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Gyorfi M, Rupp A, Abd-Elsayed A. Fibromyalgia Pathophysiology. Biomedicines 2022; 10:biomedicines10123070. [PMID: 36551826 PMCID: PMC9776089 DOI: 10.3390/biomedicines10123070] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
This article examines the biological, genetic, and environmental aspects of fibromyalgia that may have an impact on its pathogenesis. Symptoms of fibromyalgia may be related to aberrations in the endogenous inhibition of pain as well as changes in the central processing of sensory input. Genetic research has revealed familial aggregation of fibromyalgia and other related disorders like major depressive disorder. Dysfunctional pain processing may also be influenced by exposure to physical or psychological stressors, abnormal biologic reactions in the autonomic nervous system, and neuroendocrine responses. With more research the pathophysiology of fibromyalgia will be better understood, leading to more logical and focused treatment options for fibromyalgia patients.
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Affiliation(s)
- Michael Gyorfi
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
- Correspondence:
| | - Adam Rupp
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
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2
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Wilson N, Beasley MJ, Pope C, Dulake D, Moir LJ, Hollick RJ, Macfarlane GJ. UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study). BMC Health Serv Res 2022; 22:989. [PMID: 35922796 PMCID: PMC9347075 DOI: 10.1186/s12913-022-08324-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08324-4.
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Affiliation(s)
- Nicky Wilson
- Departments of Rheumatology and Therapies, King's College Hospital NHS Foundation Trust, London, UK.
| | - Marcus J Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Laura J Moir
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
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Dailey DL, Vance CGT, Chimenti R, Rakel BA, Zimmerman MB, Williams JM, Sluka KA, Crofford LJ. The Influence of Opioids on Transcutaneous Electrical Nerve Stimulation Effects in Women With Fibromyalgia. THE JOURNAL OF PAIN 2022; 23:1268-1281. [PMID: 35292378 DOI: 10.1016/j.jpain.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Transcutaneous electrical nerve stimulation (TENS) uses endogenous opioids to produce analgesia, and effectiveness can be reduced in opioid-tolerant individuals'. We examined TENS effectiveness (primary aim), and differences in fibromyalgia symptoms (secondary aim), in women with fibromyalgia regularly taking opioid (RTO) medications compared with women not- regularly taking opioids (not-RTO). Women (RTO n = 79; not-RTO not-n = 222) with fibromyalgia with daily pain levels ≥4 were enrolled and categorized into RTO (taking opioids at least 5 of 7 days in last 30 days) or not-RTO groups. Participants were categorized into tramadol n = 52 (65.8%) and other opioids n = 27 (34.2%) for the RTO group. Participants were phenotyped across multiple domains including demographics, fibromyalgia characteristics pain, fatigue, sleep, psychosocial factors, and activity. Participants were randomized to active TENS (n = 101), placebo TENS (n = 99), or no TENS (n = 99) for 1-month with randomization stratified by opioid use. Active TENS was equally effective in movement-evoked pain in those in the RTO and not-RTO groups. Women with fibromyalgia in the RTO group were older (P = .002), lower-income (P = .035), more likely to smoke (P = .014), and more likely to report depression (P = .013), hypertension (P = .005) or osteoarthritis (P = .027). The RTO group demonstrated greater bodily pain on SF-36 (P = .005), lower quality of life on the physical health component of the SF-36 (P = .040), and greater fatigue (MAF-ADL P = .047; fatigue with sit to stand test (P = .047) These differences were small of and unclear clinical significance. In summary, regular use of opioid analgesics does not interfere with the effectiveness of TENS for movement-evoked pain. Clinical Trial Registration Number: NCT01888640. PERSPECTIVE: Individuals treated with mixed frequency TENS at a strong but comfortable intensity that was taking prescription opioid analgesics showed a significant reduction in movement-evoked pain and fatigue. These data support the use of TENS, using appropriate parameters of stimulation, as an intervention for individuals with fibromyalgia taking opioid analgesics.
