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Taub R, Agmon-Levin N, Frumer L, Samuel-Magal I, Glick I, Horesh D. Mindfulness-based stress reduction (MBSR) for fibromyalgia patients: The role of pain cognitions as mechanisms of change. Complement Ther Clin Pract 2024; 56:101860. [PMID: 38692113 DOI: 10.1016/j.ctcp.2024.101860] [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: 12/20/2023] [Revised: 03/24/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a pain condition characterized by physical and psychological difficulties. This randomized controlled trial aimed to evaluate the effects of a mindfulness-based stress reduction (MBSR) on FM patients and identify the role of two pain cognitions: psychological inflexibility in pain (PIPS) and pain catastrophizing (PCS), as mechanisms of change. METHODS 95 FM patients (Mean ± SD: 49.18 ± 13.26 years) were randomly assigned to MBSR group therapy (n = 49) or a waitlist (WL) control group (n = 46). An adapted MBSR protocol for FM was employed. A series of measures were taken, covering FM symptoms, depression, perceived stress (PSS), PIPS and PCS. Three measurements were conducted: pre-intervention, post-intervention and 6-months follow up. RESULTS Compared to WL controls, the MBSR group showed greater improvements in FM symptoms (F(1,78) = 2.81, p < 0.05), PSS (F(1,78) = 4.38, p < 0.05) and Depression (F(1,78) = 21.12, p < 0.001), with mostly medium effect sizes. Improvements in PSS (F(2,68) = 7.75, p < 0.05) and depression (F(2,68) = 15.68, p < 0.05) remained stable over six months. The effect of MBSR on FM and PSS was mediated by one's reported change in PIPS. The effect of MBSR on depression was mediated by one's reported change in PCS. CONCLUSIONS These results reveal the significant therapeutic potential of MBSR for FM patients, due to the emphasis on non-judging and acceptance of negative inner states. Furthermore, this research identified two important pain-related cognitions as mechanisms of change, suggesting that MBSR contributes to cognitive change, which enables the reduction of physical and psychological distress. TRIAL REGISTRATION NUMBER NCT04304664.
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Affiliation(s)
- Renen Taub
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel.
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy, Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel.
| | - Lee Frumer
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel.
| | - Inbal Samuel-Magal
- Technion Israel Institute of Technology, Students Counseling Center, Haifa, 3200003, Israel.
| | - Ittai Glick
- Shachaf Clinic for Stress Reduction, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel.
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel; Department of Psychiatry, New York University School of Medicine, 1 Park Ave., New York, NY, 10016, USA.
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Avichal Ughreja R, Venkatesan P, Balebail Gopalakrishna D, Preet Singh Y, Vani Lakshmi R. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: A randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2024:S2095-4964(24)00339-X. [PMID: 38955652 DOI: 10.1016/j.joim.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS); however, high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population. OBJECTIVE Craniosacral therapy (CST), Bowen therapy and exercises have been found to influence the autonomic nervous system, which plays a crucial role in sleep physiology. Given the paucity of evidence concerning these effects in individuals with FMS, our study tests the effectiveness of CST, Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION A placebo-controlled randomized trial was conducted on 132 FMS participants with poor sleep at a hospital in Bangalore. The participants were randomly allocated to one of the four study groups, including CST, Bowen therapy, standard exercise program, and a manual placebo control group that received static touch. CST, Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks; the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks. After 12 weeks, all study participants performed the standard exercises at home for another 12 weeks. MAIN OUTCOME MEASURES Sleep quality, pressure pain threshold (PPT), quality of life and fibromyalgia impact, physical function, fatigue, pain catastrophizing, kinesiophobia, and positive-negative affect were recorded at baseline, and at weeks 12 and 24 of the intervention. RESULTS At the end of 12 weeks, the sleep quality improved significantly in the CST group (P = 0.037) and Bowen therapy group (P = 0.023), and the PPT improved significantly in the Bowen therapy group (P = 0.002) and the standard exercise group (P < 0.001), compared to the static touch group. These improvements were maintained at 24 weeks. No between-group differences were observed for other secondary outcomes. CONCLUSION CST and Bowen therapy improved sleep quality, and Bowen therapy and standard exercises improved pain threshold in the short term. These improvements were retained within the groups in the long term by adding exercises. CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS. TRIAL REGISTRATION NUMBER Registered at Clinical Trials Registry of India with the number of CTRI/2020/04/024551. Please cite this article as: Ughreja RA, Venkatesan P, Gopalakrishna DB, Singh YP, Lakshmi VR. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: a randomized controlled trial. J Integr Med. 2024; Epub ahead of print.
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Affiliation(s)
- Reepa Avichal Ughreja
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Prem Venkatesan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | | | - Yogesh Preet Singh
- Department of Clinical Immunology and Rheumatology, All India Institute of Medical Sciences, Bilaspur 174001, Himachal Pradesh, India
| | - R Vani Lakshmi
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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Gilron I, DeBow C, Elkerdawy H, Khan JS, Salomons TV, Duggan S, Tu D, Holden RR, Milev R, Buckley DN, Moulin DE. PRECISE trial (Pain RElief Combination Intervention StratEgies): protocol for the clinical trial of a pregabalin-melatonin combination for fibromyalgia. BMJ Open 2024; 14:e087180. [PMID: 38910006 DOI: 10.1136/bmjopen-2024-087180] [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: 06/25/2024] Open
Abstract
INTRODUCTION Fibromyalgia is associated with chronic widespread pain and disturbed sleep. Multidisciplinary, multimodal management often includes pharmacotherapy; however, current drugs used to treat fibromyalgia provide meaningful benefit to only 30-60% of treated individuals. Combining two or more different drugs is common in clinical practice with the expectation of better efficacy, tolerability or both; however, further research is needed to identify which combinations actually provide added benefit. Thus, we are planning a clinical trial to evaluate melatonin (MLT)-pregabalin (PGB) combination in participants with fibromyalgia. METHODS AND ANALYSIS This will be a single-centre, double-blind, randomised, double-dummy, three-period, crossover trial comparing a MLT-PGB combination to each monotherapy in 54 adult participants satisfying the 2016 American College of Rheumatology criteria for fibromyalgia. Participants will receive maximally tolerated doses of MLT, PGB and MLT-PGB combination for 6 weeks. The primary outcome will be daily pain intensity (0-10); secondary outcomes will include the Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events and other measures. Analysis of the primary and secondary outcomes will involve a linear mixed model with sequence, period, treatment, the first-order carryover and baseline pain score as fixed effects and participant as a random effect to test whether there are any treatment differences among three treatments and to estimate the least square mean of the mean daily pain intensity for each treatment, adjusting for carryover as well as period effects (ie, stability of pain levels). ETHICS AND DISSEMINATION This trial has been registered with the International Standard Randomised Controlled Trial Number Registry, ISRCTN #18278231, has been granted ethical approval by the Queen's University Health Sciences Research Ethics Board (Queen's HSREB Protocol #6040998) and is currently under review for a Clinical Trial Application to Health Canada Natural and Non-prescription Health Products Directorate. All participants will provide written informed consent prior to trial participation. Following trial completion, results will be disseminated in one or more biomedical journal publications and presented at one or more scientific meetings. TRIAL REGISTRATION NUMBER This trial has been registered with the International Standard Randomised Controlled Trial Number Registry, ISRCTN18278231.
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Affiliation(s)
- Ian Gilron
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Providence Care Hospital, Kingston, Ontario, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Chris DeBow
- Arcus Analytica, Halifax, Nova Scotia, Canada
| | - Hala Elkerdawy
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - James S Khan
- ANESTHESIOLOGY and Pain Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tim V Salomons
- Psychology, Queen's University, Kingston, Ontario, Canada
| | - Scott Duggan
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dongsheng Tu
- Canadian Cancer Trials Group, Queens University at Kingston, Kingston, Ontario, Canada
| | - Ronald R Holden
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, Ontario, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, Ontario, Canada
| | | | - Dwight E Moulin
- Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada
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Vancampfort D, Van Damme T, Albanio Machado V, McGrath RL, Stubbs B, Schuch FB. Levels of sedentary behaviour in people with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1921-1927. [PMID: 37211677 DOI: 10.1080/09638288.2023.2214379] [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: 01/23/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this knowledge, little attention has been attributed to estimate sedentary behaviour in this population. The aims of this meta-analysis were to: (a) establish the pooled mean time spent sedentary, (b) investigate moderators of sedentary levels, and (c) explore differences with age- and gender-matched general population controls in people with fibromyalgia (PwF). METHODS Two independent authors searched major databases until 1 December 2022. A random effects meta-analysis was performed. The methodological quality of included studies was assessed with the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS Across 7 cross-sectional studies of fair methodological quality, there were 1500 patients with fibromyalgia (age range = 43-53 years). PwF spent 545.6 min/day (95% CI = 523.7-567.5, p < 0.001, N = 3) engaging in sedentary behaviour. Self-reported questionnaires overestimate sedentary levels with 314.3 min/day (95% CI = 302.0-326.6, p = 0.001, N = 2). PwF spent 36.14 min/day (95% CI = 16.3-55.9, p < 0.001) more in sedentary behaviour than general population controls. CONCLUSIONS PwF are more sedentary than the general population. The limited available data should however be considered with caution due to substantial heterogeneity.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg - Leuven, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg - Leuven, Belgium
| | - Vanessa Albanio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Ryan L McGrath
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King"s College London, London, UK
| | - Felipe B 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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Borst M, Moeyaert M, van Rood Y. The effect of eye movement desensitization and reprocessing on fibromyalgia: A multiple-baseline experimental case study across ten participants. Neuropsychol Rehabil 2024:1-33. [PMID: 38385531 DOI: 10.1080/09602011.2024.2314883] [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: 08/11/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
Fibromyalgia (FM) is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and stiffness in muscles and joints. Traumatic life experiences and post-traumatic stress symptoms play a role in its development and persistence. Although previous research suggests that pain and FM symptoms decrease after eye movement desensitization and reprocessing (EMDR) therapy, its effectiveness has not been investigated in a controlled manner. The present study investigated the effectiveness of a six-session, 90-minute EMDR therapy using a multiple baseline single-case experimental design (SCED) across ten adult females with FM. The SCED involved a baseline, intervention, one- and three-month follow-up phase. The primary outcome was pain. Secondary outcomes included post-traumatic stress symptoms, other FM symptoms (fatigue, stiffness in muscles and joints), and the impact of FM on daily activities and sleep. Data were statistically analyzed by primarily testing means across phases on an individual and group level. Post-traumatic stress symptoms improved significantly in seven participants. Pain severity decreased significantly in six participants, with three of them maintaining significant improvement three months later. One participant showed clinically relevant change one month later. Furthermore, improvements were observed in secondary outcome measures. The findings support the efficacy of EMDR in reducing FM symptoms.
