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García-López H, García-Giménez MT, Obrero-Gaitán E, Lara-Palomo IC, Castro-Sánchez AM, Rey RRD, Cortés-Pérez I. Effectiveness of balneotherapy in reducing pain, disability, and depression in patients with Fibromyalgia syndrome: a systematic review with meta-analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02732-3. [PMID: 39008110 DOI: 10.1007/s00484-024-02732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024]
Abstract
Balneotherapy, using heated natural mineral waters at 36-38 °C, presents a comprehensive treatment approach for Fibromyalgia Syndrome (FMS). This study aims to assess the effect of balneotherapy in reducing pain intensity, disability, and depression in patients with FMS. We want to assess this effect at just four time-points: immediately at the end of the therapy, and at 1, 3, and 6 months of follow-up. Following PRISMA guidelines, we conducted an aggregate data meta-analysis, registered in PROSPERO CRD42023478206, searching PubMed Medline, Science Direct, CINAHL Complete, Scopus, and Web of Science until August 2023 for relevant randomized controlled trials (RCTs) that assess the effect of balneotherapy on pain intensity, disability, and depression in FMS patients. Methodological quality was assessed using the Cochrane methodology, and the pooled effect was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Sixteen RCTs were included in the meta-analysis. Balneotherapy is effective in reducing pain intensity (SMD - 1.67; 95% CI -2.18 to -1.16), disability (SMD - 1.1; 95% CI -1.46 to -0.7), and depression (SMD - 0.51; 95% CI -0.93 to -0.9) at the end of the intervention. This effect was maintained at 1, 3, and 6 months for pain intensity and disability. Balneotherapy improves both pain intensity and disability in patients with FMS, providing evidence that its positive effects are sustained for up to 6 months of follow-up. Nevertheless, it is important to note that the improvement in depression varies across different temporal phases.
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Affiliation(s)
- Héctor García-López
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain
| | - María Teresa García-Giménez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain
| | - Esteban Obrero-Gaitán
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain
| | - Inmaculada Carmen Lara-Palomo
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain
| | - Adelaida María Castro-Sánchez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain
| | - Raúl Romero-Del Rey
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carr. Sacramento, s/n, La Cañada, Almería, 04120, Spain.
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, Jaén, 23071, Spain
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Olivero A, Cuniberti F, Leombruni P. Well-Being Therapy for Fibromyalgia: A Case Report. J Nerv Ment Dis 2024; 212:352-357. [PMID: 38810099 DOI: 10.1097/nmd.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
ABSTRACT Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, fatigue, anxiety, depression, and sleep disturbances, significantly impairing quality of life and psychological well-being. Well-being therapy (WBT) is a brief psychotherapeutic intervention aimed at increasing well-being and optimizing functioning, which has proven effective in treating various conditions involving pain and psychological or psychiatric symptoms. We describe a case study of a 22-year-old university student experiencing FMS, highlighting the far-reaching effects of the condition on her quality of life. After eight sessions of WBT, there was a marked improvement in subjective well-being and euthymia, as well as a decrease in pain perception, improved ability to manage stress, reduced allostatic overload despite the presence of stressors, improved social relationships, and increased self-efficacy. The positive effects of WBT continued at 3-month follow-up, suggesting that WBT may represent a short-term effective intervention for patients with FMS.
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Affiliation(s)
- Alberto Olivero
- "Rita Levi Montalcini" Department of Neuroscience, Università degli Studi di Torino, Torino, Italy
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Matei D, Trăistaru R, Pădureanu V, Avramescu TE, Neagoe D, Genunche A, Amzolini A. The Efficiency of Kinesiotherapy versus Physical Modalities on Pain and Other Common Complaints in Fibromyalgia. Life (Basel) 2024; 14:604. [PMID: 38792625 PMCID: PMC11122147 DOI: 10.3390/life14050604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Due to its variety of signs and symptoms, there have been numerous attempts to treat fibromyalgia (FM), but a cure has yet to be established. The aim of this study was to evaluate the effects of a complex kinetic therapy program and a combined physical modality program on pain and other common symptoms of FM. Patients and methods: A total of 78 female patients were included in this study; 39 subjects underwent a kinesiotherapy (KT) intervention (combining aerobic and Pilates exercises), and 39 participated in a physical modality (PM) program (including electrotherapy (TENS and low-laser therapy) and thermotherapy). Results: Regarding the parameter of pain assessment, kinesiotherapy demonstrated its superiority both during the treatment period and in the evaluation 3 months after therapy cessation. Both in terms of patient-reported pain (inter-group comparisons: p = 0.000 at T3) and the examination of tender points (inter-group comparisons: p = 0.000 at T3), as well as the algometric assessment, pain was alleviated by the two forms of applied kinetic therapy. The observed functional impairment was statistically significantly influenced (p = 0.001) at the end of the kinetic program application, while for the perceived functional impairment, neither therapy proved superiority over the other at any point of evaluation (inter-group comparisons: p = 0.715 at T3). Regarding the influence of the emotional consequences implied by fibromyalgia, neither the forms of kinesiotherapy nor the chosen physical modalities proved superiority at any point of evaluation (HAQ anxiety inter-group comparisons: p = 0.000 at T3). In conclusion, even though kinesiotherapy had superior influences on fibromyalgia pain in the studied group, the current research lends credence to the significance of non-pharmacological therapy in managing fibromyalgia. Participants demonstrated positive advancements in subjective and objective pain assessments, as well as improvements in functional and emotional well-being.
