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Vancampfort D, Van Damme T, Albanio Machado V, McGrath RL, Stubbs B, Schuch FB. Levels of sedentary behaviour in people with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1921-1927. [PMID: 37211677 DOI: 10.1080/09638288.2023.2214379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this knowledge, little attention has been attributed to estimate sedentary behaviour in this population. The aims of this meta-analysis were to: (a) establish the pooled mean time spent sedentary, (b) investigate moderators of sedentary levels, and (c) explore differences with age- and gender-matched general population controls in people with fibromyalgia (PwF). METHODS Two independent authors searched major databases until 1 December 2022. A random effects meta-analysis was performed. The methodological quality of included studies was assessed with the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS Across 7 cross-sectional studies of fair methodological quality, there were 1500 patients with fibromyalgia (age range = 43-53 years). PwF spent 545.6 min/day (95% CI = 523.7-567.5, p < 0.001, N = 3) engaging in sedentary behaviour. Self-reported questionnaires overestimate sedentary levels with 314.3 min/day (95% CI = 302.0-326.6, p = 0.001, N = 2). PwF spent 36.14 min/day (95% CI = 16.3-55.9, p < 0.001) more in sedentary behaviour than general population controls. CONCLUSIONS PwF are more sedentary than the general population. The limited available data should however be considered with caution due to substantial heterogeneity.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg - Leuven, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg - Leuven, Belgium
| | - Vanessa Albanio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Ryan L McGrath
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King"s College London, London, UK
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
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Cramer H. Ask the Expert: A Recap on Patient-Reported Outcomes. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:207-208. [PMID: 38484316 DOI: 10.1089/jicm.2024.29129.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- Editor-in-Chief
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Duhn PH, Wæhrens EE, Pedersen MB, Nielsen SM, Locht H, Bliddal H, Christensen R, Amris K. Effectiveness of patient education as a stand-alone intervention for patients with chronic widespread pain and fibromyalgia: a systematic review and meta-analysis of randomized trials. Scand J Rheumatol 2023; 52:654-663. [PMID: 37162478 DOI: 10.1080/03009742.2023.2192450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Patient education is recommended as an integral component of the therapeutic plan for the management of chronic widespread pain (CWP) and fibromyalgia (FM). The key purpose of patient education is to increase the patient's competence to manage his or her own health requirements, encouraging self-management and a return to desired everyday activities and lifestyle. The aim of this systematic review was to evaluate the evidence for the benefits and potential harms associated with the use of patient education as a stand-alone intervention for individuals with CWP and FM through randomized controlled trials (RCTs). METHOD On 24 November 2021 a systematic search of PubMed, MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, ClinicalTrials.gov, American College of Rheumatology, European League Against Rheumatism, and the World Health Organization International Clinical Trials Registry Platform identified 2069 studies. After full-text screening, five RCT studies were found to be eligible for the qualitative evidence synthesis. RESULTS Patient education as a stand-alone intervention presented an improvement in patients' global assessment (standardized mean difference 0.79, 95% confidence interval 0.13 to 1.46). When comparing patient education with usual care, no intervention, or waiting list, no differences were found for functioning, level of pain, emotional distress in regard to anxiety and depression, or pain cognition. CONCLUSION This review reveals the need for RCTs investigating patient education as a stand-alone intervention for patients with FM, measuring outcomes such as disease acceptance, health-related quality of life, enhancement of patients' knowledge of pain, pain coping skills, and evaluation of prioritized learning outcomes.
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Affiliation(s)
- P H Duhn
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science and Occupational Therapy, User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M B Pedersen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Orthopaedic Research Unit at Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - H Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
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Varrassi G, Rekatsina M, Perrot S, Bouajina E, Paladini A, Coaccioli S, Narvaez Tamayo MA, Sarzi Puttini P. Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery? Cureus 2023; 15:e44852. [PMID: 37809234 PMCID: PMC10560069 DOI: 10.7759/cureus.44852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. "Overlapping symptoms" describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic pain syndromes. A variety of pharmacologic and nonpharmacologic treatments are available for fibromyalgia, but treatment is best personalized for an individual and recognizes potential comorbidities. Opioids are not the recommended front-line treatment, cannabinoids hold promise but with limitations and nonpharmacologic options, such as aerobic or resistance exercise and cognitive behavior therapy, can play a very important but often underestimated role. Amitriptyline appears to be safe and effective in treating six of the main fibromyalgia domains: pain, disturbed sleep, fatigue, affective symptoms, functional limitations, and impaired cognition ("fibro fog"). Very low-dose naltrexone (2.5-4.5 mg) may offer analgesic and anti-inflammatory benefits to fibromyalgia patients, but further studies are needed. Fibromyalgia can be a devastating and debilitating condition for patients, and clinicians are challenged with its diagnosis and treatment as well. Further research as well as compassionate approaches to offering personalized care to those with fibromyalgia are required.
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Affiliation(s)
| | | | | | - Elyse Bouajina
- Rheumatology, Farhat Hached University Hospital Center, Sousse, TUN
| | - Antonella Paladini
- Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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Ciaffi J, Lisi L, Mari A, Mancarella L, Brusi V, Pignatti F, Ricci S, Vitali G, Stefanelli N, Assirelli E, Neri S, Naldi S, Faldini C, Ursini F. Efficacy, safety and tolerability of very low-calorie ketogenic diet in obese women with fibromyalgia: a pilot interventional study. Front Nutr 2023; 10:1219321. [PMID: 37502721 PMCID: PMC10369071 DOI: 10.3389/fnut.2023.1219321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Obesity can worsen fibromyalgia (FM) and very low-calorie ketogenic diet (VLCKD) is a potential therapeutic option for diseases that share clinical and pathophysiological features with FM. In this pilot interventional study, we investigated the effects of VLCKD in obese women with FM. Methods Female patients with FM and a body mass index (BMI) ≥ 30 kg/m2 were eligible for VLCKD. The ketogenic phase (T0 to T8) was followed by progressive reintroduction of carbohydrates (T8 to T20). Changes in BMI, Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), EuroQol 5D (EQ-5D) and 36-item Short Form Health Survey (SF-36) were evaluated. A change of 14% in FIQ was considered clinically relevant. The longitudinal association between BMI and patient-reported outcomes (PROs) was assessed using generalized estimating equations. Results Twenty women were enrolled. Two discontinued the intervention. The mean age of the 18 patients who reached T20 was 51.3 years and mean BMI was 37.2 kg/m2. All patients lost weight during the first period of VLCKD and this achievement was maintained at T20. Mean BMI decreased from 37.2 kg/m2 at T0 to 34.8 kg/m2 at T4, 33.5 kg/m2 at T8 and 32.1 kg/m2 at T20 (p < 0.001). A significant reduction of mean FIQ from 61.7 at T0 to 37.0 at T4 and to 38.7 at T8 (p < 0.001) was observed and it was maintained at T20 with a mean FIQ of 39.1 (p = 0.002). Similar results were obtained for HADS, EQ-5D and SF-36. Analysing each participant, the reduction of FIQ was clinically meaningful in 16 patients (89%) at T4, in 13 (72%) at T8 and in 14 (78%) at T20. No significant association was observed between change in BMI and improvement of the PROs over time. Adverse effects were mild and transient. No major safety concerns emerged. Conclusion These are the first data on the efficacy of VLCKD in FM. All patients achieved improvement in different domains of the disease, which was maintained also after carbohydrate reintroduction. Our results suggest that ketosis might exert beneficial effects in FM beyond the rapid weight loss. Clinical trial registration This trial is registered on ClinicalTrials.gov, number NCT05848544.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Lisi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Mari
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Pignatti
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Susanna Ricci
- Dietetic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgia Vitali
- Dietetic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Elisa Assirelli
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Susanna Naldi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Döhmen A, Kock M, Fischer F, Rose M, Obbarius A, Klapproth CP. Are OMERACT recommendations followed in clinical trials on fibromyalgia? A systematic review of patient-reported outcomes and their measures. Qual Life Res 2023; 32:1521-1536. [PMID: 36181588 PMCID: PMC10172242 DOI: 10.1007/s11136-022-03261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE Patient-Reported Outcomes (PROs) and its measures (PROMs) are key to outcome assessment in Fibromyalgia (FM) trials. The aim of this review was to investigate which domains and instruments were assessed in recent FM trials and to compare them to recommendations by the Outcome Measures in Rheumatology (OMERACT) initiative. In addition, we investigated the overlap with a generic health assessment approach, i.e. eight domains suggested by the Patient-Reported Outcome Measurement Information System® (PROMIS®). METHODS In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search in scientific databases including PubMed, PsycInfo, and Embase was conducted to identify studies that assessed at least two dimensions of health-related quality of life (HRQoL) from 2015 to June 2022. Non-randomized and randomized controlled trials were included in the analysis. We extracted PROs and PROMs used in each study. RESULTS From 1845 identified records, 107 records out of 105 studies met the inclusion criteria. Studies investigated 50 PROs using 126 different PROMs. Most frequently assessed domains were pain, depression, fatigue, and anxiety (> 95% of the studies). The disease-specific FIQ was the most frequently applied PROM (82%). Overall, only 9% of the studies covered all domains deemed mandatory by OMERACT. Very few studies covered all eight generic health domains suggested by PROMIS. CONCLUSION The majority of trials covered most OMERACT domains or generic PROMIS health domains. There was, however, great variability in the instruments used to assess the domains, which points at a limited degree of standardization in the field.
