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Koca TT, Tugan CB, Koçyiğit BF, Nacitarhan V. Fibromyalgia awareness in women aged between 18 and 75 years: a current view to fibromyalgia. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Stratton KJ, Wells BD, Hawn SE, Amstadter AB, Cifu DX, Walker WC. Pain Descriptors Used by Military Personnel Deployed to Iraq and Afghanistan Following Combat-Related Blast Experience. MILITARY PSYCHOLOGY 2016; 27:376-383. [PMID: 26726285 DOI: 10.1037/mil0000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kelcey J Stratton
- Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd. (116-B), Richmond, VA 23249, USA ; Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA ; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 East Leigh Street, Biotech 1, Suite 101, Richmond VA 23219, USA
| | - Benjamin D Wells
- Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd. (116-B), Richmond, VA 23249, USA ; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 East Leigh Street, Biotech 1, Suite 101, Richmond VA 23219, USA
| | - Sage E Hawn
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA ; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 East Leigh Street, Biotech 1, Suite 101, Richmond VA 23219, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 East Leigh Street, Biotech 1, Suite 101, Richmond VA 23219, USA
| | - David X Cifu
- Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd. (116-B), Richmond, VA 23249, USA ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E. Marshall St., 4th Fl., PO Box 980677, Richmond, VA 23298, USA
| | - William C Walker
- Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd. (116-B), Richmond, VA 23249, USA ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E. Marshall St., 4th Fl., PO Box 980677, Richmond, VA 23298, USA
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Martín J, Torre F, Padierna A, Aguirre U, González N, Matellanes B, Quintana JM. Interdisciplinary treatment of patients with fibromyalgia: improvement of their health-related quality of life. Pain Pract 2013; 14:721-31. [PMID: 24279638 DOI: 10.1111/papr.12134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/16/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess whether an interdisciplinary intervention is more effective than usual care for improving the health-related quality of life (HRQoL) among patients with fibromyalgia (FM), and to identify variables that were predictors of improvement in HRQoL. METHODS In a randomized controlled clinical trial carried out on an outpatient basis in a hospital pain management unit, 153 patients with FM were randomly allocated to an experimental group (EG) or a control group (CG). Participants completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6 months after the intervention. The EG received an interdisciplinary treatment (12 sessions for 6 weeks) which consisted of coordinated psychological, medical, educational, and physiotherapeutic interventions while the CG received standard-of-care pharmacologic treatment. Descriptive statistics, ANOVA, Chi square and Fisher tests and generalized linear models were used for data analysis. RESULTS Six months after the intervention, statistically significant improvements in HRQoL were observed in physical functioning (P = 0.01), pain (P = 0.03) and total FIQ score (P = 0.04) in the EG compared to the CG. The number of physical illnesses was identified as a predictor for improvement. CONCLUSIONS This interdisciplinary intervention has shown effectiveness in improving the HRQoL of this sample of patients with FM. The number of physical illnesses was identified as a predictor of that improvement.
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Affiliation(s)
- Josune Martín
- Research Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
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Liu W, Zahner L, Cornell M, Le T, Ratner J, Wang Y, Pasnoor M, Dimachkie M, Barohn R. Benefit of Qigong exercise in patients with fibromyalgia: a pilot study. Int J Neurosci 2012; 122:657-64. [PMID: 22784212 DOI: 10.3109/00207454.2012.707713] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) patients present with widespread chronic pain and other symptoms. Some studies in the literature have reported inconsistent results after a Qigong exercise intervention in patients with FM. The purpose of this study was to test the feasibility of a home-based Qigong exercise in patients with FM. METHODS A total of 14 subjects were randomly assigned into one of two groups. The experimental group went through a six-week Qigong exercise program involving meditation, deep breathing, and synchronized rhythmic body movements. The control group took part in a sham Qigong exercise program using the same body movements also for six weeks. Clinical assessments at baseline and end of intervention used the Short-Form McGill Pain Questionnaire, Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, and Fibromyalgia Impact Questionnaire. RESULTS Group mean scores of four measurements were significantly (p < .0125) reduced in the intervention group, but not in the control group. The percentage changes in the four measurements were 44.2%, 24.8%, 37.3%, and 44.3% in the intervention group, and 10.1%, 6.3%, 9.9%, and 11.8% in the control group. CONCLUSION Qigong exercise may potentially be an effective self-management approach in controlling FM symptoms. In this pilot study, regular daily Qigong exercise, accumulated number of exercise sessions, and the specific form of Qigong exercise may all be important factors for the significant improvement in the study subjects. Future research is required to determine whether the same benefit can be obtained in a larger sample.
