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Rivera FA, Munipalli B, Allman ME, Hodge DO, Wieczorek MA, Wang B, Abril A, Perlman A, Knight D, Bruce B. A retrospective analysis of the prevalence and impact of associated comorbidities on fibromyalgia outcomes in a tertiary care center. Front Med (Lausanne) 2024; 10:1301944. [PMID: 38288305 PMCID: PMC10824271 DOI: 10.3389/fmed.2023.1301944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Background This retrospective study was designed to analyze the prevalence and impact of associated comorbidities on fibromyalgia (FM) outcomes (functionality, pain, depression levels) for patients who participated in an intensive multicomponent clinical program in a tertiary care center. Methods Participants included a sample of 411 patients diagnosed with FM at a large tertiary medical center using the 2016 ACR criteria. Patients completed an intensive 2-day cognitive behavioral treatment (CBT) program, filled out the Fibromyalgia Impact Questionnaire Revised (FIQR), the Center for Epidemiologic Studies Depression Scale (CES-D), the Pain Catastrophizing Scale (PCS), and were followed for 6 months after treatment completion. T-tests were performed to analyze differences between the presence or absence of select comorbidities for the three outcomes at follow-up. Statistically significant comorbidities (p < 0.05) were used as predictors in multivariable logistic regression models. Results The FM associated comorbidities in this cohort that had significant impact on the measured outcome domains after treatment program completed were Obesity (FIQR p = 0.024), Hypothyroidism (CES-D p = 0.023, PCS p = 0.035), Gastroesophageal reflux disease GERD (PCS p < 0.001), Osteoarthritis (CES-D p = 0.047). Interestingly, Headache, the most frequent FM associated comorbidity in this cohort (33.6%), did not have a significant impact on the outcome domains at follow-up. Obesity (18.2%) was the only FM associated comorbidity significantly impacting all three outcome domains at follow-up. Conclusion The present study suggests that addressing obesity may significantly impact outcomes in FM patients.
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Affiliation(s)
- Fernando A. Rivera
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Bala Munipalli
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Mikolaj A. Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Benjamin Wang
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, United States
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, United States
| | - Adam Perlman
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Dacre Knight
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Barbara Bruce
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
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2
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Hazrati E, Eftekhar SP, Mosaed R, Shiralizadeh Dini S, Namazi M. Understanding the kynurenine pathway: A narrative review on its impact across chronic pain conditions. Mol Pain 2024; 20:17448069241275097. [PMID: 39093627 PMCID: PMC11331475 DOI: 10.1177/17448069241275097] [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: 05/07/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
Chronic pain is a debilitating symptom with a significant negative impact on the quality of life and socioeconomic status, particularly among adults and the elderly. Major Depressive Disorder (MDD) stands out as one of the most important comorbid disorders accompanying chronic pain. The kynurenine pathway serves as the primary route for tryptophan degradation and holds critical significance in various biological processes, including the regulation of neurotransmitters, immune responses, cancer development, metabolism, and inflammation. This review encompasses key research studies related to the kynurenine pathway in the context of headache, neuropathic pain, gastrointestinal disorders, fibromyalgia, chronic fatigue syndrome, and MDD. Various metabolites produced in the kynurenine pathway, such as kynurenic acid and quinolinic acid, exhibit neuroprotective and neurotoxic effects, respectively. Recent studies have highlighted the significant involvement of kynurenine and its metabolites in the pathophysiology of pain. Moreover, pharmacological interventions targeting the regulation of the kynurenine pathway have shown therapeutic promise in pain management. Understanding the underlying mechanisms of this pathway presents an opportunity for developing personalized, innovative, and non-opioid approaches to pain treatment. Therefore, this narrative review explores the role of the kynurenine pathway in various chronic pain disorders and its association with depression and chronic pain.
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Affiliation(s)
- Ebrahim Hazrati
- Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Seyed Parsa Eftekhar
- Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Mosaed
- Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran
| | | | - Mehrshad Namazi
- Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran
- Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran
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3
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Analysis of malingered psychological symptoms in a clinical sample for early detection in initial interviews. Eur Arch Psychiatry Clin Neurosci 2022; 273:427-438. [PMID: 35587278 PMCID: PMC10070281 DOI: 10.1007/s00406-022-01422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
Malingering consists of the production of false physical or psychological symptoms motivated by external incentives that are normally reproduced in pathologies that are not related to organic origin or there are no laboratory tests for their diagnosis, as is the case of mixed anxiety-depressive disorder and fibromyalgia syndrome. The objective of this research consisted of comparing the profile of simulative patients with fibromyalgia and mixed anxiety-depressive disorder to obtain a profile and facilitate its detection in initial interviews. The research was carried out with 78 patients (42 patients with fibromyalgia and 36 patients with mixed anxiety-depressive disorder) who were administered the professional's structured clinical judgment, the Beck Depression Inventory, the State-Trait Anxiety Questionnaire, and the Structured Symptom Simulation Inventory. The main obtained results show that the simulation classification proposed by the questionnaire is in the range of 66.67-80% with regard to coinciding with the judgment of experts, and people with suspicion of simulation of both groups of patients present similar characteristics. The simulators thus present incongruous responses in relation to the questionnaires, and high levels of trait anxiety, state, and depression predict the simulation of symptoms.
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4
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Zahid M, Unal E, Özdemir Işık Ö, Oksuz S, Karakaya J, Erguney Cefle A. The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire for patients with fibromyalgia. Int J Rheum Dis 2022; 25:685-691. [PMID: 35505570 DOI: 10.1111/1756-185x.14325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 01/03/2023]
Abstract
AIM Although the importance of biopsychosocial models for chronic diseases is emphasized nowadays, the lack of assessment tools to meet this need draws attention. This study was planned to assess the validity, reliability, and responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in patients with fibromyalgia. METHOD Hospital Anxiety and Depression Scale (HADS), Mindful Attention Awareness Scale, Health Assessment Questionnaire, the Fibromyalgia Impact Questionnaire, and Short-Form 36 (SF-36) were used for the validity of BETY-BQ. For the reliability study, evaluations were repeated at 1-week intervals and for the responsiveness, the same scales were applied to patients under medical treatment at 3-month intervals. RESULTS The correlations of BETY-BQ with the other scales were found to be moderate to high (respectively r = .591, P < .001 and r = .441, P < .001; r = -.419, P < .001; r = .617, P < .001; r = .722, P < .001; r = -.580 and -.374, P = .001 and P < .001) and with SF-36 sub-parameters were found to be weak-moderate. The test-retest method was used for reliability, and the correlation between the responses was very high (r = .901, P < .001). The intraclass correlation coefficient (ICC) was found to be high (ICC = 0.899, P < .001). Cronbach's alpha (α) value was found to be .947. In the correlation analysis of time-dependent changes, BETY-BQ correlated weakly with other scales and moderately correlated with HADS (HADS-anxiety r = .489, P = .006, HADS-depression r = .500, P = .005). CONCLUSIONS BETY-BQ was presented in the literature as a valid, reliable, and sensitive scale that can be used both in the biopsychosocial evaluation and as an easily understood, practical scale that can be answered in a short time in the practices of healthcare professionals.
