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Ramírez Medina CR, Feng M, Huang YT, Jenkins DA, Jani M. Machine learning identifies risk factors associated with long-term opioid use in fibromyalgia patients newly initiated on an opioid. RMD Open 2024; 10:e004232. [PMID: 38772680 DOI: 10.1136/rmdopen-2024-004232] [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: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Fibromyalgia is frequently treated with opioids due to limited therapeutic options. Long-term opioid use is associated with several adverse outcomes. Identifying factors associated with long-term opioid use is the first step in developing targeted interventions. The aim of this study was to evaluate risk factors in fibromyalgia patients newly initiated on opioids using machine learning. METHODS A retrospective cohort study was conducted using a nationally representative primary care dataset from the UK, from the Clinical Research Practice Datalink. Fibromyalgia patients without prior cancer who were new opioid users were included. Logistic regression, a random forest model and Boruta feature selection were used to identify risk factors related to long-term opioid use. Adjusted ORs (aORs) and feature importance scores were calculated to gauge the strength of these associations. RESULTS In this study, 28 552 fibromyalgia patients initiating opioids were identified of which 7369 patients (26%) had long-term opioid use. High initial opioid dose (aOR: 31.96, mean decrease accuracy (MDA) 135), history of self-harm (aOR: 2.01, MDA 44), obesity (aOR: 2.43, MDA 36), high deprivation (aOR: 2.00, MDA 31) and substance use disorder (aOR: 2.08, MDA 25) were the factors most strongly associated with long-term use. CONCLUSIONS High dose of initial opioid prescription, a history of self-harm, obesity, high deprivation, substance use disorder and age were associated with long-term opioid use. This study underscores the importance of recognising these individual risk factors in fibromyalgia patients to better navigate the complexities of opioid use and facilitate patient-centred care.
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Affiliation(s)
- Carlos Raúl Ramírez Medina
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Mengyu Feng
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Yun-Ting Huang
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
| | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
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Varallo G, Scarpina F, Arnison T, Giusti EM, Tenti M, Rapelli G, Cattivelli R, Landi G, Tossani E, Grandi S, Franceschini C, Baldini V, Plazzi G, Capodaglio P, Castelnuovo G. Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:239-247. [PMID: 37843440 PMCID: PMC10906707 DOI: 10.1093/pm/pnad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation. METHODS In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected. RESULTS 3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation. DISCUSSION The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.
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Affiliation(s)
- Giorgia Varallo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo 28884, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin 10126, Italy
| | - Tor Arnison
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of medical Sciences, Örebro University, Örebro 70182, Sweden
| | - Emanuele Maria Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Micheal Tenti
- Institute for Research on Pain, ISAL Foundation, Rimini 47921, Italy
| | - Giada Rapelli
- Department of Medicine and surgery, University of Parma, Parma 43125, Italy
| | - Roberto Cattivelli
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Giulia Landi
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Eliana Tossani
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - Silvana Grandi
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | | | - Valentina Baldini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40126, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna 40139, Italy
| | - Paolo Capodaglio
- Laboratory of Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, Verbania 28884, Italy
- Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Torino, Turin 10124, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart of Milan, Milan 20123, Italy
- IRCCS Istituto Auxologico Italiano, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania 28884, Italy
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Varallo G, Suso-Ribera C, Ghiggia A, Veneruso M, Cattivelli R, Guerrini Usubini A, Franceschini C, Musetti A, Plazzi G, Fontana JM, Capodaglio P, Castelnuovo G. Catastrophizing, Kinesiophobia, and Acceptance as Mediators of the Relationship Between Perceived Pain Severity, Self-Reported and Performance-Based Physical Function in Women with Fibromyalgia and Obesity. J Pain Res 2022; 15:3017-3029. [PMID: 36186755 PMCID: PMC9525026 DOI: 10.2147/jpr.s370718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Individuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity. Patients and Methods In this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed. Results Pain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning. Conclusion Pain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning.
