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Santo JE, Lavilla-Lerma ML, Del Carmen Carcelén-Fraile M, de Loureiro NEM, Brandão-Loureiro V, Alzar-Teruel M, Ortiz-Quesada R. Associations between the severity of menopausal symptoms and musculoskeletal pain in postmenopausal Portuguese women. Int J Gynaecol Obstet 2024; 165:138-147. [PMID: 38093603 DOI: 10.1002/ijgo.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To analyze the association of the severity of the menopausal symptoms with musculoskeletal pain in Portuguese postmenopausal women. METHODS A cross-sectional, observational study was conducted on 167 women (63.85 ± 9.36 years). The Menopause Rating Scale was used to evaluate the menopausal symptoms severity, while the Nordic Musculoskeletal Questionnaire was employed to assess the localization of the musculoskeletal pain, and multi-located pain was determined if two or more body regions were affected. Depression (Hospital Anxiety and Depression Scale), age, body mass index (BMI) and physical activity level were considered as potential confounders. RESULTS A greater severity of the somato-vegetative menopausal symptoms was related to the prevention from usual activities because of pain in the neck, shoulders, elbows, wrists/hands and knees (R2 of Nagelkerke = 0.064, 0.043, 0.074, 0.045 and 0.045, respectively). Associations were also observed between greater age and pain in the knees, ankles and feet (R2 of Nagelkerke = 0.036 and 0.034, respectively), and being physically inactive with upper back pain (R2 of Nagelkerke = 0.060). Higher depressive symptoms were linked to pain in the hip/thighs and knees (R2 of Nagelkerke = 0.067 and 0.085, respectively), as well as being physically inactive was related ton in the neck (R2 of Nagelkerke = 0.053). Only a greater BMI was related to multi-located pain in the last 7 days (R2 of Nagelkerke = 0.041). CONCLUSIONS The findings of our study showed that, taking into account possible confounders, greater severity of the menopausal symptoms at a somatic-vegetative level was associated with more anatomical regions with musculoskeletal pain.
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Affiliation(s)
- João Espírito Santo
- Escola Superior de Saúde Atlântica, Barcarena, Portugal
- Escola Superior de Educação, Instituto Politécnico de Beja, Beja, Portugal
| | | | | | | | | | - María Alzar-Teruel
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Raúl Ortiz-Quesada
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain
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Öznur Ö, Schlee C, Utz S, Langhorst J. Investigating the Influential Factors of Mild Water-Filtered Infrared-A Whole-Body Hyperthermia for Pain Relief in Fibromyalgia: A Mixed-Methods Approach Focusing on Predictors and Patient Perspectives. Biomedicines 2023; 11:2949. [PMID: 38001951 PMCID: PMC10669402 DOI: 10.3390/biomedicines11112949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic condition characterized by chronic widespread pain, persistent fatigue, and disrupted sleep, significantly impacting well-being. Mild water-filtered infrared-A (wIRA) whole-body hyperthermia (WBH) is emerging as a promising pain management approach to FMS. Within the present randomized controlled trial (ClinicalTrials ID: NCT05135936), FMS patients underwent six sessions of mild wIRA-WBH over 3 weeks. Their pain levels were assessed at baseline and at week 12, while body core temperature and plateau phase duration were monitored during WBH. Qualitative interviews were conducted at week 12. Results from this mixed-methods study revealed that baseline pain intensity and plateau phase duration significantly predicted pain intensity at week 12. Thematic analysis of the interviews revealed diverse patient experiences with the treatment, with all patients reporting improvements in perceived pain and overall well-being. The onset and duration of pain relief varied among individuals. Overall, the findings suggest that the duration of the plateau phase may serve as an indicator for long-term pain reduction, although individual factors may influence treatment outcomes. Despite varying experiences, a prevailing trend of positive patient evaluations emerged. This study sheds light on the potential of wIRA-WBH as a therapeutic option for alleviating pain for and enhancing the well-being of FMS patients.
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Affiliation(s)
- Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Christoph Schlee
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Sociology, University of Bamberg, 96052 Bamberg, Germany
| | - Sandra Utz
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
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3
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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Langhorst J, Koch AK, Kehm C, Öznur Ö, Engler H, Häuser W. Mild Water-Filtered Infrared-A Whole-Body Hyperthermia Reduces Pain in Patients with Fibromyalgia Syndrome-A Randomized Sham-Controlled Trial. J Clin Med 2023; 12:jcm12082945. [PMID: 37109279 PMCID: PMC10144038 DOI: 10.3390/jcm12082945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The challenging treatment situation of patients with fibromyalgia syndrome (FMS) requires additional therapy options. The effects of water-filtered infrared-A whole-body hyperthermia (WBH) versus sham hyperthermia on pain intensity were investigated in an outpatient setting within a two-armed randomized sham-controlled trial. n = 41 participants aged between 18 and 70 years with a medically confirmed diagnosis of FMS were randomized to WBH (intervention; n = 21) or sham hyperthermia (control; n = 20). Six treatments with mild water-filtered infrared-A WBH over a period of three weeks with at least one day in between treatments were applied. On average, the maximum temperature was 38.7 °C for a duration of approximately 15 min. The control group received exactly the same treatment except that an insulating foil between the patient and the hyperthermia device blocked most of the radiation. Primary outcome was pain intensity measured by the Brief Pain Inventory at week 4. Secondary outcomes included blood cytokine levels and FMS-related core symptoms and quality of life. Pain intensity at week 4 was significantly different between the groups in favor of WBH (p = 0.015). A statistically significant pain reduction in favor of WBH was also found at week 30 (p = 0.002). Mild water-filtered infrared-A WBH effectively reduced pain intensity at the end of treatment and follow-up.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Anna K Koch
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Christina Kehm
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational and Behavioral Neurosciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, 81675 Munich, Germany
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Hyder Zaidi ST, Ashraf H, Javaid SS, Rashid AM, -Haque SU, Fatima SS, Ali NM. Survey of knowledge and attitude towards fibromyalgia among physicians in Karachi, Pakistan. Br J Pain 2022; 16:593-600. [PMID: 36452123 PMCID: PMC9703244 DOI: 10.1177/20494637221106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Objectives Our study aims to assess knowledge and understanding of FM among doctors employed at a tertiary care hospital in Karachi, Pakistan with a focus on its diagnostic criteria, treatment modalities, and general knowledge of symptoms. Study Design Cross-sectional Study. Methods Our cross-sectional study recruited participants through convenience sampling. A total of 104 participants responded, which included (a) House Officers, (b) Medical Officers, and (c) Residents. A structured questionnaire was used, and an electronic form was generated which was then emailed to the participants to acquire their responses. Results The majority (66.3%) of our respondents were female and the median age was 26 years. A majority (93.3%) accepted FM as a separate and distinct clinical identity, and 79.8% were confident in recognizing its general symptoms. Widespread pain (95.2%) and fatigue (80.8%) were correctly identified as most commonly observed symptoms. Moreover, 68.3% of respondents possessed no knowledge of both ACR 1990 and 2010 diagnostic criteria for FM. Of those aware, majority favored using the most recent ACR 2010 criteria (72.7%). Majority of our respondents (75%) preferred using pharmaceutical and non-pharmaceutical interventions simultaneously in the treatment. Conclusions Our study indicates that while physicians have satisfactory knowledge of the symptoms and treatment modalities of FM, a knowledge gap concerning its diagnostic criteria exists. Proper treatment can only be successful when physicians successfully diagnose FM, therefore, future training programs should use this fact as a stepping stone for advances in its healthcare.
