Somatic symptom presentations in women with fibromyalgia are differentially associated with elevated depression and anxiety

The role of pain intensity and depressive symptoms in the relationship between sleep quality and postural control among middle-aged and older adults with Fibromyalgia

OBJECTIVE

Fibromyalgia (FM) is a chronic pain condition often accompanied by sleep problems and depression that are each associated with reduced physical ability including postural control. Research supports a sequential association between pain intensity and depression in FM, and poor sleep quality may play a key role in this relationship. This study aimed to verify a serial pattern of associations among sleep quality, pain intensity, and depressive symptoms and quantify these effects on objective postural control.

DESIGN

Community-residing adults diagnosed with FM (n = 155; Mage = 61.08, SD = 7.70; 93% female; 79% White) were included in this cross-sectional study.

MAIN OUTCOMES

Participants self-rated sleep quality (restorative sleep, sleep waking, and sleep latency), pain intensity, and depressive symptoms, and the Fullerton Advanced Balance (FAB) scale and 8-Foot Up and Go Test (8FUPGT) measured objective postural control.

RESULTS

Findings indicated that the serial association between pain intensity and depressive symptoms fully mediated the relationship between sleep quality and both FAB (95% CI [-.125, -.013]), and 8FUPGT (95% CI [.002, .033]) performance.

CONCLUSION

Findings highlight the serial association of pain intensity and depressive symptoms with objective postural control performance and the potential for sleep and depression interventions that may maximize functional outcomes in FM.

Sleep profile and its correlation with clinical variables in fibromyalgia syndrome: A cross-sectional study

Objective

A scarcity of literature exists on sleep quality in fibromyalgia syndrome (FMS) in Indian patients. The current study described the sleep profile of patients with FMS with poor sleep quality residing in urban Bangalore and determined the relationship between poor sleep and fibromyalgia variables.

Methods

Eighty-six patients with FMS were included in the study. Pittsburgh Sleep Quality Index (PSQI) and Revised Fibromyalgia Impact Questionnaire (FIQR) were used to evaluate the sleep profile and fibromyalgia variables. Spearman's rank correlation, t-test, and one-way analysis of variance were used for the analyses.

Results

Ninety-one percent of patients with FMS were identified as poor sleepers (PSQI >5). The mean PSQI global score of the included patients was 12.04 ± 3.5. The global sleep score varied with sex (p = 0.003) and fibromyalgia severity (p = 0.001). A significant correlation was found between PSQI global score and FIQR total score (r = 0.4, p < 0.001), FIQR subdomains (r = 0.2-0.4, p < 0.05), and FMS duration (r = 0.26, p < 0.05). The PSQI global score was also correlated with pain, depression, memory, anxiety, balance, and sensitivity (r = 0.2-0.3, p < 0.05).

Conclusion

Sleep disturbance is highly prevalent in patients with FMS residing in urban Bangalore. Sleep quality tends to worsen in females with increasing FMS severity and duration but does not differ across other demographic variables. Sleep quality is significantly correlated with somatic as well as psychological variables. Future studies evaluating the predictors of poor sleep are needed to further corroborate these findings.

The protective roles of affectionate behaviors and communication on mental quality of life of couples living with fibromyalgia: movement toward a dyadic perspective

This study assessed the impact of affectionate behaviors and communication problems on the mental quality of life (mQoL) in couples with fibromyalgia. Dyadic multilevel modeling in 204 fibromyalgia couples found that people with fibromyalgia (PwFM) who engaged in high levels of affectionate behaviors with their partner had improved mQoL. There was no significant association between affectionate behaviors and mQoL for their partners. Similarly, when PwFM and their partners had more communication problems within the couple, they had poor mQoL. Both models found that higher levels of pain interference for PwFM were significantly associated with poorer mQoL for both members of the couple. Young partners were significantly more likely to report poorer mQoL. Findings highlight the importance of the interpersonal context of fibromyalgia and the protective roles that affectionate behaviors and positive communication can play. Clinicians should include the partner in the care plan and treat the couple as one unit to better optimize the health of both members.

The frequency of psychiatric disorder co-morbidities in patients with fibromyalgia: A cross-sectional study in Iran

AIM

This study aimed to investigate psychiatric disorders in Iranian female patients with fibromyalgia (FM).