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Affiliation(s)
| | - Edibe Unal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özlem Özdemir Işık
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | - Sevim Oksuz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayse Erguney Cefle
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
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5
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Rivera Redondo J, Díaz Del Campo Fontecha P, Alegre de Miquel C, Almirall Bernabé M, Casanueva Fernández B, Castillo Ojeda C, Collado Cruz A, Montesó-Curto P, Palao Tarrero Á, Trillo Calvo E, Vallejo Pareja MÁ, Brito García N, Merino Argumánez C, Plana Farras MN. Recommendations by the Spanish Society of Rheumatology on the management of patients with fibromyalgia. Part II. REUMATOLOGIA CLINICA 2022; 18:260-265. [PMID: 34538611 DOI: 10.1016/j.reumae.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of "formal assessment" or "reasoned judgement". RESULTS Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This part II shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.
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Affiliation(s)
- Javier Rivera Redondo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | | | | | | | - Pilar Montesó-Curto
- Departamento y Facultad de Enfermería, Universitat Rovira i Virgili, Campus Terres de l'Ebre, Tortosa, Tarragona, Spain
| | | | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain
| | - Miguel Ángel Vallejo Pareja
- Departamento de Psicología Clínica, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - M Nieves Plana Farras
- Hospital Príncipe de Asturias, CIBER de Epidemiología y Salud Pública, Meco, Madrid, Spain
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6
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Häuser W, Fisher E, Perrot S, Moore RA, Makri S, Bidonde J. Non-pharmacological interventions for fibromyalgia (fibromyalgia syndrome) in adults: an overview of Cochrane Reviews. Hippokratia 2022. [DOI: 10.1002/14651858.cd015074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | | | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
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7
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Vidal LF, Messina O, Rodríguez T, Vidal M, Pineda C, Morales R, Collado A. Refractory fibromyalgia. Clin Rheumatol 2021; 40:3853-3858. [PMID: 34169373 DOI: 10.1007/s10067-021-05818-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022]
Abstract
In the medical literature, there are only a few references on refractory fibromyalgia and there is no consensus definition available on this concept. Some definitions of refractory fibromyalgia have been proposed based on the lack of response to a number of medications, and perhaps the most appropriate term is treatment-refractory fibromyalgia. To achieve the definition of treatment-refractory fibromyalgia, it is necessary to consider several previous steps, such as making sure the diagnosis has been made properly and a differential diagnosis with entities that can mimic fibromyalgia symptoms (including complete physical examination and laboratory test) has been made. The possibility that another factor that alters the response to treatment should be investigated, and in particular review all prescribed medication and search for some non-medical reasons that could mask the response to treatment (e.g., legal compensation). The definition of refractory fibromyalgia is complex and probably should include a lack of response to a specified number of drugs or to combination therapy with at least two non-pharmacological measures. In this article, it is not our purpose to present a formal definition, but to raise the possible bases for this purpose. We believe that it is a subject that must be discussed extensively before reaching a consensus definition. Key Points • There is no appropriate definition to classify fibromyalgia patients who do not respond to the usual pharmacological and non-pharmacological measures according to the national or international guidelines. • A consensus definition is required to classify these patients, which could help standardize future management strategies. In this article, we propose the bases on which refractory fibromyalgia could be defined.
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Affiliation(s)
- Luis F Vidal
- Centro de Diagnóstico de Osteoporosis y Enfermedades Reumáticas (CEDOR), Lima, Perú.,Servicio de Reumatología, Hospital Nacional María Auxiliadora, Lima, Perú
| | - Osvaldo Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Buenos Aires, Argentina.,Servicio de Reumatología, Hospital Argerich, Buenos Aires, Argentina
| | | | - Maritza Vidal
- Centro de Diagnóstico de Osteoporosis y Enfermedades Reumáticas (CEDOR), Lima, Perú.
| | - Carlos Pineda
- División de Enfermedades Musculoesqueléticas y Reumáticas, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, México
| | - Rasec Morales
- Servicio de Reumatología, Hospital Nacional María Auxiliadora, Lima, Perú
| | - Antonio Collado
- Servicio de Reumatología, Hospital Clinic, Barcelona, España.,Fibromyalgia Unit Coordinator, Hospital Clinic, Barcelona, España
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8
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Chaves C, Bittencourt PCT, Pelegrini A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. PAIN MEDICINE 2021; 21:2212-2218. [PMID: 33118602 PMCID: PMC7593796 DOI: 10.1093/pm/pnaa303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective To determine the benefit of a tetrahydrocannabinol (THC)-rich cannabis oil on symptoms and quality of life of fibromyalgia patients. Methods A double-blind, randomized, placebo-controlled clinical trial was conducted for eight weeks to determine the benefit of a THC-rich cannabis oil (24.44 mg/mL of THC and 0.51 mg/mL of cannabidiol [CBD]) on symptoms and quality of life of 17 women with fibromyalgia, residents of a neighborhood with a low socioeconomic profile and a high incidence of violence in the city of Florianopolis, Brazil. The initial dose was one drop (∼1.22 mg of THC and 0.02 mg of CBD) a day with subsequent increases according to symptoms. The Fibromyalgia Impact Questionnaire (FIQ) was applied at pre- and postintervention moments and in five visits over eight weeks. Results There were no significant differences on baseline FIQ score between groups. However, after the intervention, the cannabis group presented a significant decrease in FIQ score in comparison with the placebo group (P = 0.005) and in comparison with cannabis group baseline score. (P < 0.001). Analyzing isolated items on the FIQ, the cannabis group presented significant improvement on the “feel good,” “pain,” “do work,” and “fatigue” scores. The placebo group presented significant improvement on the “depression” score after intervention. There were no intolerable adverse effects. Conclusions Phytocannabinoids can be a low-cost and well-tolerated therapy to reduce symptoms and increase the quality of life of patients with fibromyalgia. Future studies are still needed to assess long-term benefits, and studies with different varieties of cannabinoids associated with a washout period must be done to enhance our knowledge of cannabis action in this health condition.
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Affiliation(s)
- Carolina Chaves
- Public Health School, Municipal Health Secretary, Florianopolis, Brazil
| | | | - Andreia Pelegrini
- Department of Physical Education, Santa Catarina State University, Florianopolis, Brazil
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9
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Rivera Redondo J, Díaz Del Campo Fontecha P, Alegre de Miquel C, Almirall Bernabé M, Casanueva Fernández B, Castillo Ojeda C, Collado Cruz A, Montesó-Curto P, Palao Tarrero Á, Trillo Calvo E, Vallejo Pareja MÁ, Brito García N, Merino Argumánez C, Plana Farras MN. Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00063-2. [PMID: 33933369 DOI: 10.1016/j.reuma.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment» or «reasoned judgement». RESULTS Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.
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Affiliation(s)
- Javier Rivera Redondo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | | | | | | | | | | - Pilar Montesó-Curto
- Departamento y Facultad de Enfermería, Universitat Rovira i Virgili, Campus Terres de l'Ebre, Tortosa, Tarragona, España
| | | | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, España
| | - Miguel Ángel Vallejo Pareja
- Departamento de Psicología Clínica, Facultad de Psicología. Universidad Nacional de Educación a Distancia (UNED), Madrid, España
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - M Nieves Plana Farras
- Hospital Príncipe de Asturias, CIBER de Epidemiología y Salud Pública, Meco, Madrida, España
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10
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Pallanti S, Porta F, Salerno L. Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities. J Psychiatr Res 2021; 136:537-542. [PMID: 33127072 DOI: 10.1016/j.jpsychires.2020.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
In the broader list of cognitive concerns, neuropsychological testing has shown that attentional impairment may have a specific burden in Fibromyalgia Syndrome (FMS). Preliminary observations have reported a subset of FMS patient screened for attention disorders fulfilling the actual diagnosis of ADHD, a neurodevelopmental disorder characterized by developmentally inadequate levels of inattention, hyperactivity and impulsivity that might persist in adulthood. Yet, no study to date has systematically examined the history and the specific contribution of ADHD to FMS in terms of clinical impact and related specific disabilities. In this study, 106 individuals with a FMS diagnosis based on the 2010 criteria of the American College of Rheumatology have been assessed for (a) the presence of ADHD; (b) the burden of disability caused by ADHD versus FMS; (c) the presence of other psychiatric disorders. Results indicated that ADHD was present in 24.5% of FMS individuals, it was associated with higher FMS symptoms severity and a greater functional impairment, particularly in the work/school domain. Moreover, patients with both FMS and ADHD had higher frequency of substance use disorders than those with FMS only (38.5% versus 3.8%) and mainly opioids. Overall, results suggest that ADHD can increase burden adding specific disability in work and social activities, and it is associated with a trend for the excessive use of opioid painkillers. Detection of neurodevelopmental and actual symptoms of ADHD is highly recommended especially in patient prone to increase the dose of anti-pain medication.