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Affiliation(s)
| | - Hira Ashraf
- Department of Physiology, Foundation University, Islamabad, Pakistan
| | - Syed Sarmad Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Shajee-Ul -Haque
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Syeda Sidra Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Nouman Mansoor Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Alorfi NM. Pharmacological treatments of fibromyalgia in adults; overview of phase IV clinical trials. Front Pharmacol 2022; 13:1017129. [PMID: 36210856 PMCID: PMC9537626 DOI: 10.3389/fphar.2022.1017129] [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: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Fibromyalgia is a chronic neurological condition characterized by widespread pain. The effectiveness of current pharmacological treatments is limited. However, several medications have been approved for phase IV trials in order to evaluate them. Aim: To identify and provide details of drugs that have been tested in completed phase IV clinical trials for fibromyalgia management in adults, including the primary endpoints and treatment outcomes. This article was submitted to Neuropharmacology, a section of the journal Frontiers in Pharmacology. Method: Publicly available and relevant phase IV trials registered at ClinicalTrials.gov were analyzed. The uses of the trialed drugs for fibromyalgia were reviewed. Results: As of 8 August 2022, a total of 1,263 phase IV clinical trials were identified, of which 121 were related to fibromyalgia. From these, 10 clinical trials met the inclusion criteria for the current study. The drugs used in phase IV trials are milnacipran, duloxetine, pregabalin, a combination of tramadol and acetaminophen, and armodafinil. The effectiveness of the current pharmacological treatments is apparently limited. Conclusion: Due to its complexity and association with other functional pain syndromes, treatment options for fibromyalgia only are limited and they are designed to alleviate the symptoms rather than to alter the pathological pathway of the condition itself. Pain management specialists have numerous pharmacologic options available for the management of fibromyalgia.
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Gharibpoor F, Ghavidel-Parsa B, Sattari N, Bidari A, Nejatifar F, Montazeri A. Effect of vitamin B12 on the symptom severity and psychological profile of fibromyalgia patients; a prospective pre-post study. BMC Rheumatol 2022; 6:51. [PMID: 36045399 PMCID: PMC9434892 DOI: 10.1186/s41927-022-00282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) as a prototypical nociplastic pain condition displays a difficult therapeutic situation in many cases. Given the promising data on the effect of vitamin B12 in improving pain and cognitive functions in various nociplastic pain conditions, we aimed to determine the efficacy of 1000 mcg daily dose of oral vitamin B12 on the symptom severity and psychological profile of FM patients. METHODS This open-label, pre-post study was performed on FM patients whose diagnoses were confirmed by a rheumatologist based on the 2016 American College of Rheumatology (ACR). Patients were instructed to take a daily dose of 1000mcg vitamin B12 for fifty days. Outcome measures including the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), 12-item Short-Form health survey (SF-12), and pain Visual Analog Scale (pain-VAS) were fulfilled by patients before and after the treatment. RESULTS Of 30 eligible patients, 28 patients completed the study protocol. Patients were female with a mean age of 47.50 ± 8.47 years. FIQR scores in all domains improved significantly after treatment (total FIQR: 49.8 ± 21.86 vs 40.00 ± 18.36, p value < 0.01; function: 13.17 ± 7.33 vs 10.30 ± 5.84, p value: 0.01; overall: 10.32 ± 6.22 vs 8.25 ± 6.22, p value: 0.03; symptoms: 26.30 ± 10.39 vs 21.44 ± 8.58, p value < 0.01). Vitamin B12 also improved anxiety scores from 9.33 ± 4.30 to 7.70 ± 3.60, p value: 0.01. Depression, pain-VAS, and SF-12 didn't improve following the treatment. The Generalized estimating equations (GEE) analysis showed the improvement in total FIQR score is not cofounded by the improvement of anxiety and patients' baseline characteristics. CONCLUSIONS This study showed a short course of sublingual vitamin B12, 1000 mcg daily, significantly improves the severity of FM and anxiety score. We postulate that vitamin B12 has a strong potential to consider, at least, as adjunctive therapy of FM. TRIAL REGISTRATION The study protocol was approved by the ethics committee of Guilan University of Medical Sciences (IR.GUMS.REC.1400.197) in accordance with the World Medical Association's code of ethics (Declaration of Helsinki, revised in Brazil 2013), and registered at an ICMJE and WHO recognized registry of clinical trials ( www.irct.ir ) on 28/08/2021 (registration number: IRCT20200920048782N1).
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Affiliation(s)
- Faeze Gharibpoor
- Student Research Committee, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Banafsheh Ghavidel-Parsa
- Department of Rheumatology, School of Medicine, Rheumatology Research Center, Razi Hospital, Guilan University of Medical Science, Sardar Jangal St, Rasht, 41448-95655, Guilan, Iran.
| | - Nazila Sattari
- Student Research Committee, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nejatifar
- Department of Hematology and Medical Oncology, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Gentle Touch Therapy, Pain Relief and Neuroplasticity at Baseline in Fibromyalgia Syndrome: A Randomized, Multicenter Trial with Six-Month Follow-Up. J Clin Med 2022; 11:jcm11164898. [PMID: 36013137 PMCID: PMC9410244 DOI: 10.3390/jcm11164898] [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: 05/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Fibromyalgia (FM) is considered a stress-related disorder characterized mainly by chronic widespread pain. Its pathogenesis is unknown, but cumulative evidence points at dysfunctional transmitter systems and inflammatory biomarkers that may underlie the major symptoms of the condition. This study aimed to evaluate pain scores (primary outcome), quality of life, inflammatory biomarkers and neurotransmitter systems in women with FM (secondary outcomes) subjected to gentle touch therapy (GTT) or placebo. Methods: A total of 64 female patients with FM were randomly assigned to two groups, namely GTT (n = 32) or Placebo (n = 32). Clinical assessments were conducted at baseline and post-intervention with six-month follow-up. We measured serum catecholamines (dopamine), indolamines and intermediary metabolites (serotonin or 5-hydroxyindolacetic acid (5-HIAA)), as well as tetrahydrobiopterin (BH4), which is a cofactor for the synthesis of neurotransmitters and inflammatory biomarkers in women with FM. A group of healthy individuals with no intervention (control group) was used to compare biochemical measurements. Intervention effects were analyzed using repeated measures (RM) two-way ANOVA followed by Bonferroni post hoc test and mixed ANCOVA model with intention to treat. Results: Compared to placebo, the GTT group presented lower pain scores and brain-derived neurotrophic factor (BDNF) levels without altering the quality of life of women with FM. Changes in BDNF had a mediating role in pain. Higher baseline serum BDNF and 5-HIAA or those with a history of anxiety disorder showed a higher reduction in pain scores across time. However, women with higher serum dopamine levels at baseline showed a lower effect of the intervention across the observation period revealed by an ANCOVA mixed model. Conclusions: In conclusion, lower pain scores were observed in the GTT group compared to the placebo group without altering the quality of life in women with FM. Reductions in BDNF levels could be a mechanism of FM pain status improvement. In this sense, the present study encourages the use of these GTT techniques as an integrative and complementary treatment of FM.