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Affiliation(s)
- Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; Department of Physical Therapy St. Ambrose University, Davenport, Iowa.
| | - Carol G T Vance
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Barbara A Rakel
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | | | - Jon M Williams
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | - Leslie J Crofford
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
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El Miedany Y, Gadallah N, Mohasseb D, Gaballah NM, El Zohiery AK, Hassan M, El Gaafary M, Hassan W, Mortada M, Eissa M, Tabra SA, Foad N, El Nouby FH, Saber S, Galal S. Consensus evidence-based clinical practice recommendations for the management of fibromyalgia. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00129-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and, at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice. The aim of this study was to develop an up-to-date consensus and evidence-based clinical practice guidelines for a treat-to-target management of fibromyalgia. Fifteen key clinical questions were identified by a scientific committee according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize the evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.
Results
An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (ranks 7–9) ranged from 85 to 100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. An algorithm for the management of fibromyalgia has been suggested.
Conclusions
These recommendations provide an updated consensus on both the non-pharmacological and the pharmacological treatments of fibromyalgia. The provided strategies to reach optimal treat-to-target outcomes in common clinical scenarios are based on a combination of evidence and expert opinions. Best treatment decisions should be tailored to each individual patient situation.
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Anderl P. Selected Disorders of the Musculoskeletal System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Fibromyalgia (FM) is a condition of chronic widespread pain (CWP) that can occur throughout the life cycle and is likely underrecognized in older patients. FM is associated with considerable suffering and reduction in quality of life and may occur as a unique condition, but in older patients is most likely to be associated with another medical illness. Understood mechanistically to be a sensitization of the nervous system, recently identified as nociplastic pain, FM is accepted as a valid medical illness that requires a positive diagnosis and directed treatments. The cornerstone of treatments for FM are nonpharmacologic interventions, with the understanding that medications provide only modest benefit for most patients, and with particular concern about adverse effects in older patients. If FM is not recognized, treatments may be misdirected to the other medical condition, with failure to address FM symptoms, leading to overall poor outcome. In contrast, new complaints in older patients should not immediately be attributed to FM, and physicians should be vigilant to ensure that onset of a new illness is not ignored. As FM is most often a lifelong condition, patients should be encouraged to identify their own personal strategies that can attenuate symptoms, especially when symptoms flare. Continued life participation should be the outcome goal.
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Affiliation(s)
- Amir Minerbi
- Institute for Pain Medicine, Rambam Health Campus, Haifa, Israel.,Ruth and Bruce Rapaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mary-Ann Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada. .,Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada.
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Migliorini F, Maffulli N, Eschweiler J, Tingart M, Driessen A, Colarossi G. BMI but not age and sex negatively impact on the outcome of pharmacotherapy in fibromyalgia: a systematic review. Expert Rev Clin Pharmacol 2021; 14:1029-1038. [PMID: 33990169 DOI: 10.1080/17512433.2021.1929923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The impact of sex, age, body mass index (BMI) in fibromyalgia is still unclear. A systematic review was conducted to investigate whether sex, age and BMI influence the clinical outcomes and rate of adverse events. METHODS The present study was performed according to the PRISMA guidelines. The literature search was performed in February 2021. All the RCTs investigating pharmacological strategies for fibromyalgia were accessed. RESULTS Data from 51 RCTs (17,311 patients) were collected. Short Form 36 emotional, Social function and physical role subscales showed evidence of a negative association with BMI (P = 0.02, P = 0.002 and P = 0.0001, respectively). Depression and anxiety subscales of the Hospital Anxiety and Depression score demonstrated evidence of a positive association with age (P = 0.04 and P = 0.001, respectively) and sex (P = 0.00005 and P = 0.0001, respectively). Visual analog scale evidenced a positive association with BMI (P = 0.04). Clinical Global Impression Severity scale demonstrated evidence of a negative association with BMI (P = 0.02). CONCLUSION Irrespective from the pharmacological approach, a higher BMI is negatively associated with a favorable outcome in patients with fibromyalgia. The association with sex and age remains controversial. LEVEL OF EVIDENCE I, systematic review of RCTs.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK
