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Hügle T, Prétat T, Suter M, Lovejoy C, Ming Azevedo P. Disease Phenotypes in Refractory Musculoskeletal Pain Syndromes Identified by Unsupervised Machine Learning. ACR Open Rheumatol 2024. [PMID: 39210607 DOI: 10.1002/acr2.11699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Overlapping chronic pain syndromes, including fibromyalgia, are heterogeneous and often treatment-resistant entities carrying significant socioeconomic burdens. Individualized treatment approaches from both a somatic and psychological side are necessary to improve patient care. The objective of this study was to identify and visualize patient clusters in refractory musculoskeletal pain syndromes through an extensive set of clinical variables, including immunologic, psychosomatic, wearable, and sleep biomarkers. METHODS Data were collected during a multimodal pain program involving 202 patients. Seventy-eight percent of the patients fulfilled the criteria for fibromyalgia, 77% had a concomitant psychiatric-mediated disorder, and 22% a concomitant rheumatic immune-mediated disorder. Five patient phenotypes were identified by hierarchical agglomerative clustering as a form of unsupervised learning, and a predictive model for the Brief Pain Inventory (BPI) response was generated. Based on the clustering data, digital personas were created with DALL-E (OpenAI). RESULTS The most relevant distinguishing factors among clusters were living alone, body mass index, peripheral joint pain, alexithymia, psychiatric comorbidity, childhood pain, neuroleptic or benzodiazepine medication, and response to virtual reality. Having an immune-mediated disorder was not discriminatory. Three of five clusters responded to the multimodal treatment in terms of pain (BPI intensity), one cluster responded in terms of functional improvement (BPI interference), and one cluster notably responded to the virtual reality intervention. The independent predictive model confirmed strong opioids, trazodone, neuroleptic treatment, and living alone as the most important negative predictive factors for reduced pain after the program. CONCLUSION Our model identified and visualized clinically relevant chronic musculoskeletal pain subtypes and predicted their response to multimodal treatment. Such digital personas and avatars may play a future role in the design of personalized therapeutic modalities and clinical trials.
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Affiliation(s)
- Thomas Hügle
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Tiffany Prétat
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Marc Suter
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Chris Lovejoy
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Pedro Ming Azevedo
- University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
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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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Augière T, Simoneau M, Mercier C. Visuotactile integration in individuals with fibromyalgia. Front Hum Neurosci 2024; 18:1390609. [PMID: 38826615 PMCID: PMC11140151 DOI: 10.3389/fnhum.2024.1390609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Our brain constantly integrates afferent information, such as visual and tactile information, to perceive the world around us. According to the maximum-likelihood estimation (MLE) model, imprecise information will be weighted less than precise, making the multisensory percept as precise as possible. Individuals with fibromyalgia (FM), a chronic pain syndrome, show alterations in the integration of tactile information. This could lead to a decrease in their weight in a multisensory percept or a general disruption of multisensory integration, making it less beneficial. To assess multisensory integration, 15 participants with FM and 18 pain-free controls performed a temporal-order judgment task in which they received pairs of sequential visual, tactile (unisensory conditions), or visuotactile (multisensory condition) stimulations on the index and the thumb of the non-dominant hand and had to determine which finger was stimulated first. The task enabled us to measure the precision and accuracy of the percept in each condition. Results indicate an increase in precision in the visuotactile condition compared to the unimodal conditions in controls only, although we found no intergroup differences. The observed visuotactile precision was correlated to the precision predicted by the MLE model in both groups, suggesting an optimal integration. Finally, the weights of the sensory information were not different between the groups; however, in the group with FM, higher pain intensity was associated with smaller tactile weight. This study shows no alterations of the visuotactile integration in individuals with FM, though pain may influence tactile weight in these participants.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University, Quebec, QC, Canada
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Goldstein A, Shahar Y, Weisman Raymond M, Peleg H, Ben-Chetrit E, Ben-Yehuda A, Shalom E, Goldstein C, Shiloh SS, Almoznino G. Multi-Dimensional Validation of the Integration of Syntactic and Semantic Distance Measures for Clustering Fibromyalgia Patients in the Rheumatic Monitor Big Data Study. Bioengineering (Basel) 2024; 11:97. [PMID: 38275577 PMCID: PMC10813477 DOI: 10.3390/bioengineering11010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
This study primarily aimed at developing a novel multi-dimensional methodology to discover and validate the optimal number of clusters. The secondary objective was to deploy it for the task of clustering fibromyalgia patients. We present a comprehensive methodology that includes the use of several different clustering algorithms, quality assessment using several syntactic distance measures (the Silhouette Index (SI), Calinski-Harabasz index (CHI), and Davies-Bouldin index (DBI)), stability assessment using the adjusted Rand index (ARI), and the validation of the internal semantic consistency of each clustering option via the performance of multiple clustering iterations after the repeated bagging of the data to select multiple partial data sets. Then, we perform a statistical analysis of the (clinical) semantics of the most stable clustering options using the full data set. Finally, the results are validated through a supervised machine learning (ML) model that classifies the patients back into the discovered clusters and is interpreted by calculating the Shapley additive explanations (SHAP) values of the model. Thus, we refer to our methodology as the clustering, distance measures and iterative statistical and semantic validation (CDI-SSV) methodology. We applied our method to the analysis of a comprehensive data set acquired from 1370 fibromyalgia patients. The results demonstrate that the K-means was highly robust in the syntactic and the internal consistent semantics analysis phases and was therefore followed by a semantic assessment to determine the optimal number of clusters (k), which suggested k = 3 as a more clinically meaningful solution, representing three distinct severity levels. the random forest model validated the results by classification into the discovered clusters with high accuracy (AUC: 0.994; accuracy: 0.946). SHAP analysis emphasized the clinical relevance of "functional problems" in distinguishing the most severe condition. In conclusion, the CDI-SSV methodology offers significant potential for improving the classification of complex patients. Our findings suggest a classification system for different profiles of fibromyalgia patients, which has the potential to improve clinical care, by providing clinical markers for the evidence-based personalized diagnosis, management, and prognosis of fibromyalgia patients.