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Affiliation(s)
- Giorgia Varallo
- Department of Medicine and Surgery, University of Parma, Parma, 43121, Italy
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellon de la Plana, 12071, Spain
| | - Ada Ghiggia
- Department of Life Sciences, University of Trieste, Trieste, 34127, Italy
| | - Marco Veneruso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Anna Guerrini Usubini
- Department of Psychology, Catholic University of Milan, Milan, 20123, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, 28824, Italy
| | | | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, 43125, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, 40139, Italy
| | - Jacopo Maria Fontana
- Istituto Auxologico Italiano IRCCS, Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Verbania, 28824, Italy
- Correspondence: Jacopo Maria Fontana, San Giuseppe Hospital, Strada Cadorna 90, Verbania, 28824, Italy, Tel +39 0323 514 331, Email
| | - Paolo Capodaglio
- Istituto Auxologico Italiano IRCCS, Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Verbania, 28824, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, 10121, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, 20123, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, 28824, Italy
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The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. J Pers Med 2021; 11:jpm11080810. [PMID: 34442454 PMCID: PMC8401554 DOI: 10.3390/jpm11080810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.
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Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. Semin Arthritis Rheum 2021; 51:409-424. [PMID: 33676126 DOI: 10.1016/j.semarthrit.2021.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/30/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Obesity has been associated with several complications, including musculoskeletal disorders. Aim of the present systematic review was to identify all available evidence on the relationship between fibromyalgia (FM) and obesity, including epidemiological association, impact of obesity on FM severity and effect of weight loss strategies on FM symptoms. METHODS MedLine, Cochrane Central Register of Controlled Trials and Web of Science databases were searched up to September 2020 to identify eligible articles. Data from studies reporting the prevalence of obesity in FM patients were pooled using a random-effects model. RESULTS After removal of duplicate records, 393 studies proceeded to review. A total of 41 articles were deemed eligible for inclusion in final synthesis. Quality assessment revealed that the overall risk of bias was high. The overall prevalence of obesity in FM was 35.7% (95% CI: 31.8 - 39.9%), with higher figures reported for USA. The majority of studies included demonstrated that obesity is associated with different domains of the disorder, including composite measures of activity, pain severity, tender point count, stiffness, fatigue, physical functioning/disability, sleep, cognitive dysfunction, and quality of life; the strength of correlation was weak on average. Inconsistent data were available regarding the correlation with depression and anxiety. Only few studies addressed the effect of therapeutic weight loss in FM, either by bariatric surgery, diet/exercise combination or behavioral weight loss, providing preliminary evidence for a potential benefit of weight loss in ameliorating FM symptoms. CONCLUSIONS Available data support a potential interplay between obesity and FM-related symptoms. Weight management should be encouraged in patients with FM.
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Estévez-López F, Rodriguez-Ayllon M, Soriano-Maldonado A, Acosta-Manzano P, Segura-Jiménez V, Álvarez-Gallardo IC, Pulido-Martos M, Herrador-Colmenero M, Geenen R, Carbonell-Baeza A, Delgado-Fernández M. Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Ándalus Project. PAIN MEDICINE 2020; 20:2506-2515. [PMID: 30698774 DOI: 10.1093/pm/pny304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association. DESIGN Cross-sectional study in 420 women with fibromyalgia. SETTING Fibromyalgia associations from southern Spain. METHODS Physical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses. RESULTS Physical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P < 0.001). Negative affect was independently associated with general fatigue, physical fatigue, reduced motivation, and mental fatigue (all P ≤ 0.04). The interaction of overall physical fitness and positive affect was related to general fatigue and physical fatigue (all P ≤ 0.02). Women with fibromyalgia with higher levels of overall physical fitness and positive affect showed the lowest general fatigue and physical fatigue. CONCLUSIONS In women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.