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Affiliation(s)
- Daniela Matei
- Department of Medical Rehabilitation, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.M.); (R.T.)
| | - Rodica Trăistaru
- Department of Medical Rehabilitation, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.M.); (R.T.)
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.N.); (A.A.)
| | | | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.N.); (A.A.)
| | - Amelia Genunche
- Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.N.); (A.A.)
| | - Anca Amzolini
- Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (D.N.); (A.A.)
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Nunes JC, Costa GPA, Weleff J, Rogan M, Compton P, De Aquino JP. Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations. Br J Clin Pharmacol 2024. [PMID: 38556851 DOI: 10.1111/bcp.16055] [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: 09/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.
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Affiliation(s)
- Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Habibi Asgarabad M, Salehi Yegaei P, Jafari F, Azami-Aghdash S, Lumley MA. The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis. Eur J Pain 2023; 27:321-337. [PMID: 36471652 DOI: 10.1002/ejp.2064] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM. DATABASES AND DATA TREATMENT Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses. RESULTS The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM. CONCLUSIONS Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended.
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Affiliation(s)
- Mojtaba Habibi Asgarabad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute), Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Salehi Yegaei
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
| | - Fatemeh Jafari
- Department of Psychology, Faculty of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Michigan, Detroit, USA
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The effectiveness of major ozone autohemotherapy in the treatment of fibromyalgia syndrome. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1032050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Fibromyalgia syndrome (FMS) is a disease that seriously affects the quality of life. Although many modalities are used in treatment, there is still no common protocol. The aim of this study was to evaluate the effectiveness of major autohemotherapy (MAH) with ozone, which has come into use in recent years.
Methods: The retrospective cohort study included 45 male and female patients who were admitted to the Physical Medicine and Rehabilitation (PMR) outpatient clinic of Private Medar Hospital between January 2017 and October 2020 and were treated with MAH for a diagnosis of FMS. Evaluations were made before and after the last session of treatment using a visual analog scale (VAS), the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form Health Survey-36 (SF-36). The scores of the patients were compared.
Results: Posttreatment VAS and FIQ scores decreased significantly (P = 0.014, P = 0.022 respectively) compared to pretreatment. After treatment, SF-36; PF, PH, EP, Fatigue, EW, SF, Pain, GH, HC scores increased significantly (P < 0.05 for all) compared to before treatment. The use of analgesics after treatment decreased significantly (P = 0.033) compared to before treatment.
Conclusion: MAH applied twice a week is an effective and practical method in the treatment of FMS.
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Mengshoel AM, Skarbø Å, Hasselknippe E, Petterson T, Brandsar NL, Askmann E, Ildstad R, Løseth L, Sallinen MH. Enabling personal recovery from fibromyalgia - theoretical rationale, content and meaning of a person-centred, recovery-oriented programme. BMC Health Serv Res 2021; 21:339. [PMID: 33853607 PMCID: PMC8045361 DOI: 10.1186/s12913-021-06295-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Fibromyalgia (FM) is a contested, chronic widespread pain syndrome on which recommended therapies have short-lasting, moderate effects. Nevertheless, some patients become symptom-free, and their recovery experiences inspired us to develop a patient-centred recovery-oriented programme (PROP) delivered in a group format. Presently, we describe the theoretical rationale, purpose and content of the PROP, and its meanings for clinicians and patients. Methods A multidisciplinary clinical team, a leader of a rehabilitation unit, and two researchers coproduced the PROP. Five full-day seminars were arranged to bridge research and clinical experiences. Qualitative studies about patients’ illness and recovery experiences and questions by researchers facilitated reflections on clinical experiences. The meaning of the PROP was examined using focus group and individual interviews with patients and clinicians immediately after completing the course and after 1–1.5 years. Results The biopsychosocial model displays the research evidence across biological, mental and social impacts of FM, justifying that life stress can be an illness-maintaining factor in FM. The content addresses enabling patients to heal their own life and self by modifying life stress. Patients engage in making sense of the relationship between FM, themselves, and life through exploring, discovering and creating appropriate solutions for their daily social life. The PROP reduced uncertainties and brought a positive attitude and hope to the groups. After 1 year, patients are still engaged in recovery work, experience more good days, and maintain hope for further recovery. By sharing and reflecting on clinical experiences, a unified clinical team was established that continues to develop their competency. Conclusion To our knowledge, the PROP is the first programme for patients with FM that results from a process of coproducing knowledge, is based on explicit theoretical rationale, and facilitates a personal experiential recovery process. PROP is found to be meaningful and to work by patients and clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06295-6.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.
