Balance deficits in Chronic Fatigue Syndrome with and without fibromyalgia

Effects of photobiomodulation and an aerobic exercise on the level of pain and quality of life in women with fibromyalgia

To evaluate the effectiveness of photobiomodulation (PBM) in conjunction with an aerobic exercise program (AEP) on the level of pain and quality of life of women with fibromyalgia (FM).

METHODS

A double-blinded randomized controlled trial in which 51 participants with FM were allocated into 4 groups: control group (CG) (n = 12); active PBM group (APG) (n = 12); AEP and placebo PBM group (EPPG) (n = 13); AEP and active PBM group (EAPG) (n = 14). AEP was performed on an ergometric bicycle; and a PBM (with an increase dosage regime) [20 J, 32 J and 40 J] was applied using a cluster device. Both interventions were performed twice a week for 12 weeks. A mixed generalized model analysis was performed, evaluating the time (initial and final) and group (EAPG, EPPG, APG and CG) interaction. All analyses were based on intent-to-treat for a significance level of p ≤ 0.05.

RESULTS

The intra-group analysis demonstrated that all treated groups presented a significant improvement in the level of pain and quality of life comparing the initial and final evaluation (p < 0.05). Values for SF-36 and 6-minute walk test increased significant in intragroup analysis for EPPG comparing the initial and final evaluation. No intergroup differences were observed.

CONCLUSIONS

Both exercised and PBM irradiated volunteers present improvements in the variables analyzed. However, further studies should be performed, with other PBM parameters to determine the best regime of irradiation to optimize the positive effects of physical exercises in FM patients.

Effectiveness of manual lymphatic drainage in women with fibromyalgia: A pilot study

BACKGROUND

Currently there is no treatment capable of significantly alleviating all the symptoms of fibromyalgia (FM), even though it is a complex syndrome with a high prevalence in the population.

DESIGN

Experimental study using a single-blind, randomised, clinical trial.

OBJECTIVE

To analyse the efficacy of manual lymphatic drainage (MLD) as an alternative to traditional treatment of fibromyalgia (FM) in women.

METHODS

This was an experimental study using a single-blind, randomised, clinical trial of 20 women between 30 and 55 years old with FM. Patients were divided into an experimental group (n = 10) and a control group (n = 10). During the study, 3 measurements of pain (visual analogue scale and algometry), FM impact (Fibromyalgia Impact Questionnaire), sleep quality (Index Pittsburgh), anxiety and depression (Hospital Anxiety and Depression Scale) were recorded. Treatment of the experimental group consisted of 2 weekly MLD sessions for 6 weeks.

RESULTS

The effect of the interaction of MLD showed statistically significant results in Right intercostal space (F2,36 = 3.54; p = 0.04; n2p = 0.16). The sleep quality was significantly better favour of the treatment (F2,36 = 4.16; p = 0.01; n2p = 0.20).

CONCLUSIONS

MLD therapy demonstrated effects in the experimental group in contrast to the control group across the intervention period concerning the right intercostal space and sleep-related factors. However, MLD did not result in observable alterations in pain perception.

People with Long Covid and ME/CFS Exhibit Similarly Impaired Balance and Physical Capacity: A Case-Case-Control Study

PURPOSE

Postural sway and physical capacity had not previously been compared between people with long COVID and people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Therefore, this study determined postural sway and physical capacity in people with long COVID (∼16-month illness duration; n = 21) and ME/CFS (∼16-year illness duration; n = 20), vs age-matched healthy controls (n = 20).

METHODS

Postural sway was during a 30-s static stand test. Physical capacity was determined using the Timed Up and Go test and 5 Times Sit to Stand test. Throughout, participants wore isoinertial measurement units.

RESULTS

Postural sway was worse (ie, greater) in people with long COVID and ME/CFS than controls, but not different between long COVID and ME/CFS. Performance of the Timed Up and Go test and 5 Times Sit to Stand test were worse in long COVID and ME/CFS than controls, but not different between long COVID and ME/CFS. Of long COVID and ME/CFS participants, 87% and 13% exceeded the threshold for muscle weakness in the 5 Times Sit to Stand test and Timed Up and Go test, respectively.

CONCLUSIONS

These data suggest that both people with long COVID and people with ME/CFS have similarly impaired balance and physical capacity. Therefore, there is an urgent need for interventions to target postural sway and physical capacity in people with ME/CFS, and given the current pandemic, people with long COVID.

The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue

Purpose

Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with a broad spectrum of symptoms, including headache. A simple, yet powerful tool – the pain drawing identifies essential aspects such as pain distribution. The aim with this study was to 1) evaluate the significance of pain drawing as a screening tool for cervicogenic headache using a predefined C2 pain pattern, 2) assess whether there was an association between dizziness/imbalance and a C2 pain pattern, and 3) compare subgroups according to the pain drawing with respect to pain characteristics and quality of life.

Patients and Methods

Pain drawings and clinical data from 275 patients investigated for ME/CFS were stratified into: 1) cervicogenic headache as determined by a C2 pain pattern, 2) headache with no C2 pain pattern, and 3) no headache. For inference logistic regression presented with odds ratios (OR) and 95% confidence intervals (95% CI) and Kruskal–Wallis test were applied.

Results

One hundred sixteen participants (42%) were stratified to the group for which the pain drawing corresponded to the C2 pain pattern, thus indicating putative cervicogenic origin of the headache. Dizziness/imbalance was strongly associated with a C2 pain pattern; OR 6.50 ([95% CI 2.42–17.40] p ˂ 0.00), whereas this association was non-significant for patients with headache and no C2 pain pattern. Those demonstrating a C2 pain pattern reported significantly higher pain intensity (p = 0.00) and greater pain extent (p = 0.00) than the other groups, and lower health-related quality of life (p = 0.00) than the group with no headache.

