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Pfalzgraf AR, Friend R, Jones KD. Do FIQR Severity Categories and Symptoms, Differentiate Between Continuous, Intermittent and Non-Opioid Users in the Treatment of Fibromyalgia? Pain Manag Nurs 2024; 25:181-188. [PMID: 37993311 PMCID: PMC11016416 DOI: 10.1016/j.pmn.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Many fibromyalgia patients utilize opioids to treat symptoms. It is important to better understand nuances regarding this treatment option and any stigma associated with this treatment modality. AIM This study: (1) assessed the prevalence of opioid use among continuous, intermittent, and non-opioid users in fibromyalgia patients; (2) determined whether the Revised Fibromyalgia Impact Questionnaire (FIQR) was useful in distinguishing opioid use and symptom burden; and (3) assessed whether fibromyalgia patients encountered stigma and/or invalidation. DESIGN A cross-sectional, observational study of 1,105 participants' responses to validated fibromyalgia and invalidation scales and demographic questions. METHODS The study employed online survey methodology. RESULTS A total of 45% of patients reported utilizing opioids (27% continuous, 18% intermittent, 55% non-users). FIQR disease categories (mild to most severe) strongly distinguished between opioid and non-opioid users with 59% of users falling in the most severe category and 68% of non-users falling in mild disease category (p < .0001). Interestingly, intermittent users were similar to non-users on FIQR severity (65.9 versus 65.7; p <0.60, 0-100) while continuous users reported greater severity than the former (73.9, p < .0001). Continuous users particularly reported more problems with daily activities (p < .0001), being overwhelmed (p < .0001), and being unable to accomplish goals (p < .0001). Stigma related to being 'drug seeking' and being 'judged'. Invalidation was infrequent. CONCLUSIONS Opioid use is common in fibromyalgia and increases monotonically with FIQR severity. Multidisciplinary approaches which help patients perform daily activities, decrease feelings of overwhelm, accomplish goals, and reduce stigma may be beneficial.
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Affiliation(s)
- Andrea R Pfalzgraf
- From the National University of Natural Medicine, Helfgott Research Institute, Portland, OR.
| | - Ronald Friend
- Department of Psychology, College of Arts and Sciences, Stony Brook University, Stony Brook, NY (emeritus); Fibromyalgia Research Unit, Oregon Health & Science University, Portland, OR
| | - Kimberly Dupree Jones
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Oregon Health & Science University, Division of Neurology, Portland, OR
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2
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An J, Fan W, Mittal A, Zhang Y, Chen AT. Mobile App Use among Persons with Fibromyalgia: A Cross-sectional Survey. THE JOURNAL OF PAIN 2024:104515. [PMID: 38522593 DOI: 10.1016/j.jpain.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Persons with fibromyalgia experience a diverse set of symptoms. Recommendations for management generally focus on multidisciplinary approaches involving multiple modalities. Mobile apps can be an essential component for self-management, yet little is known about how persons with fibromyalgia use mobile apps for health-related purposes. A cross-sectional survey (N = 663) was conducted to understand the real-world use of apps among persons with fibromyalgia. The survey included 2 main foci: 1) eHealth literacy and use of information sources, and 2) mobile app use patterns and preferences for health-related purposes, including the types of apps used and usage characteristics of apps currently in use, as well as those that had been discontinued. Respondents' average eHealth literacy as measured by eHealth Literacy Scale (eHEALS) was 31.4 (SD = 7.1), and they utilized diverse information sources. Approximately two-thirds of the sample used mobile apps; the remaining one-third did not. Diverse health management needs were represented in the apps reported, including scheduling/time management, notetaking, fitness, and wellness. Compared to apps that had been discontinued, participants rated apps that they still used higher in terms of ease of use and used them more frequently. Reasons for discontinuing app use included issues with privacy, the effort required, lack of interest, and lack of perceived quality. Other reasons for app nonuse were lack of awareness and how-to knowledge, indicating that disseminating information about apps and addressing other barriers, such as providing user support, are critical to increasing uptake. These study findings can inform both app design and dissemination. PERSPECTIVE: This article presents how persons with fibromyalgia use mobile apps to manage their health. The findings could inform the development of digital interventions or programs for this population.
