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Haider S, Janowski AJ, Lesnak JB, Hayashi K, Dailey DL, Chimenti R, Frey-Law LA, Sluka KA, Berardi G. A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study. Pain 2023; 164:385-401. [PMID: 36006296 PMCID: PMC9797623 DOI: 10.1097/j.pain.0000000000002711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.
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Affiliation(s)
- Saman Haider
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Adam J. Janowski
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kazuhiro Hayashi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Dana L. Dailey
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803
| | - Ruth Chimenti
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Laura A. Frey-Law
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
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Gower C, Trevitt J, Cherry BJ, Zettel-Watson L. Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia. Front Med (Lausanne) 2022; 9:1033936. [PMID: 36590966 PMCID: PMC9794591 DOI: 10.3389/fmed.2022.1033936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age. Methods The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale. Results It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors. Discussion Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.
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Affiliation(s)
- Caitlin Gower
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States
| | - Jennifer Trevitt
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States
| | - Barbara J. Cherry
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States,Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, United States
| | - Laura Zettel-Watson
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States,Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, United States,*Correspondence: Laura Zettel-Watson,
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Coping and Beliefs as Predictors of Functioning and Psychological Adjustment in Fibromyalgia Subgroups. Pain Res Manag 2022; 2022:1066192. [PMID: 35463626 PMCID: PMC9023200 DOI: 10.1155/2022/1066192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
Abstract
Objectives Research has pointed to two profiles of persons with fibromyalgia according to differences in functionality, thus distinguishing between functional and dysfunctional patients. The role of psychological factors underlying such clusters is unclear. This study aims to explore the contribution of pain beliefs and coping on fibromyalgia clustering. Methods A cluster analysis was performed to classify 238 women with fibromyalgia using the Fibromyalgia Impact Questionnaire and the Beck Depression Inventory as clustering variables. Cluster differences in physical functioning, depression, pain beliefs, coping, and age were then calculated (Student's t-test). Finally, a binary logistic regression was conducted to study the unique contribution of age, beliefs, and coping on cluster classification. Results Two clusters were revealed. Cluster 1 had a poor adaptation to fibromyalgia regarding physical functioning and depression. They generally embraced less adaptive beliefs (i.e., disability, harm, emotion, and requests) and coping strategies (i.e., guarding, resting, and asking for assistance). Cluster 2 showed a better adaptation to fibromyalgia and adopted more favorable beliefs (i.e., control) and coping strategies (i.e., exercise and task persistence). Cluster differences in age were significant but small. The backward binary logistic regression suggested a final model with six predictors (guarding, task persistence, harm, emotion, solicitude, and age) that explained 31% of the variance of group membership. Discussion. These results suggest that only a subset of psychological variables uniquely and independently contribute to functional/dysfunctional group membership. The results support the need to address psychological components in the management of fibromyalgia and point to a subset of preferred target beliefs and coping strategies.
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Karaş H, Çetingök H, İlişer R, Çarpar E, Kaşer M. Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact. Int J Psychiatry Clin Pract 2020; 24:257-263. [PMID: 32401570 DOI: 10.1080/13651501.2020.1764585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The first aim of this study was to determine the prevalence of childhood and current attention deficit hyperactivity disorder (ADHD) symptoms in patients with fibromyalgia. The second aim is to assess the role of depression and anxiety on the relationship between childhood and adult ADHD symptoms with disease impact in this population.Methods: Sixty-four patients with fibromyalgia were compared to matched 58 healthy controls. All participants completed the Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Fibromyalgia Impact Questionnaire (FIQ).Results: Patients with fibromyalgia had significantly higher mean scores of depression (BDI), anxiety (BAI), childhood ADHD symptoms (WURS) and adult ADHD symptoms (ASRS total, ASRS hyperactivity/impulsivity subscale and ASRS attention deficit subscale) than the control group. Fibromyalgia impact (FIQ) was significantly correlated with depression (BDI; r = 0.57, p < .001), anxiety (BAI; r = 0.56, p < .001) and childhood ADHD symptoms (WURS; r = 0.41, p < .001) in fibromyalgia group. There was no significant correlation between fibromyalgia impact (FIQ) and adult ADHD symptoms (ASRS total or sub-scale scores). Hierarchical multiple regression indicated that childhood ADHD symptoms (WURS), anxiety (BAI) and depression (BDI) predicted fibromyalgia impact. Both anxiety (BAI) and depression (BDI) mediated the relationship between childhood ADHD symptoms (WURS) and fibromyalgia impact (FIQ).Conclusion: Childhood ADHD symptoms may be a contributory factor to poorer functioning in the patients with fibromyalgia. The relationship was more pronounced in the presence of depression and anxiety symptoms. Evaluation of childhood and adult ADHD symptoms in patients with fibromyalgia is important for recognition and treatment of ADHD comorbidity and also for attenuating the severity of the disease.