| | - Åse Skarbø
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | | | - Tamara Petterson
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Nina Linnea Brandsar
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ellen Askmann
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ragnhild Ildstad
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Lena Løseth
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Merja Helena Sallinen
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042075. [PMID: 33672691 PMCID: PMC7924356 DOI: 10.3390/ijerph18042075] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Background: We analyzed the immediate effects of a Telerehabilitation Program (TP) based on aerobic exercise in women with fibromyalgia (FM) syndrome during the lockdown declared in Spain due to the COVID-19 pandemic. Methods: A single-blind randomized controlled trial was designed. Thirty-four women with FM were randomized into two groups: TP group and Control group. The intervention lasted 15 weeks, with 2 sessions per week. The TP based on aerobic exercise was guided by video and the intensity of each session was monitored using the Borg scale. Pain intensity (Visual Analogue Scale), mechanical pain sensitivity (algometer), number of tender points, FM impact (Revised Fibromyalgia Impact Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), physiological distress (Hospital Anxiety and Depression Scale), upper (Arm Curl Test) and lower-limb physical function (6-min Walk Test) were measured at baseline and after the intervention. Results: The TP group improved pain intensity (p = 0.022), mechanical pain sensitivity (p < 0.05), and psychological distress (p = 0.005), compared to the Control group. The Control group showed no statistically significant changes in any variable (p > 0.05). Conclusions: A TP based on aerobic exercise achieved improvements on pain intensity, mechanical pain sensitivity, and psychological distress compared to a Control group during the lockdown declared in Spain due to COVID-19 pandemic.
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KARABULUT İ, KOCAMAZ D, TURHAN B. Fibromiyalji hastalarında d vitamini eksikliğinin fiziksel semptomlara etkisinin incelenmesi: Sistematik derleme. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.818963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Kong KR, Lee EN. [Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial]. J Korean Acad Nurs 2021; 51:347-362. [PMID: 34215712 DOI: 10.4040/jkan.21025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program's clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey. METHODS To confirm the program's effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA. RESULTS The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts. CONCLUSION This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.
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Affiliation(s)
| | - Eun Nam Lee
- College of Nursing, Dong-A University, Busan, Korea.
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11
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Diagnosis of fibromyalgia: comparison of the 2011/2016 ACR and AAPT criteria and validation of the modified Fibromyalgia Assessment Status. Rheumatology (Oxford) 2020; 59:3042-3049. [DOI: 10.1093/rheumatology/keaa061] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/25/2020] [Indexed: 02/01/2023] Open
Abstract
Abstract
Objective
To compare the concordance of the three diagnostic criteria, respectively the 2011 ACR criteria (ACR 2011 Cr), the ACR 2016 criteria (ACR 2016 Cr) and the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION)-APS Pain Taxonomy criteria (AAPT Cr), and to explore the performance of an additional set of criteria, the modified Fibromyalgia Assessment Status (FAS 2019 modCr), in the diagnosis of FM syndrome.
Methods
Consecutive patients with chronic widespread pain, referred by the primary care setting, underwent rheumatologic assessment that established the presence or not of FM and were investigated through the four sets of proposed criteria. For the FAS 2019 modCr, discriminant validity to distinguish patients with FM and non-FM was assessed with receiver operating characteristic curve analysis.
Results
A total of 732 (405 with FM and 327 with other common chronic pain problems) patients were evaluated. Against the clinical diagnosis of FM, the sensitivity, specificity and correct classification were, respectively: 79.8, 91.7 and 85.1% for ACR 2011 Cr; 78, 90.5 and 83.6% for the ACR 2016 Cr; and 73.8, 91.7 and 81.8% for the AAPT Cr. The alternative set, proposed on the FAS 2019 modCr, provided a maximal diagnostic accuracy with a score ≥20 (Youden’s index), with a sensitivity of 84.2%, specificity 89.0% and positive likelihood ratio 7.65.
Conclusion
There is a considerable agreement between criteria-based diagnoses of FM, although the AAPT Cr perform least well in terms of percentage of correct classification. The FAS 2019 modCr had comparable characteristics.
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Evcik D, Ketenci A, Sindel D. The Turkish Society of Physical Medicine and Rehabilitation (TSPMR) guideline recommendations for the management of fibromyalgia syndrome. Turk J Phys Med Rehabil 2019; 65:111-123. [PMID: 31453551 PMCID: PMC6706830 DOI: 10.5606/tftrd.2019.4815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/23/2019] [Indexed: 11/21/2022] Open
Abstract
In the present study, we aimed to establish a national guideline including recommendations of the Turkish Society of Physical Medicine and Rehabilitation (TSPMR) for the management of Fibromyalgia (FM) syndrome. This guideline was built mainly in accordance with the 2017 revised European League Against Rheumatism (EULAR) guideline recommendations for the management of FM. A total of 46 physical medicine and rehabilitation specialists were included. A systematic literature search was carried out in PubMed, Scopus, Cochrane, and Turkish Medical Index between 2000 and 2018. Evidence levels of the publications were evaluated, and the levels of recommendation were graded on the basis of relevant levels of evidence, The Assessment of Level of Agreement with opinions by task force members was established using the electronic Delphi technique. Recommendations were assessed by two Delphi rounds and 7 of 10 points were deemed necessary for agreement. The treatment recommendations were classified as non-pharmacological therapies (6 main items), pharmacological treatments (10 items), and complementary therapies (5 items). These were recommended in the light of evidence, depending on the clinical and general condition of each patient. This is the first national TSPMR guideline recommendations for the management of FM in Turkey. We believe our effort would be helpful for the physicians who are interested in the treatment of FM.
