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Del-Río-Guerrero V, Martínez-Martínez LA, Arias-Callejas K, Carbonell-Bobadilla N, Mejía-Segura A, Azamar-Morales G, Espinosa-Orantes A, Molina-Sánchez JR, Mora-Ramírez M, Mejía-Ávila MF, Vargas Guerrero A, Silveira LH, Martínez-Lavín M. The value of inquiring patients about local discomfort during blood pressure measurement for fibromyalgia detection. A cross-sectional study. Semin Arthritis Rheum 2023; 61:152218. [PMID: 37229846 DOI: 10.1016/j.semarthrit.2023.152218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Fibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. OBJECTIVE To evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. PATIENTS AND METHODS All adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: "I am going to take your blood pressure; tell me if the cuff's pressure causes pain". Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated "did it hurt much or little". Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. RESULTS Four hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having "much" local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. CONCLUSIONS Inquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.
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Affiliation(s)
| | | | - Karina Arias-Callejas
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Alejandra Mejía-Segura
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Gibran Azamar-Morales
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - José-Raúl Molina-Sánchez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Mauricio Mora-Ramírez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Angélica Vargas Guerrero
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Luis H Silveira
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Manuel Martínez-Lavín
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico.
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Eldin C, Boudjema S, Meddeb L, Boyer L, Soriano C, Parola P, Lagier JC, Stein A, Gouriet F, Gautret P, Million M, Raoult D. Evaluation of pain susceptibility by taking blood pressure in patients with infections: A prospective comparative study. Medicine (Baltimore) 2021; 100:e26511. [PMID: 34397794 PMCID: PMC8341363 DOI: 10.1097/md.0000000000026511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
Pain sensitization leading to polyalgia can be observed during infectious diseases. The blood pressure cuff-evoked pain threshold (BPCEPT) has been used in previous studies as a screening tool for fibromyalgia.We aimed to use the BPCEPT as a screening test for detecting pain sensitization in patients suffering from infectious diseases. We also investigated whether specific factors were associated with pain sensitization.We performed a prospective comparative study including all patients of our infectious diseases center in a 1-year period. We created a positive control group of patients suffering from fibromyalgia and a negative control group of "apparently healthy" patients consulting for vaccination.The blood pressure (BP) cuff was inflated until the patient signaled that they experienced pain, and this pressure value was noted.A total of 2355 patients were included. The positive control group had significantly lower values of the BPCEPT than all other groups. Among hospitalized patients with infectious diseases, a low BPCEPT was significantly associated with high temperature (P < .0001), older age (P = .002), being a woman (P = .004), high serum glutamic-oxaloacetic transaminase (P = .007), and high C reactive protein levels (P = .02). Moreover, in multivariate analysis, respiratory infection, meningitis, urinary tract infection, febrile neutropenia, and Q fever were independently associated with a low BPCEPT. A significant negative dynamic correlation between the BPCEPT and temperature was also observed (P < .001).We demonstrated for the first time in a large sample of patients that the BPCEPT method can be used to detect pain susceptibility. We observed a significant dynamic correlation between pain sensitization and temperature. Additionally, pain sensitization was associated with some diseases, suggesting that they trigger pain sensitivity.
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Affiliation(s)
- Carole Eldin
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Sophia Boudjema
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Line Meddeb
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Laurent Boyer
- Faculty of Medicine - Timone Medical Campus, EA 3279: Health service Research and quality of life Center, Aix Marseille University, Marseille, France
| | | | - Philippe Parola
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Andreas Stein
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Frédérique Gouriet
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Philippe Gautret
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
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3
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Maugars Y, Berthelot JM, Le Goff B, Darrieutort-Laffite C. Fibromyalgia and Associated Disorders: From Pain to Chronic Suffering, From Subjective Hypersensitivity to Hypersensitivity Syndrome. Front Med (Lausanne) 2021; 8:666914. [PMID: 34336880 PMCID: PMC8316633 DOI: 10.3389/fmed.2021.666914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
The concept of fibromyalgia has progressed to achieve a certain consensus regarding the definition of the condition. We summarize what is known in 2020, be it in terms of diagnosis, with the criteria that have changed over the years, or at the level of the psychological profile, via the notions of "catastrophizing" and "coping" and post-traumatic syndrome. The importance of fatigue and sleep disorders is underlined, with the chronological sequence of post-traumatic syndrome, chronic fatigue, and then amplification of the pain and the onset of multiple associated symptoms. The etiopathogenic debate has been enriched thanks to neuro-imaging data to discover the start of the central neurological signature. The many associated symptoms are reanalyzed in the context of so-called sister conditions which form sometimes more or less separate entities, such as chronic fatigue syndrome or restless legs syndrome for example. What these conditions have in common is hypersensitivity, not just to pain, but also to all exteroceptive stimuli, from deep sensitivity in the neuro-vegetative system, the sense organs and certain functions of the central nervous system, to the psychological aspects and sleep control. In summary, it is possible to define fibromyalgia as a cognitive disorder of cortical integration of chronic pain, with amplification of painful and sensory nociception, decrease in the threshold for the perception of pain, and persistence of a stimulus that maintains the process in chronicity. Fibromyalgia is part of a group of chronic hypersensitivity syndromes of central origin, with a very wide range of means of expression.