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Affiliation(s)
- Hakan Karaş
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Halil Çetingök
- Department of Algology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Reşat İlişer
- Fizyorom Physical Therapy and Rehabilitation Center, Diyarbakır, Turkey
| | - Elif Çarpar
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Muzaffer Kaşer
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, Bahçeşehir University, Istanbul, Turkey
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Muller V, Chan F, Iwanaga K, Wu JR, Chen X, Lee B, Tao J, Rumrill P, Bezyak J. An Empirically Derived Taxonomy of Biopsychosocial Factors of Adjustment to Fibromyalgia: Results of a Multivariate Analysis. REHABILITATION COUNSELING BULLETIN 2020. [DOI: 10.1177/0034355220925157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Fibromyalgia (FM) is a lifelong central nervous system disorder that is precipitated by a range of biological, psycho-cognitive, and social factors. The aims of this exploratory study were to (a) identify biopsychosocial and cognitive factors that may affect an individual’s response to FM, (b) determine whether individuals with FM can be grouped into homogeneous subgroups based on biopsychosocial factors associated with response to FM, and (c) compare subgroup differences in health outcomes and life satisfaction. This study included 302 participants with FM. Principal components analysis yielded three sets of biopsychosocial factors that may affect response to FM (i.e., protective, cognitive-affective, and physical factors). Based on these three factors, a cluster analysis was performed, which produced three homogeneous subgroups: (a) the moderate amount of problems group, (b) the least amount of problems group, and (c) the many problems group. Analysis of variance (ANOVA) results indicated that these three subgroups differed significantly in terms of health outcomes and life satisfaction. The findings of this study broaden the existing literature related to understanding FM from a multidimensional symptom response perspective and contribute to the development and validation of biopsychosocial interventions for people with FM.
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Affiliation(s)
- Veronica Muller
- Hunter College, The City University of New York, New York City, USA
| | - Fong Chan
- University of Wisconsin–Madison, USA
| | | | - Jia-Rung Wu
- Northeastern Illinois University, Chicago, USA
| | | | | | - Jing Tao
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | | | - Jill Bezyak
- University of Northern Colorado, Greeley, USA
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Hadlandsmyth K, Dailey DL, Rakel BA, Zimmerman MB, Vance CG, Merriwether EN, Chimenti RL, Geasland KM, Crofford LJ, Sluka KA. Somatic symptom presentations in women with fibromyalgia are differentially associated with elevated depression and anxiety. J Health Psychol 2017; 25:819-829. [PMID: 29076404 DOI: 10.1177/1359105317736577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study examined whether depression and anxiety differentially relate to fatigue, sleep disturbance, pain catastrophizing, fear of movement, and pain severity in women with fibromyalgia. Baseline data from the Fibromyalgia Activity Study with Transcutaneous Electrical Nerve Stimulation were analyzed. Of 191 participants, 50 percent reported high anxiety and/or depression (17% high anxiety, 9% high depression, and 24% both). Fatigue and sleep impairment were associated with high depression (p < 0.05). Pain severity, pain catastrophizing, and fear of movement were associated with high anxiety and high depression (p < 0.05). Possible implications for underlying mechanisms and the need for targeted treatments are discussed.