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Affiliation(s)
- Michiel Borst
- Social and Specialist Division, GGZ Noord-Holland-Noord, Heiloo, Netherlands
| | - Mariola Moeyaert
- Department of Educational Psychology and Methodology, University at Albany - State University of New York, New York, USA
| | - Yanda van Rood
- Department of Psychiatry, University Medical Center of Leiden, Leiden, Netherlands
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Ecija C, Gutierrez L, Catala P, Peñacoba C. Preference for Hedonic Goals in Fibromyalgia; Is It Always an Avoidance Mechanism? Looking the Relationship with Pain Acceptance from a Positive Psychology Perspective. Pain Manag Nurs 2024; 25:80-87. [PMID: 38129209 DOI: 10.1016/j.pmn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
The aim of this study was to analyze the effect of openness to experience on pain acceptance through positive affect (PA) considering the moderating role of preference for mood management goals in women with fibromyalgia (FM). A cross-sectional study (n = 231) was carried out. A simple mediation model and a moderate mediation model were conducted by SPSS macro-PROCESS. Results showed that PA mediated positively the effect of openness to experience on acceptance (B = 0.46, SE = 0.80, t = 5,59; 95% CI = [0.3016, 0.6298], p < .001) and that the contribution of openness to experience to PA varied at different values of mood management goals (medium: - .04; ß = .40, p < .001; high: .95; ß = .61, p<.001). Findings may serve as a foundation for tailored interventions to promote activity through acceptance focusing on PA and mood management goals among women with medium to high level of hedonic goals.
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Affiliation(s)
- Carmen Ecija
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lorena Gutierrez
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Cecilia Peñacoba
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
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Turcotte K, Oelke ND, Whitaker G, Holtzman S, O'Connor B, Pearson N, Teo M. Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial. Rheumatol Int 2023; 43:2201-2210. [PMID: 37566253 PMCID: PMC10587329 DOI: 10.1007/s00296-023-05403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.
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Affiliation(s)
- Kara Turcotte
- Department of Nursing, Western University, London, ON, Canada
| | - Nelly D Oelke
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Gina Whitaker
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Brian O'Connor
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Neil Pearson
- Faculty of Medicine, School of Physical Therapy, University of British Columbia, Kelowna, BC, Canada
| | - Michelle Teo
- Department of Medicine, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
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Vancampfort D, McGrath RL, Hemmings L, Gillis V, Bernar K, Van Damme T. Physical activity correlates in people with fibromyalgia: a systematic review. Disabil Rehabil 2023; 45:4165-4174. [PMID: 36398698 DOI: 10.1080/09638288.2022.2146911] [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: 07/17/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Understanding the enablers of and barriers to physical activity (PA) participation in people with fibromyalgia (PwF) is an essential first step to developing effective PA interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental, and policy level) in PwF. MATERIALS AND METHODS PubMed, Embase, and CINAHL were searched from inception until 12 July 2022. Keywords included "physical activity" or "exercise" and "fibromyalgia" or "fibrositis." Summary coding was used to quantify the PA correlates. RESULTS Out of 74 PA correlates retrieved from 39 articles (n = 9426), co-morbid depression and higher pain intensity were found to be consistent (i.e., reported in four or more articles) barriers to PA in PwF, while higher self-efficacy and better endurance were found to be consistent enablers to PA. Despite the abundance of evidence for the PA benefits for PwF, we only found consistent evidence for PA correlates at the intrapersonal level. CONCLUSIONS Health professionals should consider mental and physical health barriers when promoting PA in PwF. There remains a need to better understand social, environmental, and policy-related factors associated with PA participation in PwFImplications for rehabilitationCo-morbid depression is a notable barrier to physical activity participation in people with fibromyalgia.Experienced pain intensity should be considered as a barrier when promoting physical activity for people with fibromyalgia.Rehabilitation professionals should facilitate self-efficacy in physical activity interventions for people with fibromyalgia.Rehabilitation professionals should promote endurance when motivating people with fibromyalgia towards an active lifestyle.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg-Leuven, Belgium
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Laura Hemmings
- University of Birmingham, School of Sport and Exercise Sciences, Birmingham, UK
| | | | - Koen Bernar
- University Hospital Pellenberg, Pellenberg, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg-Leuven, Belgium
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Öznur Ö, Schlee C, Utz S, Langhorst J. Investigating the Influential Factors of Mild Water-Filtered Infrared-A Whole-Body Hyperthermia for Pain Relief in Fibromyalgia: A Mixed-Methods Approach Focusing on Predictors and Patient Perspectives. Biomedicines 2023; 11:2949. [PMID: 38001951 PMCID: PMC10669402 DOI: 10.3390/biomedicines11112949] [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: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic condition characterized by chronic widespread pain, persistent fatigue, and disrupted sleep, significantly impacting well-being. Mild water-filtered infrared-A (wIRA) whole-body hyperthermia (WBH) is emerging as a promising pain management approach to FMS. Within the present randomized controlled trial (ClinicalTrials ID: NCT05135936), FMS patients underwent six sessions of mild wIRA-WBH over 3 weeks. Their pain levels were assessed at baseline and at week 12, while body core temperature and plateau phase duration were monitored during WBH. Qualitative interviews were conducted at week 12. Results from this mixed-methods study revealed that baseline pain intensity and plateau phase duration significantly predicted pain intensity at week 12. Thematic analysis of the interviews revealed diverse patient experiences with the treatment, with all patients reporting improvements in perceived pain and overall well-being. The onset and duration of pain relief varied among individuals. Overall, the findings suggest that the duration of the plateau phase may serve as an indicator for long-term pain reduction, although individual factors may influence treatment outcomes. Despite varying experiences, a prevailing trend of positive patient evaluations emerged. This study sheds light on the potential of wIRA-WBH as a therapeutic option for alleviating pain for and enhancing the well-being of FMS patients.
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Affiliation(s)
- Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Christoph Schlee
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Sociology, University of Bamberg, 96052 Bamberg, Germany
| | - Sandra Utz
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
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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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Courel-Ibáñez J, Estévez-López F, Hughes C, Adams N, Fullen BM, Davison G, Montgomery A, Cramp F, Maestre C, Martin D, McVeigh JG. Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia. BMJ Open 2023; 13:e070609. [PMID: 37451740 PMCID: PMC10351288 DOI: 10.1136/bmjopen-2022-070609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM). SETTINGS Open-label, feasibility clinical trial. PARTICIPANTS Eleven people with FM (10 women). INTERVENTIONS The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention. RESULTS One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation. CONCLUSIONS This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support. TRIAL REGISTRATION NUMBER NCT03764397.