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Affiliation(s)
- Yves Maugars
- Rheumatology Department, Nantes University Hospital, Nantes, France
| | | | - Benoit Le Goff
- Rheumatology Department, Nantes University Hospital, Nantes, France
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Lee MC, Nahorski MS, Hockley JRF, Lu VB, Ison G, Pattison LA, Callejo G, Stouffer K, Fletcher E, Brown C, Drissi I, Wheeler D, Ernfors P, Menon D, Reimann F, Smith ESJ, Woods CG. Human Labor Pain Is Influenced by the Voltage-Gated Potassium Channel K V6.4 Subunit. Cell Rep 2021; 32:107941. [PMID: 32697988 PMCID: PMC7383234 DOI: 10.1016/j.celrep.2020.107941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/19/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
By studying healthy women who do not request analgesia during their first delivery, we investigate genetic effects on labor pain. Such women have normal sensory and psychometric test results, except for significantly higher cuff pressure pain. We find an excess of heterozygotes carrying the rare allele of SNP rs140124801 in KCNG4. The rare variant KV6.4-Met419 has a dominant-negative effect and cannot modulate the voltage dependence of KV2.1 inactivation because it fails to traffic to the plasma membrane. In vivo, Kcng4 (KV6.4) expression occurs in 40% of retrograde-labeled mouse uterine sensory neurons, all of which express KV2.1, and over 90% express the nociceptor genes Trpv1 and Scn10a. In neurons overexpressing KV6.4-Met419, the voltage dependence of inactivation for KV2.1 is more depolarized compared with neurons overexpressing KV6.4. Finally, KV6.4-Met419-overexpressing neurons have a higher action potential threshold. We conclude that KV6.4 can influence human labor pain by modulating the excitability of uterine nociceptors. KCNG4 variant highly prevalent in women requiring no analgesia in childbirth KCNG4 variant encodes KV6.4Met-419; KV6.4 is a silent subunit modifying KV activity KV6.4Met-419 is retained in the cytoplasm and acts in a dominant-negative manner KV6.4Met-419 overexpression results in hypoexcitable sensory neurons
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Affiliation(s)
- Michael C Lee
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - Michael S Nahorski
- Cambridge Institute for Medical Research, Wellcome Trust MRC Building, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - James R F Hockley
- Department of Pharmacology, Tennis Court Road, Cambridge CB2 1PD, UK
| | - Van B Lu
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Gillian Ison
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Luke A Pattison
- Department of Pharmacology, Tennis Court Road, Cambridge CB2 1PD, UK
| | - Gerard Callejo
- Department of Pharmacology, Tennis Court Road, Cambridge CB2 1PD, UK
| | - Kaitlin Stouffer
- Cambridge Institute for Medical Research, Wellcome Trust MRC Building, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Emily Fletcher
- Cambridge Institute for Medical Research, Wellcome Trust MRC Building, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Christopher Brown
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 7ZA, UK
| | - Ichrak Drissi
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Daniel Wheeler
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Patrik Ernfors
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - David Menon
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Frank Reimann
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | | | - C Geoffrey Woods
- Cambridge Institute for Medical Research, Wellcome Trust MRC Building, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
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Fayed N, Oliván B, Lopez del Hoyo Y, Andrés E, Perez-Yus MC, Fayed A, Angel LF, Serrano-Blanco A, Roca M, Garcia Campayo J. Changes in metabolites in the brain of patients with fibromyalgia after treatment with an NMDA receptor antagonist. Neuroradiol J 2019; 32:408-419. [PMID: 31215319 PMCID: PMC6856999 DOI: 10.1177/1971400919857544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aims of this work were to evaluate whether the treatment of patients with fibromyalgia with memantine is associated with significant changes in metabolite concentrations in the brain, and to explore any changes in clinical outcome measures. Magnetic resonance spectroscopy was performed of the right anterior and posterior insula, both hippocampi and the posterior cingulate cortex. Questionnaires on pain, anxiety, depression, global function, quality of life and cognitive impairment were used. Ten patients were studied at baseline and after three months of treatment with memantine. Significant increases were observed in the following areas: N-acetylaspartate (4.47 at baseline vs. 4.71 at three months, p = 0.02) and N-acetylaspartate+N-acetylaspartate glutamate in the left hippocampus (5.89 vs. 5.98; p = 0.007); N-acetylaspartate+N-acetylaspartate glutamate in the right hippocampus (5.31 vs 5.79; p = 0.01) and the anterior insula (7.56 vs. 7.70; p = 0.033); glutamate+glutamine/creatine ratio in the anterior insula (2.03 vs. 2.17; p = 0.022) and the posterior insula (1.77 vs. 2.00; p = 0.004); choline/creatine ratio in the posterior cingulate (0.18 vs. 0.19; p = 0.023); and creatine in the right hippocampus (3.60 vs. 3.85; p = 0.007). At the three-month follow-up, memantine improved cognitive function assessed by the Cognition Mini-Exam (31.50, SD = 2.95 vs. 34.40, SD = 0.6; p = 0.005), depression measured by the Hamilton Depression Scale (7.70, SD = 0.81 vs. 7.56, SD = 0.68; p = 0.042) and severity of illness measured by the Clinical Global Impression severity scale (5.79, SD = 0.96 vs. 5.31, SD = 1.12; p = 0.007). Depression, clinical global impression and cognitive function showed improvement with memantine. Magnetic resonance spectroscopy could be useful in monitoring response to the pharmacological treatment of fibromyalgia.