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Affiliation(s)
- Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | | | | | - Carol Gt Vance
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Ericka N Merriwether
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Katharine M Geasland
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | | | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
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Yim YR, Lee KE, Park DJ, Kim SH, Nah SS, Lee J, Kim SK, Lee YA, Hong SJ, Kim HS, Lee HS, Kim H, Joung CI, Kim SH, Lee SS. Identifying fibromyalgia subgroups using cluster analysis: Relationships with clinical variables. Eur J Pain 2016; 21:374-384. [DOI: 10.1002/ejp.935] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Y.-R. Yim
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - K.-E. Lee
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - D.-J. Park
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
| | - S.-H. Kim
- Department of Internal Medicine; Inje University Haeundae Paik Hospital; Busan Korea
| | - S.-S. Nah
- Department of Internal Medicine; College of Medicine; Soonchunhyang University; Cheonan Korea
| | - J.H. Lee
- Department of Internal Medicine; Maryknoll Medical Center; Busan Korea
| | - S.-K. Kim
- Department of Internal Medicine; School of Medicine; Catholic University of Daegu; Korea
| | - Y.-A. Lee
- Department of Internal Medicine; School of Medicine; Kyung Hee University; Seoul Korea
| | - S.-J. Hong
- Department of Internal Medicine; School of Medicine; Kyung Hee University; Seoul Korea
| | - H.-S. Kim
- Department of Internal Medicine; Soonchunhyang University Seoul Hospital; Korea
| | - H.-S. Lee
- Hanyang University College of Medicine and the Hospital for Rheumatic Diseases; Seoul Korea
| | - H.A. Kim
- Department of Allergy and Rheumatology; Ajou University Hospital; Ajou University School of Medicine; Suwon Korea
| | - C.-I. Joung
- Department of Internal Medicine; Konyang University Medical School; Daejeon Korea
| | - S.-H. Kim
- Department of Internal Medicine; School of Medicine; Keimyung University; Daegu Korea
| | - S.-S. Lee
- Department of Rheumatology; Chonnam National University Hospital & Medical School; Gwangju Korea
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Relation of dopamine receptor 2 binding to pain perception in female fibromyalgia patients with and without depression--A [¹¹C] raclopride PET-study. Eur Neuropsychopharmacol 2016; 26:320-330. [PMID: 26708319 DOI: 10.1016/j.euroneuro.2015.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/26/2015] [Accepted: 12/01/2015] [Indexed: 12/17/2022]
Abstract
Dopamine D2/D3 receptor availability at rest and its association with individual pain perception was investigated using the [(11)C] raclopride PET-method in 24 female Fibromyalgia (FMS) participants with (FMS+, N=11) and without (FMS-, N=13) comorbid depression and in 17 healthy women. Thermal pain thresholds (TPT) and pain responses were assessed outside the scanner. We compared the discriminative capacity, i.e. the individual׳s capacity to discriminate between lower and higher pain intensities and the response criterion, i.e. the subject׳s tendency to report pain during noxious stimulation due to psychological factors. [(11)C] raclopride binding potential (BP), defined as the ratio of specifically bound non-displaceable radioligand at equilibrium (BP(ND)) was used as measure of D2/D3 receptor availability. We found significant group effects of BP(ND) in striatal regions (left ventral striatum, left caudate nucleus and left nucleus accumbens) between FMS+ and FMS- compared to healthy subjects. Correlational analysis showed negative associations between TPT and D2/D3 receptor availability in the left caudate nucleus in FMS-, between TPT and D2/D3 receptor availability in the right caudate nucleus in FMS + and positive associations between TPT and D2/D3 receptor availability in the left putamen and right caudate nucleus in healthy controls. The response criterion was positively associated with D2/D3 receptor availability in the right nucleus accumbens in FMS - and negatively with D2/D3 receptor availability in the left caudate nucleus in healthy controls. Finally, no significant associations between D2/D3 receptor availability and discriminative capacity in any of the groups or regions were determined. These findings provide further support for a disruption of dopaminergic neurotransmission in FMS and implicate DA as important neurochemical moderator of differences in pain perception in FMS patients with and without co-morbid depression.
