TREATMENT OF “RESISTANT” FIBROMYALGIA

A parallel randomized controlled trial examining the effects of rhythmic sensory stimulation on fibromyalgia symptoms

This double-blind, two-arm parallel randomized controlled trial investigated the effects of gamma-frequency rhythmic sensory stimulation on fibromyalgia. We were interested in whether rhythmic sensory stimulation would promote significant changes in fibromyalgia and associated symptoms, and whether treatment effects would differ between two distinct treatment parameters. Fifty patients with a formal diagnosis of fibromyalgia were randomly assigned to two test groups. One group received vibrotactile stimulation from a continuous sine wave single-frequency stimulation (40 Hz) for 30 minutes, five days per week, over five weeks, concomitant with usual care. The second group completed the same treatment protocol but received a different stimulation, consisting of random and intermittent complex wave gamma-range vibrotactile stimulation. Fibromyalgia symptoms, pain severity and interference, depression symptoms, quality of life and sleep quality were assessed at baseline and post-intervention. Results indicated that there were statistically significant changes from baseline to post-treatment in measures of fibromyalgia symptom severity, pain interference, depression, and sleep quality. However, treatment outcomes did not differ significantly between groups. These findings provide preliminary evidence that gamma-frequency rhythmic vibroacoustic stimulation may decrease fibromyalgia symptoms and ease associated comorbidities, opening new avenues for further investigation of the effects of rhythmic sensory stimulation on chronic pain conditions.

Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables

We aimed to investigate the changes in the objective and subjective sleep variables during painful episodes of fibromyalgia and post-episode period, and to evaluate the impact of the sleep variables on the current clinical, psychological, and immunologic parameters. Thirty-one consecutive patients who were referred to the Erenköy Physical Therapy and Rehabilitation Polyclinic with a diagnosis of fibromyalgia were evaluated before and in the sixth week of the acute pain treatment. The sleep variables were measured by polysomnography, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. The clinical and psychiatric assessment of patients was performed by using Fibromyalgia Impact Questionnaire; Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms; and Visual Analog Scale. Serum pro-inflammatory molecules were measured to evaluate the immunological status. The pain treatment significantly affected subjective sleep variables, psychiatric variables, clinical variables, and IL-6 levels. The subjective sleep parameters, clinical and psychiatric variables, and IL-6 levels were improved with pain treatment in fibromyalgia. The objective sleep variables, IL-1 and TNF-alpha levels were not significantly improved with the pain treatment, and they were not related to clinical presentation of patients with fibromyalgia. Subjective variability of sleep contributes to the clinical presentation, suggesting that the objective structure is trait-specific with IL-1 and TNF-alpha.

[A comparative study of fibromyalgia treatment: ultrasonography and physiotherapy versus sertraline treatment]

OBJECTIVE

To compare the efficacy of sertraline versus physical therapy (ultrasonography and physical therapy) in fibromyalgia.

DESIGN

A 6-month comparative, prospective, randomised study of 70 female patients, aged 42 to 52, with fibromyalgia according to the criteria of the American College of Rheumatology. One group (N=36) underwent 6-month treatment with sertraline, 50 mg/24 h. The other group (N=34) received 15 sessions of 1 W/cm2 ultrasonography on the cervical trigger points plus physical therapy. Variables analyzed on a visual 10-point scale were pain and morning stiffness and sleep disorders by use of the sleep questionnaire of the Medical Outcome Study (MOS). Measurements were taken at the beginning of the study and at 3-month and 6-month follow-up.

RESULTS

Pain significantly diminished in the sertraline group during the entire study (visual numeric scale: 7.2+/-1.1 initially, 5.3+/-?? at 3 months and 3+/-0.7 at 6 months, P<0.05). Morning stiffness and sleep disorder scores were positive only for the sertraline group during the entire 6 months (P<0.05). Results from the MOS questionnaire showed improvement only for the sertraline group. Of the Sertraline group, 83% evaluated the treatment as good or very good, as compared with only 6% of the ultrasonography group. No patient withdrew from the study.