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Affiliation(s)
- Ayelet Goldstein
- Computer Science Department, Hadassah Academic College, Jerusalem 9101001, Israel;
| | - Yuval Shahar
- Medical Informatics Research Center, Department of Software and Information Systems Engineering, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel; (Y.S.)
| | - Michal Weisman Raymond
- Medical Informatics Research Center, Department of Software and Information Systems Engineering, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel; (Y.S.)
| | - Hagit Peleg
- Rheumatology Unit, Hadassah Medical Center, Jerusalem 9112102, Israel
| | - Eldad Ben-Chetrit
- Rheumatology Unit, Hadassah Medical Center, Jerusalem 9112102, Israel
| | - Arie Ben-Yehuda
- Division of Internal Medicine, Hadassah Medical Center, Jerusalem 9112102, Israel
| | - Erez Shalom
- Medical Informatics Research Center, Department of Software and Information Systems Engineering, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel; (Y.S.)
| | - Chen Goldstein
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory, Dean’s Office, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Shmuel Shay Shiloh
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory, Dean’s Office, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Galit Almoznino
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory, Dean’s Office, Hadassah Medical Center, Jerusalem 91120, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Vancampfort D, Van Damme T, McGrath RL, Machado VA, Schuch F. Physical activity levels among people with fibromyalgia: A systematic review and meta-analysis. Musculoskeletal Care 2023; 21:623-632. [PMID: 37186016 DOI: 10.1002/msc.1771] [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: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is unclear how much physical activity (PA) people with fibromyalgia (PwF) engage in. We conducted a meta-analysis to examine PA levels in PwF and compared levels with age- and gender-matched controls and between objective and subjective assessments. METHODS Embase, PubMed and CINAHL Plus were searched by two independent reviewers from inception till 3 January 2023 using the keywords: 'fibromyalgia' OR 'fibrositis' AND 'physical activity' OR 'exercise' OR 'sports'. A random effects meta-analysis adjusting for publication bias was conducted. RESULTS Across 22 studies, there were 5997 (5956 women) PwF (median age = 44 years). After trim and fill adjustment, PwF spent a mean of 4.0 (95% CI = 2.3-5.8) min/day in vigorous PA, 67.5 (95% CI = 35.4-99.6) min/day in moderate intensity PA and 270.5 (95% CI = 99.6-441.4) min/day in light PA. Only 37.7% (95% CI = 18.7-61.5) of PwF achieved the public PA recommendation of 150 min of moderate to vigorous PA per week. PwF walked 5663.7 (95% CI = 4493.5-6833.9) steps per day, which is below the 6000 steps per day recommendation. PwF spent 39.0 min/day (95% CI = 22.8-55.1, p < 0.001) less in PA than healthy controls, while MET-minutes per week is 1324.7 (95 % CI = 237.6-2411.7, p = 0.017) lower. There were no significant differences between subjective and objective PA assessments (p = 0.69). CONCLUSION Our data demonstrate that the majority of PwF are still insufficiently physically active to obtain significant health benefits. Future clinical PA interventions specifically targeting the prevention of physical inactivity in PwF and engaging physically inactive PwF to become physically active are warranted.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Belgium
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Vanessa Albanio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
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Forejtová Z, Serranová T, Sieger T, Slovák M, Nováková L, Věchetová G, Růžička E, Edwards MJ. The complex syndrome of functional neurological disorder. Psychol Med 2023; 53:3157-3167. [PMID: 34991744 DOI: 10.1017/s0033291721005225] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with functional neurological disorders (FND) often present with multiple motor, sensory, psychological and cognitive symptoms. In order to explore the relationship between these common symptoms, we performed a detailed clinical assessment of motor, non-motor symptoms, health-related quality of life (HRQoL) and disability in a large cohort of patients with motor FND. To understand the clinical heterogeneity, cluster analysis was used to search for subgroups within the cohort. METHODS One hundred fifty-two patients with a clinically established diagnosis of motor FND were assessed for motor symptom severity using the Simplified Functional Movement Disorder Rating Scale (S-FMDRS), the number of different motor phenotypes (i.e. tremor, dystonia, gait disorder, myoclonus, and weakness), gait severity and postural instability. All patients then evaluated each motor symptom type severity on a Likert scale and completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints and HRQoL. RESULTS Significant correlations were found among the self-reported and all objective motor symptoms severity measures. All self-reported measures including HRQoL correlated strongly with each other. S-FMDRS weakly correlated with HRQoL. Hierarchical cluster analysis supplemented with gap statistics revealed a homogenous patient sample which could not be separated into subgroups. CONCLUSIONS We interpret the lack of evidence of clusters along with a high degree of correlation between all self-reported and objective measures of motor or non-motor symptoms and HRQoL within current neurobiological models as evidence to support a unified pathophysiology of 'functional' symptoms. Our results support the unification of functional and somatic syndromes in classification schemes and for future mechanistic and therapeutic research.
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Affiliation(s)
- Zuzana Forejtová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Tereza Serranová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, 166 27, Czech Republic
| | - Matěj Slovák
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Lucia Nováková
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, SW17 0RE, UK
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Krock E, Morado-Urbina CE, Menezes J, Hunt MA, Sandström A, Kadetoff D, Tour J, Verma V, Kultima K, Haglund L, Meloto CB, Diatchenko L, Kosek E, Svensson CI. Fibromyalgia patients with elevated levels of anti-satellite glia cell immunoglobulin G antibodies present with more severe symptoms. Pain 2023:00006396-990000000-00274. [PMID: 36943275 DOI: 10.1097/j.pain.0000000000002881] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/16/2022] [Indexed: 03/23/2023]
Abstract
ABSTRACT Transferring fibromyalgia patient immunoglobulin G (IgG) to mice induces pain-like behaviour, and fibromyalgia IgG binds mouse and human satellite glia cells (SGCs). These findings suggest that autoantibodies could be part of fibromyalgia pathology. However, it is unknown how frequently fibromyalgia patients have anti-SGC antibodies and how anti-SGC antibodies associate with disease severity. Here, we quantified serum or plasma anti-SGC IgG levels in 2 fibromyalgia cohorts from Sweden and Canada using an indirect immunofluorescence murine cell culture assay. Fibromyalgia serum IgG binding to human SGCs in human dorsal root ganglia tissue sections was also assessed by immunofluorescence. In the cell culture assay, anti-SGC IgG levels were increased in both fibromyalgia cohorts compared with control group. Elevated anti-SGC IgG was associated with higher levels of self-reported pain in both cohorts, and higher fibromyalgia impact questionnaire scores and increased pressure sensitivity in the Swedish cohort. Anti-SGC IgG levels were not associated with fibromyalgia duration. Swedish fibromyalgia (FM) patients were clustered into FM-severe and FM-mild groups, and the FM-severe group had elevated anti-SGC IgG compared with the FM-mild group and control group. Anti-SGC IgG levels detected in culture positively correlated with increased binding to human SGCs. Moreover, the FM-severe group had elevated IgG binding to human SGCs compared with the FM-mild and control groups. These results demonstrate that a subset of fibromyalgia patients have elevated levels of anti-SGC antibodies, and the antibodies are associated with more severe fibromyalgia symptoms. Screening fibromyalgia patients for anti-SGC antibodies could provide a path to personalized treatment options that target autoantibodies and autoantibody production.