Conclusion

For patients with chronic fatigue who present with a C2 pain pattern (interpreted as cervicogenic headache) the pain drawing seems applicable as a screening tool for signs associated with neuropathic and more severe pain, dizziness and reduced quality of life as detection of these symptoms is essential for targeted treatment.

Effects of Non-Pharmacological Treatment on Pain, Flexibility, Balance and Quality of Life in Women with Fibromyalgia: A Randomised Clinical Trial

Background: The functional deficits in people with fibromyalgia can be related to the level of physical activity performed. This study investigated the effectiveness of an active exercise programme versus exercise for well-being improving pain, flexibility, static balance, perceived exertion and quality of life of women with fibromyalgia; Methods: A randomised, single-blind, controlled trial was conducted. A total of 141 of women diagnosed with fibromyalgia were enrolled and randomised to an active exercise program group (n = 47), where they performed physical active exercises, an exercise for well-being group (n = 47), which performed the Qi Gong exercises named ‘the twenty Wang Ziping figures for health and longevity’, and a control group (n = 47), which did not receive any intervention, for a period of 4 weeks. Measures were taken at baseline and after the treatment. The primary outcome measures were static balance and centre of gravity (Wii-Fit Nintendo ©), flexibility (test de Wells and Dillon), pain (Visual Analogue Scale) and quality of life (Spanish-Fibromyalgia Impact Questionnaire). The secondary outcome measure was the perceived exertion during activity (BORG Scale). Results: In total, 93 participants completed the study. The mean value of the age was 52.24 ± 6.19. The post intervention results showed statistically significant improvements in the exercise for well-being and the active exercise programme groups vs. the control group in relation to pain (p = 0.006 active exercise programme group, p = 0.001 exercise for well-being group), static balance (p < 0.001 active exercise programme group) and quality of life (p < 0.001 active exercise programme group, p = 0.002 exercise for well-being group). In addition, the mean scores related to perceived fatigue during the sessions were 6.30 ± 1.88 for the active exercise programme group and 5.52 ± 1.55 for the exercise for well-being group. These differences were not significant. Conclusions: The active exercise program and exercise for well-being improved flexibility, static balance, pain and quality of life of women with fibromyalgia. The participants of the active exercise programme achieved better results that those of the exercise for well-being.

Numeric Rating Scales Show Prolonged Post-exertional Symptoms After Orthostatic Testing of Adults With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Introduction: Muscle pain, fatigue, and concentration problems are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). These symptoms are commonly increased as part of the phenomenon of postexertional malaise (PEM). An increase in the severity of these symptoms is described following physical or mental exercise in ME/CFS patients. Another important symptom of ME/CFS is orthostatic intolerance, which can be detected by head-up tilt testing (HUT). The effect of HUT on PEM has not been studied extensively. For this purpose, we assessed numeric rating scales (NRS) for pain, fatigue, and concentration pre- and post-HUT. As pain is a core symptom in fibromyalgia (FM), we subgrouped ME/CFS patients by the presence or absence of FM. Methods and Results: In eligible ME/CFS patients who underwent HUT, NRS of pain, fatigue, and concentration were obtained pre-HUT, immediately after HUT, at 24 and 48 h, and at 7 days posttest. We studied 174 ME/CFS patients with FM, 104 without FM, and 30 healthy controls (HC). Values for all symptoms were unchanged for HC pre- and post-HUT. Compared with pre-HUT, the three NRS post-HUT were significantly elevated in both ME/CFS patient groups even after 7 days. NRS pain was significantly higher at all time points measured in the ME/CFS patients with FM compared with those without FM. In ME/CFS patients, the maximum fatigue and concentration scores occurred directly post-HUT, whereas pain perception reached the maximum 24 h post-HUT. Conclusion: NRS scores of pain, fatigue, and concentration were significantly increased even at 7 days post-HUT compared with pre-HUT in ME/CFS patients with and without FM, suggesting that orthostatic stress is an important determinant of PEM.

Alteration of Postural Balance in Patients with Fibromyalgia Syndrome-A Systematic Review and Meta-Analysis

Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.

Effectiveness of Active Therapy-Based Training to Improve the Balance in Patients with Fibromyalgia: A Systematic Review with Meta-Analysis

Balance impairment is a frequent disorder in patients with fibromyalgia (FMS), increasing the risk of falls and decreasing physical function and quality of life. In recent years, the use of active therapy-based training (ATBT) has increased, with the aim of improving balance in women with FMS. Our study aimed to assess the effect of ATBT to improve different balance outcomes in subjects with FMS. A systematic review with meta-analysis was carried out. We searched PubMed Medline, SCOPUS, Web of Science, CINAHL, and PEDro (Physiotherapy Evidence Database) databases up to September 2020. We included randomized controlled trials (RCT) that assessed the balance in patients with FMS after ATBT and compared to other treatments or no intervention. In a random-effects model, the standardized mean difference (SMD) was used to calculate the effect size. Ten studies were included in the review providing data from 546 FMS patients with a mean age of 52.41 ± 2.90 years old (98% females). Our results showed a medium effect favors ATBT with respect to other therapies for monopedal static balance (SMD = 0.571; 95% CI = 0.305, 0.836; p < 0.001), dynamic balance (SMD = 0.618; 95% CI = 0.348, 0.888; p < 0.001), and functional balance (SMD = 0.409; 95% CI = 0.044, 0.774; p = 0.028). No statistically significant differences were found for balance on unstable support. The present meta-analysis showed moderate-quality evidence of a medium effect of ATBT to improve dynamic and functional balance and low-quality evidence of a medium effect to improve monopedal static balance with respect to other therapies or no intervention.