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Menzies V, Jallo N, Kinser P, Robins JLW, An K, Driscoll C, Starkweather A, Bajaj JS, Lyon DE. Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research. Biol Res Nurs 2015; 17:222-9. [PMID: 25037448 PMCID: PMC5818716 DOI: 10.1177/1099800414541541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.
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Affiliation(s)
- Victoria Menzies
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Nancy Jallo
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Patricia Kinser
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Jo Lynne W Robins
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Kyungeh An
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Carolyn Driscoll
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jasmohan S Bajaj
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Debra E Lyon
- College of Nursing, University of Florida, Gainesville, FL
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Vincent A, Hoskin TL, Whipple MO, Clauw DJ, Barton DL, Benzo RP, Williams DA. OMERACT-based fibromyalgia symptom subgroups: an exploratory cluster analysis. Arthritis Res Ther 2014; 16:463. [PMID: 25318839 PMCID: PMC4221670 DOI: 10.1186/s13075-014-0463-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/23/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction The aim of this study was to identify subsets of patients with fibromyalgia with similar symptom profiles using the Outcome Measures in Rheumatology (OMERACT) core symptom domains. Methods Female patients with a diagnosis of fibromyalgia and currently meeting fibromyalgia research survey criteria completed the Brief Pain Inventory, the 30-item Profile of Mood States, the Medical Outcomes Sleep Scale, the Multidimensional Fatigue Inventory, the Multiple Ability Self-Report Questionnaire, the Fibromyalgia Impact Questionnaire–Revised (FIQ-R) and the Short Form-36 between 1 June 2011 and 31 October 2011. Hierarchical agglomerative clustering was used to identify subgroups of patients with similar symptom profiles. To validate the results from this sample, hierarchical agglomerative clustering was repeated in an external sample of female patients with fibromyalgia with similar inclusion criteria. Results A total of 581 females with a mean age of 55.1 (range, 20.1 to 90.2) years were included. A four-cluster solution best fit the data, and each clustering variable differed significantly (P <0.0001) among the four clusters. The four clusters divided the sample into severity levels: Cluster 1 reflects the lowest average levels across all symptoms, and cluster 4 reflects the highest average levels. Clusters 2 and 3 capture moderate symptoms levels. Clusters 2 and 3 differed mainly in profiles of anxiety and depression, with Cluster 2 having lower levels of depression and anxiety than Cluster 3, despite higher levels of pain. The results of the cluster analysis of the external sample (n = 478) looked very similar to those found in the original cluster analysis, except for a slight difference in sleep problems. This was despite having patients in the validation sample who were significantly younger (P <0.0001) and had more severe symptoms (higher FIQ-R total scores (P = 0.0004)). Conclusions In our study, we incorporated core OMERACT symptom domains, which allowed for clustering based on a comprehensive symptom profile. Although our exploratory cluster solution needs confirmation in a longitudinal study, this approach could provide a rationale to support the study of individualized clinical evaluation and intervention.
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12
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Diaz-Piedra C, Di Stasi LL, Baldwin CM, Buela-Casal G, Catena A. Sleep disturbances of adult women suffering from fibromyalgia: a systematic review of observational studies. Sleep Med Rev 2014; 21:86-99. [PMID: 25456469 DOI: 10.1016/j.smrv.2014.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 11/15/2022]
Abstract
Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lacks statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.