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Affiliation(s)
- Nicolas Fayed
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Barbara Oliván
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Yolanda Lopez del Hoyo
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Eva Andrés
- CIBER Epidemiology and Public Health,
Clinical Epidemiology Unit, October 12 Hospital, Spain
| | | | - Alicia Fayed
- Department of Neurorehabilitation, San
Juan de Dios Hospital, Spain
| | - Luisa F Angel
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Antoni Serrano-Blanco
- Department of Psychiatry, Parc Sanitari
St. Joan of God and the St. Joan of God Foundation, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Miquel Roca
- Health Sciences Research University
Institute, Juan March Hospital, Illes Balears University, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Javier Garcia Campayo
- Department of Psychiatry, Miguel Servet
Hospital and the University of Zaragoza. Aragon Institute for Health Research (IIS
Aragon), Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
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Jones KD, Aebischer JH, St John AW, Friend R, Bennett RM. A simple screening test to recognize fibromyalgia in primary care patients with chronic pain. J Eval Clin Pract 2018; 24:173-179. [PMID: 29063661 DOI: 10.1111/jep.12836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Primary care providers are increasingly expected to recognize and treat fibromyalgia (FM) without significant interaction with rheumatologists. The purpose of this study was to evaluate the potential usefulness of 3 simple measures (tenderness to digital pressure, BP cuff-evoked pain, and a single patient question) as a screening test for possible FM in a patient with chronic pain. METHODS A total of 352 patients (mean age 50 ± 16.3 years, 70% female) scheduled for routine examination in 2 primary care practices were studied. They were comprised of 52 patients (14.8%) who carried a chart diagnosis of FM, 108 (30.7%) with chronic pain but not FM, and 192 who had neither pain nor FM (54.5%). Subjects were assessed for tenderness to digital pressure at 10 locations, BP cuff-evoked pain, and a single question, "I have a persistent deep aching over most of my body" (0-10). RESULTS FM patients endorsed the single deep ache question substantially more than those with chronic pain but without FM (7.4 ± 2.9 vs 3.2 ± 3.4; P < .0001) and exhibited greater bilateral digital evoked tenderness (6.1 ± 3.1 vs 2.4 ± 2.4, P < 0.0001), and BP-evoked pressure pain (132.6 mmHg ±45.5 vs 169.2 mmHg ±48.0, P < 0.0001). However, on multivariate logistic regressions, the BP cuff-evoked pain became non-significant. On further analyses, a useful screening test was provided by: (1) pain on pinching the Achilles tendon at 4 kg/pressure over 4 seconds, and (2) and positive endorsement of the question "I have a persistent deep aching over most of my body". CONCLUSION These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient. In the case of a positive screen, a follow-up examination is required for confirmation or refutation.
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Affiliation(s)
- Kim D Jones
- School of Nursing, Oregon Health and Science University, Portland, USA.,School of Medicine (Anesthesiology and Perioperative Medicine), Oregon Health and Science University, Portland, USA
| | - Jonathan H Aebischer
- School of Medicine (Family Medicine), Oregon Health and Science University, Portland, USA
| | - Amanda W St John
- School of Medicine (Anesthesiology and Perioperative Medicine), Oregon Health and Science University, Portland, USA
| | - Ronald Friend
- School of Nursing, Oregon Health and Science University, Portland, USA.,Department of Psychology, College of Arts and Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Robert M Bennett
- School of Nursing, Oregon Health and Science University, Portland, USA
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Hughes LD. Memantine for fibromyalgia and Alzheimer's disease: An observational case comparison. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjmh.2017.6.1.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schaefer CP, Adams EH, Udall M, Masters ET, Mann RM, Daniel SR, McElroy HJ, Cappelleri JC, Clair AG, Hopps M, Staud R, Mease P, Silverman SL. Fibromyalgia Outcomes Over Time: Results from a Prospective Observational Study in the United States. Open Rheumatol J 2016; 10:109-121. [PMID: 28077978 PMCID: PMC5204069 DOI: 10.2174/1874312901610010109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/29/2022] Open
Abstract
Background: Longitudinal research on outcomes of patients with fibromyalgia is limited. Objective: To assess clinician and patient-reported outcomes over time among fibromyalgia patients. Methods: At enrollment (Baseline) and follow-up (approximately 2 years later), consented patients were screened for chronic widespread pain (CWP), attended a physician site visit to determine fibromyalgia status, and completed an online questionnaire assessing pain, sleep, function, health status, productivity, medications, and healthcare resource use. Results: Seventy-six fibromyalgia patients participated at both time points (at Baseline: 86.8% white, 89.5% female, mean age 50.9 years, and mean duration of fibromyalgia 4.1 years). Mean number of tender points at each physician visit was 14.1 and 13.5, respectively; 11 patients no longer screened positive for CWP at follow-up. A majority reported medication use for pain (59.2% at Baseline, 62.0% at Follow-up). The most common medication classes were opioids (32.4%), SSRIs (16.9%), and tramadol (14.1%) at Follow-up. Significant mean changes over time were observed for fibromyalgia symptoms (modified American College of Rheumatology 2010 criteria: 18.4 to 16.9; P=0.004), pain interference with function (Brief Pain Inventory-Short Form: 5.9 to 5.3; P=0.013), and sleep (Medical Outcomes Study-Sleep Scale: 58.3 to 52.7; P=0.004). Patients achieving ≥2 point improvement in pain (14.5%) experienced greater changes in pain interference with function (6.8 to 3.4; P=0.001) and sleep (62.4 to 51.0; P=0.061). Conclusion: Fibromyalgia patients reported high levels of burden at both time points, with few significant changes observed over time. Outcomes were variable among patients over time and were better among those with greater pain improvement.