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Affiliation(s)
- Javier Courel-Ibáñez
- Department of Physical Education and Sports, Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Department of Education, Faculty of Education Sciences, SPORT Research Group (CTS-1024) and CERNEP Research Center, University of Almería, Almería, Spain
| | - Ciara Hughes
- School of Health Sciences, Ulster University, Belfast, UK
| | - Nicola Adams
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gareth Davison
- Sport and Exercise Sciences Research Institute, Ulster University, Belfast, UK
| | | | - Fiona Cramp
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Cristina Maestre
- Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Denis Martin
- School of Health and Life Sciences, Teesside University & NIHR Applied Research Collaboration for the North East and North Cumbria, Middlesbrough, UK
| | - Joseph G McVeigh
- Discipline of Physiotherapy, College of Medicine and Health, University College Cork, Cork, Ireland
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12
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Langhorst J, Koch AK, Kehm C, Öznur Ö, Engler H, Häuser W. Mild Water-Filtered Infrared-A Whole-Body Hyperthermia Reduces Pain in Patients with Fibromyalgia Syndrome-A Randomized Sham-Controlled Trial. J Clin Med 2023; 12:jcm12082945. [PMID: 37109279 PMCID: PMC10144038 DOI: 10.3390/jcm12082945] [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: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The challenging treatment situation of patients with fibromyalgia syndrome (FMS) requires additional therapy options. The effects of water-filtered infrared-A whole-body hyperthermia (WBH) versus sham hyperthermia on pain intensity were investigated in an outpatient setting within a two-armed randomized sham-controlled trial. n = 41 participants aged between 18 and 70 years with a medically confirmed diagnosis of FMS were randomized to WBH (intervention; n = 21) or sham hyperthermia (control; n = 20). Six treatments with mild water-filtered infrared-A WBH over a period of three weeks with at least one day in between treatments were applied. On average, the maximum temperature was 38.7 °C for a duration of approximately 15 min. The control group received exactly the same treatment except that an insulating foil between the patient and the hyperthermia device blocked most of the radiation. Primary outcome was pain intensity measured by the Brief Pain Inventory at week 4. Secondary outcomes included blood cytokine levels and FMS-related core symptoms and quality of life. Pain intensity at week 4 was significantly different between the groups in favor of WBH (p = 0.015). A statistically significant pain reduction in favor of WBH was also found at week 30 (p = 0.002). Mild water-filtered infrared-A WBH effectively reduced pain intensity at the end of treatment and follow-up.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Anna K Koch
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Christina Kehm
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational and Behavioral Neurosciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, 81675 Munich, Germany
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13
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Vancampfort D, Brunner E, McGrath RL, Hemmings L, Van Damme T. Correlates of sedentary behavior in people with fibromyalgia: A systematic review. Int J Rheum Dis 2023; 26:841-849. [PMID: 36972974 DOI: 10.1111/1756-185x.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Understanding the correlates of sedentary behavior (SB) is important in the development of interventions which reduce and interrupt SB in people with fibromyalgia (PwF). This systematic review aimed to investigate the correlates of SB in PwF using the socio-ecological model. METHODS Three databases (Embase, CINAHL and PubMed) were search from inception until July 21, 2022 using "sedentary" or different types of SB and "fibromyalgia" or "fibrositis" as keywords. The data collected was then analyzed using summary coding. RESULTS Out of 23 SB correlates retrieved from 7 reports (n = 1698), no correlates were consistently reported (ie, reported in 4 or more studies). Higher pain intensity was the most commonly reported barrier for reducing/interrupting SB (reported in 3 reports). Other reported barriers to reducing/interrupting SB were experiencing physical and mental fatigue, a more severe disease impact, and a lack of motivation to be physically active (all reported in 1 study). A better experienced social and physical functioning and more vitality were facilitators for reducing/interrupting SB (all reported in 1 study). To date, in PwF no correlates of SB at the interpersonal, environmental and policy levels have been explored. CONCLUSION Research on correlates of SB in PwF is still in its infancy. The current preliminary evidence suggests that clinicians should consider physical and mental barriers when aiming to reduce or interrupt SB in PwF. Further research on modifiable correlates at all levels of the socio-ecological model is required to inform future trials aiming to modify SB in this vulnerable population.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Emanuel Brunner
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Gesundheit, Ostschweizer Fachhochschule, St. Gallen, Switzerland
- Institut für Therapie und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Laura Hemmings
- University of Birmingham, School of Sport and Exercise Sciences, Birmingham, UK
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
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14
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Combination analgesic development for enhanced clinical efficacy (the CADENCE trial): a double-blind, controlled trial of an alpha-lipoic acid-pregabalin combination for fibromyalgia pain. Pain 2023:00006396-990000000-00256. [PMID: 36877492 DOI: 10.1097/j.pain.0000000000002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 03/07/2023]
Abstract
ABSTRACT Drug therapy for fibromyalgia is limited by incomplete efficacy and dose-limiting adverse effects (AEs). Combining agents with complementary analgesic mechanisms-and differing AE profiles-could provide added benefits. We assessed an alpha-lipoic acid (ALA)-pregabalin combination with a randomized, double-blind, 3-period crossover design. Participants received maximally tolerated doses of ALA, pregabalin, and ALA-pregabalin combination for 6 weeks. The primary outcome was daily pain (0-10); secondary outcomes included Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. The primary outcome of daily pain (0-10) during ALA (4.9), pregabalin (4.6), and combination (4.5) was not significantly different (P = 0.54). There were no significant differences between combination and each monotherapy for any secondary outcomes, although combination and pregabalin were both superior to ALA for measures of mood and sleep. Alpha-lipoic acid and pregabalin maximal tolerated doses were similar during combination and monotherapy, and AEs were not frequent with combination therapy. These results do not support any additive benefit of combining ALA with pregabalin for fibromyalgia. The observation of similarly reached maximal tolerated drug doses of these 2 agents (which have differing side-effect profiles) during combination and monotherapy-without increased side effects-provides support for future development of potentially more beneficial combinations with complementary mechanisms and nonoverlapping side effects.
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15
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Barceló-Soler A, Morillo-Sarto H, Fernández-Martínez S, Monreal-Bartolomé A, Chambel MJ, Gardiner P, López-del-Hoyo Y, García-Campayo J, Pérez-Aranda A. A Systematic Review of the Adherence to Home-Practice Meditation Exercises in Patients with Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4438. [PMID: 36901448 PMCID: PMC10001876 DOI: 10.3390/ijerph20054438] [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: 01/20/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Mindfulness-, compassion-, and acceptance-based (i.e., "third wave") psychotherapies are effective for treating chronic pain conditions. Many of these programs require that patients engage in the systematic home practice of meditation experiences so they can develop meditation skills. This systematic review aimed at evaluating the frequency, duration, and effects of home practice in patients with chronic pain undergoing a "third wave" psychotherapy. A comprehensive database search for quantitative studies was conducted in PubMed, Embase, and Web of Sciences Core Collection; 31 studies fulfilled the inclusion criteria. The reviewed studies tended to indicate a pattern of moderately frequent practice (around four days/week), with very high variability in terms of time invested; most studies observed significant associations between the amount of practice and positive health outcomes. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy were the most common interventions and presented low levels of adherence to home practice (39.6% of the recommended time). Some studies were conducted on samples of adolescents, who practiced very few minutes, and a few tested eHealth interventions with heterogeneous adherence levels. In conclusion, some adaptations may be required so that patients with chronic pain can engage more easily and, thus, effectively in home meditation practices.
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Affiliation(s)
- Alberto Barceló-Soler
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Navarra Medical Research Institute (IdiSNA), 31008 Pamplona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 50009 Zaragoza, Spain
| | - Héctor Morillo-Sarto
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 50009 Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
| | - Selene Fernández-Martínez
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Department of Psychiatry, University of Zaragoza, 50009 Zaragoza, Spain
| | - Alicia Monreal-Bartolomé
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 50009 Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
| | - Maria José Chambel
- CicPsi, Faculdade de Psicologia, Universidade de Lisboa, 1649-004 Lisbon, Portugal
| | - Paula Gardiner
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA 02141, USA
- Department of Family Medicine, Medical School, University of Massachusetts, Worcester, MA 01655, USA
| | - Yolanda López-del-Hoyo
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 50009 Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
| | - Javier García-Campayo
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 50009 Zaragoza, Spain
- Department of Psychiatry, University of Zaragoza, 50009 Zaragoza, Spain
| | - Adrián Pérez-Aranda
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Department of Basic, Developmental and Educational Psychology, 08193 Cerdanyola del Vallès, Spain
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16
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Saracoglu I, Akin E. Reply to "Comment on effectiveness of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis". Int J Rheum Dis 2023; 26:1005-1006. [PMID: 36737410 DOI: 10.1111/1756-185x.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Ismail Saracoglu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
| | - Esra Akin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
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17
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Serrat M, Ferrés S, Auer W, Almirall M, Lluch E, D’Amico F, Maes M, Lorente S, Navarrete J, Montero-Marín J, Neblett R, Nijs J, Borràs X, Luciano JV, Feliu-Soler A. Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study). Front Physiol 2022; 13:1046613. [DOI: 10.3389/fphys.2022.1046613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes.Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 (clinicaltrials.gov).
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Arfuch VM, Caballol Angelats R, Aguilar Martín C, Gonçalves AQ, Carrasco-Querol N, González Serra G, Sancho Sol MC, Fusté Anguera I, Friberg E, Berenguera A. Patients' Lived Experience in a Multicomponent Intervention for Fibromyalgia Syndrome in Primary Care: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13322. [PMID: 36293900 PMCID: PMC9603341 DOI: 10.3390/ijerph192013322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Fibromyalgia syndrome (FMS) disrupts patients' biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia's primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients' lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients' needs, which will hopefully increase its effectiveness and improve their quality of life.
