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Mohabbat AB, Salonen BR, Davis XD, Volcheck MM, Luedtke CA, Natividad LT, Pena Guzman TD, Johnson SM, Ledvina AJ, Merza CTL, Wight EC. In-Person or Virtual Educational Preferences in Patients With Fibromyalgia: A Cross-Sectional Survey Study at an Academic Medical Center. Pain Manag Nurs 2024:S1524-9042(24)00104-8. [PMID: 38570215 DOI: 10.1016/j.pmn.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Patient education is a core component of treating fibromyalgia and central sensitization disorders. We sought to evaluate whether patients with fibromyalgia prefer virtual or in-person educational classes as part of their treatment program, identify underlying factors with their educational modality choice, and highlight benefits or barriers associated with in-person or online educational sessions. DESIGN A cross-sectional survey with a qualitative feedback component was utilized. METHODS A voluntary, anonymous survey was distributed to all participants (in-person and virtual) of the fibromyalgia and chronic fatigue clinic treatment program from October 2021 through March 2022. RESULTS In total 90 participants completed the survey. Nearly all (94%) agreed that the pathophysiologic education was relevant and valuable and (98%) agreed to feeling confident with implementing management strategies. Perceived connection between the participants varied between groups (85% of in-person vs 48% of online; p < .001), as did perceived engagement (100% of in-person vs 71% of online; p = .001). CONCLUSIONS Patients value education and find it useful in treating fibromyalgia, regardless of the educational modality. The online group reported more limitations including less engagement, class participation, and connection with peers. CLINICAL IMPLICATIONS As virtual education platforms become more widely available and may be easier to access than in-person options, it is important to understand patient preferences, benefits, and disadvantages of educational modalities to ensure education and patient outcomes remain equitable.
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Affiliation(s)
- Arya B Mohabbat
- Mayo Clinic, Division of General Internal Medicine, Rochester, MN.
| | | | - Xiomari D Davis
- Mayo Clinic, Enterprise Office of Access Management, Access Technologies & Systems Unit, Rochester, MN
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Otón T, Carmona L, Rivera J. Patient-journey of fibromyalgia patients: A scoping review. REUMATOLOGIA CLINICA 2024; 20:96-103. [PMID: 38395498 DOI: 10.1016/j.reumae.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system. OBJECTIVES The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up. METHODS A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on "patient journey". Results were organized using a deductive classification of themes. RESULTS Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor-patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment. CONCLUSIONS This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Javier Rivera
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Catella S, Gendreau RM, Kraus AC, Vega N, Rosenbluth MJ, Soefje S, Malhotra S, Luciano JV, McCracken LM, Williams DA, Arnold LM. Self-guided digital acceptance and commitment therapy for fibromyalgia management: results of a randomized, active-controlled, phase II pilot clinical trial. J Behav Med 2024; 47:27-42. [PMID: 37382794 PMCID: PMC10867073 DOI: 10.1007/s10865-023-00429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 06/30/2023]
Abstract
Although empirically validated for fibromyalgia (FM), cognitive and behavioral therapies, including Acceptance and Commitment Therapy (ACT), are inaccessible to many patients. A self-guided, smartphone-based ACT program would significantly improve accessibility. The SMART-FM study assessed the feasibility of conducting a predominantly virtual clinical trial in an FM population in addition to evaluating preliminary evidence for the safety and efficacy of a digital ACT program for FM (FM-ACT). Sixty-seven patients with FM were randomized to 12 weeks of FM-ACT (n = 39) or digital symptom tracking (FM-ST; n = 28). The study population was 98.5% female, with an average age of 53 years and an average baseline FM symptom severity score of 8 out of 11. Endpoints included the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Patient Global Impression of Change (PGIC). The between-arm effect size for the change from baseline to Week 12 in FIQ-R total scores was d = 0.44 (least-squares mean difference, - 5.7; SE, 3.16; 95% CI, - 11.9 to 0.6; P = .074). At Week 12, 73.0% of FM-ACT participants reported improvement on the PGIC versus 22.2% of FM-ST participants (P < .001). FM-ACT demonstrated improved outcomes compared to FM-ST, with high engagement and low attrition in both arms. Retrospectively registered at ClinicalTrials.gov (NCT05005351) on August 13, 2021.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan V Luciano
- Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Santari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | | | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lesley M Arnold
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
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Tilbor E, Hadar A, Portnoy V, Ganor O, Braw Y, Amital H, Ablin J, Dror C, Bloch Y, Nitzan U. TMS in combination with a pain directed intervention for the treatment of fibromyalgia - A randomized, double-blind, sham-controlled trial. J Psychiatr Res 2024; 170:167-173. [PMID: 38150768 DOI: 10.1016/j.jpsychires.2023.12.016] [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] [Received: 05/01/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. OBJECTIVE To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. METHODS 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. RESULTS DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group × time interaction [F(2, 32) = 3.51, p < .05,ηp2 = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. CONCLUSION Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.
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Affiliation(s)
- Einat Tilbor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Aviad Hadar
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Victor Portnoy
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel.
| | - Ori Ganor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yoram Braw
- Ariel University, Department of Psychology, 65 Ramat HaGolan Street, Ari'el, Israel.
| | - Howard Amital
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Sheba Medical Center Hospital, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Jacob Ablin
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
| | - Chen Dror
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yuval Bloch
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Uri Nitzan
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
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Tobajas Y, Alemany-Fornés M, Samarra I, Romero-Giménez J, Cuñé-Castellana J, Tintoré M, del Pino A, Canela N, del Bas JM, Ortega-Olivé N, de Lecea C, Escoté X. Exploring the Relationship between Diamine Oxidase and Psychotropic Medications in Fibromyalgia Treatment, Finding No Reduction in Diamine Oxidase Levels and Activity except with Citalopram. J Clin Med 2024; 13:792. [PMID: 38337486 PMCID: PMC10856182 DOI: 10.3390/jcm13030792] [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: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Histamine intolerance manifests when there is an imbalance between the production of histamine and the body's capacity to metabolise it. Within the gastrointestinal tract, diamine oxidase (DAO) plays a pivotal role in breaking down ingested histamine. Insufficient levels of DAO have been linked to various diseases affecting the respiratory, cardiovascular, nervous, muscular, and digestive systems; some of these symptoms are evidenced in fibromyalgia syndrome. This underscores the crucial role of DAO in maintaining the histamine balance and highlights its association with diverse physiological systems and health conditions. The management of fibromyalgia commonly involves the use of psychotropic medications; however, their potential interactions with DAO remain not fully elucidated. Methods: This study delved into the influence of various psychotropic medications on DAO activity through in vitro experiments. Additionally, we explored their impact on the human intestinal cell line Caco-2, examining alterations in DAO expression at both the mRNA and protein levels along with DAO activity. Results: Notably, the examined drugs-sertraline, pregabalin, paroxetine, alprazolam, and lorazepam-did not exhibit inhibitory effects on DAO activity or lead to reductions in DAO levels. In contrast, citalopram demonstrated a decrease in DAO activity in in vitro assays without influencing DAO levels and activity in human enterocytes. Conclusions: These findings imply that a collaborative approach involving psychotropic medications and DAO enzyme supplementation for individuals with fibromyalgia and a DAO deficiency could offer potential benefits for healthcare professionals in their routine clinical practice.
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Affiliation(s)
- Yaiza Tobajas
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health, 43204 Reus, Spain; (Y.T.); (J.R.-G.); (N.O.-O.)
| | - Marc Alemany-Fornés
- DR Healthcare-AB Biotek HNH, 43204 Reus, Spain; (M.A.-F.); (J.C.-C.); (M.T.); (C.d.L.)
| | - Iris Samarra
- Centre for Omic Sciences (COS), Joint Unit URV-Eurecat, Unique Scientific and Technical Infrastructures (ICTS), Eurecat, Centre Tecnològic de Catalunya, 43204 Reus, Spain; (I.S.); (A.d.P.); (N.C.)
| | - Jordi Romero-Giménez
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health, 43204 Reus, Spain; (Y.T.); (J.R.-G.); (N.O.-O.)
| | - Jordi Cuñé-Castellana
- DR Healthcare-AB Biotek HNH, 43204 Reus, Spain; (M.A.-F.); (J.C.-C.); (M.T.); (C.d.L.)
| | - Maria Tintoré
- DR Healthcare-AB Biotek HNH, 43204 Reus, Spain; (M.A.-F.); (J.C.-C.); (M.T.); (C.d.L.)
| | - Antoni del Pino
- Centre for Omic Sciences (COS), Joint Unit URV-Eurecat, Unique Scientific and Technical Infrastructures (ICTS), Eurecat, Centre Tecnològic de Catalunya, 43204 Reus, Spain; (I.S.); (A.d.P.); (N.C.)
| | - Núria Canela
- Centre for Omic Sciences (COS), Joint Unit URV-Eurecat, Unique Scientific and Technical Infrastructures (ICTS), Eurecat, Centre Tecnològic de Catalunya, 43204 Reus, Spain; (I.S.); (A.d.P.); (N.C.)
| | - Josep M. del Bas
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, 43204 Reus, Spain;
| | - Nàdia Ortega-Olivé
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health, 43204 Reus, Spain; (Y.T.); (J.R.-G.); (N.O.-O.)
| | - Carlos de Lecea
- DR Healthcare-AB Biotek HNH, 43204 Reus, Spain; (M.A.-F.); (J.C.-C.); (M.T.); (C.d.L.)
| | - Xavier Escoté
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health, 43204 Reus, Spain; (Y.T.); (J.R.-G.); (N.O.-O.)
- Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, Campus Sescelades, 43007 Tarragona, Spain
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Yu JS, Kim ES, Park KS, Lee YJ, Park YC, Nam D, Kim EJ, Ha IH. Trends in the treatment of fibromyalgia in South Korea between 2011 and 2018: a retrospective analysis of cross-sectional health insurance data. BMJ Open 2023; 13:e071735. [PMID: 38056939 PMCID: PMC10711815 DOI: 10.1136/bmjopen-2023-071735] [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: 01/12/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES Fibromyalgia treatment trends vary globally; however, the trend in South Korea has not been investigated yet. This study aimed to analyse the fibromyalgia treatment trends in South Korea. DESIGN Retrospective, observational study using serial cross-sectional data. SETTING The National Patient Samples of the Korean Health Insurance Review & Assessment Service from 2011 to 2018 were used. PARTICIPANTS A total of 31 059 patients with fibromyalgia were included in this study. The basic characteristics of the patients were stratified by sex, age and comorbidity. A patient was considered to have a condition if it was recorded as a principal diagnosis at least once in a year. PRIMARY AND SECONDARY OUTCOME MEASURES Trends in the types of medical visits and prescribed treatments were investigated and the values are presented as rates per 100 patients. The types of pharmacological treatment were presented according to the existing clinical guidelines. Additionally, combination prescription trends and associated characteristics were investigated. RESULTS Of the patients, 66.2% were female. Visits to internal medicine departments showed the most significant increase (2011: 11.34; 2018: 21.99; p<0.001). Non-pharmacological treatment rates declined (physical therapy 2011: 18.11; 2018: 13.69; p<0.001, acupuncture 2011: 52.03; 2018: 30.83; p<0.001). Prescription rates increased for analgesics, relaxants, antiepileptics and antidepressants. Non-steroidal anti-inflammatory drug prescriptions had the highest increase (2011: 27.65; 2018: 40.02; p<0.001). Serotonin-norepinephrine reuptake inhibitor prescriptions showed significant growth (2011: 2.4; 2018: 8.05; p<0.001). Prescription durations were generally longer for women (p<0.001), with higher rate increases in this group. Combinations of ≥3 medication classes increased (2011: 8.2; 2018: 9.64; p=0.041). Women were more likely to receive combination prescriptions (crude OR 1.47 (95% CI 1.29 to 1.68), adjusted 1.18 (95% CI 1.03 to 1.36)). CONCLUSIONS Our findings provide basic reference data for the development and application of national guidelines for fibromyalgia.
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Affiliation(s)
- Jin-Sil Yu
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
| | - Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | | | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Yeon Cheol Park
- Acupuncture and Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Dongwoo Nam
- Department of Acupuncture and Moxibustion, Kyung Hee University, Seoul, South Korea
| | - Eun-Jung Kim
- Department of Acupuncture and Moxibustion, College of Oriental Medicine, Dongguk University, Seongnam-si, South Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
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McConnell K, Heron N, Hart ND. Explaining a diagnosis of fibromyalgia in primary care: a scoping review. BJGP Open 2023; 7:BJGPO.2023.0033. [PMID: 37468158 PMCID: PMC11176698 DOI: 10.3399/bjgpo.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Fibromyalgia is a common cause of chronic pain in the UK, with a huge individual and societal impact. Despite this, it remains difficult to diagnose and treat. The explanation of a fibromyalgia diagnosis can lead to difficult therapeutic relationships, with attitudinal issues and negative profiling of patients. This can lead to frustration, and have a harmful impact on health outcomes. AIM To review how an explanation of a fibromyalgia diagnosis is provided in primary care in order to establish a model of best practice when educating patients on their diagnosis. DESIGN & SETTING Scoping review of articles written in English. METHOD MEDLINE, Embase, Web of Science, and grey literature were searched. Articles were extracted, reviewed, and analysed according to the inclusion criteria. RESULTS In total, 29 records met the inclusion criteria. The following six overarching themes were identified: patient education; physician education; importance of the multidisciplinary team; importance of patient-centred care; the value of primary care; and useful resources. The literature illustrated that describing fibromyalgia using analogies to illustrate the pain sensitisation process can help patients understand their diagnosis better. This improves their willingness to accept management plans, particularly engagement with non-pharmacological therapies, which the literature suggested are best delivered within a multidisciplinary team. CONCLUSION Key aspects of fibromyalgia should be explained to patients in order for them to gain a better understanding of their diagnosis. A 'one-size-fits-all' model for explaining the fibromyalgia diagnosis to patients is inappropriate because patients' experiences are individualised. Further research is required on whether different explanations impact patient outcomes.
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Affiliation(s)
- Kerrie McConnell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Neil Heron
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Antunes MD, Schmitt ACB, Pasqual Marques A. Amigos de Fibro (Fibro Friends): validation of an e-book to promote health in fibromyalgia. Prim Health Care Res Dev 2023; 24:e41. [PMID: 37254451 PMCID: PMC11091835 DOI: 10.1017/s1463423623000270] [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: 03/20/2022] [Revised: 03/27/2023] [Accepted: 04/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Educational strategies are necessary for the care of patients with fibromyalgia. The objective was to develop and validate an e-book to promote the health of individuals with fibromyalgia. METHODS Methodological research in which, initially, through a bibliographic survey, the available publications on the subject were analyzed. Then, this knowledge was used to build the theoretical content addressed, and the art and layout of the e-book were elaborated. In the third phase, validation of the constructed material, content specialists (n = 23), technicians (n = 23) and design specialists (n = 23), and individuals with fibromyalgia (n = 45) evaluated the e-book through the Delphi technique. For data collection, different questionnaires were used, according to the evaluation focus of each participant group, analyzed for reliability using Cronbach's Alpha (αC) and agreement using the Content Validity Index (CVI). RESULTS In the global assessment of agreement from all groups of judges, the CVI presented a considerable minimum: content (0.79), technical (0.89), design (0.92), and target audience (0.97). Regarding reliability, all groups also had a αC within the acceptable range: content (0.960), technical (0.963), design (0.977), and target audience (1.08). CONCLUSIONS The e-book was developed and validated in terms of content and relevance and can be used to promote the health of individuals with fibromyalgia.
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Affiliation(s)
- Mateus Dias Antunes
- Doctoral Student in the Program in Rehabilitation Sciences, Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Carolina Basso Schmitt
- Researcher, Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Amélia Pasqual Marques
- Researcher, Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Abd Elmaaboud MA, Awad MM, El-Shaer RAA, Kabel AM. The immunomodulatory effects of ethosuximide and sodium butyrate on experimentally induced fibromyalgia: The interaction between IL-4, synaptophysin, and TGF-β1/NF-κB signaling. Int Immunopharmacol 2023; 118:110061. [PMID: 36989891 DOI: 10.1016/j.intimp.2023.110061] [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: 01/03/2023] [Revised: 03/01/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND AIMS Fibromyalgia is a widespread chronic pain syndrome associated with several comorbid conditions that affect the quality of patients' life. Its pathogenesis is complex, and the treatment strategies are limited by partial efficacy and potential adverse effects. So, our aim was to investigate the possible ameliorative effects of ethosuximide and sodium butyrate on fibromyalgia and compare their effects to pregabalin. MATERIALS AND METHODS In a mouse model of reserpine induced fibromyalgia, the effect of ethosuximide, sodium butyrate, and pregabalin was investigated. Evaluation of mechanical allodynia, cold hypersensitivity, anxiety, cognitive impairment, and depression was performed. Also, the brain and spinal cord tissue serotonin, dopamine and glutamate in addition to the serum levels of interleukin (IL)-4 and transforming growth factor beta 1 (TGF-β1) were assayed. Moreover, the expression of nuclear factor kappa B (NF-κB) synaptophysin was immunoassayed in the hippocampal tissues. KEY FINDINGS Ethosuximide and sodium butyrate restored the behavioral tests to the normal values except for the antidepressant effect which was evident only with ethosuximide. Both drugs elevated the levels of the anti-inflammatory cytokines IL-4 and TGF-β1, reduced the hippocampal NF-κB, and increased synaptophysin expression with superiority of sodium butyrate. Ethosuximide reduced only spinal cord and brain glutamate while improved brain dopamine while sodium butyrate elevated spinal cord dopamine and serotonin with no effect on glutamate. Also, sodium butyrate elevated brain serotonin and reduced glutamate with no effect on brain dopamine. SIGNIFICANCE Each of sodium butyrate and ethosuximide would serve as a promising therapeutic modality for management of fibromyalgia and its comorbid conditions.
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Affiliation(s)
| | - Marwa M Awad
- Department of physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rehab A A El-Shaer
- Department of physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed M Kabel
- Department of pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Gebke KB, McCarberg B, Shaw E, Turk DC, Wright WL, Semel D. A practical guide to recognize, assess, treat and evaluate (RATE) primary care patients with chronic pain. Postgrad Med 2023; 135:244-253. [PMID: 35060834 DOI: 10.1080/00325481.2021.2017201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The management of patients with chronic pain is one of the most important issues In medicine and public health. Chronic pain conditions cause substantial suffering for patients, their significant others and society over years and even decades and increases healthcare utilization resources including the cost of medical care, loss of productivity and provision of disability services. Primary care providers are at the frontline in the identification and management of patients with chronic pain, as the majority of patients enter the healthcare system through primary care and are managed by primary care providers. Due to the complexity of chronic pain and the range of issues involved, the accurate diagnosis of the causes of pain and the formulation of effective treatment plans presents significant challenges in the primary care setting. In this review, we use the classification of pain types based on pathophysiology as the template to guide the assessment, treatment, and monitoring of patients with chronic pain conditions. We outline key methods that can be used to efficiently and accurately diagnose the putative pathophysiological mechanisms underlying chronic pain conditions and describe how this information should be used to tailor the treatment plan to meet the patient's needs. We discuss methods to evaluate patients and the impact of treatment plans over a series of consultations, with a particular focus on strategies to improve the patient's ability to self-manage their pain and related symptoms and perform daily functions despite persistent pain. Finally, we introduce the mnemonic RATE (Recognize, Assess, Treat, and Evaluate) as a general strategy that healthcare providers can use to aid their management of patients presenting with chronic pain.