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Affiliation(s)
| | - Edgar H Adams
- Covance Market Access Services Inc., Gaithersburg, MD, USA
| | | | | | | | | | | | | | | | | | | | - Philip Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA
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10
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Adams EH, McElroy HJ, Udall M, Masters ET, Mann RM, Schaefer CP, Cappelleri JC, Clair AG, Hopps M, Daniel SR, Mease P, Silverman SL, Staud R. Progression of fibromyalgia: results from a 2-year observational fibromyalgia and chronic pain study in the US. J Pain Res 2016; 9:325-36. [PMID: 27330325 PMCID: PMC4898260 DOI: 10.2147/jpr.s100043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background A previous fibromyalgia (FM) research reports that 20%–47% of diagnosed patients may not meet the study definition of FM 1–2 years after diagnosis. The aim of this study was to gain a better understanding of the progression of FM in a geographically diverse cohort over a 2-year time period. Methods This cohort study followed 226 subjects recruited online to assess FM and chronic widespread pain (CWP) diagnosis stability over time. At enrollment (baseline), subjects provided informed consent, completed an online questionnaire consisting of the London Fibromyalgia Epidemiology Study Screening Questionnaire to screen for CWP (bilateral pain above/below waist lasting ≥1 week in the past 3 months), visited a site for physician evaluation for FM, and completed a questionnaire with validated patient-reported outcome instruments. Subjects were classified into mutually exclusive groups: FM+CWP+ (screened positive for CWP and received physician diagnosis of FM), FM−CWP+ (screened positive for CWP but did not receive physician diagnosis of FM), and FM−CWP− (screened negative for CWP). Approximately 2 years later (follow-up), subjects were reassessed at the same study site and completed a questionnaire with the same patient-reported outcomes. Results Seventy-six FM+CWP+ subjects completed assessments at both time points; 56 (73.7%) met the FM study definition at follow-up. Twenty subjects no longer met the FM study definition (eleven became FM−CWP− and nine became FM−CWP+). Ten subjects (two from FM−CWP− and eight from FM−CWP+) transitioned into the FM+CWP+ group at follow-up; they reported more tender points and pain interference with sleep and worse physical function at baseline compared with subjects who did not transition to FM+CWP+. Most (76.7%) of the subjects who transitioned into/out of FM+CWP+ experienced changes in CWP, number of positive tender points, or both. Conclusion The results suggest that some FM+CWP+ patients experience fluctuation in symptoms over time, which may reflect the waxing and waning nature of FM and affect diagnosis and treatment.
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Affiliation(s)
- Edgar H Adams
- Covance Market Access Services Inc, Gaithersburg, MD, USA
| | | | | | | | | | | | | | | | | | | | - Philip Mease
- Division of Rheumatology Research, Swedish Medical Center, Seattle, WA, USA; Department of Rheumatology, University of Washington, Seattle, WA, USA
| | - Stuart L Silverman
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, University of California, Los Angeles, CA, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
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Schaefer C, Mann R, Masters ET, Cappelleri JC, Daniel SR, Zlateva G, McElroy HJ, Chandran AB, Adams EH, Assaf AR, McNett M, Mease P, Silverman S, Staud R. The Comparative Burden of Chronic Widespread Pain and Fibromyalgia in the United States. Pain Pract 2015; 16:565-79. [PMID: 25980433 DOI: 10.1111/papr.12302] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND/PURPOSE Little information exists on the comparative patient and economic burden of chronic widespread pain (CWP) and fibromyalgia (FM) in the United States. METHODS This multistage, observational study included an online screening survey of a large geographically diverse US sample to assess CWP status, a physician/site visit to determine FM diagnosis, and an online subject questionnaire to capture clinical characteristics, pain, health status, functioning, sleep, healthcare resource use (HRU), productivity, and costs. Based on the screener and physician evaluation, mutually exclusive groups of subjects without CWP (CWP-), with CWP but without FM (CWP+), and with confirmed FM were identified. RESULTS Disease burden was examined in 472 subjects (125 CWP-, 176 CWP+, 171 FM). Age, race, and ethnicity were similar across groups. Mean body mass index and number of comorbidities increased from CWP- to CWP+ to FM (P = 0.0044, P < 0.0001, respectively). From CWP- to CWP+ to FM, there were reductions in health status (EQ-5D, SF-12) and sleep outcomes (MOS-SS, SSQ) (all P < 0.05). Pain severity, interference with function (BPI-SF), and overall work impairment (WPAI:SHP) increased from CWP- to CWP+ to FM (all P < 0.0001). Higher proportions of CWP+ (52.8%) and FM subjects (62.6%) were taking pain-related prescription medications relative to CWP- subjects (32.8%; P < 0.0001). Significant differences in total direct and indirect costs across the three groups (both P < 0.0001) were observed, with highest costs among FM subjects. CONCLUSION Fibromyalgia subjects were characterized by the greatest disease burden with more comorbidities and pain-related medications, poorer health status, function, sleep, lower productivity, and higher costs.