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Affiliation(s)
- Annika Döhmen
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Milan Kock
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Worcester, MA, USA
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
| | - Christoph Paul Klapproth
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Partridge S, Quadt L, Bolton M, Eccles J, Thompson C, Colasanti A, Bremner S, Jones CI, Bruun KD, Van Marwijk H. A systematic literature review on the clinical efficacy of low dose naltrexone and its effect on putative pathophysiological mechanisms among patients diagnosed with fibromyalgia. Heliyon 2023; 9:e15638. [PMID: 37206027 PMCID: PMC10189400 DOI: 10.1016/j.heliyon.2023.e15638] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Background Low dose naltrexone (LDN) is used off-label by many individuals with fibromyalgia to help manage their pain. There is no current systematic literature review summarising the evidence to support this use of LDN. The objectives of this study were to evaluate if patients with fibromyalgia prescribed LDN have reduced pain scores and greater quality of life compared with those allocated to placebo in randomized controlled trials. Secondly to determine if changes in inflammatory markers and brain structure and function are observed among patients with fibromyalgia taking LDN. Methods Systematic literature searches were conducted in MEDLINE, Embase Classic + Embase, APA PsychInfo, and The Cochrane Library from inception to May 2022. Reference lists from the selected papers were cross-checked with database search results. Results Three studies met our inclusion criteria for the assessment of efficacy, and two studies on potential LDN mechanisms. Results indicated some evidence to suggest LDN reduces pain and increases quality of life. One study reported baseline erythrocyte sedimentation rate (ESR) predicted LDN response (≥30% reduction in fibromyalgia symptoms) and a second study showed plasma concentrations of inflammatory biomarkers were lower after LDN treatment. To our knowledge, there are no brain imaging studies reporting the effect of LDN in patients with fibromyalgia. All studies were based on small sample sizes, were restricted to women and the risk of bias was assessed to be high. There is also some evidence of publication bias. Conclusion The strength of evidence from randomized controlled trials to support the use of LDN among patients with fibromyalgia is low. Two small studies suggest ESR and cytokines may be involved in the mechanism by which LDN exerts its effects. Two trials (INNOVA and FINAL) are currently in progress, but further work is needed among men and different ethnic groups.
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Affiliation(s)
- Sarah Partridge
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Lisa Quadt
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Monica Bolton
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Jessica Eccles
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | | | - Alessandro Colasanti
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Stephen Bremner
- Brighton and Sussex Medical School, University of Sussex, UK
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Lin TH, Wei JCC. Letter to the editor:" International, multidisciplinary delphi consensus recommendations on non-pharmacological interventions for fibromyalgia". Semin Arthritis Rheum 2023; 59:152169. [PMID: 36716600 DOI: 10.1016/j.semarthrit.2023.152169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Affiliation(s)
- Ting-Hsun Lin
- Department of Anaesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Anaesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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Reply on: International, multidisciplinary Delphi consensus recommendations on non-pharmacological interventions for fibromyalgia. Semin Arthritis Rheum 2023; 59:152162. [PMID: 36716598 DOI: 10.1016/j.semarthrit.2023.152162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
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Vancampfort D, Brunner E, McGrath RL, Hemmings L, Van Damme T. Correlates of sedentary behavior in people with fibromyalgia: A systematic review. Int J Rheum Dis 2023; 26:841-849. [PMID: 36972974 DOI: 10.1111/1756-185x.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Understanding the correlates of sedentary behavior (SB) is important in the development of interventions which reduce and interrupt SB in people with fibromyalgia (PwF). This systematic review aimed to investigate the correlates of SB in PwF using the socio-ecological model. METHODS Three databases (Embase, CINAHL and PubMed) were search from inception until July 21, 2022 using "sedentary" or different types of SB and "fibromyalgia" or "fibrositis" as keywords. The data collected was then analyzed using summary coding. RESULTS Out of 23 SB correlates retrieved from 7 reports (n = 1698), no correlates were consistently reported (ie, reported in 4 or more studies). Higher pain intensity was the most commonly reported barrier for reducing/interrupting SB (reported in 3 reports). Other reported barriers to reducing/interrupting SB were experiencing physical and mental fatigue, a more severe disease impact, and a lack of motivation to be physically active (all reported in 1 study). A better experienced social and physical functioning and more vitality were facilitators for reducing/interrupting SB (all reported in 1 study). To date, in PwF no correlates of SB at the interpersonal, environmental and policy levels have been explored. CONCLUSION Research on correlates of SB in PwF is still in its infancy. The current preliminary evidence suggests that clinicians should consider physical and mental barriers when aiming to reduce or interrupt SB in PwF. Further research on modifiable correlates at all levels of the socio-ecological model is required to inform future trials aiming to modify SB in this vulnerable population.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Emanuel Brunner
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Gesundheit, Ostschweizer Fachhochschule, St. Gallen, Switzerland
- Institut für Therapie und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Laura Hemmings
- University of Birmingham, School of Sport and Exercise Sciences, Birmingham, UK
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
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Ince B, Kara M, Erdem I, Yurdakul OV, Erden T, Aydın T. Effectiveness of spinal manipulation in addition to pharmacological treatment in fibromyalgia: A blinded randomized trial. PM R 2023; 15:342-351. [PMID: 36695286 DOI: 10.1002/pmrj.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND It has been suggested that spinal manipulation may alter sensorimotor integration in the central nervous system and therefore may be used to treat central sensitization syndromes. OBJECTIVE To investigate the effectiveness of spinal manipulation in addition to pharmacological treatment in patients with fibromyalgia. DESIGN A single-center, randomized, and placebo-controlled trial with three parallel arms SETTING: Outpatient clinics at a tertiary health care facility. PARTICIPANTS Female patients aged 18-55 years receiving pharmacological treatment. INTERVENTIONS Spinal manipulation, sham manipulation, and control groups. Patients in the spinal manipulation group received high-velocity low-amplitude manipulation treatment twice a week for 3 weeks. Patients in the sham group received an application that was very similar to the active treatment but was not expected to have any real therapeutic effect. Patients in the control group continued to receive pharmacological therapy. MAIN OUTCOME MEASURES The primary outcome, pain score (visual analog scale), and secondary outcomes, pressure pain threshold (PPT), Revised Fibromyalgia Impact Questionnaire (FIQR), Widespread Pain Index (WPI), and Fibromyalgia Severity Score (FSS) were measured before, 1 month, and 3 months after randomization. RESULTS Sixty patients with a mean age of 41.7 years (SD = 8.0) were enrolled in the study. A mixed-design repeated analysis of covariance was used to test the data. At 1 month after randomization, pain scores did not differ between groups. At 3 months after randomization, the spinal manipulation group had a significantly lower pain score (adjusted mean = 4.3 cm, SE: 0.4) than the control group (adjusted mean = 6.8 cm, SE: 0.4) and the sham manipulation group (adjusted mean = 5.7 cm, SE: 0.4). PPT did not differ between groups at any time point. FIQR, WPI, and FSS showed some improvement 1 or 3 months after randomization in favor of the spinal manipulation group. CONCLUSIONS Spinal manipulation used in addition to pharmacological treatment in young/middle-aged female patients with fibromyalgia could be an effective treatment for pain, disease severity, and functionality.
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Affiliation(s)
- Bugra Ince
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Mert Kara
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Irem Erdem
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopaedics and Traumatology, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Teoman Aydın
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
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Does Fibromyalgia Affect the Outcomes of Spinal Cord Stimulation: An 11-Year, Multicenter, Retrospective Matched Cohort Study. Neuromodulation 2023; 26:206-214. [PMID: 35840522 DOI: 10.1016/j.neurom.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fibromyalgia is a prevalent disorder manifesting with widespread musculoskeletal pain and central sensitization, as well as fatigue, sleep issues, psychologic distress, and poor quality of life. Patients with fibromyalgia also may be diagnosed with other painful conditions amenable to treatment with spinal cord stimulation (SCS), although it is unclear how these patients respond to SCS compared with patients without fibromyalgia. MATERIALS AND METHODS We performed an 11-year, multicenter, retrospective matched cohort study comparing SCS-treated patients with fibromyalgia and those without fibromyalgia. The primary outcome was comparison in mean calculated percentage pain relief between cohorts at six months after SCS implantation. Secondary outcomes included comparison of patient satisfaction between six and 12 months after SCS implantation, and percentage of patients reporting opioid intake and neuropathic medication intake at six months and 12 months after SCS implantation. Adjusted regression analysis was performed to make comparisons while adjusting for age, sex, body mass index, Charlson comorbidity index, preoperative opioid intake, and preoperative neuropathic medication intake. RESULTS Of 90 patients with fibromyalgia who underwent SCS trial, 18 patients (20%) failed their SCS trial and did not proceed toward implantation. Sixty-eight patients with fibromyalgia were matched to 141 patients in the control cohort based on age, sex, Charlson comorbidity index, and the American Society of Anesthesiologists physical status score. At six months after SCS implantation, there was no statistical difference in calculated percentage change in pain intensity between the fibromyalgia cohort (46.6 ± 29.0) and the control cohort (50.9 ± 32.8; β, -18.4; 95% CI, -44.3 to 7.6; p = 0.157). At baseline, a greater percentage of patients in the fibromyalgia cohort reported preoperative opioid intake (51.5% vs 22.7%, p < 0.001) and preoperative neuropathic medication intake (67.6% vs 15.6%, p < 0.001). However, there was no difference between cohorts in the percentage of patients taking opioid or neuropathic medications at six months and 12 months after SCS implantation. Similarly, there was no difference between cohorts in the percentage of patients reporting satisfaction between six and 12 months. CONCLUSION Patients with fibromyalgia who received a diagnosis approved for treatment with SCS may expect similar post-SCS-implantation pain relief, overall satisfaction, and analgesic use rate to those of patients without fibromyalgia.