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Affiliation(s)
- Kevin B Gebke
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Metyas S, Chen C, Joseph M, Hanna N, Basta J, Khalil A. Subcategories of Fibromyalgia: A New Concept. Curr Rheumatol Rev 2022; 18:18-25. [PMID: 35220935 DOI: 10.2174/2666255815666220225103234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023]
Abstract
Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.
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Affiliation(s)
- Samy Metyas
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Marina Joseph
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Joseph Basta
- Covina Arthritis Clinic, Covina, California, CA, USA
| | - Andrew Khalil
- Covina Arthritis Clinic, Covina, California, CA, USA
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12
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Wilson N, Beasley MJ, Pope C, Dulake D, Moir LJ, Hollick RJ, Macfarlane GJ. UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study). BMC Health Serv Res 2022; 22:989. [PMID: 35922796 PMCID: PMC9347075 DOI: 10.1186/s12913-022-08324-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08324-4.
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Affiliation(s)
- Nicky Wilson
- Departments of Rheumatology and Therapies, King's College Hospital NHS Foundation Trust, London, UK.
| | - Marcus J Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Laura J Moir
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
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Cohen-Biton L, Buskila D, Nissanholtz-Gannot R. The Effect of the Fibrotherapy Intervention Program on the Coping Patterns of Fibromyalgia Patients. J Clin Rheumatol 2022; 28:278-283. [PMID: 35775743 PMCID: PMC9336555 DOI: 10.1097/rhu.0000000000001866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fibromyalgia (FM) syndrome is characterized by physical symptoms such as pain, fatigue, and sleep disorders, as well as mental symptoms that include depression, mental exhaustion, and a sense of hopelessness. The current study focuses on 3 main strategies used by FM patients living in communities in the Gaza Envelope who are under constant security threat: problem-oriented, emotion-oriented, and avoidance. METHODS The study introduces a groundbreaking intervention program based on a fibrotherapy intervention (FTI) program developed at the Rehabilitation Center "Ezra Le'Marpeh" led by Rabbi Avraham Elimelech Firer. The cohort study sample consists of 96 women who have been diagnosed with FM and have participated in the FTI program for 10 weeks. The study uses mixed methods of quantitative and qualitative analyses in which 16 women from the sample were interviewed. In addition to collecting demographic information and medical data, the study used the Brief Cope questionnaire. RESULTS The findings corroborate the hypothesis and show a difference between the coping patterns of FM patients before and after the intervention. CONCLUSIONS The sharing experience as a part of the FTI program can lead FM patients to adopt positive disease management strategies, which may improve their quality of life.
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Affiliation(s)
| | - Dan Buskila
- Ben-Gurion University of the Negev, Be'er Sheva
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14
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Life among Chinese fibromyalgia patients: a cross-sectional study. Clin Rheumatol 2022; 41:3479-3485. [PMID: 35831690 DOI: 10.1007/s10067-022-06290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study is to examine the impact of age on the clinical characteristics, fibromyalgia-related symptom severity and quality of life (QOL) among Chinese fibromyalgia patients. METHODS A packet of questionnaires on demographics, medical history, and severity of six major symptoms of fibromyalgia (i.e., pain, fatigue, sleep quality, depression, stress, and QOL) was completed by 124 Chinese patients. The patients were stratified into three groups by age (32 (25.8%) "young" patients, ≤ 39 years; 73 (58.9%) "middle-age" patients, 40-59 years; and 19 (15.3%) "older" patients, ≥ 60 years). Analysis of covariance was conducted and adjusted for body mass index and symptom fibromyalgia duration. RESULTS The majority of patients in this study were women (107, 86.3%), and the mean age was 49.4 years (SD 10.8 years). Pairwise comparisons among the three age groups found that the young and middle-aged patients were significantly more troubled than the older patients by their symptoms in several categories: morning tiredness (P ≤ 0.012), depression (P ≤ 0.002), anxiety (P ≤ 0.004), mental health index (P ≤ 0.002), and mental component summary score (P ≤ 0.017). The middle-aged patients reported more trouble than the older patients with regard to social functioning (P = 0.008), emotional roles (P = 0.012), depression (P = 0.012), and sleep quality (P = 0.017). The young patients exhibited the highest levels of current experienced stress (young vs. old, P = 0.013). CONCLUSION This study has identified that middle-aged Chinese fibromyalgia patients exhibited less compromise of their QOL than did their older peers. This discrepancy begs a logical explanation and deserves further study. Key Points • This is the first clinical study to show the potential effect of age on fibromyalgia patients in China. • Characteristics, symptom severity, and QOL differ in different age groups. • The younger patients are, the worse their quality of life.
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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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Scaturro D, Vitagliani F, Tomasello S, Filippetti M, Picelli A, Smania N, Letizia Mauro G. Can the Combination of Rehabilitation and Vitamin D Supplementation Improve Fibromyalgia Symptoms at All Ages? J Funct Morphol Kinesiol 2022; 7:jfmk7020051. [PMID: 35736022 PMCID: PMC9224733 DOI: 10.3390/jfmk7020051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have indicated a correlation between vitamin D deficiency and widespread chronic pain syndromes, such as fibromyalgia. During this study, the effect of supplementation with vitamin D in association with physical exercise in patients with fibromyalgia was evaluated, in terms of improvement of pain, functional capacity and quality of life, also evaluating the presence of any differences in age. A single-center, observational, comparative study was conducted in 80 fibromyalgia patients. They are randomized into 2 groups: Group A, consisting of patients ≤50 years; and group B, consisting of patients >50 years. Both received weekly supplementation with 50,000 IU cholecalciferol for 3 months in association with a rehabilitation protocol. Patients were assessed at enrollment (T0), 3 months (T1), and 6 months (T2) from the initial assessment with blood vitamin D dosage and administration of rating scales (NRS, FIQ, and SF-12). From the comparison between the two groups, we have seen that in young people, supplementation with high-dose vitamin D improves short-term musculoskeletal pain and long-term functional capacity. Conversely, musculoskeletal pain and long-term quality of life improve in the elderly. Supplementing with high doses of vitamin D in fibromyalgia patients improves the quality of life and pain in the elderly and also the functional capacity in the young.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90127 Palermo, Italy;
- Correspondence:
| | - Fabio Vitagliani
- Faculty of Medicine and Surgery, University of Catania, 90121 Catania, Italy;
| | - Sofia Tomasello
- Faculty of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy;
| | - Mirko Filippetti
- Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy; (M.F.); (A.P.); (N.S.)
| | - Alessandro Picelli
- Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy; (M.F.); (A.P.); (N.S.)
- Neuromotor and Cognitive Rehabilitation Research Center, Physical and Rehabilitation Medicine Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
| | - Nicola Smania
- Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy; (M.F.); (A.P.); (N.S.)
- Neuromotor and Cognitive Rehabilitation Research Center, Physical and Rehabilitation Medicine Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90127 Palermo, Italy;
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Staud R. Advances in the management of fibromyalgia: what is the state of the art? Expert Opin Pharmacother 2022; 23:979-989. [PMID: 35509228 DOI: 10.1080/14656566.2022.2071606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic pain syndrome associated with fatigue, insomnia, dyscognition, and emotional distress. Critical illness mechanisms include central sensitization to nociceptive and non-nociceptive stimuli often resulting in hypersensitivity to all sensory input. AREAS COVERED The clinical presentation of FM can vary widely and therefore requires therapies tailored to each patient's set of symptoms. This manuscript examines currently prescribed therapeutic approaches supported by empirical evidence as well as promising novel treatments. Although pharmacological therapy until now has been only moderately effective for FM symptoms, it represents a critical component of every treatment plan. EXPERT OPINION Currently approved pharmacological therapies for FM symptoms have limited but proven effectiveness. Novel therapies with cannabinoids and naltrexone appear promising. Recent functional imaging studies of FM have discovered multiple brain network abnormalities that may provide novel targets for mechanism-based therapies. Future treatment approaches, however, need to improve more than clinical pain but also other FM domains like fatigue, insomnia, and distress.
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Affiliation(s)
- Roland Staud
- Division of Rheumatology and Clinical Immunology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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18
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Loftus CG, Ebbert JO, Aakre CA, Caine NA, DeZutter MA, Eastman RJ, Fischer SM, Gilman EA, Johnson MG, Luedtke CA, Mohabbat AB, Reinschmidt KJ, Roellinger DL, Sanchez W, Philpot LM. Creation of a Multispecialty Clinic for Patients with Central Sensitization-Based Chronic Pain Conditions. Mayo Clin Proc Innov Qual Outcomes 2022; 6:45-54. [PMID: 35005437 PMCID: PMC8715289 DOI: 10.1016/j.mayocpiqo.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To design and evaluate, through a human-centered design approach, a multispeciality clinic for patients with central sensitization syndromes that combined virtual previsit consultations, traditional face-to-face appointments, and technology-enabled educational programming. Patients and Methods Patients with suspected fibromyalgia and chronic abdominal pain were seen in a multispecialty practice, and the performance of the clinic was evaluated against a contemporary cohort. Quantitative and qualitative evaluation measures included team estimates of time spent on care-related tasks, physician rank of alignment of patient need with clinic design, major appointment changes, and nonvisit care tasks. Members of the care team also evaluated strengths, weaknesses, opportunities, and threats to the success of the clinic. Results The pilot clinic was operated from April 1, 2020, to April 30, 2021, and included 34 patients with suspected fibromyalgia/chronic abdominal pain. During the pilot period, physicians ranked the value of the virtual previsit consultations in providing care as 7.5 on a scale of 0 to 10 and reported an average of 50 minutes in preparation for the appointment, execution of the appointment, and postvisit documentation. We did not observe substantial differences in the number of added appointments or messages received within the patient portal when compared with a comparison cohort. Patients who participated in the combination nurse educator–led and digital education program provided positive feedback about their experience. Conclusion Our clinic model provides a framework for the treatment of patients with debilitating centrally sensitized conditions and future expansion of virtual care delivery models to better meet patient care and educational needs.