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Affiliation(s)
- Jiaxin An
- School of Information, University of Texas at Austin, Austin, Texas
| | - Wei Fan
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Anant Mittal
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington
| | - Yan Zhang
- School of Information, University of Texas at Austin, Austin, Texas
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
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3
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Apriliyasari RW, Chou CW, Tsai PS. Pain Catastrophizing as a Mediator Between Pain Self-Efficacy and Disease Severity in Patients with Fibromyalgia. Pain Manag Nurs 2023; 24:622-626. [PMID: 37321890 DOI: 10.1016/j.pmn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, sleep disturbances, cognitive impairment, and mood disturbance. Both pain catastrophizing and pain self-efficacy have been found to be mediators of pain treatment effectiveness. However, whether pain catastrophizing mediates the association between pain self-efficacy and FM severity remains unclear. AIM To examine whether pain catastrophizing mediates the association between pain self-efficacy and disease severity in patients with FM. METHODS This cross-sectional study included the baseline data of 105 people with FM from a randomized controlled trial. Hierarchical linear regression analysis was performed to examine the predictive ability of pain catastrophizing for FM severity. Furthermore, we examined the mediating effect of pain catastrophizing on the association between pain self-efficacy and FM severity. RESULTS Pain self-efficacy was negatively associated with pain catastrophizing (β = -.4043, p < .001). FM severity was positively associated with pain catastrophizing (β = .8290, p < .001) and negatively associated with pain self-efficacy (β = -.3486, p = .014). Pain self-efficacy had a direct effect on FM severity (β = -.6837, p < .001) and an indirect effect on FM severity through the effect of pain catastrophizing (β = -.3352, 95% CI bootstrapping -.5008 to -.1858). CONCLUSION Pain catastrophizing independently predicts FM severity and mediates the association between pain self-efficacy and FM severity. Pain catastrophizing should be monitored through interventions aimed at improving pain self-efficacy to reduce symptom burden in patients with FM.
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Affiliation(s)
- Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Institut Teknologi Kesehatan (ITEKES) Cendekia Utama Kudus, Kudus, Indonesia
| | - Chia-Wen Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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4
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Di Renzo L, Gualtieri P, Zomparelli S, De Santis GL, Seraceno S, Zuena C, Frank G, Cianci R, Centofanti D, De Lorenzo A. Modified Mediterranean-Ketogenic Diet and Carboxytherapy as Personalized Therapeutic Strategies in Lipedema: A Pilot Study. Nutrients 2023; 15:3654. [PMID: 37630844 PMCID: PMC10457774 DOI: 10.3390/nu15163654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, the use of the ketogenic diet as a proper nutritional treatment for lipedema has been hypothesized in the literature. This is the first clinical study evaluating the ketogenic diet and carboxytherapy in lipedema patients. In the present study, it was decided to use a modified Mediterranean ketogenic diet (MMKD) in combination with carboxytherapy. Since lipedema is characterized by microangiopathy, local hypoxia, and increased subcutaneous adipose tissue (SAT) deposition, carboxytherapy could improve painful symptoms and skin tone. A total of 22 subjects were included in the data analysis, divided into three groups; 8 patients underwent MMKD combined with carboxytherapy sessions (KDCB group), 8 underwent MMKD nutritional treatment alone (KD group), and 6 patients underwent only carboxytherapy sessions (CB group), for a total of 10 weeks of treatment for all three groups. It was observed that the ketogenic diet effectively induced weight and fat mass loss, including in the limbs, areas considered unresponsive to diet therapy in lipedema patients. However, the best results were obtained from the combination of the ketogenic diet and carboxytherapy, which showed improvements in both body composition and skin texture and a reduction in pain, along with an improvement in sleep quality. It would be helpful to conduct a clinical trial on a larger scale and over a more extended period to observe the results in the long term as well.
