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Jones KD. Promoting physical activity in fibromyalgia. Pain Manag 2016; 6:321-4. [PMID: 27312858 DOI: 10.2217/pmt-2016-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kim D Jones
- Oregon Health & Science University, Portland, OR, USA
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Vallejo MA, Ortega J, Rivera J, Comeche MI, Vallejo-Slocker L. Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: A randomized control trial. J Psychiatr Res 2015; 68:106-13. [PMID: 26228408 DOI: 10.1016/j.jpsychires.2015.06.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to explore the effectiveness of Internet-delivered cognitive-behavioral therapy (iCBT) in treating fibromyalgia (FM) compared with an identical protocol using conventional group face-to-face CBT. METHODS Sixty participants were assigned to either (a) the waiting list group, (b) the CBT group, or (c) the iCBT group. The groups were assessed at baseline, after 10 weeks of treatment, and at 3-, 6-, and 12-month follow-ups. The primary outcome measured was the impact of FM on daily functioning, as measured by the Fibromyalgia Impact Questionnaire (FIQ). The secondary outcomes were psychological distress, depression, and cognitive variables, including self-efficacy, catastrophizing, and coping strategies. RESULTS In post-treatment, only the CBT group showed improvement in the primary outcome. The CBT and iCBT groups both demonstrated improvement in psychological distress, depression, catastrophizing, and utilizing relaxation as a coping strategy. The iCBT group showed an improvement in self-efficacy that was not obtained in the CBT group. CBT and iCBT were dissimilar in efficacy at follow-up. The iCBT group members improved their post-treatment scores at their 6- and 12-month follow-ups. At the 12-month follow-up, the iCBT group showed improvement over their primary outcome and catastrophizing post-treatment scores. A similar effect of CBT was expected, but the positive results observed at the post-treatment assessment were not maintained at follow-up. CONCLUSIONS The results suggest that some factors, such as self-efficacy or catastrophizing, could be enhanced by iCBT. Specific characteristics of iCBT may potentiate the social support needed to improve treatment adherence.
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Affiliation(s)
- Miguel A Vallejo
- Department of Clinical Psychology, National Distance Education University (UNED), Madrid, Spain.
| | - José Ortega
- Department of Clinical Psychology, National Distance Education University (UNED), Madrid, Spain
| | - Javier Rivera
- Rheumatology Unit, Rehabilitation Institute, University General Hospital "Gregorio Marañón", Madrid, Spain
| | - María I Comeche
- Department of Clinical Psychology, National Distance Education University (UNED), Madrid, Spain
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Bourgault P, Lacasse A, Marchand S, Courtemanche-Harel R, Charest J, Gaumond I, Barcellos de Souza J, Choinière M. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS One 2015; 10:e0126324. [PMID: 25978402 PMCID: PMC4433106 DOI: 10.1371/journal.pone.0126324] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluated the efficacy of the PASSAGE Program, a structured multicomponent interdisciplinary group intervention for the self-management of FMS. METHODS A mixed-methods randomized controlled trial (intervention (INT) vs. waitlist (WL)) was conducted with patients suffering from FMS. Data were collected at baseline (T0), at the end of the intervention (T1), and 3 months later (T2). The primary outcome was change in pain intensity (0-10). Secondary outcomes were fibromyalgia severity, pain interference, sleep quality, pain coping strategies, depression, health-related quality of life, patient global impression of change (PGIC), and perceived pain relief. Qualitative group interviews with a subset of patients were also conducted. Complete data from T0 to T2 were available for 43 patients. RESULTS The intervention had a statistically significant impact on the three PGIC measures. At the end of the PASSAGE Program, the percentages of patients who perceived overall improvement in their pain levels, functioning and quality of life were significantly higher in the INT Group (73%, 55%, 77% respectively) than in the WL Group (8%, 12%, 20%). The same differences were observed 3 months post-intervention (Intervention group: 62%, 43%, 38% vs Waitlist Group: 13%, 13%, 9%). The proportion of patients who reported ≥ 50% pain relief was also significantly higher in the INT Group at the end of the intervention (36% vs 12%) and 3 months post-intervention (33% vs 4%). Results of the qualitative analysis were in line with the quantitative findings regarding the efficacy of the intervention. The improvement, however, was not reflected in the primary outcome and other secondary outcome measures. CONCLUSION The PASSAGE Program was effective in helping FMS patients gain a sense of control over their symptoms. We suggest including PGIC in future clinical trials on FMS as they appear to capture important aspects of the patients' experience. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number Register ISRCTN14526380.