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Affiliation(s)
- Victoria Mailen Arfuch
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 3 Berzelius väg Street, 6 Floor, 171 77 Stockholm, Sweden
| | - Rosa Caballol Angelats
- Centre d’Atenció Primària (CAP) El Temple, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), Plaça Carrilet sn., 43500 Tortosa, Spain
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L‘Ebre, Institut Català de la Salut (ICS), 44-58 Esplanetes Street, 43500 Tortosa, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Gemma González Serra
- Servei de Rehabilitació i Medicina Física, Hospital de Tortosa Verge de la Cinta, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 44-58 Esplanetes Street, 43500 Tortosa, Spain
| | - Maria Cinta Sancho Sol
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Centre de Salut Mental d’Adults (CSMA) de Fundació Pere Mata Terres de l’Ebre, 50 Rambla de Pompeu Fabra, 43500 Tortosa, Spain
| | - Immaculada Fusté Anguera
- Centre d’Atenció Primària (CAP) El Temple, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), Plaça Carrilet sn., 43500 Tortosa, Spain
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 3 Berzelius väg Street, 6 Floor, 171 77 Stockholm, Sweden
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Central Research Unit, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Department of Nursing, Universitat de Girona, Plaça de Sant Domènec, 3, 17004 Girona, Spain
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19
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Serrat M, Albajes K, Navarrete J, Almirall M, Lluch Girbés E, Neblett R, Luciano JV, Moix J, Feliu-Soler A. Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial. Behav Res Ther 2022; 158:104188. [PMID: 36116229 DOI: 10.1016/j.brat.2022.104188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/28/2022] [Accepted: 09/01/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. METHODS A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. RESULTS Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. CONCLUSIONS This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. TRIAL REGISTRATION NUMBER NCT04571528.
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Affiliation(s)
- Mayte Serrat
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain; Escoles Universitàries Gimbernat, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Klara Albajes
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jaime Navarrete
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.
| | - Miriam Almirall
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | | | | | - Juan V Luciano
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jenny Moix
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
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20
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Samartin-Veiga N, González-Villar AJ, Pidal-Miranda M, Vázquez-Millán A, Carrillo-de-la-Peña MT. Active and sham transcranial direct current stimulation (tDCS) improved quality of life in female patients with fibromyalgia. Qual Life Res 2022; 31:2519-2534. [PMID: 35229253 PMCID: PMC9250466 DOI: 10.1007/s11136-022-03106-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Fibromyalgia (FM) is a chronic pain syndrome with a strong impact on quality of life (QoL). Treatment of this condition remains a challenge, due to the scarce evidence for the effectiveness of the therapeutic approaches available. Current attention is focused on transcranial direct current stimulation (tDCS), which has yielded promising results for pain treatment. Rather than focusing only on pain relief, in this study, we aimed to determine how active or sham tDCS (over three cortical targets -the primary motor cortex, the dorsolateral prefrontal cortex and the operculo-insular cortex-) affect QoL in patients with FM. METHODS Using a double-blind, placebo-controlled design, we applied fifteen tDCS sessions of 20' to initial 130 participants (randomized to any of the four treatment groups). We evaluated the QoL (assessed by SF-36) and the symptoms' impact (assessed by FIQ-R) in baseline, after treatment and at 6 months follow-up. RESULTS All groups were comparable as regards age, medication pattern and severity of symptoms before the treatment. We found that QoL and symptoms' impact improved in all treatment groups (including the sham) and this improvement lasted for up to 6 months. However, we did not observe any group effect nor group*treatment interaction. CONCLUSIONS After the intervention, we observed a non-specific effect that may be due to placebo, favoured by the expectations of tDCS efficacy and psychosocial variables inherent to the intervention (daily relationship with therapists and other patients in the clinic). Therefore, active tDCS is not superior to sham stimulation in improving QoL in FM.
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Affiliation(s)
- N Samartin-Veiga
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Facultade de Psicoloxia, Universidade de Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, A Coruña, Spain.
| | - A J González-Villar
- Psychological Neuroscience Lab, Research Center in Psychology, School of Psychology, University of Minho, Braga, Portugal
| | - M Pidal-Miranda
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Facultade de Psicoloxia, Universidade de Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, A Coruña, Spain
| | - A Vázquez-Millán
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Facultade de Psicoloxia, Universidade de Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, A Coruña, Spain
| | - M T Carrillo-de-la-Peña
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Facultade de Psicoloxia, Universidade de Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, A Coruña, Spain
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21
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Dailey DL, Vance CGT, Chimenti R, Rakel BA, Zimmerman MB, Williams JM, Sluka KA, Crofford LJ. The Influence of Opioids on Transcutaneous Electrical Nerve Stimulation Effects in Women With Fibromyalgia. THE JOURNAL OF PAIN 2022; 23:1268-1281. [PMID: 35292378 DOI: 10.1016/j.jpain.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Transcutaneous electrical nerve stimulation (TENS) uses endogenous opioids to produce analgesia, and effectiveness can be reduced in opioid-tolerant individuals'. We examined TENS effectiveness (primary aim), and differences in fibromyalgia symptoms (secondary aim), in women with fibromyalgia regularly taking opioid (RTO) medications compared with women not- regularly taking opioids (not-RTO). Women (RTO n = 79; not-RTO not-n = 222) with fibromyalgia with daily pain levels ≥4 were enrolled and categorized into RTO (taking opioids at least 5 of 7 days in last 30 days) or not-RTO groups. Participants were categorized into tramadol n = 52 (65.8%) and other opioids n = 27 (34.2%) for the RTO group. Participants were phenotyped across multiple domains including demographics, fibromyalgia characteristics pain, fatigue, sleep, psychosocial factors, and activity. Participants were randomized to active TENS (n = 101), placebo TENS (n = 99), or no TENS (n = 99) for 1-month with randomization stratified by opioid use. Active TENS was equally effective in movement-evoked pain in those in the RTO and not-RTO groups. Women with fibromyalgia in the RTO group were older (P = .002), lower-income (P = .035), more likely to smoke (P = .014), and more likely to report depression (P = .013), hypertension (P = .005) or osteoarthritis (P = .027). The RTO group demonstrated greater bodily pain on SF-36 (P = .005), lower quality of life on the physical health component of the SF-36 (P = .040), and greater fatigue (MAF-ADL P = .047; fatigue with sit to stand test (P = .047) These differences were small of and unclear clinical significance. In summary, regular use of opioid analgesics does not interfere with the effectiveness of TENS for movement-evoked pain. Clinical Trial Registration Number: NCT01888640. PERSPECTIVE: Individuals treated with mixed frequency TENS at a strong but comfortable intensity that was taking prescription opioid analgesics showed a significant reduction in movement-evoked pain and fatigue. These data support the use of TENS, using appropriate parameters of stimulation, as an intervention for individuals with fibromyalgia taking opioid analgesics.
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Affiliation(s)
- Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; Department of Physical Therapy St. Ambrose University, Davenport, Iowa.
| | - Carol G T Vance
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Barbara A Rakel
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | | | - Jon M Williams
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | - Leslie J Crofford
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
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22
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Samartin-Veiga N, Pidal-Miranda M, González-Villar AJ, Bradley C, Garcia-Larrea L, O'Brien AT, Carrillo-de-la-Peña MT. Transcranial direct current stimulation of 3 cortical targets is no more effective than placebo as treatment for fibromyalgia: a double-blind sham-controlled clinical trial. Pain 2022; 163:e850-e861. [PMID: 34561393 DOI: 10.1097/j.pain.0000000000002493] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) and the dorsolateral prefrontal cortex seem to improve pain and other symptoms of fibromyalgia (FM), although the evidence on the effectiveness of tDCS and the optimal stimulation target is not robust enough. Our main objective was to establish the optimal area of stimulation, comparing the 2 classical targets and a novel pain-related area, the operculo-insular cortex, in a sham-controlled trial. Using a double-blind design, we randomly assigned 130 women with FM to 4 treatment groups (M1, dorsolateral prefrontal cortex, operculo-insular cortex, and sham), each receiving fifteen 20-minute sessions of 2 mA anodal tDCS over the left hemisphere. Our primary outcome was pain intensity. The secondary outcomes were the other core symptoms of FM (fatigue, mood, cognitive and sleep disorders, and hyperalgesia measured by the pressure pain threshold). We performed the assessment at 3 time points (before, immediately after treatment, and at 6 months follow-up). The linear mixed-model analysis of variances showed significant treatment effects across time for clinical pain and for fatigue, cognitive and sleep disturbances, and experimental pain, irrespective of the group. In mood, the 3 active tDCS groups showed a significantly larger improvement in anxiety and depression than sham. Our findings provide evidence of a placebo effect, support the use of tDCS for the treatment of affective symptoms, and challenge the effectiveness of tDCS as treatment of FM.
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Affiliation(s)
- Noelia Samartin-Veiga
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Marina Pidal-Miranda
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto J González-Villar
- Department of Basic Psychology, Psychological Neuroscience Lab, Research Center in Psychology, School of Psychology, University of Minho, Braga, Portugal
| | - Claire Bradley
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
- Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
- Queensland Brain Institute, St Lucia, Australia
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
- Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
| | | | - María T Carrillo-de-la-Peña
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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23
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Droppert KM, Knowles SR. The Role of Pain Acceptance, Pain Catastrophizing, and Coping Strategies: A Validation of the Common Sense Model in Females Living with Fibromyalgia. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09873-w. [PMID: 35505201 DOI: 10.1007/s10880-022-09873-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 02/08/2023]
Abstract
This study aimed to examine the extent to which illness beliefs, coping styles, pain acceptance, pain catastrophizing, and psychological distress mediate the relationship between fibromyalgia symptoms and quality of life (QoL) in a female cohort diagnosed with Fibromyalgia (n = 151). Measures used included the Revised Fibromyalgia Impact Questionnaire, Carver Brief COPE scale, Chronic Pain Acceptance Questionnaire Revised, Pain Catastrophizing Scale, Brief Illness Perceptions Questionnaire, Depression and Anxiety Stress Scales, and European Health Interview Survey Quality of Life 8-item Index. Using structural equation modelling, the final model indicated that fibromyalgia symptom severity had a significant direct influence on illness perceptions and psychological distress. In turn, illness perceptions had a significant direct influence on maladaptive coping, pain catastrophizing, pain acceptance, and QoL. Pain catastrophizing and maladaptive coping influenced psychological distress, and in turn distress impacted QoL. Acceptance of pain was found to be influenced by maladaptive coping and in turn acceptance of pain influenced QoL.
