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Schweiger V, Martini A, Nizzero M, Bonora E, Del Balzo G, Gottin L, Torroni L, Polati L, Zuliani G, Secchettin E, Polati E. Prevalence of FMS Diagnosis According to ACR 2016 Revised Criteria in a Pain Therapy Centre in Italy: Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:599. [PMID: 38674245 PMCID: PMC11052143 DOI: 10.3390/medicina60040599] [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: 02/29/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Fibromyalgia syndrome (FMS) is a multifaceted disease with a strong preference for the female sex. It is characterised by chronic widespread pain, sleep-wake disorders, fatigue, cognitive disturbances, and several other somatic symptoms. Materials and Methods: In this prospective observational study, we analysed data regarding 302 patients who were referred to our pain centre for a first clinical assessment evaluation and were then inspected for the physician-based 2016 revision of the ACR diagnostic criteria for FMS, regardless of the final diagnosis previously made by the pain therapist. Results: Among the 280 patients who adhered to the 2016 ACR questionnaire, 20.3% displayed positive criteria for FMS diagnosis. The level of agreement between the FMS discharge diagnosis made by the pain clinician and the ACR 2016 criteria-positivity was moderate (kappa = 0.599, with moderate agreement set at a kappa value of 0.6). Only four patients (1.7%) diagnosed as suffering from FMS at discharge did not satisfy the minimal 2016 ACR diagnostic criteria. Conclusions: This prospective observational study confirmed the diagnostic challenge with FMS, as demonstrated by the moderate grade of agreement between the FMS diagnosis at discharge and the positivity for 2016 ACR criteria. In our opinion, the use of widely accepted diagnostic guidelines should be implemented in clinical scenarios and should become a common language among clinicians who evaluate and treat patients reporting widespread pain and FMS-suggestive symptoms. Further methodologically stronger studies will be necessary to validate our observation.
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Affiliation(s)
- Vittorio Schweiger
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Alvise Martini
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Marta Nizzero
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Eleonora Bonora
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Giovanna Del Balzo
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, 37134 Verona, Italy;
| | - Leonardo Gottin
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Lorena Torroni
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy;
| | - Luca Polati
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Giada Zuliani
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Erica Secchettin
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
| | - Enrico Polati
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry and Maternal Sciences, University of Verona, 37124 Verona, Italy; (A.M.); (M.N.); (E.B.); (L.G.); (L.P.); (G.Z.); (E.S.); (E.P.)
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Valera-Calero JA, Fernández-de-las-Peñas C, Navarro-Santana MJ, Plaza-Manzano G. Efficacy of Dry Needling and Acupuncture in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169904. [PMID: 36011540 PMCID: PMC9408486 DOI: 10.3390/ijerph19169904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 06/01/2023]
Abstract
Fibromyalgia (FM) is a syndrome that involves chronic pain, fatigue, sleep disturbance and impaired quality of life and daily functioning. In addition to medical and psychological therapies, other therapies including acupuncture and dry needling aim to reduce pain and disability in patients with FM. The aim of this study was to investigate the efficacy of dry needling and acupuncture in patients with FM regarding pain, function and disability in both the short and the long term. MEDLINE, PubMed, SCOPUS and Web of Science databases were systematically searched for randomized controlled trial studies evaluating efficacy data of dry needling or/and acupuncture treatments to improve pain, fatigue, sleep disturbance and impaired quality of life and/or daily function. A qualitative analysis including the methodological quality and a systematic data synthesis was performed. A total of 25 studies addressed the selection criteria. Most studies had an acceptable methodological quality. Four studies assessed the effect of dry needling, and twenty-one studies assessed the effect of acupuncture. In general, both interventions improved pain, anxiety, depression, fatigue, stiffness, quality of sleep and quality of life. However, both techniques were not compared in any study. Acupuncture and dry needling therapies seems to be effective in patients with FM, since both reduced pain pressure thresholds, anxiety, depression, fatigue, sleep disturbances and disability in the short term. It is still required to compare both techniques and their application in the long term.
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Affiliation(s)
- Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | | | - Gustavo Plaza-Manzano
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Plaut S. Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS One 2022; 17:e0263087. [PMID: 35171940 PMCID: PMC8849503 DOI: 10.1371/journal.pone.0263087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. METHODS Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. FINDINGS 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. CONCLUSIONS MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.
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Affiliation(s)
- Shiloh Plaut
- School of Medicine, St. George’s University of London, London, United Kingdom
- * E-mail:
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Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol. Brain Sci 2020; 10:brainsci10120997. [PMID: 33561042 PMCID: PMC7766461 DOI: 10.3390/brainsci10120997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Dry needling (DN) is an emerging technique commonly used in neurological and musculoskeletal pain conditions, but there have been no previous studies in patients with multiple sclerosis (pwMS). This trial aims to assess the efficacy of deep DN, compared with sham placebo DN, on gait performance, spasticity level, pain, electromyographic activity, range-of-movement (ROM) and quality of life in pwMS. Forty adults with MS were randomly assigned to one study group. The DN group will undergo 2 sessions (once per week) using DN over the rectus femoris (RF) and gastrocnemius medialis (GM) muscles at the lower extremity with higher spasticity. The placebo group will receive the same protocol using a sham placebo needle (Dong Bang needle). Outcome measures will include gait performance, using the GaitRite® system, spasticity level with the Modified Ashworth Scale, superficial electromyographic activity of RF and GM, pain (pressure algometer), ROM (goniometer), and quality of life (Musiqol). This study is the first investigating the short-term effect of DN, compared with placebo, in pwMS, and taking into account the possible changes in the electromyographic activity of the lower limb. Therefore, the results may help to understand the suitability of using this technique in the clinical setting for this population. Trial registration: ACTRN12619000880145.
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