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Allsop VL, Schmid AA, Miller KK, Slaven JE, Daggy JK, Froman A, Kline M, Sargent C, French DD, Ang D, Van Puymbroeck M, Schalk NL, Bair MJ. The Pain Outcomes Comparing Yoga vs. Structured Exercise (POYSE) Trial in Veterans With Fibromyalgia: Study Design and Methods. FRONTIERS IN PAIN RESEARCH 2022; 3:934689. [PMID: 35875477 PMCID: PMC9300933 DOI: 10.3389/fpain.2022.934689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFibromyalgia is a common pain condition that often leads to significant disability. Unfortunately, the effectiveness of most medications for fibromyalgia is limited, and there is a need for alternative, non-pharmacological therapies. Yoga and aerobic exercise are both evidence-based non-pharmacological treatments for fibromyalgia. However, no prior studies have directly compared the effectiveness of yoga vs. exercise.ObjectiveThis article describes the study design and recruitment outcomes of the Pain Outcomes comparing Yoga vs. Structured Exercise (POYSE) Trial, a two-arm randomized comparative effectiveness trial.MethodsVeterans with fibromyalgia, defined by the 2010 American College of Rheumatology diagnostic criteria, who also experienced at least moderate pain severity were enrolled. The participants were randomized to a 12-week yoga-based or a structured exercise program (SEP) and will undergo comprehensive outcome assessments at baseline, 1, 3, 6, and 9 months by interviewers blinded to treatment assignment. The primary outcome will be the overall severity of fibromyalgia as measured by the total Fibromyalgia Impact Questionnaire-Revised. Secondary outcomes included depression, anxiety, health-related quality of life, pain beliefs, fatigue, sleep, and self-efficacy.ResultsA total of 2,671 recruitment letters were sent to potential participants with fibromyalgia. Of the potential participants, 623 (23.3%) were able to be contacted by telephone and had their eligibility assessed. Three hundred seventy-one of those interviewed were found to be eligible (59.6%) and 256 (69.0%) agreed to participate and were randomized to the YOGA (n = 129) or the SEP (n = 127) arm of the trial.ConclusionsClinicians are faced with numerous challenges in treating patients with fibromyalgia. The interventions being tested in the POYSE trial have the potential to provide primary care and other care settings with new treatment options for clinicians while simultaneously providing a much needed relief for patients suffering from fibromyalgia.Trial RegistrationFunded by VA Rehabilitation Research and Development (D1100-R); Trial registration: ClinicalTrials.gov, NCT01797263.
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Affiliation(s)
- Vivianne L. Allsop
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Kristine K. Miller
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States
| | - James E. Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joanne K. Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amanda Froman
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew Kline
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Christy Sargent
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Dustin D. French
- Department of Ophthalmology and Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL, United States
- Department of Veterans Affairs, Health Services Research and Development Service, Chicago, IL, United States
| | - Dennis Ang
- Section of Rheumatology and Immunology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Marieke Van Puymbroeck
- Department of Parks, Recreation, and Tourism Management, School of Health Research, Clemson University, Clemson, SC, United States
| | - Nancy L. Schalk
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew J. Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN, United States
- *Correspondence: Matthew J. Bair ;
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Therapeutic Patient Education for Fibromyalgia during Spa Therapy: The FiETT Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084613. [PMID: 35457480 PMCID: PMC9030628 DOI: 10.3390/ijerph19084613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
Spa therapy is known to improve quality of life and diminish pain. We assessed the efficacy (Fibromyalgia Impact Questionnaire-FIQ) and safety at 6 months of a fibromyalgia-specific therapeutic patient education (TPE) program added to fibromyalgia-specific standardized spa therapy (SST), compared to SST alone, in a controlled randomized trial. We enrolled 157 patients, mostly women, attending spa centers in Southwest France in 2015–2016, and randomized them to SST + TPE (79) or SST (78). The intention-to-treat with “missing as failure” analysis showed a tendency toward a higher, though non-significant, benefit with TPE than without for FIQ (−9 vs. −3; p = 0.053) or pain intensity (−0.9 vs. −1.1; p = 0.58). In addition, pain relief (+3.2 vs. +4.3; p = 0.03) and fatigue (−1.6 vs. −3.7; p = 0.02) were significantly improved, and 87% patients in the SST + TPE arm still regularly practiced the physical exercises taught to them at 6 months. We suspect significant and lasting improvement from spa therapy, as well as our already well-informed and well-managed participants, to have prevented the demonstration of a significant benefit of TPE on FIQ.
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Bruun KD, Amris K, Vaegter HB, Blichfeldt-Eckhardt MR, Holsgaard-Larsen A, Christensen R, Toft P. Low-dose naltrexone for the treatment of fibromyalgia: protocol for a double-blind, randomized, placebo-controlled trial. Trials 2021; 22:804. [PMID: 34781989 PMCID: PMC8591911 DOI: 10.1186/s13063-021-05776-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/29/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Low-dose naltrexone (LDN) is used widely as an off-label treatment for pain despite limited evidence for its effectiveness. A few small trials with a high risk of bias have investigated the effect of LDN on pain associated with fibromyalgia in women, but larger and more methodologically robust studies are needed. The primary aim of this randomized controlled trial is to investigate if 12 weeks of LDN treatment is superior to placebo in reducing the average pain intensity during the last 7 days in women with fibromyalgia. METHODS A single-center, permuted block randomized, double-blind, placebo-controlled, parallel-group trial will be performed in Denmark. Randomization comprises 100 women aged 18-64 years diagnosed with fibromyalgia who will be treated with either LDN or placebo for 12 weeks including a 4-week titration phase. The primary outcome is change in average pain intensity (during the last 7 days) from baseline to 12 weeks. Secondary outcomes are other fibromyalgia-related symptoms, i.e., tenderness, fatigue, sleep disturbance, stiffness, memory problems, depression, anxiety and measures of global assessment, physical function, impact of fibromyalgia, pain distribution, and health-related quality of life. Intention-to-treat analysis will be performed, and the number of responders with a more than 15%, 30%, and 50% improvement of pain after 12 weeks will be calculated for the LDN and placebo groups. Exploratory outcomes include measures of pain sensitivity, muscle performance, and biomarkers. DISCUSSION This study will contribute with high-level evidence on the efficacy of low-dose naltrexone for the treatment of pain in women with fibromyalgia. Secondary outcomes include both disease-specific and generic components investigating whether LDN influences other symptoms than pain. Explorative outcomes are included to provide greater insight into the mechanism of action of LDN and possibly a better understanding of the underlying pathology in fibromyalgia. TRIAL REGISTRATION EudraCT 2019-000702-30. Registered on 12 July 2019. ClinicalTrials.gov NCT04270877. Registered on 17 February 2020.
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Affiliation(s)
- Karin Due Bruun
- Pain Research Group, Pain Center, Odense University Hospital, Heden 7-9, Indgang 20, DK - 5000, Odense C, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Kirstine Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Heden 7-9, Indgang 20, DK - 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Morten Rune Blichfeldt-Eckhardt
- Pain Research Group, Pain Center, Odense University Hospital, Heden 7-9, Indgang 20, DK - 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anders Holsgaard-Larsen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Robin Christensen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Palle Toft
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
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Su YC, Guo YH, Hsieh PC, Lin YC. Efficacy of Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10204669. [PMID: 34682790 PMCID: PMC8538417 DOI: 10.3390/jcm10204669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/12/2023] Open
Abstract
This article aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia. The PubMed, Medline, Cochrane Library, and Web of Science databases were searched for articles published through 14 August 2021. We enrolled only randomized controlled trials. The Cochrane Collaboration risk of bias tool was used for quality assessment. Outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs. The beta coefficient and p value were adopted for meta-regression. We included 18 studies comprising 643 participants. A significant reduction in disease influence, as measured by the Fibromyalgia Impact Questionnaire, was observed (SMD, −0.700, 95% CI, −1.173 to −0.228), and the reduction was larger in older patients (β = −0.1327, p = 0.008). The effect persisted at least two weeks after the final treatment session (SMD, −0.784, 95% CI, −1.136 to −0.432). Reductions in pain, depression, and anxiety were discovered, which persisted for at least two weeks after the last intervention. The effects on pain and depression remained significant up to one and a half months after the final session. No serious adverse events were reported by the included articles. In conclusion, our systematic review and meta-analysis revealed that rTMS is safe and effective for managing multiple domains of fibromyalgia-related symptoms and older patients may have a stronger treatment effect. Larger randomized controlled trials with sufficient male populations are warranted to confirm our findings, detect rare adverse events, and determine the optimal stimulation parameters.