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The Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia Syndrome and Chronic Musculoskeletal Pain. Nutrients 2022; 14:nu14153010. [PMID: 35893864 PMCID: PMC9330000 DOI: 10.3390/nu14153010] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Fibromyalgia syndrome (FMS) and chronic widespread musculoskeletal pain (CMP) are diffuse suffering syndromes that interfere with normal activities. Controversy exists over the role of vitamin D in the treatment of these diseases. We carried out a systematic literature review of randomized controlled trials (RCT) to establish whether vitamin D (25OHD) deficiency is more prevalent in CMP patients and to assess the effects of vitamin D supplementation in pain management in these individuals. We searched PubMed, Physiotherapy Evidence Database (PEDro), and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published in English from 1 January 1990 to 10 July 2022. A total of 434 studies were accessed, of which 14 satisfied the eligibility criteria. In our review three studies, of which two had the best-quality evidence, a correlation between diffuse muscle pain and 25OHD deficiency was confirmed. Six studies, of which four had the best-quality evidence, demonstrated that appropriate supplementation may have beneficial effects in patients with established blood 25OHD deficiency. Eight studies, of which six had the best-quality evidence, demonstrated that 25OHD supplementation results in pain reduction. Our results suggest a possible role of vitamin D supplementation in alleviating the pain associated with FMS and CMP, especially in vitamin D-deficient individuals.
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Younis A, Qasem Y, Ali Neamat Sulaiman Alallaf. The Frequency of Fibromyalgia in Migraine Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Fibromyalgia (FM) is a prevailing debilitating ailment that has been described in patients with migraines in several investigations.
AIM: The study aimed to investigate the frequency of FM in migraine patients and to study the characteristics of migraine patients with comorbid FM.
METHODS: This case–control study was piloted in the Neurology Unit, Department of Medicine in Ibn Sina Teaching Hospital in Mosul, Iraq, between March and November 2020. One hundred consecutive patients with migraine and 100 healthy controls were included in this study. The sociodemographic and headache characteristics of the patients were recorded.
RESULTS: The frequency of FM was statistically higher among participants with migraines (27%) when compared to the controls (5%). Migraine patients with FM had a substantially older mean age and a higher ratio of female gender than migraine patients without FM. FM was found to be more common in patients without versus with aura. Patients with comorbid FM had greater headache frequency (p = 0.0002), headache intensity (p = 0.007), and higher scores on the “Headache Impact Test (HIT-6)” (p = 0.0001).
CONCLUSIONS: There is a high frequency of FM in patients with migraines. Patients with coexistent “FM” and “migraine” tended to have more depressive symptoms, greater headache intensity, headache frequency, and when compared to healthy people, they are more likely to have a significant headache-related disability.
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11
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Gatta G, La Forgia D, Fanizzi A, Massafra R, Somma F, Belfiore MP, Pacella D, Cappabianca S, Salvia AAH. Prevalence of Patients Affected by Fibromyalgia in a Cohort of Women Underwent Mammography Screening. Healthcare (Basel) 2021; 9:1340. [PMID: 34683021 PMCID: PMC8544442 DOI: 10.3390/healthcare9101340] [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: 08/03/2021] [Revised: 09/11/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022] Open
Abstract
Fibromyalgia is a widespread condition which is currently underdiagnosed; therefore we conceived this study in order to assess whether a diagnostic suspicion may be assumed during widespread screening procedures, so that patients for which a reasonable diagnostic suspicion exist may be redirected towards rheumatologic evaluation. We analyzed a sample of 1060 patients, all of whom were female and undergoing standard breast cancer screening procedures, and proceeded to evaluate the level of pain they endured during mammographic exam. We also acquired a range of other information which we related to the level of pain endured; we suggested a rheumatologic examination for those patients who endured the highest level of pain and then we evaluated how many patients in this subgroup were actually diagnosed with fibromyalgia. Out of the 1060 patients who participated to our study, 139 presented level 4 pain intensity; One patient did not go for rheumatologic examination; the remaining 138 underwent rheumatologic evaluation, and 50 (36%, 28-44, 95% CI) were diagnosed with fibromyalgia. Our study shows that assessing the level of pain endured by patients during standard widespread screening procedures may be an effective asset in deciding whether or not to suggest specialist rheumatologic evaluation for fibromyalgia.
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Affiliation(s)
- Gianluca Gatta
- Dipartimento di Medicina di Precisione Università Della Campania “Luigi Vanvitelli”, 80127 Napoli, Italy; (G.G.); (M.P.B.); (S.C.); (A.A.H.S.)
| | - Daniele La Forgia
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Annarita Fanizzi
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Raffaella Massafra
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | | | - Maria Paola Belfiore
- Dipartimento di Medicina di Precisione Università Della Campania “Luigi Vanvitelli”, 80127 Napoli, Italy; (G.G.); (M.P.B.); (S.C.); (A.A.H.S.)
| | - Daniela Pacella
- Dipartimento Sanità Pubblica, Università degli Studi di Napoli “Federico II”, 80127 Napoli, Italy;
| | - Salvatore Cappabianca
- Dipartimento di Medicina di Precisione Università Della Campania “Luigi Vanvitelli”, 80127 Napoli, Italy; (G.G.); (M.P.B.); (S.C.); (A.A.H.S.)
| | - Antonio Alessandro Heliot Salvia
- Dipartimento di Medicina di Precisione Università Della Campania “Luigi Vanvitelli”, 80127 Napoli, Italy; (G.G.); (M.P.B.); (S.C.); (A.A.H.S.)
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12
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Boulis M, Boulis M, Clauw D. Magnesium and Fibromyalgia: A Literature Review. J Prim Care Community Health 2021; 12:21501327211038433. [PMID: 34392734 PMCID: PMC8371721 DOI: 10.1177/21501327211038433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fibromyalgia, a widespread chronic pain disorder, imposes a multitude of
hardships on patients and their communities. Supplements, specifically magnesium
supplements, have been widely used by fibromyalgia patients in an attempt to
control their symptoms. The aim of this work is to investigate if the widespread
use of magnesium in fibromyalgia is supported by evidence in the literature.
This review provides a layout of the studies examining the correlation between
body magnesium levels and fibromyalgia. Furthermore, it elaborates on the trials
testing the effectiveness of magnesium in treating different clinical parameters
of fibromyalgia.
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Affiliation(s)
| | | | - Daniel Clauw
- University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Ozcivit IB, Erel CT, Durmusoglu F. Can fibromyalgia be considered a characteristic symptom of climacterium? Postgrad Med J 2021; 99:postgradmedj-2021-140336. [PMID: 34373344 DOI: 10.1136/postgradmedj-2021-140336] [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: 04/19/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. Currently, studies focus on the similarities of FMS and climacteric syndrome in terms of age of occurrence, epidemiology, etiopathogenesis, symptomatology and treatment. Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.
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Affiliation(s)
- Ipek Betul Ozcivit
- Obstetrics and Gynecology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Turkey
| | - Cemal Tamer Erel
- Obstetrics and Gynecology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Turkey
| | - Fatih Durmusoglu
- Department of Obstetrics and Gynecology, Istanbul Medipol University, Istanbul, Turkey
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14
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Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci 2021; 12:573-580. [PMID: 33538586 PMCID: PMC7874499 DOI: 10.1021/acschemneuro.0c00793] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved. This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases. The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID. Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological
Sciences, Sunway University, Petaling Jaya, Selangor 47500, Malaysia
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15
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Mueller C, Ness TJ, Younger JW. Low-Dose Dextromethorphan for the Treatment of Fibromyalgia Pain: Results from a Longitudinal, Single-Blind, Placebo-Controlled Pilot Trial. J Pain Res 2021; 14:189-200. [PMID: 33542651 PMCID: PMC7851375 DOI: 10.2147/jpr.s285609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Fibromyalgia (FM) is a debilitating chronic pain condition with few treatment options. Central sensitization and neuroinflammation have been forwarded as models of FM pathophysiology, both of which indicate dextromethorphan (DXM) as a potential treatment. DXM is an NMDA-receptor antagonist and microglial modulator with anti-neuroinflammatory properties at low doses. It is available for clinical use but has not been tested as a treatment for FM at low dosages. This study evaluated the effectiveness of DXM in treating FM-associated symptoms. Methods In a single-blind, placebo-controlled trial, 14 women meeting the 2010 American College of Rheumatology criteria for FM received a placebo for five weeks, followed by 20 mg DXM for ten weeks, while providing daily symptom reports on a 0–100 scale. Pain and physical activity were the primary and secondary outcomes, respectively. Daily symptom ratings during the last four weeks of placebo were contrasted with ratings during the last four weeks of the active treatment using generalized estimating equations (GEE). Results DXM was well tolerated, and treatment adherence was high. Baseline pain was reduced by at least 20% in six participants. Self-reported daily pain and physical activity in the entire cohort were not significantly different between the placebo and DXM conditions, and the primary hypotheses were not supported. Exploratory analyses using the entire placebo and DXM data showed that pain was significantly lower in the DXM condition than in the placebo condition (b=−9.933, p=0.013). Discussion A strong clinical effect of DXM was not observed at the 20mg/day dosage.