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Affiliation(s)
| | - Rachael Mann
- Covance Market Access Services Inc, San Diego, CA, U.S.A
| | | | | | | | | | | | | | - Edgar H Adams
- Covance Market Access Services Inc, Gaithersburg, MD, U.S.A
| | | | | | - Philip Mease
- Swedish Medical Center and University of Washington, Seattle, WA, U.S.A
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Efficacy of memantine in the treatment of fibromyalgia: A double-blind, randomised, controlled trial with 6-month follow-up. Pain 2014; 155:2517-2525. [DOI: 10.1016/j.pain.2014.09.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/09/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022]
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Fayed N, Olivan-Blázquez B, Herrera-Mercadal P, Puebla-Guedea M, Pérez-Yus MC, Andrés E, López del Hoyo Y, Magallon R, Viguera L, Garcia-Campayo J. Changes in metabolites after treatment with memantine in fibromyalgia. A double-blind randomized controlled trial with magnetic resonance spectroscopy with a 6-month follow-up. CNS Neurosci Ther 2014; 20:999-1007. [PMID: 25230216 DOI: 10.1111/cns.12314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia (FM) patients. METHODS Doubled-blind parallel randomized controlled trial. Twenty-five patients diagnosed with FM were enrolled in the study. Patients were administered questionnaires on pain, anxiety, depression, quality of life, and cognitive impairment, and single-voxel MRS of the brain was performed. All assessments were performed at baseline and after 6 months of treatment with memantine or placebo. RESULTS Patients treated with memantine exhibited a significant increase in the glutamate (P = 0.010), glutamate/creatine ratio (P = 0.013), combined glutamate + glutamine (P = 0.016) and total N-acetyl-aspartate (NAA+NAAG) (P = 0.034) in the posterior cingulate cortex compared with those on placebo. Furthermore, the memantine group exhibited increases in creatine (P = 0.013) and choline (Cho) (P = 0.025) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire (FIQ) in the posterior insula (P = 0.050) was observed. CONCLUSION Memantine treatment resulted in an increase in cerebral metabolism in FM patients, suggesting its utility for the treatment of the illness.
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Affiliation(s)
- Nicolás Fayed
- Magnetic Resonance Unit, Department of Radiology, Clinica Quiron, Zaragoza, Spain
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Olivan-Blázquez B, Puebla M, Masluk B, Pérez-Yus MC, Arcega R, Andrés E, López-del-Hoyo Y, Magallon R, Roca M, Garcia-Campayo J. Evaluation of the efficacy of memantine in the treatment of fibromyalgia: study protocol for a doubled-blind randomized controlled trial with six-month follow-up. Trials 2013; 14:3. [PMID: 23286311 PMCID: PMC3598995 DOI: 10.1186/1745-6215-14-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Fibromyalgia is a prevalent chronic rheumatic disease of great clinical importance. Recent studies have found raised levels of glutamate in the insula, hippocampus and posterior cingulate cortex regions of the brains of fibromyalgia (FM) patients. This finding has led researchers to speculate about the usefulness of glutamate-blocking drugs such as memantine in the treatment of fibromyalgia. The hypothesis of this study is that the administration of memantine will reduce the glutamate levels, and futhermore, will decrease the perceived pain. The aim of this study is to evaluate the efficacy of memantine in the treatment of pain (pain perception). A secondary objective is to evaluate the efficacy of memantine in the treatment of other clinical symptoms of FM, and to evaluate the efficacy of memantine in reducing brain levels of glutamate, and its effects on the central nervous system as a whole. Method/Design A double-blind parallel randomized controlled trial. Participants, Seventy patients diagnosed with FM will be recruited from primary health care centers in Zaragoza, Spain. Intervention. The subjects will be randomized in two groups: A) A treatment group (n = 35), which will receive 20 mg of memantine daily; B) A control group (n = 35), to which will be administered a placebo. There will be a six-month follow-up period (including a titration period of one month). Outcomes. The main efficacy variable of this study is pain (pain perception). The secondary efficacy variables are clinical symptoms (pain threshold, cognitive function, health status, anxiety, depression, clinical impression and quality of life) and glutamate levels in different regions of the brain, which will be assessed by magnetic resonance spectroscopy. Randomization and blinding. Randomization has been computer-generated, and the random allocation sequence will be implemented by telephone. Subjects of the study and the research assistants will be blinded to group assignment. Discussion There is a need for the development of innovative and more effective treatments for fibromyalgia. This clinical trial will determine whether memantine can be an effective pharmacological treatment for fibromyalgia patients. Trial registration Current Controlled Trials
http://ISRCTN45127327 EUDRACT 2011-006244-73