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Affiliation(s)
- Yu-Chi Su
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan;
| | - Yao-Hong Guo
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; (Y.-H.G.); (P.-C.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan
- Correspondence:
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Haugmark T, Hagen KB, Provan SA, Smedslund G, Zangi HA. Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial. BMJ Open 2021; 11:e046943. [PMID: 34187823 PMCID: PMC8245472 DOI: 10.1136/bmjopen-2020-046943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Non-pharmacological approaches are recommended as first-line treatment for patients with fibromyalgia. This randomised controlled trial investigated the effects of a multicomponent rehabilitation programme for patients with recently diagnosed fibromyalgia in primary and secondary healthcare. METHODS Patients with widespread pain ≥3 months were referred to rheumatologists for diagnostic clarification and assessment of study eligibility. Inclusion criteria were age 20-50 years, engaged in work or studies at present or during the past 2 years, and fibromyalgia diagnosed according to the American College of Rheumatology 2010 criteria. All eligible patients participated in a short patient education programme before inclusion and randomisation. The multicomponent programme, a 10-session mindfulness-based and acceptance-based group programme followed by 12 weeks of physical activity counselling was evaluated in comparison with treatment as usual, that is, no treatment or any other treatment of their choice. The primary outcome was the Patient Global Impression of Change (PGIC). Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life and work ability at 12-month follow-up. RESULTS In total, 170 patients were randomised, 1:1, intervention:control. Overall, the multicomponent rehabilitation programme was not more effective than treatment as usual; 13% in the intervention group and 8% in the control group reported clinically relevant improvement in PGIC (p=0.28). No statistically significant between-group differences were found in any disease-related secondary outcomes. There were significant between-group differences in patient's tendency to be mindful (p=0.016) and perceived benefits of exercise (p=0.033) in favour of the intervention group. CONCLUSIONS A multicomponent rehabilitation programme combining patient education with a mindfulness-based and acceptance-based group programme followed by physical activity counselling was not more effective than patient education and treatment as usual for patients with recently diagnosed fibromyalgia at 12-month follow-up. TRIAL REGISTRATION NUMBER BMC Registry (ISRCTN96836577).
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Affiliation(s)
- Trond Haugmark
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kåre Birger Hagen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Sella Aarrestad Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
| | - Geir Smedslund
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi A Zangi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
- Faculty of Health, VID Specialized University, Oslo, Norway
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Measuring Outcomes in Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:82-109. [DOI: 10.1002/acr.24242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
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19
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Dailey DL, Vance CGT, Rakel BA, Zimmerman MB, Embree J, Merriwether EN, Geasland KM, Chimenti R, Williams JM, Golchha M, Crofford LJ, Sluka KA. Transcutaneous Electrical Nerve Stimulation Reduces Movement-Evoked Pain and Fatigue: A Randomized, Controlled Trial. Arthritis Rheumatol 2020; 72:824-836. [PMID: 31738014 PMCID: PMC7188591 DOI: 10.1002/art.41170] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/14/2019] [Indexed: 12/29/2022]
Abstract
Objective Fibromyalgia (FM) is characterized by pain and fatigue, particularly during physical activity. Transcutaneous electrical nerve stimulation (TENS) activates endogenous pain inhibitory mechanisms. This study was undertaken to investigate if using TENS during activity would improve movement‐evoked pain and other patient‐reported outcomes in women with FM. Methods Participants were randomly assigned to receive active TENS (n = 103), placebo TENS (n = 99), or no TENS (n = 99) and instructed to use it at home during activity 2 hours each day for 4 weeks. TENS was applied to the lumbar and cervicothoracic regions using a modulated frequency (2–125 Hz) at the highest tolerable intensity. Participants rated movement‐evoked pain (primary outcome measure) and fatigue on an 11‐point scale before and during application of TENS. The primary outcome measure and secondary patient‐reported outcomes were assessed at baseline (time of randomization) and at 4 weeks. Results After 4 weeks, a greater reduction in movement‐evoked pain was reported in the active TENS group versus the placebo TENS group (group mean difference –1.0 [95% confidence interval –1.8, –0.2]; P = 0.008) and versus the no TENS group (group mean difference –1.8 [95% confidence interval –2.6, –1.0]; P < 0.0001). A reduction in movement‐evoked fatigue was also reported in the active TENS group versus the placebo TENS group (group mean difference –1.4 [95% confidence interval –2.4, –0.4]; P = 0.001) and versus the no TENS group (group mean difference –1.9 [95% confidence interval –2.9, –0.9]; P = <0.0001). A greater percentage of the patients in the active TENS group reported improvement on the global impression of change compared to the placebo TENS group (70% versus 31%; P < 0.0001) and the no TENS group (9%; P < 0.0001). There were no TENS‐related serious adverse events, and <5% of participants experienced minor adverse events from TENS. Conclusion Among women who had FM and were on a stable medication regimen, 4 weeks of active TENS use compared to placebo TENS or no TENS resulted in a significant improvement in movement‐evoked pain and other clinical outcomes. Further research is needed to examine effectiveness in a real‐world setting to establish the clinical importance of these findings.
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Affiliation(s)
- Dana L Dailey
- University of Iowa, Iowa City, and St. Ambrose University, Davenport, Iowa
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Laroche F, Azoulay D, Trouvin AP, Coste J, Perrot S. Fibromyalgia in the workplace: risk factors for sick leave are related to professional context rather than fibromyalgia characteristics- a French national survey of 955 patients. BMC Rheumatol 2019; 3:44. [PMID: 31673681 PMCID: PMC6815377 DOI: 10.1186/s41927-019-0089-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/26/2019] [Indexed: 12/28/2022] Open
Abstract
Background Work and workplace factors are important in fibromyalgia management. We investigated factors associated with sick leave in professionally active women living with fibromyalgia. Methods A questionnaire for fibromyalgia patients in employment was developed by pain and occupational physicians and patients' organizations. Women in full-time work, screened for fibromyalgia with the FiRST questionnaire, were recruited for a national online survey. Sick leave over the preceding year was analyzed. Results In 5 months, we recruited 955 women, with a mean of 37 days of sick leave in the previous year: no sick leave (36%), up to 1 month (38%), 1 to 2 months (14%), more than 2 months (12%). In the groups displayed no differences in demographic characteristics, fibromyalgia symptoms, functional severity and psychological distress were observed. However, they differed in workplace characteristics, commute time, stress and difficulties at work, repetitive work, noisy conditions, career progression problems and lack of recognition, which were strong independent risk factors for longer sick leave. Sedentary positions, an extended sitting position, heavy loads, exposure to thermal disturbances and the use of vibrating tools did not increase the risk of sick leave. Conclusions Women with fibromyalgia frequently take sick leave, the risk factors for which are related to the workplace rather than fibromyalgia characteristics. Perspective This is the first study to assess the impact of occupational and clinical factors on sick leave in women living with fibromyalgia. Risk factors were found to be related to the workplace rather than fibromyalgia and personal characteristics. Workplace interventions should be developed for women with fibromyalgia.
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Affiliation(s)
- F Laroche
- 1Pain department, Paris Medicine Sorbonne University and Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - D Azoulay
- 1Pain department, Paris Medicine Sorbonne University and Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - A P Trouvin
- 2Pain department, Cochin Hospital, Paris Descartes University, INSERM U987, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - J Coste
- Biostatistics, Cochin Hospital, Paris Descartes University, Paris, France
| | - S Perrot
- 2Pain department, Cochin Hospital, Paris Descartes University, INSERM U987, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Laroche F, Guérin J, Coste J, Trouvin AP, Perrot S. Importance of feelings of injustice in fibromyalgia, large internet survey on experiences of 4516 French patients. Joint Bone Spine 2019; 86:808-810. [PMID: 31067504 DOI: 10.1016/j.jbspin.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Françoise Laroche
- Pain department, Saint-Antoine University Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Medical University Sorbonne, 75012 Paris, France; Inserm - N°UMRS 938, 75012 Paris, France.
| | - Julien Guérin
- Pain department, Saint-Antoine University Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Medical University Sorbonne, 75012 Paris, France
| | - Joël Coste
- Pain department, Paris Descartes University, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques 75014 Paris, France
| | | | - Serge Perrot
- Pain department, Paris Descartes University, 75014 Paris, France
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Chiarotto A, Kaiser U, Choy E, Christensen R, Conaghan PG, Cowern M, Gill M, de Wit M, Gargon E, Horgan B, Kirkham JJ, Simon LS, Singh JA, Tugwell P, Turk DC, Mease PJ. Pain Measurement in Rheumatic and Musculoskeletal Diseases: Where To Go from Here? Report from a Special Interest Group at OMERACT 2018. J Rheumatol 2019; 46:1355-1359. [DOI: 10.3899/jrheum.181099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 12/28/2022]
Abstract
Objective.Establishing a research agenda on standardizing pain measurement in clinical trials in rheumatic and musculoskeletal diseases (RMD).Methods.Discussion during a meeting at the Outcome Measures in Rheumatology (OMERACT) 2018, prepared by a systematic review of existing core outcome sets and a patient online survey.Results.Several key questions were debated: Is pain a symptom or a disease? Are pain core (sub)domains consistent across RMD? How to account for pain mechanistic descriptors (e.g., central sensitization) in pain measurement?Conclusion.Characterizing and assessing the spectrum of pain experience across RMD in a standardized fashion is the objective of the OMERACT Pain Working Group.