| | - Jörg Eschweiler
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Arne Driessen
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Giorgia Colarossi
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
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8
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Hayashi K, Miki K, Hayashi N, Hashimoto R, Yukioka M. Weather sensitivity associated with quality of life in patients with fibromyalgia. BMC Rheumatol 2021; 5:14. [PMID: 33966632 PMCID: PMC8108353 DOI: 10.1186/s41927-021-00185-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Fibromyalgia is characterized by chronic widespread pain, and more than half of patients with fibromyalgia report that weather-related variables aggravate their symptoms. However, the differences in actual symptoms have not been measured between those with and without weather sensitivity. The present study aimed to investigate whether weather sensitivity associated with the minimal clinically important difference values of quality of life in patients with fibromyalgia, between those with and without weather sensitivity. Methods Sixty-four consecutive outpatients with fibromyalgia on their first visit to our tertiary center were included. Weather sensitivity was measured using self-perceived symptoms. Pain intensity was measured using the 0–10 Numerical Rating Scale (NRS). Quality of life was measured using the Euro Quality of life-5 Dimensions-3 level (EQ-5D-3L) scale. The variables were subjected to univariable and multivariable analysis using the EQ-5D-3L scale. Results The mean age of the patients was 50 years. Forty-eight patients (75%) were women. The mean EQ-5D-3L score was 0.55. Thirty-seven patients (58%) reported weather sensitivity. In univariable analysis, the welfare recipient, weather sensitivity, and NRS values were associated with EQ-5D-3L scale scores. In multivariable analysis, NRS value and weather sensitivity were independently associated with EQ-5D-3L scale scores. The NRS and EQ-5D-3L scale scores were significantly worse in those with weather sensitivity than those without weather sensitivity. The difference in NRS values was less than 1.5 points between groups. The differences in EQ-5D-3L scale scores were 0.16 points between groups. Conclusions Weather sensitivity was significantly associated with quality of life in patients with fibromyalgia. There was an association with weather sensitivity and the minimal clinically important difference values of quality of life in patients with fibromyalgia. The presence of weather sensitivity could have a key role in the quality of life in patients with fibromyalgia. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00185-4.
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Affiliation(s)
- Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Kenji Miki
- Center for pain management, Hayaishi Hospital, Osaka, Japan. .,Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan.
| | | | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masao Yukioka
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan.,Department Rheumatology, Yukioka Hospital, Osaka, Japan
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Kumbhare D, Tesio L. A theoretical framework to improve the construct for chronic pain disorders using fibromyalgia as an example. Ther Adv Musculoskelet Dis 2021; 13:1759720X20966490. [PMID: 33796154 PMCID: PMC7970670 DOI: 10.1177/1759720x20966490] [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: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
Fibromyalgia (FM) is a frequent, complex condition of chronic musculoskeletal pain with no evidence for biological correlates. For this reason, despite many efforts from the medical community, its construct still appears ill defined. Promising candidate biomarkers are critically reviewed. A research agenda is proposed for developing a clearer construct of FM. The ideal theoretical framework is one of overcoming the illness–disease dichotomy and considering reciprocal interactions between biology and behaviour. This approach may foster research in other fields of pain medicine and of medicine in general.