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Affiliation(s)
- Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain; College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain; Department of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Carol M Baldwin
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Andres Catena
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain
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13
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The Impact of Pain on Anxiety and Depression is Mediated by Objective and Subjective Sleep Characteristics in Fibromyalgia Patients. Clin J Pain 2014; 30:852-9. [DOI: 10.1097/ajp.0000000000000040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Chen AT. Information use and illness representations: Understanding their connection in illness coping. J Assoc Inf Sci Technol 2014. [DOI: 10.1002/asi.23173] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Annie T. Chen
- University of North Carolina at Chapel Hill; School of Information and Library Science; 216 Lenoir Drive CB #3360 100 Manning Hall Chapel Hill NC 27599-3360
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15
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Docampo E, Collado A, Escaramís G, Carbonell J, Rivera J, Vidal J, Alegre J, Rabionet R, Estivill X. Cluster analysis of clinical data identifies fibromyalgia subgroups. PLoS One 2013; 8:e74873. [PMID: 24098674 PMCID: PMC3787018 DOI: 10.1371/journal.pone.0074873] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/08/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is mainly characterized by widespread pain and multiple accompanying symptoms, which hinder FM assessment and management. In order to reduce FM heterogeneity we classified clinical data into simplified dimensions that were used to define FM subgroups. MATERIAL AND METHODS 48 variables were evaluated in 1,446 Spanish FM cases fulfilling 1990 ACR FM criteria. A partitioning analysis was performed to find groups of variables similar to each other. Similarities between variables were identified and the variables were grouped into dimensions. This was performed in a subset of 559 patients, and cross-validated in the remaining 887 patients. For each sample and dimension, a composite index was obtained based on the weights of the variables included in the dimension. Finally, a clustering procedure was applied to the indexes, resulting in FM subgroups. RESULTS VARIABLES CLUSTERED INTO THREE INDEPENDENT DIMENSIONS: "symptomatology", "comorbidities" and "clinical scales". Only the two first dimensions were considered for the construction of FM subgroups. Resulting scores classified FM samples into three subgroups: low symptomatology and comorbidities (Cluster 1), high symptomatology and comorbidities (Cluster 2), and high symptomatology but low comorbidities (Cluster 3), showing differences in measures of disease severity. CONCLUSIONS We have identified three subgroups of FM samples in a large cohort of FM by clustering clinical data. Our analysis stresses the importance of family and personal history of FM comorbidities. Also, the resulting patient clusters could indicate different forms of the disease, relevant to future research, and might have an impact on clinical assessment.
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Affiliation(s)
- Elisa Docampo
- Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Antonio Collado
- Fibromyalgia Unit, Rheumatology Service, Hospital Clínic, Barcelona, Spain
- Fibromyalgia and Chronic Fatigue Syndrome, Spanish Genetic and Clinical Data Bank Group, Foundation Fibromyalgia and Fatigue, Barcelona, Spain
- * E-mail:
| | - Geòrgia Escaramís
- Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jordi Carbonell
- Fibromyalgia Unit, Rheumatology Service, Parc de Salut Mar; and Hospital del Mar Research Institute, Barcelona, Spain
- Fibromyalgia and Chronic Fatigue Syndrome, Spanish Genetic and Clinical Data Bank Group, Foundation Fibromyalgia and Fatigue, Barcelona, Spain
| | - Javier Rivera
- Rheumatology Unit, Instituto Provincial de Rehabilitación, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Fibromyalgia and Chronic Fatigue Syndrome, Spanish Genetic and Clinical Data Bank Group, Foundation Fibromyalgia and Fatigue, Barcelona, Spain
| | - Javier Vidal
- Rheumatology Unit, Hospital General de Guadalajara, Guadalajara, Spain
- Fibromyalgia and Chronic Fatigue Syndrome, Spanish Genetic and Clinical Data Bank Group, Foundation Fibromyalgia and Fatigue, Barcelona, Spain
| | - José Alegre
- Chronic Fatigue Syndrome Unit, Hospital Vall d’Hebron, Barcelona, Spain
- Fibromyalgia and Chronic Fatigue Syndrome, Spanish Genetic and Clinical Data Bank Group, Foundation Fibromyalgia and Fatigue, Barcelona, Spain
| | - Raquel Rabionet
- Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Xavier Estivill