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Affiliation(s)
- Kathryn M Droppert
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, PO Box 218, Melbourne, 3122, Australia
| | - Simon Robert Knowles
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, PO Box 218, Melbourne, 3122, Australia. .,Faculty of Medicine, Dentistry, & Health Sciences, The University of Melbourne, Melbourne, Australia. .,Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia.
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24
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Araya-Quintanilla F, Gutiérrez-Espinoza H, Fuentes J, Prieto-Lafrentz F, Pavez L, Cristi-Montero C, Cavero-Redondo I, Álvarez-Bueno C. Effectiveness of multicomponent treatment in patients with fibromyalgia: protocol for a systematic review and meta-analysis. Syst Rev 2022; 11:69. [PMID: 35422009 PMCID: PMC9012030 DOI: 10.1186/s13643-022-01944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of this protocol is to provide a new systematic review with meta-analysis using the current methodology to compare the effectiveness of multicomponent treatment versus other interventions for patients with fibromyalgia. METHODS This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL, LILACS, CINAHL, and PEDro, from inception until April 2022. There will be no language restrictions. The Cochrane Collaboration tool for assessing the risk of bias (RoB2) will be used. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scale will be used to evaluate the strength of the evidence. The Hartung-Knapp-Sidik-Jonkman random effects or Mantel-Haenszel fixed effects methods will be used, depending on the heterogeneity, to compute a pooled estimate of the mean difference (MD) or standardized mean difference (SMD) and respective 95% confidence intervals for clinical outcomes. DISCUSSION This systematic review will synthesize evidence on the effectiveness of multicomponent treatment in patients with fibromyalgia and could add important evidence in the treatment of FM to improve clinical practice and decision-making/actions in this field. This new systematic review will try to show the effects of multicomponent treatment by type (endurance, resistance, stretching, or mind-body exercises [pilates or taichi]) and intensity (light, moderate, moderate-to-vigorous, vigorous) of exercise in patients with FM. The results will be disseminated by publication in a peer-reviewed journal. Ethics approval will not be needed because the data used for this systematic review will be obtained from individual trials and there will be no concerns about privacy. However, if we identify ethical issues during the development of the systematic review, these findings will be reported in the discussion of the study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020142082.
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Affiliation(s)
- Felipe Araya-Quintanilla
- Rehabilitation in Health Research Center (CIRES), Universidad de Las Américas, Manuel Montt Avenue 948, 7510549, Santiago, Chile.
| | - Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Jorge Fuentes
- Department of Physical Therapy, Catholic University of Maule, Talca, Chile.,Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Leonardo Pavez
- Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago, Chile.,Departamento de Ciencias Químicas y Biológicas, Universidad Bernardo O'Higgins, Santiago, Chile
| | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Viña del Mar, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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25
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López-Roig S, Ecija C, Peñacoba C, Ivorra S, Nardi-Rodríguez A, Lecuona O, Pastor-Mira MA. Assessing Walking Programs in Fibromyalgia: A Concordance Study between Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052995. [PMID: 35270687 PMCID: PMC8910142 DOI: 10.3390/ijerph19052995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023]
Abstract
This study analyzes the degree of agreement between three self-report measures (Walking Behavior, WALK questionnaire and logbooks) assessing adherence to walking programs through reporting their components (minutes, rests, times a week, consecutive weeks) and their concordance with a standard self-report of physical activity (IPAQ-S questionnaire) and an objective, namely number of steps (pedometer), in 275 women with fibromyalgia. Regularized partial correlation networks were selected as the analytic framework. Three network models based on two different times of assessment, namely T1 and T2, including 6 weeks between both, were used. WALK and the logbook were connected with Walking Behavior and also with the IPAQ-S. The logbook was associated with the pedometers (Z-score > 1 in absolute value). When the behavior was assessed specifically and in a detailed manner, participants’ results for the different self-report measures were in agreement. Specific self-report methods provide detailed information that is consistent with validated self-report measures (IPAQ-S) and objective measures (pedometers). The self-report measures that assess the behavioral components of physical activity are useful when studying the implementation of walking as physical exercise.
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Affiliation(s)
- Sofía López-Roig
- Department of Behavioral Sciences and Health, University Miguel Hernández, 03540 San Juan de Alicante, Spain; (S.L.-R.); (A.N.-R.); (M.A.P.-M.)
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, 28922 Madrid, Spain; (C.P.); (O.L.)
- Correspondence: ; Tel.: +34-914888943
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, 28922 Madrid, Spain; (C.P.); (O.L.)
| | - Sofía Ivorra
- Official College of Nursing, 03007 Alicante, Spain;
| | - Ainara Nardi-Rodríguez
- Department of Behavioral Sciences and Health, University Miguel Hernández, 03540 San Juan de Alicante, Spain; (S.L.-R.); (A.N.-R.); (M.A.P.-M.)
| | - Oscar Lecuona
- Department of Psychology, Rey Juan Carlos University, 28922 Madrid, Spain; (C.P.); (O.L.)
| | - María Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, University Miguel Hernández, 03540 San Juan de Alicante, Spain; (S.L.-R.); (A.N.-R.); (M.A.P.-M.)
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26
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Voute M, Riant T, Amodéo J, André G, Barmaki M, Collard O, Colomb C, Créac’h C, Deleens R, Delorme C, Montgazon G, Dixneuf V, Dy L, Gaillard J, Gov C, Kieffer X, Lanteri‐Minet M, Le Borgne J, Le Caër F, Maamar F, Maindet C, Marcaillou F, Plantevin F, Pluchon Y, Rioult B, Rostaing S, Salvat E, Sep Hieng V, Sorel M, Vergne‐Salle P, Morel V, Chazeron I, Pickering G. Ketamine in chronic pain: a Delphi survey. Eur J Pain 2022; 26:873-887. [DOI: 10.1002/ejp.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Marion Voute
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
| | - Thibault Riant
- Unité douleur, Le Confluent, Catherine de Sienne Center Nantes France
| | | | | | | | - Olivier Collard
- Centre d'Evaluation et de Traitement de la Douleur, Clinique Sainte Clotilde Ile de la Réunion France
| | | | - Christelle Créac’h
- Centre d'Evaluation et de Traitement de la Douleur, CHU Sainte Etienne Saint Etienne France
| | - Rodrigue Deleens
- Centre d'Evaluation et de Traitement de la Douleur, CHU Rouen France
| | - Claire Delorme
- Centre d'Evaluation et de Traitement de la Douleur, CH Bayeux Bayeux France
| | | | - Véronique Dixneuf
- Evaluation et de Traitement de la Douleur, Clinique Brétéché Nantes France
| | - Lénaïg Dy
- Evaluation et de Traitement de la Douleur, Clinique mutualiste de la porte de l’orient Lorient France
| | | | - Christian Gov
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital neurologique France
| | - Xavier Kieffer
- Centre de la Douleur Chronique et Rebelle, CH Versailles Le Chesnay France
| | - Michel Lanteri‐Minet
- Département d’Evaluation et Traitement de la Douleur Hopital de Cimiez Nice France
| | | | | | | | - Caroline Maindet
- Centre de la Douleur, Hôpital Albert Michallon La Tronche France
| | - Fabienne Marcaillou
- Centre d'Evaluation et de Traitement de la Douleur, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Plantevin
- Centre d'Evaluation et de Traitement de la Douleur, CH Mâcon Mâcon France
| | - Yves‐Marie Pluchon
- Centre d'Evaluation et de Traitement de la Douleur, CHD Vendée La Roche sur Yon France
| | - Bruno Rioult
- Unité douleur, Le Confluent, Catherine de Sienne Center Nantes France
| | | | - Eric Salvat
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital de Hautepierre Strasbourg France
| | | | - Marc Sorel
- Centre de la Douleur, CH Nemours Nemours France
| | | | - Véronique Morel
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
| | - Ingrid Chazeron
- Service de Psychiatrie B, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Gisèle Pickering
- CHU Clermont‐Ferrand Plateforme d’Investigation Clinique/CIC Inserm 1405 France
- Inserm, CIC 1405 UMR Neurodol 1407 Clermont‐Ferrand France
- Clermont Université, Laboratoire de Pharmacologie, Faculté de médecine Clermont‐Ferrand France
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27
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Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031513. [PMID: 35162534 PMCID: PMC8835050 DOI: 10.3390/ijerph19031513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.