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Affiliation(s)
- Wen Liu
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, Kansas 66160-7601, USA.
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Sarzi-Puttini P, Atzeni F, Salaffi F, Cazzola M, Benucci M, Mease PJ. Multidisciplinary approach to fibromyalgia: what is the teaching? Best Pract Res Clin Rheumatol 2012; 25:311-9. [PMID: 22094204 DOI: 10.1016/j.berh.2011.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/03/2011] [Indexed: 10/15/2022]
Abstract
Fibromyalgia (FM) is a rheumatic disease that is characterised by chronic musculoskeletal pain, stiffness, fatigue, sleep and mood disorder. FM patients demonstrate dysregulation of pain neurotransmitter function and experience a neurohormone-mediated association with sleep irregularities. There are currently no instrumental tests or specific diagnostic markers for FM, and many of the existing indicators are only significant for research purposes. Anti-depressants, non-steroidal anti-inflammatory drugs (NSAIDS), opioids, sedatives, muscle relaxants and antiepileptics have all been used to treat FM with varying results. It has been shown that interdisciplinary treatment programmes lead to greater improvements in subjective pain and function than monotherapies. Physical exercise and multimodal cognitive behavioural therapy are the most widely accepted and beneficial forms of non-pharmacological therapy.
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Affiliation(s)
- Piercarlo Sarzi-Puttini
- Rheumatology Unit, L. Sacco University Hospital, Ospedale L. Sacco, Via GB Grassi 74, Milan, Italy.
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Patients' views on an education booklet following spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1609-15. [PMID: 22382727 PMCID: PMC3535244 DOI: 10.1007/s00586-012-2242-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/03/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study evaluated an evidence-based education booklet developed for patients undergoing spinal surgery which was used as a treatment intervention in a multi-centre, factorial, randomised controlled trial (FASTER: Function after spinal treatment, exercise and rehabilitation) investigating the post-operative management of spinal surgery patients. This study sought to determine the acceptability and content of the booklet to patients. METHODS Patients receiving the educational booklet before discharge from hospital as part of the FASTER study were asked to complete an evaluation, which rated the booklet "Your Back Operation" with regard to content, information, usability, etc. using forced and open questions. This assessment was conducted at the same time as the initial 6-week post-operative review performed as part of the larger study. RESULTS Therefore, 97% of the 117 trial participants who returned their 6-week evaluation and randomised to receive a booklet returned their questionnaire. The booklet was highly rated receiving an overall rating of 7 or more out of 10 from 101/111 (91%), and high ratings for content, readability and information. The booklet's key messages were clear to the majority of patients; however, many patients highlighted deficiencies with respect to content particularly in relation to wound care and exercise. CONCLUSIONS Patients valued the booklet and rated its content highly. Many suggested that the booklet be developed further and there was a clear desire for specific exercises to be included even though there is no evidence to support specific exercise prescription.
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Twelve evidence-based principles for implementing self-management support in primary care. Jt Comm J Qual Patient Saf 2011; 36:561-70. [PMID: 21222358 DOI: 10.1016/s1553-7250(10)36084-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. FINDINGS The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. CONCLUSIONS There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.