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Affiliation(s)
- Christina Mueller
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy J Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Jeon Y. Fibromyalgia: practical considerations for oral health care providers. J Dent Anesth Pain Med 2020; 20:263-269. [PMID: 33195804 PMCID: PMC7644357 DOI: 10.17245/jdapm.2020.20.5.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023] Open
Abstract
Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia. This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.
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Affiliation(s)
- Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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17
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Abstract
In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the N-methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. These beneficial effects of magnesium therapy have also been reported in patients with neuropathic pain, such as malignancy-related neurologic symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatment is reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. Although magnesium plays an evolving role in pain management, better understanding of the mechanism underlying its antinociceptive action and additional clinical studies is required to clarify its role as an adjuvant analgesic.
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18
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Littlejohn G, Guymer E. Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia. Biomedicines 2020; 8:biomedicines8070223. [PMID: 32709082 PMCID: PMC7400313 DOI: 10.3390/biomedicines8070223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023] Open
Abstract
The promulgation of the American College of Rheumatology (ACR) 1990 criteria for fibromyalgia (FM) classification has significantly contributed to an era of increased research into mechanisms that underlie the disorder. The previous emphasis on putative peripheral nociceptive mechanisms has advanced to identifying of changes in central neural networks that modulate pain and other sensory processes. The influences of psychosocial factors on the dynamic and complex neurobiological mechanisms involved in the fibromyalgia clinical phenotype are now better defined. This review highlights key milestones that have directed knowledge concerning the fundamental mechanisms contributing to fibromyalgia.
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Affiliation(s)
- Geoffrey Littlejohn
- Departments of Medicine, Monash University, Melbourne 3168, Australia;
- Departments of Rheumatology, Monash Health, Melbourne 3168, Australia
- Correspondence: ; Tel.: +61-3-95942575
| | - Emma Guymer
- Departments of Medicine, Monash University, Melbourne 3168, Australia;
- Departments of Rheumatology, Monash Health, Melbourne 3168, Australia
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19
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Çakit O, Gümüştepe A, Duyur Çakit B, Pervane Vural S, Özgün T, Genç H. Coexistence of fibromyalgia and metabolic syndrome in females: The effects on fatigue, clinical features, pain sensitivity, urinary cortisol and norepinephrine levels: A cross-sectional study. Arch Rheumatol 2020; 36:26-37. [PMID: 34046566 PMCID: PMC8140867 DOI: 10.46497/archrheumatol.2021.7534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives
This study aims to evaluate the coexistence of metabolic syndrome (MetS) and fibromyalgia syndrome (FMS) and determine the effects of this coexistence on neuroendocrine levels and clinical features of FMS. Patients and methods
One-hundred female FMS patients (mean age 40.1±7.8 years; range, 24 to 58 years) and 38 healthy females (mean age 40.4±5.8 years; range, 30 to 55 years) were included in this cross-sectional study. MetS was identified by using the criteria from the Adult Treatment Panel III. Widespread pain index, symptom severity score and number of tender points were determined. Visual analog scale, Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Beck Depression Inventory, and pain pressure threshold were used as the outcome measures. The severity of FMS was assessed with total myalgic score (TMS) and control point score. Results
Twenty-four (24%) of the 100 FMS patients and three (7.9%) of the 38 control patients fulfilled the MetS criteria (p=0.047). The coexistence of FMS and MetS was associated with higher symptom severity score (p=0.004), widespread pain index (p=0.001), number of tender points (p=0.039), and lower total myalgic score (p=0.029) values. There was a significant association between the occurrence of FMS and MetS (odds ratio=3.76; 95% confidence interval: 1.04-13.4; p=0.043). Conclusion We found that patients with FMS had a nearly four times higher risk for MetS and the coexisting MetS may increase the severity of FMS. In clinical practice, when evaluating a patient with FMS, metabolic characteristics should also be evaluated.
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Affiliation(s)
- Onat Çakit
- Department of Family Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alper Gümüştepe
- Department of Physical Medicine and Rehabilitation, Kahramankazan Goverment Hospital, Ankara, Turkey
| | - Burcu Duyur Çakit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Seçil Pervane Vural
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Tuba Özgün
- Department of Biochemistry, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hakan Genç
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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20
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Erdrich S, Hawrelak JA, Myers SP, Harnett JE. Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review. BMC Musculoskelet Disord 2020; 21:181. [PMID: 32192466 PMCID: PMC7083062 DOI: 10.1186/s12891-020-03201-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association between fibromyalgia and irritable bowel syndrome is well-established. Alterations in the composition and diversity of the gut microbiome in irritable bowel syndrome have been reported, however, this association is poorly understood in fibromyalgia. Our aim was to summarise the research reporting on the gastrointestinal microbiome and its biomarkers in people with fibromyalgia. METHODS A systematic review of published original research reporting on the gastrointestinal microbiota and its biomarkers in adults with a diagnosis of fibromyalgia was undertaken. RESULTS From 4771 studies, 11 met our inclusion criteria and were separated into four main groups: papers reporting Helicobacter pylori; other gut bacterial markers; metabolomics and other biomarkers, which included intestinal permeability and small intestinal bacterial overgrowth. CONCLUSION The results suggest there is a paucity of quality research in this area, with indications that the gut microbiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis. Further investigations into the relationship between the gut microbiota, gut dysfunction and fibromyalgia are warranted.