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28
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Saracoglu I, Akin E, Aydin Dincer GB. Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta‐analysis. Int J Rheum Dis 2022; 25:394-404. [DOI: 10.1111/1756-185x.14293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Ismail Saracoglu
- Faculty of Health Sciences Department of Physiotherapy and Rehabilitation Kutahya Health Sciences University Kutahya Turkey
| | - Esra Akin
- Faculty of Health Sciences Department of Physiotherapy and Rehabilitation Kutahya Health Sciences University Kutahya Turkey
| | - Gökce Basak Aydin Dincer
- Faculty of Health Sciences Department of Physiotherapy and Rehabilitation Kutahya Health Sciences University Kutahya Turkey
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29
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Colomer-Carbonell A, Sanabria-Mazo JP, Hernández-Negrín H, Borràs X, Suso-Ribera C, García-Palacios A, Muchart J, Munuera J, D'Amico F, Maes M, Younger JW, Feliu-Soler A, Rozadilla-Sacanell A, Luciano JV. Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study). BMJ Open 2022; 12:e055351. [PMID: 34992118 PMCID: PMC8739052 DOI: 10.1136/bmjopen-2021-055351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost-utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up. METHODS AND ANALYSIS A single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities. TRIAL REGISTRATION NUMBER NCT04739995.
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Affiliation(s)
- Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Halbert Hernández-Negrín
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Universidad de Ciencias Médicas de Villa Clara, Santa Clara, Cuba
| | - Xavier Borràs
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Jordi Muchart
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Francesco D'Amico
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | | | - Albert Feliu-Soler
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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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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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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Bruce BK, Allman ME, Rivera FA, Wang B, Berianu F, Butendieck RR, Calamia KT, Hines SL, Rummans TA, Niazi SK, Abril A. Intensive Multicomponent Fibromyalgia Treatment: A Translational Study to Evaluate Effectiveness in Routine Care Delivery. J Clin Rheumatol 2021; 27:e496-e500. [PMID: 32897994 DOI: 10.1097/rhu.0000000000001555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The current study was designed to evaluate the translation of clinical trial outcomes and clinical guidelines for the treatment of fibromyalgia (FM) into an intensive multicomponent clinical program embedded in routine care delivery. The study aimed to assess the adaptation of these recommended strategies into routine clinical care while evaluating their effectiveness and durability in improving functional status and level of distress in a large clinical sample of FM patients. METHODS Four hundred eighty-nine patients with FM completed a 2-day program that incorporated best practice recommendations for the treatment of FM. Patients completed the Fibromyalgia Impact Questionnaire-Revised, the Center for Epidemiologic Studies Depression Scale, and the Pain Catastrophizing Scale at admission to the program and at follow-up on average 5 months posttreatment. RESULTS Significant improvements were seen in functional status (p < 0.0001), depressive symptoms (p < 0.0001), and pain catastrophizing (p < 0.0001) after participation in the intensive multicomponent treatment program. CONCLUSIONS The present study shows that an intensive multicomponent treatment program embedded in routine care delivery is effective in significantly improving functional status and psychological distress in a large sample of FM patients. The significant improvements were durable and maintained at follow-up.
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Affiliation(s)
- Barbara K Bruce
- From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | | | - Teresa A Rummans
- From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
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Ledermann K, von Känel R, Berna C, Sprott H, Burckhardt M, Jenewein J, Garland EL, Martin-Sölch C. Understanding and restoring dopaminergic function in fibromyalgia patients using a mindfulness-based psychological intervention: a [18F]-DOPA PET study. Study protocol for the FIBRODOPA study—a randomized controlled trial. Trials 2021; 22:864. [PMID: 35078536 PMCID: PMC8790842 DOI: 10.1186/s13063-021-05798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fibromyalgia (FM) is a very prevalent and debilitating chronic pain disorder that is difficult to treat. Mindfulness-based techniques are regarded as a very promising approach for the treatment of chronic pain and in particular FM. The Mindfulness-Oriented Recovery Enhancement (MORE) intervention, a mindfulness-based group intervention, has shown beneficial effects in opioid-treated chronic pain patients, including reduced pain severity, functional interference, and opioid dosing, by restoring neurophysiological and behavioral responses to reward. The first evidence for a hypodopaminergic state and impaired reward processing in FM has been reported. However, little is known about its impact on dopamine (DA) function and in particular with regard to DA responses to monetary reward in FM. The aim of the present study protocol is to evaluate if MORE is able to restore the DA function in FM patients, in particular with regard to the DA responses to reward, and to reduce pain and mood complaints in FM.
Methods
The present study is a multi-center interventional RCT with 3 time points: before the intervention, after completion of the intervention, and 3 months after completion of the intervention. Sixty-four FM patients will be randomly assigned to either the MORE intervention (N = 32) or a non-intervention control group (N = 32). Additionally, a comparison group of healthy women (N = 20) for PET measures will be enrolled and another group of healthy women (N = 15) will do the ambulatory assessments only. The MORE intervention consists of eight 2-h-long group sessions administered weekly over a period of 8 weeks. Before and after the intervention, FM participants will undergo [18F] DOPA positron emission tomography (PET) and functional MR imaging while performing a reward task. The primary outcome will be endogeneous DA changes measured with [18F] DOPA PET at baseline, after the intervention (after 8 weeks for the non-intervention control group), and at 3 months’ follow-up. Secondary outcomes will be (1) clinical pain measures and FM symptoms using standardized clinical scales; (2) functional brain changes; (3) measures of negative and positive affect, stress, and reward experience in daily life using the ambulatory assessment method (AA); and (4) biological measures of stress including cortisol and alpha-amylase.
Discussion
If the findings of this study confirm the effectiveness of MORE in restoring DA function, reducing pain, and improving mood symptoms, MORE can be judged to be a promising means to improve the quality of life in FM patients. The findings of this trial may inform health care providers about the potential use of the MORE intervention as a possible non-pharmacological intervention for FM.
Trial registration
ClinicalTrials.govNCT 04451564. Registered on 3 July 2020. The trial was prospectively registered.
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Arfuch VM, Queiroga Gonçalves A, Caballol Angelats R, Aguilar Martín C, Carrasco-Querol N, Sancho Sol MC, González Serra G, Fusté Anguera I, Berenguera A. Patients' appraisals about a multicomponent intervention for fibromyalgia syndrome in primary care: a focus group study. Int J Qual Stud Health Well-being 2021; 16:2005760. [PMID: 34839810 PMCID: PMC8843386 DOI: 10.1080/17482631.2021.2005760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
PURPOSE To assess fibromyalgia patients' experiences and appraisals about a multidisciplinary intervention programme, in Catalonia's primary care, regarding its format and contents, benefits, and health impact in the short and long term. METHOD Qualitative interpretative research design through hermeneutic phenomenology perspective. Two focus groups discussions were conducted in February and July 2020. The purposive heterogeneous sample included 19 fibromyalgia patients who attended a multicomponent programme. In addition, thematic analysis on the verbatims was performed. RESULTS Findings were organized into five main domains with an explanatory theme each. Overall, the informants valued the programme as a positive experience due to its holistic approach, health benefits, suffering relief, group effect, and fibromyalgia legitimacy promotion. Detected improvable aspects focused on extending the timeframe, including family members as beneficiaries, deepening the thematic contents, and getting regular access to this healthcare service. Furthermore, the intervention was considered feasible to be incorporated into usual clinical care. CONCLUSION the programme fulfilled users' expectations about results and procedure and showed promise as a treatment strategy to reinforce the usual practice. Our findings suggest a broad perspective on fibromyalgia patients' suffering, which urges us to adjust the intervention programme to their real health needs.
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Affiliation(s)
- Victoria Mailen Arfuch
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Spain.,Insurance Medicine Division, Department of Neuroscience, Karolinska Institutet, Sweden
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Unitat Docent de Medicina de Família I Comunitària Tortosa-Terres de L'Ebre, Institut Català de La Salut (Ics), Spain
| | - Rosa Caballol Angelats
- Centre d'Atenció Primària Baix Ebre Tortosa Est, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain
| | - Maria Cinta Sancho Sol
- Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Centro de Salut Mental Adultos (Csma) de Fundació Pere Mata Terres de l'Ebre, Tortosa, Spain
| | - Gemma González Serra
- Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Servei de Rehabilitació I Medicina Física, Hospital Verge de La Cinta, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Immaculada Fusté Anguera
- Centre d'Atenció Primària Baix Ebre Tortosa Est, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Spain.,Central Research Unit, Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (Idiapjgol), Barcelona, Spain.,Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Su YC, Guo YH, Hsieh PC, Lin YC. Efficacy of Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10204669. [PMID: 34682790 PMCID: PMC8538417 DOI: 10.3390/jcm10204669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/12/2023] Open
Abstract
This article aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia. The PubMed, Medline, Cochrane Library, and Web of Science databases were searched for articles published through 14 August 2021. We enrolled only randomized controlled trials. The Cochrane Collaboration risk of bias tool was used for quality assessment. Outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs. The beta coefficient and p value were adopted for meta-regression. We included 18 studies comprising 643 participants. A significant reduction in disease influence, as measured by the Fibromyalgia Impact Questionnaire, was observed (SMD, −0.700, 95% CI, −1.173 to −0.228), and the reduction was larger in older patients (β = −0.1327, p = 0.008). The effect persisted at least two weeks after the final treatment session (SMD, −0.784, 95% CI, −1.136 to −0.432). Reductions in pain, depression, and anxiety were discovered, which persisted for at least two weeks after the last intervention. The effects on pain and depression remained significant up to one and a half months after the final session. No serious adverse events were reported by the included articles. In conclusion, our systematic review and meta-analysis revealed that rTMS is safe and effective for managing multiple domains of fibromyalgia-related symptoms and older patients may have a stronger treatment effect. Larger randomized controlled trials with sufficient male populations are warranted to confirm our findings, detect rare adverse events, and determine the optimal stimulation parameters.