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Affiliation(s)
- Emerson Krock
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carlos E Morado-Urbina
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joana Menezes
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matthew A Hunt
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
| | - Vivek Verma
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Kim Kultima
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lisbet Haglund
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Carolina B Meloto
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Sandström is now with the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. Tour is now with the Oncology Surgery Department, Blekinge Hospital, Karlskrona, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Peñacoba C, Ecija C, Gutiérrez L, Catalá P. Does Pain Acceptance Contribute to Improved Functionality through Walking in Women with Fibromyalgia? Looking at Depressive Comorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5005. [PMID: 36981913 PMCID: PMC10048968 DOI: 10.3390/ijerph20065005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
In the last decade, research has pointed to physical exercise as an effective treatment in fibromyalgia patients. Some studies have highlighted the role of acceptance and commitment therapy in optimizing the benefits of exercise in patients. However, given the high comorbidity in fibromyalgia, it is necessary to value its possible influence on the effect of certain variables, such as acceptance, on the benefits of treatments, such as physical exercise. Our aim is to test the role of acceptance in the benefits of walking over functional limitation, further assessing whether this model is equally valid, considering depressive symptomatology as an additional differential diagnosis. A cross-sectional study with a convenience sample through contacting Spanish fibromyalgia associations was carried out. A total of 231 women with fibromyalgia (mean age 56.91 years) participated in the study. Data were analyzed with the Process program (Model 4, Model 58, Model 7). The results highlight the role of acceptance as a mediator between walking and functional limitation (B = -1.86, SE = 0.93, 95% CI = [-3.83, -0.15]). This model, when depression is incorporated as a moderator, is significant only in patients without depression, revealing the need for personalized treatments in fibromyalgia, considering their most prevalent comorbidity.
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Catalá P, Peñacoba C, López-Roig S, Pastor-Mira MA. Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:190. [PMID: 36612511 PMCID: PMC9819620 DOI: 10.3390/ijerph20010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.
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Affiliation(s)
- Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernandez University, Elche, 03550 Alicante, Spain
| | - María Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernandez University, Elche, 03550 Alicante, Spain
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Mertens MG, Meeus M, Noten S, Verborgt O, Fransen E, Lluch Girbés E, Aguilar Rodríguez M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F, Dueñas L. Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study. BMJ Open 2022; 12:e056563. [PMID: 36410809 PMCID: PMC9680192 DOI: 10.1136/bmjopen-2021-056563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. The aim of the current study was to examine to what extent range of motion (ROM) limitation, metabolic factors (diabetes mellitus and thyroid disorders), autonomic symptoms and pain sensitivity may contribute to the prognosis in terms of shoulder pain and disability and quality of life in patients with FS. METHODS Patients with stage 1 or 2 FS were longitudinally followed-up during 9 months after baseline assessment. They completed six questionnaires and underwent quantitative sensory testing (pressure pain thresholds, temporal summation and conditioned pain modulation) and ROM assessment. RESULTS One hundred and forty-nine patients with FS were initially recruited and 121 completed at least one follow-up measurement. Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. Several domains of quality of life also improved over time and external rotation ROM, diabetes mellitus, thyroid disorder and autonomic symptoms were found to be prognostic factors for final outcome. These prognostic factors explained 2.5%-6.3% of the final outcome of shoulder pain and disability and quality of life. DISCUSSION AND CONCLUSION In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. Other variables not explored in this study might contribute to the prognosis of patients with FS, which should be investigated in future research. In clinical practice, baseline assessment of prognostic factors and focusing on a more holistic approach might be useful to inform healthcare practitioners about progression of patients with FS during a 9-month period.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Suzie Noten
- Department of Rehabilitation Medicine, Erasmus MC University medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerpen, Belgium
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium
| | - Enrique Lluch Girbés
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marta Aguilar Rodríguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | | | | | - Filip Struyf
- Rehabilitation Sciences, Universiteit Antwerpen Campus Drie Eiken, Wilrijk, Belgium
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
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Liew BXW, Valera-Calero JA, Varol U, Nijs J, Arendt-Nielsen L, Plaza-Manzano G, Fernández-de-las-Peñas C. Distress and Sensitization as Main Mediators of Severity in Women with Fibromyalgia: A Structural Equation Model. Biomedicines 2022; 10:1188. [PMID: 35625923 PMCID: PMC9138673 DOI: 10.3390/biomedicines10051188] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