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Chandran AB, Coon CD, Martin SA, McLeod LD, Coles TM, Arnold LM. Sphygmomanometry-evoked allodynia in chronic pain patients with and without fibromyalgia. Nurs Res 2012; 61:363-8. [PMID: 22729143 DOI: 10.1097/nnr.0b013e318259b6cc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fibromyalgia is a chronic pain syndrome that affects about 2% of the U.S. general population, with greater prevalence among women (3.5%) than men (0.5%). Previous research results suggest that the experience of pain (allodynia) upon sphygmomanometry may indicate the presence of fibromyalgia. OBJECTIVE The aim of this study was to confirm these findings in patients with fibromyalgia and other chronic pain conditions and evaluate the use of sphygmomanometry as a potential screening tool for the identification of patients with fibromyalgia. METHODS A total of 150 people participated in this multicenter, cross-sectional observational study. The study included a physician-conducted evaluation to determine if the participant met the American College of Rheumatology (ACR) 1990 diagnostic criteria for fibromyalgia. The presence of sphygmomanometry-evoked allodynia was assessed during a seated cuff pressure inflation that was repeated three times on each arm. Each site was provided a sphygmomanometer to ensure standardization, and the pressure of the cuff at the moment of pain initiation was recorded. If the patient did not indicate pain prior to 180 mmHg, then the inflation was stopped, a notation of no pain was made, and a cuff pressure of 180 mmHg was recorded. The mean of the six cuff pressure measurements was used for the analyses. Logistic regression was performed to analyze the relationship between sphygmomanometry-evoked allodynia and fibromyalgia. RESULTS The evaluable sample was 148 (one participant had too large an arm circumference for the sphygmomanometer and another did not receive the clinician evaluation of ACR-determined fibromyalgia diagnosis). Over half of the participants were determined to have an ACR diagnosis of fibromyalgia. Of these, 71 (91%) were women and had an average age of 54 years. Of the 70 participants with no fibromyalgia diagnosis, 42 (60%) were women and also had an average age of 54 years. Sixty-one (78%) of the fibromyalgia participants, compared with 25 (36%) of those with no fibromyalgia diagnosis, reported sphygmomanometry-evoked allodynia. The participants with fibromyalgia reported pain ata lower cuff pressure compared with those without fibromyalgia (132 mmHg vs. 166 mmHg, p < .01). The logistic regression showed that sphygmomanometry-evoked allodynia predicted an ACR-determined FM diagnosis (χ(2) = 19.4, p < .01). DISCUSSION These findings support previous research suggesting that patients who report pain upon sphygmomanometry may warrant further evaluation for the presence of fibromyalgia.
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Affiliation(s)
- Arthi B Chandran
- Global Health Economics and Outcomes Research, Pfizer, Inc., New York, New York, USA.
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Oshinsky ML, Sanghvi MM, Maxwell CR, Gonzalez D, Spangenberg RJ, Cooper M, Silberstein SD. Spontaneous trigeminal allodynia in rats: a model of primary headache. Headache 2012; 52:1336-49. [PMID: 22963523 DOI: 10.1111/j.1526-4610.2012.02247.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Animal models are essential for studying the pathophysiology of headache disorders and as a screening tool for new therapies. Most animal models modify a normal animal in an attempt to mimic migraine symptoms. They require manipulation to activate the trigeminal nerve or dural nociceptors. At best, they are models of secondary headache. No existing model can address the fundamental question: How is a primary headache spontaneously initiated? In the process of obtaining baseline periorbital von Frey thresholds in a wild-type Sprague-Dawley rat, we discovered a rat with spontaneous episodic trigeminal allodynia (manifested by episodically changing periorbital pain threshold). Subsequent mating showed that the trait is inherited. Animals with spontaneous trigeminal allodynia allow us to study the pathophysiology of primary recurrent headache disorders. To validate this as a model for migraine, we tested the effects of clinically proven acute and preventive migraine treatments on spontaneous changes in rat periorbital sensitivity. Sumatriptan, ketorolac, and dihydroergotamine temporarily reversed the low periorbital pain thresholds. Thirty days of chronic valproic acid treatment prevented spontaneous changes in trigeminal allodynia. After discontinuation, the rats returned to their baseline of spontaneous episodic threshold changes. We also tested the effects of known chemical human migraine triggers. On days when the rats did not have allodynia and showed normal periorbital von Frey thresholds, glycerol trinitrate and calcitonin gene related peptide induced significant decreases in the periorbital pain threshold. This model can be used as a predictive model for drug development and for studies of putative biomarkers for headache diagnosis and treatment.
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Affiliation(s)
- Michael L Oshinsky
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107-6799, USA.