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Affiliation(s)
- Sharon Erdrich
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
| | - Jason A Hawrelak
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen P Myers
- NatMed Research Unit, Division of Research, Southern Cross University, Lismore, New South Wales, Australia
| | - Joanna E Harnett
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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21
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Knisely MR, Conley YP, Smoot B, Paul SM, Levine JD, Miaskowski C. Associations Between Catecholaminergic and Serotonergic Genes and Persistent Arm Pain Severity Following Breast Cancer Surgery. THE JOURNAL OF PAIN 2019; 20:1100-1111. [PMID: 30904518 PMCID: PMC6736756 DOI: 10.1016/j.jpain.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/17/2019] [Accepted: 03/19/2019] [Indexed: 01/09/2023]
Abstract
Persistent arm pain is a common problem after breast cancer surgery. Little is known about genetic factors that contribute to this type of postsurgical pain. Study purpose was to explore associations between persistent arm pain phenotypes and genetic polymorphisms among 15 genes involved in catecholaminergic and serotonergic neurotransmission. Women (n = 398) rated the presence and intensity of arm pain monthly for 6 months after breast cancer surgery. Three distinct latent classes of patients were identified (ie, no arm pain [41.6%], mild arm pain (23.6%), and moderate arm pain (34.8%). Logistic regression analyses were used to evaluate for differences between genotype or haplotype frequencies and the persistent arm pain classes. Compared with the no arm pain class, 3 single nucleotide polymorphisms and 1 haplotype, in 4 genes, were associated with membership in the mild arm pain class: COMT rs4633, HTR2A haplotype B02 (composed of rs1923886 and rs7330636), HTR3A rs1985242, and TH rs2070762. Compared with the no arm pain class, 4 single nucleotide polymorphisms in 3 genes were associated with membership in the moderate arm pain class: COMT rs165656, HTR2A rs2770298 and rs9534511, and HTR3A rs1985242. Findings suggest that variations in catecholaminergic and serotonergic genes play a role in the development of persistent arm pain. PERSPECTIVE: Limited information is available on genetic factors that contribute to persistent arm pain after breast cancer surgery. Genetic polymorphisms in genes involved in catecholaminergic and serotonergic neurotransmission were associated with 2 persistent arm pain phenotypes. Findings may be used to identify patients are higher risk for this common pain condition.
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Affiliation(s)
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Betty Smoot
- Schools of Medicine, University of California, San Francisco, California
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, California
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, California
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22
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Penn IW, Chuang E, Chuang TY, Lin CL, Kao CH. Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ Open 2019; 9:e026581. [PMID: 30962236 PMCID: PMC6500182 DOI: 10.1136/bmjopen-2018-026581] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Fibromyalgia (FM) and migraine are common pain disorders that tend to coexist. This study determined whether these two conditions exhibited any mutual influences. SETTING Cohort study. PARTICIPANTS A retrospective, longitudinal cohort study was conducted using data obtained from a nationwide healthcare database. This study had two arms. Arm 1 comprised 33 216 patients with FM and arm 2 consisted of 7420 patients with migraine; all of these patients were diagnosed between 2000 and 2010. Using the aforementioned database, control subjects who had neither FM nor migraine and were matched with the FM and migraine patients by sex, age and index date of diagnosis were recruited. Each control cohort was four times the size of the corresponding study cohort. Follow-up for the control and study cohorts was conducted until the end of 2011. RESULTS The incidence rates of FM and migraine were calculated in arms 1 and 2, respectively. The overall incidence of migraine was greater in the FM cohort than in the corresponding control cohort (4.39 vs 2.07 per 1000 person-years (PY)); crude HR=2.12, 95% CI=1.96 to 2.30; adjusted HR (aHR)=1.89, 95% CI=1.75 to 2.05). After adjustment for sex, age and comorbidities, the overall incidence of FM in the migraine cohort was 1.57 times greater than that in the corresponding control cohort (7.01 vs 4.49 per 1000 PY; aHR=1.52, 95% CI=1.39 to 1.65). CONCLUSIONS The present study revealed a bidirectional link between FM and migraine.
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Grants
- This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW108-TDU-B-212-133004), China Medical University Hospital (DMR-107-192), Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation o
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Affiliation(s)
- I-Wen Penn
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, FuJen Catholic University Hospital, Fu Jen Catholic University, NewTaipei City, Taiwan
| | - Eric Chuang
- Intended B.S. Molecular and Cell Biology, University of California Berkeley, Berkeley, California, USA
| | - Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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23
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Comparing duloxetine and pregabalin for treatment of pain and depression in women with fibromyalgia: an open-label randomized clinical trial. ACTA ACUST UNITED AC 2019; 27:149-158. [PMID: 30877484 DOI: 10.1007/s40199-019-00257-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Duloxetine and pregabalin are among the most widely used medications in the treatment of patients with fibromyalgia syndrome (FM). OBJECTIVES To add to the very few lines of evidence that exist on the comparative safety and efficacy of these two medications. METHODS In this open-label randomized clinical trial, outpatient women, who were diagnosed with FM based on American College of Rheumatology 2010 criteria, and had an age range of 18-65 years old were assigned to either duloxetine 30-60 mg or pregabalin 75-150 mg per day for 4 weeks. Patients were excluded in cases of having used duloxetine, pregabalin, gabapentin, or antidepressants within 12 weeks prior to the study, having had a history of comorbid medical conditions that could provoke chronic pain, or having had comorbid neuropsychiatric disorders, except for major depressive/anxiety disorders. Primary outcomes were between-group differences in mean score changes from baseline to end point for Widespread Pain Index (WPI) and Beck Depression Inventory-II. Secondary outcomes were the same statistical estimates, but for Fibromyalgia Impact Questionnaire-Revised and 12-Item Short Form Survey. Descriptive statistics and independent samples t-test were the main methods of analysis. ( www.irct.ir ; IRCT2016030626935N1). RESULTS Among all the scales, only WPI scores improved with a statistically significant difference between the two treatment arms, favoring duloxetine (Mean difference in score change - 2.32, 95% CI, -4.46 to - 0.18; p = 0.034; Cohen's d 0.53 95% CI, 0.04 to 1.02). Drop out rate and cumulative incidence of nausea was significantly higher in the duloxetine arm compared to the pregabalin arm. CONCLUSION This study provides further evidence on higher efficacy of duloxetine compared to pregabalin for the treatment of pain in patients with fibromyalgia. Future comprehensive pragmatic clinical trials are warranted.
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24
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Caumo W, Hidalgo MP, Souza A, Torres ILS, Antunes LC. Melatonin is a biomarker of circadian dysregulation and is correlated with major depression and fibromyalgia symptom severity. J Pain Res 2019; 12:545-556. [PMID: 30787633 PMCID: PMC6365222 DOI: 10.2147/jpr.s176857] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective This study compared urinary 6-sulfatoxymelatonin (aMT6s) over 24 hours among fibromyalgia (FM), major depression disorder (MDD), and healthy control (HC) groups, and examined whether rhythm is correlated with depressive symptoms. To answer this question we compared the rhythm of urinary aMT6s secretion among each group in four time series: morning (06:00–12:00 hours), afternoon (12:00–18:00 hours), evening (18:00–24:00 hours), and night (24:00–06:00 hours). In the FM subjects, we assessed if the rhythm of urinary aMT6s secretion is associated with pain severity, sleep quality, number of trigger points (NTPs), and the pain pressure threshold (PPT). Patients and methods We included 54 women, aged 18–60 years with diagnosis of FM (n=18), MDD (n=19), and HC (n =17). The 24-hour urinary aMT6s was evaluated according to four standardized periods. The assessment instruments were the Hamilton Depression Rating Scale (HDRS), Pittsburgh Sleep Quality Index, and Fibromyalgia Impact Questionnaire. Results A generalized estimating equation revealed no difference in the daily load of aMT6s secretion among the three groups (P=0.49). However, at the daily time (06:00–18:00 hours), the load secretion of aMT6s reached 41.54% and 60.71% in the FM and MDD, respectively, as compared to 20.73% in the HC (P<0.05). A higher score in the HDRS was positively correlated with the amount of aMT6s secretion during daytime (06:00–18:00 hours). Also, multivariate linear regression revealed that in FM subjects, the aMT6s secretion during daytime (06:00–18:00 hours) was negatively correlated with the PPTlog (partial η2=0.531, P=0.001). However, it was positively correlated with depressive symptoms (partial η2=0.317, P=0.01); PQSI (partial η2=0.306, P=0.017), and NTPs (partial η2=0.23, P=0.04). Conclusion A more significant load of aMT6s secretion during daytime hours was observed in MDD and FM subjects compared to HC. These findings help to comprehend the biological basis of these disorders and show how disruption in melatonin secretion is positively correlated with clinical symptoms.