CONCLUSION

Patients treated with sertraline had a better outcome in terms of pain, morning stiffness and sleep disorders, than the group treated with ultrasonography and physical therapy.

A realistic approach to managing patients with fibromyalgia

Fibromyalgia syndrome is common and variable in impact, with some patients having a milder and shorter duration of symptoms and others suffering significant and prolonged pain. Disability also varies. It is thought that the syndrome arises from a disordered neurophysiology that, through links to central control inputs, involves emotions, thoughts, and cognitions. Social and psychological sequelae contribute to and result from this process. The biopsychosocial model of disease epitomizes fibromyalgia. Although management may be difficult at times, and much needs to be done, the growing appreciation of strategies that use this described model and the knowledge of the potential reversibility of the syndrome are resulting in improved outcomes.

Treating fibromyalgia with a brief interdisciplinary program: initial outcomes and predictors of response

OBJECTIVES

To evaluate the efficacy of a brief, intense treatment program for fibromyalgia and to determine which patient characteristics are associated with a better treatment response.

PATIENTS AND METHODS

Two self-report measures, the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory (MPI), were administered before patients completed treatment and 1 month after participating in the program. The main outcome measure was the difference in FIQ score and MPI scale before and after program participation.

RESULTS

Of 139 patients who met the American College of Rheumatology criteria for fibromyalgia, 100 chose to participate in the 1 1/2-day Fibromyalgia Treatment Program at the Mayo Clinic, Rochester, Minn. Of these 100 patients, 74 completed the follow-up surveys. Patients were less affected by fibromyalgia after participation in the treatment program. This was demonstrated by a posttreatment improvement in the total FIQ score (P<.001), the MPI pain severity score (P<.001), and the MPI interference score (P=.01). The 1 patient characteristic found to be significantly associated (P<.001) with a better response to treatment was a high pretreatment level of impairment from fibromyalgia, as measured by the pretreatment FIQ score.

CONCLUSIONS

A brief interdisciplinary program for treating fibromyalgia reduced some associated symptoms. Patients more severely affected by fibromyalgia may benefit most from this approach. Clinicians may apply these findings to develop beneficial and convenient treatment programs for patients with fibromyalgia.

Diagnosis, etiology, and therapy of fibromyalgia

Fibromyalgia is characterized by diffuse pain, multiple tender points, fatigue, and sleep disturbance. Its frequent concurrence with rheumatic diseases modifies the clinical picture of the "primary" disease. This article reviews new information about the etiopathogenesis and treatment of this syndrome.

Fibromyalgia. Recognizing and addressing the multiple interrelated factors

Recognition of fibromyalgia is crucial to avoid extraneous, costly diagnostic testing and ineffective, potentially dangerous therapy. Furthermore, failure to recognize that symptomatic physiologic change does result in a patient's response to stress demeans the legitimate importance of psychiatric disease. The keys to successful therapy are (1) specific pharmacologic manipulation of important processes and prognostic factors, (2) participation in aerobic exercise, which increases time spent in stages 3 and 4 (non-rapid eye movement) sleep and reduces stress, and (3) education, which reduces worry and perceived stress.

A cost-effective approach to the diagnosis and treatment of fibromyalgia

The diagnosis of teh myalgic patient can prove to be challenging for even the most experienced of clinicians. The differential diagnosis includes many diseases that often present with weakness as well as pain. The diagnosis of fibromyalgia may now be made using the positive features of the patient's illness and classified according to well-defined criteria. The process is facilitated by the demonstration of FTPs that are quite specific for the condition. The elicitation of tenderness over these points is highly reliable and valid owing to high intrarater and interrater agreements observed in multiple studies. An algorithmic approach to differential diagnosis is presented. In addition, a stepwise approach to treatment based on published studies and geared to functional outcome measures in put forward in an attempt to encourage a cost-effective approach to care of these difficult patients.