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Development and validation of Fibromyalgia Knowledge Questionnaire: FKQ. Rheumatol Int 2010; 32:655-62. [PMID: 21132552 DOI: 10.1007/s00296-010-1627-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED The objective of this study is to develop and validate a questionnaire for evaluating patients' specific knowledge regarding fibromyalgia. The development of items and questions of the questionnaire was done using four focus group that included physicians, physical therapists, a nurse, and patients with fibromyalgia. Other 30 consecutive patients were recruited to evaluate the questionnaire's reproducibility (intra- and inter-observer). In order to construct validity, the questionnaire was applied to healthcare professionals with knowledge on fibromyalgia and 20 other patients. To investigate sensitivity to change, the questionnaire was applied to 56 patients before and after an educational program (intervention group) or a waiting list (control group). Eighteen questions fulfilled the inclusion criteria and were understandable for more than 90% of the participants. The intraclass correlation coefficients for inter-observer and intra-observer reproducibility ranged from 0.65 to 0.90 and from 0.86 to 0.96, respectively (P < 0.01). For construct validation, healthcare professionals obtained significant higher scores than the patients (P < 0.01). On the sensitivity to change evaluation, the intervention group obtained higher scores than the control group after the educational program (P < 0.01). CONCLUSION The Fibromyalgia Knowledge Questionnaire was developed and it is reliable, valid, and sensitive to changes, for evaluating disease-specific knowledge in patients with fibromyalgia.
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Hunt J, BOGG JAN. An Evaluation of the Impact of a Fibromyalgia Self-management Programme on Patient Morbidity and Coping. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/140381900750063436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Abstract
Patient education is a medical intervention for patients with chronic diseases to increase knowledge of their disease, self-efficacy, self-management and consumer behaviour. The goal is to improve their disease outcome, social participation and quality of life. This article reviews concepts, modalities and knowledge on effectiveness of patient education. The results of different studies in different rheumatic diseases on efficacy will be summarized including a small number of cost-benefit analyses. Most studies report on significant and relevant improvements of knowledge, self-efficacy and health status. With respect to disease specific outcomes low to moderate effect sizes with a short duration have been observed. Especially good results have been reported when physical training or other methods of rehabilitation were included. There are marked improvements in consumer behaviour of health measures and sickness leave. A better understanding of information needs and baseline characteristics of patients is necessary to develop more appropriate educational interventions focussed on relevant outcomes that can be improved by educational measures.
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Affiliation(s)
- E Genth
- Rheumaklinik und Rheumaforschungsinstitut Aachen, Burtscheider Markt 24, 52066 Aachen.
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de Andrade SC, de Carvalho RFPP, Soares AS, de Abreu Freitas RP, de Medeiros Guerra LM, Vilar MJ. Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool. Rheumatol Int 2008; 29:147-52. [PMID: 18600327 DOI: 10.1007/s00296-008-0644-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 06/15/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate the effectiveness of aerobic exercise in water pool compared with aerobic exercise performed in sea by women with fibromyalgia (FM). A total of 46 patients were randomly allocated into two groups: pool group (23 patients) and sea group (23 patients) that performed the same aerobic exercise program. Patients were evaluated baseline and after 12 weeks using: VAS, number of tender points, FIQ, SF-36, PSQI, and BDI. Both groups improved significantly in post-treatment for all the evaluated variables. There were no significant differences between two groups, except for BDI (F=2.418, P<0.0001). Aerobic exercise program performed in water (pool or sea) was effective for patients with FM. However, sea water exercises have been shown to bring more advantages related to emotional aspects. Then, exercise performed sea water (thalassotherapy) is an option for effective treatment with low cost for patients with FM.
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Affiliation(s)
- Sandra Cristina de Andrade
- Division of Rheumatology, Department of Clinical Medicine, Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F. Treatment Strategy in Fibromyalgia Syndrome: Where Are We Now? Semin Arthritis Rheum 2008; 37:353-65. [DOI: 10.1016/j.semarthrit.2007.08.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 07/29/2007] [Accepted: 08/20/2007] [Indexed: 11/17/2022]
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Evcik D, Yigit I, Pusak H, Kavuncu V. Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study. Rheumatol Int 2008; 28:885-90. [PMID: 18278501 DOI: 10.1007/s00296-008-0538-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 01/24/2008] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the efficacy of aquatic exercises in fibromyalgia syndrome (FMS). A total of 63 patients were included and allocated to two groups. Group I (n = 33) received an aquatic exercise program and Group II (n = 30) received a home-based exercise program for 60 min, 3x a week, over 5 weeks. Patients were evaluated for pain (visual analogue scale, VAS), number of tender points (NTP), Beck depression inventory (BDI), and functional capacity (fibromyalgia impact questionnaire, FIQ). All assessment parameters were measured at baseline, and at weeks 4, 12, and 24. There were statistically significant differences in FIQ and NTP in both groups at the end and during follow-up (P < 0.05). Group I showed a statistically significant decrease in BDI scores after 4 and 12 weeks (P < 0.05) that remained after 24 weeks (P < 0.001). In Group II, a significant decrease in BDI scores was observed at the end and during follow-up (P < 0.001). Also, a significant improvement was found in VAS at weeks 4 and 12 in both groups (P < 0.001). The average of reduction in pain scores was 40% in Group1 and 21% in Group II. However, this was still significant at week 24 only in the aquatic therapy group. A comparison of the two groups showed no statistically significant difference for FIQ, NTP, and BDI scores except VAS (P < 0.001) Our results showed that both aquatic therapy and home-based exercise programs have beneficial effects on FIQ, BDI, and NTP. In pain management, only aquatic therapy seems to have long-term effects.
