in women with fibromyalgia are differentially associated with elevated depression and anxiety. J Health Psychol 2017; 25:819-829. [PMID: 29076404 DOI: 10.1177/1359105317736577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study examined whether depression and anxiety differentially relate to fatigue, sleep disturbance, pain catastrophizing, fear of movement, and pain severity in women with fibromyalgia. Baseline data from the Fibromyalgia Activity Study with Transcutaneous Electrical Nerve Stimulation were analyzed. Of 191 participants, 50 percent reported high anxiety and/or depression (17% high anxiety, 9% high depression, and 24% both). Fatigue and sleep impairment were associated with high depression (p < 0.05). Pain severity, pain catastrophizing, and fear of movement were associated with high anxiety and high depression (p < 0.05). Possible implications for underlying mechanisms and the need for targeted treatments are discussed.
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Affiliation(s)
- Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | | | | | - Carol Gt Vance
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Ericka N Merriwether
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Katharine M Geasland
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | | | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
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32
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Novo R, Gonzalez B, Peres R, Aguiar P. A meta-analysis of studies with the Minnesota Multiphasic Personality Inventory in fibromyalgia patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Sancassiani F, Machado S, Ruggiero V, Cacace E, Carmassi C, Gesi C, Dell'Osso L, Carta MG. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry 2017; 29:473-488. [PMID: 28681628 DOI: 10.1080/09540261.2017.1320982] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) is a central sensitization syndrome characterized by chronic widespread pain. FM is often comorbid with psychiatric disorders, as well as psychological distress that worsens the quality-of-life of people affected. The aim was to collect current evidence about the management of FM from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed; review articles, meta-analysis, overview, and guidelines published in the last 10 years written in English were included. Five main topics (Diagnostic criteria of FM; Pathogenesis of chronic widespread pain in FM; Early stress and trauma as predisposing factors for central sensitization; FM and Psychiatric comorbidity; Implications for treatment) were pointed out and discussed. Much evidence underlies the importance of considering and treating the comorbidity of FM with psychiatric disorders and psychological factors that affect pain management. Validation of FM as a central sensitization syndrome by a clinician facilitates therapeutic strategies that involve patients as active participants in the pain management process, likely leading to improved outcomes.
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Affiliation(s)
- Federica Sancassiani
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Sergio Machado
- b Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , RJ , Brazil.,c Physical Activity Neuroscience , Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University , Niterói , Brazil
| | - Valeria Ruggiero
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Enrico Cacace
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Claudia Carmassi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Camilla Gesi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Liliana Dell'Osso
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
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Häuser W, Perrot S, Clauw DJ, Fitzcharles MA. Unravelling Fibromyalgia-Steps Toward Individualized Management. THE JOURNAL OF PAIN 2017; 19:125-134. [PMID: 28943233 DOI: 10.1016/j.jpain.2017.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 11/30/2022]
Abstract
The heterogeneity of the clinical presentation and the pathophysiologic mechanisms associated with fibromyalgia (FM), and the modest results on average for any therapy, call for a more individualized management strategy. Individualized treatment can be on the basis of subgrouping of patients according to associated conditions (mental health problems, chronic overlapping pain conditions, other somatic diseases) or on disease severity. Categorizing FM as mild, moderate, or severe can be on the basis of clinical assessment (eg, degree of daily functioning) or on questionnaires. Shared decision-making regarding treatment options can be directed according to patient preferences, comorbidities, and availability in various health care settings. The European League Against Rheumatism guidelines recommend a tailored approach directed by FM key symptoms (pain, sleep disorders, fatigue, depression, disability), whereas the German guidelines recommend management tailored to disease severity, with mild disease not requiring any specific treatment, and more severe disease requiring multicomponent therapy (combination of drug treatment with aerobic exercise and psychological treatments). When indicated, treatments should follow a stepwise approach beginning with easily available therapies such as aerobic exercise and amitriptyline. Successful application of a tailored treatment approach that is informed by individual patient characteristics should improve outcome of FM. PERSPECTIVE This article presents suggestions for an individualized treatment strategy for FM patients on the basis of subgroups and disease severity. Categorizing FM as mild, moderate, or severe can be on the basis of clinical assessment (eg, degree of daily functioning) or questionnaires. Subgroups can be defined according to mental health and somatic comorbidities.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany; Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich.
