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Varrassi G, Rekatsina M, Perrot S, Bouajina E, Paladini A, Coaccioli S, Narvaez Tamayo MA, Sarzi Puttini P. Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery? Cureus 2023; 15:e44852. [PMID: 37809234 PMCID: PMC10560069 DOI: 10.7759/cureus.44852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. "Overlapping symptoms" describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic pain syndromes. A variety of pharmacologic and nonpharmacologic treatments are available for fibromyalgia, but treatment is best personalized for an individual and recognizes potential comorbidities. Opioids are not the recommended front-line treatment, cannabinoids hold promise but with limitations and nonpharmacologic options, such as aerobic or resistance exercise and cognitive behavior therapy, can play a very important but often underestimated role. Amitriptyline appears to be safe and effective in treating six of the main fibromyalgia domains: pain, disturbed sleep, fatigue, affective symptoms, functional limitations, and impaired cognition ("fibro fog"). Very low-dose naltrexone (2.5-4.5 mg) may offer analgesic and anti-inflammatory benefits to fibromyalgia patients, but further studies are needed. Fibromyalgia can be a devastating and debilitating condition for patients, and clinicians are challenged with its diagnosis and treatment as well. Further research as well as compassionate approaches to offering personalized care to those with fibromyalgia are required.
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Affiliation(s)
| | | | | | - Elyse Bouajina
- Rheumatology, Farhat Hached University Hospital Center, Sousse, TUN
| | - Antonella Paladini
- Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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2
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Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies. Healthcare (Basel) 2022; 10:healthcare10101975. [PMID: 36292422 PMCID: PMC9602604 DOI: 10.3390/healthcare10101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Fibromyalgia (FM) is a chronic pain syndrome with an unclear etiology. In addition to pain, FM patients suffer from a diverse array of symptoms and comorbidities, encompassing fatigue, cognitive dysfunction, mood disorders, sleep deprivation, and dizziness. Due to the complexity of FM, the diagnosis and treatment of it are highly challenging. The aim of the present work was to investigate some clinical and psychological characteristics of FM patients, and to uncover possible correlations with pharmacological and non-pharmacological therapies. We conducted a cross-sectional, questionnaire-based study aimed at evaluating pain, psychological traits, and the self-perceived effectiveness of pharmacological and non-pharmacological treatments in an Italian population of FM patients. Descriptive statistics, correlation, and inference analyses were performed. We found a prevalence of a neuropathic/nociplastic type of pain, which correlated with psychological traits such as anxiety, low mood, psychophysical discomfort, and the inability to relax. The pain type and psychological traits proved to play a role in determining the self-perceived effectiveness of therapeutic interventions. Patients revealed a better response to non-pharmacological therapies, particularly dietary interventions, relaxation techniques, and psychotherapy rather than pharmacological interventions. The sum of our data indicates that for better outcomes, the type of pain and psychological traits should be considered for tailor-made treatments considering non-pharmacological protocols as a complement to the use of drugs.
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3
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VOSviewer-Based Bibliometric Network Analysis for Evaluating Research on Juvenile Primary Fibromyalgia Syndrome (JPFS). CHILDREN 2022; 9:children9050637. [PMID: 35626815 PMCID: PMC9139718 DOI: 10.3390/children9050637] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 01/03/2023]
Abstract
Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome that affects children and adolescents. Methods: A VOSviewer-based bibliometric network analysis was performed by scanning the global literature on JPFS in the Web of Science (WOS) online database. The search string applied to identify the closest matching articles was “juvenile primary fibromyalgia syndrome (all field)”. Results: A total of 67 articles on JPFS were published from 1985 to March 2022, in the WOS. Regarding article types, 39 were research manuscripts, 16 reviews, 8 meeting abstracts, 2 letters, 1 book chapter, 1 correction, and 1 proceeding paper. The Quartile analysis demonstrated that 44% of papers were published in Q1, 37% in Q2, 8% in Q3, and 11% in Q4. Conclusions: Our analysis highlights that more efforts are warranted to increase the production of quality papers and enhance the connections between the various research groups. JFPS represents a research field still to be explored and which deserves greater investments to obtain quality scientific evidence.