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Affiliation(s)
- Patricia Bourgault
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Anaïs Lacasse
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Serge Marchand
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de neurochirurgie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roxanne Courtemanche-Harel
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jacques Charest
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Isabelle Gaumond
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Juliana Barcellos de Souza
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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Sener U, Ucok K, Ulasli AM, Genc A, Karabacak H, Coban NF, Simsek H, Cevik H. Evaluation of health-related physical fitness parameters and association analysis with depression, anxiety, and quality of life in patients with fibromyalgia. Int J Rheum Dis 2013; 19:763-72. [PMID: 24289723 DOI: 10.1111/1756-185x.12237] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The purpose of this study was to investigate the physical fitness parameters (maximal aerobic capacity, muscle strength and flexibility), daily physical activity, resting metabolic rate (RMR), pulmonary function tests (PFTs), body composition, depression, anxiety and health-related quality of life (HRQoL) changes as well as the associations among these parameters in patients with fibromyalgia and to compare them with healthy controls. METHODS Thirty-nine women with fibromyalgia and 40 controls were included in this study. Physical measurements, HRQoL questionnaire, Beck Depression Inventory (BDI) score and Beck Anxiety Inventory (BAI) score were applied to all participants. RESULTS Maximal aerobic capacity, trunk flexibility, daily step numbers, total energy expenditure, RMR and PFT values were not significantly different between the patients and the controls. Fibromyalgia patients had higher daily moderate activity times, active energy expenditure values, and BDI and BAI scores, while their lower handgrip strength and back-leg strength values and Short-form health survey (SF)-36 scores were comparable to controls. Handgrip strength and back-leg strength values showed moderately positive correlations with SF-36 scores (total, physical health, mental health) and moderately negative correlations with BDI and BAI scores in patients with fibromyalgia. CONCLUSION Our results suggested that muscle strength, HRQoL, depression and anxiety symptomatology were impaired in fibromyalgia patients compared to healthy controls. Low muscle strength is related to reduced HRQoL and increased depression and anxiety symptomatology in patients with fibromyalgia. Also we suggest that performing daily exercises, including aerobic and strength training, as part of one's lifestyle may have beneficial effects in fibromyalgia patients.
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Affiliation(s)
- Umit Sener
- Department of Physiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Kagan Ucok
- Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Alper M Ulasli
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Abdurrahman Genc
- Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Hatice Karabacak
- Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Necip F Coban
- Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Hasan Simsek
- Department of Physiology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Halime Cevik
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing, outcomes from a randomized-controlled trial. Clin J Pain 2013; 29:296-304. [PMID: 23042474 DOI: 10.1097/ajp.0b013e318254ac76] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. METHODS A total of 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire (FIQ)-Physical Impairment score, assessed at pretreatment, posttreatment, and 3-month and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. RESULTS There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, P=0.06). Compared with EC participants, MI participants also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 m, P=0.03). In addition, MI was superior to EC in increasing the number of hours of physical activity immediately postintervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. CONCLUSIONS Despite a lack of benefits on long-term outcome, MI seems to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim.
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Dailey DL, Rakel BA, Vance CGT, Liebano RE, Amrit AS, Bush HM, Lee KS, Lee JE, Sluka KA. Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain 2013; 154:2554-2562. [PMID: 23900134 DOI: 10.1016/j.pain.2013.07.043] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 07/08/2013] [Accepted: 07/24/2013] [Indexed: 11/18/2022]
Abstract
Because transcutaneous electrical nerve stimulation (TENS) works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo-controlled cross-over design to test the effects of a single treatment of TENS with people with fibromyalgia. Three treatments were assessed in random order: active TENS, placebo TENS and no TENS. The following measures were assessed before and after each TENS treatment: pain and fatigue at rest and in movement; pressure pain thresholds, 6-m walk test, range of motion; 5-time sit-to-stand test, and single-leg stance. Conditioned pain modulation was completed at the end of testing. There was a significant decrease in pain and fatigue with movement for active TENS compared to placebo and no TENS. Pressure pain thresholds increased at the site of TENS (spine) and outside the site of TENS (leg) when compared to placebo TENS or no TENS. During active TENS, conditioned pain modulation was significantly stronger compared to placebo TENS and no TENS. No changes in functional tasks were observed with TENS. Thus, the current study suggests TENS has short-term efficacy in relieving symptoms of fibromyalgia while the stimulator is active. Future clinical trials should examine the effects of repeated daily delivery of TENS, similar to the way in which TENS is used clinically on pain, fatigue, function, and quality of life in individuals with fibromyalgia.