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19
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Vyshlova I, Karpov S, Raevskaya A, Reverchuk I. Rehabilitation of patients with chronic low back pain. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:14-19. [DOI: 10.17116/jnevro202212206114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis. PLoS One 2021; 16:e0254642. [PMID: 34270606 PMCID: PMC8284796 DOI: 10.1371/journal.pone.0254642] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 06/30/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic widespread pain (CWP) including fibromyalgia has a prevalence of up to 15% and is associated with substantial morbidity. Supporting psychosocial and behavioural self-management is increasingly important for CWP, as pharmacological interventions show limited benefit. We systematically reviewed the effectiveness of interventions applying self-management principles for CWP including fibromyalgia. METHODS MEDLINE, Embase, PsycINFO, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry were searched for studies reporting randomised controlled trials of interventions adhering to self-management principles for CWP including fibromyalgia. Primary outcomes included physical function and pain intensity. Where data were sufficient, meta-analysis was conducted using a random effects model. Studies were narratively reviewed where meta-analysis could not be conducted Evidence quality was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (PROSPERO-CRD42018099212). RESULTS Thirty-nine completed studies were included. Despite some variability in studies narratively reviewed, in studies meta-analysed self-management interventions improved physical function in the short-term, post-treatment to 3 months (SMD 0.42, 95% CI 0.20, 0.64) and long-term, post 6 months (SMD 0.36, 95% CI 0.20, 0.53), compared to no treatment/usual care controls. Studies reporting on pain narratively had greater variability, however, those studies meta-analysed showed self-management interventions reduced pain in the short-term (SMD -0.49, 95% CI -0.70, -0.27) and long-term (SMD -0.38, 95% CI -0.58, -0.19) compared to no treatment/usual care. There were few differences in physical function and pain when self-management interventions were compared to active interventions. The quality of the evidence was rated as low. CONCLUSION Reviewed studies suggest self-management interventions can be effective in improving physical function and reducing pain in the short and long-term for CWP including fibromyalgia. However, the quality of evidence was low. Future research should address quality issues whilst making greater use of theory and patient involvement to understand reported variability.
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21
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Correa-Rodríguez M, Rueda-Medina B, Casas-Barragán A, Tapia-Haro RM, Molina F, Aguilar-Ferrándiz ME. Dietary Intake Assessment, Severity of Symptoms, and Pain in Women with Fibromyalgia. Clin Nurs Res 2021; 30:1164-1173. [PMID: 33896220 DOI: 10.1177/10547738211012464] [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] [Indexed: 11/15/2022]
Abstract
A cross-sectional study was conducted to assess dietary intake in 92 FMS compared to 96 healthy control patients and to examine the potential associations between daily intake and pain and the severity of symptoms in women with FMS. The tender point count (TPC), the Visual Analog Scale (VAS), and the Revised Fibromyalgia Impact Questionnaire (FIQR) were assessed. FIQ-R correlated negatively with phosphorus (r = -.230, p = .028), iron (r = -.320, p = 0.002), zinc (r = -.238, p = .023), vitamin B1 (r = -.218, p = .038), vitamin B6 (r = -.123, p = .012), folic acid (r = -.250, p = .017), and vitamin C (r = -.217, p = .039). A negative correlation was also found between VAS pain and the intake of vitamin B6 (r = -.322, p = .002). Lower intakes of certain micronutrients correlated with higher scores in FIQ-R and a lower intake of vitamin B6 correlated with higher scores in VAS pain, supporting the potential relevance of these micronutrients in the severity of symptoms and in levels of global pain in FMS women.
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22
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Jiao J, Cheng Z, Wang W, Zhao Y, Jiang Q. Demographic Characteristics and Clinical Features of Fibromyalgia in China: A Cross-Sectional Study. Rheumatol Ther 2021; 8:817-831. [PMID: 33813715 PMCID: PMC8217401 DOI: 10.1007/s40744-021-00303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023] Open
Abstract
Objective The aim of this study is to characterize the demographics, fibromyalgia-related symptom severity and quality of life (QOL) among Chinese fibromyalgia patients. Methods A total of 124 patients who met the ACR 1990 criteria were recruited. Each subject completed a packet of questionnaires for collecting data on the demographics, medical history and severity of six major symptoms of fibromyalgia (i.e., pain, fatigue, sleep quality, depression, stress and QOL). Results The majority of the study subjects were women (86.3%), were married (78.2%) and had a mean age of 49.4 years and a median symptom duration of 24 months. Compared to their female counterparts, male patients were younger, were more likely to be employed, had a higher income and were more likely to be current smokers and alcohol drinkers (all p ≦ 0.027). Most patients experienced moderate to severe pain (69.4%), severe fatigue (70.2%) and moderate to severe depression (53.3%). A small percentage (19.4%) of the patients had very poor quality of sleep, and over one third (37.1%) suffered from moderate to severe stress. Less than one third (27.5%) patients’ health status was moderately or highly impacted by fibromyalgia. The mental health of men was affected significantly more than that of women, with lower SF-36 scores in the SF-36 mental component summary (p = 0.043) and role emotional (p = 0.006). Conclusion This study has revealed that Chinese fibromyalgia patients might share similar demographics but milder fibromyalgia-related symptoms and better mental QOL compared to patients of other races and ethnic groups. Some differences between male and female patients were found, too. Further cross-sectional studies with a larger sample size and nationwide study sites are needed to replicate those clinical findings.
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Affiliation(s)
- Juan Jiao
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China
| | - Zengyu Cheng
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China
| | - Wen Wang
- Rehabilitation Department, Shenzhen Hyzhen Hospital, Shenzhen, China
| | - Yayun Zhao
- Graduate School, Hebei University of Chinese Medicine, Hebei, China.,Rheumatology Department, Hebei Hospital of Traditional Chinese Medicine, Hebei, China
| | - Quan Jiang
- Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange Street, Beijing, 100053, Xicheng District, China.
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Pang HY, Farrer C, Wu W, Gakhal NK. Quality of rheumatology care for patients with fibromyalgia and chronic pain syndromes. BMJ Open Qual 2021; 10:bmjoq-2020-001061. [PMID: 33766832 PMCID: PMC7996658 DOI: 10.1136/bmjoq-2020-001061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background One-third of primary care providers (PCPs) refer patients with fibromyalgia or chronic pain (FM/CP) to specialist care, typically rheumatology. Yet, comprehensive data on the quality of rheumatology care for patients with FM/CP are currently lacking. Methods Records of patients referred for rheumatology consultation for FM/CP and seen at a single academic centre between 2017 and 2018 were extracted by retrospective chart review. Variables were diagnostic accuracy (at referral vs consultation), resource utilisation (investigations, medications, medical and allied health referral), direct costs (physician billing, staff salary, investigation fees) and access (consult wait time). Patient experience and referring PCP experience surveys were administered. Results 79 charts were identified. Following consultation, 81% of patients (n=64) maintained the same diagnosis of FM/CP, 19% (n=15) were diagnosed with regional pain and 0% of patients (n=0) were diagnosed with an inflammatory arthritis or connective tissue disease. Investigations were ordered for 37% of patients (n=29), medication prescribed for 10% (n=8) and an allied health referral provided for 54% (n=43). Direct costs totalled $19 745 (average $250/consult; range $157–$968/consult). Consultation wait time averaged 184 days (range 62–228 days). Out of the seven (64%) responses to the patient experience survey, 86% of patients (n=6) were satisfied with provider communication but the consultation ‘definitely’ met the expectations of only 57% (n=4). The PCP survey returned an insufficient response rate. Conclusions This study found that no patient referred to rheumatology care for FM/CP was diagnosed with an inflammatory arthritis or connective tissue disease. Furthermore, patients with FM/CP experience lengthy wait times for rheumatology care which delay their management of chronic pain. Interdisciplinary and collaborative healthcare models can potentially provide higher quality care for patients with FM/CP.
