Sexual dysfunction, mood, anxiety, and personality disorders in female patients with fibromyalgia

A systematic review of personality and musculoskeletal disorders: evidence from general population studies

Introduction

We conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide.

Methods

A search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged ≥15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results

There were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were ≥18 years in these studies. No published gray literature was identified. Semi-structured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs.

Discussion

The main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs.

Conclusions

The quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021243094.

The Effect of Frequency of Sexual Intercourse on Symptoms in Women with Fibromyalgia

Objectives

Fibromyalgia is known to affect sexual function, but the effect of frequency of sexual intercourse on fibromyalgia symptom severity is unclear. This study investigated how frequently women with fibromyalgia engaged in sexual activity affected how severe the disease was.

Methods

The depression status of the participants was evaluated with the Beck Depression Inventory (BDI) and the mean monthly frequency of sexual intercourse in the last 3 months was noted. Pain levels of fibromyalgia patients were evaluated with Visual Analog Scale (VAS), pain prevalence Widespread Pain Index (WPI), symptom level Symptom Severity Scale (SSS), and fibromyalgia exposure status with Fibromyalgia Impact Questionnaire (FIQ).

Results

A hundred women with fibromyalgia with a mean age of 37.11±6.2 years and 100 healthy female controls with a mean age of 36.53 ± 5.85 years participated in the study. Female patients with fibromyalgia had higher BDI and VAS scores and lower frequency of sexual intercourse (p<0.001). While no significant relationship was observed between the frequency of sexual intercourse and VAS, FIQ, SSS and WPI scores, it was found that BDI was lower in those with an average monthly frequency of 8 or more sexual intercourses (p=0.02).

Conclusion

This study revealed that the frequency of sexual intercourse is low in female patients with FM and that depression is less common in women with FM who have a higher frequency of sexual intercourse.

Personality Disorders and Traits of ABC Clusters in Fibromyalgia in a Neurological Setting

BACKGROUND

Evidence suggests that there is substantial comorbidity between fibromyalgia and Axis II pathology (i.e., personality disorders-PDs). The aim of the current study was to find out the exact cluster (A, B, C) of PDs or traits that are more prominent in FM and may be predictors of FM diagnosis.

METHODS

Data from 86 subjects (53 with FM and 33 controls without FM) were analyzed in an observational, cross-sectional, comparative study in a neurological setting. The assessment of categorical PDs and traits was performed independently with the Structured Clinical Interview for Personality Disorders (SCID-II). Binary logistic regression was used to determine FM predictors among PD traits.

RESULTS

Compared with controls, FM patients had a higher rate of PD diagnoses (56.7 vs. 18.2%, p < 0.001). However, the rate was significantly higher only for borderline PD diagnosis (28.3% vs. 6.1% p < 0.05). The binary logistic regression analysis showed that schizotypal and schizoid (cluster A), borderline (cluster B), and dependent (cluster C) personality traits may be significant predictors of fibromyalgia (Nagelkerke R2 = 0.415).

CONCLUSIONS

Our results may reflect the association of FM with personality traits of all three PD clusters: A (eccentric), B (dramatic), and C (anxious). However, the most consistent evidence seems to be for borderline PD.

Sexuality in Women with Fibromyalgia Syndrome: A Metasynthesis of Qualitative Studies

Fibromyalgia syndrome (FMS) is a nonarticular rheumatic syndrome which presents as chronic musculoskeletal pain, stiffness and body aches. FMS affects approximately 2.5% of the population, mostly women. FMS causes physical and psychological problems and reduces quality of life. The objective of this study is to identify qualitative evidence about experiences of women diagnosed with FMS about their sexuality.

METHODS

Metasynthesis of qualitative studies. The search included articles published between 2000 and June 2023 on the PubMed, WOS, CINAHL, SCOPUS, and SCIELO databases.

RESULTS

450 articles were found through the initial search, of which, only nine fulfilled the criteria and were included in the thematic synthesis. From this analysis, three main themes emerged: (1) "I want to, but I can't": FMS causes a shift in feminine sexuality. (2) Resetting sex life and intimacy. (3) Taking charge of a "new sexuality."

CONCLUSIONS

Women with FMS suffer from limitations of their sexuality that affect their partner. Pain, stiffness and a loss of desire make sexual encounters difficult. Becoming aware of this and striving not to lose their sexuality is key to coping with this problem. Women and their sexual partners can change roles and encourage communication, games, foreplay or touching. The use of lubricants, physical exercise and complementary therapies, along with social, professional and partner support, are key to coping with FMS.