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Affiliation(s)
- Deniz Evcik
- Department of Physical Medicine and Rehabilitation, Guven Hospital, Ankara, Turkey
| | - Ayşegül Ketenci
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Dilşad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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13
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DeBar L, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Mayhew M, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2018; 67:91-99. [PMID: 29522897 PMCID: PMC5931339 DOI: 10.1016/j.cct.2018.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. METHODS/DESIGN This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. DISCUSSION This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592.
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Affiliation(s)
- Lynn DeBar
- Kaiser Permanente Center for Health Research, Portland, OR, United States.
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland, OR, United States; University of Portland, School of Nursing, Portland, OR, United States
| | - Allison Bonifay
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Richard A Deyo
- Oregon Health and Science University, School of Medicine, Portland, OR, United States
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Francis J Keefe
- Duke University, School of Medicine, Durham, NC, United States
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Ashli Owen-Smith
- Georgia State University, School of Public Health, Atlanta, GA, United States; Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, GA, United States
| | - David H Smith
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Connie M Trinacty
- Kaiser Permanente Center for Health Research, Honolulu, HI, United States
| | - William M Vollmer
- Kaiser Permanente Center for Health Research, Portland, OR, United States
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Montesó-Curto P, García-Martinez M, Romaguera S, Mateu ML, Cubí-Guillén MT, Sarrió-Colas L, Llàdser AN, Bradley S, Panisello-Chavarria ML. Problems and solutions for patients with fibromyalgia: Building new helping relationships. J Adv Nurs 2017; 74:339-349. [DOI: 10.1111/jan.13412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Pilar Montesó-Curto
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Spain
| | | | - Sara Romaguera
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Spain
| | - María Luisa Mateu
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Spain
| | | | - Lidia Sarrió-Colas
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Spain
| | - Anna Núria Llàdser
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Spain
| | - Stephen Bradley
- School of Nursing and Midwifery; University College Cork; Brookfield Health Sciences Centre; Cork Ireland
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15
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16
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Gerardi MC, Atzeni F, Batticciotto A, Di Franco M, Rizzi M, Sarzi-Puttini P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin Drug Saf 2016; 15:1541-1548. [DOI: 10.1080/14740338.2016.1242575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Chiara Gerardi
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza, University of Rome, Rome, Italy
| | - Maurizio Rizzi
- Pulmonary Department, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
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17
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Ericsson A, Palstam A, Larsson A, Löfgren M, Bileviciute-Ljungar I, Bjersing J, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther 2016; 18:176. [PMID: 27473164 PMCID: PMC4967304 DOI: 10.1186/s13075-016-1073-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/06/2016] [Indexed: 01/03/2023] Open
Abstract
Background Fibromyalgia (FM) affects approximately 1–3 % of the general population. Fatigue limits the work ability and social life of patients with FM. A few studies of physical exercise have included measures of fatigue in FM, indicating that exercise can decrease fatigue levels. There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM. The present study is a sub-study of a multicenter randomized controlled trial in women with FM. The purpose of the present sub-study was to examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM, and to investigate predictors of the potential change in fatigue. Methods A total of 130 women with FM (age 22–64 years) were included in this assessor-blinded randomized controlled multicenter trial examining the effects of person-centered progressive resistance exercise compared with an active control group. The intervention was performed twice a week for 15 weeks. Outcomes were five dimensions of fatigue measured with the Multidimensional Fatigue Inventory (MFI-20). Information about background was collected and the women also completed several health-related questionnaires. Multiple linear stepwise regression was used to analyze predictors of change in fatigue in the total population. Results A higher improvement was found at the post-treatment examination for change in the resistance exercise group, as compared to change in the active control group in the MFI-20 subscale of physical fatigue (resistance group Δ –1.7, SD 4.3, controls Δ 0.0, SD 2.7, p = 0.013), with an effect size of 0.33. Sleep efficiency was the strongest predictor of change in the MFI-20 subscale general fatigue (beta = −0.54, p = 0.031, R2 = 0.05). Participating in resistance exercise (beta = 1.90, p = 0.010) and working fewer hours per week (beta = 0.84, p = 0.005) were independent significant predictors of change in physical fatigue (R2 = 0.14). Conclusions Person-centered progressive resistance exercise improved physical fatigue in women with FM when compared to an active control group. Trial registration ClinicalTrials.gov NCT01226784. Registered 21 October 2010.
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Affiliation(s)
- Anna Ericsson
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden.
| | - Annie Palstam
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anette Larsson
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden
| | - Monika Löfgren
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Stockholm, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Stockholm, Stockholm, Sweden
| | - Jan Bjersing
- Institute of Medicine, Department of Rheumatology and Inflammation research, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Division of Community Medicine, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Center, Anesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Göteborg, Sweden
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18
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Ericsson A, Mannerkorpi K. How to manage fatigue in fibromyalgia: nonpharmacological options. Pain Manag 2016; 6:331-8. [PMID: 27297077 DOI: 10.2217/pmt-2016-0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this article is to suggest recommendations for the management of fatigue in fibromyalgia (FM) by reviewing and compiling findings of nonpharmacological treatment for fatigue in patients with FM. The management of fatigue in FM should incorporate regular physical exercise maintained for a longer period of time, which contributes to improved general health and facilitates coping with fatigue and other symptoms. The evidence is still low and the effect of exercise on fatigue in FM needs to be further studied. Patients with FM appear to benefit from general sleep hygiene advice and also need to develop individual strategies to manage the complex factors in everyday life that may be related to fatigue.