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Affiliation(s)
- Fernando Estévez-López
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Northern Ireland, UK.,Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - María Rodriguez-Ayllon
- PROmoting FITness and Health Through Physical Activity (PROFITH) Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | | | - Manuel Pulido-Martos
- Department of Psychology, Faculty of Humanities and Sciences of Education, University of Jaén, Jaén, Spain
| | - Manuel Herrador-Colmenero
- PROmoting FITness and Health Through Physical Activity (PROFITH) Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Rinie Geenen
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ana Carbonell-Baeza
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
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Pain catastrophizing mediates the negative influence of pain and trait-anxiety on health-related quality of life in fibromyalgia. Qual Life Res 2020; 29:1871-1881. [PMID: 32112278 DOI: 10.1007/s11136-020-02457-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with fibromyalgia syndrome (FMS) usually display a decrease in health-related quality of life (HRQoL). This decrease in HRQoL is related to clinical pain, anxiety, and depression. This cross-sectional study analyzes the mediating role of pain-coping strategies (especially catastrophizing) in the negative relationships of pain, anxiety, depression, and HRQoL in FMS. METHODS One hundred and thirteen women with FMS and 63 healthy women were assessed using the Short-Form Health Survey (SF-36). Participants completed self-report questionnaires to evaluate clinical pain, anxiety, depression, and pain-coping strategies. RESULTS Pain catastrophizing was inversely associated with the physical function, general health perception, vitality, emotional role, mental health, the physical and mental general components, and the global index of HRQoL, with percentages of variance explained ranging between 9 and 18%. Cognitive distraction showed a positive association with the physical function, general health perception, vitality, emotional role, mental health, physical component, and global index of HRQoL, with percentages of variance explained ranging between 4 and 7%. Mediation analysis showed that catastrophizing mediates the negative influence of clinical pain and trait-anxiety on the physical function, general health perception, vitality, mental health, and global index of HRQoL. No mediating effect of pain catastrophizing on the relation between depression and HRQoL was observed. CONCLUSIONS Patients with FMS exhibited markedly lower HRQoL than healthy individuals. While pain catastrophizing was inversely related to several domains of HRQL, associations were positive for cognitive distraction. Catastrophizing mediates the negative influence of clinical pain and trait-anxiety on HRQoL. Therefore, cognitive behavioral treatments focused on adaptive management and control of catastrophizing and negative emotional states may be helpful.
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Kaleth AS, Slaven JE, Ang DC. Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia. Clin J Pain 2018; 34:76-81. [PMID: 28272119 PMCID: PMC5831245 DOI: 10.1097/ajp.0000000000000500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM. MATERIALS AND METHODS This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI≥30 kg/m) and nonobese (BMI<30 kg m) groups, mixed linear models were used to determine interaction between treatment arms and obesity status with regards to the primary outcome of global FM symptom severity (Fibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory), 6-Minute Walk Test, and self-reported physical activity (Community Health Activities Model Program for Seniors). RESULTS Of the 198 participants, 91 (46%) were nonobese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the nonobese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared with AC. The interaction analysis was also significant for Brief Pain Inventory pain intensity (P=0.01), but not for the walk test and self-reported physical activity. DISCUSSION This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.