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Affiliation(s)
- Deniz Evcik
- Department of Physical Rehabilitation Medicine, Ufuk University, Mevlana bulvari, No: 86-88, 06520, Ankara, Turkey.
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Jerjes W, Madland G, Feinmann C, El Maaytah M, Kumar M, Hopper C, Upile T, Newman S. Psycho-education programme for temporomandibular disorders: a pilot study. J Negat Results Biomed 2007; 6:4. [PMID: 17381840 PMCID: PMC1839113 DOI: 10.1186/1477-5751-6-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 03/23/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are by far the most predominant condition affecting the temporomandibular joint (TMJ), however many patients have mild self-limiting symptoms and should not be referred for specialist care. The aim of this pilot study was to develop a simple, cost-effective management programme for TMDs using CD-ROM. 41 patients (age 18-70) participated in this study, patients were divided into three groups: the 1st group were involved in an attention placebo CD-ROM (contain anatomical information about the temporomandibular system), the 2nd group received information on CD-ROM designed to increase their control and self efficacy, while the 3rd group received the same programme of the 2nd group added to it an introduction to self-relaxing techniques followed by audio tape of progressive muscle relaxation exercises. Each of the groups was asked to complete a number of questionnaires on the day of initial consultation and six weeks afterwards. RESULTS The two experimental groups (2nd & 3rd) were equally effective in reducing pain, disability and distress, and both were more effective than the attention placebo group (1st), however the experimental groups appeared to have improved at follow-up relative to the placebo-group in terms of disability, pain and depressed mood. CONCLUSION This pilot study demonstrates the feasibility and acceptability of the design. A full, randomized, controlled trial is required to confirm the efficacy of the interventions developed here.
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Affiliation(s)
- Waseem Jerjes
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Department of Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK
- National Medical Laser Centre, Department of Surgery, Royal Free & University College Medical School, London, UK
| | - Geir Madland
- Unit of Oral Medicine & Special Needs Dentistry, Oral Medicine and Special Needs Dentistry, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute, London, UK
- Centre for Behavioural and Social Sciences in Medicine, Royal Free & University College Medical School, London, UK
| | - Charlotte Feinmann
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Unit of Oral Medicine & Special Needs Dentistry, Oral Medicine and Special Needs Dentistry, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute, London, UK
- Centre for Behavioural and Social Sciences in Medicine, Royal Free & University College Medical School, London, UK
| | - Mohammed El Maaytah
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Department of Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK
| | - Mahesh Kumar
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Department of Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK
| | - Colin Hopper
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Department of Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK
- National Medical Laser Centre, Department of Surgery, Royal Free & University College Medical School, London, UK
| | - Tahwinder Upile
- Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK
- Department of Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK
| | - Stanton Newman
- Centre for Behavioural and Social Sciences in Medicine, Royal Free & University College Medical School, London, UK
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Robinson RL, Jones ML. In search of pharmacoeconomic evaluations for fibromyalgia treatments: a review. Expert Opin Pharmacother 2006; 7:1027-39. [PMID: 16722813 DOI: 10.1517/14656566.7.8.1027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fibromyalgia is characterised by chronic widespread pain of unknown aetiology and affects approximately 2% of the population. It can cause significant patient disability, sizeable economic costs, complex management decisions and controversy for healthcare providers. In lieu of uniformly approved treatments for fibromyalgia, patients may try multiple pharmacological and non-pharmacological therapies with questionable efficacy. The literature lacks pharmacoeconomic studies that balance the cost and benefit of interventions. In the absence of this work, cost outcomes are reviewed in this paper. Due to inconclusive results, further study is needed on fibromyalgia treatment cost-effectiveness. These analyses could provide useful information for policy and evidence-based practice guidelines toward optimal disease management. Medical professionals should be a driving force in understanding the clinical and economic challenges of fibromyalgia.