We aimed to explore a path model identified using a structural equation model (SEM) which best explains the multivariate contributions of sensitization, sensitivity, and emotional variables to clinical severity in women with FMS. Pain features, the Central Sensitization Inventory (CSI), painDETECT, S-LANSS, the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), the 11-item Tampa Scale for Kinesiophobia (TSK-11), and pressure pain thresholds (PPTs) were collected from 113 women with FMS. Four latent variables were created: severity (clinical pain features), sensitivity (PPTs), sensitization (S-LANSS, CSI, painDETECT), and distress (HADS-A, HADS-D, PCS, PVAQ, TSK-11). Data fit for the measurement model were considered excellent (RMSEA = 0.043, CFI = 0.966, SRMR = 0.067, and NNFI = 0.960). Distress had a significant relationship with the mediators of sleep (β = 0.452, p = 0.031) and sensitization (β = 0.618, p = 0.001). The only mediator with a significant effect (β = 1.113, p < 0.001) on severity was sensitization. A significant indirect effect of sensitization (β = 0.687, p = 0.001) that explained the relationship between distress and severity was also identified. The proposed model suggests that distress and sensitization, together with poor sleep, have a complex mediating effect on severity in women with FMS. The identified path model can be leveraged in clinical trials investigating treatment approaches for FMS.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK;
| | - Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain;
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1050 Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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12
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Braun A, Evdokimov D, Frank J, Pauli P, Wabel T, Üçeyler N, Sommer C. Relevance of Religiosity for Coping Strategies and Disability in Patients with Fibromyalgia Syndrome. JOURNAL OF RELIGION AND HEALTH 2022; 61:524-539. [PMID: 33484390 PMCID: PMC8837569 DOI: 10.1007/s10943-020-01177-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 05/17/2023]
Abstract
Coping strategies are essential for the outcome of chronic pain. This study evaluated religiosity in a cohort of patients with fibromyalgia syndrome (FMS), its effect on pain and other symptoms, on coping and FMS-related disability. A total of 102 FMS patients were recruited who filled in questionnaires, a subgroup of 42 patients participated in a face-to-face interview, and data were evaluated by correlation and regression analyses. Few patients were traditionally religious, but the majority believed in a higher existence and described their spirituality as "transcendence conviction". The coping strategy "praying-hoping" and the ASP dimension "religious orientation" (r = 0.5, P < 0.05) showed a significant relationship independent of the grade of religiosity (P < 0.05). A high grade of belief in a higher existence was negatively associated with the choice of ignoring as coping strategy (r = - 0.4, P < 0.05). Mood and affect-related variables had the highest impact on disability (b = 0.5, P < 0.05). In this cohort, the grade of religiosity played a role in the choice of coping strategies, but had no effects on health and mood outcome.
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Affiliation(s)
- Alexandra Braun
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Dimitar Evdokimov
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Johanna Frank
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), Center of Mental Health, University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany
| | - Thomas Wabel
- Department of Systematic Theology, University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Kang JH, Choi SE, Park DJ, Lee SS. Disentangling Diagnosis and Management of Fibromyalgia. JOURNAL OF RHEUMATIC DISEASES 2022; 29:4-13. [PMID: 37476701 PMCID: PMC10324920 DOI: 10.4078/jrd.2022.29.1.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 07/22/2023]
Abstract
Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain accompanied by symptoms such as fatigue, sleep disturbance, cognitive dysfunction, and mood disorder. The pathophysiology of FM has been unclear, leading to inconsistent diagnosis and ineffective management. Several diagnostic criteria for FM have been proposed in recent years, including the revised 2016 American College of Rheumatology (ACR) criteria, the criteria of the ACTTION-American Pain Society Pain Taxonomy (AAPT) group, and the modified 2019 Fibromyalgia Assessment Status (FAS) criteria. Despite the appearance of newer criteria for FM diagnosis, the 2016 ACR criteria demonstrate the best performance. Many randomized controlled studies and systematic reviews have shown the therapeutic efficacies of pharmacological and non-pharmacological treatments of FM. Nevertheless, further research is needed to develop better treatment options.
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Affiliation(s)
- Ji-Hyoun Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sung-Eun Choi
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Dong-Jin Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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14
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Govillard L, Gorbeña S, Iraurgi I. Cognitive behavioral therapy with and without biofeedback in fibromyalgia: Assessment of functional and clinical change. Health Psychol Open 2022; 9:20551029221106044. [PMID: 35733450 PMCID: PMC9208052 DOI: 10.1177/20551029221106044] [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] [Indexed: 11/16/2022] Open
Abstract
The study compared the effectiveness of Cognitive Behavioral Therapy (CBT) with biofeedback or with emotional expression in individuals with fibromyalgia, and a waiting list control group. 88 women participated in a naturalistic study with random assignment. The Fibromyalgia Impact Questionnaire, SCL-90R, and a visual analog quality of life scale were used. Both intervention groups improved, but differed in physical and emotional control response. Using the reliable change index procedure, clinical improvement occurred in 18.8% of participants, and 4.8% achieved scores comparable with clinical recovery. Greater specificity on therapeutic objectives is warranted.