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Affiliation(s)
- Wolnei Caumo
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, .,Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil, .,Pain and Anesthesia in Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil,
| | - Maria Paz Hidalgo
- Psychiatry Department, School of Medicine, UFRGS, Porto Alegre, Brazil.,Laboratorio de Cronobiologia e Sono do Hospital de Clinicas de Porto Alegre; Porto Alegre, Brazil
| | - Andressa Souza
- Postgraduate Program in Health and Human Development, La Salle Universitary Center, Canoas, Brazil
| | - Iraci L S Torres
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, .,Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Brazil
| | - Luciana C Antunes
- Centro de Ciências da Saúde - Departamento de Nutrição da Universidade Federal De Santa Catarina, Florianopolis, Brazil
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25
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D’Agnelli S, Arendt-Nielsen L, Gerra MC, Zatorri K, Boggiani L, Baciarello M, Bignami E. Fibromyalgia: Genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers. Mol Pain 2019; 15:1744806918819944. [PMID: 30486733 PMCID: PMC6322092 DOI: 10.1177/1744806918819944] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/03/2018] [Accepted: 11/21/2018] [Indexed: 12/26/2022] Open
Abstract
Fibromyalgia is a disease characterized by chronic widespread pain with additional symptoms, such as joint stiffness, fatigue, sleep disturbance, cognitive dysfunction, and depression. Currently, fibromyalgia diagnosis is based exclusively on a comprehensive clinical assessment, according to 2016 ACR criteria, but validated biological biomarkers associated with fibromyalgia have not yet been identified. Genome-wide association studies investigated genes potentially involved in fibromyalgia pathogenesis highlighting that genetic factors are possibly responsible for up to 50% of the disease susceptibility. Potential candidate genes found associated to fibromyalgia are SLC64A4, TRPV2, MYT1L, and NRXN3. Furthermore, a gene-environmental interaction has been proposed as triggering mechanism, through epigenetic alterations: In particular, fibromyalgia appears to be characterized by a hypomethylated DNA pattern, in genes implicated in stress response, DNA repair, autonomic system response, and subcortical neuronal abnormalities. Differences in the genome-wide expression profile of microRNAs were found among multiple tissues, indicating the involvement of distinct processes in fibromyalgia pathogenesis. Further studies should be dedicated to strength these preliminary findings, in larger multicenter cohorts, to identify reliable directions for biomarker research and clinical practice.
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Affiliation(s)
- Simona D’Agnelli
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Maria C Gerra
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Katia Zatorri
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Boggiani
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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26
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Multanen J, Häkkinen A, Heikkinen P, Kautiainen H, Mustalampi S, Ylinen J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018; 39:405-413. [PMID: 29709070 DOI: 10.1002/bem.22127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/12/2018] [Indexed: 11/09/2022]
Abstract
Low-energy pulsed electromagnetic field (PEMF) therapy has been suggested as a promising therapy to increase microcirculation, which is of great concern in patients with fibromyalgia. This study evaluated the effectiveness of PEMF therapy on the treatment of fibromyalgia. A group of 108 women with fibromyalgia were allocated to a 12-week treatment period with an active Bio-Electro-Magnetic-Energy-Regulation (BEMER) device and a similar treatment period with an inactive device. Each patient received active and sham treatments in a random order. Pain and stiffness were assessed on a visual analog scale (VAS, scale 0-100 mm), and functional status was assessed by the Fibromyalgia Impact Questionnaire (FIQ). Mean VAS pain scores before the active and sham treatment periods were 66 (SD 22) and 63 (SD 22), respectively. After treatment periods, mean VAS pain scores had decreased significantly in active treatment, -12, 95% CI [-18, -6], and in sham treatment, -11, 95% CI [-17, -5]. Similarly, the decrease in stiffness and FIQ index after both treatments was statistically significant. However, per-protocol analysis showed no differences between active and sham treatments at any of the outcomes. This study demonstrated that low-energy PEMF therapy was not efficient in reducing pain and stiffness or in improving functioning in women with fibromyalgia. Bioelectromagnetics. 39:405-413, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pauli Heikkinen
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
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Stehlik R, Ulfberg J, Zou D, Hedner J, Grote L. Morning cortisol and fasting glucose are elevated in women with chronic widespread pain independent of comorbid restless legs syndrome. Scand J Pain 2018; 18:187-194. [DOI: 10.1515/sjpain-2018-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 02/07/2018] [Indexed: 12/19/2022]
Abstract
Abstract
Background and aims:
Chronic widespread pain (CWP) is associated with poor quality of sleep, but the detailed underlying mechanisms are still not fully understood. In this study we investigated the influence of CWP on morning cortisol and fasting glucose concentrations as well as sleep disordered breathing.
Methods:
In this case-control study, subjects with CWP (n=31) and a control group without CWP (n=23) were randomly selected from a population-based cohort of women. Current pain intensity, sleep quality, excessive daytime sleepiness [Epworth sleepiness scale (ESS)], psychiatric comorbidity and occurrence of restless legs syndrome (RLS) were assessed. Overnight polygraphy was applied to quantify sleep apnoea, airflow limitation and attenuations of finger pulse wave amplitude (>50%) as a surrogate marker for increased skin sympathetic activity. Morning cortisol and fasting glucose concentrations were determined. Generalised linear models were used for multivariate analyses.
Results:
CWP was associated with higher cortisol (464±141 vs. 366±111 nmol/L, p=0.011) and fasting glucose (6.0±0.8 vs. 5.4±0.7 mmol/L, p=0.007) compared with controls. The significance remained after adjustment for age, body mass index, RLS and anxiety status (β=122±47 nmol/L and 0.89±0.28 mmol/L, p=0.009 and 0.001, respectively). The duration of flow limitation in sleep was longer (35±22 vs. 21±34 min, p=0.022), and pulse wave attenuation was more frequent (11±8 vs. 6±2 events/h, p=0.048) in CWP subjects compared with controls. RLS was associated with higher ESS independent of CWP (β=3.1±1.3, p=0.018).
Conclusions:
Elevated morning cortisol, impaired fasting glucose concentration and increased skin sympathetic activity during sleep suggested an activated adrenal medullary system in subjects with CWP, which was not influenced by comorbid RLS.
Implications:
CWP is associated with activated stress markers that may deteriorate sleep.
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Affiliation(s)
- Romana Stehlik
- Multidisciplinary Pain Centre , Uppsala University Hospital , S-751 85 Uppsala , Sweden , Phone: +46 767036667
- Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Jan Ulfberg
- Sleep Disorders Center, Capio Health Center , Orebro , Sweden
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
- Sleep Disorders Center , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
- Sleep Disorders Center , Sahlgrenska University Hospital , Gothenburg , Sweden
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28
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Shakiba M, Moazen-Zadeh E, Noorbala AA, Jafarinia M, Divsalar P, Kashani L, Shahmansouri N, Tafakhori A, Bayat H, Akhondzadeh S. Saffron ( Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. AVICENNA JOURNAL OF PHYTOMEDICINE 2018; 8:513-523. [PMID: 30456199 PMCID: PMC6235666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Saffron was found efficient and safe in treatment of neuropsychiatric disorders, in particular depression. We compared the efficacy of saffron with duloxetine in treatment of patients with fibromyalgia. MATERIALS AND METHODS In this double-blind parallel-group clinical trial, outpatients with fibromyalgia were randomized to receive either saffron 15 mg or duloxetine 30 mg starting with 1 capsule per day in the first week followed by 2 capsules per day from week 2 until the end of week 8. Participants were men and women aged 18-60 years diagnosed with fibromyalgia based on the American College of Rheumatology 2010 criteria who also had a pain score≥40 based on visual analogue scale. Participants were excluded in case they had rheumatologic diseases, inflammatory/infectious/autoimmune arthritis, comorbid neuropsychiatric disorders except depressive disorders, pain due to traumatic injuries, drug history of duloxetine or saffron use, current use of psychoactive medications, recent use of muscle relaxants, steroids, opioid analgesics, benzodiazepines, anti-epileptics, or injective analgesics. Primary outcomes included differences in mean score changes from baseline to endpoint between the treatment arms for Hamilton Rating Scale for Depression, Fibromyalgia Impact Questionnaire, and Brief Pain Inventory. RESULTS Socio-demographic characteristics and baseline scores were similarly distributed between the two treatment arms (2n=46). No significant difference was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms (Mean score changes: -4.26 to 2.37; p-values: 0.182-0.900) nor in terms of timetreatment interactions (p-values: 0.209-0.964). CONCLUSIONS Saffron and duloxetine demonstrated comparable efficacy in treatment of fibromyalgia symptoms.