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Affiliation(s)
- Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Samanta Zomparelli
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Gemma Lou De Santis
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Silvia Seraceno
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Zuena
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giulia Frank
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | | | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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5
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Valladales-Restrepo LF, Oyuela-Gutiérrez MC, Alzate-García M, Osorio-Rodas I, Quintero-Flórez V, Restrepo-Muñoz JF, Suárez-Cardona JA, Barroso-Fernandes ST, Machado-Alba JE. Treatment patterns in fibromyalgia including the use of opioids. Musculoskeletal Care 2023; 21:66-77. [PMID: 35765712 DOI: 10.1002/msc.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Opioids (except for tramadol) have not been shown to be effective in patients with fibromyalgia, but they can increase the risk of adverse drug reactions. The aim was to determine the treatment patterns of a group of patients with fibromyalgia and to identify the factors associated with the use of opioids in Colombia. METHODS This was a cross-sectional study of a group of patients with fibromyalgia from a pain clinic in Colombia. Sociodemographic, clinical and pharmacological variables were identified. Descriptive, bivariate, and multivariate analyses were performed. RESULTS A total of 559 patients were analysed, 88.6% of whom were women, and the mean age was 53.4 ± 12.6 years. A total of 40.6% received nonpharmacological management, and the majority were treated with acetaminophen (96.1%) and pregabalin (62.8%). A total of 69.6% received opioids, the most common of which was hydrocodone (36.3%). The average morphine equivalent milligrammes was 36.9 ± 91.2 (range: 2.3-750 mg), and 43.8% had intermediate/high doses. Being male (OR: 3.12; 95% CI: 1.40-6.91), having arterial hypertension (OR: 1.67; 95% CI: 1.04-2.69), obesity (OR: 2.23; 95% CI: 1.18-4.24), degenerative disease of vertebral discs (OR: 2.32; 95% CI: 1.10-4.88) and comedication with gabapentinoids (OR: 1.75; 95% CI: 1,15-2.65) were associated with a higher probability of receiving opioids, while patients treated with muscle relaxants had a lower risk of opioid treatment (OR: 0.64; 95% CI: 0.41-0.98). CONCLUSIONS A significant proportion of patients were treated with opioids, the most common of which was hydrocodone, which goes against the recommendations of clinical practice guidelines.
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Affiliation(s)
- Luis F Valladales-Restrepo
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - María C Oyuela-Gutiérrez
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Mariana Alzate-García
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Isabella Osorio-Rodas
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Valentina Quintero-Flórez
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Juan F Restrepo-Muñoz
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Julián A Suárez-Cardona
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Sergio T Barroso-Fernandes
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge E Machado-Alba
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
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6
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Pasini I, Perlini C, Donisi V, Mason A, Schweiger V, Secchettin E, Lugoboni F, Valenza G, Del Piccolo L. "INTEGRO INTEGRated Psychotherapeutic InterventiOn" on the Management of Chronic Pain in Patients with Fibromyalgia: The Role of the Therapeutic Relationship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3973. [PMID: 36900982 PMCID: PMC10002139 DOI: 10.3390/ijerph20053973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Fibromyalgia (FM) is a chronic disease characterized by a heterogeneous set of physical and psychological conditions. The chronic experience of disability felt by patients and the impact on quality of life (QoL) of the disease may worsen the cognitive reappraisal ability and contribute to maintaining an altered pain modulation mechanism. This paper presents the study protocol of an INTEGRated psychotherapeutic interventiOn on the management of chronic pain in patients with fibromyalgia (INTEGRO). The aim of the study is to investigate the efficacy of an integrated psychotherapeutic intervention focused on pain management on QoL and pain perception, in a pilot sample of 45 FM patients with idiopathic chronic pain. The contribution of perceived therapeutic relationship (alliance) and physiological attunement, in both the patient and therapist, will be considered as possible mediators of intervention efficacy. Attachment dimensions, traumatic experiences, difficulties in emotion regulation, mindfulness attitude and psychophysiological profile will also be considered as covariates. The objectives are to evaluate longitudinally if patients will experience an increase in QoL perception (primary endpoint), pain-managing self-efficacy and emotion-regulation abilities as well as a reduction in pain intensity (secondary endpoints), considering the mediating role of perceived therapeutic alliance and physiological attunement in both the patient and therapist.