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Affiliation(s)
- Yu-Chi Su
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan;
| | - Yao-Hong Guo
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan
- Correspondence:
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Serrat M, Coll-Omaña M, Albajes K, Solé S, Almirall M, Luciano JV, Feliu-Soler A. Efficacy of the FIBROWALK Multicomponent Program Moved to a Virtual Setting for Patients with Fibromyalgia during the COVID-19 Pandemic: A Proof-of-Concept RCT Performed Alongside the State of Alarm in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10300. [PMID: 34639600 PMCID: PMC8508552 DOI: 10.3390/ijerph181910300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
FIBROWALK is a multicomponent program including pain neuroscience education, therapeutic exercise, cognitive behavioral therapy and mindfulness training that has recently been found to be effective in patients with fibromyalgia (FM). This RCT started before the COVID-19 pandemic and was moved to a virtual format (i.e., online videos) when the lockdown was declared in Spain. This study is aimed to evaluate the efficacy of a virtual FIBROWALK compared to Treatment-As-Usual (TAU) in patients with FM during the first state of alarm in Spain. A total of 151 patients with FM were randomized into two study arms: FIBROWALK plus TAU vs. TAU alone. The primary outcome was functional impairment. Secondary outcomes were kinesiophobia, anxiety and depressive symptomatology, and physical functioning. Differences between groups at post-treatment assessment were analyzed using Intention-To-Treat (ITT) and completer approaches. Baseline differences between clinical responders and non-responders were also explored. Statistically significant improvements with small-to-moderate effect sizes were observed in FIBROWALK+TAU vs. TAU regarding functional impairment and most secondary outcomes. In our study, the NNT was 5, which was, albeit modestly, indicative of an efficacious intervention. The results of this proof-of-concept RCT preliminarily support the efficacy of virtual FIBROWALK in patients with FM during the Spanish COVID-19 lockdown.
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Affiliation(s)
- Mayte Serrat
- Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
- Escoles Universitàries Gimbernat, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Mireia Coll-Omaña
- Eodyne Systems, Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O) Research Group, University of Vic, 08500 Vic, Spain;
| | - Klara Albajes
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain;
| | - Sílvia Solé
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain;
| | - Miriam Almirall
- Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Juan V. Luciano
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain; (J.V.L.); (A.F.-S.)
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Albert Feliu-Soler
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain; (J.V.L.); (A.F.-S.)
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review. Complement Ther Clin Pract 2021; 45:101477. [PMID: 34507243 DOI: 10.1016/j.ctcp.2021.101477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/02/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE There is limited evidence on the effects of myofascial release on fibromyalgia symptoms. This review aims to update the evidence on the effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome. METHODS The review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, Physiotherapy Evidence Database, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Complete, and ProQuest Medical library were searched from their inception to April 1, 2021 for randomized or nonrandomized clinical trials published in English. Studies consisting of myofascial release alone or in combination with exercise as the intervention were included. The quality of the studies was evaluated using Cochrane Risk of Bias 2.0. RESULTS Six studies, including a total of 279 participants, were included in the review. The meta-analysis showed a large significant effect of myofascial release on pain posttreatment (-0.81[95% CI = -1.15 to -0.47], p < 0.00001) and a moderate effect at 6 months post-treatment (-0.61, 95% CI = -0.95 to -0.28, p = 0.0003). CONCLUSION The review demonstrated moderate evidence for the effect of therapist administered and self-myofascial release in improving pain, sleep subscales, and quality of life against sham and no treatment, respectively, in fibromyalgia syndrome patients. However, more high-quality randomized controlled trials with manual control group are required to be conducted at different geographical locations to generalize the findings.
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Cabral CMN, Miyamoto GC, Franco KFM, Bosmans JE. Economic evaluations of educational, physical, and psychological treatments for fibromyalgia: a systematic review with meta-analysis. Pain 2021; 162:2331-2345. [PMID: 33605655 DOI: 10.1097/j.pain.0000000000002233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Nonpharmacological interventions are recommended for the treatment of fibromyalgia, but there is a lack of knowledge about the cost-effectiveness of these interventions. The aim of this study was to systematically review economic evaluations of educational, physical, and psychological interventions for the treatment of fibromyalgia. The search was performed in PUBMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, PsycINFO, EconLit, National Health Service Economic Evaluation Database, and Health Technology Assessment. Economic evaluations of educational, physical, and psychological interventions for adult patients with fibromyalgia were included. Primary outcomes were healthcare and societal costs, and quality-adjusted life-years, and secondary outcomes were any disease-specific clinical outcome. Costs and effects were pooled in a meta-analysis, when possible. Eleven studies were included, of which 7 compared a psychological intervention with another intervention or usual care/control. Over a 6-month time horizon, healthcare and societal costs of the psychological intervention were significantly lower than usual care (mean difference: $-2087, 95% confidence interval [CI]: -3061 to -1112; mean difference: $-2411, 95% CI: -3582 to -1240, respectively), and healthcare costs were significantly lower for the psychological intervention compared with a pharmacological intervention (mean difference: $-1443, 95% CI: -2165 to -721). Over a 12-month time horizon, healthcare costs for the psychological intervention were significantly lower than for usual care (mean difference: $-538, 95% CI: -917 to -158). Incremental cost-effectiveness ratios for quality-adjusted life-years and impact of fibromyalgia showed that the psychological intervention was cost-effective compared with other interventions and control conditions. There is a need of more economic evaluations conducted alongside randomized controlled trials with interventions recommended for the treatment of fibromyalgia, such as physical exercise.
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Affiliation(s)
- Cristina Maria Nunes Cabral
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | - Gisela Cristiane Miyamoto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Judith Ekkina Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
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Comment on Siracusa et al. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci. 2021, 22, 3891. Int J Mol Sci 2021; 22:ijms22169075. [PMID: 34445778 PMCID: PMC8396514 DOI: 10.3390/ijms22169075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
We have read the study by Siracusa et al. [...].
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Bruce BK, Allman ME, Rivera FA, Abril A, Gehin JM, Oliphant LM, Nordan LM, White LJ, Martinez D, Niazi SK. Opioid Use in Fibromyalgia Continues Despite Guidelines That Do Not Support Its Efficacy or Risk. J Clin Rheumatol 2021; 27:187-193. [PMID: 32040055 DOI: 10.1097/rhu.0000000000001273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVE The aim of this cross-sectional study is to determine the prevalence of opioid use in a large sample of fibromyalgia (FM) patients and examine the factors associated with opioid prescription/use despite multiple clinical guidelines that do not recommend opioid use in this population. METHODS Data were collected from a convenience sample of 698 patients admitted from August 2017 to May 2019 into an intensive 2-day Fibromyalgia Treatment Program at a tertiary medical center in the United States after FM diagnosis. Patients were administered the Fibromyalgia Impact Questionnaire-Revised, the Center for Epidemiologic Study of Depression Scale, and the Pain Catastrophizing Scale upon admission to the program. Demographic information and opioid use were self-reported. Logistic regression analysis was utilized to determine associations between patient-related variables and opioid use in this prospective study. RESULTS Of 698 patients, 27.1% (n = 189) were taking opioids at intake. Extended duration of symptoms (>3 years), increased age, higher degree of functional impairment, and increased pain catastrophizing were significantly associated with opioid use. CONCLUSIONS Opioids are not recommended for the treatment of FM under current guidelines. Greater burden of illness appeared to be associated with the prescription and use of opioids in this population. These findings suggest that some providers may not be aware of current recommendations that have been found to be effective in the management of FM that are contained in guidelines. Alternative approaches to the management of FM that do not involve opioids are reviewed in an effort to improve care.
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Affiliation(s)
- Barbara K Bruce
- From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | | | | | - Jessica M Gehin
- From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Loretta M Oliphant
- From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Lisa M Nordan
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Launia J White
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Dayana Martinez
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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Ketamine for refractory chronic pain: a one-year follow-up study. Pain 2021; 163:690-701. [PMID: 34252909 DOI: 10.1097/j.pain.0000000000002403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ketamine is often used in pain clinics for refractory chronic pain, but its long-term efficacy is poorly reported. The main objective was to assess the long-term effect of ketamine on pain and health variables in patients with refractory chronic pain.A prospective, multicenter, one-year follow-up observational study (NCT03319238) was conducted in thirty French pain clinics where ketamine is commonly prescribed. This study focused on patients with one ketamine delivery procedure (n=256). The primary endpoint was pain intensity (0-10 numerical pain rating scale) before and after ketamine every month for one year. Secondary outcomes aimed to identify pain trajectories by semi-parametric mixture models and to collect adverse events.The following data were obtained for 256 patients: pain intensity decreased significantly (6.8±1.8, n=240 at baseline versus 5.7±1.8, n=93 at 12 months, p<0.001). The effect size of the main endpoint was 0.61 (95%CI: [0.40; 0.80]; p<0.001). Three pain trajectories were identified: 16.0% of patients in "mild pain" (mostly neuropathic pain), 35.3% in "moderate pain" and 45.7% in "severe pain" (mostly fibromyalgia) trajectory. Neuropathic pain and fibromyalgia presented opposite outcomes, pain severity being associated with anxiety, depression and a poorer quality of life. Adverse events occurred at one week in 108/218 [50%] patients and this rate gradually decreased throughout the follow-up.This real-life study in chronic pain identified distinct pain trajectories and predictive variables of ketamine efficacy. It is now pivotal to further study and optimize the subtyping of patients to provide the most effective and safe ketamine treatment in this vulnerable population.