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Affiliation(s)
- Stefano Pallanti
- INS, Istituto di Neuroscienze, Florence, Italy; Albert Einstein College of Medicine (New York), Department of Psychiatry and Behavioral Sciences, USA
| | - Francesco Porta
- INS, Istituto di Neuroscienze, Florence, Italy; MedCare, Pistoia, Italy
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11
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Popkirov S, Enax-Krumova EK, Mainka T, Hoheisel M, Hausteiner-Wiehle C. Functional pain disorders - more than nociplastic pain. NeuroRehabilitation 2021; 47:343-353. [PMID: 32986624 DOI: 10.3233/nre-208007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE To summarize the current understanding of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS This was a narrative literature review. RESULTS Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | | | - Constanze Hausteiner-Wiehle
- Neurocenter, BG Trauma Center Murnau, Murnau, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
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12
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Hackshaw KV. The Search for Biomarkers in Fibromyalgia. Diagnostics (Basel) 2021; 11:diagnostics11020156. [PMID: 33494476 PMCID: PMC7911687 DOI: 10.3390/diagnostics11020156] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
Fibromyalgia is the most common of the central sensitivity syndromes affecting 2–5% of the adult population in the United States. This pain amplification syndrome has enormous societal impact as measured by work absenteeism, decreased work productivity, disability and injury compensation and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook and redirect valuable healthcare resources towards more appropriate targeted therapy. Efforts have been made towards improving diagnostic accuracy through updated criteria. The search for biomarkers for diagnosis and verification of Fibromyalgia is an ongoing process. Inadequacies with current diagnostic criteria for this condition have fueled these efforts for identification of a reproducible marker that can verify this disease in a highly sensitive, specific and reproducible manner. This review focuses on areas of research for biomarkers in fibromyalgia and suggests that future efforts might benefit from approaches that utilize arrays of biomarkers to identify this disorder that presents with a diverse clinical phenotype.
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Affiliation(s)
- Kevin V Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School at the University of Texas at Austin, 1601 Trinity St, Austin, TX 78712, USA
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13
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Hackshaw K. Assessing our approach to diagnosing Fibromyalgia. Expert Rev Mol Diagn 2020; 20:1171-1181. [PMID: 33301346 DOI: 10.1080/14737159.2020.1858054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022]
Abstract
Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2-5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria. Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature. Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.
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Affiliation(s)
- Kevin Hackshaw
- Division Chief of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Dell Medical School, the University of Texas , Austin, TX, USA
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Rulleau T, Planche L, Etcheverrigaray F, Dorion A, Kacki N, Miot M, Liaigre A, Ganem Y, Schmidt A, Taddéi F, Acapo S, Nizard J, Pluchon YM. Comparison of patient-led, fibromyalgia-orientated physical activity and a non-specific, standardised 6-month physical activity program on quality of life in individuals with fibromyalgia: a protocol for a randomised controlled trial. Trials 2020; 21:800. [PMID: 32943085 PMCID: PMC7499844 DOI: 10.1186/s13063-020-04730-3] [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: 03/27/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Exercise has been shown to significantly improve pain and function in individuals with fibromyalgia. Research into the effectiveness of exercise is often based on standardised exercise programmes that are chosen by the investigating clinical research team. However, such programmes may not necessarily be appealing to the participating patients. Furthermore, in addition to being taught exercises, patients with chronic conditions like fibromyalgia also need to learn to manage their condition themselves and so be actively involved in their treatment. The primary aim of this study is to compare the effects of two, 6-month physical activity programs on quality of life in patients with fibromyalgia. One group followed a patient-led, fibromyalgia-orientated programme (experimental) whilst the control group followed a standard, general exercise programme. Methods This protocol is an open-label, two-centre, randomised, controlled superiority trial. Two treatment arms will be compared: an experimental group (patient-led, fibromyalgia-orientated exercise) and a control group (general exercise program). The control group will participate in the exercise programme currently provided in our centre, which involves general, group exercise for patients with various pathologies. The experimental group will be taught the principles of exercise specifically for fibromyalgia during a one-to-one coaching session. They will then be guided in the choice of one or several types of exercise that they enjoy. They will be instructed to perform the exercise according to the recommendations for exercise in fibromyalgia with regard to intensity, duration and frequency. The protocol will last for 6 months; participants will then be followed-up for a further 6 months. They will also be encouraged to continue exercising after the end of the protocol. Outcomes will be evaluated at baseline, 6 and 12 months. The primary outcome will be quality of life (Fibromyalgia Impact Questionnaire) and the secondary outcomes will include measures of pain (including a visual analogue scale and the neuropathic characteristics of the pain), depression (Hospital Anxiety and Depression Scale), kinesiophobia (Tampa scale of kinesiophobia) and adherence (Polar OH1 heart rate monitor). Discussion The results of this study will show if patient-led, fibromyalgia-orientated exercise is more effective than a general exercise programme on fibromyalgia-related outcomes, including quality of life, and on adherence to continued exercise. Trial registration ClinicalTrials.gov NCT03895086. Registration no. 2018-A02881-54. Registered on 29 March 2019
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Affiliation(s)
- T Rulleau
- Unité de Recherche Clinique, CHD-Vendée, La Roche-sur-Yon, France.