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Affiliation(s)
- Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto; Pain Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, ON M5G 2A2, Canada
| | - Luigi Tesio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Mascarenhas RO, Souza MB, Oliveira MX, Lacerda AC, Mendonça VA, Henschke N, Oliveira VC. Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis. JAMA Intern Med 2021; 181:104-112. [PMID: 33104162 PMCID: PMC7589080 DOI: 10.1001/jamainternmed.2020.5651] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Fibromyalgia is a chronic condition that results in a significant burden to individuals and society. OBJECTIVE To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia. DATA SOURCES Searches were performed in the MEDLINE, Cochrane, Embase, AMED, PsycInfo, and PEDro databases without language or date restrictions on December 11, 2018, and updated on July 15, 2020. STUDY SELECTION All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias using the 0 to 10 PEDro scale. Effect sizes for specific therapies were pooled using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. MAIN OUTCOMES AND MEASURES Pain intensity measured by the visual analog scale, numerical rating scales, and other valid instruments and QOL measured by the Fibromyalgia Impact Questionnaire. RESULTS A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], -0.9; 95% CI, -1.4 to -0.3) for pain in the short term and was found in favor of central nervous system depressants (WMD, -1.2 [95% CI, -1.6 to -0.8]) and antidepressants (WMD, -0.5 [95% CI, -0.7 to -0.4]) for pain in the medium term. There was also high-quality evidence in favor of antidepressants (WMD, -6.8 [95% CI, -8.5 to -5.2]) for QOL in the short term and in favor of central nervous system depressants (WMD, -8.7 [95% CI, -11.3 to -6.0]) and antidepressants (WMD, -3.5 [95% CI, -4.5 to -2.5]) in the medium term. However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggests that most of the currently available therapies for the management of fibromyalgia are not supported by high-quality evidence. Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.
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Affiliation(s)
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana Cristina Lacerda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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11
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Eik H, Kirkevold M, Solbrække KN, Mengshoel AM. Rebuilding a tolerable life: narratives of women recovered from fibromyalgia. Physiother Theory Pract 2020; 38:1188-1197. [PMID: 33026930 DOI: 10.1080/09593985.2020.1830454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain and fatigue condition. Despite extensive research, there is currently no known therapy leading to a cure for FMS. Although studies have reported that some patients can regain their health, little is known about their personal process of becoming well.Objevtive: This study aimed to explore women's narratives about the process of recovering from FMS.Methods: The empirical material consists of qualitative interviews of eight Norwegian women who all have previously had, but do not have FMS any more. Inspired by a narrative approach we analyzed their experiences of becoming better with a focus on recovery as a meaning-making process.Results: The findings revealed a recovery process consisting of two intertwined narratives that are mutually nurturing each other. The first narrative telling moments of prompting changes refers to events during the recovery process where women understood themselves and their suffering in new ways and thereby enabled them to act in new ways or take further action. The second narrative a mundane process of rebuilding a tolerable daily life refers to a lasting, mundane everyday process of exploration how they initially should act to avoid becoming worse and, later, to promote improvement.Conclusion: Our findings show how the women explain their recovery in terms of overcoming fear of movement, making sense of their symptoms and becoming more active in everyday life. The close analysis reveals a recovery narrative portraying a complex and ambiguous process consisting of small dramas about the efforts trying to rebuild a meaningful life.
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Affiliation(s)
- Hedda Eik
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kari Nyheim Solbrække
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Marit Mengshoel
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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12
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Sedentary Time Accumulated in Bouts is Positively Associated with Disease Severity in Fibromyalgia: The Al-Ándalus Project. J Clin Med 2020; 9:jcm9030733. [PMID: 32182753 PMCID: PMC7141225 DOI: 10.3390/jcm9030733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023] Open
Abstract
To examine the associations of prolonged sedentary time (ST) with disease severity in women with fibromyalgia, and to analyse the combined association of total ST and prolonged ST with the disease severity in this population. Women (n = 451; 51.3 ± 7.6 years old) with fibromyalgia participated. Sedentary time and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometry and ST was processed into 30- and 60-min bouts. Dimensions of fibromyalgia (function, overall, symptoms) and the overall disease impact were assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Body fat percentage was assessed using a bio-impedance analyser, and physical fitness was assessed with the Senior Fitness Tests Battery. Greater percentage of ST in 30-min bouts and 60-min bouts were associated with worse function, overall, symptoms and the overall impact of the disease (all, P < 0.05). Overall, these associations were statistically significant when additionally controlling for MVPA and overall physical fitness. Participants with low levels of total ST and prolonged ST (>60-min bouts) presented lower overall impact compared to participants with high levels of total ST and prolonged ST (mean difference = 6.56; 95% confidence interval (CI) = 1.83 to 11.29, P = 0.002). Greater percentage of ST accumulated in 30- and 60-min bouts and a combination of high levels of total and prolonged ST are related to worse disease severity. Although unable to conclude on causality, results suggest it might be advisable to motivate women with fibromyalgia to break prolonged ST and reduce their total daily ST.