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Affiliation(s)
| | - James E Slaven
- Department of Biostatistics, Indiana University, Indianapolis, IN
| | - Dennis C Ang
- Department of Medicine, Division of Rheumatology, Wake Forest University School of Medicine, Winston-Salem, NC
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Ruiz-Cabello P, Soriano-Maldonado A, Delgado-Fernandez M, Alvarez-Gallardo IC, Segura-Jimenez V, Estevez-Lopez F, Camiletti-Moirón D, Aparicio VA. Association of Dietary Habits with Psychosocial Outcomes in Women with Fibromyalgia: The al-Ándalus Project. J Acad Nutr Diet 2016; 117:422-432.e1. [PMID: 27890478 DOI: 10.1016/j.jand.2016.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a complex multidimensional disorder with pain as its main symptom. Fibromyalgia imposes a psychosocial burden on individuals that negatively impacts quality of life. The relationship of dietary habits with these psychosocial aspects is still unclear. OBJECTIVE The purpose of this cross-sectional study was to assess dietary habits in a representative sample of women with FM and to explore their association with mental health, depression, and optimism in this population. DESIGN A cross-sectional study was conducted between November 2011 and January 2013. PARTICIPANTS The study sample comprised 486 women (ages 35 to 65 years) with FM from Andalucía (southern Spain). MAIN OUTCOME MEASURES Mental health, depression, and optimism were evaluated by means of the mental component scale of the 36-item Short-Form Health Survey, the Beck Depression Inventory (BDI-II), and the Life Orientation Test Revised, respectively. A short form of a validated food frequency questionnaire was used to assess dietary habits. STATISTICAL ANALYSES PERFORMED Analysis of covariance was used to assess associations between dietary habits and mental health, depression, and optimism. The presence of severe depression (BDI-II ≥29) as a function of dietary habits was examined with logistic regression. RESULTS A daily or almost-daily consumption of fruit and vegetables and a moderate consumption of fish (2 to 5 servings per week) were associated with higher scores in mental health (P<0.001, P<0.05, and P<0.001, respectively) and lower levels of depression (P<0.001, P<0.01, and P<0.01, respectively). A daily or almost-daily consumption of vegetables and a moderate consumption of dairy products and fish were associated with higher levels of optimism (P<0.05, P<0.05, and P<0.001, respectively). A daily or almost-daily consumption of cured meats and sweetened beverages were associated with higher levels of depression and lower levels of optimism, respectively (both P<0.05). CONCLUSION The results this study suggest that a daily or almost-daily intake of fruit and vegetables and a moderate intake of fish may be associated with more favorable psychosocial outcomes in women with FM. Conversely, excessive intake of cured meats and sweetened beverages was related to worse scores in optimism and depression outcomes. Future research analyzing dietary patterns as well as intervention studies evaluating the effects of healthy dietary patterns on psychosocial and physical outcomes in individuals with FM are warranted.
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Fred-Jiménez RM, Arroyo-Ávila M, Mayor ÁM, Ríos G, Vilá LM. Clinical Manifestations Associated with Overweight/Obesity in Puerto Ricans with Fibromyalgia Syndrome. J Obes 2016; 2016:1379289. [PMID: 26885384 PMCID: PMC4739457 DOI: 10.1155/2016/1379289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 12/20/2022] Open
Abstract
Objective. To determine the clinical manifestations associated with overweight/obesity in Hispanics from Puerto Rico with fibromyalgia syndrome (FMS). Methods. A cross-sectional study was performed in 144 patients with FMS (per American College of Rheumatology (ACR) classification criteria). Sociodemographic features, FMS-related symptoms, tender points (per ACR criteria), comorbidities, and FMS treatment were examined. BMI was calculated and patients were grouped into two categories: BMI ≤ 24.9 kg/m(2) (nonoverweight/obese) and BMI ≥ 25 kg/m(2) (overweight/obese). Bivariate and multivariate analyses were used to evaluate differences between the study groups. Results. The mean (standard deviation (SD)) age of patients was 50.2 (9.9) years; 95.1% were females and 75.7% were overweight/obese. In the bivariate analysis, overweight/obese patients were more likely to have self-reported memory impairment, anxiety, shortness of breath, and urinary frequency than nonoverweight/obese patients. In addition, the tender point count was higher in the overweight/obese group. In the logistic regression analyses, self-reported memory impairment and urinary frequency differences remained significant after adjusting for confounding variables. Conclusion. In this population of Puerto Ricans with FMS, overweight/obese patients experienced more FMS-related manifestations than nonoverweight/obese individuals. However, prospective studies are needed to confirm these associations and to elucidate if weight reduction interventions could favorably impact the severity of FMS.