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Affiliation(s)
- Leila Govillard
- Departamento de Ciencias Sociales y Humanas, Universidad de Deusto, Bilbao, País Vasco, Spain
| | - Susana Gorbeña
- Departamento de Psicología, Universidad de Deusto, Bilbao, País Vasco, Spain
| | - Ioseba Iraurgi
- Departamento de Psicología, Universidad de Deusto, Bilbao, País Vasco, Spain
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15
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Augière T, Desjardins A, Paquette Raynard E, Brun C, Pinard AM, Simoneau M, Mercier C. Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2021; 2:740897. [PMID: 35295451 PMCID: PMC8915638 DOI: 10.3389/fpain.2021.740897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by sensorimotor deficits and distortions of body representation, that could both be caused by alterations in sensory processing. Several studies suggest a hypersensitivity to various sensory stimulations in fibromyalgia but results on detection of both noxious and non-noxious tactile stimulation, which are particularly relevant for body representation and motor control, remain conflicting. Therefore, the aim of this study is to systematically review and quantify the detection thresholds to noxious and non-noxious tactile stimuli in individuals with fibromyalgia compared to pain-free controls. A systematic review and a meta-analysis were performed in the MEDLINE, EMBASE, CINAHL, Cochrane, PsycInfo and Web of Science databases using keywords related to fibromyalgia, tactile pain detection threshold, tactile detection threshold and quantitative sensory testing. Nineteen studies were included in the review, with 12 in the meta-analysis. Despite the heterogeneity of the results, the data from both the review and from the meta-analysis suggest a trend toward hyperalgesia and no difference of sensitivity to non-noxious tactile stimuli in participants with fibromyalgia compared to healthy controls. This contradicts the hypothesis of a general increase in responsiveness of the central nervous system to noxious and non-noxious stimulations in fibromyalgia. This study shows no alteration of the sensitivity to non-noxious tactile stimulation in fibromyalgia, suggesting that an altered unimodal processing is not sufficient to explain symptoms such as sensorimotor impairments and body representation distortions. Future research should investigate whether alterations in multisensory integration could contribute to these symptoms.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Audrey Desjardins
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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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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Gaynor SM, Bortsov A, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, Diatchenko L, Nackley A, Tchivileva IE, Whitehead W, Alonso AA, Buchheit TE, Boortz-Marx RL, Liedtke W, Park JJ, Maixner W, Smith SB. Phenotypic profile clustering pragmatically identifies diagnostically and mechanistically informative subgroups of chronic pain patients. Pain 2021; 162:1528-1538. [PMID: 33259458 PMCID: PMC8049946 DOI: 10.1097/j.pain.0000000000002153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
ABSTRACT Traditional classification and prognostic approaches for chronic pain conditions focus primarily on anatomically based clinical characteristics not based on underlying biopsychosocial factors contributing to perception of clinical pain and future pain trajectories. Using a supervised clustering approach in a cohort of temporomandibular disorder cases and controls from the Orofacial Pain: Prospective Evaluation and Risk Assessment study, we recently developed and validated a rapid algorithm (ROPA) to pragmatically classify chronic pain patients into 3 groups that differed in clinical pain report, biopsychosocial profiles, functional limitations, and comorbid conditions. The present aim was to examine the generalizability of this clustering procedure in 2 additional cohorts: a cohort of patients with chronic overlapping pain conditions (Complex Persistent Pain Conditions study) and a real-world clinical population of patients seeking treatment at duke innovative pain therapies. In each cohort, we applied a ROPA for cluster prediction, which requires only 4 input variables: pressure pain threshold and anxiety, depression, and somatization scales. In both complex persistent pain condition and duke innovative pain therapies, we distinguished 3 clusters, including one with more severe clinical characteristics and psychological distress. We observed strong concordance with observed cluster solutions, indicating the ROPA method allows for reliable subtyping of clinical populations with minimal patient burden. The ROPA clustering algorithm represents a rapid and valid stratification tool independent of anatomic diagnosis. ROPA holds promise in classifying patients based on pathophysiological mechanisms rather than structural or anatomical diagnoses. As such, this method of classifying patients will facilitate personalized pain medicine for patients with chronic pain.
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Affiliation(s)
- Sheila M. Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Eric Bair
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
- Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain; Department of Anesthesia, School of Medicine, School of Dentistry, McGill University, Montréal, Quebec, Canada
| | - Andrea Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - Inna E. Tchivileva
- Center for Pain Research and Innovation, Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William Whitehead
- Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aurelio A. Alonso
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Thomas E. Buchheit
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Anesthesiology Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Richard L. Boortz-Marx
- Pain Medicine Division, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Wolfgang Liedtke
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jongbae J. Park
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Shad B. Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
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Abstract
Given the high prevalence and associated cost of chronic pain, it has a significant impact on individuals and society. Improvements in the treatment and management of chronic pain may increase patients’ quality of life and reduce societal costs. In this paper, we evaluate state-of-the-art machine learning approaches in chronic pain research. A literature search was conducted using the PubMed, IEEE Xplore, and the Association of Computing Machinery (ACM) Digital Library databases. Relevant studies were identified by screening titles and abstracts for keywords related to chronic pain and machine learning, followed by analysing full texts. Two hundred and eighty-seven publications were identified in the literature search. In total, fifty-three papers on chronic pain research and machine learning were reviewed. The review showed that while many studies have emphasised machine learning-based classification for the diagnosis of chronic pain, far less attention has been paid to the treatment and management of chronic pain. More research is needed on machine learning approaches to the treatment, rehabilitation, and self-management of chronic pain. As with other chronic conditions, patient involvement and self-management are crucial. In order to achieve this, patients with chronic pain need digital tools that can help them make decisions about their own treatment and care.
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Rehm S, Sachau J, Hellriegel J, Forstenpointner J, Børsting Jacobsen H, Harten P, Gierthmühlen J, Baron R. Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep 2021; 6:e901. [PMID: 33718743 PMCID: PMC7952123 DOI: 10.1097/pr9.0000000000000901] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Sensory abnormalities through quantitative sensory testing in fibromyalgia were not substantially influenced by psychological comorbidities. A significant subgroup showed signs of central sensitization, influenced by pain intensity. Introduction: Patients suffering from fibromyalgia syndrome (FMS) are heterogenous. They often present with sensory abnormalities and comorbidities. Objectives: We aimed to answer the following questions: (1) Is there a specific somatosensory profile in our patient cohort? (2) Can we detect subgroups characterized by a specific combination of sensory and psychological features? and (3) Do psychological parameters influence sensory signs? Methods: In 87 patients with FMS quantitative sensory testing was performed on the hand and evaluated in combination with questionnaire results regarding pain, psychological comorbidities, sleep, and functionality. Results: Patients presented different somatosensory patterns, but no specific subgroups regarding sensory signs and psychological features were detected. Hypersensitivity for noxious mechanical and thermal stimuli and hyposensitivity for nonnoxious mechanical stimuli were the most prominent features. Thirty-one percent of patients showed signs of central sensitization as indicated by abnormally increased pinprick hyperalgesia or dynamic mechanical allodynia. Central sensitization was associated with higher pain intensities (P < 0.001). Only a small influence of psychiatric comorbidities on mechanical pain sensitivity (P = 0.044) and vibration detection (P = 0.028) was found, which was partly associated with high pain intensities. A small subgroup of patients (11.4%) demonstrated thermal hyposensitivity (loss of small-fiber function). Conclusion: Patients with FMS showed various somatosensory abnormalities. These were not significantly influenced by psychological comorbidities. Signs for central sensitization were detected in about one-third of patients and associated with higher pain intensities. This supports the notion of central sensitization being a major pathophysiological mechanism in FMS, whereas small-fiber loss may be less important.