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Affiliation(s)
- Rebecca L Robinson
- Eli Lilly and Company, US Medical Division, Outcomes Research, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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Abstract
Fibromyalgia is a syndrome of widespread pain, nonrestorative sleep, disturbed mood, and fatigue. Optimal treatment involves a multidisciplinary approach with a team of health care providers using pharmacologic and nonpharmacologic treatment. Because of the heterogeneity of the illness, management should be individualized for the patient. Pharmacologic treatment should address issues of pain control, sleep disturbance, fatigue, and any underlying coexisting mood disorder. Nonpharmacologic treatment should include patient education, a regular exercise and stretching program, and cognitive behavioral therapy. All of these are essential to improving functional capacity and quality of life. This review provides general guidelines in initiating a successful pharmacologic treatment program for patients with fibromyalgia.
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Affiliation(s)
- Kathryn Baker
- Arthritis & Rheumatic Diseases, Oregon Health & Science University, OP-09, Portland, OR 97239, USA.
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Dönmez A, Karagülle MZ, Tercan N, Dinler M, Işsever H, Karagülle M, Turan M. SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int 2005; 26:168-72. [PMID: 15965635 DOI: 10.1007/s00296-005-0623-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 03/22/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the effectiveness of spa therapy in the management of fibromyalgia. METHODS Thirty women with fibromyalgia were randomly assigned to either a spa therapy group or a control group. The spa therapy group (n = 16) had spa treatment for 2 weeks in addition to their medical treatment. The control group (n = 14) continued to have their medical treatment and/or daily exercises. An investigator who was blinded for the intervention assessed all the patients for 9 months. Improvements in Fibromyalgia Impact Questionnaire (FIQ), pain and number of tender points were primary outcomes. Secondary outcome measures were improvement in sleep disturbance, fatigue, gastrointestinal symptoms, anxiety, Beck Depression Inventory and patient's global evaluation. RESULTS the spa group was found to be superior to the control group at the end of intervention in terms of FIQ, pain, tender point count, fatigue and patients' global assessment. This superiority remained for 6 months in FIQ, 1 month in pain and tender point count. CONCLUSION It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia.
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Affiliation(s)
- Arif Dönmez
- Department of Medical Ecology and Hydroclimatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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Abstract
Fibromyalgia syndrome (FMS) is a chronic multisymptom illness characterized by widespread pain and associated with neuropsychological symptoms including fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression. A discreet cause of FMS has not been identified. It is likely that multiple mechanisms give rise to symptom expression. Understanding specific etiologic factors and pathogenic mechanisms in individual patients will allow clinicians to determine treatments that are most effective for a given patient. Available evidence implicates the central nervous system as key in maintaining pain and other core symptoms of FMS. The approach to treatment of pain will typically address these central mechanisms. Nonpain symptoms may be treated by drugs affecting similar central neurochemicals. This paper will review the rationale for the different types of pharmaceutical treatments that may be useful for the treatment of FMS and issues regarding new drug development for this indication.
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Affiliation(s)
- Leslie J Crofford
- Division of Rheumatology, University of Michigan, Room 5510, MSRB-I, 1150 W. Medical Center Dr., Ann Arbor, MI 48109-0680, USA.
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Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A, Allaz AF, Vischer TL. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management. Ann Rheum Dis 2004; 63:290-6. [PMID: 14962965 PMCID: PMC1754921 DOI: 10.1136/ard.2002.004945] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a treatment programme for patients with fibromyalgia (FM) based on self management, using pool exercises and education. METHODS Randomised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme; 164 patients with FM were allocated to an immediate 6 week programme (n = 84) or to a waiting list control group (n = 80). The main outcomes were changes in quality of life, functional consequences, patient satisfaction and pain, using a combination of patient questionnaires and clinical examinations. The questionnaires included the Fibromyalgia Impact Questionnaire (FIQ), Psychological General Well-Being (PGWB) index, regional pain score diagrams, and patient satisfaction measures. RESULTS 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations. Six months after programme completion, significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ (total score p = 0.025; fatigue p = 0.003; depression p = 0.031) and PGWB (total score p = 0.032; anxiety p = 0.011; vitality p = 0.013,). All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups; between-group differences were statistically significant for "control of symptoms", "psychosocial factors", and "physical therapy" No change in pain was seen. CONCLUSION A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment. These improvements are sustained for at least 6 months after programme completion.