| | - L Planche
- Unité de Recherche Clinique, CHD-Vendée, La Roche-sur-Yon, France
| | | | - A Dorion
- Unité de Recherche Clinique, CHD-Vendée, La Roche-sur-Yon, France
| | - N Kacki
- Unité de Recherche Clinique, CHD-Vendée, La Roche-sur-Yon, France
| | - M Miot
- Groupe Associatif Siel Bleu, Strasbourg, France
| | - A Liaigre
- Groupe Associatif Siel Bleu, Strasbourg, France
| | - Y Ganem
- Centre d'Etude et de Traitement de la Douleur, CHD-Vendée, La Roche-sur-Yon, France
| | - A Schmidt
- Centre d'Etude et de Traitement de la Douleur, CHD-Vendée, La Roche-sur-Yon, France
| | - F Taddéi
- Centre d'Etude et de Traitement de la Douleur, CHD-Vendée, La Roche-sur-Yon, France
| | - S Acapo
- Laboratoire Thérapeutique EA 3826, CHU Nantes et cabinet de kinésithérapie, 5 rue Nina Simone, 44000, Nantes, France
| | - J Nizard
- Service Douleur Soins Palliatifs et de Support, Médecine intégrative, Unité de Recherche Clinique Douleur et Neurochirurgie, CHU Nantes, et UMR INSERM SPHERE, Nantes, France
| | - Y M Pluchon
- Centre d'Etude et de Traitement de la Douleur, CHD-Vendée, La Roche-sur-Yon, France
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Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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16
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Vijayan BV, Nair VCP, M G. Burden of Illness Due to Fibromyalgia in a Neurology Clinic. J Neurosci Rural Pract 2020; 11:411-415. [PMID: 32753805 PMCID: PMC7394628 DOI: 10.1055/s-0040-1712586] [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: 11/02/2022] Open
Abstract
Background Fibromyalgia (FM) is a common disorder in general population and it causes an increased patient load in hospitals and specialty clinics. FM attendance will be high in clinics dealing with neuropathic pain and other pain syndromes. Though prevalence of FM has been studied in community and pain clinics in other countries, it has not so far been studied in India. So, a study is relevant and hence it was planned in neurology clinic of a teaching government hospital. At present, they are treated mainly by nonsteroidal anti-inflammatory drugs (NSAIDs) which are public health hazard. Methods Using 2016 revision of 2010/2011 American College of Rheumatology criteria of FM, patients were screened in neurology OPD. Proportion and clinical profile were noted. Study was continued for 6 months till the sample size was met. Results A total of 2,300 patients were screened. Two hundred and ninety-eight FM patients were identified among them. Proportion was 12.96%. Delayed diagnosis of more than a year occurred in 55%. Only 29.2% were treated, but none was offered cognitive behavioral therapy (CBT) before. NSAIDs for pain were given for 51.01%. Conclusion Proportion of FM detected is considerable. Affection of homemakers and manual laborers, delayed diagnosis, coexisting comorbid illness, and treatment of pain with NSAIDs are causes of concern. Clinicians should be sensitized to clinical profile and criteria of FM. Patients should be diagnosed and treated by CBT at the earliest and NSAIDs should be avoided as far as possible.
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Affiliation(s)
| | | | - Geethadevi M
- Department of Community Medicine, Government Medical College Hospital, Kottayam, Kerala, India
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17
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Üçüncü MZ, Çoruh Akyol B, Toprak D. The early diagnosis of fibromyalgia in irritable bowel syndrome patients. Med Hypotheses 2020; 143:110119. [PMID: 32721811 DOI: 10.1016/j.mehy.2020.110119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS) is a common disorder worldwide, but the diagnosis is often overlooked. This study aimed to evaluate the sociodemographic characteristics of IBS patients and the relationship between IBS and fibromyalgia. 202 patients with gastrointestinal system complaints who were admitted to Sisli Hamidiye Etfal Trainnig and Research Hospital, Family Medicine Clinic were included in the study. P < 0.05 was considered statistically significant. Fibromyalgia was associated with IBS in 26.7% of the participants. There was a positive correlation between the incidence of fibromyalgia and use of medication due to IBS, change in stool frequency, generalized pain, frequent illness, headache, excessive stress cancer anxiety , workforce loss due to IBS symptoms and fibromyalgia (p < 0.05). The presence of generalized pain, among IBS symptoms, caused the most robust increase in the likelihood of fibromyalgia (80%). The symptoms which were increasing the possibility of fibromyalgia were mostly generalized pain, high WHOQOL total score, family history of cancer, and loss of workforce at admission. IBS is a condition that affects the daily life quality of individuals and is often a condition that can be confused or associated with other diseases. Primary care physicians should approach patients holistically, especially in patients with generalized pain, family history of cancer, loss of workforce at admission, and more careful about fibromyalgia in patients with high WHOQOL total score. This awareness will increase the chances of early diagnosis and treatment of patients and will provide less cost but more effective treatment.
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Affiliation(s)
| | | | - Dilek Toprak
- Department of Family Physician, Tekirdağ Namık Kemal University, Medicine Faculty, Tekirdağ, Turkey
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Climent‐Sanz C, Gea‐Sánchez M, Moreno‐Casbas MT, Blanco‐Blanco J, García‐Martínez E, Valenzuela‐Pascual F. A web‐based therapeutic patient education intervention for pain and sleep for women with fibromyalgia: A sequential exploratory mixed‐methods research protocol. J Adv Nurs 2020; 76:1425-1435. [DOI: 10.1111/jan.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Carolina Climent‐Sanz
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Montserrat Gea‐Sánchez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - María T. Moreno‐Casbas
- Instituto de Salud Carlos III Nursing and Healthcare Research Unit (Investen‐isciii) Madrid Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid Spain
| | - Joan Blanco‐Blanco
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Ester García‐Martínez
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
| | - Fran Valenzuela‐Pascual
- Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura GESEC Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Grup de Recerca de Cures en Salut GRECS Institut de Recerca Biomèdica Lleida Spain
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19
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Fibromyalgia frequency and course in renal transplantation patients. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.557096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Barjandi G, Louca Jounger S, Löfgren M, Bileviciute‐Ljungar I, Kosek E, Ernberg M. Plasma tryptophan and kynurenine in females with temporomandibular disorders and fibromyalgia—An exploratory pilot study. J Oral Rehabil 2019; 47:150-157. [DOI: 10.1111/joor.12892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Golnaz Barjandi
- Department of Dental Medicine Karolinska Institutet & Scandinavian Center for Oral Neurosciences Huddinge Sweden
| | - Sofia Louca Jounger
- Department of Dental Medicine Karolinska Institutet & Scandinavian Center for Oral Neurosciences Huddinge Sweden
| | - Monika Löfgren
- Department of Clinical Sciences Karolinska Institutet Stockholm Sweden
- Department of Rehabilitation Medicine Danderyd Hospital Stockholm Sweden
| | - Indre Bileviciute‐Ljungar
- Department of Clinical Sciences Karolinska Institutet Stockholm Sweden
- Department of Rehabilitation Medicine Danderyd Hospital Stockholm Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Neuroradiology Karolinska University Hospital Stockholm Sweden
| | - Malin Ernberg
- Department of Dental Medicine Karolinska Institutet & Scandinavian Center for Oral Neurosciences Huddinge Sweden
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21
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Stewart JA, Mailler-Burch S, Müller D, Studer M, von Känel R, grosse Holtforth M, Schwegler K, Egloff N. Rethinking the criteria for fibromyalgia in 2019: the ABC indicators. J Pain Res 2019; 12:2115-2124. [PMID: 31372029 PMCID: PMC6630090 DOI: 10.2147/jpr.s205299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/16/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress. PATIENTS AND METHODS We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated. RESULTS The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28). CONCLUSION The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.