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Somatic and Abdominal Acupuncture for Pain Treatment in Adolescent Complex Regional Pain Syndrome (CRPS) of the Upper Limb: A Case Report. CHILDREN 2021; 8:children8121187. [PMID: 34943383 PMCID: PMC8699959 DOI: 10.3390/children8121187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 12/02/2022]
Abstract
Complex regional pain syndrome (CRPS) is still poorly understood. It is a pain disorder in which pain is disproportionate to the initial stimulus. There is no specific therapy for CRPS, but it can be managed by a combination of treatments. We report a 13-year-old girl with CRPS of the upper limb treated with somatic and abdominal acupuncture. She described a severe, pulsating pain in the left wrist and hand, with hypersensitivity, allodynia, a marked reduction in strength, and swelling and sweating at the level of the fingers. Pain began three months previously, after a trauma to the left wrist. The diagnostic tests performed were negative. At the first visit we recommended oral tramadol. During the first two sessions we used somatic acupuncture. At the third session, the girl reported suffering intolerable pain in the affected limb during the previous sessions, so we decided to use abdominal acupuncture. After 8 sessions of abdominal acupuncture the pain completely disappeared. Acupuncture could be a potential alternative when conservative therapy with physical and medical treatment fails, but more often parents and adolescents prefer this therapy since other comorbidities are often present in pediatric populations and abdominal acupuncture could be a valuable alternative aid.
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Mansouri N, Marjani M, Tabarsi P, von Garnier C, Mansouri D. Successful Treatment of Covid-19 Associated Cytokine Release Syndrome with Colchicine. A Case Report and Review of Literature. Immunol Invest 2021; 50:884-890. [PMID: 32633162 PMCID: PMC7441796 DOI: 10.1080/08820139.2020.1789655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We describe the case of a 42 year old, healthy patient with Covid-19 who despite improvement in his respiratory symptoms developed a mild to moderate cytokine release syndrome (CRS) and an associated monoarticular gout flare. Since the patient refused admission to the hospital and had stable vital signs, we chose to treat him with a safe anti-inflammatory and non-immunosuppressive therapy. To hit two birds with one stone, we considered colchicine, as it has systemic anti-inflammatory effects and is also effective in gout flare. Unexpectedly, 48 hours after treatment, not only did his ongoing fever and toe pain disappear, he also had significant improvements in his general state of health and all his inflammatory markers including fibrinogen, ferritin, D-dimer, and IL-6 levels normalized. To our knowledge, the use of colchicine in Covid-19 and CRS has not been reported. This observation merits the consideration of colchicine as a safe, inexpensive and oral medication for the treatment of mild to moderate CRS in Covid-19 patients. More importantly, in Covid-19 patients with early lung involvement colchicine may be an appropriate candidate to prevent CRS in adjunction with routine antiviral agents. Indeed, multicenter, randomized controlled studies are required to evaluate the benefits of this therapy.
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Affiliation(s)
- Nahal Mansouri
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne
(UNIL), Lausanne, Switzerland
- Department of Clinical Immunology and Infectious Diseases,
National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- The Clinical Tuberculosis and Epidemiology Research
Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- The Clinical Tuberculosis and Epidemiology Research
Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Christophe von Garnier
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne
(UNIL), Lausanne, Switzerland
| | - Davood Mansouri
- Department of Clinical Immunology and Infectious Diseases,
National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- The Clinical Tuberculosis and Epidemiology Research
Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Respiratory Diseases Research Center, National
Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Abd-Elsayed A, Tang T, Karri J, Hughes M, Urits I, Gupta M, Pasqualucci A, Myrcik D, Varrassi G, Viswanath O. Neuromodulation for Pain Management in the Inpatient Setting: A Narrative Review. Cureus 2021; 13:e13892. [PMID: 33880248 PMCID: PMC8046682 DOI: 10.7759/cureus.13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
Pain is highly prevalent and pharmacological therapy is not always efficacious. There are a few pathophysiological reasons to believe that neuromodulation would increase the rate of success of pain management. This review article is focused on that aspect, discussing non-invasive or minimally invasive neuromodulation techniques in both the inpatient and outpatient setting. This article provides an in-depth discussion of the multiple neuromodulation techniques available over time to be suitable and effective when used as analgesic therapies for chronic pain. We reviewed the literature and discussed all available neuromodulation options that were tested in the inpatient and outpatient setting. Neuromodulation plays a very important role in treating chronic pain in both inpatient and outpatient setting.