Evaluation of sexual dysfunction in females with neck and upper back myofascial pain syndrome: a cross-sectional study

Myofascial pain syndrome (MPS) is a prevalent chronic musculoskeletal pain disorder that is frequently encountered in clinical practice and can cause sexual dysfunction in women. While there have been studies examining sexual function in various painful rheumatic conditions, particularly fibromyalgia, no studies have been conducted specifically on primary MPS. In this context, we aimed to investigate the frequency of sexual intercourse and the factors associated with it in women diagnosed with MPS. The study was designed as a cross-sectional study at a tertiary rehabilitation center between May 2022 and April 2023. Forty-five consecutive sexually active women (mean age: 38.1 ± 6.8 years) diagnosed with primary MPS were included in the study. They were compared to 45 healthy women of similar ages. The participants were interviewed regarding their weekly frequency of sexual intercourse and the importance of sexual life. Also, the Beck Depression Inventory (BDI) and the Visual Analog Scale (VAS) were assessed. The importance of sexual life score (p = 0.008), BDI (p < 0.001), VAS pain (p < 0.001), and VAS fatigue (p < 0.001) values were found to be lower in the patient group compared to the control group. The frequency of sexual intercourse was lower in the patient group, although this difference did not reach statistical significance (p = 0.083). In patients with a higher BDI score (≥ 17), the number of sexual intercourse was lower (p = 0.044), and the severity of fatigue was higher (p = 0.013). Significant associations were observed in MPS patients between the weekly frequency of sexual intercourse and VAS pain, VAS fatigue, BDI, and the importance of the sexual life score. A positive correlation was observed between the number of weekly sexual intercourses and the importance of the sexual life score (r = 0.577, p < 0.001), and negative correlations were found between BDI (r = - 0.478, p < 0.001), VAS pain (r = - 0.409, p < 0.001), and VAS fatigue (r = - 0.439, p < 0.001). Patients with MPS should be assessed for depressive mood and fatigue, as these factors may contribute to sexual dysfunction. These results may also emphasize the importance of adopting a multidisciplinary approach in the management of MPS patients with concurrent sexual dysfunction. Clinicaltrials.gov identifier: NCT05727566.

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.

Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia

Introduction

Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age.

Methods

The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale.

Results

It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors.

Discussion

Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.

Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research

Characterised by chronic widespread musculoskeletal pain, generalised hyperalgesia, and psychological distress, fibromyalgia (FM) is a significant unmet clinical need. The endogenous cannabinoid system plays an important role in modulating both pain and the stress response. Here, we appraise the evidence, from preclinical and clinical studies, for a role of the endocannabinoid system in FM and the therapeutic potential of targeting the endocannabinoid system. While many animal models have been used to study FM, the reserpine-induced myalgia model has emerged as perhaps the most translatable to the clinical phenotype. Inhibition of fatty acid amide hydrolase (FAAH) has shown promise in preclinical studies, ameliorating pain- and anxiety-related behaviour . Clinically, there is evidence for alterations in the endocannabinoid system in patients with FM, including single nucleotide polymorphisms and increased levels of circulating endocannabinoids and related N-acylethanolamines. Single entity cannabinoids, cannabis, and cannabis-based medicines in patients with FM show promise therapeutically but limitations in methodology and lack of longitudinal studies to assess efficacy and tolerability preclude the current recommendation for their use in patients with FM. Gaps in the literature that warrant further investigation are discussed, particularly the need for further development of animal models with high validity for the multifaceted nature of FM, balanced studies to eliminate sex-bias in preclinical research, and ultimately, better translation between preclinical and clinical research.

Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review

BACKGROUND

Changes in sex hormones during menopause may have detrimental effects on a woman's sexual function and cause mood disorders. The treatment of both conditions is a challenge in gynecology.

AIM

To review the published literature on sexual function and mood disorders among peri- and postmenopausal women.

METHODS

The review is based on the methodological framework of scoping reviews. We searched electronic databases including Medline (PubMed), Scopus, Embase, and Web of Science (WoS). Publications that reported data about the relationship between sexual function and mood disorders among menopausal women were included in the review. The search was not subject to any limitation in terms of time or method.

OUTCOMES

The main outcome measures used for the review were sexual dysfunction and mood disorders.

RESULTS

We found 106 total records. After a full-text screening we included 19 studies from 1986 to 2020 based on various methodologies; the majority of the studies16 were cross-sectional. Investigations that addressed the symptoms of mood disorders and some domains of sexual function showed a close relationship between sexual dysfunction and mood disorders among menopausal women.