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Affiliation(s)
- Hilary Ym Pang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chandra Farrer
- Department of Rheumatology, Women's College Hospital, Toronto, Ontario, Canada.,Faculty of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Natasha K Gakhal
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Rheumatology, Women's College Hospital, Toronto, Ontario, Canada
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Zhang X, Xu H, Zhang Z, Li Y, Pauer L, Liao S, Zhang F. Efficacy and Safety of Pregabalin for Fibromyalgia in a Population of Chinese Subjects. J Pain Res 2021; 14:537-548. [PMID: 33658841 PMCID: PMC7920593 DOI: 10.2147/jpr.s281483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Fibromyalgia (FM) may go underdiagnosed and untreated in China in part due to a lack of awareness and understanding of the condition, and limited available treatments. PATIENTS AND METHODS This randomized, double-blind, Phase III local registration trial compared the efficacy and safety of pregabalin (flexibly dosed 300-450 mg/day) versus placebo for the management of pain in Chinese adults diagnosed with FM according to American College of Rheumatology 1990 criteria, across 22 centers within China. Patients reported pain score of ≥40 mm on 100-mm scale (from 0 "no pain" to 100 "worst possible pain"). The primary efficacy endpoint was change from baseline to Week 14 in mean pain score (MPS). Secondary endpoints included measures of sleep and sleep interference. Safety and tolerability were monitored throughout. RESULTS Median pregabalin dose was 335 mg/day. A significant reduction from baseline to Week 14 in weekly MPS was seen for patients treated with pregabalin (n=170) versus placebo (n=164) (least-squares mean difference [95% confidence interval]: -0.73 [-1.10 to -0.36]; P=0.0001). Significantly greater proportions of patients experienced ≥30% and ≥50% reductions in MPS at Week 14 with pregabalin versus placebo. Pregabalin-treated subjects demonstrated improvements in measures of sleep and sleep interference. Pregabalin was generally well tolerated. The most common adverse events were dizziness and somnolence; no serious adverse events (SAEs) occurred in pregabalin-treated subjects. Nine placebo-treated subjects experienced SAEs. CONCLUSION Pregabalin (300-450 mg/day) is a safe and effective treatment for reducing pain and improving sleep in native Chinese subjects with FM. CLINICALTRIALSGOV IDENTIFIER NCT01387607.
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Affiliation(s)
- Xiao Zhang
- Department of Rheumatology, Guangdong General Hospital, Guangdong, People’s Republic of China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Affiliated to Second Military Medical University, Shanghai, People’s Republic of China
| | - Zhiyi Zhang
- School of Clinical Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Yang Li
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Lynne Pauer
- Global Research and Development, Pfizer, Groton, CT, USA
| | - Shanmei Liao
- Pfizer China Statistics Department, Global Innovative Pharma Business, Shanghai, People’s Republic of China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Beijing, People’s Republic of China
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Arnold LM, Blauwet MB, Tracy K, Cai N, Walzer M, Blahunka P, Marek GJ. Efficacy and Safety of ASP0819 in Patients with Fibromyalgia: Results of a Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial. J Pain Res 2020; 13:3355-3369. [PMID: 33328761 PMCID: PMC7735791 DOI: 10.2147/jpr.s274562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE ASP0819 is a novel, non-opioid KCa3.1 channel opener that reverses abnormal nerve firing of primary sensory afferent nerves. Currently available treatments for fibromyalgia provide only modest relief and are accompanied by a host of adverse side effects. PATIENTS AND METHODS In this phase 2a, double-blind trial (NCT03056690), adults meeting fibromyalgia diagnostic criteria were randomized 1:1 to receive either 15 mg/day of oral ASP0819 (n=91) or placebo (n=95). The primary endpoint was the change from baseline to Week 8 in the mean daily average pain score. Changes in the Fibromyalgia Impact Questionnaire Revised (FIQR) symptoms, function, and overall impact subscales, as well as changes in the patients' global impression of change, were secondary endpoints; treatment effects on FIQR total score and impact on sleep were exploratory analyses. RESULTS There was no statistically significant difference between ASP0819 and placebo for the primary endpoint (P=0.086); however, ASP0819 versus placebo significantly improved daily average pain at Weeks 2, 6, and 7 (all P<0.05). Numerical improvements were observed on the FIQR total score and several sleep items showed statistically significant improvements with ASP0819 versus placebo. There were no major safety concerns with ASP0819. Headache was the most common treatment-emergent adverse event (TEAE) occurring in both study arms; most TEAEs were mild or moderate in severity and no TEAEs suggestive of potential drug abuse were observed, as assessed by TEAE reporting and/or safety evaluations. Withdrawal effects also were not observed. CONCLUSION ASP0819 demonstrated some signals suggestive of efficacy and had a good tolerability profile in patients with fibromyalgia. Further studies are required to determine if ASP0819 can be a novel non-opioid treatment option in this patient group. CLINICALTRIALSGOV REGISTRATION NCT03056690.
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Affiliation(s)
- Leslie M Arnold
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Katherine Tracy
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Na Cai
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Mark Walzer
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Paul Blahunka
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Gerard J Marek
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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Trainor H, Baranoff J, Henke M, Winefield H. Functioning with fibromyalgia: The role of psychological flexibility and general psychological acceptance. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Heather Trainor
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - John Baranoff
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Miriam Henke
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helen Winefield
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Effects of a six-week mobile app versus paper book intervention on quality of life, symptoms, and self-care in patients with fibromyalgia: a randomized parallel trial. Braz J Phys Ther 2020; 25:428-436. [PMID: 33248904 DOI: 10.1016/j.bjpt.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/23/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The ProFibro application (app) was developed as a Mobile Health resource to promote self-care in fibromyalgia management. OBJECTIVE This study aimed to assess the effects of the use of the ProFibro app for six weeks compared to the use of a traditional paper book of similar content to improve health-related quality of life, symptoms, and self-care agency in individuals with fibromyalgia. METHODS Forty individuals with fibromyalgia were included in this randomized, single-blind, parallel trial. One group received intervention content using the ProFibro app on a smartphone while the other received similar information using a paper book. Participants were assessed at baseline and after six weeks. The primary outcome was the Revised Fibromyalgia Impact Questionnaire. Secondary outcomes were Widespread Pain Index, Pain Visual Analog Scale, Symptom Severity Scale, and Appraisal of Self-Care Agency Scale - Revised. RESULTS No differences in changes were found between groups at the end of the treatment for any outcome. Both groups showed improvements in symptom severity. CONCLUSIONS The use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. Both groups showed improvements from baseline on severity of symptoms, suggesting that the self-care program using a mobile app or a paper book may be beneficial for individuals with fibromyalgia.
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Clark S, Martin F, McGowan RTS, Smidt J, Anderson R, Wang L, Turpin T, Langenfeld-McCoy N, Bauer B, Mohabbat AB. The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia. Mayo Clin Proc 2020; 95:2442-2461. [PMID: 32819740 DOI: 10.1016/j.mayocp.2020.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the direct physiological and emotional impact of an animal-assisted activity (AAA) session (a form of complementary and integrative medicine) in patients with fibromyalgia (FM). PATIENTS AND METHODS The study population consisted of 221 participants with FM who were attending Mayo Clinic's Fibromyalgia Treatment Program between August 5, 2017, and September 1, 2018. This was a randomized controlled trial. Participants were randomly assigned to either the treatment group (a 20-minute session with a certified therapy dog and handler) or the control group (a 20-minute session with a handler only). To gain a better understanding of the direct physiological and emotional effects of AAA in patients with FM, we used multiple noninvasive physiologic-emotional biomarkers, including salivary cortisol and oxytocin concentrations, tympanic membrane temperatures, and various cardiac parameters, in addition to standardized pain and mood-based questionnaires. RESULTS Results show a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants in the treatment group were in a more positive emotional-physiologic state as a result of the AAA session compared with the control group. CONCLUSION Our results suggest that a 20-minute therapy dog visit in an outpatient setting can significantly and positively impact the physical and mental health of patients with FM.
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Affiliation(s)
- Stephanie Clark
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Jessica Smidt
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Lei Wang
- Nestlé Purina Research, St. Louis, MO
| | | | | | - Brent Bauer
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Arya B Mohabbat
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
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Doebl S, Macfarlane GJ, Hollick RJ. "No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence. Pain 2020; 161:1716-1725. [PMID: 32701832 DOI: 10.1097/j.pain.0000000000001870] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Fibromyalgia is a common and complex long-term pain condition. Despite advancements in our understanding and treatment of fibromyalgia, patients report patchy health care provision and frustrating journeys through the health care system. To inform how best to deliver care, we undertook 2 narrative reviews examining existing evidence on (1) models of care for fibromyalgia and (2) patients' experiences, preferences, and unmet needs regarding their health care. Seven databases were systematically searched. Quantitative data was narratively synthesised and qualitative data thematically analysed. No evidence-based model of care covering the patient journey through the entire health care system was identified. Limited evidence suggests no clear benefit for ongoing care in secondary care settings. Patients with fibromyalgia report difficult interactions with the health care system that might equally be expressed by those with other long-term conditions, such as inconsistent and poorly coordinated care. However, they also face unique problems; fibromyalgia was often not viewed as a real condition, resulting in difficult encounters with health care staff, in particular not feeling believed or listened to. Significant delays in diagnosis were commonplace. Positive care experiences such as being listened to and shared decision-making made patients feeling better informed, well supported, and more satisfied. There is little evidence to inform how best to organise health care for patients with fibromyalgia and ensure care is delivered in a coordinated and consistent way. These findings provide a strong rationale for developing a new model of care for fibromyalgia.