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Affiliation(s)
- Alaa Abd-Elsayed
- Anesthesiology and Pain Management, University of Wisconsin, Madison, USA
| | - Tuan Tang
- Anesthesiology and Critical Care, University of Texas at Houston, Houston, USA
| | - Jay Karri
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Meghan Hughes
- Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Mayank Gupta
- Pain Management, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | | | | | | | - Omar Viswanath
- Pain Management, Creighton University School of Medicine, Phoenix, USA
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7
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Bodéré C, Cabon M, Woda A, Giroux-Metges MA, Bodéré Y, Saliou P, Quinio B, Misery L, Le Fur-Bonnabesse A. A training program for fibromyalgia management: A 5-year pilot study. SAGE Open Med 2020; 8:2050312120943072. [PMID: 33110601 PMCID: PMC7564648 DOI: 10.1177/2050312120943072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/24/2020] [Indexed: 12/23/2022] Open
Abstract
We studied the effects of a specific cardio training program lasting 5 years on
pain and quality of life in fibromyalgia patients.
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Affiliation(s)
- Céline Bodéré
- Laboratory Interactions Epitheliums Neurones (LIEN), Université de Bretagne Occidentale, Brest, France.,Centre d'évaluation et de traitement de la douleur, CHRU Brest, Brest, France.,Département de sciences anatomiques et physiologiques, UFR d'Odontologie de Brest UBO, Brest, France
| | - Mathilde Cabon
- Laboratory Interactions Epitheliums Neurones (LIEN), Université de Bretagne Occidentale, Brest, France
| | - Alain Woda
- Département d'odontologie, CROC (EA 3847), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie-Agnès Giroux-Metges
- ORPHY (EA4324), Université de Bretagne Occidentale, Brest, France.,Service des explorations fonctionnelles respiratoires, CHRU Brest, Brest, France
| | - Youenn Bodéré
- Physiothérapeute, Fédération Française de Voile, Brest, France
| | - Philippe Saliou
- Service de santé publique et épidémiologie, CHRU Brest, Brest, France
| | - Bertrand Quinio
- Centre d'évaluation et de traitement de la douleur, CHRU Brest, Brest, France
| | - Laurent Misery
- Laboratory Interactions Epitheliums Neurones (LIEN), Université de Bretagne Occidentale, Brest, France
| | - Anais Le Fur-Bonnabesse
- Laboratory Interactions Epitheliums Neurones (LIEN), Université de Bretagne Occidentale, Brest, France.,Centre d'évaluation et de traitement de la douleur, CHRU Brest, Brest, France.,Département de sciences anatomiques et physiologiques, UFR d'Odontologie de Brest UBO, Brest, France
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8
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9
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Varrassi G, Alon E, Bagnasco M, Lanata L, Mayoral-Rojals V, Paladini A, Pergolizzi JV, Perrot S, Scarpignato C, Tölle T. Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus. Adv Ther 2019; 36:2618-2637. [PMID: 31485978 PMCID: PMC6822819 DOI: 10.1007/s12325-019-01053-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks. To date, mechanisms associated with inflammatory pain are not completely understood because of their complex nature and the involvement of both peripheral and central mechanisms. This Expert Consensus document is intended to update clinicians about evolving areas of clinical practice and/or available treatment options for the management of patients with inflammatory pain. METHOD An international group of experts in pain management covering the pharmacology, neurology and rheumatology fields carried out an independent qualitative systematic literature search using MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines. CONCLUSIONS Increasing clinicians' knowledge of the available pharmacologic options to treat different pain mechanisms offers the potential for safe, individualized treatment decisions. We hope that it will help implement the needed changes in the management of inflammatory pain by providing the best strategies and new insights to achieve the ultimate goal of managing the disease and obtaining optimal benefits for patients. FUNDING Dompé Farmaceutici SPA and Paolo Procacci Foundation.