CLINICAL IMPLICATIONS

In clinical practice, it would be appropriate to screen women for at least one mood disorder or sexual dysfunction. If a woman suffers from either, it will be necessary to assess for a further disorder as well.

STRENGTHS & LIMITATIONS

The review was based on a detailed search of the published literature concerning mood disorders and sexual dysfunction among menopausal women compared to women of reproductive age. Despite the clinical importance of the subject, the number of studies eligible for inclusion in the review are rather small. Further investigation of the topic is clearly warranted.

CONCLUSIONS

While the association between sexual dysfunction and mood disorders appears to be bidirectional, future studies will have to investigate the specific mechanisms by which sexual dysfunction could lead to mood disorders (or vice versa). Future studies should specifically address sexual dysfunctions and attitudes of partners, BMI, family support, sleep, and multiparity. Azam Rahmani, Elahe Afsharnia, Julia Fedotova, Shirin Shahbazi, Arezoo Fallahi, Leila Allahqoli, Reza GhaneipoklGheshlagh, Sarah Abboud, Ibrahim Alkatout. Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review. J Sex Med 2022;19:1098-1115.

Body Image, Medication Use, and Mental Health among Women with Fibromyalgia in Flanders, Belgium

Fibromyalgia (FM) is a chronic illness that does not have clear physical consequences, yet research shows that FM patients often have a low body image. An online cross-sectional study was conducted in Flanders, Belgium, among FM women who are connected to the Flemish League for fibromyalgia patients. An adjusted Body Image Scale (BIS) was used to assess body image, the General Health Questionnaire-12 (GHQ-12) was used for mental health, and the Visual Analogue Scale Fibromyalgia Impact Questionnaire (VASFIQ) was used for FM symptoms. Medication use was assessed by using a 4-point Likert scale. Time since diagnosis and age was assessed. A total of 103 women with FM responded. Linear regression showed that BIS was best predicted in a model by using VASFIQ, GHQ-12, time since diagnosis, and sleep medication, wherein only the GHQ-12 was significant as a variable (B = 0.292; p = 0.009). This model explained 19.3% of the variance. The role of sleep medication use disappeared when controlling for mental health. Mental health was more clearly associated with body image than medication use, or even fibromyalgia symptoms. Thus, having negative mental health is associated with a negative body image. In order to improve the body image of FM patients, symptom control alone is not enough; improving mental health is equally important.

Exploring the comorbidity between personality and musculoskeletal disorders among adults: A scoping review

INTRODUCTION

There is growing awareness of the comorbidity between mental and musculoskeletal disorders (MSDs) and their associated burden. We aimed to explore what is known regarding the existing epidemiological clinical-and population- based literature on the comorbidity between personality disorders (PDs) and MSDs specifically. In addition, we aimed to investigate their associated burden by examining a range of outcomes including morbidity/mortality, patient- and clinical-reported outcomes, work-related outcomes, hospital admissions, and financial costs. Finally, we sought to identify gaps in the literature and provide recommendations for further research.

METHODS

Studies with participants 15 years of age were eligible. Categorical PDs/features (DSM-III/IV/5 or ICD 9/10), identified by a health care professional, medical records, diagnostic interviews, or self-administered questionnaires. The definitions/groupings of MSDs were guided by the ICD-10 including conditions of the back, joints, and soft tissue, and disorders of bone density and structure. Published peer-reviewed and gray literature were considered. Eligible study designs were cohort, case-control, and cross-sectional studies, and existing reviews of observational studies. Identification and selection of articles, data extraction and the presentation of the results was conducted according to the Joanna Briggs Institute methodological guidance and the PRISMA extension for scoping reviews.

RESULTS

In total, 57 articles were eligible including 10 reviews and 47 individual studies. Across clinical and population settings, we detected evidence of comorbidity between PDs and chronic back/neck/spine conditions, arthritis, and fibromyalgia, and emerging evidence of associations between PDs and reduced bone mineral density. In terms of knowledge gaps, the burden associated with PDs and MSDs is poorly understood, as is their underlying mechanisms.

DISCUSSION

This scoping review might prompt further research into PDs and MSDs as separate groups of disorders, along with their comorbidity and the mechanisms that may link them.

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/mxbr2/registrations.

Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders

Background

Fibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.

Aim

To investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.

Methods

An online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).

Main Outcome Measure

Global sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.