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Affiliation(s)
- Ilenia Pasini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Anna Mason
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Erica Secchettin
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Gaetano Valenza
- Bioengineering and Robotics Research Center “E. Piaggio”, Department of Information Engineering, School of Engineering, University of Pisa, 56122 Pisa, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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7
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Althobaiti NK, Amin BA, Alhamyani AD, Alzahrani SM, Alamri AM, Alhomayani FKH. Prevalence of Fibromyalgia Syndrome in Taif City, Saudi Arabia. Cureus 2022; 14:e32489. [DOI: 10.7759/cureus.32489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
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8
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Salaffi F, Farah S, Mariani C, Sarzi‐Puttini P, Di Carlo M. Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. Pain Pract 2022; 22:702-710. [PMID: 36097821 PMCID: PMC9826291 DOI: 10.1111/papr.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The goal of this study was to explore additional evidence of convergent and discriminant validity of the Central Sensitization Inventory (CSI) in a large sample of subjects with fibromyalgia (FM). METHODS Patients were consecutively enrolled for a cross-sectional assessment comprehensive of three FM-specific measures (the revised Fibromyalgia Impact Questionnaire [FIQR], the modified Fibromyalgia Assessment Status [modFAS], and the Polysymptomatic Distress Scale [PDS]) and of CSI. To test the convergent validity, the Spearman's rho was used to measure the degree of correlation between the variables CSI and the FM-specific measures. To assess discriminant validity, CSI scores were grouped according to FIQR disease severity states, and differences between these groups studied with the Kruskal-Wallis test. Interpretative cutoffs were established with the interquartile reconciliation approach. RESULTS The study included 562 FM patients, 199 (35.4%) were classified as having central sensitization syndrome (CSI ≥40). CSI was largely correlated with modFAS (ρ = 0.580; p < 0.0001), FIQR (ρ = 0.542; p < 0.0001), and PDS (ρ = 0.518; p < 0.0001). The differences between the CSI scores in accordance with the FIQR were significant (p < 0.000001). CSI cutoffs proposed for FM: 21 between remission and mild severity, 30 between mild and moderate severity, 37 between moderate and severe disease, and 51 between severe and very severe disease. CONCLUSION The current study successfully showed additional evidence of the convergent and discriminant validity of the CSI in FM patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Sonia Farah
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Claudia Mariani
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Piercarlo Sarzi‐Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli‐SaccoMilan University School of MedicineMilanItaly
| | - Marco Di Carlo
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
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9
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Abstract
Fibromyalgia developed in the 1950s from a substrate of difficult to explain regional and widespread pain mixed with symptoms of psychosocial distress. Controversies regarding psychological issues were common. Multiple criteria arose to define the disorder, but each identified a different set of patients. The identification of widespread pain as a criterion changed the nature of the disorder by effectively eliminating regional pain as a component condition. The easy-to-measure and relatively reliable widespread pain criterion then came to define the disorder. In the primary care community, diagnostic criteria were largely ignored, and a substantial fraction of diagnosed patients with lower pain scores, particularly women and those with high non-pain symptom scores, were diagnosed. Non-pain symptoms were added back to the fibromyalgia definition and criteria in 2010. Recognition grew that fibromyalgia fit the description of a functional somatic disorder. The idea of fibromyalgia as a primary pain disorder with a neurobiological basis contended with fibromyalgia as a broader biopsychosocial disorder. It is increasingly recognized that fibromyalgia represents a dimensional, non-binary condition and that features of fibromyalgia extend to persons who do not satisfy the criteria. Severity assessments are now available but rarely used. The course of fibromyalgia is not well studied, and improvement and remission criteria have not been successfully defined. The future of fibromyalgia as a discrete disorder remains uncertain as features of fibromyalgia are increasingly observed in patients with multiple different medical conditions.