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Rome, Italy.
- President of World Institute of Pain (WIP), Winston-Salem, NC, USA.
| | - Eli Alon
- University of Zurich, Zurich, Switzerland
| | - Michela Bagnasco
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | - Luigi Lanata
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | | | | | | | - Serge Perrot
- Descartes University and Cochin-Hotel Dieu Hospital, Paris, France
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10
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Galvani C, Caramaschi P, Mura P, Paladini A, Piroli A, Arnaudo E, De Franceschi L, Evangelista M, Pari A, Ongaro G, Finco G, Ciannameo A, Carletto A, Varrassi G, Biasi D. Postural counseling represents a novel option in pain management of fibromyalgia patients. J Pain Res 2019; 12:327-337. [PMID: 30666151 PMCID: PMC6333156 DOI: 10.2147/jpr.s164714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM. Patients and methods This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score. Results Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC. Conclusion Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM.
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Affiliation(s)
- Carla Galvani
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paolo Mura
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | | | - Alba Piroli
- Department of MESVA, University of L'Aquila, L'Aquila, Italy
| | - Elisa Arnaudo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Lucia De Franceschi
- Internal Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Evangelista
- Emergency Department, Institute of Anesthesia, Resuscitation and Pain Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Alice Pari
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Giovanna Ongaro
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Gabriele Finco
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Anna Ciannameo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Giustino Varrassi
- Department of MESVA, University of L'Aquila, L'Aquila, Italy.,Paolo Procacci Foundation, Rome, Italy
| | - Domenico Biasi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
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11
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Bonezzi C, Leoni ML, Terranova G. Fibromyalgia: A “Chronic Pain Condition” or a True “Chronic Pain Disease”? Pain Pract 2018; 18:283. [DOI: 10.1111/papr.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cesare Bonezzi
- Pain Unit; Clinical Scientific Institutes Maugeri; Pavia Italy
| | | | - Gaetano Terranova
- Pain Unit; Clinical Scientific Institutes Maugeri; Pavia Italy
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
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12
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Ramzy EA. Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study. Pain Pract 2016; 17:32-40. [DOI: 10.1111/papr.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/31/2015] [Accepted: 09/05/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Eiad A. Ramzy
- Pain Clinic; Department of Anaesthesia and Surgical Intensive Care; Mansoura University; Mansoura Egypt
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13
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Del Giorno R, Skaper S, Paladini A, Varrassi G, Coaccioli S. Palmitoylethanolamide in Fibromyalgia: Results from Prospective and Retrospective Observational Studies. Pain Ther 2015; 4:169-78. [PMID: 26334329 PMCID: PMC4676767 DOI: 10.1007/s40122-015-0038-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Fibromyalgia syndrome (FM) is characterized by persistent pain which is often refractory to common analgesic therapies and is particularly disabling. The objective of this study was to evaluate the therapeutic efficacy of duloxetine (DLX) + pregabalin (PGB) in patients suffering from FM and the possible added benefit of the lipid signaling molecule, palmitoylethanolamide (PEA). PEA is well-documented to exert anti-inflammatory, analgesic, and pain-relieving effects at both the preclinical and clinical level. Methods A total of 80 patients were recruited in two steps. The first was a retrospective observational study comprising 45 patients. This patient group received DLX + PGB for 6 months. The second step was a prospective observational study with 35 patients. Patients in this cohort began treatment with DLX + PGB at the same dosage as for the retrospective study plus micronized PEA (PEA-m®; Epitech Group, Italy) and ultramicronized PEA (PEA-um®; Epitech Group, Italy) for 3 months. Positive tender points (TPs), pain evoked, and pain intensity were evaluated at baseline and after 3 and 6 months in both studies. Statistical analyses were employed for comparison of data within the two studies and between them. Results The retrospective observational study (DLX + PGB), after 3 months of treatment showed a decrease of positive TPs, pain evoked, and pain intensity. After 6 months of treatment, these parameters had further improvement. In the prospective observational study (DLX + PGB + PEA), PEA introduction after 3 months of therapeutic regimen with DLX + PGB provided a significant improvement in pain symptoms, with a further reduction in the number of TPs and significant reduction in pain, compared to combined DLX + PGB only (p < 0.0001 for TPs and Visual Analog Scale comparisons). None of the patients experienced adverse side effects. Conclusion Our study confirms the efficacy of DLX + PGB and demonstrates as well the added benefit and safety of PEA in the treatment of pain in patients affected by FM. Electronic supplementary material The online version of this article (doi:10.1007/s40122-015-0038-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosaria Del Giorno
- Institute of Internal Medicine, Rheumatology and Medical Therapy of Pain, Perugia University, District of Terni, Perugia, Italy.
