Fibromyalgia: Timely diagnosis and treatment options

Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress

OBJECTIVES

Fibromyalgia syndrome (FMS) is a chronically painful condition whose symptoms are widely reported to be exacerbated by stress. We hypothesized that female patients with FMS differ from pain-free female controls in their sympathetic responses, a fact that may unmask important biomarkers and factors that contribute to the etiology of FMS.

MATERIALS AND METHODS

In a pilot study, blood pressure (BP), skin temperature, thermogenic activity, circulating glucose, and pain sensitivity of 13 individuals with FMS and 11 controls at room temperature (24°C) were compared with that after exposure to cold (19°C).

RESULTS

When measured at 24°C, BP, skin temperature, blood glucose, and brown adipose tissue (BAT) activity, measured using F-fluorodeoxyglucose positron-emission tomography/computed tomography, did not differ between controls and individuals with FMS. However, after cold exposure (19°C), BP and BAT activity increased in controls but not in individuals with FMS; skin temperature on the calf and arm decreased in controls more than in individiuals with FMS; and circulating glucose was lower in individiuals with FMS than in controls. Pain sensitivity did not change during the testing interval in response to cold.

DISCUSSION

The convergence of the effect of cold on 4 relatively simple measures of thermogenic, cardiovascular, and metabolic activity, each regulated by sympathetic activity, strongly indicate that individuals with FMS have impaired sympathetic responses to stress that are observable and highly significant even when measured in extraordinarily small sample populations. If insufficient sympathetic responses to stress are linked to FMS, stress may unmask and maximize these potential clinical biomarkers of FMS and be related to its etiology.

Normalizing fibromyalgia as a chronic illness

Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.

The effects of local cold application on fibromyalgia pain

AIM

This study was conducted to evaluate the effects of local cold application on pain when applied to the trapezius muscles of patients with fibromyalgia.

METHOD

A one-group, pre-test/post-test, pre-experimental model was applied in this study, which was conducted with 55 fibromyalgia patients who presented to a rheumatology outpatient clinic. A 10-min cold application was administered to one trapezius muscle of each patient. The participants' pain was evaluated, in total, four times (before the cold application and 10 min, 1.5 h and 24 h after the cold application). The visual analogue scale (VAS) for pain was used to collect data for the study, and Friedman and Wilcoxon tests were used to assess the data.

RESULTS

The patients' pain mean score before (6.45, SD:1.27) the cold applications was found to be significantly higher than the scores noted 10 min (2.75, SD:1.73), 1.5 h (2.45, SD:1.29), and 24 h (3.36, SD:1.30) after the application (P < 0.001).

CONCLUSION

The study found that local cold applications performed on the trapezius muscles of patients with fibromyalgia significantly decreased their pain. With its discovery of a new method of pain control in fibromyalgia patients, this study will significantly contribute to science and will serve as a guide for pain management, especially in nursing practice. Further studies to evaluate the maximum effect duration and effect mechanisms of local cold applications to the trapezius muscles of FM patients are indicated.