- Genomics and Disease Group, Centre for Genomic Regulation (CRG), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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KENDALL S, HOLM NR, HØJSTED J, FRICH L, ROTBØLL NIELSEN P, JENSEN NH, SJØGREN P. Chronic pain and the development of a symptom checklist: a pilot study. Acta Anaesthesiol Scand 2013; 57:920-8. [PMID: 23750563 DOI: 10.1111/aas.12137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is currently no instrument to systematically assess the range of symptoms/problems and their bothersomeness in patients with chronic non-cancer pain (CNPN). Systematic assessment and prioritizing may target treatments and improve outcomes. METHODS The authors developed a checklist of symptoms and problems, the Copenhagen Symptom Checklist (CSC), presented clinically by patients. Fifty-three items representing biological, psychological and social areas were selected. Symptom/problem severity was rated on a 5-point scale anchored at 0 = 'not at all' and 4 = 'severe'. Patients ranked the five most bothersome symptoms/problems and could add five open-ended items. Patients completed the CSC after the first visit at the multidisciplinary pain centre. RESULTS One hundred and twelve consecutive patients completed the CSC. Eighty-nine percent scored pain as rather severe or very severe (score = 3 plus score = 4), followed by reduction in physical activity (67%), fatigue (66%) and sleep disturbance (53%). Pain and fatigue, but not reduction in physical activity, were given highest priority. Cognitive problems were important to a third of the patients. Depressive symptoms, cognitive problems and worry explained 17.5% of the total variance. Patients filled in the CSC without important loss of information, but a minority prioritized more than three areas or used the free text alternative. CONCLUSIONS Patients prioritized pain and fatigue as the most burdensome symptoms, but reduction in physical activity and sleep problems were also highly ranked. Patients were positive to the idea of symptom reporting; however, the 53-item number in this version of CSC is larger than may be necessary.
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Affiliation(s)
| | - N. R. HOLM
- Rigshospitalet; Multidisciplinary Pain Centre; Copenhagen; Denmark
| | - J. HØJSTED
- Rigshospitalet; Multidisciplinary Pain Centre; Copenhagen; Denmark
| | - L. FRICH
- Rigshospitalet; Multidisciplinary Pain Centre; Copenhagen; Denmark
| | | | - N.-H. JENSEN
- Multidisciplinary Pain Centre; Herlev Hospital; Herlev; Denmark
| | - P. SJØGREN
- Section of Acute Pain Management and Palliative Medicine; Rigshospitalet; Copenhagen; Denmark
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Cherry BJ, Zettel-Watson L, Shimizu R, Roberson I, Rutledge DN, Jones CJ. Cognitive performance in women aged 50 years and older with and without fibromyalgia. J Gerontol B Psychol Sci Soc Sci 2012; 69:199-208. [PMID: 23275498 DOI: 10.1093/geronb/gbs122] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). METHOD Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test). RESULTS Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding). DISCUSSION Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.
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Affiliation(s)
- Barbara J Cherry
- Correspondence should be addressed to Barbara Cherry, Department of Psychology, California State University, Fullerton, P.O. Box 6846, Fullerton, CA 92834-6846. E-mail:
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Chen AT. Information seeking over the course of illness: the experience of people with fibromyalgia. Musculoskeletal Care 2012; 10:212-220. [PMID: 22736537 DOI: 10.1002/msc.1022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Although there is literature addressing the fibromyalgia illness experience, there has been limited work concerning how people with fibromyalgia utilize health information. The aim of this study was therefore to investigate the information needs and information-seeking patterns of such individuals, and how these might change over time. METHODS Data were collected through an online survey of fibromyalgia-related information behaviours (N = 190). The participants were recruited through two methods: an email invitation sent out over a university listserv including faculty, staff and students, and invitational posts on fibromyalgia discussion boards on various health-related websites. RESULTS Respondents used the internet most frequently, but also placed great value on information from others, including healthcare practitioners, family and friends. Among the online sources, organization websites, health portals and health-related social networking sites were most frequently used. Topics of interest to people with fibromyalgia vary as they move from an initial stage of confusion, to diagnosis and eventually to a stage of equilibrium in which they are satisfied with their management of their condition. Aside from symptoms and treatments, topics often reflect a need to understand the meaning of their condition and coping skills. CONCLUSION The areas of information need identified in the present study can be used to tailor patient education materials and information services to address contextual and temporal factors in the illness experiences of those with fibromyalgia.