| | - Serge Perrot
- Centre de la douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, The University of Michigan, Ann Arbor, Michigan
| | - Mary-Ann Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Quebec, Canada; Division of Rheumatology, McGill University Health Centre, Quebec, Canada
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35
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Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification. THE JOURNAL OF PAIN 2017; 17:T93-T107. [PMID: 27586833 DOI: 10.1016/j.jpain.2016.06.002] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED There is increasing recognition that many if not most common chronic pain conditions are heterogeneous with a high degree of overlap or coprevalence of other common pain conditions along with influences from biopsychosocial factors. At present, very little attention is given to the high degree of overlap of many common pain conditions when recruiting for clinical trials. As such, many if not most patients enrolled into clinical studies are not representative of most chronic pain patients. The failure to account for the heterogeneous and overlapping nature of most common pain conditions may result in treatment responses of small effect size when these treatments are administered to patients with chronic overlapping pain conditions (COPCs) represented in the general population. In this brief review we describe the concept of COPCs and the putative mechanisms underlying COPCs. Finally, we present a series of recommendations that will advance our understanding of COPCs. PERSPECTIVE This brief review describes the concept of COPCs. A mechanism-based heuristic model is presented and current knowledge and evidence for COPCs are presented. Finally, a set of recommendations is provided to advance our understanding of COPCs.
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Affiliation(s)
- William Maixner
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina.
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Shad B Smith
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Larsson B, Gerdle B, Bernfort L, Levin LÅ, Dragioti E. Distinctive subgroups derived by cluster analysis based on pain and psychological symptoms in Swedish older adults with chronic pain - a population study (PainS65+). BMC Geriatr 2017; 17:200. [PMID: 28865445 PMCID: PMC5581449 DOI: 10.1186/s12877-017-0591-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/21/2017] [Indexed: 12/22/2022] Open
Abstract
Background Improved knowledge based on clinical features of chronic pain in older adults would be valuable in terms of patient-orientated approaches and would provide support for health care systems in optimizing health care resources. This study identifies subgroups based on pain and psychological symptoms among Swedish older adults in the general population and compares derived subgroups with respect to socio-demographics, health aspects, and health care costs. Methods This cross-sectional study uses data collected from four registers and one survey. The total sample comprised 2415 individuals ≥65 years old. A two-step cluster analysis was performed. Data on pain intensity, number of pain sites, anxiety, depression, and pain catastrophizing were used as classification variables. Differences in socio-demographics, quality of life, general health, insomnia, and health care costs among the clusters were investigated. Association of the clusters with the above parameters was further evaluated using multinomial logistic regression. Results Four major clusters were identified: Subgroup 1 (n = 325; 15%) – moderate pain and high psychological symptoms; Subgroup 2 (n = 516; 22%) – high pain and moderate psychological symptoms; Subgroup 3 (n = 686; 30%) – low pain and moderate psychological symptoms; and Subgroup 4 (n = 767; 33%) – low pain and low psychological symptoms. Significant differences were found between the four clusters with regard to age, sex, educational level, family status, quality of life, general health, insomnia, and health care costs. The multinomial logistic regression analysis revealed that Subgroups 1 and 2, compared to Subgroup 4, were significantly associated with decreased quality of life, decreased general health, and increased insomnia. Subgroup 3, compared to Subgroup 4, was associated with decreased general health and increased insomnia. In addition, compared to Subgroup 4, Subgroups 1 and 2 were significantly associated with higher health care costs. Conclusions Two high risk clusters of older adults suffering from chronic pain; one mainly based on psychological symptoms and one mainly on pain intensity and pain spread, associated with decreased quality of life and health and increased health care costs were identified. Our findings indicate that subgroup-specific treatment will improve pain management and reduce health care costs. Electronic supplementary material The online version of this article (10.1186/s12877-017-0591-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Britt Larsson
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, 581 85, Linköping, SE, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, 581 85, Linköping, SE, Sweden
| | - Lars Bernfort
- Division of Health Care Analysis and Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, SE, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis and Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, SE, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, 581 85, Linköping, SE, Sweden
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Alappattu M, Lamvu G, Feranec J, Witzeman K, Robinson M, Rapkin A. Vulvodynia is not created equally: empirical classification of women with vulvodynia. J Pain Res 2017; 10:1601-1609. [PMID: 28740427 PMCID: PMC5505540 DOI: 10.2147/jpr.s136751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity. Objective The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity. Design A cross-sectional study. Methods We conducted an exploratory hierarchical agglomerative cluster analysis using Ward’s cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity. Subjects Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration. Results Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain. Conclusion Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity.