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Affiliation(s)
- Anna Ericsson
- University of Gothenburg, Sahlgrenska Academy, Institution of Neuroscience & Physiology - Section of Health & Rehabilitation, Physiotherapy, Göteborg, Sweden.,Närhälsan Research & Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Kaisa Mannerkorpi
- University of Gothenburg, Sahlgrenska Academy, Institution of Neuroscience & Physiology - Section of Health & Rehabilitation, Physiotherapy, Göteborg, Sweden
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Calandre EP, Rico-Villademoros F, Slim M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin Pharmacother 2015; 16:1347-68. [PMID: 26001183 DOI: 10.1517/14656566.2015.1047343] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different symptoms such as fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress. Multidisciplinary treatment combining pharmacological and nonpharmacological therapies is advised. AREAS COVERED Publications describing randomized controlled trials and long-term extension studies evaluating drug treatment for fibromyalgia were searched in PubMed and Scopus and included in this review. EXPERT OPINION Different drugs are recommended for the treatment of fibromyalgia by different published guidelines, although only three of them have been approved for this indication by the US FDA, and none have been approved by the European Medicines Agency. According to the available evidence, pregabalin, duloxetine and milnacipran should be the drugs of choice for the treatment of this disease, followed by amitriptyline and cyclobenzaprine. Other drugs with at least one positive clinical trial include some selective serotonin reuptake inhibitors, moclobemide, pirlindole, gabapentin, tramadol, tropisetron, sodium oxybate and nabilone. None of the currently available drugs are fully effective against the whole spectrum of fibromyalgia symptoms, namely pain, fatigue, sleep disturbances and depression, among the most relevant symptoms. Combination therapy is an option that needs to be more thoroughly investigated in clinical trials.
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Affiliation(s)
- Elena P Calandre
- Universidad de Granada, Instituto de Neurociencias , Granada, 18012 , Spain +0034 958246291 ; +0034 958246187 ;
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20
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Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysomnographic variables explaining poor sleep quality in patients. Sleep Med 2015; 16:917-25. [DOI: 10.1016/j.sleep.2015.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/10/2015] [Accepted: 03/04/2015] [Indexed: 11/21/2022]
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21
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Sarzi-Puttini P, Atzeni F, Clauw DJ, Perrot S. The impact of pain on systemic rheumatic diseases. Best Pract Res Clin Rheumatol 2015; 29:1-5. [PMID: 26266994 DOI: 10.1016/j.berh.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pain is associated with the different types of rheumatic syndromes because it is often the most troubling symptom of patients affected by any of these diseases. Some risk factors clearly play a major role in the clinical expression of pain and related syndromes, including genetics, age, gender, co-morbidities, traumas and psychological patterns, but there are no specific clinical, laboratory or neuroimaging markers that can indicate why and when a patient's localised pain will become chronic and widespread. Any type of pain must be treated not only appropriately, but also rapidly because the likelihood of developing some form of chronic pain is related to the duration of the peripheral pain stimulus. Chronic pain inevitably has a major impact on patients' quality of life because the loss of function undermines their ability to do everyday activities. Pain can be most effectively treated by carefully selecting various pharmacological and non-pharmacological interventions based on the characteristics of the pain itself, disease factors, psychological coping abilities, and lifestyle.
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Affiliation(s)
| | | | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, The University of Michigan, 24 Frank Lloyd Wright Dr, PO Box 385, Ann Arbor, MI 48105, USA
| | - Serge Perrot
- Université Paris Descartes-Sorbonne Paris Cité, APHP, Hôtel Dieu de Paris, Service de Médecine Interne et Thérapeutique, Pain Center, Paris, France; INSERM U 987, Pain Center, Boulogne, France
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22
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Montesó-Curto P, García-Martínez M, Gómez-Martínez C, Ferré-Almo S, Panisello-Chavarria ML, Genís SR, Mateu Gil ML, Cubí Guillén MT, Colás LS, Usach TS, Herrero AS, Ferré-Grau C. Effectiveness of Three Types of Interventions in Patients with Fibromyalgia in a Region of Southern Catalonia. Pain Manag Nurs 2015; 16:642-52. [PMID: 26104223 DOI: 10.1016/j.pmn.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
Abstract
Several pharmacological and nonpharmacological treatments can be used to alleviate the symptoms of fibromyalgia, although none of them are completely effective at present. In this study, we analyzed the effectiveness of different therapies in three groups of people diagnosed with fibromyalgia. The sample for this randomized controlled trial was made up of 66 people diagnosed with fibromyalgia in southern Catalonia. In turn, this sample was divided into three groups of 22 participants each, who were treated with: i) cervical infiltration with botulinum toxin, ii) group problem-solving therapy, or iii) both therapies. The variables recorded were quality of life, suicidal thoughts, perception of pain, quality of sleep, and satisfaction. Female patients composed 96.9% (n = 64) of the study sample. Satisfaction with the infiltration was 5.1 ± 2.7 points, while in group problem-solving therapy it was 6.6 ± 3.2. Self-perceived health in the infiltration group (p = .016) and the therapy group (p = .001) improved after the intervention took place. The risk of suicide decreased in the both treatments/groups (p = .049). Pain was reduced by 31.8% with infiltration, 13.6% with therapy, and 22.7% with both treatments. Anxiety/depression decreased by 45% with therapy, 36.3% with infiltration, and 36.3% with both treatments. The results also showed that the use of both treatments significantly reduces suicidal thoughts (p = .049). In conclusion, this study showed the complexity of reducing chronic pain and increasing the quality of life of people with fibromyalgia.