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Affiliation(s)
- Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jana Hellriegel
- Division of Psychiatry, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.,Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Mind-Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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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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21
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Braun A, Evdokimov D, Frank J, Pauli P, Üçeyler N, Sommer C. Clustering fibromyalgia patients: A combination of psychosocial and somatic factors leads to resilient coping in a subgroup of fibromyalgia patients. PLoS One 2020; 15:e0243806. [PMID: 33370324 PMCID: PMC7769259 DOI: 10.1371/journal.pone.0243806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Coping strategies and their efficacy vary greatly in patients suffering from fibromyalgia syndrome (FMS). Objective We aimed to identify somatic and psychosocial factors that might contribute to different coping strategies and resilience levels in FMS. Subjects and methods Standardized questionnaires were used to assess coping, pain, and psychological variables in a cohort of 156 FMS patients. Quantitative real-time polymerase chain reaction (qRT-PCR) determined gene expression of selected cytokines in white blood cells of 136 FMS patients and 25 healthy controls. Data of skin innervation, functional and structural sensory profiles of peripheral nociceptive nerve fibers of a previous study were included into the statistics. An exploratory factor analysis was used to define variance explaining factors, which were then included into cluster analysis. Results 54.9% of the variance was explained by four factors which we termed (1) affective load, (2) coping, (3) pain, and (4) pro-inflammatory cytokines (p < 0.05). Considering differences in the emerged factors, coping strategies, cytokine profiles, and disability levels, 118 FMS patients could be categorized into four clusters which we named “maladaptive”, “adaptive”, “vulnerable”, and “resilient” (p < 0.05). The adaptive cluster had low scores in disability and in all symptom categories in contrast to the vulnerable cluster, which was characterized by high scores in catastrophizing and disability (p < 0.05). The resilient vs. the maladaptive cluster was characterized by better coping and a less pro-inflammatory cytokine pattern (p < 0.05). Conclusion Our data suggest that problem- and emotion-focused coping strategies and an anti-inflammatory cytokine pattern are associated with reduced disability and might promote resilience. Additional personal factors such as low anxiety scores, ability of acceptance, and persistence further favor a resilient phenotype. Individualized therapy should take these factors into account.
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Affiliation(s)
- Alexandra Braun
- Department of Neurology, University of Würzburg, Würzburg, Germany
- * E-mail:
| | | | - Johanna Frank
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), and Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
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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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Catala P, Lopez-Roig S, Ecija C, Suso-Ribera C, Peñacoba Puente C. Why do some people with severe chronic pain adhere to walking prescriptions whilst others won't? A cross-sectional study exploring clinical and psychosocial predictors in women with fibromyalgia. Rheumatol Int 2020; 41:1479-1484. [PMID: 33048198 DOI: 10.1007/s00296-020-04719-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
Fibromyalgia (FM) is a highly disabling condition characterized by widespread chronic pain. Physical exercise, such as walking, has been recommended as the treatment of choice for FM. However, adherence to physical exercise tends to be poor. Pain is one of the main inhibitors to adhere to walking in FM patients. The main objective of this study has been to determine whether there is a clinical and psychosocial profile to help predict individual differences in adherence to walking in a sample of patients with FM with severe pain levels. In this cross-sectional study, the sample was composed of 172 women with FM and severe pain levels (> 7 in an 11-point numerical scale). Women were classified into two groups: (1) those who walked regularly and (2) patients who rarely or never walked. Group differences regarding clinical outcomes (e.g., FM impact, anxiety, depression, cognitive fusion, catastrophizing, affect, and personality), sociodemographic variables, and medical history were analyzed. Patients who walked despite pain significantly reported less impact of FM, anxiety, depression, catastrophizing, cognitive fusion, negative affect, openness to experience, agreeableness, and conscientiousness. The unique predictors of group membership (walking versus no walking) in a binary regression were FM impact and negative affect. The results show that adherence to exercise might be influenced and predicted by the clinical profile of the patient, which suggests that personalized motivational interventions should be addressed to this at-risk subgroup.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas S/N, 28922, Alcorcón, Madrid, Spain
| | - Sofia Lopez-Roig
- Department of Behavioral Sciences and Health, Universidad Miguel Hernández, Alicante, Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas S/N, 28922, Alcorcón, Madrid, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Cecilia Peñacoba Puente
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas S/N, 28922, Alcorcón, Madrid, Spain.
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24
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Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia. J Clin Med 2020; 9:jcm9061992. [PMID: 32630430 PMCID: PMC7356211 DOI: 10.3390/jcm9061992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
The nociceptive withdrawal reflex (NWR) is used to probe spinal cord excitability in chronic pain states. Here, we used an automated and unbiased procedure for determining the NWR threshold and compared the reflex thresholds and corresponding pain ratings in a well-characterized cohort of fibromyalgia (n = 29) and matched healthy controls (n = 21). Surface electrical stimuli were delivered to the foot in a stepwise incremental and decremental manner. The surface electromyographic activity was recorded from the ipsilateral tibialis anterior muscle. Fibromyalgia patients reported significantly higher scores for psychological distress and pain-related disability and a significantly lower score for perceived state of health compared to the matched controls. The subjective pain ratings were significantly higher in patients. The NWR thresholds were similar to the controls. In the patients, but not in controls, the NWR thresholds and subjective pain ratings were significantly correlated. Our results showed an increased subjective pain sensitivity in fibromyalgia, but we found no evidence for spinal sensitization based on the reflex measures.