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Affiliation(s)
- Meryl Alappattu
- Department of Physical Therapy.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville
| | - Georgine Lamvu
- Division of Surgery, Gynecology Section, Veteran Affairs Medical Center.,University of Central Florida, Orlando, FL
| | - Jessica Feranec
- Division of Surgery, Gynecology Section, Veteran Affairs Medical Center.,University of Central Florida, Orlando, FL
| | - Kathryn Witzeman
- Women's Integrated Health Program, Department of OBGYN, Denver Health Medical Center, Denver, CO
| | - Michael Robinson
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrea Rapkin
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Thieme K, Mathys M, Turk DC. Evidenced-Based Guidelines on the Treatment of Fibromyalgia Patients: Are They Consistent and If Not, Why Not? Have Effective Psychological Treatments Been Overlooked? THE JOURNAL OF PAIN 2017; 18:747-756. [DOI: 10.1016/j.jpain.2016.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/14/2016] [Accepted: 12/05/2016] [Indexed: 01/08/2023]
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Yim YR, Lee KE, Park DJ, Kim SH, Nah SS, Lee J, Kim SK, Lee YA, Hong SJ, Kim HS, Lee HS, Kim H, Joung CI, Kim SH, Lee SS. Identifying fibromyalgia subgroups using cluster analysis: Relationships with clinical variables. Eur J Pain 2016; 21:374-384. [DOI: 10.1002/ejp.935] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Y.-R. Yim
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - K.-E. Lee
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - D.-J. Park
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - S.-H. Kim
- Department of Internal Medicine; Inje University Haeundae Paik Hospital; Busan Korea
| | - S.-S. Nah
- Department of Internal Medicine; College of Medicine; Soonchunhyang University; Cheonan Korea
| | - J.H. Lee
- Department of Internal Medicine; Maryknoll Medical Center; Busan Korea
| | - S.-K. Kim
- Department of Internal Medicine; School of Medicine; Catholic University of Daegu; Korea
| | - Y.-A. Lee
- Department of Internal Medicine; School of Medicine; Kyung Hee University; Seoul Korea
| | - S.-J. Hong
- Department of Internal Medicine; School of Medicine; Kyung Hee University; Seoul Korea
| | - H.-S. Kim
- Department of Internal Medicine; Soonchunhyang University Seoul Hospital; Korea
| | - H.-S. Lee
- Hanyang University College of Medicine and the Hospital for Rheumatic Diseases; Seoul Korea
| | - H.A. Kim
- Department of Allergy and Rheumatology; Ajou University Hospital; Ajou University School of Medicine; Suwon Korea
| | - C.-I. Joung
- Department of Internal Medicine; Konyang University Medical School; Daejeon Korea
| | - S.-H. Kim
- Department of Internal Medicine; School of Medicine; Keimyung University; Daegu Korea
| | - S.-S. Lee
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Turk DC, Adams LM. Using a biopsychosocial perspective in the treatment of fibromyalgia patients. Pain Manag 2016; 6:357-69. [PMID: 27301637 DOI: 10.2217/pmt-2016-0003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fibromyalgia (FM) is a complex illness that manifests in different ways across individuals. Given that there are currently no known cures for FM, like treatment for other chronic diseases, interventions focus on learning strategies to alleviate symptom severity, to cope with and manage residual symptoms of the illness and to maximize health-related quality of life despite symptoms. In this article, we highlight the need for providers to adopt a biopsychosocial perspective for understanding and addressing patients with FM, noting that biological, psychosocial and behavioral factors function interdependently to affect a person's experience and adaptation. A cognitive-behavioral approach, which incorporates a biopsychosocial perspective, is detailed, along with specific treatment considerations for helping patients with FM manage their symptoms.