Results

One hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.

Conclusion

Depressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.

Van Overmeire R, Vesentini L, Vanclooster S, et al. Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders. Sex Med 2022;10:100457.

Chronic primary or secondary non-inflammatory musculoskeletal pain is associated with disrupted sexual function and relationships: a systematic review

OBJECTIVE

Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across non-inflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and secondary musculoskeletal pain with intimate relationships and sexual function.

METHODS

Four electronic databases were searched from 1^st January 1990 to 5^th September 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria.

RESULTS

Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores ≤26.55 for the pain group, indicating sexual dysfunction. In four studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image and self-worth.

CONCLUSION

Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic non-inflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centred musculoskeletal pain care.

Association between Psychopathological Dimensions and Sexual Functioning/Sexual Arousal in Young Adults

Psychological-psychiatric factors have a different effect on sexual functioning in men and women. This research aimed to examine the association between psychopathological dimensions and dimensions of sexual functioning in Spanish young adults in two studies. Study 1 examined sexual functioning and psychopathological dimensions in 700 women and 516 men. Study 2 conducted an experimental laboratory task to evaluate subjective sexual arousal and genital sensations when watching visual sexual stimuli in a subsample of participants from Study 1 (143 women and 123 men). As a result, the first study showed that depression and anxiety-related symptoms had a negative effect, both in men and women, and having a partner had a positive influence on the dimensions of sexual functioning. The second study showed that anxiety symptoms were positively associated with subjective sexual arousal in both men and women, and anxiety was associated with the assessment of genital sensations in men. The differences between the results of anxiety may be explained because sexual arousal was evaluated in general terms in Study 1, whereas it was evaluated as a state in Study 2. These findings confirm that the presence of psychopathological symptoms contributes to sexual functioning, as well as the necessity of strengthening mental illness prevention programs that include sexual health components.

Fibromyalgia and sexual performance: a cross-sectional study in 726 Brazilian patients

Fibromyalgia (FM) causes generalized musculoskeletal pain and sexual life may also be impaired in these patients. We aimed to study sexual performance in FM patients comparing them with healthy controls and verify if there is association of epidemiological variables, degree of musculoskeletal pain and associated diseases with sexual performance in this group of patients. This is a cross-sectional study based in an internet survey. FM and controls filled a questionnaire on epidemiological data, associated diseases, and musculoskeletal pain. Also answered the validate questionnaires Female Sexual Function Index (FSFI) and the Sexual Quotient-Females (SQ-F) to evaluate the sexual performance. The survey was answered for 1584 individuals: 726 FM patients and 858 paired controls. Sexual performance evaluated by FSFI and by SQ-F was worse in the FM group than controls in all studied domains (all with p < 0.0001). According to SQ-F, 63% of them had a regular to null performance; according to FSFI, 83% had sexual dysfunction. Sexual performance was worse in those on menopause (< 0.0001). A modest correlation of age (rho - 0.09 for SQ-F and - 0.10 for FSFI) and degree of musculoskeletal pain (rho = - 0.21 for SQ-F and - 0.23 for FSFI) with sexual performance indexes were found. Psychiatric illness was also associated with lower SQ-F (p = 0.001). There is a high prevalence of sexual dysfunction in FM that associates with the presence of menopause, psychiatric comorbidities, older age, and high degree of musculoskeletal pain.

Sexual performance and pelvic floor muscle strength in patients with fibromyalgia: a controlled cross-sectional study

BACKGROUND

Fibromyalgia (FM) is characterized by chronic and widespread pain, sleep disturbances, fatigue, psychological distress and morning stiffness. These patients also present symptoms such as depression, sexual dysfunctions and reproductive problems. Sexuality involves several aspects, including pelvic floor functionality, and one question is whether the sexual performance of women with fibromyalgia is associated with pelvic floor function or other characteristics of the disease.

OBJECTIVE

The aim of this study was to gauge the association between perineal function and sexual performance in women with and without fibromyalgia.

METHODS

We performed a cross-sectional study with 109 sexually active women from 19 to 65 years of age, either suffering from fibromyalgia (FM group, n = 51) or free from fibromyalgia (non-FM group, n = 58). Perineal function was measured with the use of perineometry and digital vaginal palpation (PERFECT Scheme), while sexual performance was assessed by the Sexual Quotient Female questionnaire (QS-F).