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Abstract
Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. For many patients, these symptoms persist for years and lead to frequent health care use; for some, fibromyalgia and its symptoms can be debilitating. Although many treatments are available, management remains challenging. This article highlights the clinical features of fibromyalgia, discusses diagnostic criteria and their evolution, and reviews treatment options.
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Affiliation(s)
- Matthew J Bair
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana (M.J.B.)
| | - Erin E Krebs
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.E.K.)
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Araya-Quintanilla F, Gutiérrez-Espinoza H, Muñoz-Yánez MJ, Cavero-Redondo I, Álvarez-Bueno C, Martinez-Vizcaíno V. Effectiveness of a multicomponent treatment versus conventional treatment in patients with fibromyalgia: Study protocol. Medicine (Baltimore) 2020; 99:e18833. [PMID: 31977878 PMCID: PMC7004771 DOI: 10.1097/md.0000000000018833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain and multiple symptoms. It is a common clinical condition whose etiology is unclear. Currently, there is no gold standard treatment for FM. Management of this condition is therefore aimed at reducing symptoms and maintaining the individual's ability to function optimally. Based on the principal symptoms and characteristics of individuals with FM, we hypothesized that the implementation of a multicomponent treatment (with physical exercise, cognitive behavioral therapy adding to a graded motor imagery program, and therapeutic neuroscience education) would be more effective than conventional treatment in women with FM. This paper describes the rationale and methods of study intended to test the effectiveness of multicomponent treatment versus conventional treatment in patients with FM. METHOD/DESIGN Fifty-six female individuals between 18 and 65 years of age, who were referred to the physical therapy department of the Rehabilitar Center in Chile, will be randomized into two treatment arms. The intervention group will receive a multicomponent treatment program for duration of 12 weeks. The control group will receive a conventional treatment for this condition for 12 weeks. The primary outcome measure will be the pain intensity score, measured by the numeric pain rating scale (NPRS), and the secondary outcomes will be the FM Impact Questionnaire (FIQ), and affective components of pain, such as catastrophizing using the Pain Catastrophizing Scale (PCS), fear of movement using the Tampa Scale Kinesiophobia (TSK), and sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI). DISCUSSION This paper reports the design of a randomized clinical trial aimed at assessing the effectiveness of the multicomponent treatment versus conventional treatment in women with FM. TRIAL REGISTRATION Brazilian registry of clinical trials UTN number U1111-1232-0862. Registered 22 April 2019.