| | - Stephen Skaper
- Department of Pharmaceutical and Pharmacological Sciences, Padua University, Padua, Italy
| | - Antonella Paladini
- Institute of Anesthesiology and Pain Therapy, L'Aquila University, L'Aquila, Italy
| | - Giustino Varrassi
- Paolo Procacci Foundation, L'Aquila University, L'Aquila, Italy.,European League Against Pain, Zürich, Switzerland
| | - Stefano Coaccioli
- Institute of Internal Medicine, Rheumatology and Medical Therapy of Pain, Perugia University, District of Terni, Perugia, Italy.,European League Against Pain, Zürich, Switzerland
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14
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Martín J, Torre F, Padierna A, Aguirre U, González N, Matellanes B, Quintana JM. Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial. Int J Clin Pract 2014; 68:618-27. [PMID: 24868587 DOI: 10.1111/ijcp.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM Fibromyalgia (FM) is a persistent disorder that can have a devastating effect on patients' lives. The purpose of the study was to assess the effects of an interdisciplinary treatment for FM on patients' physical and psychosocial parameters. METHODS A randomised controlled clinical trial carried out among 153 patients. The control group (CG) received standard pharmacological therapy. The experimental group (EG) received an interdisciplinary treatment. At baseline and 6 months after the intervention, participants completed assessment for impact of FM in the quality of life, anxiety, depression, coping with pain, social support and satisfaction with the treatment. RESULTS A total of 110 participants completed the trial. Six months after the intervention, statistically significant improvements in quality of life (p = 0.04), pain (p = 0.03), self-assertiveness (p = 0.01), mental self-control (p = 0.05), social support (p = 0.02) and satisfaction (p = 0.0001) were observed in the EG. Randomisation to the EG was identified as a predictor for improvement. CONCLUSION An interdisciplinary intervention may be appropriate for patients referred to a hospital pain management unit.
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15
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Martín J, Torre F, Padierna A, Aguirre U, González N, Matellanes B, Quintana JM. Interdisciplinary treatment of patients with fibromyalgia: improvement of their health-related quality of life. Pain Pract 2013; 14:721-31. [PMID: 24279638 DOI: 10.1111/papr.12134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/16/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess whether an interdisciplinary intervention is more effective than usual care for improving the health-related quality of life (HRQoL) among patients with fibromyalgia (FM), and to identify variables that were predictors of improvement in HRQoL. METHODS In a randomized controlled clinical trial carried out on an outpatient basis in a hospital pain management unit, 153 patients with FM were randomly allocated to an experimental group (EG) or a control group (CG). Participants completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6 months after the intervention. The EG received an interdisciplinary treatment (12 sessions for 6 weeks) which consisted of coordinated psychological, medical, educational, and physiotherapeutic interventions while the CG received standard-of-care pharmacologic treatment. Descriptive statistics, ANOVA, Chi square and Fisher tests and generalized linear models were used for data analysis. RESULTS Six months after the intervention, statistically significant improvements in HRQoL were observed in physical functioning (P = 0.01), pain (P = 0.03) and total FIQ score (P = 0.04) in the EG compared to the CG. The number of physical illnesses was identified as a predictor for improvement. CONCLUSIONS This interdisciplinary intervention has shown effectiveness in improving the HRQoL of this sample of patients with FM. The number of physical illnesses was identified as a predictor of that improvement.