RESULTS

Patients with fibromyalgia presented poor sexual performance compared to those without fibromyalgia (QS-F score 58 (32-66) vs. 66 (56-70); p = 0.002) as well as lower pelvic floor muscle strength measured by perineometry (32.5 (18.2-40.5) vs. 37.9 (23.4- 57.3); p = 0.03). Patients without fibromyalgia presented a positive correlation between perineometry and QS-F (r = 0.22; p = 0.038), while those with fibromyalgia presented no correlation between those two variables (r = 0.22; p = 0.12). The regression model showed an association between sexual performance and the presence of fibromyalgia, pelvic floor muscle strength (perineometry) and age, according to the following equation: sexual performance = 48.52 + (9.5 * non-FM group) + (0.23 * perineometry)-(0.4 * age), with adjusted R² = 0.19.

CONCLUSION

Women with FM present poor sexual performance and lower pelvic floor muscle strength compared to those without FM. However, the correlation between these variables among women without FM was not observed in women with FM. Sexual performance showed a positive association with absence of fibromyalgia and higher pelvic floor muscle strength, and a negative association with age.

[Systematic review of personality disorders and sexual dysfunction]

BACKGROUND

Personality disorders and sexual response are two closely related aspects, and knowledge of the relationship between both variables will serve to provide quality care to patients.

METHODS

The aim of the present study was to conduct a systematic review on the relationship between personality disorders and sexual dysfunctions.

RESULTS

Fourteen scientific articles published between 2006 and 2016 met the inclusion criteria to be part of this review. This work has allowed organizing the scarce information coming from scientific works referred to the existing relations between personality disorders and sexual dysfunctions.

CONCLUSION

It concludes with the need to carry out more research in this area.

Morphological changes in the temporomandibular joints in women with fibromyalgia and myofascial pain: A case series

Objective: This study investigated the temporomandibular joint (TMJ) morphological changes in women with fibromyalgia (FM) through clinical and tomographic evaluation.Methods: Ten women diagnosed with myofascial pain who were being treated for FM in a university hospital were included in this study. The data were collected through clinical examination and cone beam computed tomography evaluation of the TMJ in closed and open mouth positions.Results: All patients had crackling in the joint, a habit of grinding teeth during sleep, muscle stiffness, and tinnitus. The tomographic findings revealed a higher frequency of condylar bone wear, reduction of joint space, and posterior positioning of the mandibular condyle. The temporomandibular disorders with the highest prevalence were osteoarthritis and disc displacement with reduction.Conclusion: The findings suggest that women with FM have a high frequency of TMD related to the displacement of the articular disc, condyle position, and occurrence of osteoarthritis.

Sexual pain and IC/BPS in women

Interstitial cystitis/bladder pain syndrome (IC/BPS) and female sexual dysfunction (FSD) are common conditions that substantially reduce women's health. In particular, women with IC/BPS show vulvodynia, a kind of FDS that originates from consistent pain around the vulvar area. There have been many studies attempting to find the underlying mechanisms that induce the chronic pain associated with IC/BPS and vulvodynia and explain why these two conditions often coexist. Proposed theories suggest that pain hypersensitivity is being mediated by peripheral and central sensitization. However, there are still many unknown factors, such as etiologies, that can evoke pain hypersensitivity and may be linking the casual relationship between IC/BPS and vulvodynia. At present, knowledge regarding IC/BPS and vulvodynia are insufficient when considering their clinical importance. Therefore, efforts are necessary to elucidate the issues surrounding IC/BPS and vulvodynia.

The association between fibromyalgia and female sexual dysfunction: a systematic review and meta-analysis of observational studies

Female sexuality in patients with fibromyalgia has received little attention in the literature, and published data have mainly relied upon a small sample size with evident heterogeneity. Our aim was to pool the observational studies on the association between fibromyalgia and sexual dysfunction in female patients to reach a more comprehensive and reliable result. The literature search comprised of Pubmed-Medline, Cochrane, and Embase databases. The relevant studies that met the inclusion criteria were gathered and the pooled effect size was calculated. The standard mean difference of the global sexual function score as well as the sub-items scores were calculated using the random-effect size model. Sensitivity analysis was conducted. Publication bias was assessed using Funnel plots and Begg and Mazumdar rank correlation tests. The meta-analysis was conducted in accordance with the MOOSE guideline. The six selected studies contained 919 participants (ranging from 51 to 362). Of those, 578 were patients with fibromyalgia, and 341 were the controls. While four studies evaluated the sexual function using the female sexual function index (FSFI) questionnaire, two used changes in the sexual functioning questionnaire (CSFQ). Patients with fibromyalgia had a decreased total sexual function score [(-5.02 (-7.58 to -2.46), p < 0.0001; Q = 664.28; p-value for heterogeneity = p < 0.0001; I² = 99.24%)]. All sexual response cycle domains including desire, arousal, orgasm, pain, lubrication, and satisfaction were found detrimental in patients with fibromyalgia compared with the healthy controls. For the sensitivity analysis, omitting any one of the six studies did not produce a significant difference in the original pooled summary effect size. Our meta-analysis provided a clear association between female sexual dysfunction and fibromyalgia, suggesting patients with fibromyalgia should be assessed regarding sexual health, although further, well designed longitudinal studies are needed to establish the causality between fibromyalgia and female sexual dysfunction.

Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review

Introduction:

Fibromyalgia (FM) is the second most common rheumatic disease with many effects on patient's quality of life. It has been described as a chronic condition characterized by widespread musculo-skeletal pain, sleep disorders and prominent fatigue. Regarding the role of personality factors in fibromyalgia, researchers have focused both on personality traits and psychopathological aspects showing inconsistent results. In particular, several studies have examined the role of alexithymia in FM patients, a trait of personality characterized by difficulty in identification, recognition and description of emotions and feelings, while others have focused on a specific type of personality, such as type D personality (distressed personality). Other studies investigated personality in FM patients referring to Cloninger’s model, a psychobiological model of personality that includes both temperamental and character dimensions of personality. Analyzing scientific literature on this subject seems well suited to provide a critical review of the latest studies and their results.

Methods:

The method used for this review satisfies the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). We identified PsycInfo and PubMed as databases for our research.

Results:

Personality is studied under many aspects and a reference model is not always present. Many studies underline high levels of alexithymia and type D personality in FM patients but when depression is controlled, these results do not differ from those of healthy controls.

Conclusion:

Studies that use a comprehensive model of personality present a different theoretical approach and use alternatively the Big-Five model, Eysenck’s and Cloninger’s models. The use of a comprehensive model of personality and the control of psychopathological disorders, such as anxiety and depression, seem to be very relevant for a better understanding of a specific personality profile associated with fibromyalgia.

Frequency of mental disorders among chronic pain patients with or without fibromyalgia in Japan

Aim

To explore the characteristics of psychiatric morbidity in chronic pain patients who present with or without fibromyalgia.

Methods

Patients are referred to our chronic pain clinic from primary medical institutions, as we are a secondary medical institution. Although some patients have chronic pain, they have no clear organic disorder such as rheumatoid arthritis to account for the pain. Among the 367 new patients seen during the period from March 2009 to August 2012, 347 patients underwent psychiatric evaluation in face‐to‐face interviews with mental health specialists before a physical examination.

Results

Of the 347 patients examined, at least one psychiatric diagnosis was made for 94.6%. The average number of DSM‐IV‐TR diagnoses was 1.46 in the 330 chronic pain patients who had at least one psychiatric diagnosis. The breakdown of the number of psychodiagnoses was one in 60.8%, two in 27.1%, three in 4.9%, and more than three in 2.3% chronic pain patients with or without fibromyalgia. In fibromyalgia patients, the highest relative frequencies were found for somatoform disorders (76%), followed by dysthymic disorder (17%) and major depressive disorder (15%). In patients without fibromyalgia, the highest relative frequencies were found for somatoform disorders (64%), followed by major depressive disorder (15%) and dysthymic disorder (14%). Psychiatric disorders were found in 96.9% of fibromyalgia patients, and in 93.5% of chronic pain patients without fibromyalgia in Japan (no significant difference using chi‐square test).

Conclusion

Results show that chronic pain patients with or without fibromyalgia are extremely likely to be diagnosed with a psychiatric disorder.

Psychodiagnoses of fibromyalgia patients and chronic pain patients without fibromyalgia.

The complexities of fibromyalgia and its comorbidities

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.

Prevalence of personality disorders in patients with fibromyalgia: a brief review

Fibromyalgia (FM) is a complex musculoskeletal pain disorder characterized by widespread pain, fatigue, and other functional symptoms. Patients with FM are frequently affected by psychiatric disorders. Clinicians typically observe certain personality characteristics or traits associated with FM, but there is still a lack of studies about personality disorders (PDs) in patients with FM. Aim of our brief review is to summarize the literature to date on prevalence of PDs in FM. We searched the PubMed electronic database for all articles up to 1 February 2017, and identified a number of reports about prevalence of PDs in patients with FM. Most of studies show that the proportion of PDs diagnosed in patients with FM appears far greater than that found in the general population. We suggest that is very useful to evaluate PDs in patients with FM systematically, in order to improve the understanding, assessment, and treatment of this clinical condition.