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Affiliation(s)
- Julian A Stewart
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Mailler-Burch
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darius Müller
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martina Studer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland von Känel
- Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin grosse Holtforth
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Kyrill Schwegler
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niklaus Egloff
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland
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Le Fur Bonnabesse A, Cabon M, L’Heveder G, Kermarrec A, Quinio B, Woda A, Marchand S, Dubois A, Giroux-Metges MA, Rannou F, Misery L, Bodéré C. Impact of a specific training programme on the neuromodulation of pain in female patient with fibromyalgia (DouFiSport): a 24-month, controlled, randomised, double-blind protocol. BMJ Open 2019; 9:e023742. [PMID: 30782715 PMCID: PMC6352822 DOI: 10.1136/bmjopen-2018-023742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The main symptom of fibromyalgia (FM) is diffuse pain. There is currently no aetiological treatment for FM. However, all pain associations and best practice guidelines strongly advocate the practice of aerobic physical activity to improve the symptoms of FM subjects. The mechanisms of dysfunctional pain are mostly central and related to stress axis dysfunction (autonomic nervous system and corticotropic axis). Our main objective is to assess the efficacy of a specific training programme on endogenous pain control mechanisms in female patients with FM. Further aims include rebalancing the autonomic neurovegetative system, improving quality of life and sleep quality, and reintegrating patients into society and work. METHODS AND ANALYSIS 110 female patients with FM diagnosed on American College of Rheumatology 2010 criteria, aged 18-65 years and meeting inclusion conditions will be recruited and randomised into two groups (active and semiactive). The training programme will consist of three 45 min sessions per week of supervised, individualised physical activity over 2 years. Only the intensity of the exercises will differ between the two groups (moderate intensity vs low intensity).All outcome measures will be conducted at baseline (T0), after 6-9 months of training (T6-9) and after 24 months of training (T24). The primary endpoint will be an improvement of pain modulation (activation of diffuse noxious inhibitory control) evaluated by the stimulation test. The secondary endpoint will be relief of pain, anxiety, depression, stress, sleep disorders, pain impact on life quality, and improved heart rate, blood pressure and salivary cortisol. ETHICS AND DISSEMINATION This study is approved by the Committee for the Protection of Persons West VI. The results will be published in specialised scientific journals and will be presented at scientific meetings on pain and/or physical activity. TRIAL REGISTRATION NUMBER NCT02486965; Pre-results.
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Affiliation(s)
- Anais Le Fur Bonnabesse
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
| | - Mathilde Cabon
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Gildas L’Heveder
- Neurological Functional Explorations, University Hospital of Brest, Brest, France
| | - Aurélie Kermarrec
- Physiotherapy Training Institute, University Hospital of Brest, Brest, France
| | - Bertrand Quinio
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
| | - Alain Woda
- Odontology Department, University Clermont Auvergne, CROC and Teaching Hospital EA3847, Clermont-Ferrand, France
| | - Serge Marchand
- Department of Surgery, Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, Quebec, Canada
| | - Amandine Dubois
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Cognition, Behaviour, Communication (LP3C), EA1285, Laboratoire de Psychologie, Rennes, France
- Département de Psychologie, University of Western Brittany (UBO), Brest, France
| | - Marie-Agnes Giroux-Metges
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Fabrice Rannou
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Laurent Misery
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Céline Bodéré
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
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Khoonsari PE, Musunri S, Herman S, Svensson CI, Tanum L, Gordh T, Kultima K. Systematic analysis of the cerebrospinal fluid proteome of fibromyalgia patients. J Proteomics 2019; 190:35-43. [DOI: 10.1016/j.jprot.2018.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 01/08/2023]
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Abstract
Fibromyalgia (FM) is characterized by chronic widespread pain, unrefreshing sleep, physical exhaustion, and cognitive difficulties. It occurs in all populations throughout the world, with prevalence between 2% and 4% in general populations. Definition, pathogenesis, diagnosis, and treatment of FM remain points of contention, with some even contesting its existence. The various classification systems according to pain medicine, psychiatry, and neurology (pain disease; persistent somatoform pain disorder; masked depression; somatic symptom disorder; small fiber neuropathy; brain disease) mostly capture only some components of this complex and heterogeneous disorder. The diagnosis can be established in most cases by a general practitioner when the symptoms meet recognized criteria and a somatic disease sufficiently explaining the symptoms is excluded. Evidence-based interdisciplinary guidelines give a strong recommendation for aerobic exercise and cognitive behavioral therapies. Drug therapy is not mandatory. Only a minority of patients experience substantial symptom relief with duloxetine, milnacipran, and pregabalin.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany. Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, McGill University Health Centre, Quebec, Canada, Alan Edwards Pain Management Unit, McGill University Health Centre, Quebec, Canada
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Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W. Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias. PLoS One 2018; 13:e0203755. [PMID: 30212526 PMCID: PMC6136749 DOI: 10.1371/journal.pone.0203755] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/27/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose Multiple clinical and epidemiological studies have provided estimates of fibromyalgia prevalence and sex ratio, but different criteria sets and methodology, as well as bias, have led to widely varying (0.4%->11%) estimates of prevalence and female predominance (>90% to <61%). In general, studies have failed to distinguish Criteria based fibromyalgia (CritFM) from Clinical fibromyalgia (ClinFM). In the current study we compare CritFM with ClinFM to investigate gender and other biases in the diagnosis of fibromyalgia. Methods We used a rheumatic disease databank and 2016 fibromyalgia criteria to study prevalence and sex ratios in a selection biased sample of 1761 referred and diagnosed fibromyalgia patients and in an unbiased sample of 4342 patients with no diagnosis with respect to fibromyalgia. We compared diagnostic and clinical variables according to gender, and we reanalyzed a German population study (GPS) (n = 2435) using revised 2016 criteria for fibromyalgia. Results In the selection-biased sample of referred patients with fibromyalgia, more than 90% were women. However, when an unselected sample of rheumatoid arthritis (RA) patients was studied for the presence of fibromyalgia, women represented 58.7% of fibromyalgia cases. Women had slightly more symptoms than men, including generalized pain (36.8% vs. 32.4%), count of 37 symptoms (4.7 vs. 3.7) and mean polysymptomatic distress scores (10.2 vs. 8.2). We also found a linear relation between the probability of being females and fibromyalgia and fibromyalgia severity. Women in the GPS represented 59.2% of cases. Discussion The perception of fibromyalgia as almost exclusively (≥90%) a women’s disorder is not supported by data in unbiased studies. Using validated self-report criteria and unbiased selection, the female proportion of fibromyalgia cases was ≤60% in the unbiased studies, and the observed CritFM prevalence of fibromyalgia in the GPS was ~2%. ClinFM is the public face of fibromyalgia, but is severely affected by selection and confirmation bias in the clinic and publications, underestimating men with fibromyalgia and overestimating women. We recommend the use of 2016 fibromyalgia criteria for clinical diagnosis and epidemiology because of its updated scoring and generalized pain requirement. Fibromyalgia and generalized pain positivity, widespread pain (WPI), symptom severity scale (SSS) and polysymptomatic distress (PSD) scale should always be reported.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, United States of America
- University of Kansas School of Medicine, Wichita, Kansas, United States of America
- * E-mail:
| | - Brian Walitt
- Georgetown University, Washington, DC, United States of America
| | - Serge Perrot
- Pain Clinic, Cochin-Hôtel Dieu Hospital, Paris Descartes University, Paris, France
| | - Johannes J. Rasker
- Faculty of Behavioral Management & Social Sciences, Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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Abstract
PURPOSE OF REVIEW Fibromyalgia syndrome (FMS) is defined as chronic, widespread musculoskeletal pain and tenderness with concomitant mood and cognitive dysfunction. Several comorbidities have been reported to be associated with FMS. We reviewed the literature concerning the most noteworthy chronic conditions associated with FMS. RECENT FINDINGS There is mounting evidence displaying the concurrence of fibromyalgia and coexisting medical and psychiatric conditions. Such comorbidities may blur the classical clinical presentations and erroneously lead to misinterpretation of disease activity. The recognition of this fact should be underlined, as misrecognition may lead to excessive therapy and avoidable side-effects of medications on the one hand and to a better handling of FMS on the other hand, leading to improved clinical outcomes. SUMMARY A greater proportion of psychiatric and rheumatologic disorders are associated with FMS patients than the population. Consequently, physicians treating patients with either condition should keep in mind that these patients may have such comorbidities and should be treated accordingly.