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Kang J, An M, Choi S, Xu H, Park D, Lee J, Lee S. Authors reply to "What is the significance of diagnostic criteria of fibromyalgia?". Int J Rheum Dis 2019; 22:1946-1947. [DOI: 10.1111/1756-185x.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ji‐Hyoun Kang
- Division of Rheumatology Department of Internal Medicine Chonnam National University Medical School & Hospital Gwangju Korea
| | - Minjeong An
- College of Nursing Chonnam National University Gwangju Korea
| | - Sung‐Eun Choi
- Division of Rheumatology Department of Internal Medicine Chonnam National University Medical School & Hospital Gwangju Korea
| | - Haimuzi Xu
- Division of Rheumatology Department of Internal Medicine Chonnam National University Medical School & Hospital Gwangju Korea
| | - Dong‐Jin Park
- Division of Rheumatology Department of Internal Medicine Chonnam National University Medical School & Hospital Gwangju Korea
| | - Jung‐Kil Lee
- Department of Neurosurgery Chonnam National University Medical School & Hospital Gwangju Korea
| | - Shin‐Seok Lee
- Division of Rheumatology Department of Internal Medicine Chonnam National University Medical School & Hospital Gwangju Korea
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26
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Villafaina S, Collado-Mateo D, Domínguez-Muñoz FJ, Fuentes-García JP, Gusi N. Benefits of 24-Week Exergame Intervention on Health-Related Quality of Life and Pain in Women with Fibromyalgia: A Single-Blind, Randomized Controlled Trial. Games Health J 2019; 8:380-386. [PMID: 31259617 DOI: 10.1089/g4h.2019.0023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To evaluate the effects of 24-week exergame-based intervention on health-related quality of life (HRQoL) and pain in patients with fibromyalgia as well as to analyze the effectiveness of the intervention in subgroups of patients with different pain intensity levels. Design: Single-blinded, randomized controlled trial. Setting: University facilities Participants: Fifty-five women with fibromyalgia participated in the study. Intervention: The exercise group (EG) completed 24 weeks of exergames focused on mobility, postural control, upper and lower limbs coordination, aerobic fitness, and strength. A total of 120 minutes per week, divided into two sessions of 60 minutes, was completed. Main outcome measures: The Euroqol-5 Dimensions-5 Levels (EQ-5D-5L) was used to assess the HRQoL. In addition, pain intensity was measured using a visual analog scale (VAS). Results: Twenty-five out of 28 women allocated to the EG completed the intervention, which means an 89.29% of adherence. They were randomly divided into an exercise (age = 54.04 [8.45]) and a control group (52.72 [9.98]). Significant effects on the perceived health status and pain intensity (P < 0.05) were found. K-means clustering procedure revealed two groups with different response to the intervention. The respond group obtained significant effects of the exergame intervention in EQ-5D-5L, pain VAS, and VAS-EQ, compared with those who did not respond. Conclusions: Exergames could be a useful tool to improve perceived health status and pain intensity level in women with fibromyalgia with a reduced health-related quality of life.
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Affiliation(s)
| | - Daniel Collado-Mateo
- Faculty of Sport Science, University of Cáceres, Cáceres, Spain.,Facultad de Educación, Universidad Autónoma de Chile, Talca, Chile
| | | | | | - Narcis Gusi
- Faculty of Sport Science, University of Cáceres, Cáceres, Spain
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27
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Kashikar-Zuck S, Cunningham N, Peugh J, Black WR, Nelson S, Lynch-Jordan AM, Pfeiffer M, Tran ST, Ting TV, Arnold LM, Carle A, Noll J, Powers SW, Lovell DJ. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain 2019; 160:433-441. [PMID: 30335681 PMCID: PMC6344278 DOI: 10.1097/j.pain.0000000000001415] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Juvenile-onset fibromyalgia (JFM) is typically diagnosed in adolescence and characterized by widespread pain and marked functional impairment. The long-term impact of JFM into adulthood is poorly understood. The objectives of this study were to describe physical and psychosocial outcomes of youth diagnosed with JFM in early adulthood (∼8-year follow-up), examine longitudinal trajectories of pain and depressive symptoms from adolescence to young adulthood, and examine the impact of pain and depressive symptoms on physical functioning over time. Participants were 97 youth with JFM enrolled in a prospective longitudinal study in which pain symptoms, and physical and psychosocial functioning were assessed at 4 time points over approximately 8 years. At the time 4 follow-up (Mage = 24.2 years), the majority continued to suffer from pain and impairment in physical, social, and psychological domains. However, trajectories of pain and emotional symptoms showed varying patterns. Longitudinal analysis using growth mixture modeling revealed 2 pain trajectories (Steady Improvement and Rapid Rebounding Improvement), whereas depressive symptoms followed 3 distinct trajectories (Low-Stable, Improving, and Worsening). Membership in the Worsening Depressive symptoms group was associated with poorer physical functioning over time (P < 0.001) compared with the Low-Stable and Improving groups. This study offers evidence that although JFM symptoms persist for most individuals, pain severity tends to decrease over time. However, depressive symptoms follow distinct trajectories that indicate subgroups of JFM. In particular, JFM patients with worsening depressive symptoms showed decreasing physical functioning and may require more intensive and consistent intervention to prevent long-term disability.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Natoshia Cunningham
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - James Peugh
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - William R. Black
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Sarah Nelson
- Department of Anesthesia, Pain and Perioperative Medicine, Boston Children’s Hospital
- Department of Psychiatry, Harvard Medical School
| | - Anne M. Lynch-Jordan
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Megan Pfeiffer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | | | - Tracy V. Ting
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Psychology, DePaul University, Chicago
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
| | - Lesley M. Arnold
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
| | - Jennie Noll
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Scott W. Powers
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
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28
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Minetto MA, Botter A, Gamerro G, Varvello I, Massazza G, Bellomo RG, Maffiuletti NA, Saggini R. Contralateral effect of short-duration unilateral neuromuscular electrical stimulation and focal vibration in healthy subjects. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.05004-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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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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30
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Davis F, Gostine M, Roberts B, Risko R, Cappelleri JC, Sadosky A. Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome. J Pain Res 2018; 11:2551-2560. [PMID: 30425566 PMCID: PMC6205129 DOI: 10.2147/jpr.s147199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background While fibromyalgia (FM) is characterized by chronic widespread pain and tenderness, its presentation among patients as a continuum of diseases rather than a single disease contributes to the challenges of diagnosis and treatment. The purpose of this analysis was to distinguish and characterize classes of FM within the continuum using data from chronic pain patients. Methods FM patients were identified from administrative claims data from the ProCare Systems’ network of Michigan pain clinics between January 1999 and February 2015. Identification was based on either use of traditional criteria (ie, ICD-9 codes) or a predictive model indicative of patients having FM. Patients were classified based on similarity of comorbidities (symptom severity), region of pain (widespread pain), and type and number of procedures (treatment intensity) using unsupervised learning. Text mining and a review of physician notes were conducted to assist in understanding the FM continuum. Results A total of 2,529 FM patients with 79,570 observations or clinical visits were evaluated. Four main classes of FM patients were identified: Class 1) regional FM with classic symptoms; Class 2) generalized FM with increasing widespread pain and some additional symptoms; Class 3) FM with advanced and associated conditions, increasing widespread pain, increased sleep disturbance, and chemical sensitivity; and Class 4) FM secondary to other conditions. Conclusion FM is a disease continuum characterized by progressive and identifiable classifications. Four classes of FM can be differentiated by pain and symptom severity, specific comorbidities, and use of clinical procedures.