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Casanueva B, Rodero B, Quintial C, Llorca J, González-Gay MA. Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients. Rheumatol Int 2012; 33:2665-70. [PMID: 22842953 DOI: 10.1007/s00296-012-2490-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/13/2012] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to evaluate the short-term efficacy of topical capsaicin treatment in patients severely affected by fibromyalgia. One hundred and thirty fibromyalgia patients were randomly divided into two groups. The control group, 56 women and 4 men who continued their medical treatment, and the capsaicin group, 70 women who apart from continuing their medical treatment, also underwent topical capsaicin 0.075 % 3 times daily for 6 weeks. At the beginning of the program, there were no significant differences between the two groups in any of the analyzed parameters. At the end of the treatment, there were significant improvements in the capsaicin group in the myalgic score (5.21 vs 3.8, p = 0.02) and global subjective improvement (22.8 vs 5 %, p = 0.001). Six weeks after the end of the treatment, the experimental group showed significant differences in Visual Analogue Scale of depression (5.63 vs 7.35, p = 0.02), Fibromyalgia Impact Questionnaire (67.89 vs 77.7, p = 0.02), role limitations due to emotional problems (36.17 vs 17.2, p = 0.05), Fatigue Severity Scale (6.2 vs 6.6, p = 0.04), myalgic score (3.94 vs 2.66, p = 0.02) and pressure pain threshold (79.25 vs 56.71, p = 0.004). In conclusion, patients severely affected by fibromyalgia can obtain short-term improvements following topical capsaicin 0.075 % treatment three times daily for 6 weeks.
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Affiliation(s)
- Benigno Casanueva
- Rheumatology Service at the Specialist Clinic of Cantabria, Santander, Spain
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Maurel S, Rodero B, Lopez-del-Hoyo Y, Luciano JV, Andrés E, Roca M, Bergos RDM, Ruiz-Lancina Y, García-Campayo J. Correlational analysis and predictive validity of psychological constructs related with pain in fibromyalgia. BMC Musculoskelet Disord 2011; 12:4. [PMID: 21214948 PMCID: PMC3024273 DOI: 10.1186/1471-2474-12-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 01/08/2011] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a prevalent and disabling disorder characterized by a history of widespread pain for at least three months. Pain is considered a complex experience in which affective and cognitive aspects are crucial for prognosis. The aim of this study is to assess the importance of pain-related psychological constructs on function and pain in patients with FM. METHODS DESIGN Multicentric, naturalistic, one-year follow-up study. SETTING AND STUDY SAMPLE: Patients will be recruited from primary care health centres in the region of Aragon, Spain. Patients considered for inclusion are those aged 18-65 years, able to understand Spanish, who fulfil criteria for primary FM according to the American College of Rheumatology, with no previous psychological treatment. MEASUREMENTS The variables measured will be the following: main variables (pain assessed with a visual analogue scale and with sphygmomanometer and general function assessed with Fibromyalgia Impact Questionnaire, and), psychological constructs (pain catastrophizing, pain acceptance, mental defeat, psychological inflexibility, perceived injustice, mindfulness, and positive and negative affect), and secondary variables (sociodemographic variables, anxiety and depression assessed with Hospital Anxiety and Depression Scale, and psychiatric interview assessed with MINI). Assessments will be carried at baseline and at one-year follow-up. MAIN OUTCOME Pain Visual Analogue Scale. ANALYSIS The existence of differences in socio-demographic, main outcome and other variables regarding pain-related psychological constructs will be analysed using Chi Square test for qualitative variables, or Student t test or variance analysis, respectively, for variables fulfilling the normality hypothesis. To assess the predictive value of pain-related psychological construct on main outcome variables at one-year follow-up, use will be made of a logistic regression analysis adjusted for socio-demographic and clinical variables. A Spearman Rho non-parametric correlation matrix will be developed to determine possible overlapping between pain-related psychological constructs. DISCUSSION In recent years, the relevance of cognitive and affective aspects for the treatment of chronic pain, not only in FM but also in other chronic pain diseases, has been widely acknowledged. However, the relative importance of these psychological constructs, the relationship and possible overlapping between them, or the exact meaning of them in pain are not enough known.
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Affiliation(s)
- Sara Maurel
- Servicio de Psiquiatría, Hospital Miguel Servet y Universidad de Zaragoza, Spain
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Fayed N, Garcia-Campayo J, Magallón R, Andrés-Bergareche H, Luciano JV, Andres E, Beltrán J. Localized 1H-NMR spectroscopy in patients with fibromyalgia: a controlled study of changes in cerebral glutamate/glutamine, inositol, choline, and N-acetylaspartate. Arthritis Res Ther 2010; 12:R134. [PMID: 20609227 PMCID: PMC2945024 DOI: 10.1186/ar3072] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 05/10/2010] [Accepted: 07/07/2010] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to investigate whether single-voxel (SV) proton magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI) detected differences between fibromyalgia (FM) patients and healthy controls. We also searched for correlations between neuroimaging abnormalities and neuropsychological variables. METHODS Ten patients with FM and 10 gender- and age-matched control subjects were studied. A neuropsychological examination, DWI, DTI, and proton MRS were performed on the brain areas known to be associated with pain processing. RESULTS Compared with healthy controls, FM patients had significantly higher levels of glutamate + glutamine (Glx) (mean ± SD, 10.71 ± 0.50 arbitrary institutional units versus 9.89 ± 1.04; P = 0.049) and higher glutamate + glutamine/creatine (Glx/Cr) ratios (1.90 ± 0.12 versus 1.72 ± 0.23; P = 0.034) in the posterior gyrus. Myoinositol (Ins) levels of the right and left hippocampi were significantly lower in FM patients (4.49 ± 0.74 versus 5.17 ± 0.62; P = 0.008 and 4.91 ± 0.85 versus 6.09 ± 0.78; P = 0.004, respectively). In FM patients, decreased myoinositol/creatine (Ins/Cr) ratios were found in the left sensorimotor area (P = 0.05) and the left hippocampus (P = 0.002) and lower levels of choline (P = 0.019) and N-acetyl aspartate + N-acetyl aspartyl glutamate (NAA + NAG) (P = 0.034) in the left hippocampus. Significant correlations between depression, pain, and global function and the posterior gyrus Glx levels and Glx/Cr ratios were observed. CONCLUSIONS Glx within the posterior gyrus could be a pathologic factor in FM. Hippocampal dysfunction may be partially responsible for the depressive symptoms of FM. Additional studies with larger samples are required to confirm these preliminary data.