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Affiliation(s)
- Pilar Montesó-Curto
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain.
| | | | | | - Sandra Ferré-Almo
- Department of Anesthesiology, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | | | - Sara Romaguera Genís
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | - Maria Luisa Mateu Gil
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | | | - Lidia Sarrió Colás
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | - Teresa Salvadó Usach
- Pathology Department, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, Spain
| | | | - Carme Ferré-Grau
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
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Peñacoba Puente C, Velasco Furlong L, Écija Gallardo C, Cigarán Méndez M, Bedmar Cruz D, Fernández-de-las-Peñas C. Self-Efficacy and Affect as Mediators Between Pain Dimensions and Emotional Symptoms and Functional Limitation in Women With Fibromyalgia. Pain Manag Nurs 2015; 16:60-8. [DOI: 10.1016/j.pmn.2014.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/12/2014] [Accepted: 04/13/2014] [Indexed: 11/27/2022]
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24
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Geriatric frailty applied to fibromyalgia patients. Rheumatol Int 2015; 35:193-4. [DOI: 10.1007/s00296-014-3048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
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25
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Pain mystery score beliefs: a comparison of fibromyalgia and rheumatoid arthritis. Int J Rheumatol 2014; 2014:593507. [PMID: 25548570 PMCID: PMC4274713 DOI: 10.1155/2014/593507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/25/2014] [Indexed: 01/14/2023] Open
Abstract
Objectives. To compare the mysteriousness scores of the Pain Beliefs and Perceptions Inventory in fibromyalgia. Methods. Two cohorts of patients, one with fibromyalgia (FM) and one with rheumatoid arthritis (RA), completed the Mystery Scale component of the Pain Beliefs and Perceptions Inventory to determine whether subjects in the two diagnostic groups had significantly different scores on the Mystery Scale. Results. A total of 126 subjects (64 FM, 62 RA) completed all questionnaires. The FM group had a greater percentage of female subjects, more severe pain, more severe anxiety, more severe depression, and a higher perceived injustice score. When the RA and FM group scores for the Mystery Scale were adjusted for age, sex, pain severity, HADS scores, and perceived injustice scores, the FM group still had a higher Mystery Scale score. Discussion. Fibromyalgia is associated with a higher level of perception of mysteriousness in the Pain Beliefs and Perceptions Inventory than is seen with rheumatoid arthritis. This difference appears to be independent of levels of pain, depression, anxiety, and perceived injustice. This sense of mysteriousness may reflect a lack of understanding of pain in fibromyalgia as previously reported and may be an area to be addressed in therapy.
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26
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Boehm K, Raak C, Cramer H, Lauche R, Ostermann T. Homeopathy in the treatment of fibromyalgia—A comprehensive literature-review and meta-analysis. Complement Ther Med 2014; 22:731-42. [DOI: 10.1016/j.ctim.2014.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/14/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022] Open
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27
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Crossland V, Field R, Ainsworth P, Edwards CJ, Cherry L. Is there evidence to support multidisciplinary healthcare working in rheumatology? A systematic review of the literature. Musculoskeletal Care 2014; 13:51-66. [PMID: 25052547 DOI: 10.1002/msc.1081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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McCuish WJ, Bearne LM. Do inpatient multidisciplinary rehabilitation programmes improve health status in people with long-term musculoskeletal conditions? A service evaluation. Musculoskeletal Care 2014; 12:244-50. [PMID: 24840767 DOI: 10.1002/msc.1072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-term musculoskeletal (MSK) conditions impair health and function. Guidelines recommend a multidisciplinary team (MDT) approach for the optimum management of people with long-term MSK conditions, but there is limited evidence for MDT care. This service evaluation investigates the short-term effectiveness of an inpatient MDT rehabilitation programme on self-reported function and disease status in people with long-term MSK conditions. METHODS A convenience sample of adults with rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP) and chronic widespread pain (CWP) participated in an inpatient MDT rehabilitation programme, consisting of needs assessment, collaborative goal setting and planning, exercise and self-management. The Routine Assessment of Patient Index Data (RAPID3) (primary outcome), the Multi-Dimensional Health Assessment Questionnaire (MDHAQ), Pain Visual Analogue Scale (VAS) and global well-being VAS were assessed at baseline and immediately following MDT rehabilitation. RESULTS A total of 183 people [mean age 62 (standard deviation, 14.5) years, 145 females] with RA, OA, LBP or CWP were evaluated before and after inpatient MDT rehabilitation (median duration, ten days). Overall, there was a 28% improvement in RAPID3 (mean difference [95% confidence intervals] in effect size, 5.0 [4.3, 5.8], d=-0.98, p<0.05). Clinically relevant changes were found in people with RA (5.7 [4.4, 6.9], d=-1.08, p<0.05, 32%), OA 6.1 [3.4, 8.7], d=-1.07, p<0.05, 35%), LBP 4.0 [2.8, 5.2], d=-0.91, p<0.05, 22%), CWP 4.6 [2.7, 6.6], d=-0.84, p<0.05, 25%). These changes were reflected in all secondary outcomes. CONCLUSION This inpatient MDT rehabilitation programme provides short-term evidence of improved function and disease status in people with long term MSK conditions.