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Häuser W. Facts and myths pertaining to fibromyalgia. DIALOGUES IN CLINICAL NEUROSCIENCE 2018; 20:53-62. [PMID: 29946212 PMCID: PMC6016048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Fibromyalgia (FM) is characterized by chronic widespread pain, unrefreshing sleep, physical exhaustion, and cognitive difficulties. It occurs in all populations throughout the world, with prevalence between 2% and 4% in general populations. Definition, pathogenesis, diagnosis, and treatment of FM remain points of contention, with some even contesting its existence. The various classification systems according to pain medicine, psychiatry, and neurology (pain disease; persistent somatoform pain disorder; masked depression; somatic symptom disorder; small fiber neuropathy; brain disease) mostly capture only some components of this complex and heterogeneous disorder. The diagnosis can be established in most cases by a general practitioner when the symptoms meet recognized criteria and a somatic disease sufficiently explaining the symptoms is excluded. Evidence-based interdisciplinary guidelines give a strong recommendation for aerobic exercise and cognitive behavioral therapies. Drug therapy is not mandatory. Only a minority of patients experience substantial symptom relief with duloxetine, milnacipran, and pregabalin.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany. Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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Fitzcharles MA, Brachaniec M, Cooper L, Dubin R, Flynn T, Gerhold K, Häuser W, Cowan K, Laupacis A, Marleau R, Milot M, Szajcz-Keller N, Sumpton J, Walsh Z, El-Gabalawy H. A paradigm change to inform fibromyalgia research priorities by engaging patients and health care professionals. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:137-147. [PMID: 35005349 PMCID: PMC8730558 DOI: 10.1080/24740527.2017.1374820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Research objectives should be focused toward advancing knowledge that has meaningful impact on health. However, research agendas are mostly driven by the health care community, with limited input from patients. Aims: In this study, prioirities of uncertainties for the management of fibromyalgia (FM) that could propel future research were identified by a defined process using the James Lind Alliance Priority Setting Partnership (JLA-PSP) methodology. Methods: As a first step, a survey was distributed across Canada that engaged patients, caregivers, and health care professionals to provide narrative input to eight open-ended questions regarding FM care. Responses were thematically condensed and synthesized into an initial list of 43 uncertainties used to guide a comprehensive literature search. Questions already effectively addressed in the literature were excluded, leaving 25 uncertainties that were ranked during a one-day consensus workshop. Results: Three broad themes emerged: the value of personalized targeted treatment and subgrouping of patients; the efficacy of various self-management strategies and educational initiatives; and identification of the ideal health care setting to provide FM care. Opioids and cannabinoids were the only specific pharmacologic interventions ranked as needing further research. Conclusions: The prioritized questions highlight the importance of recognizing the heterogeneity of FM symptoms, the need for a personalized treatment approach, and a better understanding of the value of self-management strategies. This is the first study that uses an established and transparent methodology to engage all FM stakeholders to help inform researchers and funding bodies of clinically relevant research priorities.
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Affiliation(s)
- Mary-Ann Fitzcharles
- Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Ruth Dubin
- Department of Family Medicine, Queen’s University, Kingston, Canada
| | | | - Kerstin Gerhold
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Winfried Häuser
- Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | | | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto and Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Nicole Szajcz-Keller
- Canadian Institutes for Health Research, Institute of Musculoskeletal Health and Arthritis, Winnipeg, MB, Canada
| | - Janice Sumpton
- Department of Pharmacy, London Health Sciences Centre, London, ON, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Hani El-Gabalawy
- Canadian Institutes for Health Research, Institute of Musculoskeletal Health and Arthritis, Winnipeg, MB, Canada
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Ben-Ami Shor D, Weitzman D, Dahan S, Gendelman O, Bar-On Y, Amital D, Shalev V, Chodick G, Amital H. Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization. J Rheumatol 2017; 44:1499-1506. [DOI: 10.3899/jrheum.170098] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/08/2023]
Abstract
Objective.To assess 1-year persistence and adherence rates with drug therapy among patients with fibromyalgia (FM) and to identify factors associated with therapy discontinuation.Methods.This retrospective, cohort study included members ≥ 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. Medications of interest included the anticonvulsant pregabalin, antidepressants [selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)], and tricyclic antidepressants (TCA). Time to treatment discontinuation and proportion of days covered (PDC) with FM-specific therapies during the year from first dispensed were analyzed. PDC < 20% was considered low adherence and PDC ≥ 80% was considered high adherence. Logistic regression models were constructed for multivariable analyses.Results.Overall, 3932 patients with FM were included; 88.7% were female. Pre-diagnosis use of medication of interest was documented in 41% of the study population. Of the remaining 2312 patients, 56.1% were issued a prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis. Among newly prescribed patients, 1-year discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC ≥ 80%).Conclusion.This study clearly shows that in an Israeli “real-life” population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low.
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Häuser W, Clauw DJ, Fitzcharles M. Treat‐to‐Target Strategy for Fibromyalgia: Opening the Dialogue. Arthritis Care Res (Hoboken) 2017; 69:462-466. [DOI: 10.1002/acr.22970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/13/2016] [Accepted: 06/21/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Winfried Häuser
- Klinikum Saarbrücken, Saarbrücken, and Technische Universität MünchenMünchen Germany
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Rivera J, Vallejo MA. Fibromyalgia is associated to receiving chronic medications beyond appropriateness: a cross-sectional study. Rheumatol Int 2016; 36:1691-1699. [PMID: 27664140 PMCID: PMC5102937 DOI: 10.1007/s00296-016-3568-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/19/2016] [Indexed: 12/29/2022]
Abstract
The objectives of this study are to describe appropriateness and drug treatment of comorbidities in fibromyalgia (FM). Cross-sectional study of a group of patients. Number of drugs, indication, duration and appropriateness of prescriptions were evaluated. Patients were classified as: group 1, (FM/FM) previous FM diagnosis and fulfilling criteria; group 2, (noFM/noFM) other diagnosis and not fulfilling criteria; and group 3, (noFM/FM) other diagnosis but fulfilling criteria. Drugs were classified into drugs for nervous system, analgesics/NSAID and drugs for other comorbidities. Appropriateness was evaluated following clinical therapeutic guidelines. A total of 159 patients were included in the study and classified into group 1, with 59 patients; group 2, with 67 patients; and group 3, with 33 patients. Group 1 received a greater number of different drugs and for a longer period of time, there were less severe comorbidities and more unjustified treatments. No difference was found between the other two groups. Major opioids were only consumed in group 1. Also, in group 1, 45.8 % of patients were attended in psychiatry versus 15.6 % in group 3 and 3 % in group 2. The number of somatic symptoms correlated significantly with the number of drugs. Nervous system treatments were of shorter duration than other drug treatments. There was no difference in severe comorbidities. Comorbidities in FM are similar to those of other patients, but they receive more drugs and for a longer period of time. Drugs for nervous system comorbidities are introduced later, when other somatic symptoms are already treated. In patients with FM the treatments for mild comorbidities are not well justified.