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Affiliation(s)
- C Cedraschi
- Division of Rheumatology, Geneva University Hospital, 1211 Geneva, Switzerland.
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21
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Waxman R, Woodburn H, Powell M, Woodburn J, Blackburn S, Helliwell P. FOOTSTEP: a randomized controlled trial investigating the clinical and cost effectiveness of a patient self-management program for basic foot care in the elderly. J Clin Epidemiol 2003; 56:1092-9. [PMID: 14615000 DOI: 10.1016/s0895-4356(03)00197-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Podiatry (chiropody) services are one of the most frequently requested services in primary care. The elderly are given priority access to podiatry services in the UK blocking access for other priority groups. To evaluate the clinical and cost-effectiveness of a self-management program as a means of managing nonurgent demands for podiatry services by the elderly without compromising foot-related disability. METHOD Randomized clinical trial with blinded 6-month follow-up and economic evaluation. People aged 60+ seeking self-initiated or primary referred podiatric consultation were screened. Five hundred ninety-nine were excluded on the basis of health status, and 259 refused to participate or did not attend initially. Seventy-eight were randomized to receive a self-management program, and 75 usual care. The main outcome measure was foot disability, as measured by the Manchester Foot Disability Questionnaire. RESULTS At 6 months, self-management program participants had lower foot disability scores than the usual care group (difference between scores -1, 95% C.I. -2, 0), and returned for fewer treatments within the 6-month study period (39 vs. 92 treatments). The cost per patient for the self-management program (pound sterling 10.92) was found to be the same as for usual care (pound sterling 10.71), but this included the cost of nail care packs. CONCLUSION In this group a self-care program for routine foot care did not compromise therapeutic outcomes, and may be more cost effective in the long term. Further work is required to extend self-management programs to other target groups, such as people with diabetes at low risk for foot problems.
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Affiliation(s)
- Robin Waxman
- The Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds, LS2 9NZ, UK
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Sim J, Adams N. Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists. Eur J Pain 2003; 7:173-80. [PMID: 12600799 DOI: 10.1016/s1090-3801(02)00095-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.
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Affiliation(s)
- Julius Sim
- Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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Abstract
The exponential increase in pain research over the last 10 years has established fibromyalgia (FM) as a common chronic pain syndrome with similar neurophysiologic aberrations to other chronic pain states. As such, the pathogenesis is considered to involve an interaction of augmented sensory processing (central sensitization) and peripheral pain generators. The notion, that FM symptomatology results from an amplification of incoming sensory impulses, has revolutionized the contemporary understanding of this enigmatic problem and provided a more rational approach to treatment. To date, the management of FM has been mainly palliative, with the aims of reducing pain, improving sleep, maintaining function, treating psychologic distress and diminishing the impact of associated syndromes. The rapidly evolving neurophysiologic, psychophysiologic and molecular biologic basis for chronic pain states has already opened up new avenues for management which should be applicable to this difficult group of patients. Indeed, it is now possible to think about a "rational" approach to managing FM patients that was unthinkable just a few years ago.
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Affiliation(s)
- Robert M Bennett
- Department of Medicine (OP09), Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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24
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Abstract
Clinicians using the results of the extant research base can take an optimistic view of the role of nonpharmacologic treatment strategies for fibromyalgia. There were no negative outcomes in any of the reviewed studies, although in a few studies the experimental treatment did not prove to be more effective than the attention control. Rather than viewing this negatively, one could look more closely at the attention control groups and attempt to better understand what they contained that worked as an active treatment. A number of trials include a follow-up component and all but one of them find maintenance of at least one outcome change. Maintenance of changes is more likely to occur when the patient continues to participate in the experimental activity long-term. Patients especially need strategies that help them continue in exercise regimens. Unlike cognitive skills strategies that once learned are likely to become part of a person's coping repertoire, both exercise and behavioral strategies, like progressive muscle relaxation, need to be performed on a consistent basis in order to have their effect. The goals of increased self-efficacy, symptom reduction, increased functional status and quality of life along with decreased inappropriate use of health care resources are realistic when patients persevere in their use of strategy combinations and receive support from their providers.