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Affiliation(s)
- Josune Martín
- Research Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
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Chen CK, Nizar AJ. Myofascial pain syndrome in chronic back pain patients. Korean J Pain 2011; 24:100-4. [PMID: 21716607 PMCID: PMC3111556 DOI: 10.3344/kjp.2011.24.2.100] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/15/2011] [Accepted: 04/21/2011] [Indexed: 11/12/2022] Open
Abstract
Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P < 0.001) in Visual Analogue Score (VAS) and Modified Oswestry Disability Score (MODS) with standard management during three consecutive visits at six-month intervals. Conclusions MPS prevalence among chronic back pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome.
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Affiliation(s)
- Chee Kean Chen
- Department of Anesthesiology and Intensive Care, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Tomasević-Todorović S, Pjević M, Bosković K. [Fibromyalgia-up to date aspects of pathophysiology diagnosis and treatment]. ACTA ACUST UNITED AC 2011; 63:507-11. [PMID: 21446139 DOI: 10.2298/mpns1008507t] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic pain condition with spontaneous, chronic, widespread musculoskeletal pain and tenderness accompanied by a number of nonspecific symptoms. The low prevalence of FM is considered an underestimation and results from insufficient knowledge about FM In order to increase the general awareness of the unique nature of pain in fibromyalgia and the right of patients to receive specific attention, EFIC (European Federation of the IASP Chapters) launched the European campaign against pain in fibromyalgia. PATHOPHYSIOLOGICAL MECHANISMS The pathogenesis of fibromyalgia is not yet clear. An altered processing of pain is probably the main contributor to the pathogenesis, arising from a number of neuroendocrine, neurotransmitter and neurosensory disturbances in genetically predisposed patients. According to numerous findings. FM originates in the central nervous system and indicates a state of central sensitization in fibromyalgia. There are many reasons for considering that FM and neuropathic pain share similar mechanisms. DIAGNOSTIC CRITERIA AND FIBROMYALGIA ASSESSMENT The ACR criteria (1990) are currently a "gold standard" applied for FM diagnosing, but a number of scoring systems and scales are valid tools for fibromyalgia assessment, differential diagnosis. treatment evaluation and estimation of patient's quality of life. TREATMENT According, to multiple pathophysiological mechanisms, the treatment involves multidisciplinary and multimodal approach, including a combination of pharmacological and non-pharmacological interventions based on EULAR (European League Against Rheumatism) recommendations from 2007. Pharmacological treatment (antidepressants, anticonvulsants and conventional analgesics) is directed toward the control of pain and other symptoms, but nonpharmacological management (aerobic exercise, strength training and cognitive behavioural therapy) is directed to functional consequences of the symptoms. Although the treatment rarely relieves the symptoms completely the active role of an educated FM patient and supportive surrounding are secondary necessary to provide beneficial clinical effects on this complex painful condition.
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Smith HS, Bracken D, Smith JM. Pharmacotherapy for fibromyalgia. Front Pharmacol 2011; 2:17. [PMID: 21772818 PMCID: PMC3131797 DOI: 10.3389/fphar.2011.00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 03/09/2011] [Indexed: 12/27/2022] Open
Abstract
Fibromyalgia (FM) is a chronic disorder characterized by multifocal pain and other associated somatic symptoms including fatigue, insomnia, cognitive/memory problems, and even psychological distress. It appears that 2–4% of the general population suffers from FM. FM negatively impacts the physical functioning of its patients, as evidenced by difficulties with multiple daily activities, as well as affecting emotional health, social functioning, and health related quality of life. This review will discuss the potential theories that possibly contribute to the pathogenesis of FM, although the precise mechanism is unknown. The evolution of the assessment of FM will also be examined, with the waning use of tender point examinations and the appearance of new simple, practical diagnostic criteria. Although non-pharmacologic therapeutic options (exercise, education, cognitive–behavioral therapy) have been shown to be extremely effective in FM, the focus of this article will be on pharmacologic strategies. Non-Food and Drug Administration (FDA) approved as well as FDA approved agents will be presented. Each agent's therapeutic “niche” in FM management will be discussed based on its pharmacologic profile, patient responsiveness, and tolerability. Finally a clinical algorithm will be presented for the step-wise management of pain and other associated symptoms of FM.