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Evaluation of composite responder outcomes of pain intensity and physical function in neuropathic pain clinical trials: an ACTTION individual patient data analysis. Pain 2019; 159:2245-2254. [PMID: 30001225 DOI: 10.1097/j.pain.0000000000001324] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Integrating information on physical function and pain intensity into a composite measure may provide a useful method for assessing treatment efficacy in clinical trials of chronic pain. Accordingly, we evaluated composite outcomes in trials of duloxetine, gabapentin, and pregabalin. Data on 2287 patients in 9 trials for painful diabetic peripheral neuropathy (DPN) and 1513 patients in 6 trials for postherpetic neuralgia (PHN) were analyzed. All trials assessed pain intensity on a 0 to 10 numeric rating scale and physical function with the 10-item subscale of the Short Form-36, ranging 0 to 100 with higher scores indicating better function. Correlation between change in pain intensity from baseline to posttreatment and change in physical function was small in DPN (ρ = -0.22; P < 0.001) and nonsignificant in PHN (ρ = -0.05; P = 0.08). Assay sensitivities of 10 composite outcomes were examined in a random subsample of patients enrolled in pregabalin trials for DPN and PHN. Of these, a responder outcome of ≥50% improvement in pain intensity, or a ≥20% improvement in pain intensity and ≥30% improvement in physical function was not only significantly associated with pregabalin vs placebo in the development cohorts for both pain conditions but also in the validation cohorts. Furthermore, this composite outcome was cross-validated in trials of gabapentin for PHN and duloxetine for DPN, and had slightly lower number needed to treat than a standard responder outcome of ≥50% reduction in pain intensity. In summary, this study identified a composite outcome of pain intensity and physical function that may improve the assay sensitivity of future neuropathic pain trials.
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Taylor SJ, Steer M, Ashe SC, Furness PJ, Haywood-Small S, Lawson K. Patients' perspective of the effectiveness and acceptability of pharmacological and non-pharmacological treatments of fibromyalgia. Scand J Pain 2019; 19:167-181. [PMID: 30315738 DOI: 10.1515/sjpain-2018-0116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023]
Abstract
Background and aims Fibromyalgia is a complex condition characterised by widespread pain, sleep disturbance, fatigue and cognitive impairment, with a global mean prevalence estimated at 2.7%. There are inconsistencies in guidelines on the treatment of fibromyalgia leading to dissatisfaction from patients and healthcare professionals. This study investigated patient-reported outcomes of pharmacological and non-pharmacological treatment usage and effectiveness with an assessment of acceptability. Methods Nine hundred and forty-one participants completed a self-administered anonymous questionnaire giving quantitative data of demographics, treatment usage and treatment outcomes. Participant-reported effectiveness and side effects were compared in the following treatment classes: analgesics, antidepressants, gabapentinoids, gastrointestinal treatments, activity interventions, dietary-based treatments, and psychological, physical and alternative therapies. Participants also reported whether they knew about or had tried different treatments. Results The results from the online survey indicated that the range of mean effectiveness ratings were similar for pharmacological and non-pharmacological treatments, whereas non-pharmacological treatments had lower side effects ratings and higher acceptability relative to pharmacological treatments. Participants were not aware of some treatment options. Conclusions The results show lower side effects ratings and higher acceptability for non-pharmacological treatments compared to pharmacological treatments despite similar effectiveness ratings. Implications This article presents results from a large online survey on fibromyalgia patient perspectives of pharmacological and non-pharmacological treatments. Results will inform healthcare professionals and patients about optimal treatments based on ratings of effectiveness, side effects and acceptability that are tailored to patient symptom profiles. Some participants were unaware of treatment options highlighting the importance of patient education allowing collaboration between patients and healthcare professionals to find optimal treatments.
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Affiliation(s)
- Sophie J Taylor
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Michael Steer
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Simon C Ashe
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Penny J Furness
- Centre for Behavioural Science and Applied Psychology, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Sarah Haywood-Small
- Biomolecular Sciences Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Kim Lawson
- Biomolecular Sciences Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Laroche F, Guérin J, Azoulay D, Coste J, Perrot S. La fibromyalgie en France : vécu quotidien, fardeau professionnel et prise en charge. Enquête nationale auprès de 4516 patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rhum.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haugmark T, Hagen KB, Provan SA, Bærheim E, Zangi HA. Effects of a community-based multicomponent rehabilitation programme for patients with fibromyalgia: protocol for a randomised controlled trial. BMJ Open 2018; 8:e021004. [PMID: 29866731 PMCID: PMC5988178 DOI: 10.1136/bmjopen-2017-021004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION People with fibromyalgia (FM) suffer from symptoms such as widespread pain, non-refreshing sleep, fatigue and reduced quality of life. Effects of pharmacological treatment are questionable and non-pharmacological treatments are recommended as first-line therapy. To date the majority of patients with FM in Norway are not offered any targeted treatment. The aim of this randomised controlled trial is to investigate the effects of a community-based multicomponent rehabilitation programme comprising an acceptance-based and mindfulness-based group intervention, the Vitality Training Programme (VTP), followed by tailored physical activity counselling. MATERIALS AND METHODS General practitioners refer potential participants to a rheumatologist in specialist healthcare for diagnostic clarification and assessment of comorbidities. Inclusion criteria are widespread pain/FM ≥3 months, age 20-50 and work participation (minimum part-time) within the last 2 years. The intervention group attends the VTP comprising 10 weekly 4 hour group sessions plus a booster session after 6 months. Thereafter, they receive 12 weeks of individually tailored physical exercise counselled by physiotherapists at community-based Healthy Life Centers. The control group follows treatment as usual. The primary outcome is Patient Global Impression of Change. Secondary outcomes include self-reported pain, fatigue and sleep quality, psychological distress, mindfulness, health-related quality of life, physical activity, work ability and exercise beliefs and habits. To achieve a power of 80% and allow for 10% dropout, 70 participants are needed in each arm. All analyses will be conducted on intention-to-treat bases and measured as differences between groups at 12 months follow-up. ETHICS AND DISSEMINATION The study is approved and granted by the Norwegian South-Eastern Regional Health Authority (reference 2016015). Ethics approval was obtained from Regional Committee for Medical and Health Research Ethics (reference 2015/2447/REK sør-øst A). Results will be submitted to appropriate journals and presented in relevant conferences and social media. TRIAL REGISTRATION ISRCTN 96836577.
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Affiliation(s)
- Trond Haugmark
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | - Heidi A Zangi
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health, VID Specialized University, Oslo, Norway
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Fioravanti A, Manica P, Bortolotti R, Cevenini G, Tenti S, Paolazzi G. Is balneotherapy effective for fibromyalgia? Results from a 6-month double-blind randomized clinical trial. Clin Rheumatol 2018; 37:2203-2212. [DOI: 10.1007/s10067-018-4117-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
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Abstract
This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients' lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general.
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Davis F, Gostine M, Roberts BA, Risko R, Cappelleri JC, Sadosky A. Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients. Pain Pract 2017; 18:611-624. [PMID: 29064627 DOI: 10.1111/papr.12651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of opioids and/or pregabalin on patient-reported outcomes among fibromyalgia (FM) patients based on levels of improvement. METHODS A total of 1,421 FM patients were identified, with 3,082 observational periods of opioids with or without pregabalin use between April 2008 and February 2015. Patients were categorized by opioids, and pregabalin with and without opioids; opioids were designated by morphine equivalent dose (MED) of ≤ 20 (low MED), > 20 to < 100 (moderate MED), ≥ 100 (high MED), and pregabalin doses of ≤ 150 mg, 151 to 300 mg, and 301 to 450 mg. Proportions of patients meeting clinically relevant thresholds of ≥ 30% and ≥ 50% improvement for pain interference (ability to enjoy life; activity; mood; relationships; sleep), pain severity, and fatigue were compared among treatments, and area under the curve (AUC) for improvement and worsening of effects was determined, enabling ranking of treatments. Further analysis compared pregabalin doses. RESULTS Pregabalin without opioids resulted in the highest proportions of patients with ≥ 30% improvement on all pain items and pain interference with "ability to enjoy life," "activity" "mood," and "sleep." For the ≥ 50% threshold, pregabalin alone was highest for all pain interference items and for "average pain" and "worst pain." Pregabalin was consistently lowest across thresholds for fatigue, but showed better results combined with moderate MED opioids. Pregabalin doses recommended for treatment of FM (151 to 450 mg) generally resulted in the highest proportion of patients achieving thresholds relative to opioids. The AUC results were consistent with thresholds; pregabalin without opioids resulted in the greatest benefits with regard to improvement, with the highest ranking for overall improvement and overall effects. CONCLUSION Pregabalin without opioids provided the most favorable outcomes overall based on ≥ 30% and ≥ 50% improvement thresholds and AUC, with support for moderate MED opioids + pregabalin in patients suffering from fatigue. While most patients took less than recommended pregabalin doses, higher doses may lead to improved outcomes.