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Affiliation(s)
- Carol S Burckhardt
- School of Nursing, SN-5N, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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25
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Abstract
The office management of fibromyalgia (FM) is best determined by two variables: (1) the severity and complexity of each patient's symptoms, and (2) the specialization and interest of the treating physician. Because there are 6 to 10 million Americans with FM, most patient visits will be to the primary care physician. Rheumatologists, physiatrists, and other musculoskeletal specialists must work with primary care physicians to foster the early diagnosis and appropriate treatment of FM. Primary care physicians are faced with enormous challenges in caring for patients with chronic pain disorders like FM. Our managed health care system insists that patient encounters be brief. Specialty referrals are often discouraged. There is little if any reimbursement for patient education. FM treatment is labor-intensive. Therefore, optimal planning and use of precious office time and resources are most important. Rheumatologists should train our primary care colleagues to recognize FM. Many patients still go months or years before this common syndrome is diagnosed. Rheumatologists should also spearhead teaching primary care physicians the basic treatment principles of FM. If the diagnosis is made early, patients with FM in community practice do very well with simple management techniques. As consultants, rheumatologists should confirm the diagnosis of FM and suggest basic FM management. Some primary care providers or other specialists will be fully capable of bypassing this consultation, especially if the patient responds to simple management suggestions. Manpower surveys have not studied the cost-effectiveness of specialty care in FM. Rheumatologists should also assume the responsibility for the management of FM patients who have not responded to basic FM management. Additionally, some rheumatologists may wish to subspecialize in FM, a major career commitment to this perplexing disorder. These situations constitute advanced FM management.
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Affiliation(s)
- Don L Goldenberg
- Division of Rheumatology, Newton-Wellesley Hospital, Department of Medicine, Tufs University School of Medicine, Newton, MA 02462, USA.
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Ramos-Remus C, Salcedo-Rocha AL, Prieto-Parra RE, Galvan-Villegas F. How important is patient education? Best Pract Res Clin Rheumatol 2000; 14:689-703. [PMID: 11092796 DOI: 10.1053/berh.2000.0107] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.
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Affiliation(s)
- C Ramos-Remus
- Department of Rheumatology, Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Mexico
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Abstract
This chapter addresses the issues associated with self-management in arthritis care. Alternative approaches to traditional medical care have gained popularity in the past decade. Some of the factors that have led to this are discussed in this chapter, including personal self-determination, the patient as consumer in a global economy, the backlash against medical technology, and fundamental questions about the medical model of care. Following this introduction, the goals of the Arthritis Self-Management and Bone-up on Arthritis Programs are outlined, along with the major theoretical underpinnings of both programmes. The impact of self-management programmes on the outcomes of disability, pain, depression and fatigue are reviewed, as are the potential implications for both the direct and indirect cost savings for a health system and society. The potential negative effects of self-management programmes are considered, and issues related to implementation, dissemination, quality control and long-term maintenance are reviewed. Finally, the value of self-management as a tool to be used effectively by the person with arthritis, in conjunction with his or her rheumatologist, is outlined. The relevance of well-established, valid and reliable self-management programmes is underscored by the growing number of people who seek help over the Internet. Without guidance, information can become harmful or distracting rather than helpful.
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Affiliation(s)
- S M Edworthy
- Medicine and Community Health Science, University of Calgary, Room 442,HMR Building, 3330 Hospital Drive NW, Calgary, Alberta, Canada
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28
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Abstract
This study was done to review the literature concerning the influence of minor and major stress factors on onset and course of rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE), and fibromyalgia syndrome (FS). Major life events and chronic minor stress seem to be very important factors in JCA and are significantly associated with the onset of the disease. With respect to RA and FS, stress may be a provoking factor but the data in the literature are equivocal. However, during the course of the disease, minor stress aggravates SLE, FS, JCA, and RA. Patients with FS and RA may profit from psychological therapies. Optimistic and confronting coping strategies were found most frequently and perceived to be most effective. Very important for psychological function is the social background, especially the functioning of the family is of outstanding importance for clinical and psychological outcome.