DESIGN

Female patients, newly diagnosed with FM, were interviewed by a psychiatrist for psychiatric assessments during a 2-year period.

METHODS

The diagnosis of the psychiatric disorders was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

In total, 159 patients with the mean age of 42.15 ± 9.89 were recruited in this study. Over 92% of the cases were also diagnosed with at least one type of psychiatric disorder. Sleep disorders (SDs, 90.57%), mood disorders (MDs, 52.83%), personality disorders (PDs, 40.25%) and anxiety disorders (ADs, 16.98%) were the most prevalent diagnoses among these patients. The logistic regression results correspondingly showed that suffering from Cluster-B PDs was associated with a higher prevalence rate of somatic symptom disorders (SSDs), with a p-value of 0.019 and an odds ratio (OR) of 2.7.

The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM.

DATABASES AND DATA TREATMENT

Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses.

RESULTS

The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM.

CONCLUSIONS

Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended.

Pathological Cycle between Pain, Insomnia, and Anxiety in Women with Fibromyalgia and its Association with Disease Impact

BACKGROUND

Pain, sleep disturbances, and mood disorders are considered common symptoms of fibromyalgia (FM). However, the interactions that are established between them and the implication that this has in the disease are not clear. The main objective of this study is to clarify the relationships established between insomnia, pain intensity and anxiety in women with FM. Additionally, the effect that the indicated pathological cycle between pain, insomnia and anxiety may have on the impact of the disease in these patients is explored.

METHODS

A total of 228 women diagnosed with FM participated in this study (mean age = 56.99 years, SD = 10.35). Measurements were conducted at two time points. Initially, the women completed self-report questionnaires about anxiety (The Hospital Anxiety and Depression Scale; HADS), sleep problems (The Insomnia Severity Index; ISI) and pain intensity (Brief Pain Inventory; BPI), and a week later, they answered questions about the impact of fibromyalgia (Fibromyalgia Impact Questionnaire- Revised; FIQ-R). For data analysis, models 4 and 6 of the Macro Process for SPSS were used.

RESULTS

Insomnia predicts higher levels of pain, which in turn predicts higher levels of anxiety, which in turn predicts a higher impact of fibromyalgia (B = 2.76, SE = 1.10, 95% CI = [0.79,5.11]). No significant results were found for the other interactions between the variables.

CONCLUSIONS

Due to the clinical and scientific relevance of the insomnia-pain-anxiety pathological cycle and given the impact it has on FM, it is especially relevant to develop programs for patients with fibromyalgia based mainly on improving sleep quality.

Validation of the 2011 and 2016 American college of rheumatology diagnostic criteria for fibromyalgia in a Chinese population

PURPOSE

To provide a foundation for clinical diagnosis, epidemiological investigation and intervention trials, we examined the reliability and validity of the American College of Rheumatology (ACR) 2011 and 2016 survey diagnostic criteria among Chinese patients based on the fibromyalgia severity (FS) scale.

METHODS

In this study, 200 fibromyalgia patients diagnosed according to the 1990 criteria (1990c) were matched with rheumatoid arthritis (RA) patients based on age and gender. The FS scale score and its subscales were examined to determine their correlations with the revised fibromyalgia impact questionnaire (FIQR). Receiver operator characteristic (ROC) analysis was performed, and test-retest reliability, internal consistency, and construct validity were examined.

RESULTS

The area under the curve (AUC) for the ACR 2011c and 2016c was 0.870 and 0.845, respectively, and the sensitivity and specificity were 78.0% and 96.0% for the 2011c and 70.5% and 98.5% for the 2016c, respectively. The FS scale and its subscales were confirmed to exhibit good internal consistency, and they were significantly correlated with the FIQR, thereby indicating adequate construct validity. Using a lower cutoff value 11 points for the FS scale score based on the generalized pain requirement might be a more effective approach in the Chinese population; this approach yielded an AUC of 0.923 and a sensitivity of 87.0% and specificity of 97.5%.

CONCLUSION

The 2011c and 2016c are reliable instruments for diagnosing fibromyalgia patients in China. The FS scale could be a valid tool to assist in fibromyalgia diagnosis, and a cutoff value 11 points is more suitable in Chinese patients.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03381131.