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Affiliation(s)
- Dennis C Turk
- Department of Anesthesiology & Pain Medicine, Box 356540, University of Washington, Seattle, WA 98195, USA
| | - Leah M Adams
- Department of Anesthesiology & Pain Medicine, Box 356540, University of Washington, Seattle, WA 98195, USA.,Women's Health & Aging, Group Health Research Institute, Seattle, WA 98195, USA
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Thieme K, Turk D, Gracely R, Flor H. Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia. Eur J Pain 2016; 20:1478-89. [DOI: 10.1002/ejp.872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Affiliation(s)
- K. Thieme
- Department of Medical Psychology; Philipps-University Marburg; Germany
- Center for Pain Research and Innovation; University of North Carolina; Chapel Hill USA
| | - D.C. Turk
- Center for Pain Research on Impact, Measurement & Effectiveness (C-PRIME); Department of Anesthesiology and Pain Medicine; University of Washington; Seattle USA
| | - R.H. Gracely
- Center for Pain Research and Innovation; University of North Carolina; Chapel Hill USA
| | - H. Flor
- Department of Clinical and Cognitive Neuroscience; Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
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Salaffi F, Mozzani F, Draghessi A, Atzeni F, Catellani R, Ciapetti A, Di Carlo M, Sarzi-Puttini P. Identifying the symptom and functional domains in patients with fibromyalgia: results of a cross-sectional Internet-based survey in Italy. J Pain Res 2016; 9:279-86. [PMID: 27257392 PMCID: PMC4874639 DOI: 10.2147/jpr.s100829] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aims of this cross-sectional study were to investigate the usefulness of using an Internet survey of patients with fibromyalgia in order to obtain information concerning symptoms and functionality and identify clusters of clinical features that can distinguish patient subsets. Methods An Internet website has been used to collect data. Fibromyalgia Impact Questionnaire Revised version, self-administered Fibromyalgia Activity Score, and Self-Administered Pain Scale were used as questionnaires. Hierarchical agglomerative clustering was applied to the data obtained in order to identify symptoms and functional-based subgroups. Results Three hundred and fifty-three patients completed the study (85.3% women). The highest scored items were those related to sleep quality, fatigue/energy, pain, stiffness, degree of tenderness, balance problems, and environmental sensitivity. A high proportion of patients reported pain in the neck (81.4%), upper back (70.1%), and lower back (83.2%). A three-cluster solution best fitted the data. The variables were significantly different (P<0.0001) among the three clusters: cluster 1 (117 patients) reflected the lowest average scores across all symptoms, cluster 3 (116 patients) the highest scores, and cluster 2 (120 patients) captured moderate symptom levels, with low depression and anxiety. Conclusion Three subgroups of fibromyalgia samples in a large cohort of patients have been identified by using an Internet survey. This approach could provide rationale to support the study of individualized clinical evaluation and may be used to identify optimal treatment strategies.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Polytechnic University of Marche, Jesi (Ancona), Parma, Italy
| | - Flavio Mozzani
- Department of Internal Medicine and Rheumatology, University Hospital of Parma, Parma, Italy
| | - Antonella Draghessi
- Rheumatology Department, Polytechnic University of Marche, Jesi (Ancona), Parma, Italy
| | | | - Rosita Catellani
- Department of Internal Medicine and Rheumatology, University Hospital of Parma, Parma, Italy
| | - Alessandro Ciapetti
- Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, Wales, Italy
| | - Marco Di Carlo
- Rheumatology Department, Polytechnic University of Marche, Jesi (Ancona), Parma, Italy
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Abstract