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Veterans' Insights on Heart Rate Variability Biofeedback to Treat Fibromyalgia-Related Pain. Pain Manag Nurs 2021; 23:196-203. [PMID: 34284943 DOI: 10.1016/j.pmn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart rate variability biofeedback (HRVB) is a self-management strategy that guides individuals to breathe at a designated resonance frequency of the cardiovascular system. Resonant breathing may reduce FM-related symptoms as well as improve physical functioning and quality of life. Although prior research recommends HRVB for chronic pain, we found no studies testing the feasibility for individuals with FM regarding protocol adherence or acceptability of the treatment. AIMS To determine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) protocol in a group of Veterans with fibromyalgia (FM). DESIGN A multi-method feasibility and acceptability study. SETTINGS A Veterans Health outpatient pain medicine clinic. PARTICIPANTS/SUBJECTS We enrolled 7 women and 3 men between the ages of 33 and 68 years with a diagnosis of FM. METHODS We enrolled 10 veterans in a HRVB study using a recommended protocol to treat FM. Veterans were given a HRVB device, emWave2, and instructed to practice at home twice daily for 20 minutes per session. Following a 7-week intervention period, we conducted an end of study focus group. We used content analysis to develop themes to determine the feasibility of engaging in HRVB and adhering to the intervention protocol, as well as insights of veterans about the intervention. RESULTS Three common themes emerged: intervention implementation, protocol adherence, and self-awareness. CONCLUSIONS Results of this study suggest difficulties operating the emWave2 and scheduling challenges interfered with HRVB implementation. However, veterans reported self-awareness of the benefits of HRVB, positive physiological effects, and improved psychological effects. Future studies require a larger sample size to provide a deeper insight.
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Alvarez G, Zegarra-Parodi R, Esteves JE. Person-centered versus body-centered approaches in osteopathic care for chronic pain conditions. Ther Adv Musculoskelet Dis 2021; 13:1759720X211029417. [PMID: 34290833 PMCID: PMC8274118 DOI: 10.1177/1759720x211029417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gerard Alvarez
- Spain National Centre, Foundation Centre for Osteopathic Medicine Collaboration, Barcelona, Spain
| | | | - Jorge E Esteves
- Foundation Centre for Osteopathic Medicine Collaboration, Italy National Centre, Pescara, Italy
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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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Masquelier E, D'haeyere J. Physical activity in the treatment of fibromyalgia. Joint Bone Spine 2021; 88:105202. [PMID: 33962033 DOI: 10.1016/j.jbspin.2021.105202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents.
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Affiliation(s)
- Etienne Masquelier
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium; Institute of NeuroScience (IoNS), Université catholique de Louvain, Louvain, Belgium.
| | - Jacques D'haeyere
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium
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Coste J, Medkour T, Maigne JY, Pérez M, Laroche F, Perrot S. Osteopathic medicine for fibromyalgia: a sham-controlled randomized clinical trial. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009017. [PMID: 33948127 PMCID: PMC8053754 DOI: 10.1177/1759720x211009017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.
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Affiliation(s)
- Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, Paris University, 27 rue du faubourg Saint-Jacques, Paris, 75014, France
| | - Terkia Medkour
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Jean-Yves Maigne
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Marc Pérez
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine University Hospital and Medical University Sorbonne, Paris, France
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
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Bilir I, Askin A, Sengul I, Tosun A. Effects of High-Frequency Neuronavigated Repetitive Transcranial Magnetic Stimulation in Fibromyalgia Syndrome: A Double-Blinded, Randomized Controlled Study. Am J Phys Med Rehabil 2021; 100:138-146. [PMID: 32701637 DOI: 10.1097/phm.0000000000001536] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary aim of the study was to investigate the effect of 10-Hz repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex on pain in fibromyalgia. Secondary aims were to determine its effects on stiffness, fatigue, quality of life, depression/anxiety, and cognitive functions. DESIGN Twenty participants were randomized into two groups. Group A received 10-Hz repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex and group B received sham stimulation. Visual analog scale for pain, visual analog scale-stiffness, Fibromyalgia Impact Questionnaire, and Fatigue Severity Scale were assessed at the baseline, 2nd, and 6th weeks, whereas Hospital Anxiety Depression Scale and Addenbrooke's cognitive examination were assessed at the baseline and 6th week. RESULTS There was no significant difference in visual analog scale-pain and Fatigue Severity Scale within and between groups over time (P > 0.05). In group A, significant improvement was found in visual analog scale-stiffness and fibromyalgia impact questionnaire at the 2nd week in comparison to the baseline (P < 0.05). However, no significant difference was detected in comparison with group B. There was no significant change in Hospital Anxiety Depression Scale scores between and within groups. All cognitive measures were similar in terms of differences from baseline between the groups (P > 0.05). CONCLUSIONS High-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex did not show any significant beneficial effect on pain, stiffness, fatigue, quality of life, mood, and cognitive state over sham stimulation.
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Affiliation(s)
- Ibrahim Bilir
- From the Department of Physical Medicine and Rehabilitation, Katip Çelebi University, Faculty of Medicine, Izmir, Turkey
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Gonzalez B, Novo R, Peres R. Personality and psychopathology heterogeneity in MMPI‐2 and health‐related features in fibromyalgia patients. Scand J Psychol 2020; 62:203-210. [DOI: 10.1111/sjop.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bárbara Gonzalez
- HEI‐Lab: Digital Human‐Environment Interactions Lab Universidade Lusófona de Humanidades e Tecnologias Lisbon Portugal
| | - Rosa Novo
- CICPSI, Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Rodrigo Peres
- Instituto de Psicologia Universidade Federal de Uberlândia Uberlândia Brazil
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Arfuch VM, Caballol Angelats R, Aguilar Martín C, Carrasco-Querol N, Sancho Sol MC, González Serra G, Fusté Anguera I, Gonçalves AQ, Berenguera A. Assessing the benefits on quality of life of a multicomponent intervention for fibromyalgia syndrome in primary care: patients' and health professionals' appraisals: a qualitative study protocol. BMJ Open 2020; 10:e039873. [PMID: 33177139 PMCID: PMC7661363 DOI: 10.1136/bmjopen-2020-039873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fibromyalgia syndrome (FMS) is a complex condition still scarcely understood and with ambiguity when prescribing treatment. Both patients and healthcare providers can supply valuable information for the development of new treatment strategies. The qualitative narrative analysis of participant's accounts is potentially helpful to reveal new insights about their opinions, needs, and experiences and, consequently, to model healthcare interventions accurately. International treatment guidelines suggest a promising future for multicomponent intervention (MI) approaches for FMS. This study aims to assess the benefits of a MI for patients with FMS in the context of primary care (PC) in Terres de L'Ebre, Catalonia (Spain). Furthermore, it is intended to detect the overall perception of effectiveness and to understand patients' lived experience and its impact on the quality of life. METHOD AND ANALYSIS Qualitative research from a socioconstructivism paradigm perspective and a Hermeneutic Phenomenological method. For data collection, four focus group discussions (FGDs) of 8-12 people (2 FGDs of patients and 2 of professionals) and 10-12 key informant interviews with the participants in the MI group will be carried out. All the information will be recorded and verbatim transcribed to perform an interpretive thematic analysis. ETHICS AND DISSEMINATION This study protocol has been approved by the Clinical Research Ethics Committee from the IDIAPJGol Institute, on 25 April 2018 (code P18/068), according to the Declaration of Helsinki/Tokyo. All participants will receive oral/written information about the study, and they will be required to sign an informed consent sheet. Data anonymity will be guaranteed. Dissemination will be carried out through publications in scientific journals, presentations in academic meetings, workshops and through the local and national media. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT04049006; Pre-results.
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Affiliation(s)
- Victoria Mailen Arfuch
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
| | - Rosa Caballol Angelats
- Equip d'Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa, Catalunya, Spain
- Unitat d'Expertesa en Sindromes de Sensibilització Central Terres de l'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Maria Cinta Sancho Sol
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Unitat d'Expertesa en Sindromes de Sensibilització Central Terres de l'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Gemma González Serra
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Unitat d'Expertesa en Sindromes de Sensibilització Central Terres de l'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Immaculada Fusté Anguera
- Equip d'Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa, Catalunya, Spain
- Unitat d'Expertesa en Sindromes de Sensibilització Central Terres de l'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
- Central Research Unit, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
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Reneau M. Feasibility and Acceptability of Heart Rate Variability Biofeedback in a Group of Veterans with Fibromyalgia. J Altern Complement Med 2020; 26:1025-1031. [DOI: 10.1089/acm.2020.0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Marcelaine Reneau
- Integrative Pain Clinic, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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