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Affiliation(s)
- Stefanie Doebl
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Rosemary J Hollick
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
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Castro-Sánchez AM, Garcia-López H, Fernández-Sánchez M, Perez-Marmol JM, Leonard G, Gaudreault N, Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupunct Med 2020; 38:140-149. [DOI: 10.1136/acupmed-2017-011504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Fibromyalgia syndrome (FMS) is a condition characterised by the presence of chronic, widespread musculoskeletal pain, low pain threshold and hyperalgesia. Myofascial trigger points (MTrPs) may worsen symptoms in patients with FMS. Objective: The purpose of this randomised controlled trial was to compare the effects of dry needling and transcutaneous electrical nerve stimulation (TENS) on pain intensity, heart rate variability, galvanic response and oxygen saturation (SpO2). Methods: 74 subjects with FMS were recruited and randomly assigned to either the dry needling group or the TENS group. Outcomes measures (pain intensity, heart rate variability, galvanic skin response, SpO2 and photoplethysmography) were evaluated at baseline and after 6 weeks of treatment. 2×2 mixed-model analyses of variance (ANOVAs) were performed. Results: The mixed-model ANOVAs showed significant differences between groups for the sensory dimension of pain, affective dimension of pain, total dimension of pain, visual analogue scale (VAS) and present pain intensity (PPI) (P=0.001). ANOVAs also showed that significant differences between groups were achieved for very low frequency power of heart rate variability (P=0.008) and low frequency power (P=0.033). There were no significant differences in dry needling versus TENS groups on the spectral analysis of the photoplethysmography and SpO2. Conclusions: This trial showed that application of dry needling therapy and TENS reduced pain attributable to MTrPs in patients with FMS, with greater improvements reported in the dry needling group across all dimensions of pain. Additionally, there were between-intervention differences for several parameters of heart rate variability and galvanic skin responses. Trial registration number: NCT02393352
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Affiliation(s)
- Adelaida María Castro-Sánchez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | | | | | - José Manuel Perez-Marmol
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
- Department of Physical Therapy, University of Granada, Granada, Spain
| | - Guillaume Leonard
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Nathaly Gaudreault
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Guillermo Adolfo Matarán-Peñarrocha
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
- Andalusian Health Service, Primary Health Medical, Distrito Sanitario Málaga, Málaga, Spain
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31
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Paz C, Aguilera M, Salla M, Compañ V, Medina JC, Bados A, García-Grau E, Castel A, Cañete Crespillo J, Montesano A, Medeiros-Ferreira L, Feixas G. Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial. Neuropsychiatr Dis Treat 2020; 16:301-311. [PMID: 32021219 PMCID: PMC6987966 DOI: 10.2147/ndt.s235161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. METHODS AND ANALYSIS This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions. TRIAL REGISTRATION ClinicalTrials.gov: NCT02711020.
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Affiliation(s)
- Clara Paz
- School of Psychology, Universidad de Las Américas, Quito, Ecuador
| | - Mari Aguilera
- Department of Cognition, Development and Educational Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Marta Salla
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Compañ
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Joan C Medina
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Arturo Bados
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Eugeni García-Grau
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Castel
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | | | - Adrián Montesano
- Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
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Effects of Ganoderma lucidum and Ceratonia siliqua on blood glucose, lipid profile, and body composition in women with fibromyalgia. NUTR HOSP 2020; 38:139-145. [PMID: 33319566 DOI: 10.20960/nh.03190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: fibromyalgia (FM) is a chronic rheumatic disorder that is related to high levels of cholesterol, high values of diastolic pressure, higher waist-to-hip-ratio (WHR), and higher body mass index. Objectives: the aim of this study was to evaluate the effects of Ganoderma lucidum (GL) and Ceratonia siliqua (CS) on blood parameters and anthropometrical measures in women with fibromyalgia. Methods: a double-blind randomized pilot trial was carried out. One group took 6 g/day of micro-milled carpophore powder of GL for 6 weeks, while the second group took the same dose of CS flour. Fasting glucose, cholesterol, triglycerides levels, weight, fat mass, muscular mass, waist-hip ratio, and blood pressure were assessed. Results: our results did not show any statistically significant differences in any of the outcome measures, even if there was a CS tendency to reduce fasting glucose levels and increase WHR. Conclusions: our results did not support the utility of both GL and CS as nutritional supplements to control blood parameters and anthropometric measures as assessed in women with fibromyalgia. Due to the limitations of the research, additional studies will be necessary to confirm our findings.
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Paredes S, Cantillo S, Candido KD, Knezevic NN. An Association of Serotonin with Pain Disorders and Its Modulation by Estrogens. Int J Mol Sci 2019; 20:E5729. [PMID: 31731606 PMCID: PMC6888666 DOI: 10.3390/ijms20225729] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Ovarian hormones play an important role in pain perception, and are responsible, at least in part, for the pain threshold differences between the sexes. Modulation of pain and its perception are mediated by neurochemical changes in several pathways, affecting both the central and peripheral nervous systems. One of the most studied neurotransmitters related to pain disorders is serotonin. Estrogen can modify serotonin synthesis and metabolism, promoting a general increase in its tonic effects. Studies evaluating the relationship between serotonin and disorders such as irritable bowel syndrome, fibromyalgia, migraine, and other types of headache suggest a clear impact of this neurotransmitter, thereby increasing the interest in serotonin as a possible future therapeutic target. This literature review describes the importance of substances such as serotonin and ovarian hormones in pain perception and illustrates the relationship between those two, and their direct influence on the presentation of the aforementioned pain-related conditions. Additionally, we review the pathways and receptors implicated in each disorder. Finally, the objective was to stimulate future pharmacological research to experimentally evaluate the potential of serotonin modulators and ovarian hormones as therapeutic agents to regulate pain in specific subpopulations.
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Affiliation(s)
- Stephania Paredes
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Santiago Cantillo
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Kenneth D. Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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Wan B, Gebauer S, Salas J, Jacobs CK, Breeden M, Scherrer JF. Gender-Stratified Prevalence of Psychiatric and Pain Diagnoses in a Primary Care Patient Sample with Fibromyalgia. PAIN MEDICINE 2019; 20:2129-2133. [PMID: 31009534 DOI: 10.1093/pm/pnz084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Comorbid psychiatric and pain-related conditions are common in patients with fibromyalgia. Most studies in this area have used data from patients in specialty care and may not represent the characteristics of fibromyalgia in primary care patients. We sought to fill gaps in the literature by determining if the association between psychiatric diagnoses, conditions associated with chronic pain, and fibromyalgia differed by gender in a primary care patient population. DESIGN Retrospective cohort. SETTING AND SUBJECTS Medical record data obtained from 38,976 patients, ≥18 years of age with a primary care encounter between July 1, 2008, to June 30, 2016. METHODS International Classification of Diseases-9 codes were used to define fibromyalgia, psychiatric diagnoses, and conditions associated with chronic pain. Unadjusted associations between patient demographics, comorbid conditions, and fibromyalgia were computed using binary logistic regression for the entire cohort and separately by gender. RESULTS Overall, 4.6% of the sample had a fibromyalgia diagnosis, of whom 76.1% were women. Comorbid conditions were more prevalent among patients with vs without fibromyalgia. Depression and arthritis were more strongly related to fibromyalgia among women (odds ratio [OR] = 2.80, 95% confidence interval [CI] = 2.50-3.13; and OR = 5.19, 95% CI = 4.62-5.84) compared with men (OR = 2.16, 95% CI = 1.71-2.71; and (OR = 3.91, 95% CI = 3.22-4.75). The relationship of fibromyalgia and other diagnoses did not significantly differ by gender. CONCLUSIONS Except for depression and arthritis, the burden of comorbid conditions in patients with fibromyalgia is similar in women and men treated in primary care. Fibromyalgia comorbidities in primary care are similar to those found in specialty care.
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Affiliation(s)
- Betsy Wan
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Christine K Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Breeden
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Velasco M. DOLOR MUSCULOESQUELÉTICO: FIBROMIALGIA Y DOLOR MIOFASCIAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Martín-Martínez JP, Villafaina S, Collado-Mateo D, Pérez-Gómez J, Gusi N. Effects of 24-week exergame intervention on physical function under single- and dual-task conditions in fibromyalgia: A randomized controlled trial. Scand J Med Sci Sports 2019; 29:1610-1617. [PMID: 31206782 DOI: 10.1111/sms.13502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/09/2019] [Accepted: 06/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effects of 24-week exergame intervention in the physical fitness of women with fibromyalgia in both single- and dual-task conditions. DESIGN Single-blinded, randomized controlled trial. SETTING University facilities. PARTICIPANTS Fifty-five women with fibromyalgia, recruited from the local fibromyalgia association, were randomly assigned to one of the two groups: exercise group and control group. INTERVENTION The exercise group completed 24 weeks of supervised and group-based exergame protocol, divided into two sessions of 60 minutes. The intervention was focused on mobility, postural control, upper and lower limbs coordination, aerobic fitness, and strength. MAIN OUTCOME MEASURES The strength of the upper limbs was measured using the arm curl test. The mobility skill was assessed through the timed-up and go test, and the flexibility of both upper and lower limbs was measured using the back scratch and the sit and reach tests, respectively. RESULTS Fifty participants completed the study. In the single-task condition, exergame intervention led to significantly higher effects in the arm curl test (P = 0.008), sit and reach test (P = 0.033), and timed-up and go test (P = 0.021). Moreover, under dual-task condition, exergames led to significant effects in all the physical fitness tests (arm curl test, timed-up and go test, back scratch test, and sit and reach test) compared to the control group. CONCLUSIONS Exergame is an effective tool to improve the physical fitness in women with fibromyalgia under single or dual-task conditions.