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Affiliation(s)
- Ruth M. Fred-Jiménez
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
| | - Mariangelí Arroyo-Ávila
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
| | - Ángel M. Mayor
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
- Retrovirus Research Center, Department of Internal Medicine, Universidad Central del Caribe School of Medicine, Bayamón, PR 00960, USA
| | - Grissel Ríos
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
| | - Luis M. Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
- *Luis M. Vilá:
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12
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del Pozo-Cruz J, Alfonso-Rosa RM, Castillo-Cuerva A, Sañudo B, Nolan P, del Pozo-Cruz B. Depression symptoms are associated with key health outcomes in women with fibromyalgia: a cross-sectional study. Int J Rheum Dis 2015; 20:798-808. [DOI: 10.1111/1756-185x.12564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesús del Pozo-Cruz
- Department of Physical Education and Sports; University of Seville; Seville Spain
| | - Rosa M. Alfonso-Rosa
- Department of Physical Education and Sports; University of Seville; Seville Spain
| | | | - Borja Sañudo
- Department of Physical Education and Sports; University of Seville; Seville Spain
| | - Paul Nolan
- Department of Sport and Exercise Science; University of Auckland; Auckland New Zealand
| | - Borja del Pozo-Cruz
- Department of Sport and Exercise Science; University of Auckland; Auckland New Zealand
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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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Castel A, Castro S, Fontova R, Poveda MJ, Cascón-Pereira R, Montull S, Padrol A, Qanneta R, Rull M. Body mass index and response to a multidisciplinary treatment of fibromyalgia. Rheumatol Int 2014; 35:303-14. [PMID: 25080875 DOI: 10.1007/s00296-014-3096-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/11/2014] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to determine whether there are some differences in the treatment responses to a multidisciplinary fibromyalgia (FM) treatment related with the baseline body mass index (BMI) of the participants. Inclusion criteria consisted of female sex, a diagnosis of FM (American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Baseline BMI was determined, and patients were randomly assigned to one of the two treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were pain intensity, functionality, catastrophizing, psychological distress, health-related quality of life, and sleep disturbances. One hundred thirty patients participated in the study. No statistical significant differences regarding pre-treatment outcomes were found among the different BMI subgroups, and between the two experimental conditions for each BMI category. General linear model analysis showed a significant interaction group treatment × time in pain intensity (p < .01), functionality (p < .0001), catastrophizing (p < .01), psychological distress (p < .0001), sleep index problems (p < .0001), and health-related quality of life (p < .05). No significant interactions were found in BMI × time, and in BMI × group treatment × time. There are not differences among normal weight, overweight and obese patients with FM regarding their response to a multidisciplinary treatment programme for FM which combines pharmacological treatment, education, physical therapy and cognitive behavioural therapy.
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Affiliation(s)
- Antoni Castel
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, C/Doctor Mallafré Guasch, 4, 43007, Tarragona, Spain,
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Vincent A, Clauw D, Oh TH, Whipple MO, Toussaint LL. Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms. PM R 2014; 6:802-7. [PMID: 24534101 DOI: 10.1016/j.pmrj.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/03/2014] [Accepted: 02/13/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although previous studies report associations between increased body mass index (BMI) and fibromyalgia symptoms, there is uncertainty as to whether this relationship is driven by physical factors, psychological factors, or both. OBJECTIVE To assess these relationships in a clinical sample of patients with fibromyalgia. DESIGN Cross-sectional study. SETTING Tertiary care facility. PATIENTS A total of 686 patients from an existing national fibromyalgia registry. METHODS Patients completed a demographic form and self-report questionnaires including the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the Medical Outcomes Study Short Form-36 (SF-36), the Brief Pain Inventory (BPI), and the 30-item Profile of Mood States (30-item POMS). MAIN OUTCOME MEASUREMENTS FIQ-R overall impact subscale. RESULTS BMI was significantly correlated with fibromyalgia impact (P < .001). The relationship between BMI and fibromyalgia impact was almost fully accounted for by physical factors and not by psychological factors. CONCLUSIONS Despite patient report that pain hinders physical activity, clinicians who encounter patients with fibromyalgia, particularly patients with increased BMI, should be cognizant of the need to invest time and resources to counsel patients on physical factors (ie, physical activity) that could improve the patients' symptom experience.