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Affiliation(s)
- Fred Davis
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
| | - Mark Gostine
- Michigan Pain Consultants, Grand Rapids, Michigan, U.S.A
| | | | - Rebecca Risko
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Hou WH, Wang TY, Kang JH. The effects of add-on non-invasive brain stimulation in fibromyalgia: a meta-analysis and meta-regression of randomized controlled trials. Rheumatology (Oxford) 2016; 55:1507-17. [PMID: 27150193 DOI: 10.1093/rheumatology/kew205] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The effects of non-invasive brain stimulation (NBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (TDCS), in treating FM remain inconclusive. The aim of this study was to investigate present evidence of using NBS as an add-on treatment in treating FM. METHODS We conducted a database search of the Medline, Embase, PsycINFO and Cochrane Library electronic databases, from inception to July 2015, to analyse randomized controlled trials of NBS in treating FM. A total of 16 studies were included in the current meta-analysis. RESULTS The pooled mean effect sizes of the 16 included studies revealed significant favourable effects of NBS. The weighted mean effect size in reducing pain, depression, fatigue, sleep disturbance and tender points and improving general health/function were 0.667 (95% CI 0.446, 0.889), 0.322 (95% CI 0.140, 0.504), 0.511 (95% CI 0.247, 0.774), 0.682 (95% CI 0.350, 1.014), 0.867 (95% CI 0.310, 1.425) and 0.473 (95% CI 0.285, 0.661), respectively. rTMS stimulation yielded a greater effect size compared with that of TDCS (effect size 0.698 and 0.568, respectively; P < 0.0001). The primary motor cortex (M1) stimulation yielded a subtle greater effect size in pain reduction compared with that of the dorsolateral prefrontal cortex (effect size 0.709 and 0.693, respectively; P < 0.0001). No linear relationships were found between the effect sizes and treatment regimens and dose. Most of reported adverse effects were minor. CONCLUSIONS Both rTMS and TDCS may be feasible and safe modalities for treating FM. The general effects of rTMS and TDCS are compatible in FM patients. M1 stimulation may be better in pain reduction and the dorsolateral prefrontal cortex may be better in depression improvement.
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Affiliation(s)
- Wen-Hsuan Hou
- Master Program in Long-Term Care School of Gerontology Health Management, College of Nursing Department of Physical Medicine & Rehabilitation Center of Evidence-based Medicine
| | - Tzu-Ya Wang
- Graduate Institute of Nursing, College of Nursing
| | - Jiunn-Horng Kang
- Department of Physical Medicine & Rehabilitation Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine Sleep Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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Abstract
OBJECTIVES To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. METHODS A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ≤0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. RESULTS Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. DISCUSSION The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.
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A meta-analysis to determine the effect of pharmacological and non-pharmacological treatments on fibromyalgia symptoms comprising OMERACT-10 response criteria. Clin Rheumatol 2015; 35:573-86. [PMID: 26676810 DOI: 10.1007/s10067-015-3144-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/04/2015] [Accepted: 12/05/2015] [Indexed: 01/23/2023]
Abstract
Fibromyalgia is characterized by widespread pain, sleep problems, fatigue, functional impairment, psychological distress, and cognitive dysfunction. The objective of this meta-analysis is to synthesize the available data on the effectiveness of pharmacological and non-pharmacological interventions across all domains included in the Outcome Measures in Rheumatology Clinical Trials (OMERACT-10) fibromyalgia response definitions, and to examine response based on these definitions. We searched Cochrane, PubMed, Scopus, and the reference lists of articles for randomized controlled trials of any drug formulation or non-pharmacological intervention used for fibromyalgia treatment. We extracted efficacy data regarding pain, sleep, physical function, fatigue, anxiety, depression, and cognition. The available data were insufficient to draw definite conclusions regarding response. Indirect evidence indicates that it may be expected with the use of serotonin noradrenaline reuptake inhibitors (SNRIs), noradrenaline reuptake inhibitors (NRIs), and multidisciplinary treatment.
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van Tuyl LHD, Boers M. Patient-reported outcomes in core domain sets for rheumatic diseases. Nat Rev Rheumatol 2015; 11:705-12. [PMID: 26324860 DOI: 10.1038/nrrheum.2015.116] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patient-reported outcomes (PROs) are abundant in rheumatology and their numbers continue to increase. But which of the available measures are most important? Core outcome sets-including groups of domains and instruments for measuring them-have been defined for many rheumatic diseases, with the aim that all these outcomes should be measured in every clinical trial. The subgroup of PROs included in these core sets is, therefore, undoubtedly important. This Review summarizes the PROs included in core outcome sets developed for use in clinical trials across a wide range of rheumatic diseases. Three PROs are commonly utilized across the majority of rheumatic conditions: pain, physical functioning and the patient global assessment of disease activity. However, additional research is needed to fully understand the role of the patient global assessment of disease activity, to distinguish specific domains within the broad concept of health-related quality of life, and to work towards consensus on the choice between generic and disease-specific instruments in various contexts.
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Affiliation(s)
- Lilian H D van Tuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Centre, PO Box 7057, Amsterdam, 1007 MB, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, VU University Medical Centre, PO Box 7057, Amsterdam, 1007 MB, Netherlands.,Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, Netherlands
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FRIEND RONALD, BENNETT ROBERTM. A Critical Examination of the Polysymptomatic Distress Scale Construct as a Symptom Severity Questionnaire. J Rheumatol 2015; 42:1364-7. [DOI: 10.3899/jrheum.150611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gota CE, Kaouk S, Wilke WS. The impact of depressive and bipolar symptoms on socioeconomic status, core symptoms, function and severity of fibromyalgia. Int J Rheum Dis 2015; 20:326-339. [PMID: 26230959 DOI: 10.1111/1756-185x.12603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the prevalence of depressive and bipolar symptoms in a cohort of consecutive fibromyalgia (FM) patients seen in a tertiary care center and to determine the relationship between depressive and manic symptoms with FM symptoms, socioeconomic status, severity and function. METHODS Three hundred and five FM patients were enrolled; demographic, clinical and questionnaire data were collected. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9), manic symptoms by the Mood Disorders Questionnaire (MDQ). RESULTS The FM cohort had the following characteristics: age 43.53 (11.7) years; 86.5% white; 82.7% female; PHQ-9 ≥ 10, 59.7%, mean 11.9 (7.3); no depression 11.4%, mild 29.1%, moderate 27.5%, moderate severe 17.7%, severe 14%; anxiety 41.6%; 21.3% had either an MDQ score ≥ 7 and/or reported a past diagnosis of bipolar disorder (BD). Increasing levels of depression severity, as well as a positive screen for BD were significantly associated with increasing prevalence and severity of FM symptoms, longer duration of morning stiffness, and increased severity of FM. Increasing levels of depression were significantly associated with increase in prevalence of reported past sexual abuse, and a decline in socioeconomic status, including higher disability and unemployment rates. CONCLUSION Patients with severe FM disease activity, high load of symptoms, prolonged morning stiffness, increased disability, lower socioeconomic status and those who take a lot of medications for FM should be evaluated for depressive and manic symptoms.
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Affiliation(s)
- Carmen E Gota
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sahar Kaouk
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William S Wilke
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
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Walitt B, Urrútia G, Nishishinya MB, Cantrell SE, Häuser W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015; 2015:CD011735. [PMID: 26046493 PMCID: PMC4755337 DOI: 10.1002/14651858.cd011735] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fibromyalgia is a clinically well-defined chronic condition with a biopsychosocial aetiology. Fibromyalgia is characterized by chronic widespread musculoskeletal pain, sleep problems, cognitive dysfunction, and fatigue. Patients often report high disability levels and poor quality of life. Since there is no specific treatment that alters the pathogenesis of fibromyalgia, drug therapy focuses on pain reduction and improvement of other aversive symptoms. OBJECTIVES The objective was to assess the benefits and harms of selective serotonin reuptake inhibitors (SSRIs) in the treatment of fibromyalgia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5), MEDLINE (1966 to June 2014), EMBASE (1946 to June 2014), and the reference lists of reviewed articles. SELECTION CRITERIA We selected all randomized, double-blind trials of SSRIs used for the treatment of fibromyalgia symptoms in adult participants. We considered the following SSRIs in this review: citalopram, fluoxetine, escitalopram, fluvoxamine, paroxetine, and sertraline. DATA COLLECTION AND ANALYSIS Three authors extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion. MAIN RESULTS The quality of evidence was very low for each outcome. We downgraded the quality of evidence to very low due to concerns about risk of bias and studies with few participants. We included seven placebo-controlled studies, two with citalopram, three with fluoxetine and two with paroxetine, with a median study duration of eight weeks (4 to 16 weeks) and 383 participants, who were pooled together.All studies had one or more sources of potential major bias. There was a small (10%) difference in patients who reported a 30% pain reduction between SSRIs (56/172 (32.6%)) and placebo (39/171 (22.8%)) risk difference (RD) 0.10, 95% confidence interval (CI) 0.01 to 0.20; number needed to treat for an additional beneficial outcome (NNTB) 10, 95% CI 5 to 100; and in global improvement (proportion of patients who reported to be much or very much improved: 50/168 (29.8%) of patients with SSRIs and 26/162 (16.0%) of patients with placebo) RD 0.14, 95% CI 0.06 to 0.23; NNTB 7, 95% CI 4 to 17.SSRIs did not statistically, or clinically, significantly reduce fatigue: standard mean difference (SMD) -0.26, 95% CI -0.55 to 0.03; 7.0% absolute improvement on a 0 to 10 scale, 95% CI 14.6% relative improvement to 0.8% relative deterioration; nor sleep problems: SMD 0.03, 95 % CI -0.26 to 0.31; 0.8 % absolute deterioration on a 0 to 100 scale, 95% CI 8.3% relative deterioration to 6.9% relative improvement.SSRIs were superior to placebo in the reduction of depression: SMD -0.39, 95% CI -0.65 to -0.14; 7.6% absolute improvement on a 0 to 10 scale, 95% CI 2.7% to 13.8% relative improvement; NNTB 13, 95% CI 7 to 37. The dropout rate due to adverse events was not higher with SSRI use than with placebo use (23/146 (15.8%) of patients with SSRIs and 14/138 (10.1%) of patients with placebo) RD 0.04, 95% CI -0.06 to 0.14. There was no statistically or clinically significant difference in serious adverse events with SSRI use and placebo use (3/84 (3.6%) in patients with SSRIs and 4/84 (4.8%) and patients with placebo) RD -0.01, 95% CI -0.07 to 0.05. AUTHORS' CONCLUSIONS There is no unbiased evidence that SSRIs are superior to placebo in treating the key symptoms of fibromyalgia, namely pain, fatigue and sleep problems. SSRIs might be considered for treating depression in people with fibromyalgia. The black box warning for increased suicidal tendency in young adults aged 18 to 24, with major depressive disorder, who have taken SSRIs, should be considered when appropriate.