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29
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Medium-/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:474029. [PMID: 24616894 PMCID: PMC3925511 DOI: 10.1155/2014/474029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 12/01/2013] [Indexed: 11/18/2022]
Abstract
Objective. To propose a rehabilitation protocol able to produce immediate and long-term beneficial effects on level of disability and overall performance in ADLs. Materials and Methods. Forty-one FM patients were randomized to an exercise and educational-behavioral programme group (experimental group, EG = 21) or to a control group (CG = 20). Each subject was evaluated before, at the end (T1), and after 6 months (T6) from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ), the visual analogue scale (VAS), the Health Assessment Questionnaire (HAQ), the fatigue severity scale (FSS), the 6-minute walking test (6MWT), tender points count (TPC), and spinal active range of motion. The exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine flexibility, and aerobic exercises, which patients were subsequently educated to perform at home. Results. The two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and significant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04). The positive results were maintained at the follow-up. Conclusion. The proposed programme was well tolerated and produced immediate and medium-term beneficial effects improving function and strain endurance. This trial is registered with DRKS00005071 on DRKS.
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30
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Friedberg F, Williams DA, Collinge W. Lifestyle-oriented non-pharmacological treatments for fibromyalgia: a clinical overview and applications with home-based technologies. J Pain Res 2012; 5:425-35. [PMID: 23166446 PMCID: PMC3500923 DOI: 10.2147/jpr.s35199] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Fibromyalgia (FM) is a persistent and disabling widespread pain condition often accompanied by chronic fatigue, cognitive problems, sleep disturbance, depression, anxiety, and headache. To date, the most thoroughly studied non-pharmacological approaches to managing FM are those with a focus on changing patient activities and beliefs that affect the illness. These interventions are intended to facilitate enduring improvement in pain and functional status. Lifestyle-oriented treatments include patient education, aerobic or other physical exercise, and cognitive-behavioral therapy (CBT). These interventions in FM can be delivered in medical or behavioral health care settings by trained professionals, through patient-oriented treatment manuals, or via remote-access technologies. Non-pharmacological treatments, in particular exercise and CBT, have yielded effect sizes and cost–benefit ratios comparable to medications. This paper describes lifestyle-oriented non-pharmacological treatments for FM and highlights selected literature reviews of these interventions. In addition, behavioral and practical issues are addressed that may affect these non-pharmacological treatments, including patient expectations, participant burden, and treatment availability. Recommendations are made to facilitate these interventions and potentially improve outcomes. In particular, the increasing availability of convenient home-based mobile technologies to deliver these non-pharmacological treatments is described.
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Affiliation(s)
- Fred Friedberg
- Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York
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31
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Debar LL, Kindler L, Keefe FJ, Green CA, Smith DH, Deyo RA, Ames K, Feldstein A. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med 2012; 2:523-530. [PMID: 23440672 DOI: 10.1007/s13142-012-0163-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain.
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Affiliation(s)
- Lynn L Debar
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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32
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Lynch M, Sawynok J, Hiew C, Marcon D. A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther 2012; 14:R178. [PMID: 22863206 PMCID: PMC3580572 DOI: 10.1186/ar3931] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/03/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction Fibromyalgia is difficult to treat and requires the use of multiple approaches. This study is a randomized controlled trial of qigong compared with a wait-list control group in fibromyalgia. Methods One hundred participants were randomly assigned to immediate or delayed practice groups, with the delayed group receiving training at the end of the control period. Qigong training (level 1 Chaoyi Fanhuan Qigong, CFQ), given over three half-days, was followed by weekly review/practice sessions for eight weeks; participants were also asked to practice at home for 45 to 60 minutes per day for this interval. Outcomes were pain, impact, sleep, physical function and mental function, and these were recorded at baseline, eight weeks, four months and six months. Immediate and delayed practice groups were analyzed individually compared to the control group, and as a combination group. Results In both the immediate and delayed treatment groups, CFQ demonstrated significant improvements in pain, impact, sleep, physical function and mental function when compared to the wait-list/usual care control group at eight weeks, with benefits extending beyond this time. Analysis of combined data indicated significant changes for all measures at all times for six months, with only one exception. Post-hoc analysis based on self-reported practice times indicated greater benefit with the per protocol group compared to minimal practice. Conclusions This study demonstrates that CFQ, a particular form of qigong, provides long-term benefits in several core domains in fibromyalgia. CFQ may be a useful adjuvant self-care treatment for fibromyalgia. Trial registration clinicaltrials.gov NCT00938834.