Attachment styles, pain intensity and emotional variables in women with fibromyalgia

This study aims to explore the relations between attachment styles and pain intensity and certain emotional variables (anxiety, depression and alexithymia) in a sample of fibromyalgia patients, in comparison with healthy women. Data were collected from 146 women with fibromyalgia and 122 healthy women. The variables studied were attachment style, pain intensity, anxiety, depression and alexithymia dimensions. Patients with fibromyalgia showed lower percentages of secure attachment style (69.9% vs. 86%) whilst showing higher avoidant attachment (19.8% vs. 7.4%), as well as increased numbers of anxious-ambivalent attachment (10.3% vs. 6.6%) than healthy women (X²  = 9.915, p = .007). Also, fibromyalgia patients showed significantly higher scores in two of the insecure attachment factors (p < .000; p = .020) and lower scores on the secure attachment factor (p = .008) in comparison with healthy women. Higher scores of alexithymia were found in women showing anxious-ambivalent and avoidant attachment styles in comparison with those showing a secure attachment style, regardless of the group they belonged to. In fibromyalgia patients, higher anxiety (p = .005) was found among the women with anxious-ambivalent attachment styles (Mean = 15.15; SD = 1.15) in comparison with those with secure attachment style (Mean = 11.18; SD = .45). No relation was found between attachment style and pain intensity. Avoidant attachment seems to carry out a contradictory role and warrants further research. The results found seem to highlight the need for the Attachment-Diathesis Model of Chronic Pain to include attachment styles as a predictor of the emotional experience of pain in fibromyalgia patients.

Depression, sexuality and fibromyalgia syndrome: clinical findings and correlation to hematological parameters

Objective

To investigate sexuality and depression in women with FM compared with controls and to correlate the findings with hematological parameters.

Methods

33 women with FM and 19 healthy women were included and evaluated with the following instruments: Female Sexual Function Index, Beck Inventory, Visual Analogue Scale, medical history and laboratory exams.

Results

The prevalence of sexual dysfunction (P = 0.007) and depression (P < 0.001) were higher in the study group than in the control group; they were positively correlated (P = 0.023). The study group showed lower serum concentrations of testosterone, free T4, antinuclear factor, and lower blood hemoglobin and hematocrit.

Conclusions

FM was associated with high scores of sexual dysfunction and depression, and there were correlations with hematological parameters. We suggest the involvement of immune-inflammatory mediators and FM, which need further investigation to understand their role in FM syndrome and its comorbidities.

Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study

Fibromyalgia and chronic fatigue syndrome are disorders that often occur simultaneously and are characterized by widespread pain and persistent fatigue. The patients are associated with disability and impairment social and physical functions. There are many remedies in traditional Persian medicine suggested for management of the disease complaints. The aim of this study was to investigate the clinical presentations and pathophysiology of disorders with the basic and principal textbook of traditional Persian medicine written by Avicenna (Canon of Medicine). According to Persian medicine, the term E’aya can be matched by mentioned disorders. Avicenna believed that strenuous activities play an important role in the beginning of some types of fatigue. He classified fatigue into 4 groups, and in each type the clinical symptoms varied. The multifaceted entity of fibromyalgia and chronic fatigue syndrome in Persian medicine and conventional medicine suggests multidisciplinary therapies in management of these disabling disorders.

Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study

AIMS

The aim of this study was to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality.

BACKGROUND

Fibromyalgia syndrome is a chronic pathology, which compromises a woman's physical, mental and emotional health. Although concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms.

DESIGN

An interpretive qualitative research methodology using Gadamer's philosophical hermeneutics was carried out.

METHODS

This qualitative study explores the sexuality of women with fibromyalgia syndrome. A focus group and semi-structured interviews were conducted with 13 women with fibromyalgia syndrome. Data were collected between April - June 2014. Participants were recruited until findings reached saturation.

FINDINGS

Three themes define the perception of sexuality for these women: (i) Physical impact: don't touch, don't look; (ii) Sexuality and identity: fighting against their loss; (iii) Impact on the relationship: sexuality as a way of connecting the couple.

CONCLUSION

Despite limitations, sexuality is important for the identity and quality of life of women with fibromyalgia syndrome. Together with the physical symptomology, guilt, fear and a lack of understanding compromise the coping process. Women need the support of their partner, their socio-family environment and health professionals. Nurses can aid the successful adjustment to sexual problems related to fibromyalgia syndrome.