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Affiliation(s)
- Mansoor Shakiba
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran ,Equal first author
| | - Ehsan Moazen-Zadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran ,Equal first author
| | - Ahmad Ali Noorbala
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Jafarinia
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Divsalar
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Kashani
- Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Shahmansouri
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Neurology Ward, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hannaneh Bayat
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran ,Corresponding Author: Tel: +98 21-88281866, Fax: +98 21-55419113,
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Abstract
This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients' lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general.
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30
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Grandhi R, Tavakoli S, Ortega C, Simmonds MJ. A Review of Chronic Pain and Cognitive, Mood, and Motor Dysfunction Following Mild Traumatic Brain Injury: Complex, Comorbid, and/or Overlapping Conditions? Brain Sci 2017; 7:brainsci7120160. [PMID: 29211026 PMCID: PMC5742763 DOI: 10.3390/brainsci7120160] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/25/2017] [Accepted: 12/02/2017] [Indexed: 11/29/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is commonly encountered in clinical practice. While the cognitive ramifications of mTBI are frequently described in the literature, the impact of mTBI on emotional, sensory, and motor function is not as commonly discussed. Chronic pain is a phenomenon more prevalent among patients with mTBI compared to those with moderate or severe traumatic brain injury. Chronic pain can become a primary disorder of the central nervous system (CNS) expressed as widespread pain, and cognitive, mood, and movement dysfunction. Shared mechanisms across chronic pain conditions can account for how pain is generated and maintained in the CNS, irrespective of the underlying structural pathology. Herein, we review the impact of mTBI on cognitive, emotional, sensory, and motor domains, and the role of pain as an important confounding variable in patient recovery and dysfunction following mTBI.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229-3900, USA.
| | - Samon Tavakoli
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229-3900, USA.
| | - Catherine Ortega
- Department of Physical Therapy, University of Texas Health San Antonio, San Antonio, TX 78229, USA.
| | - Maureen J Simmonds
- Department of Physical Therapy, University of Texas Health San Antonio, San Antonio, TX 78229, USA.
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31
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Oezel L, Then H, Jung AL, Jabari S, Bonaterra GA, Wissniowski TT, Önel SF, Ocker M, Thieme K, Kinscherf R, Di Fazio P. Fibromyalgia syndrome: metabolic and autophagic processes in intermittent cold stress mice. Pharmacol Res Perspect 2016; 4:e00248. [PMID: 27713820 PMCID: PMC5045934 DOI: 10.1002/prp2.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and depression. The aim was to analyze potential mitochondrial dysfunction or autophagy in mice after exposure to intermittent cold stress (ICS). Muscle and liver specimens were obtained from 36 mice. Lactate dehydrogenase (LDH) activity was measured. Microtubule-associated protein light chain 3 (MAP1LC3B) and glycogen content were determined histologically; muscle ultrastructure by electron microscopy. Mitochondrial- and autophagy-related markers were analyzed by RT-qPCR and Western blotting. ATP level, cytotoxicity, and caspase 3 activity were measured in murine C2C12 myoblasts after ICS exposure. Coenzyme Q10B (COQ10B) transcript was up-regulated in limb muscle of ICS mice, whereas its protein content was stable. Cytochrome C oxidase 4 (COX4I1) and LDH activity increased in limb muscle of male ICS mice. Glycogen content was lower in muscle and liver tissue of male ICS mice. Electron micrographs of ICS mice specimens showed mitochondrial damage and autophagic vesicles. A significant up-regulation of autophagic transcripts of MAP1LC3B and BECLIN 1 (BECN1) was observed. Map1lc3b protein showed an aggregated distribution in ICS mice and SqSTM1/p62 (p62) protein level was stable. Furthermore, ATP level and caspase activity, detected as apoptotic marker, were significantly lowered after ICS exposure in differentiated C2C12 myoblasts. The present study shows that ICS mice are characterized by mitochondrial dysfunction, autophagic processes, and metabolic alterations. Further investigations could dissect autophagy process in the proposed model and link these mechanisms to potential therapeutic options for fibromyalgia.
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Affiliation(s)
- Lisa Oezel
- Department of Visceral Thoracic and Vascular Surgery Philipps University of Marburg Baldingerstrasse 35043 Marburg Germany
| | - Hanna Then
- Institute of Anatomy and Cell Biology Philipps University of Marburg Robert-Koch-Strasse 8 35032 Marburg Germany
| | - Anna L Jung
- Institute for Lung Research Philipps University of Marburg Baldingerstrasse 35043 Marburg Germany
| | - Samir Jabari
- Institute for Anatomy I University Hospital Erlangen Krankenhausstrasse 9 91054 Erlangen Germany
| | - Gabriel A Bonaterra
- Institute of Anatomy and Cell Biology Philipps University of Marburg Robert-Koch-Strasse 8 35032 Marburg Germany
| | - Thaddeus T Wissniowski
- Department of Gastroenterology and Endocrinology Philipps University of Marburg Baldingerstrasse 35043 Marburg Germany
| | - Susanne F Önel
- Developmental Biology Department of Biology Philipps University of Marburg Karl-von-Frisch-Strasse 8 35043 Marburg Germany
| | - Matthias Ocker
- Experimental Medicine Oncology Bayer Pharma AG Berlin Germany
| | - Kati Thieme
- Institute for Medical Psychology Philipps University of Marburg Karl-von-Frisch-Strasse 4 35032 Marburg Germany
| | - Ralf Kinscherf
- Institute of Anatomy and Cell Biology Philipps University of Marburg Robert-Koch-Strasse 8 35032 Marburg Germany
| | - Pietro Di Fazio
- Department of Visceral Thoracic and Vascular Surgery Philipps University of Marburg Baldingerstrasse 35043 Marburg Germany
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32
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Gracely RH, Schweinhardt P. Programmed symptoms: disparate effects united by purpose. Curr Rheumatol Rev 2016; 11:116-30. [PMID: 26088212 PMCID: PMC4997946 DOI: 10.2174/1573397111666150619095125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/14/2015] [Accepted: 06/17/2015] [Indexed: 01/23/2023]
Abstract
Central sensitivity syndromes (CSS) share features of similar multiple symptoms, virtually unknown mechanisms and lack of effective treatments. The CSS nomenclature was chosen over alternatives because it focused on a putative physiological mechanism of central sensitization common to disorders such as fibromyalgia, irritable bowel syndrome, vulvodynia and temporomandibular disorder. Increasing evidence from multiple biological systems suggests a further development. In this new model central sensitization is part of a ensemble that includes also the symptoms of widespread pain, fatigue, unrefreshing sleep and dyscognition. The main feature is an intrinsic program that produces this ensemble to guide behavior to restore normal function in conditions that threaten survival. The well known “illness response” is a classic example that is triggered in response to the specific threat of viral infection. The major leap for this model in the context of CSS is that the symptom complex is not a reactive result of pathology, but a purposeful feeling state enlisted to combat pathology. Once triggered, this state is produced by potential mechanisms that likely include contributions of the peripheral and central immune systems, as well as stress response systems such as the autonomic system and the hypothalamic–pituitary–adrenal (HPA) axis. These act in concert to alter behavior in a beneficial direction. This concept explains similar symptoms for many triggering conditions, the poorly understood pathology, and the resistance to treatment.