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Affiliation(s)
- Fred Davis
- ProCare Systems Inc, Grand Rapids, MI, USA,
| | - Mark Gostine
- Michigan Pain Consultants, Grand Rapids, MI, USA
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31
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Pickering G, Macian N, Delage N, Picard P, Cardot JM, Sickout-Arondo S, Giron F, Dualé C, Pereira B, Marcaillou F. Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2485-2496. [PMID: 30127596 PMCID: PMC6089099 DOI: 10.2147/dddt.s162810] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Fibromyalgia is characterized by widespread and chronic pain, and its prevalence is increasing worldwide. Milnacipran, an antidepressant, is often prescribed for fibromyalgia with a possible beneficial effect on central pain modulation. The aim of this study was to evaluate if milnacipran could modify the status of conditioned pain modulation (CPM) in patients suffering from fibromyalgia. Design and setting Randomized, double-blind controlled trial. Subjects and methods Women with fibromyalgia received milnacipran 100 mg or placebo. The primary end point was the evolution of CPM with treatments after a 30-second painful stimulus. Secondary outcomes included the predictability of milnacipran efficacy from CPM performance, evolution of global pain, mechanical sensitivity, thermal pain threshold, mechanical allodynia, cognitive function, and tolerance. Results Fifty-four women with fibromyalgia (46.7±10.6 years) were included and randomized, and 24 patients were analyzed in each group. At inclusion, CPM was dysfunctional (CPM30=-0.5±1.9), and global pain was 6.5±1.8. After treatment, there was a nonsignificant CPM difference between milnacipran and placebo (CPM30=-0.46±1.22 vs -0.69±1.43, respectively, p=0.55) and 18.8% vs 6.3% (p=0.085) patients did reactivate CPM after milnacipran vs placebo. Initial CPM was not a predictor of milnacipran efficacy. Global pain, mechanical and thermal thresholds, allodynia, cognition, and tolerance were not significantly different between both groups. Conclusion Milnacipran did not display a significant analgesic effect after 1-month treatment, but the tendency of milnacipran to reactivate CPM in a number of patients must be explored with longer treatment duration in future studies and pleads for possible subtypes of fibromyalgia patients.
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Affiliation(s)
- Gisèle Pickering
- University Clermont Auvergne Neurodol, Clermont-Ferrand, France, .,Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Nicolas Macian
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Noémie Delage
- Pain Clinic, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascale Picard
- Pain Clinic, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Cardot
- University Clermont Auvergne MEDIS, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophia Sickout-Arondo
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Fatiha Giron
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Christian Dualé
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Almeida SC, George SZ, Leite RDV, Oliveira AS, Chaves TC. Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes. Physiother Theory Pract 2018; 35:1218-1232. [PMID: 29771165 DOI: 10.1080/09593985.2018.1474512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.
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Affiliation(s)
- Suzana C Almeida
- Physical Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham NC, USA
| | - Raquel D V Leite
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anamaria S Oliveira
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Biomechanics, Medicine and Rehabilitation of the Musculoskeletal System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Thais C Chaves
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neurosciences and Behavioral Sciences Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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33
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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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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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Montero-Marín J, Navarro-Gil M, Puebla-Guedea M, Luciano JV, Van Gordon W, Shonin E, García-Campayo J. Efficacy of "Attachment-Based Compassion Therapy" in the Treatment of Fibromyalgia: A Randomized Controlled Trial. Front Psychiatry 2017; 8:307. [PMID: 29387020 PMCID: PMC5775966 DOI: 10.3389/fpsyt.2017.00307] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE There is a growing interest in evaluating the effectiveness of compassion interventions for treating psychological disorders. The present study evaluated the effectiveness of "attachment-based compassion therapy" (ABCT) in the treatment of fibromyalgia (FM), and the role of psychological flexibility as a mediator of improvements. METHODS A total of 42 patients with FM were randomly assigned to ABCT or relaxation (active control group). Both the intervention and control condition were combined with treatment as usual (TAU). The primary outcome was functional status (FIQ), and the secondary outcomes were clinical severity (CGI-S), pain catastrophizing (PCS), anxiety (HADS-A), depression (HADS-D), quality of life (EQ-5D), and psychological flexibility (AAQ-II). Differences between the groups were estimated using mixed-effects models, and mediation assessments were conducted using path analyses. RESULTS The ABCT group demonstrated superior outcomes compared to the relaxation group, including better FIQ values after treatment (B = -3.01; p = 0.003). Differences in FIQ were maintained at 3-month follow-up (B = -3.33; p = 0.001). The absolute risk reduction in ABCT compared to relaxation increased by 40.0%, with an NNT = 3 based on criteria of ≥50% FIQ reduction after treatment. Psychological flexibility had a significant mediating effect on improvements. CONCLUSION These results suggest that ABCT combined with TAU appears to be effective in the treatment of FM symptoms. CLINICAL TRIAL REGISTRATION http://ClinicalTrials.gov, identifier NCT02454244.
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Affiliation(s)
- Jesús Montero-Marín
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Mayte Navarro-Gil
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain.,Faculty of Social and Human Sciences, Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Marta Puebla-Guedea
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Juan V Luciano
- 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
| | - William Van Gordon
- Centre for Psychological Research, University of Derby, Derby, United Kingdom
| | - Edo Shonin
- Awake to Wisdom Centre for Meditation and Mindfulness Research, Ragusa, Italy
| | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain.,Instituto de Investigaciones Sanitarias (IIS), Miguel Servet Hospital, Psychiatry Service, University of Zaragoza, Zaragoza, Spain
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