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Affiliation(s)
- Brian Walitt
- National Institutes of HealthNational Center for Complementary and Integrative Health10 Center DriveBethesdaMDUSA20892
| | - Gerard Urrútia
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret, 167Pavilion 18 (D‐53)BarcelonaCataloniaSpain08025
| | - María Betina Nishishinya
- Institute of Biomedical Research (IIB Sant Pau)Iberoamerican Cochrane CentreEd. Casa de ConvalescènciaSant Antoni M. Claret 171 4 plantaBarcelonaSpainE ‐ 08041
| | - Sarah E Cantrell
- Walter Reed National Military Medical CenterDarnall Medical Library8901 Wisconsin AvenueBuilding 1, Room 3458BethesdaMDUSA20889
| | - Winfried Häuser
- Technische Universität MünchenDepartment of Psychosomatic Medicine and PsychotherapyLangerstr. 3MünchenGermanyD‐81675
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Levin AA, Gottlieb AB. The International Dermatology Outcome Measures Group: Update from the GRAPPA 2014 Annual Meeting. J Rheumatol 2015. [DOI: 10.3899/jrheum.150124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The International Dermatology Outcome Measures (IDEOM) group was formed to enhance outcomes and facilitate access to dermatologic care by creating standardized measures of disease progression and treatment efficacy that emphasize the perspectives of patients and the others involved. With these goals in mind, IDEOM enabled patients, physicians, health economists from participating pharmaceutical industries, payers, and regulatory agencies to create validated measures for use in both clinical trials and clinical practice.
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Perrot S, Russell IJ. More ubiquitous effects from non-pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: a meta-analysis examining six core symptoms. Eur J Pain 2015; 18:1067-80. [PMID: 25139817 DOI: 10.1002/ejp.564] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 01/08/2023]
Abstract
This study aimed to characterize and compare the efficacy profile on six fibromyalgia syndrome (FM) core symptoms associated with pharmacologic and non-pharmacologic treatments. We screened PubMed, Embase and the Cochrane Library for FM articles from 1990 to September 2012 to analyse randomized controlled trials comparing pharmacologic or non-pharmacologic treatments to placebo or sham. Papers including assessments of at least 2 of the 6 main FM symptom domains - pain, sleep disturbance, fatigue, affective symptoms (depression/anxiety), functional deficit and cognitive impairment - were selected for analysis. Studies exploring pharmacologic approaches (n = 21) were mainly dedicated to treating a small number of dimensions, mostly pain. They were of good quality but were not prospectively designed to simultaneously document efficacy for the management of multiple core FM symptom domains. Only amitriptyline demonstrated a significant effect on as many as three core FM symptoms, but it exhibited many adverse effects and was subject to early tachyphylaxis. Studies involving non-pharmacologic approaches (n = 64) were typically of poorer quality but were more often dedicated to multidimensional targets. Pool therapy demonstrated significant effects on five symptom domains, repetitive transcranial magnetic stimulation on four domains, balneotherapy on three domains and exercise, cognitive behaviour therapy and massage on two domains each. Differences between pharmacologic and non-pharmacologic approaches may be related to different modes of action, tolerability profiles and study designs. Very few drugs in well-designed clinical trials have demonstrated significant relief for multiple FM symptom domains, whereas non-pharmacologic treatments with weaker study designs have demonstrated multidimensional effects. Future therapeutic trials for FM should prospectively examine each of the core domains and should attempt to combine pharmacologic and non-pharmacologic therapies in well-designed clinical trials.
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Affiliation(s)
- S Perrot
- Service de Médecine Interne et Thérapeutique, Hôtel Dieu, Paris Descartes University, INSERM U 987, France
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Gottlieb AB, Armstrong AW, Christensen R, Garg A, Duffin KC, Boehncke WH, Merola JF, Gladman DD, Mease PJ, Swerlick RA, Rosen CF, Abernethy A. The International Dermatology Outcome Measures initiative as applied to psoriatic disease outcomes: a report from the GRAPPA 2013 meeting. J Rheumatol 2015; 41:1227-9. [PMID: 24882858 DOI: 10.3899/jrheum.140176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performance of physicians and treatments. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials and subsequently in clinical practice. The International Dermatology Outcome Measures group includes all willing stakeholders: patients, physicians, payers, and pharmaceutical scientists. As reported herein, the group's goal is to develop outcome measures in dermatology that address the needs of all involved.
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Affiliation(s)
- Alice B Gottlieb
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - April W Armstrong
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Robin Christensen
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Amit Garg
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Kristina Callis Duffin
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Wolf-Henning Boehncke
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Joseph F Merola
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Dafna D Gladman
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Philip J Mease
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Robert A Swerlick
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - Cheryl F Rosen
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
| | - April Abernethy
- From the Tufts Medical Center, Boston, Massachusetts; Department of Dermatology, University of Colorado, Denver, Colorado, USA; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Dermatology, Hofstra North Shore LIJ School of Medicine, Hempstead, New York; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Toronto, Toronto Western Research Institute; Psoriatic Arthritis Program, University Health Network, Toronto, Ontario, Canada; Seattle Rheumatology Associates, Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia, USA; Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; National Psoriasis Foundation, Portland, Oregon, USA.A.B. Gottlieb, MD, PhD, Tufts Medical Center; A.W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital; A. Garg, MD, Department of Dermatology, Hofstra North Shore LIJ School of Medicine; K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah; W-H. Boehncke, MD, Department of Dermatology, Geneva University Hospital; J.F. Merola, MD, Harvard Medical School, Brigham and Women's Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; Senior Scientist, Toronto Western Research Institute; Director, Psoriatic Arthritis Program, University Health Network; P.J. Mease, MD, Seattle Rheumatology Associates, Director, Rheumatology Research, Swedish Medical Center, Clinical Professor, Univ
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Gottlieb AB, Levin AA, Armstrong AW, Abernethy A, Duffin KC, Bhushan R, Garg A, Merola JF, Maccarone M, Christensen R. The International Dermatology Outcome Measures Group: Formation of patient-centered outcome measures in dermatology. J Am Acad Dermatol 2015; 72:345-8. [DOI: 10.1016/j.jaad.2014.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Mease PJ, Clauw DJ, Trugman JM, Palmer RH, Wang Y. Efficacy of long-term milnacipran treatment in patients meeting different thresholds of clinically relevant pain relief: subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study. J Pain Res 2014; 7:679-87. [PMID: 25473309 PMCID: PMC4247140 DOI: 10.2147/jpr.s70200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Fibromyalgia patients from a long-term, open-label study of milnacipran (50–200 mg/day) were eligible to participate in a 12-week, randomized, placebo-controlled withdrawal study. The withdrawal study evaluated loss of therapeutic response in patients who achieved ≥50% pain improvements after receiving up to 3.25 years of milnacipran. This post-hoc analysis investigated whether patients who met lower thresholds of pain improvement also experienced worsening of fibromyalgia symptoms upon treatment withdrawal. Method Among patients who received milnacipran ≥100 mg/day during the long-term study, three subgroups were identified based on percentage of pain reduction at randomization: ≥50% (protocol-defined “responders”; n=150); ≥30% to <50% (patients with clinically meaningful pain improvement; n=61); and <30% (n=110). Efficacy assessments included the visual analog scale (VAS) for pain, Fibromyalgia Impact Questionnaire-Revised (FIQR), 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS), and Beck Depression Inventory (BDI). Results In the ≥30 to <50% subgroup, significant worsening in pain was detected after treatment withdrawal. The difference between placebo and milnacipran in mean VAS score changes for this subgroup (+9.0, P<0.05) was similar to the difference in protocol-defined responders (+9.4, P<0.05). In the <30% subgroup, no worsening in pain was observed in either treatment arm. However, patients in this subgroup experienced significant worsening in FIQR scores after treatment withdrawal (placebo, +6.9; milnacipran, −2.8; P<0.001), as well as worsening in SF-36 PCS and BDI scores. Conclusion Patients who experienced ≥30% to <50% pain reduction with long-term milnacipran had significant worsening of fibromyalgia symptoms after treatment withdrawal. These results suggest that the conventional ≥30% pain responder cutoff may be adequate to demonstrate efficacy in randomized withdrawal studies of fibromyalgia. Patients in the <30% pain reduction subgroup had worsening scores on the FIQR and other multidimensional measures after treatment withdrawal, indicating the importance of identifying and managing the multiple symptoms of fibromyalgia.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan Health System, Ann Arbor, MI, USA
| | | | | | - Yong Wang
- Forest Research Institute, Jersey City, NJ, USA
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Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN. Beyond pain in fibromyalgia: insights into the symptom of fatigue. Arthritis Res Ther 2014; 15:221. [PMID: 24289848 PMCID: PMC3978642 DOI: 10.1186/ar4395] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.