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Affiliation(s)
| | | | - Daniel Collado-Mateo
- Faculty of Sport Science, University of Extremadura, Caceres, Spain.,Facultad de Educación, Universidad Autonoma de Chile, Talca, Chile
| | | | - Narcis Gusi
- Faculty of Sport Science, University of Extremadura, Caceres, Spain
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Martin KR, Druce KL, Murdoch SE, D'Ambruoso L, Macfarlane GJ. Differences in long-term physical activity trajectories among individuals with chronic widespread pain: A secondary analysis of a randomized controlled trial. Eur J Pain 2019; 23:1437-1447. [PMID: 31034106 DOI: 10.1002/ejp.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/25/2019] [Accepted: 04/21/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known about long-term physical activity (PA) maintenance in those with chronic widespread pain (CWP) following an exercise intervention. This study examined PA over time to identify the existence and characteristics of subgroups following distinct PA trajectories. METHODS Data come from individuals with CWP who took part in a 2 × 2 factorial randomized controlled trial, receiving either exercise or both exercise and cognitive behavioural therapy treatment. Information, including self-report PA, was collected at baseline recruitment, immediately post-intervention, 3, 24 and 60+ month post-treatment. Analyses were conducted on 196 men and women with ≥ 3 PA data points. Group-based trajectory modelling was used to identify latent PA trajectory groups and baseline characteristics (e.g., demographics, pain, self-rated health, fatigue, coping-strategy use and kinesiophobia) of these groups. RESULTS The best fitting model identified was one with three trajectories: "non-engagers" (n = 32), "maintainers" (n = 144) and "super-maintainers" (n = 20). Overall, mean baseline PA levels were significantly different between groups (non-engagers: 1.1; maintainers: 4.6; super-maintainers: 8.6, p < 0.001) and all other follow-up points. Non-engagers reported, on average, greater BMI, higher disabling chronic pain, poorer self-rated health, physical functioning, as well as greater use of passive coping strategies and lower use of active coping strategies. CONCLUSIONS The majority of individuals with CWP receiving exercise as part of a trial were identified as long-term PA maintainers. Participants with poorer physical health and coping response to symptoms were identified as non-engagers. For optimal symptom management, a stratified approach may enhance initiation and long-term PA maintenance in individuals with CWP. SIGNIFICANCE Chronic pain can be a major barrier to engaging in exercise, a popular self-management strategy. Our findings identify three distinct long-term physical activity trajectories for individuals receiving the same exercise intervention. This suggests an approach by health care providers which identifies individuals who would benefit from additional support to enhance initiation and long-term physical activity maintenance could deliver better outcomes for such patients.
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Affiliation(s)
- Kathryn R Martin
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah E Murdoch
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia D'Ambruoso
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
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Meresh ES, Artin H, Joyce C, Birch S, Daniels D, Owens JH, La Rosa AJ, Rao MS, Halaris A. Obstructive sleep apnea co-morbidity in patients with fibromyalgia: a single-center retrospective analysis and literature review. Open Access Rheumatol 2019; 11:103-109. [PMID: 31118843 PMCID: PMC6500898 DOI: 10.2147/oarrr.s196576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Fibromyalgia (FM) is a chronic medical condition characterized by widespread pain, sleep disturbance, and cognitive dysfunction. Sleep disorders are thought to play a prominent role in the etiology and symptomatic management of FM, specifically obstructive sleep apnea (OSA). In order to provide collaborative care, we need a better understanding of any overlapping presentation of FM and OSA. We conducted a site-wide review of patients from 2012-2016 to identify FM patients diagnosed with OSA. Methods: Charts were reviewed in patients aged 18 and above from 2012-2016 using ICD codes from a clinical data repository. Intersection of patients with a diagnosis of FM and OSA in clinics of psychiatry, sleep, rheumatology, and other outpatient clinics was compared. Polysomnography order patterns for FM patients were investigated. Results: Co-morbidity was highest in the sleep clinic (85.8%) compared to psychiatry (42.0%), rheumatology (18.7%), and other outpatient clinics (3.6%) (p<0.001). In the rheumatology and other outpatient clinics, 93.5% and 96% of patients respectively, had no polysomnography ordered. Pairwise comparison of co-morbidity in clinics: sleep vs psychiatry, sleep vs rheumatology, sleep vs other clinics, psychiatry vs rheumatology, psychiatry vs other clinics, and rheumatology vs other clinics were statistically significant after applying a Sidak adjustment to the p-values (all p<0.001). Conclusion: Our analysis suggests that there could be a correlation between FM and OSA, and referral to sleep studies is recommended in the management of patients with FM. The varying prevalence of FM patients with co-morbid OSA in sleep clinics when compared to other outpatient clinics suggests a discrepancy in the identification of FM patients with OSA. When properly screened, OSA co-morbidity has the potential to be higher in other outpatient clinics.
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Affiliation(s)
- Edwin S Meresh
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Hewa Artin
- Loyola Stritch School of Medicine, Maywood, IL 60153, USA
| | - Cara Joyce
- Biostatistics Core, Clinical Research Office, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Steven Birch
- Informatics and Systems Development, Loyola University Medical Center, Maywood, IL 60153, USA
| | - David Daniels
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jack H Owens
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Alvaro J La Rosa
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Murali S Rao
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Angelos Halaris
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
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Wylezinski LS, Gray JD, Polk JB, Harmata AJ, Spurlock CF. Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes. J Clin Med 2019; 8:E493. [PMID: 30979036 PMCID: PMC6518102 DOI: 10.3390/jcm8040493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. This growing population that affects close to 60 million people in the U.S. places a significant burden on the healthcare system. Characterized by relatively slow development, these diseases and syndromes prove challenging to diagnose, leading to delayed treatment against the backdrop of inevitable disability progression. Patients require healthcare attention but are initially hidden from clinician's view by the seemingly generalized, non-specific symptoms. It is imperative to identify and manage these underlying conditions to slow disease progression and reduce the likelihood that costly comorbidities will develop. Enhanced diagnostic criteria coupled with additional technological innovation to identify inflammatory conditions earlier is necessary and in the best interest of all healthcare stakeholders. The current total cost to the U.S. healthcare system is at least $90B dollars annually. Through unique analysis of financial cost drivers, this review identifies opportunities to improve clinical outcomes and help control these disease-related costs by 20% or more.
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Affiliation(s)
- Lukasz S Wylezinski
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
| | | | | | | | - Charles F Spurlock
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
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Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med 2019; 131:185-198. [DOI: 10.1080/00325481.2019.1574403] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Verne Pitman
- Global Medical Affairs, US Medical Affairs, Pfizer Inc, New York, NY, USA
| | - Kim D. Jones
- School of Nursing, Linfield College, Portland, OR, USA
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Yuan SLK, Marques AP. Development of ProFibro — a mobile application to promote self-care in patients with fibromyalgia. Physiotherapy 2018; 104:311-317. [DOI: 10.1016/j.physio.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
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Luty J. Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue. BJPSYCH ADVANCES 2018. [DOI: 10.1192/bja.2017.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SUMMARYThis is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and ‘alternative’ or ‘complementary’ interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.LEARNING OBJECTIVES•To become aware of the high prevalence of medically unexplained syndromes•To review the effectiveness of treatment of medically unexplained syndromes•To be familiar with the conflict between health professionals and patients and the difficulty this continues to createDECLARATION OF INTERESTNone.
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Thorpe J, Shum B, Moore RA, Wiffen PJ, Gilron I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst Rev 2018; 2:CD010585. [PMID: 29457627 PMCID: PMC6491103 DOI: 10.1002/14651858.cd010585.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated. Combining different agents could provide superior pain relief and possibly also fewer side effects. OBJECTIVES To assess the efficacy, safety, and tolerability of combination pharmacotherapy compared to monotherapy or placebo, or both, for the treatment of fibromyalgia pain in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to September 2017. We also searched reference lists of other reviews and trials registries. SELECTION CRITERIA Double-blind, randomised controlled trials comparing combinations of two or more drugs to placebo or other comparators, or both, for the treatment of fibromyalgia pain. DATA COLLECTION AND ANALYSIS From all studies, we extracted data on: participant-reported pain relief of 30% or 50% or greater; patient global impression of clinical change (PGIC) much or very much improved or very much improved; any other pain-related outcome of improvement; withdrawals (lack of efficacy, adverse events), participants experiencing any adverse event, serious adverse events, and specific adverse events (e.g. somnolence and dizziness). The primary comparison was between combination and one or all single-agent comparators. We also assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS We identified 16 studies with 1474 participants. Three studies combined a non-steroidal anti-inflammatory drug (NSAID) with a benzodiazepine (306 participants); two combined amitriptyline with fluoxetine (89 participants); two combined amitriptyline with a different agent (92 participants); two combined melatonin with an antidepressant (164 participants); one combined carisoprodol, paracetamol (acetaminophen), and caffeine (58 participants); one combined tramadol and paracetamol (acetaminophen) (315 participants); one combined malic acid and magnesium (24 participants); one combined a monoamine oxidase inhibitor with 5-hydroxytryptophan (200 participants); and one combined pregabalin with duloxetine (41 participants). Six studies compared the combination of multiple agents with each component alone and with inactive placebo; three studies compared combination pharmacotherapy with each individual component but did not include an inactive placebo group; two studies compared the combination of two agents with only one of the agents alone; and three studies compared the combination of two or more agents only with inactive placebo.Heterogeneity among studies in terms of class of agents evaluated, specific combinations used, outcomes reported, and doses given prevented any meta-analysis. None of the combinations of drugs found provided sufficient data for analysis compared with placebo or other comparators for our preferred outcomes. We therefore provide a narrative description of results. There was no or inadequate evidence in any comparison for primary and secondary outcomes. Two studies only reported any primary outcomes of interest (patient-reported pain relief of 30%, or 50%, or greater). For each 'Risk of bias' item, only half or fewer of studies had unequivocal low risk of bias. Small size and selective reporting were common as high risk of bias.Our GRADE assessment was therefore very low for primary outcomes of pain relief of 30% or 50% or greater, PGIC much or very much improved or very much improved, any pain-related outcome, participants experiencing any adverse event, any serious adverse event, or withdrawing because of an adverse event.Three studies found some evidence that combination pharmacotherapy reduced pain compared to monotherapy; these trials tested three different combinations: melatonin and amitriptyline, fluoxetine and amitriptyline, and pregabalin and duloxetine. Adverse events experienced by participants were not serious, and where they were reported (in 12 out of 16 studies), all participants experienced them, regardless of treatment. Common adverse events were nausea, dizziness, somnolence, and headache. AUTHORS' CONCLUSIONS There are few, large, high-quality trials comparing combination pharmacotherapy with monotherapy for fibromyalgia, consequently limiting evidence to support or refute the use of combination pharmacotherapy for fibromyalgia.