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Affiliation(s)
- Annie T Chen
- University of North Carolina, School of Information and Library Science, Chapel Hill, NC 27599–3360, USA.
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Rutledge DN, Martinez A, Traska TK, Rose DJ. Fall experiences of persons with fibromyalgia over 6 months. J Adv Nurs 2012; 69:435-48. [DOI: 10.1111/j.1365-2648.2012.06026.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen AT. Exploring online support spaces: using cluster analysis to examine breast cancer, diabetes and fibromyalgia support groups. PATIENT EDUCATION AND COUNSELING 2012; 87:250-257. [PMID: 21930359 DOI: 10.1016/j.pec.2011.08.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 08/10/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study sought to characterize and compare online discussion forums for three conditions: breast cancer, type 1 diabetes and fibromyalgia. Though there has been considerable work examining online support groups, few studies have considered differences in discussion content between health conditions. In addition, in contrast to the extant literature, this study sought to employ a semi-automated approach to examine health-related online communities. METHODS Online discussion content for the three conditions was compiled, pre-processed, and clustered at the thread level using the bisecting k-means algorithm. RESULTS Though the clusters for each condition differed, the clusters fell into a set of common categories: Generic, Support, Patient-Centered, Experiential Knowledge, Treatments/Procedures, Medications, and Condition Management. CONCLUSION The cluster analyses facilitate an increased understanding of various aspects of patient experience, including significant emotional and temporal aspects of the illness experience. PRACTICE IMPLICATIONS The clusters highlighted the changing nature of patients' information needs. Information provided to patients should be tailored to address their needs at various points during their illness. In addition, cluster analysis may be integrated into online support groups or other types of online interventions to assist patients in finding information.
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Affiliation(s)
- Annie T Chen
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3360, USA.
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Clinical dimensions of fibromyalgia symptoms and development of a combined index of severity: the CODI index. Qual Life Res 2012; 22:153-60. [PMID: 22367681 DOI: 10.1007/s11136-012-0134-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although a large body of work indicates that fibromyalgia (FM) is not a discrete entity, few studies have attempted to classify the heterogeneity of FM symptoms. The objectives of the present study were to confirm the existence of two latent dimensions underlying FM symptoms (Core-FM symptoms and Distress) by means of factor analysis techniques, and to develop and validate a new combined index of symptom severity (the CODI). METHODS We analyzed and combined the baseline scores on six visual analog scales of the FIQ (pain, general fatigue, morning fatigue, stiffness, anxiety, and depression) and on the STAI-T (trait anxiety) of 216 Spanish patients diagnosed with FM (97.7% women) who were participating in a randomized, controlled trial. RESULTS The principal component analysis indicated the presence of two correlated factors (labeled as Core-FM symptoms and Distress) that explained 64% of total variance. The subsequent confirmatory factor analysis yielded more empirical support for the two-factor model than the one-factor model (all items loading on one latent dimension). The two factors possessed adequate internal consistency and construct validity given the pattern of significant correlations with the Euroqol items. The Core-FM dimension had a stronger relationship with mobility, self-care, usual activities, and pain/discomfort than with anxiety/depression, whereas the Distress dimension showed the opposite pattern. Finally, summing the standardized scores of the two dimensions, a new combined index of symptom severity (the CODI) was developed. CONCLUSION The clinical implications and utility of the CODI are discussed in relation to previous research on FM.
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Rakovski C, Zettel-Watson L, Rutledge D. Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disabil Rehabil 2012; 34:1277-83. [PMID: 22324423 DOI: 10.3109/09638288.2011.641658] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions. METHOD Secondary data analysis of the 2007 National Fibromyalgia Association Questionnaire study resulted in employment and symptom information for 1702 people of working age with FM. In this cross-sectional internet study, six factors of symptom clusters (physical, mental health, sleeping, concentration, musculoskeletal, support) were seen in the data. Linear regression models used employment, age, income, gender, and education to predict symptom clusters. Among those employed, working conditions were also associated with symptom severity. RESULTS In the predominately female sample, 51% were working. Of these, 70% worked over 30 hours/week and half had flexible hours. Employment, higher income, and education were strongly associated with fewer symptoms. Working conditions, including level of physical and mental exertion required on the job as well as coworkers' understanding of FM, were related to symptoms, particularly physical and mental health symptoms. Many participants reported modifying their work environment (66%) or changing occupations (33%) due to FM. CONCLUSIONS Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.