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Affiliation(s)
- Ann Vincent
- Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, 200 First Street SW, Rochester, MN 55902(∗).
| | - Daniel Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI(†)
| | - Terry H Oh
- Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, MN(‡)
| | - Mary O Whipple
- Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, MN(§)
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Aparicio VA, Segura-Jiménez V, Alvarez-Gallardo IC, Estévez-López F, Camiletti-Moirón D, Latorre PA, Delgado-Fernández M, Carbonell-Baeza A. Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project. Rheumatol Int 2013; 34:811-21. [PMID: 24322452 DOI: 10.1007/s00296-013-2908-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/15/2013] [Indexed: 11/26/2022]
Abstract
Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0-34.99 kg/m(2)), obesity II (BMI 35.0-39.99 kg/m(2)), and obesity III (BMI ≥40.0 kg/m(2)). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.
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Affiliation(s)
- V A Aparicio
- Department of Physical Education and Sport, Faculty of Sports Sciences, University of Granada, Granada, Spain,
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Ruiz JR, Segura-Jiménez V, Ortega FB, Álvarez-Gallardo IC, Camiletti-Moirón D, Aparicio VA, Carbonell-Baeza A, Femia P, Munguía-Izquierdo D, Delgado-Fernández M. Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study. BMJ Open 2013; 3:bmjopen-2013-002722. [PMID: 23794573 PMCID: PMC3686217 DOI: 10.1136/bmjopen-2013-002722] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia. DESIGN Cross-sectional study. SETTING Local Association of Fibromyalgia (Granada, Spain). PARTICIPANTS The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent. PRIMARY OUTCOME MEASURES Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA). RESULTS The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (-6.6 min and -7 min, respectively, per BMI category increase, <25, 25-30, >30 kg/m(2); p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051). CONCLUSIONS These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.
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Affiliation(s)
- Jonatan R Ruiz
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Faculty of Sport Sciences, Department of Physical Education and Sports, University of Granada, Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Francisco B Ortega
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Faculty of Sport Sciences, Department of Physical Education and Sports, University of Granada, Granada, Spain
| | | | - Daniel Camiletti-Moirón
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Physiology, School of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Virginia A Aparicio
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Physiology, School of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Ana Carbonell-Baeza
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Physical Education, School of Education, University of Cadiz, Cadiz, Spain
| | - Pedro Femia
- Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain
| | - Diego Munguía-Izquierdo
- Deparment of Sports and Informatics, Section of Physical Education and Sports, Faculty of Sport, University Pablo de Olavide, Seville, Spain
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
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Depression in obese patients with primary fibromyalgia: the mediating role of poor sleep and eating disorder features. Clin Rheumatol 2012. [PMID: 23208722 DOI: 10.1007/s10067-012-2132-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Depression is a prominent feature in fibromyalgia syndrome. Patients with fibromyalgia syndrome who are obese, with poor sleep quality, and those who have recurrent episodes of binge eating are at greater risk to develop depression. The aim of this cross-sectional study was to examine the hypothesis that the relationship between obesity and depression in patients with primary fibromyalgia syndrome is mediated by poor sleep, binge eating disorder (BED), and weight and shape concern. This study included 131 patients with primary fibromyalgia syndrome. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Eating Disorder questionnaire, and Fibromyalgia Impact Questionnaire. Body mass index (BMI) provided the primary indicator of obesity. Sobel test showed that the conditions for complete mediation were satisfied on the weight and shape concern as mediator between BMI and depression because the association between BMI and depression score became insignificant after controlling of weight and shape concern. However, since the association between BMI and depression remained significant after BED and poor sleep score were controlled, thus for both mediators, the conditions for partial mediation on the depression were satisfied. The findings suggest that in patients with primary fibromyalgia syndrome, weight and shape concern, BED, and poor sleep quality are important mediators of the relationship between obesity and depression. We suggest that a greater focus on these mediators in depression treatment may be indicated.
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