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Affiliation(s)
- Joelle Thorpe
- Queen's UniversityAnesthesiology & Perioperative MedicineKingstonONCanada
| | - Bonnie Shum
- Queen's UniversityAnesthesiology & Perioperative MedicineKingstonONCanada
| | | | | | - Ian Gilron
- Queen's UniversityDepartments of Anesthesiology & Perioperative Medicine & Biomedical & Molecular Sciences76 Stuart StreetVictory 2 PavillionKingstonONCanadaK7L 2V7
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Schmidt JE, O'Brien TG, Hooten WM, Joyner MJ, Johnson BD. The effects of slow-paced versus mechanically assisted breathing on autonomic function in fibromyalgia patients. J Pain Res 2017; 10:2761-2768. [PMID: 29263690 PMCID: PMC5727106 DOI: 10.2147/jpr.s139642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Paced breathing has shown efficacy in fibromyalgia (FM), but the mechanisms associated with symptom change are largely unknown. We investigated whether changes in respiratory rate (RR) alone resulted in autonomic changes during normal, paced, and mechanically assisted breathing in untrained FM patients and controls. Participants included 20 FM patients and 14 controls matched for age and body mass index. During a single visit, participants completed three 15-minute breathing sessions: 1) normal breathing, 2) slow-paced breathing, and 3) mechanically assisted breathing (continuous positive airway pressure) while supine. Continuous blood pressure and electrocardiogram were recorded, and measures of heart rate variability (HRV) and spontaneous baroreceptor sensitivity (sBRS) were calculated. During normal breathing, FM patients had higher heart rate (HR), but lower HRV and sBRS variables compared to controls with no difference in RR. Compared to the paced breathing condition, FM patients had significantly lower HR with higher HRV and sBRS variables during mechanically assisted breathing, despite no significant change in RR. Mechanically assisted breathing provided greater benefits in autonomic function than paced breathing in untrained FM patients. Future research will be needed to elucidate the central pathways involved in these autonomic changes and whether training in paced breathing can eventually replicate the results seen in mechanically assisted patients.
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Affiliation(s)
- John E Schmidt
- Department of Psychology, Navy Medicine Professional Development Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | | | | | - Bruce D Johnson
- Department of Medicine.,Department of Physiology, Mayo Clinic, Rochester, MN, USA
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Atzeni F, Gerardi MC, Masala IF, Alciati A, Batticciotto A, Sarzi-Puttini P. An update on emerging drugs for fibromyalgia treatment. Expert Opin Emerg Drugs 2017; 22:357-367. [PMID: 29250975 DOI: 10.1080/14728214.2017.1418323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic disorder whose symptoms of pain, fatigue, sleep disturbances and depression have a devastating effect on patients' lives as it limits their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms. The aim of this narrative review is to summarise the data relating to the new therapeutic options that have become available over the last few years. Areas covered: Increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, and studies have been carried out in order to investigate the possibility of using drugs that are currently used for other diseases. Expert opinion: Slight improvements in the health of FM patients treated with drugs targeting a range of molecular mechanisms have been observed, but there is still no single drug that is capable of offering substantial efficacy against all of the characteristic symptoms of FM. The identification of new and improved therapies for FM requires consideration of the heterogeneity of the condition, which suggests the existence of different patient subgroups, a relationship between central and peripheral aspects of the pathophysiology, and the need for combined treatment with drugs targeting multiple molecular mechanisms.
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Affiliation(s)
- Fabiola Atzeni
- a Rheumatology Unit , University of Messina , Messina , Italy
| | | | | | - Alessandra Alciati
- d Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Como , Italy
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Abstract
This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients' lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general.
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Karatay S, Okur SC, Uzkeser H, Yildirim K, Akcay F. Effects of Acupuncture Treatment on Fibromyalgia Symptoms, Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled Clinical Trial. PAIN MEDICINE 2017; 19:615-628. [DOI: 10.1093/pm/pnx263] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Saliha Karatay
- Health Science Faculty, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Sibel Caglar Okur
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Hulya Uzkeser
- Department of Physical Medicine and Rehabilitation, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Kadir Yildirim
- Department of Physical Medicine and Rehabilitation, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Fatih Akcay
- Department of Biochemistry, Ataturk University, Medical Faculty, Erzurum, Turkey
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Davis F, Gostine M, Roberts BA, Risko R, Cappelleri JC, Sadosky A. Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients. Pain Pract 2017; 18:611-624. [PMID: 29064627 DOI: 10.1111/papr.12651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of opioids and/or pregabalin on patient-reported outcomes among fibromyalgia (FM) patients based on levels of improvement. METHODS A total of 1,421 FM patients were identified, with 3,082 observational periods of opioids with or without pregabalin use between April 2008 and February 2015. Patients were categorized by opioids, and pregabalin with and without opioids; opioids were designated by morphine equivalent dose (MED) of ≤ 20 (low MED), > 20 to < 100 (moderate MED), ≥ 100 (high MED), and pregabalin doses of ≤ 150 mg, 151 to 300 mg, and 301 to 450 mg. Proportions of patients meeting clinically relevant thresholds of ≥ 30% and ≥ 50% improvement for pain interference (ability to enjoy life; activity; mood; relationships; sleep), pain severity, and fatigue were compared among treatments, and area under the curve (AUC) for improvement and worsening of effects was determined, enabling ranking of treatments. Further analysis compared pregabalin doses. RESULTS Pregabalin without opioids resulted in the highest proportions of patients with ≥ 30% improvement on all pain items and pain interference with "ability to enjoy life," "activity" "mood," and "sleep." For the ≥ 50% threshold, pregabalin alone was highest for all pain interference items and for "average pain" and "worst pain." Pregabalin was consistently lowest across thresholds for fatigue, but showed better results combined with moderate MED opioids. Pregabalin doses recommended for treatment of FM (151 to 450 mg) generally resulted in the highest proportion of patients achieving thresholds relative to opioids. The AUC results were consistent with thresholds; pregabalin without opioids resulted in the greatest benefits with regard to improvement, with the highest ranking for overall improvement and overall effects. CONCLUSION Pregabalin without opioids provided the most favorable outcomes overall based on ≥ 30% and ≥ 50% improvement thresholds and AUC, with support for moderate MED opioids + pregabalin in patients suffering from fatigue. While most patients took less than recommended pregabalin doses, higher doses may lead to improved outcomes.
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Affiliation(s)
- Fred Davis
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
| | - Mark Gostine
- Michigan Pain Consultants, Grand Rapids, Michigan, U.S.A
| | | | - Rebecca Risko
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
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Makrani AH, Afshari M, Ghajar M, Forooghi Z, Moosazadeh M. Vitamin D and fibromyalgia: a meta-analysis. Korean J Pain 2017; 30:250-257. [PMID: 29123619 PMCID: PMC5665736 DOI: 10.3344/kjp.2017.30.4.250] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/06/2022] Open
Abstract
Vitamin D is a cofactor responsible for autoimmune disorders. There is no agreement in the studies investigating the association between vitamin D and fibromyalgia. This study aims to combine the conflicting results of the primary studies which compared these patients with control groups regarding the serum concentration of vitamin D. This meta-analysis has been designed based on PRISMA guidelines. Relevant keywords were searched in PubMed, Science direct, Scopus, Cochrane, and Google scholar and primary studies were selected. After screening the eligible studies according to inclusion/exclusion criteria, we investigated the risk of bias in the selected studies and also the heterogeneity between the primary results using Cochrane (Q) and I-squared (I2) indices. The primary results were combined using inverse variance method and Cohen statistics as well as a random effects model. Publication bias was assessed using Egger test. Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Suspected factors in the heterogeneity were assessed using meta-regression models. We entered 12 eligible studies in the meta-analysis including 851 cases compared with 862 controls. The standardized mean difference of Vitamin D between the two groups was −0.56 (95% confidence interval: −1.05, −0.08). Our meta-analysis showed that vitamin D serum levels of patients with fibromyalgia was significantly lower than that of control group.
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Affiliation(s)
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Marayam Ghajar
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Forooghi
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Developing and Implementing a Community-Based Model of Care for Fibromyalgia: A Feasibility Study. Pain Res Manag 2017; 2017:4521389. [PMID: 28790879 PMCID: PMC5534306 DOI: 10.1155/2017/4521389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/25/2017] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
Abstract
Background Fibromyalgia (FM) is a complex disease posing challenges for primary care providers and specialists in its management. Aim To evaluate the development and implementation of a comprehensive, integrated, community-based model of care for FM. Methods A mixed methods feasibility study was completed in a small urban centre in southern British Columbia, Canada. Eleven adults with FM and a team of seven health care providers (HCPs) participated in a 10-week intervention involving education, exercise, and sleep management. Monthly “team-huddle” sessions with HCPs facilitated the integration of care. Data included health questionnaires, patient interviews, provider focus group/interviews, and provider surveys. Results Both patients and HCPs valued the interprofessional team approach to care. Other key aspects included the benefits of the group, exercise, and the positive focus of the program. Effectiveness of the model showed promising results: quality of care for chronic illness, quality of life, and sleep showed significant (P < 0.05) differences from baseline to follow-up. Conclusions Our community-based model of care for FM was successfully implemented. Further testing of the model will be required with a larger sample to determine its effectiveness, although promising results were apparent in our feasibility study.
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