The Effects of Mindfulness Interventions on Fibromyalgia in Adults aged 65 and Older: A Window to Effective Therapy

Pain usually receives insufficient attention by individuals due to the misconception that pain is a natural consequence of aging. For persons aged 65 and older, a disease requiring further research is fibromyalgia, characterized by chronic pain without clear pathology. Mind-body therapies like mindfulness are beneficial for this population as they affect psychological and biological aspects of pain. These therapies emphasize a nonjudgmental acceptance of thoughts and attention to the experience without attempting to resist or change them. Despite the potential benefits of mindfulness interventions for persons with fibromyalgia aged 65 and older, only few studies have examined the effects of these therapies, yielding conflicting findings. Importantly, no study has yet to be conducted exclusively on this population. This comprehensive review examined existing literature focusing on the effects of mindfulness-based interventions on the physical and mental well-being of persons with fibromyalgia aged 65 and older. It highlights the need for further research on the relationship between mindfulness, fibromyalgia, and gerontology, calling for a standard protocol of intervention.

The Role of Depressive Disorders in Autonomic Cardiovascular Dysregulation in Fibromyalgia

OBJECTIVE

Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia.

METHODS

Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression ( n = 27), in participants with fibromyalgia without depression ( n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance.

RESULTS

Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls ( p values < .012, d values = 0.71-1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls ( p values < .013, d values = 0.62-0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls.

CONCLUSIONS

The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia.

The Affective Dimension of Pain Appears to Be Determinant within a Pain-Insomnia-Anxiety Pathological Loop in Fibromyalgia: A Case-Control Study

Background: Fibromyalgia (FM) is a chronic pain disease characterized by multiple symptoms whose interactions and implications in the disease pathology are still unclear. This study aimed at investigating how pain, sleep, and mood disorders influence each other in FM, while discriminating between the sensory and affective pain dimensions. Methods: Sixteen female FM patients were evaluated regarding their pain, while they underwent—along with 11 healthy sex- and age-adjusted controls—assessment of mood and sleep disorders. Analysis of variance and correlations were performed in order to assess group differences and investigate the interactions between pain, mood, and sleep descriptors. Results: FM patients reported the typical widespread pain, with similar sensory and affective inputs. Contrary to controls, they displayed moderate anxiety, depression, and insomnia. Affective pain (but neither the sensory pain nor pain intensity) was the only pain indicator that tendentially correlated with anxiety and insomnia, which were mutually associated. An affective pain–insomnia–anxiety loop was thus completed. High ongoing pain strengthened this vicious circle, to which it included depression and sensory pain. Conclusions: Discriminating between the sensory and affective pain components in FM patients disclosed a pathological loop, with a key role of affective pain; high ongoing pain acted as an amplifier of symptoms interaction. This unraveled the interplay between three of most cardinal FM symptoms; these results contribute to better understand FM determinants and pathology and could help in orienting therapeutic strategies.

Bodily Illusions and Motor Imagery in Fibromyalgia

Fibromyalgia (FM) is characterised by chronic, continuous, widespread pain, often associated with a sense of fatigue, non-restorative sleep and physical exhaustion. Due to the nature of this condition and the absence of other neurological issues potentially able to induce disorders in body representations per se, it represents a perfect model since it provides an opportunity to study the relationship between pain and the bodily self. Corporeal illusions were investigated in 60 participants with or without a diagnosis of FM by means of an ad hoc devised interview. In addition, motor imagery was investigated and illusions relating to body part movements and changes in body size, feelings of alienness, and sensations of body parts not belonging to one’s own body (disownership and somatoparaphrenic-like sensations) were found. Crucially, these symptoms do not correlate with any of the clinical measures of pain or functional deficits. The results showed that motor imagery was also impaired, and the severity of the deficits found correlated with the functional impairment of the participant. This indicates that disorders in body representations and motor imagery are part of the clinical expression of FM. However, while motor imagery seems to be linked to reduced autonomy and functional deficits, bodily illusions are independent and potentially represent a concurrent symptom.

Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials

OBJECTIVE

This systematic review aimed to evaluate the effectiveness of different interventions at reducing pain-related fear in people with fibromyalgia and to analyze whether the included trials reported their interventions in full detail.

DESIGN

Systematic review.

SETTING

No restrictions.