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Abstract
Introduction Fibromyalgia (FM) is characterized by chronic pain and reduced pain threshold. The pathophysiology involves disturbed neuroendocrine function, including impaired function of the growth hormone/insulin-like growth factor-1 axis. Recently, microRNAs have been shown to be important regulatory factors in a number of diseases. The aim of this study was to try to identify cerebrospinal microRNAs with expression specific for FM and to determine their correlation to pain and fatigue. Methods The genome-wide profile of microRNAs in cerebrospinal fluid was assessed in ten women with FM and eight healthy controls using real-time quantitative PCR. Pain thresholds were examined by algometry. Levels of pain (FIQ pain) were rated on a 0-100 mm scale (fibromyalgia impact questionnaire, FIQ). Levels of fatigue (FIQ fatigue) were rated on a 0-100 mm scale using FIQ and by multidimensional fatigue inventory (MFI-20) general fatigue (MFIGF). Results Expression levels of nine microRNAs were significantly lower in patients with FM patients compared to healthy controls. The microRNAs identified were miR-21-5p, miR-145-5p, miR-29a-3p, miR-99b-5p, miR-125b-5p, miR-23a-3p, 23b-3p, miR-195-5p, miR-223-3p. The identified microRNAs with significantly lower expression in FM were assessed with regard to pain and fatigue. miR-145-5p correlated positively with FIQ pain (r=0.709, p=0.022, n=10) and with FIQ fatigue (r=0.687, p=0.028, n=10). Conclusion To our knowledge, this is the first study to show a disease-specific pattern of cerebrospinal microRNAs in FM. We have identified nine microRNAs in cerebrospinal fluid that differed between FM patients and healthy controls. One of the identified microRNAs, miR-145 was associated with the cardinal symptoms of FM, pain and fatigue.
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Development of a multidimensional measure of fibromyalgia symptomatology: the comprehensive rating scale for fibromyalgia symptomatology. J Psychosom Res 2013; 74:384-92. [PMID: 23597325 DOI: 10.1016/j.jpsychores.2012.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is characterized by a heterogeneous group of clinical symptoms that are evaluated using a wide variety of instruments. This study sought to develop and validate a new scale, the Comprehensive Rating Scale for Fibromyalgia Symptomatology (CRSFS), to facilitate the joint evaluation of the most frequent symptoms in patients with FM. METHODS CRSFS items were based on a literature review and a focus group composed of patients and healthcare professionals. Four samples of patients (FM, non-FM rheumatic pain, depression, and healthy volunteers) were used to study the reliability and validity of the CRSFS. The factor structure of the CRSFS was determined through exploratory and confirmatory factor analyses. The test-retest and inter-examiner reliabilities were evaluated in a subsample of participants with FM. The criterion and convergent construct validity were compared using valid and reliable instruments to assess the impact of FM on quality of life, pain, fatigue, mood, and quality of sleep. The capacity to differentiate groups of patients was examined by comparing the CRSFS scores of the four samples to each other and using receiver operating characteristics curves. RESULTS The sample was composed of 240 participants, the mean age was 49.1years (SD=10.4), and 97.5% of them were women. The factor analyses, as well as the tests of reliability and validity, were positive. The final version of the CRSFS consisted of 20 symptoms evaluated using 60 items. CONCLUSION The CRSFS is a valid and reliable 4-factor scale that evaluates the most frequent clinical symptoms of patients with FM.
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Mist SD, Firestone KA, Jones KD. Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res 2013; 6:247-60. [PMID: 23569397 PMCID: PMC3616139 DOI: 10.2147/jpr.s32297] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.
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Affiliation(s)
- Scott David Mist
- Fibromyalgia Research and Treatment Group, School of Nursing, Oregon Health and Science University, Portland, OR, USA
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Bjersing JL, Erlandsson M, Bokarewa MI, Mannerkorpi K. Exercise and obesity in fibromyalgia: beneficial roles of IGF-1 and resistin? Arthritis Res Ther 2013; 15:R34. [PMID: 23446104 PMCID: PMC3672794 DOI: 10.1186/ar4187] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/21/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction Severe fatigue is a major health problem in fibromyalgia (FM). Obesity is common in FM, but the influence of adipokines and growth factors is not clear. The aim was to examine effects of exercise on fatigue, in lean, overweight and obese FM patients. Methods In a longitudinal study, 48 FM patients (median 52 years) exercised for 15 weeks. Nine patients were lean (body mass index, BMI 18.5 to 24.9), 26 overweight (BMI 25 to 29.9) and 13 obese. Fatigue was rated on a 0 to 100 mm scale (fibromyalgia impact questionnaire [FIQ] fatigue) and multidimensional fatigue inventory (MFI-20) general fatigue (MFIGF). Higher levels in FIQ fatigue and MFIGF indicate greater degree of fatigue. Free and total IGF-1, neuropeptides, adipokines were determined in serum and cerebrospinal fluid (CSF). Results Baseline FIQ fatigue correlated negatively with serum leptin (r = -0.345; P = 0.016) and nerve growth factor (NGF; r = -0.412; P = 0.037). In lean patients, baseline MFIGF associated negatively with serum resistin (r = -0.694; P = 0.038). FIQ Fatigue associated negatively with CSF resistin (r = -0.365; P = 0.073). Similarly, FIQ fatigue (r = -0.444; P = 0.026) and MFIGF correlated negatively with CSF adiponectin (r = -0.508; P = 0.01). In lean patients, FIQ fatigue (P = 0.046) decreased after 15 weeks. After 30 weeks, MFIGF decreased significantly in lean (MFIGF: P = 0.017), overweight (MFIGF: P = 0.001), and obese patients (MFIGF: P = 0.016). After 15 weeks, total IGF-1 increased in lean (P = 0.043) patients. ∆Total IGF-1 differed significantly between lean and obese patients (P = 0.010). ∆Total IGF-1 related negatively with ∆MFIGF after 15 weeks (r = -0.329; P = 0.050). After 30 weeks, ∆FIQ fatigue negatively correlated with ∆NGF (r = -0.463; P = 0.034) and positively with ∆neuropeptide Y (NPY) (r = 0.469; P = 0.032). Resistin increased after 30 weeks (P = 0.034). ∆MFIGF correlated negatively with ∆resistin (r = -0.346; P = 0.031), being strongest in obese patients (r = -0.815; P = 0.007). In obese patients, ∆FIQ fatigue after 30 weeks correlated negatively with ∆free IGF-1 (r = -0.711; P = 0.032). Conclusions Exercise reduced fatigue in all FM patients, this effect was achieved earlier in lean patients. Baseline levels of resistin in both serum and CSF associated negatively with fatigue. Resistin was increased after the exercise period which correlated with decreased fatigue. Changes in IGF-1 indicate similar long-term effects in obese patients. This study shows reduced fatigue after moderate exercise in FM and indicates the involvement of IGF-1 and resistin in these beneficial effects. Trial registration ClinicalTrials.gov: NCT00643006
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Aucott JN, Crowder LA, Kortte KB. Development of a foundation for a case definition of post-treatment Lyme disease syndrome. Int J Infect Dis 2013; 17:e443-9. [PMID: 23462300 DOI: 10.1016/j.ijid.2013.01.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/04/2013] [Accepted: 01/09/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The study objective is to demonstrate the clinical and research utility of an operationalized definition of post-treatment Lyme disease syndrome (PTLDS), as proposed by the Infectious Diseases Society of America. METHODS Seventy-four patients with confirmed erythema migrans and 14 controls were enrolled. Patient-reported symptoms and health function (SF-36) were collected pre-treatment and at follow-up visits over 6 months post-treatment. RESULTS Eight (11%) patients met our operationalized definition of PTLDS, which included self-reported symptoms of fatigue, widespread musculoskeletal pain or cognitive complaints, and functional impact as measured by a T score of <45 on the composite SF-36. No controls met the functional impact criteria. Forty-three (60% patients returned to their previous health status when measured at 6 months post-treatment. Twenty (28%) patients had either residual symptoms or functional impact, but not both, and did not meet criteria for PTLDS. CONCLUSIONS This operationalized definition of PTLDS allows for identification of those patients who are treated for early Lyme disease and have significant post-treatment illness, as they have both residual symptoms and impact on daily life functioning. With further refinement and improvement of this operationalized definition, the true incidence of PTLDS can be determined and future studies can be designed to examine its pathophysiology and treatment.
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Affiliation(s)
- John N Aucott
- Department of Medicine, The Johns Hopkins University School of Medicine, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA.
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Muquith MA, Islam MN, Haq SA, Ten Klooster PM, Rasker JJ, Yunus MB. Cross-cultural adaptation and validation of a Bengali version of the modified fibromyalgia impact questionnaire. BMC Musculoskelet Disord 2012; 13:157. [PMID: 22925458 PMCID: PMC3493366 DOI: 10.1186/1471-2474-13-157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM). The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ) into Bengali (B-FIQ) and to test its validity and reliability in Bangladeshi patients with FM. Methods The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ), selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC) was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA) patients also completed the B-FIQ. Results For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (α = 0.73) and the total scale (α = 0.83). With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86) and individual items (r = 0.73-0.86), except anxiety (r = 0.27) and morning tiredness (r = 0.64). Conclusion This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.
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Affiliation(s)
- Mohammed A Muquith
- Rheumatology Wing, Department of Medicine, Bangabandhu Sheikh Mujib, Medical University, Shahbagh, Dhaka, Bangladesh
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