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Affiliation(s)
- Richard H Gracely
- Center for Pain Research and Innovation, Koury Oral Health Sciences, CB #7455, Chapel Hill, NC 27599, USA.
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Effect of Pregabalin on Cardiovascular Responses to Exercise and Postexercise Pain and Fatigue in Fibromyalgia: A Randomized, Double-Blind, Crossover Pilot Study. PAIN RESEARCH AND TREATMENT 2015; 2015:136409. [PMID: 27026828 PMCID: PMC4710099 DOI: 10.1155/2015/136409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
Pregabalin, an approved treatment for fibromyalgia (FM), has been shown to decrease sympathetic nervous system (SNS) activity and inhibit sympathetically maintained pain, but its effects on exercise responses have not been reported. Methods. Using a randomized double-blind crossover design, we assessed the effect of 5 weeks of pregabalin (versus placebo) on acute cardiovascular and subjective responses to moderate exercise in 19 FM patients. Blood pressure (BP), heart rate (HR), and ratings of perceived exertion (RPE) during exercise and ratings of pain, physical fatigue, and mental fatigue before, during, and for 48 hours after exercise were compared in patients on pregabalin versus placebo and also versus 18 healthy controls. Results. On placebo, exercise RPE and BP were significantly higher in FM patients than controls (p < 0.04). Pregabalin responders (n = 12, defined by patient satisfaction and symptom changes) had significantly lower exercise BP, HR, and RPE on pregabalin versus placebo (p < 0.03) and no longer differed from controls (p > 0.26). Cardiovascular responses of nonresponders (n = 7) were not altered by pregabalin. In responders, pregabalin improved ratings of fatigue and pain (p < 0.04), but negative effects on pain and fatigue were seen in nonresponders. Conclusions. These preliminary findings suggest that pregabalin may normalize cardiovascular and subjective responses to exercise in many FM patients.
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34
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Becker S, Ceko M, Louis-Foster M, Elfassy NM, Leyton M, Shir Y, Schweinhardt P. Dopamine and pain sensitivity: neither sulpiride nor acute phenylalanine and tyrosine depletion have effects on thermal pain sensations in healthy volunteers. PLoS One 2013; 8:e80766. [PMID: 24236199 PMCID: PMC3827462 DOI: 10.1371/journal.pone.0080766] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022] Open
Abstract
Based on animal studies and some indirect clinical evidence, dopamine has been suggested to have anti-nociceptive effects. Here, we investigated directly the effects of increased and decreased availability of extracellular dopamine on pain perception in healthy volunteers. In Study 1, participants ingested, in separate sessions, a placebo and a low dose of the centrally acting D2-receptor antagonist sulpiride, intended to increase synaptic dopamine via predominant pre-synaptic blockade. No effects were seen on thermal pain thresholds, tolerance, or temporal summation. Study 2 used the acute phenylalanine and tyrosine depletion (APTD) method to transiently decrease dopamine availability. In one session participants ingested a mixture that depletes the dopamine amino acid precursors, phenylalanine and tyrosine. In the other session they ingested a nutritionally balanced control mixture. APTD led to a small mood-lowering response following aversive thermal stimulation, but had no effects on the perception of cold, warm, or pain stimuli. In both studies the experimental manipulation of dopaminergic neurotransmission was successful as indicated by manipulation checks. The results contradict proposals that dopamine has direct anti-nociceptive effects in acute experimental pain. Based on dopamine's well-known role in reward processing, we hypothesize that also in the context of pain, dopamine acts on stimulus salience and might play a role in the initiation of avoidance behavior rather than having direct antinociceptive effects in acute experimental pain.
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Affiliation(s)
- Susanne Becker
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marta Ceko
- National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mytsumi Louis-Foster
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Nathaniel M. Elfassy
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Marco Leyton
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, Quebec, Canada
| | - Yoram Shir
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Petra Schweinhardt
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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36
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Abstract
Fibromyalgia is a primary brain disorder or a result of peripheral dysfunctions inducing brain alterations, with underlying mechanisms that partially overlap with other painful conditions. Although there are methodologic variations, neuroimaging studies propose neural correlations to clinical findings of abnormal pain modulation in fibromyalgia. Growing evidences of specific differences of brain activations in resting states and pain-evoked conditions confirm clinical hyperalgesia and impaired inhibitory descending systems, and also demonstrate cognitive-affective influences on painful experiences, leading to augmented pain-processing. Functional data of neural activation abnormalities parallel structural findings of gray matter atrophy, alterations of intrinsic connectivity networks, and variations in metabolites levels along multiple pathways. Data from positron-emission tomography, single-photon-emission-computed tomography, blood-oxygen-level-dependent, voxel-based morphometry, diffusion tensor imaging, default mode network analysis, and spectroscopy enable the understanding of fibromyalgia pathophysiology, and favor the future establishment of more tailored treatments.
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Affiliation(s)
- Liliana Lourenço Jorge
- Hospital Israelita Albert Einstein and Instituto de Reabilitação Lucy Montoro, Avenida Albert Einstein, 627 3rd Floor Block D, 05651901, Morumbi, Sao Paulo, Brazil.
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Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K, Vallejo MS. Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women. Maturitas 2013; 75:94-100. [DOI: 10.1016/j.maturitas.2013.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 01/01/2023]
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Lorduy KM, Liegey-Dougall A, Haggard R, Sanders CN, Gatchel RJ. The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Pract 2013; 13:604-13. [PMID: 23336585 DOI: 10.1111/papr.12029] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/27/2012] [Accepted: 11/16/2012] [Indexed: 01/01/2023]
Abstract
AIMS Symptoms of central sensitization syndrome (CSS) were evaluated among three different groups of temporomandibular disorder (TMD) patients. Additionally, TMD group differences in pain and pain-related disability were assessed, as well as emotional distress. METHODS Participants were 250 patients with symptoms of acute TMD, recruited from dental clinics within a major metropolitan area. Sequential regressions and multivariate analyses of covariance were conducted in order to make group comparisons. RESULTS Those with a TMD Muscle Disorder (ie, myofacial TMD [m-TMD]) and those with more than one TMD diagnosis had the most symptoms of CSS and higher reports of pain and pain-related disability. Moreover, emotional distress accounted for a substantial amount of the variance for physical symptoms and mediated all TMD comparisons. CONCLUSIONS Myofacial TMD is characterized by a high degree of comorbidity of symptoms of CSS and associated emotional distress.
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Affiliation(s)
- Kara M Lorduy
- Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, Texas, U.S.A
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Is fibromyalgia part of the climacteric syndrome? Maturitas 2012; 73:87-93. [DOI: 10.1016/j.maturitas.2012.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/04/2012] [Indexed: 11/20/2022]
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