METHODS

The Cochrane Library, CINAHL, EMBASE, PsycINFO, PubMed, and Scopus were searched from their inception to April 2020, along with manual searches and a gray literature search. Randomized clinical trials were included if they assessed pain-related fear constructs as the primary or secondary outcome in adults with fibromyalgia. Two reviewers independently performed the study selection, data extraction, risk-of-bias assessment, Template for Intervention Description and Replication (TIDieR) checklist assessment, and grading the quality of evidence.

RESULTS

Twelve randomized clinical trials satisfied the eligibility criteria, including 11 cohorts with a total sample of 1,441 participants. Exercise, multicomponent, and psychological interventions were more effective than controls were in reducing kinesiophobia. However, there were no differences in decreasing kinesiophobia when self-management and electrotherapy were used. There were also no differences between groups with regard to the rest of the interventions and pain-related constructs (fear-avoidance beliefs, fear of pain, and pain-related anxiety). However, a serious risk of bias and a very serious risk of imprecision were detected across the included trials. This caused the overall certainty of the judged evidence to be low and very low. Additionally, the included trials reported insufficient details to allow the full replication of their interventions.

CONCLUSIONS

This systematic review shows that there are promising interventions, such as exercise, multicomponent, and psychological therapies, that may decrease one specific type of fear in people with fibromyalgia, i.e., kinesiophobia. However, because of the low-very low certainty of the evidence found, a call for action is needed to improve the quality of randomized clinical trials, which will lead to more definitive information about the clinical efficacy of interventions in this field.

Serotonergic Neurotransmission System Modulator, Vortioxetine, and Dopaminergic D2/D3 Receptor Agonist, Ropinirole, Attenuate Fibromyalgia-Like Symptoms in Mice

Fibromyalgia is a disease characterized by lowered pain threshold, mood disorders, and decreased muscular strength. It results from a complex dysfunction of the nervous system and due to unknown etiology, its diagnosis, treatment, and prevention are a serious challenge for contemporary medicine. Impaired serotonergic and dopaminergic neurotransmission are regarded as key factors contributing to fibromyalgia. The present research assessed the effect of serotonergic and dopaminergic system modulators (vortioxetine and ropinirole, respectively) on the pain threshold, depressive-like behavior, anxiety, and motor functions of mice with fibromyalgia-like symptoms induced by subcutaneous reserpine (0.25 mg/kg). By depleting serotonin and dopamine in the mouse brain, reserpine induced symptoms of human fibromyalgia. Intraperitoneal administration of vortioxetine and ropinirole at the dose of 10 mg/kg alleviated tactile allodynia. At 5 and 10 mg/kg ropinirole showed antidepressant-like properties, while vortioxetine had anxiolytic-like properties. None of these drugs influenced muscle strength but reserpine reduced locomotor activity of mice. Concluding, in the mouse model of fibromyalgia vortioxetine and ropinirole markedly reduced pain. These drugs affected emotional processes of mice in a distinct manner. Hence, these two repurposed drugs should be considered as potential drug candidates for fibromyalgia. The selection of a specific drug should depend on patient’s key symptoms.

Pain intensity and physical performance among individuals with fibromyalgia in mid-to-late life: The influence of depressive symptoms

This study investigated the mediating role of depressive symptoms among 147 middle-aged and older adults with FM in the relationship between pain intensity and 4 objective measures of physical performance: Fullerton Advanced Balance scale (FAB), 6-Minute Walk Test (6MWT), 30-Second Chair Stand (30SCS), and 8-Foot Up and Go Test (8FUPGT). Asymptotic mediation analyses revealed that depressive symptoms fully mediated the relationship between pain intensity and FAB (95% CI [-0.40, -0.10]) and 8FUPGT (CI [0.02, 0.11]) and partially mediated the relationship to 6MWT (CI [-9.15, -2.20]) and 30SCS (CI [-0.29, -0.06]). Findings support the evaluation of co-morbid depression in FM.

Ganoderma lucidum Effects on Mood and Health-Related Quality of Life in Women with Fibromyalgia

Fibromyalgia syndrome is a chronic rheumatic disorder characterized by generalized and widespread musculoskeletal pain. It is associated with several secondary symptoms such as psychological and pain-specific distress, which can directly impact daily functioning and quality of life, like anxiety and depression. The Ganoderma lucidum (GL) mushroom seems to be able to improve fibromyalgia symptoms, including depression and pain. The purpose of the study is to evaluate the effects of GL on happiness, depression, satisfaction with life, and health-related quality of life in women with fibromyalgia. A double-blind, randomized placebo pilot trial was carried out, with one group taking 6 g/day of micro-milled GL carpophores for 6 weeks, during which the second group took a placebo. Our results did not show any statistically significant between-group differences, although a distinct trend of improved levels of happiness and satisfaction with life and reduced depression were evident at the end of treatment compared to the baseline in the GL group. However, due to the limitations of the study protocol, additional studies are necessary to confirm these findings.