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Ferrari R. Quantitative assessment of the “inexplicability” of fibromyalgia patients: a pilot study of the fibromyalgia narrative of “medically unexplained” pain. Clin Rheumatol 2012; 31:1455-61. [DOI: 10.1007/s10067-012-2029-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/24/2012] [Accepted: 07/02/2012] [Indexed: 11/30/2022]
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Hansson E, Svensson H, Brorson H. Review of Dercum's disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis 2012; 7:23. [PMID: 22546240 PMCID: PMC3444313 DOI: 10.1186/1750-1172-7-23] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/06/2012] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED DEFINITION AND CLINICAL PICTURE: We propose the minimal definition of Dercum's disease to be generalised overweight or obesity in combination with painful adipose tissue. The associated symptoms in Dercum's disease include fatty deposits, easy bruisability, sleep disturbances, impaired memory, depression, difficulty concentrating, anxiety, rapid heartbeat, shortness of breath, diabetes, bloating, constipation, fatigue, weakness and joint aches. CLASSIFICATION We suggest that Dercum's disease is classified into: I. Generalised diffuse form A form with diffusely widespread painful adipose tissue without clear lipomas, II. Generalised nodular form - a form with general pain in adipose tissue and intense pain in and around multiple lipomas, and III. Localised nodular form - a form with pain in and around multiple lipomas IV. Juxtaarticular form - a form with solitary deposits of excess fat for example at the medial aspect of the knee. EPIDEMIOLOGY Dercum's disease most commonly appears between the ages of 35 and 50 years and is five to thirty times more common in women than in men. The prevalence of Dercum's disease has not yet been exactly established. AETIOLOGY Proposed, but unconfirmed aetiologies include: nervous system dysfunction, mechanical pressure on nerves, adipose tissue dysfunction and trauma. DIAGNOSIS AND DIAGNOSTIC METHODS: Diagnosis is based on clinical criteria and should be made by systematic physical examination and thorough exclusion of differential diagnoses. Advisably, the diagnosis should be made by a physician with a broad experience of patients with painful conditions and knowledge of family medicine, internal medicine or pain management. The diagnosis should only be made when the differential diagnoses have been excluded. DIFFERENTIAL DIAGNOSIS Differential diagnoses include: fibromyalgia, lipoedema, panniculitis, endocrine disorders, primary psychiatric disorders, multiple symmetric lipomatosis, familial multiple lipomatosis, and adipose tissue tumours. GENETIC COUNSELLING: The majority of the cases of Dercum's disease occur sporadically. A to G mutation at position A8344 of mitochondrial DNA cannot be detected in patients with Dercum's disease. HLA (human leukocyte antigen) typing has not revealed any correlation between typical antigens and the presence of the condition. MANAGEMENT AND TREATMENT: The following treatments have lead to some pain reduction in patients with Dercum's disease: Liposuction, analgesics, lidocaine, methotrexate and infliximab, interferon α-2b, corticosteroids, calcium-channel modulators and rapid cycling hypobaric pressure. As none of the treatments have led to long lasting complete pain reduction and revolutionary results, we propose that Dercum's disease should be treated in multidisciplinary teams specialised in chronic pain. PROGNOSIS The pain in Dercum's disease seems to be relatively constant over time.
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Affiliation(s)
- Emma Hansson
- Department of Clinical Sciences in Malmö, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Plastic and Reconstructive Surgery, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Henry Svensson
- Department of Clinical Sciences in Malmö, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Håkan Brorson
- Department of Clinical Sciences in Malmö, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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Cordero MD, Cano-García FJ, Alcocer-Gómez E, De Miguel M, Sánchez-Alcázar JA. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q₁₀ effect on clinical improvement. PLoS One 2012; 7:e35677. [PMID: 22532869 PMCID: PMC3330812 DOI: 10.1371/journal.pone.0035677] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 03/21/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome with unknown etiology and a wide spectrum of symptoms such as allodynia, debilitating fatigue, joint stiffness and migraine. Recent studies have shown some evidences demonstrating that oxidative stress is associated to clinical symptoms in FM of fibromyalgia. We examined oxidative stress and bioenergetic status in blood mononuclear cells (BMCs) and its association to headache symptoms in FM patients. The effects of oral coenzyme Q(10) (CoQ(10)) supplementation on biochemical markers and clinical improvement were also evaluated. METHODS We studied 20 FM patients and 15 healthy controls. Clinical parameters were evaluated using the Fibromyalgia Impact Questionnaire (FIQ), visual analogues scales (VAS), and the Headache Impact Test (HIT-6). Oxidative stress was determined by measuring CoQ(10), catalase and lipid peroxidation (LPO) levels in BMCs. Bioenergetic status was assessed by measuring ATP levels in BMCs. RESULTS We found decreased CoQ(10), catalase and ATP levels in BMCs from FM patients as compared to normal control (P < 0.05 and P < 0.001, respectively) We also found increased level of LPO in BMCs from FM patients as compared to normal control (P < 0.001). Significant negative correlations between CoQ(10) or catalase levels in BMCs and headache parameters were observed (r = -0.59, P < 0.05; r = -0.68, P < 0.05, respectively). Furthermore, LPO levels showed a significant positive correlation with HIT-6 (r = 0.33, P<0.05). Oral CoQ(10) supplementation restored biochemical parameters and induced a significant improvement in clinical and headache symptoms (P < 0.001). DISCUSSION The results of this study suggest a role for mitochondrial dysfunction and oxidative stress in the headache symptoms associated with FM. CoQ10 supplementation should be examined in a larger placebo controlled trial as a possible treatment in FM.
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Affiliation(s)
- Mario D Cordero
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-Junta de Andalucía and Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Sevilla, Spain.
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