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Affiliation(s)
- Nicolas Fayed
- Department of Radiology, Hospital Quirón, Paseo de Mariano Renovales, Zaragoza, Spain.
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Quantitative sensory testing and mapping: a review of nonautomated quantitative methods for examination of the patient with neuropathic pain. Clin J Pain 2009; 25:632-40. [PMID: 19692806 DOI: 10.1097/ajp.0b013e3181a68c64] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite a growing interest in neuropathic pain, neurologists and pain specialists do not have a standard, validated, office examination for the evaluation of neuropathic pain signs to complement the neurologic, musculoskeletal, and general physical examinations. An office neuropathic pain examination focused on quantifying sensory features of neuropathic pain, ranging from deficits to allodynia and hyperalgesia, and evoked by a physiologically representative array of stimuli, will be an essential tool to monitor treatment effectiveness and for clinical investigation into the mechanisms and management of neuropathic pain. Such an examination should include mapping of areas of stimulus-evoked neuropathic pain and standardized, reproducible quantitative sensory testing (QST) of tactile, punctuate, pressure, and thermal modalities. METHODS We review quantitative sensory testing methodology in general and specific tests for the evaluation of neuropathic pain phenomena. RESULTS Numerous quantitative sensory testing techniques for dynamic mechanical, pressure, vibration, and thermal sensory testing and mapping have been described. We propose a comprehensive neuropathic pain evaluation protocol that is based upon these available techniques. CONCLUSIONS A comprehensive neuropathic pain evaluation protocol is essential for further advancement of clinical research in neuropathic pain. A protocol that uses tools readily available in clinical practice, when established and validated, can be used widely and thus accelerate data collection for clinical research and increase clinical awareness of the features of neuropathic pain.
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Clasificación de la fibromialgia. Revisión sistemática de la literatura. ACTA ACUST UNITED AC 2009; 5:55-62. [DOI: 10.1016/j.reuma.2008.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/30/2008] [Indexed: 12/23/2022]
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Comments on the Paper of Vargas et al “Sphygmomanometry Regarding Fibromyalgia”. J Clin Rheumatol 2008; 14:375; author reply 375. [DOI: 10.1097/rhu.0b013e31818fdbdc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yunus MB. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol 2007; 21:481-97. [PMID: 17602995 DOI: 10.1016/j.berh.2007.03.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with widespread pain or fibromyalgia syndrome have many symptoms besides musculoskeletal pain: e.g. fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches and restless legs syndrome. There is evidence for central sensitization in these conditions, but further studies are needed. Anxiety, stress and depression are also present in 30-45% of patients. Other factors that may contribute to symptoms include endocrine dysfunction, psychosocial distress, trauma, and disrupted sleep. Evaluation of a patient presenting with widespread pain includes history and physical examination to diagnose both fibromyalgia and associated or concomitant conditions. Fibromyalgia should be diagnosed by its own characteristic features. Some patients with otherwise typical symptoms of fibromyalgia may have as few as four to six tender points in clinical practice. Patients with rheumatoid arthritis and systemic lupus erythematosus should be evaluated for fibromyalgia, since 20-30% of them have associated fibromyalgia, requiring a different treatment approach.
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Affiliation(s)
- Muhammad B Yunus
- Section of Rheumatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA.
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Nielsen LA, Henriksson KG. Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition. Best Pract Res Clin Rheumatol 2007; 21:465-80. [PMID: 17602994 DOI: 10.1016/j.berh.2007.03.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic musculoskeletal pain has biological, psychological and social components. This review deals with the biological factors, with emphasis on the fibromyalgia syndrome (FMS). Studies on central sensitization of pain-transmitting neurons, changes in endogenous pain modulation that give rise to pain disinhibition, referred pain, pain-related decrease in muscle strength and endurance, and pain generators in deep tissues are reviewed. In FMS there is strong scientific support for the statement that the biological part of the syndrome is a longstanding or permanent change in the function of the nociceptive nervous system that can be equated with a disease. Further research is necessary in order to determine which methods are best for diagnosis of the pain hypersensitivity in clinical practice. FMS may be the far end of a continuum that starts with chronic localized/regional musculoskeletal pain and ends with widespread chronic disabling pain.
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Affiliation(s)
- Lars Arendt Nielsen
- Laboratory for Experimental Pain Research, Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 7, D3DK-9220 Aalborg, Denmark.
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