The Co-Morbidity between Bipolar and Panic Disorder in Fibromyalgia Syndrome

About half of the patients with fibromyalgia (FM) had a lifetime major depression episode and one third had a panic disorder (PD). Because the co-morbidity between bipolar disorder (BD) and PD marks a specific subtype of BD we aimed to investigate if co-morbid BD/PD (comBD/PD) occurs more frequently than the single disorder in FM patients and evaluate the clinical significance and timing of this co-morbidity. Further, we explored the role of co-morbid subthreshold BD and PD. In 118 patients with FM, lifetime threshold and sub-threshold mood disorders and PD were diagnosed with Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR) Clinical Interview. Demographic and clinical variables were compared in co-morbid BD/PD (comBD/PD) and not co-morbid BD/PD (nocomBD/PD) subgroups. The co-morbidity BD/PD was seen in 46.6% of FM patients and in 68.6% when patients with minor bipolar (MinBD) and sub-threshold panic were included. These rates are higher than those of the general population and BD outpatients. There were no statistically significant differences between threshold and sub-threshold comBD/PD and nocom-BD/PD subgroups in demographic and clinical parameters. In the majority of patients (78.2%), the onset of comBD/PD preceded or was contemporary with FM. These findings support the hypothesis that comBD/PD is related to the development of FM in a subgroup of patients.

Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial

Background

The mat Pilates method is the therapeutic modalities which can be used in fibromyalgia treatment. Although there are no well-designed studies that prove the effectiveness of the mat Pilates method in this population. The objective was to evaluate the effectiveness of the mat Pilates method for improving symptoms in women with fibromyalgia.

Methods

A single blind randomized controlled trial in which 42 women with fibromyalgia were randomized into two groups: mat Pilates and aquatic aerobic exercise. The exercises were performed twice a week for 12 weeks. Two evaluations were performed: one at baseline (T0), and another at 12 weeks after randomization (T12). The primary outcome was pain measured by the Visual Analogue Scale (VAS). Secondary outcomes were function (Fibromyalgia Impact Questionnaire), sleep (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Short Form 36 [SF-36]), fear avoidance (Fear Avoidance Beliefs Questionnaire [FABQ-BR]) and pain catastrophizing (Pain-Related Catastrophizing Thoughts Scale [PRCTS]).

Results

There was improvement in both groups in relation to pain and function (p < 0.05). The aspects related to quality of life and the FABQ questionnaire only showed improvement in the mat Pilates group (p < 0.05). There was improvement in the PSQI and PRCTS variables only in the aquatic aerobic exercise group (p < 0.05), but no differences were observed between the groups for any of the evaluated variables.

Conclusion

Significant improvements were observed in the two groups in relation to the disease symptoms, and no differences were observed between mat Pilates and aquatic aerobic exercise in any of the measured variables.

Trial registration

ClinicalTrials.gov Identifier (NCT03149198), May 11, 2017. Approved by the Ethics Committee of FACISA/UFRN (Number: 2.116.314).

Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia

Here, we report an investigation on the accuracy of the Toronto Alexithymia Scale, a measure to assess alexithymia, a multidimensional construct often associate to fibromyalgia. Two groups of participants, patients with fibromyalgia (n = 38), healthy controls (n = 38) were administered the Toronto Alexithymia Scale and background tests. Machine learning models achieved an overall accuracy higher than 80% in detecting both patients with fibromyalgia and healthy controls. The parameter which alone has demonstrated maximum efficiency in classifying the single subject within the two groups has been the item 3 of the alexithymia scale. The analysis of the most informative features, based on all scales administered, revealed that item 3 and 13 of the alexithymia questionnaire and the visual analog scale scores were the most informative attributes in correctly classifying participants (accuracy above 85%). An additional analyses using only the alexithymia scale subset of items and the visual analog scale scores has shown that the predictors which efficiently classified patients with fibromyalgia and controls were the item 3 and 7 (accuracy = 85.53%). Our findings suggest that machine learning models analysis based on the Toronto Alexithymia Scale subset of items scores accurately distinguish patients with fibromyalgia from healthy controls.