OBJECTIVES In a 12-month observational study, we evaluated the effect of opioid use on the outcomes in 1700 adult patients with fibromyalgia. METHODS Data were evaluated using propensity score matching after patients were divided into cohorts based on their baseline medication use: (1) taking an opioid (concurrent use of tramadol was permitted); (2) taking tramadol (but no opioids); and (3) not taking opioids or tramadol. Changes in outcomes were assessed using the Brief Pain Inventory for severity and pain-related interference (BPI-S, BPI-I), Fibromyalgia Impact Questionnaire (FIQ), Patient Health Questionnaire for depression (PHQ-8), Insomnia Severity Index (ISI), Sheehan Disability Scale (SDS), 7-item Generalized Anxiety Disorder Scale (GAD-7), and economic factors. Time-to-opioid or tramadol discontinuation was analyzed using Kaplan-Meier survival analyses. RESULTS Compared with the opioid cohort, the nonopioid cohort demonstrated significantly greater reductions (P<0.05) in BPI-I, FIQ, PHQ-8, SDS, and ISI; the tramadol cohort compared with the opioid group showed greater reductions on FIQ and ISI. Reductions in BPI-S and GAD-7 did not differ significantly among cohorts. Compared with the opioid cohort, patients in the tramadol cohort had fewer outpatient visits to health care providers. Few significant differences were found between the tramadol and nonopioid cohorts across outcomes. DISCUSSION Although pain severity was reduced over time in all cohorts, opioid users showed less improvement in pain-related interference with daily living, functioning, depression, and insomnia. Overall, the findings show little support for the long-term use of opioid medications in patients with fibromyalgia given the poorer outcomes across multiple assessment domains associated with this cohort.
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Lourenço S, Carnide F, Benavides FG, Lucas R. Psychosocial Work Environment and Musculoskeletal Symptoms among 21-Year-Old Workers: A Population-Based Investigation (2011-2013). PLoS One 2015; 10:e0130010. [PMID: 26076365 PMCID: PMC4468175 DOI: 10.1371/journal.pone.0130010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background The current labour market is becoming more flexible and informal, with job insecurity selectively affecting young workers. However, the role of these increasing adverse psychosocial working conditions on health outcomes remains little known among newly employed workers. Objective To estimate the associations between psychosocial work environment and musculoskeletal outcomes (widespread pain syndrome features and regional pain) in a population-based sample of young workers. Methods Cross-sectional data from workers aged 21 years were collected during the third wave of the EPITeen cohort study (2011-2013; n=650). The Job Content Questionnaire was used to characterize the psychosocial work environment according to the demand-control-support model. Data on pain and non-pain dimensions of the widespread pain syndrome (Fibromyalgia Survey Questionnaire) as well as on regional musculoskeletal pain (Nordic Musculoskeletal Questionnaire) were also collected. Crude and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were computed using logistic regression and all estimates were adjusted for sex, education and occupational biomechanical demands. Results Job insecurity was significantly associated to the non-pain dimension of the widespread pain syndrome (adjusted OR [95% CI]=1.51 [1.08, 2.12]). Young workers with strain jobs were significantly more likely to report high levels of non-pain symptoms when compared with those with no-strain jobs and this effect was even stronger when social support was added to the main exposure: workers with strain jobs and low social support had twice the odds of reporting high levels of non-pain features than those with high strain but high social support jobs (adjusted OR=1.86, 95% CI: 1.04, 3.31). These significant associations were not observed when widespread pain or multisite regional pain were the outcomes. Conclusion In the beginning of professional life, high strain jobs were associated to non-pain complaints, especially when the work environment provided also low social support.