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Affiliation(s)
- Javier Rivera
- Rheumatology Unit-IPR, Hospital Universitario Gregorio Marañón, c/Francisco Silvela 40, 28028, Madrid, Spain.
| | - Miguel A Vallejo
- Department of Clinical Psychology, National Distance Education University (UNED), c/Juan del Rosal 10, 28040, Madrid, Spain
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Díaz-Toral LG, Banderas-Dorantes TR, Rivas-Vilchis JF. Impact of Electroacupuncture Treatment on Quality of Life and Heart Rate Variability in Fibromyalgia Patients. J Evid Based Complementary Altern Med 2016; 22:216-222. [PMID: 26787729 DOI: 10.1177/2156587215626615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study examines the effects of electroacupuncture treatment on health-related quality of life and heart rate variability in women with fibromyalgia. Twenty women with fibromyalgia received a 10-week treatment with electroacupuncture. Primary outcome measures were the Fibromyalgia Impact Questionnaire, the Short Form 36 Health Survey Questionnaire, and heart rate variability. Compared with pretreatment, there was a significant improvement in health-related quality of life; electroacupuncture significantly increases low frequency, low frequency/high frequency, and decreases high frequency, all indicating rise in sympathetic tone. Fibromyalgia patients showed a significant ( P < .05) improvement in pain, fatigue, morning tiredness, stiffness, anxiety, and depression on the Fibromyalgia Impact Questionnaire scores; and physical function, physical role, body pain, general health, and vitality scores on the Short Form 36 Health Survey Questionnaire. These changes mainly in mental status scores could be related to a new autonomic balance with sympathetic predominance at the horary of the study.
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Littlejohn GO, Guymer EK, Ngian GS. Is there a role for opioids in the treatment of fibromyalgia? Pain Manag 2016; 6:347-55. [PMID: 27296831 DOI: 10.2217/pmt-2016-0012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The use of opioids for chronic pain has increased significantly due to a combination of the high patient burden of pain and the more widespread availability of a range of long-acting opioid preparations. This increased opioid use has translated into the care of many patients with fibromyalgia. The pain mechanism in fibromyalgia is complex but does not seem to involve disturbance of opioid analgesic functions. Hence, there is general concern about the harms in the absence of benefits of opioids in this setting. There is no evidence that pure opioids are effective in fibromyalgia but there is some evidence that opioids with additional actions on the norepinephrine-related pain modulatory pathways, such as tramadol, can be clinically useful in some patients. Novel actions of low-dose opioid antagonists may lead to better understanding of the role of opioid function in fibromyalgia.
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Affiliation(s)
- Geoffrey O Littlejohn
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
| | - Emma K Guymer
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
| | - Gene-Siew Ngian
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
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Saral I, Sindel D, Esmaeilzadeh S, Sertel-Berk HO, Oral A. The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial. Rheumatol Int 2016; 36:1379-89. [PMID: 27055444 DOI: 10.1007/s00296-016-3473-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/23/2016] [Indexed: 11/30/2022]
Abstract
We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the 'per-protocol' set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.
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Affiliation(s)
- Ilknur Saral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Capa, Fatih, 34093, Istanbul, Turkey.,Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Capa, Fatih, 34093, Istanbul, Turkey
| | - Sina Esmaeilzadeh
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Capa, Fatih, 34093, Istanbul, Turkey.
| | | | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Capa, Fatih, 34093, Istanbul, Turkey
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Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU. Fibromyalgia diagnosis: a review of the past, present and future. Expert Rev Neurother 2016; 15:667-79. [PMID: 26035624 DOI: 10.1586/14737175.2015.1046841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
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36
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Mahagna H, Amital D, Amital H. A randomised, double-blinded study comparing giving etoricoxib vs. placebo to female patients with fibromyalgia. Int J Clin Pract 2016; 70:163-70. [PMID: 26763773 DOI: 10.1111/ijcp.12760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Current therapeutic approaches to fibromyalgia syndrome (FMS) do not provide satisfactory pain control to a high percentage of patients. This unmet need constantly fuels the pursuit for new modalities for pain relief. This randomised, double-blind, controlled study assessed the efficacy and safety of adding etoricoxib vs. placebo to the current therapeutic regimen of female patients with FMS. METHODS In this double-blind, placebo-controlled study, female patients were randomised to receive either 90 mg etoricoxib once daily or placebo for 6 weeks. Several physical and mental parameters were assessed throughout the study. The primary end-point was the response to treatment, defined as ≥ 30% reduction in the average Brief Pain Inventory score. Secondary outcomes were changes in the Fibromyalgia Impact Questionnaire, SF-36 Quality of Life assessment questionnaire and Hamilton rating scales for anxiety and depression. RESULTS Overall, 73 patients were recruited. Although many outcome measures improved throughout the study, no difference was recorded between the etoricoxib- and placebo-treated groups. The Brief Pain Inventory, Fibromyalgia Impact Questionnaire, The Hamilton Anxiety and Depression scores did not differ between the two groups. CONCLUSIONS This is the first randomised, double-blind study assessing the effect of adding etoricoxib to pre-existing medications for female patients with FMS. Although being mildly underpowered this study clearly has shown that etoricoxib did not improve pain scores and did not lead to any beneficial mental or physical effects.
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Affiliation(s)
- H Mahagna
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Amital
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ness Ziona Beer Yaacov Mental Health Center, Beer-Yaacov, Israel
| | - H Amital
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus 2015; 24:483-9. [PMID: 25801891 DOI: 10.1177/0961203314558676] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The current mode of therapy for many patients with musculoskeletal pain is unsatisfactory. PURPOSE We aimed to assess the impact of adding 4000 IU of vitamin D on pain and serological parameters in patients with musculoskeletal pain. MATERIALS AND METHODS This was a randomized, double-blinded and placebo-controlled study assessing the effect of 4000 IU of orally given vitamin D3 (cholecalciferol) (four gel capsules of 1000 IU, (SupHerb, Israel) vs. placebo on different parameters of pain. Eighty patients were enrolled and therapy was given for 3 months. Parameters were scored at three time points: prior to intervention, at week 6 and week 12. Visual analogue scale (VAS) scores of pain perception were recorded following 6 and 12 weeks. We also measured serum levels of leukotriene B4 (LTB4), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and prostaglandin E2 (PGE2) by ELISA. RESULTS The group receiving vitamin D achieved a statistically significant larger decline of their VAS measurement throughout the study compared with the placebo group. The need for analgesic 'rescue therapy' was significantly lower among the vitamin D-treated group. TNFα levels decreased by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group. PGE2 decreased by39.2% in the group treated with vitamin D and increased by 16% in the placebo group. LTB4 levels decreased in both groups by 24% (p < 0.05). CONCLUSION Adding 4000 IU of vitamin D for patients with musculoskeletal pain may lead to a faster decline of consecutive VAS scores and to a decrease in the levels of inflammatory and pain-related cytokines.
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Affiliation(s)
- O Gendelman
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Itzhaki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Central Laboratory of Clalit Health Services, Tel-Aviv, Israel
| | - S Makarov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - M Bennun
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - H Amital
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Schirmer M. Subgrouping fibromyalgia patients according to response to therapeutic interventions: a new concept for a disease with low treatment-response rates. Rheumatol Int 2015; 36:447-8. [PMID: 26676465 DOI: 10.1007/s00296-015-3407-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Schirmer
- Department of Internal Medicine, Clinic VI, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Abstract
Fibromyalgia is a common illness characterized by chronic widespread pain, sleep problems (including unrefreshing sleep), physical exhaustion and cognitive difficulties. The definition, pathogenesis and treatment are controversial, and some even contest the existence of this disorder. In 1990, the American College of Rheumatology (ACR) defined classification criteria that required multiple tender points (areas of tenderness occurring in muscles and muscle-tendon junctions) and chronic widespread pain. In 2010, the ACR preliminary diagnostic criteria excluded tender points, allowed less extensive pain and placed reliance on patient-reported somatic symptoms and cognitive difficulties. Fibromyalgia occurs in all populations worldwide, and symptom prevalence ranges between 2% and 4% in the general population. The prevalence of people who are actually diagnosed with fibromyalgia ('administrative prevalence') is much lower. A model of fibromyalgia pathogenesis has been suggested in which biological and psychosocial variables interact to influence the predisposition, triggering and aggravation of a chronic disease, but the details are unclear. Diagnosis requires the history of a typical cluster of symptoms and the exclusion of a somatic disease that sufficiently explains the symptoms by medical examination. Current evidence-based guidelines emphasize the value of multimodal treatments, which encompass both non-pharmacological and selected pharmacological treatments tailored to individual symptoms, including pain, fatigue, sleep problems and mood problems. For an illustrated summary of this Primer, visit: http://go.nature.com/LIBdDX.