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Affiliation(s)
- Carter Rakovski
- Department of Sociology, California State University, Fullerton, USA.
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Williams DA, Clauw DJ, Glass JM. Perceived Cognitive Dysfunction in Fibromyalgia Syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10582452.2011.558989] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bennett RM, Russell J, Cappelleri JC, Bushmakin AG, Zlateva G, Sadosky A. Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis. BMC Musculoskelet Disord 2010; 11:134. [PMID: 20584327 PMCID: PMC2908076 DOI: 10.1186/1471-2474-11-134] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 06/28/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether some of the clinical features of fibromyalgia (FM) that patients would like to see improved aggregate into definable clusters. METHODS Seven hundred and eighty-eight patients with clinically confirmed FM and baseline pain > or =40 mm on a 100 mm visual analogue scale ranked 5 FM clinical features that the subjects would most like to see improved after treatment (one for each priority quintile) from a list of 20 developed during focus groups. For each subject, clinical features were transformed into vectors with rankings assigned values 1-5 (lowest to highest ranking). Logistic analysis was used to create a distance matrix and hierarchical cluster analysis was applied to identify cluster structure. The frequency of cluster selection was determined, and cluster importance was ranked using cluster scores derived from rankings of the clinical features. Multidimensional scaling was used to visualize and conceptualize cluster relationships. RESULTS Six clinical features clusters were identified and named based on their key characteristics. In order of selection frequency, the clusters were Pain (90%; 4 clinical features), Fatigue (89%; 4 clinical features), Domestic (42%; 4 clinical features), Impairment (29%; 3 functions), Affective (21%; 3 clinical features), and Social (9%; 2 functional). The "Pain Cluster" was ranked of greatest importance by 54% of subjects, followed by Fatigue, which was given the highest ranking by 28% of subjects. Multidimensional scaling mapped these clusters to two dimensions: Status (bounded by Physical and Emotional domains), and Setting (bounded by Individual and Group interactions). CONCLUSION Common clinical features of FM could be grouped into 6 clusters (Pain, Fatigue, Domestic, Impairment, Affective, and Social) based on patient perception of relevance to treatment. Furthermore, these 6 clusters could be charted in the 2 dimensions of Status and Setting, thus providing a unique perspective for interpretation of FM symptomatology.
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Affiliation(s)
- Robert M Bennett
- Oregon Health & Science University, Portland, Oregon, USA
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jon Russell
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | | | - Alesia Sadosky
- Pfizer Global Outcomes Research, New York, New York, USA
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Abstract
Clinical experience suggests that many symptoms occur together. In this paper, we examine the rationale and evidence base for symptom clusters in different medical fields, particularly the cluster phenomenon in cancer. Cancer symptom clusters are a reality. Various symptoms that cluster clinically have also been verified statistically. Specific clusters such as nausea-vomiting, anxiety-depression, and cough-dyspnea are evident on both clinical observation and in research investigation. Fatigue-pain and fatigue-insomnia-pain have also been demonstrated statistically as clusters. Another proposed cluster 'depression-fatigue-pain' seems relevant to clinical practice. Other clusters may serve only as theoretical models that illustrate possible common biological etiologies in cancer; they need to be validated in future research. Analysis of the literature is complicated by considerable inconsistencies across studies. Discrepancies between clinically defined and statistically obtained clusters raise important questions. We must consider the analytical techniques used, and how methodology might influence cluster occurrence and composition. Further research is warranted to establish universally accepted statistical methods and assessment tools for symptom cluster research.
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Affiliation(s)
- Aynur Aktas
- The Harry R Horvitz Center for Palliative Medicine, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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