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Affiliation(s)
- Sara Lourenço
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- * E-mail:
| | - Filomena Carnide
- Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada—Dafundo, Portugal
| | | | - Raquel Lucas
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Latorre Román PÁ, Santos E Campos MA, García-Pinillos F. Effects of functional training on pain, leg strength, and balance in women with fibromyalgia. Mod Rheumatol 2015; 25:943-7. [PMID: 25867230 DOI: 10.3109/14397595.2015.1040614] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to analyze the effect of 18-week functional training (FT) program consisting in two sessions a week of in-water exercise and one of on-land exercise on pain, strength, and balance in women with fibromyalgia. METHODS A sample consisting of 36 fibromyalgia patients was included in the study. The patients were allocated randomly into the experimental group (EG, n = 20), and control group (CG, n = 16). Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand and handgrip strength) and agility/dynamic balance and static balance. Fibromyalgia impact and pain were analyzed by Fibromyalgia Impact Questionnaire (FIQ), tender points (TPs), visual analog scale (VAS). RESULTS We observed a significant reduction in the FIQ (p = 0.042), the algometer scale of TP (p = 0.008), TP (p < 0.001), and VAS (p < 0.001) in the EG. The EG shows better results in leg strength (p < 0.001), handgrip strength (p = 0.025), agility/dynamic balance (p = 0.032) and balance (p = 0.006). CONCLUSIONS An 18-week intervention consisting in two sessions of in-water exercise and one session of on-land exercise of FT reduces pain and improves functional capacity in FM patients. These results suggested that FT could play an important role in maintaining an independent lifestyle in patients with FM.
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Lourenço S, Costa L, Rodrigues AM, Carnide F, Lucas R. Gender and psychosocial context as determinants of fibromyalgia symptoms (fibromyalgia research criteria) in young adults from the general population. Rheumatology (Oxford) 2015; 54:1806-15. [DOI: 10.1093/rheumatology/kev110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Indexed: 12/24/2022] Open
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Moustafa IM, Diab AA. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatol Int 2015; 35:1163-74. [DOI: 10.1007/s00296-015-3248-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
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Kratz AL, Schilling SG, Goesling J, Williams DA. Development and initial validation of a brief self-report measure of cognitive dysfunction in fibromyalgia. THE JOURNAL OF PAIN 2015; 16:527-36. [PMID: 25746197 DOI: 10.1016/j.jpain.2015.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Pain is often the focus of research and clinical care in fibromyalgia (FM); however, cognitive dysfunction is also a common, distressing, and disabling symptom in FM. Current efforts to address this problem are limited by the lack of a comprehensive, valid measure of subjective cognitive dysfunction in FM that is easily interpretable, accessible, and brief. The purpose of this study was to leverage cognitive functioning item banks that were developed as part of the Patient Reported Outcomes Measurement Information System (PROMIS) to devise a 10-item short form measure of cognitive functioning for use in FM. In study 1, a nationwide (U.S.) sample of 1,035 adults with FM (age range = 18-82, 95.2% female) completed 2 cognitive item pools. Factor analyses and item response theory analyses were used to identify dimensionality and optimally performing items. A recommended 10-item measure, called the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) was created. In study 2, 232 adults with FM completed the MISCI and a legacy measure of cognitive functioning that is used in FM clinical trials, the Multiple Ability Self-Report Questionnaire (MASQ). The MISCI showed excellent internal reliability, low ceiling/floor effects, and good convergent validity with the MASQ (r = -.82). PERSPECTIVE This paper presents the MISCI, a 10-item measure of cognitive dysfunction in FM, developed through classical test theory and item response theory. This brief but comprehensive measure shows evidence of excellent construct validity through large correlations with a lengthy legacy measure of cognitive functioning.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan.
| | | | - Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; Departments of Medicine (Rheumatology), Psychiatry, and Psychology, University of Michigan, Ann Arbor, Michigan
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