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Affiliation(s)
- Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA College of Nursing, University of Iowa, Iowa City, IA, USA University of the City of Sao Paulo, Physical Therapy Department, Sao Paulo, Brazil Department of Rheumatology, University of Iowa, Iowa City, IA, USA Department of Biostatistics, University of Kentucky, College of Public Health, Lexington, KY, USA
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Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, Overend TJ, Richards RS, Sawant A, Schachter CL. Exercise therapy for fibromyalgia. Curr Pain Headache Rep 2011; 15:358-67. [PMID: 21725900 PMCID: PMC3165132 DOI: 10.1007/s11916-011-0214-2] [Citation(s) in RCA: 191] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being.
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Affiliation(s)
- Angela J Busch
- School of Physical Therapy, University of Saskatchewan, 1121 College Drive, Saskatoon, Saskatchewan S7N 0W3, Canada.
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Wilbarger JL, Cook DB. Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention. Arch Phys Med Rehabil 2011; 92:653-6. [PMID: 21440712 DOI: 10.1016/j.apmr.2010.10.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 10/18/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document sensory sensitivities to nonnoxious sensory stimuli in daily life for participants with fibromyalgia (FM). DESIGN Descriptive study of a convenience sample using a self-report survey of sensory processing. SETTING Participants were recruited from the general community. The procedure took place in a research room at the University of Wisconsin-Madison. PARTICIPANTS Women with FM (n=27) were compared with women with rheumatoid arthritis (RA) (n=28) and healthy pain-free women (controls) (n=28) (N=83). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE A self-report measure of sensory sensitivity to stimuli encountered in daily life. Items ask participants if they are sensitive to sensations that do not seem to bother other people or avoid common activities or environments because of sensory stimuli. RESULTS The FM group reported significantly increased sensory sensitivities to both somatic (tactile) and nonsomatic (eg, auditory and olfactory) sensory stimuli compared with the RA and control groups. The RA and control groups did not differ in reported hypersensitivities. CONCLUSIONS Women with fibromyalgia reported increased sensitivities to stimuli in the environment and could experience more stress related to sensory conditions in daily life.
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Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ. Internet-enhanced management of fibromyalgia: a randomized controlled trial. Pain 2010; 151:694-702. [PMID: 20855168 DOI: 10.1016/j.pain.2010.08.034] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/05/2010] [Accepted: 08/20/2010] [Indexed: 12/31/2022]
Abstract
Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.
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Affiliation(s)
- David A Williams
- Anesthesiology, Medicine, Psychiatry, and Psychology, The University of Michigan, USA Avera Research Institute, The Avera McKennan Hosptial and Health Center, Sioux Falls, SD, USA Institute for Research on Women and Gender, The University of Michigan, USA Medicine, The University of Pittsburgh, USA The Avera McKennan Hosptial and Health Center, Sioux Falls, SD, USA Anesthesiology, Medicine, and Psychiatry, The University of Michigan, USA
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Chong YY, Ng BY. Clinical Aspects and Management of Fibromyalgia Syndrome. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n11p967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiff- ness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pitutary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
Key words: Aetiology, Fibromyalgia-Fibromyositis Syndromes, History, Pain syndrome
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Williams DA, Clauw DJ. Understanding fibromyalgia: lessons from the broader pain research community. THE JOURNAL OF PAIN 2009; 10:777-91. [PMID: 19638325 PMCID: PMC2741022 DOI: 10.1016/j.jpain.2009.06.001] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 04/29/2009] [Indexed: 12/11/2022]
Abstract
UNLABELLED Fibromyalgia (FM) is a chronic pain condition marked by centrally mediated augmentation of pain and sensory processes. Skepticism has marked the history of this condition, but more recent study has identified neurobiological underpinnings supporting many of the symptoms associated with this condition. Early research in FM had unprecedented latitude within the rheumatology community to borrow heavily from theory and methods being applied in chronic pain research more generally. These insights facilitated rapid advances in FM research, not the least of which was the abandonment of a peripheral focus in favor of studying central mechanisms associated with central augmentation. Currently, rapid-paced discovery is taking place in FM genetics, patient assessment, new therapeutic targets, and novel methods of treatment delivery. Such insights are not likely to be limited in application just to FM and could have relevance to the broader field of pain research as well. PERSPECTIVE This manuscript reviews the history of FM and its diagnosis, evidence supporting central augmentation of pain in FM, potential mechanisms of central augmentation, current approaches to integrated care of FM, and areas of active collaboration between FM research and other chronic pain conditions.
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Affiliation(s)
- David A Williams
- Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, Michigan 48106, USA.
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Busch AJ, Overend TJ, Schachter CL. Fibromyalgia treatment: the role of exercise and physical activity. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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