Mat Pilates and aquatic aerobic exercises for women with fibromyalgia: a protocol for a randomised controlled blind study

INTRODUCTION

Physical exercises have been recommended to improve the overall well-being of patients with fibromyalgia, with the main objective of repairing the effects of lack of physical conditioning and of improving the symptoms, especially pain and fatigue. Although widely recommended and widely known, few studies support the use of Pilates as an effective method in improving the symptoms of the disease, comparing it with other well-founded exercise modalities. This protocol was developed to describe the design of a randomised controlled study with a blind evaluator that evaluates the effectiveness of mat Pilates, comparing it with aquatic aerobic exercises, in improving pain in women with fibromyalgia.

METHODS

Sixty women aged 18-60 years with a diagnosis of fibromyalgia, with a score of between 3 and 8 points on the Visual Analogue Scale for pain, and who sign the clear and informed consent form will be recruited according to the inclusion criteria. They will be randomised into one of the two intervention groups: (1) Pilates, to perform an exercise programme based on mat Pilates; and (2) aquatic exercise, to participate in a programme of aerobic exercises in the swimming pool. The protocol will correspond to 12 weeks of treatment, with both groups performing the exercises with supervision twice a week. The primary outcome will be pain (Visual Analogue Scale for pain). The secondary outcomes are to include impact related to the disease, functional capacity, sleep quality and overall quality of life. The evaluations will be performed at three points: at baseline and after 6 weeks and 12 weeks of treatment.

ETHICS AND DISSEMINATION

This protocol has been approved by the Ethics Committee of FACISA/UFRN (number: 2.116.314). Data collection will begin after approval by the ethics committee. There will be prior contact with the women, at which time all the information about the study and the objectives will be presented, as well as resolution no 466/2012 of the National Health Council of Brazil for the year 2012, which provides guidelines and regulatory standards for research involving human beings. Participants must sign the informed consent form before the study begins.

TRIAL REGISTRATION NUMBER

NCT03149198.

Prevalence of depressive disorder among patients with fibromyalgia: Systematic review and meta-analysis

BACKGROUND

It is acknowledged that fibromyalgia (FM) as a medical (rheumatological) disorder and major depressive disorder (MDD) as a mental disorder often co-occurs, but the inconsistency is prevailing at study-level and no overall estimate of the co-occurrence exist.

AIMS

This systematic review and meta-analysis aimed to estimate the overall point- and life-time prevalence of MDD among FM patients based on structured clinical interviews (SCI); and to estimate the point-prevalence of MDD among FM patients based on screening symptom scales (SSS).

METHOD

The electronical databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO were searched for papers that reported on prevalence of MDD among FM patients. Eligible studies were included in a random effects meta-analysis pooling the prevalence of depression.

RESULTS

The literature search identified 11 eligible studies for the meta-analysis. For SCI, the overall pooled point-prevalence (PP) was 25% (95% CI 19 to 31%), and life-time prevalence (LP) was 65% (95% CI 59 to 71%). When estimating the PP with self-administered SSS the overall pooled PP was 45% (95% CI 32 to 59%), and a single clinician-administered SSS yielded a PP of 23% (95% CI 10 to 41%). There was low inconsistency for the SCI and high inconsistency for the SSS.

CONCLUSION

One fourth of all FM patients had MDD, and more than half experienced MDD during their life-time according to clinician-administered instruments. Prevalence of MDD was almost twice as high when using self-administered symptom scales and may be likely to overestimate the co-occurrence.

What causes fibromyalgia? An online survey of patient perspectives

Fibromyalgia is a severe chronic pain condition that affects every aspect of life. Causes of the condition remain unclear, and quantitative research cannot account for patients' personal illness narratives and perceptions. This online survey gathered qualitative accounts of the perceived causes of their condition from 596 people with fibromyalgia, which were analyzed thematically. Themes were "Bodily assault, ill-health, and change"; "Emotional trauma and distress"; "Stress and vulnerability"; and "Explaining and authenticating fibromyalgia." Discussion focuses on the complexity of causation, the importance of understanding and having symptoms validated, and the potential for benefiting from patient expertise in building better practitioner-client relationships.