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Affiliation(s)
- Frederick Wolfe
- Research, National Data Bank for Rheumatic Diseases, Wichita, USA.,Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, USA
| | - Johannes J Rasker
- Faculty of Behavioural Management and Social Sciences, Department of Psychology Health and Technology, University of Twente, Enchede, NLD
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10
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Ariani A, Bazzichi L, Sarzi-Puttini P, Salaffi F, Manara M, Prevete I, Bortoluzzi A, Carrara G, Scirè CA, Ughi N, Parisi S. The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia Best practices based on current scientific evidence. Reumatismo 2021; 73:89-105. [PMID: 34342210 DOI: 10.4081/reumatismo.2021.1362] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Fibromyalgia or fibromyalgia syndrome (FMS) is defined as a central sensitization syndrome characterized by the dysfunction of neurocircuits detecting, transmitting and processing nociceptive stimuli; the prevalent manifestation is musculoskeletal pain. In addition to pain, there are multiple accompanying symptoms, in common with other algo-dysfunctional syndromes, which are reflected in a broad spectrum of somatic, neurocognitive and neuro-vegetative manifestations. An evidence-based approach is essential in FMS management, in order to improve patient health and to reduce its social burden. Since in the last ten years new international guidelines for clinical practice (Clinical Practice Guidelines or CPGs) concerning FMS diagnosis and pharmacological/ non-pharmacological management have been published, the Italian Society of Rheumatology (SIR) has decided to adapt them to the Italian national setting. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the most recent CPGs on FMS to the needs of the Italian healthcare context. A working group of rheumatologists from SIR epidemiology unit and FMS experts identified relevant clinical questions to guide the systematic review of the literature. The target audience of these CPGs included physicians and healthcare professionals who manage FMS. The adapted recommendations were finally assessed by an external multidisciplinary panel. From the systematic search in databases (Pubmed/Medline, Embase) and grey literature, 6 CPGs were selected and appraised by two independent raters. The combination of the scientific evidence underlying the original CPGs with expert opinion lead to the development of 17 recommendations. The quality of evidence for each recommendation was reported and their potential impact on clinical practice was assessed. These SIR recommendations are expected to be a valuable aid in the diagnosis and treatment of FMS, as they will contribute to disseminate the best practice on the basis of the current scientific evidence.
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Affiliation(s)
- A Ariani
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Medicina, Unità di Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma.
| | - L Bazzichi
- Unità di Reumatologia, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - P Sarzi-Puttini
- Unità di Reumatologia, ASST Fatebenefratelli-Sacco, Università di Milano.
| | - F Salaffi
- Clinica Reumatologica, Ospedale 'Carlo Urbani', Università Politecnica delle Marche, Jesi (AN).
| | - M Manara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Reumatologia Clinica, Centro Specialistico Ortopedico-Traumatologico Gaetano Pini CTO, ASST Gaetano Pini, Milano.
| | - I Prevete
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Unità di Reumatologia, Azienda Ospedaliera San Camillo-Forlanini, Roma.
| | - A Bortoluzzi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Scienze Mediche, Sezione di Reumatologia, Università di Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (FE).
| | - G Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan.
| | - C A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Scienze Mediche, Sezione di Reumatologia, Università di Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (FE).
| | - N Ughi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Division of Rheumatology, ASST Grande Ospedale Metropolitano Niguarda, Milano.
| | - S Parisi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Unità di Reumatologia, Azienda Ospedaliera Città della Salute e della Scienza di Torino.
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11
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Cavalli G, Cariddi A, Ferrari J, Suzzi B, Tomelleri A, Campochiaro C, De Luca G, Baldissera E, Dagna L. Living with fibromyalgia during the COVID-19 pandemic: mixed effects of prolonged lockdown on the well-being of patients. Rheumatology (Oxford) 2021; 60:465-467. [PMID: 33188686 PMCID: PMC7717382 DOI: 10.1093/rheumatology/keaa738] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/26/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giulio Cavalli
- Vita-Salute San Raffaele University, Milan.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | | | | | - Alessandro Tomelleri
- Vita-Salute San Raffaele University, Milan.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan
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