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Affiliation(s)
- Howard S Smith
- Department of Anesthesiology, Albany Medical College Albany, NY, USA
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Motley CP, Maxwell ML. Fibromyalgia: Helping Your Patient While Maintaining Your Sanity. Prim Care 2010; 37:743-55, vi. [DOI: 10.1016/j.pop.2010.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Terre L. Does Exercise Benefit Fibromyalgia? Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610373732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review discusses evidence-based perspectives on the potential benefits of exercise for fibromyalgia. Future directions for inquiry and clinical management also are addressed.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs 2009; 12:15-24. [PMID: 21349445 DOI: 10.1016/j.pmn.2009.10.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to review emerging data from the fields of nursing, rheumatology, dentistry, gastroenterology, gynecology, neurology, and orthopedics that support or dispute pathophysiologic similarities in pain syndromes studied by each specialty. A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional syndromes, and somatization. Each term was linked with pathophysiology and/or central sensitization. This paper presents a review of relevant articles with a specific goal of identifying pathophysiologic findings related to nociceptive processing. The extant literature presents considerable overlap in the pathophysiology of these diagnoses. Given the psychosomatic lens through which many of these disorders are viewed, demonstration of evidence-based links supporting shared pathophysiology between these disorders could provide direction to clinicians and researchers working to treat these diagnoses. "Central sensitivity syndromes" denotes an emerging nomenclature that could be embraced by researchers investigating each of these disorders. Moreover, a shared paradigm would be useful in promoting cross-fertilization between researchers. Scientists and clinicians could most effectively forward the understanding and treatment of fibromyalgia and other common chronic pain disorders through an appreciation of their shared pathophysiology.
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Affiliation(s)
- Lindsay L Kindler
- Center for Comprehensive Pain Research, University of Florida, Gainesville, Florida, USA.
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Mazza M, Mazza O, Pomponi M, Di Nicola M, Padua L, Vicini M, Bria P, Mazza S. What is the effect of selective serotonin reuptake inhibitors on temperament and character in patients with fibromyalgia? Compr Psychiatry 2009; 50:240-4. [PMID: 19374968 DOI: 10.1016/j.comppsych.2008.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/20/2008] [Accepted: 08/27/2008] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to assess a group of patients with fibromyalgia (FM) and control subjects using the personality questionnaire proposed by Cloninger and to determine possible changes in the Italian version of the Temperament and Character Inventory-Revised patterns of patients with FM after therapy with serotoninergic antidepressants (selective serotonin reuptake inhibitors [SSRIs]). METHODS Sixty patients with FM filled out the Temperament and Character Inventory-Revised and Beck Depression Inventory before and after 6-month therapy with SSRIs (escitalopram 10 mg, fluoxetine 20 mg, or paroxetine 20 mg). A total of 80 age-, sex-, and education level-matched healthy subjects were selected as a control group. RESULTS Both in the pretreatment and posttreatment period, patients were found to have higher harm avoidance and lower self-directedness scores than healthy controls. In addition, harm avoidance and self-directedness were state and trait dependent. CONCLUSIONS Depressive symptoms in patients with FM can be significantly decreased by treatment with SSRIs. A careful clinical assessment and study of personality profile is needed to identify patients with FM who may benefit from antidepressant pharmacologic therapy and specific psychotherapeutic interventions.
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Affiliation(s)
- Marianna Mazza
- Institute of Psychiatry, Catholic University of Sacred Heart of Rome, Largo F. Vito 1, Rome 00168, Italy.
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Hartrick CT. Fibromyalgia: What's in a name? Pain Pract 2008; 8:155. [DOI: 10.1111/j.1533-2500.2008.00196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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