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Affiliation(s)
- Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center. CIRES, Universidad de las Américas
- Faculty of Health Sciences, Universidad SEK
| | - Héctor Gutiérrez-Espinoza
- Rehabilitation and Health Research Center. CIRES, Universidad de las Américas
- Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | | | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Vicente Martinez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Anderl P. Selected Disorders of the Musculoskeletal System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Bourgaize S, Janjua I, Murnaghan K, Mior S, Srbely J, Newton G. Fibromyalgia and myofascial pain syndrome: Two sides of the same coin? A scoping review to determine the lexicon of the current diagnostic criteria. Musculoskeletal Care 2019; 17:3-12. [PMID: 30350334 DOI: 10.1002/msc.1366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Consistent terminology to describe the diagnostic criteria for fibromyalgia (FM) and myofascial pain syndrome (MPS) is required to address the reported inadequacies in diagnosis. The present review investigated intervention studies in FM and MPS populations to determine the lexicon of the current diagnostic criteria used to identify chronic musculoskeletal pain patients. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a scoping review to review systematically the literature obtained from five scientific databases between 1997 and February 2017. Included studies consisted of intervention studies that involved symptomatic musculoskeletal pain patients, of any age or gender, presenting with FM or MPS. Included studies were evaluated for musculoskeletal condition and the diagnostic criteria used to identify patient conditions. Extraction of study criteria focused on whether diagnostic criteria were explicitly stated, the diagnostic criteria used, physical findings, symptomatic duration and the profession of the healthcare provider who confirmed diagnosis. RESULTS We identified 493 interventions, of which 410 were related to FM and 83 to MPS. The lexicon of the diagnostic criteria used for MPS tended to be less consistent in comparison to FM criteria, with notable differences in all comparative categories. CONCLUSIONS The current review identified inconsistencies associated with the lexicon of the diagnostic criteria used to diagnose FM and MPS, and showed that there is wide variability in the terminology currently being used. These findings may have important implications for future development of consistent criteria to diagnose FM and MPS patients accurately.
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Affiliation(s)
- Sheryl Bourgaize
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Imtisal Janjua
- College of Biological Sciences, University of Guelph, Guelph, ON, Canada
| | - Kent Murnaghan
- Department of Library Services, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Silvano Mior
- Department of Graduate Education & Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Genevieve Newton
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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Hwang JM, Lee BJ, Oh TH, Park D, Kim CH. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine (Baltimore) 2019; 98:e13913. [PMID: 30608417 PMCID: PMC6344169 DOI: 10.1097/md.0000000000013913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To evaluate the association between opioid use and treatment outcome (symptom severity, quality of life [QOL]) after a brief interdisciplinary fibromyalgia treatment program (FTP). METHOD Subjects (n = 971) with fibromyalgia participated in the FTP. They filled out the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Status Questionnaire (SF-36) at baseline and 6 to 12 months after the FTP. Post-treatment changes in FIQ and SF-36 scores were compared after stratifying the participants into opioid user and non-opioid user groups. RESULTS A total of 236 patients (24.3%) were opioid users. Compared with non-opioid users, the opioid users had worse symptom severity measured using FIQ total score (p < .001) and all subscales at baseline and post treatment, as well as worse QOL measured using all SF-36 subscales and physical and mental components. Comparison of least-square means of mean change of QOL between opioid users and non-opioid users after analysis of covariance adjusted patient characteristics and baseline scores showed that the FIQ subscale scores of physical impairment (p < .05), job ability (p < .05), and fatigue (p < .05) were significantly less improved in the opioid users compared with the non-opioid users. Moreover, the SF-36 subscale score of general health perception (p < .05) was significantly less improved in the opioid users compared with non-opioid users. However, post-treatment changes in mean scores for QOL subscale generally did not significantly differ in both groups. CONCLUSIONS Opioid use did not affect response to the FTP, as measured using the FIQ total score or SF-36 physical and mental component summary scores. Furthermore, the opioid user group showed less improvement in the FIQ subscale scores of physical impairment, job ability, and fatigue and in the SF-36 subscale scores of general health perception.