Poor Illness Perceptions Are a Risk Factor for Depressive and Anxious Symptomatology in Fibromyalgia Syndrome: A Longitudinal Cohort Study

BACKGROUND

Patients with widespread pain, such as in fibromyalgia, are vulnerable for depression and anxiety, which composes a relevant public health problem. Identifying risk factors for the onset of depression and anxiety is therefore warranted. Objective of this study was to determine whether severe pain, maladaptive coping, and poor illness perceptions are associated with depressive and anxious symptomatology in fibromyalgia.

METHOD

Consecutive patients referred to an outpatient clinic completed sets of physical and psychological questionnaires at baseline and at 18-month follow-up. A total of 452 patients with fibromyalgia syndrome (FMS) were eligible for inclusion, and subsequently, 280 patients returned the baseline questionnaire. Depressive and anxious symptomatology was measured with the Hospital Anxiety and Depression Scale. To measure pain severity, coping style, and illness perceptions, the Fibromyalgia Impact Questionnaire, Pain Coping Inventory, and the Illness Perception Questionnaire-Revised (IPQ-R) were used, respectively. Multivariable logistic regression analyses, bootstrapping and calibration, were performed to examine the association of pain severity, pain coping, and illness perception with depressive and anxiety symptoms at follow-up, adjusted for sociodemographic variables. Initial level of depressive and anxiety symptoms was selected as covariates.

RESULTS

Mean age was 42.6 years and 95.4% were female. At 18-month follow-up, 68 (of the 195) patients were depressed and 80 (of the 197) were anxious. Only the IPQ-R subscale "emotional representations" showed a significant positive association with depressive symptoms at follow-up (OR = 1.10), next to the initial level of depressive symptoms (OR = 1.30). In case of anxiety, only the IPQ-R subscale "treatment control" showed a significant negative association with anxiety symptoms at follow-up (OR = 0.87), next to the initial level of anxiety symptoms (OR = 1.45).

CONCLUSION

Our data suggest that not pain severity or maladaptive coping, but poor illness perceptions are important in elevated depressive and anxious symptomatology. Patients with fibromyalgia who think their illness negatively affects their mental well-being are at increased risk for more depressive symptoms, and those who think treatment of their illness will not be effective are at increased risk for more anxiety symptoms. Strengthening illness beliefs and reducing catastrophic thinking, therefore, seem crucial factors in the treatment of patients with FMS.

Fusing literature and full network data improves disease similarity computation

Background

Identifying relatedness among diseases could help deepen understanding for the underlying pathogenic mechanisms of diseases, and facilitate drug repositioning projects. A number of methods for computing disease similarity had been developed; however, none of them were designed to utilize information of the entire protein interaction network, using instead only those interactions involving disease causing genes. Most of previously published methods required gene-disease association data, unfortunately, many diseases still have very few or no associated genes, which impeded broad adoption of those methods. In this study, we propose a new method (MedNetSim) for computing disease similarity by integrating medical literature and protein interaction network. MedNetSim consists of a network-based method (NetSim), which employs the entire protein interaction network, and a MEDLINE-based method (MedSim), which computes disease similarity by mining the biomedical literature.

Results

Among function-based methods, NetSim achieved the best performance. Its average AUC (area under the receiver operating characteristic curve) reached 95.2 %. MedSim, whose performance was even comparable to some function-based methods, acquired the highest average AUC in all semantic-based methods. Integration of MedSim and NetSim (MedNetSim) further improved the average AUC to 96.4 %. We further studied the effectiveness of different data sources. It was found that quality of protein interaction data was more important than its volume. On the contrary, higher volume of gene-disease association data was more beneficial, even with a lower reliability. Utilizing higher volume of disease-related gene data further improved the average AUC of MedNetSim and NetSim to 97.5 % and 96.7 %, respectively.

Conclusions

Integrating biomedical literature and protein interaction network can be an effective way to compute disease similarity. Lacking sufficient disease-related gene data, literature-based methods such as MedSim can be a great addition to function-based algorithms. It may be beneficial to steer more resources torward studying gene-disease associations and improving the quality of protein interaction data. Disease similarities can be computed using the proposed methods at http://www.digintelli.com:8000/.

Electronic supplementary material

The online version of this article (doi:10.1186/s12859-016-1205-4) contains supplementary material, which is available to authorized users.