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Affiliation(s)
- Winfried Häuser
- Department of Internal Medicine 1, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany.,Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Ismaninger Street 22, 81675 München, Germany
| | - Jacob Ablin
- Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Geoffrey Littlejohn
- Departments of Rheumatology and Medicine, Monash Health and Monash University, Clayton, Australia
| | - Juan V Luciano
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Chie Usui
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Brian Walitt
- National Center for Complementary and Integrative Health, and National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Patients with autoimmune diseases often present with olfactory impairment. The aim of the study was to assess the olfactory functions of female patients with fibromyalgia (FM) compared with patients with systemic sclerosis (SSc) and with healthy female controls. Olfactory functions were assessed in 24 patients with FM, 20 patients with SSc and 21 age-matched healthy controls. The sense of smell was evaluated using the Sniffin' Sticks test including the three stages of smell: threshold, discrimination, and identification (TDI) of the different odors. The severity of fibromyalgia was assessed using the fibromyalgia impact questionnaire (FIQ). The short form 36 (SF-36) questionnaire was also completed in order to seek a relationship between the patients perception of quality of life and the different aspects of the smell sense. Depression was evaluated in both FM and SSc patients utilizing the Beck depression inventory-II (BDI-II) questionnaire. Patients with FM had significantly lower TDI smell scores compared with both SSc patients and healthy controls (p < 0.005, One-Way ANOVA). Hyposmia (defined as TDI scores below 30) were observed in 14 of 24 (42 %) patients with FM compared to 3 of 20 (15 %) patients with SSc and 1 of the healthy controls (4.3 %) (p < 0.02). FM patients had significantly lower thresholds of smell compared to both healthy controls and patients with SSc (p < 0.001), whereas for patients with SSc only the ability to discriminate between odors was impaired (p < 0.006). We could not detect any statistical correlation between smell abilities and clinical manifestation of SSc or the FIQ and SF-36 scores among FM patients. However the correlation between depression, defined by the BDI-II score, and the sense of smell differed between patients with FM and patients with SSc. As only among SSc patients a lower sense of smell correlated with a higher BDI-II score (p = 0.02). Our findings suggest that there is a decrease in the sense of smell both in FM and SSc patients compared with healthy controls. However these impairments differ between patients group and might represent different mechanisms that affect the sense of smell.
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Kianmehr N, Haghighi A, Bidari A, Sharafian Ardekani Y, Karimi MA. Are general practitioners well informed about fibromyalgia? Int J Rheum Dis 2015. [PMID: 26200844 DOI: 10.1111/1756-185x.12716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Fibromyalgia syndrome (FMS) is a common rheumatologic disorder characterized by easy fatigability, widespread musculoskeletal pain and sleep disorder. In spite of its high prevalence, general practitioners, as primary care providers, seem to have inadequate knowledge about FMS. This study aimed to assess Iranian general practitioners' knowledge about FMS and its treatment. METHOD A detailed questionnaire (including items on signs and symptoms, diagnostic criteria and treatment) was completed by 190 general practitioners (54.7% male; mean age: 41 years). Data analysis was performed with SPSS for Windows 15.0 and awareness about all aspects of FMS was reported as percentages. RESULTS About one-third (30%) of the participants had seen at least one case of FMS during their practice. Most subjects (62.7%) claimed to know 1-6 tender points. Only 3.2% knew 16-18 points. The common proposed symptoms of FMS were widespread pain (72.6%), excessive fatigue (72.6%), weakness (60.5%), sleep disorder (36.3%), anxiety (34.7%) and depression (34.2%). Wrong symptoms including elevated erythrocyte sedimentation rate and C-reactive protein, arthritis, joint swelling, weight loss and abnormal radiologic findings were selected by 27.9%, 18.9%, 14.7%, 12.6% and 2.1% of the physicians, respectively. Moreover, selective serotonin reuptake inhibitors, tricyclic antidepressant and pregabalin were identified as treatment options for FMS by, respectively, 45.8%, 22.1% and 15.3% of the participants. Finally, 52.1% and 23.7% of the subjects incorrectly considered nonsteroidal anti-inflammatory drugs and corticosteroids as treatment modalities for FMS. CONCLUSION Iranian general practitioners are not well informed about FMS. Therefore, FMS should be specifically integrated in continuing medical education programs and undergraduate medical training curriculum.
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Affiliation(s)
- Nahid Kianmehr
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Anousheh Haghighi
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Bidari
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Sharafian Ardekani
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Karimi
- Department of Rheumathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:610615. [PMID: 26246841 PMCID: PMC4515506 DOI: 10.1155/2015/610615] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.
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Affiliation(s)
- Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Winfried Häuser
- Department of Internal Medicine 1, Klinikum Saarbrücken, 66119 Saarbrücken, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Munich University of Technology (TUM), 81865 München, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
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APARICIO VIRGINIAARIADNA, SEGURA-JIMÉNEZ VÍCTOR, ÁLVAREZ-GALLARDO INMACULADAC, SORIANO-MALDONADO ALBERTO, CASTRO-PIÑERO JOSÉ, DELGADO-FERNÁNDEZ MANUEL, CARBONELL-BAEZA ANA. Fitness Testing in the Fibromyalgia Diagnosis. Med Sci Sports Exerc 2015; 47:451-9. [DOI: 10.1249/mss.0000000000000445] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND AND OBJECTIVE Whether fibromyalgia syndrome (FMS) can be classified as a somatoform disorder is under debate. DATABASES AND DATA TREATMENT Literature searches on the classification of FMS as a somatoform disorder were performed in Medline and in evidence-based guideline databases. RESULTS A somatoform disorder is defined by medically unexplained somatic symptoms that persist for at least 6 months and lead to a significant impairment of the ability to function in everyday life. The nature and extent of the symptoms or the distress and pre-occupation of the patient cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder. Emotional and psychosocial conflicts play a major role in the onset, severity, exacerbation or maintenance of the physical symptoms. There is disagreement in the FMS research community on the existence of somatic factors sufficiently explaining FMS symptoms. Psychosocial factors play a major role in the onset, exacerbation or maintenance of FMS symptoms in the majority of patients. A biopsychosocial model of interacting biological and psychosocial factors in the predisposition, onset and maintenance of FMS symptoms is more appropriate than the dichotomy between a somatic disease and a mental (somatoform) disorder. CONCLUSIONS The clinical features of FMS and persistent somatoform pain disorder or somatization disorder according to the International Classification of Diseases (ICD)-10 overlap in individuals with chronic widespread pain without specific somatic disease factors. FMS is not synonymous with somatoform disorder.
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Affiliation(s)
- W Häuser
- Department of Internal Medicine I, Klinikum Saarbrücken, Germany; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Germany
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