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Affiliation(s)
- M Herrmann
- Department of Internal Medicine, University Medical Center, Regensburg, Bavaria, Germany
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Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med 1999; 21:180-91. [PMID: 10499139 DOI: 10.1007/bf02908299] [Citation(s) in RCA: 278] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate and compare the efficacy of pharmacological and nonpharmacological treatments of fibromyalgia syndrome (FMS). METHODS This meta-analysis of 49 fibromyalgia treatment outcome studies assessed the efficacy of pharmacological and nonpharmacological treatment across four types of outcome measures-physical status, self-report of FMS symptoms, psychological status, and daily functioning. RESULTS After controlling for study design, antidepressants resulted in improvements on physical status and self-report of FMS symptoms. All nonpharmacological treatments were associated with significant improvements in all four categories of outcome measures with the exception that physically-based treatment (primarily exercise) did not significantly improve daily functioning. When compared, nonpharmacological treatment appears to be more efficacious in improving self-report of FMS symptoms than pharmacological treatment alone. A similar trend was suggested for functional measures. CONCLUSION The optimal intervention for FMS would include nonpharmacological treatments, specifically exercise and cognitive-behavioral therapy, in addition to appropriate medication management as needed for sleep and pain symptoms.
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Affiliation(s)
- L A Rossy
- Department of Psychology, University of Missouri, Columbia 65211, USA
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Sim J, Adams N. Physical and other non-pharmacological interventions for fibromyalgia. Best Pract Res Clin Rheumatol 1999; 13:507-23. [PMID: 10562382 DOI: 10.1053/berh.1999.0041] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is little empirical evidence for the effectiveness of physical and other non-pharmacological approaches to the management of fibromyalgia. Although a number of studies have been conducted into such approaches, many of these are uncontrolled, and relatively few randomized controlled trials of appropriate size and methodological rigour have been carried out. This chapter provides an overview of the evidence available under the following headings: exercise, EMG biofeedback training, electrotherapy and acupuncture, patient education and self-management programmes, multimodal treatment approaches, and other interventions. It is hard to reach firm conclusions from the literature, owing to the variety of interventions that have been evaluated and the varying methodological quality of the studies concerned. Nonetheless, in terms of specific interventions, exercise therapy has received a moderate degree of support from the literature, and has been subjected to more randomized studies than any other intervention. In contrast, there is little or no evidence available for most types of electrotherapy. In terms of overall management strategies, a multimodal programme of management, including physical, psychological and educational components and delivered in a multidisciplinary setting, has gained some support from descriptive and experimental studies, and accords with current understanding of the aetiology and clinical features of fibromyalgia. There is a clear need for further systematic evaluation of the effectiveness of non-pharmacological treatment approaches in fibromyalgia.
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Affiliation(s)
- J Sim
- Primary Care Sciences Research Centre, Keele University, Staffordshire, UK
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32
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Abstract
There are three realities that need to be understood by both clinicians and patients: (1) fibromyalgia is a complex chronic pain condition and current treatment is palliative rather than curative; (2) the major aim of treatment is to improve function, not abolish pain; and (3) a cycle of chronic pain, stress, and psychological arousal often generates a set of secondary symptoms. These secondary symptoms provide a positive feedback loop that is amenable to modification by cognitive-behavioral techniques. Multidisciplinary group treatment programs are especially suited to such techniques; their aim should be to maximize subsequent clinician-patient interactions. Thus, a current concept of optimal management is a blend of multidisciplinary group therapy and individualized clinician-based treatment.
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Affiliation(s)
- R M Bennett
- Department of Medicine, Oregon Health Sciences University, Portland, USA
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33
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Abstract
This article discusses the future of fibromyalgia, including the current state of the art and potential future pathophysiologic studies. Suggestions are provided in regard to future therapeutic trials, longitudinal and outcome studies, and the role of the rheumatology community in this common disorder.
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Affiliation(s)
- D L Goldenberg
- Department of Rheumatology, Newton-Wellesley Hospital, Massachusetts, USA
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