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Affiliation(s)
- Jong-moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung-joo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital
| | - Terry H. Oh
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Chul-hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Marlow NM, Simpson KN, Vaughn IA, Jo A, Zoller JS, Short EB. Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators. Pain Pract 2018; 18:154-169. [PMID: 28419725 PMCID: PMC5647203 DOI: 10.1111/papr.12585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine medication adherence and healthcare costs for combination prescription initiators (duloxetine/milnacipran/venlafaxine with pregabalin) vs. monotherapy initiators (duloxetine, milnacipran, venlafaxine, and pregabalin) among patients with fibromyalgia syndrome (FMS). METHODS Our retrospective cohort study used claims data for the South Carolina Blue Cross Blue Shield State Health Plan (SHP). Patients with FMS ≥ 18 years of age, with prescription initiation from July 1, 2007, through June 30, 2010, and SHP enrollment for 12 months pre- and post-index periods were included (combination: n = 100; pregabalin: n = 665; duloxetine: n = 713; milnacipran: n = 131; venlafaxine: n = 272). Medication adherence measures included high adherence (medication possession ratio ≥ 80%) and total supply days. Healthcare costs comprised direct medical expenditures. Propensity score methods of inverse probability of treatment weights were used to control for selection bias due to differing pre-index characteristics. RESULTS Odds ratios for high adherence were significantly increased (P < 0.05) among the combination cohort vs. the venlafaxine (2.15), duloxetine (1.39), and pregabalin (2.20) cohorts. Rate ratios for total supply days were significantly higher (P < 0.05) for combination vs. venlafaxine (1.23), duloxetine (1.08), and pregabalin (1.32) cohorts. Expenditures for total health care were significantly higher (P < 0.05) for combination vs. duloxetine ($26,291 vs. $17,190), milnacipran ($33,638 vs. $22,886), and venlafaxine ($26,586 vs. $16,857) cohorts. CONCLUSIONS Medication adherence was considerably better for combination prescription initiators; however, expenditures for total health care were higher. Still, our findings suggest important clinical benefits with the use of combination prescription therapy, and prospective studies of medication adherence are warranted to examine causal relationships with outcomes not captured by healthcare claims databases.
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Affiliation(s)
- Nicole M. Marlow
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Kit N. Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Ivana A. Vaughn
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Ara Jo
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - James S. Zoller
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - E. Baron Short
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
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Clauw DJ, D'Arcy Y, Gebke K, Semel D, Pauer L, Jones KD. Normalizing fibromyalgia as a chronic illness. Postgrad Med 2017; 130:9-18. [PMID: 29256764 DOI: 10.1080/00325481.2018.1411743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.
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Affiliation(s)
- Daniel J Clauw
- a Department of Anesthesiology , University of Michigan , Ann Arbor , MI , USA
| | - Yvonne D'Arcy
- b Pain Management Nurse Practitioner , Ponte Vedra Beach , FL , USA
| | - Kevin Gebke
- c Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | | | - Kim D Jones
- f Schools of Nursing & Medicine , Oregon Health & Science University , Portland , OR , USA
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Fitzcharles MA, Brachaniec M, Cooper L, Dubin R, Flynn T, Gerhold K, Häuser W, Cowan K, Laupacis A, Marleau R, Milot M, Szajcz-Keller N, Sumpton J, Walsh Z, El-Gabalawy H. A paradigm change to inform fibromyalgia research priorities by engaging patients and health care professionals. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:137-147. [PMID: 35005349 PMCID: PMC8730558 DOI: 10.1080/24740527.2017.1374820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Research objectives should be focused toward advancing knowledge that has meaningful impact on health. However, research agendas are mostly driven by the health care community, with limited input from patients. Aims: In this study, prioirities of uncertainties for the management of fibromyalgia (FM) that could propel future research were identified by a defined process using the James Lind Alliance Priority Setting Partnership (JLA-PSP) methodology. Methods: As a first step, a survey was distributed across Canada that engaged patients, caregivers, and health care professionals to provide narrative input to eight open-ended questions regarding FM care. Responses were thematically condensed and synthesized into an initial list of 43 uncertainties used to guide a comprehensive literature search. Questions already effectively addressed in the literature were excluded, leaving 25 uncertainties that were ranked during a one-day consensus workshop. Results: Three broad themes emerged: the value of personalized targeted treatment and subgrouping of patients; the efficacy of various self-management strategies and educational initiatives; and identification of the ideal health care setting to provide FM care. Opioids and cannabinoids were the only specific pharmacologic interventions ranked as needing further research. Conclusions: The prioritized questions highlight the importance of recognizing the heterogeneity of FM symptoms, the need for a personalized treatment approach, and a better understanding of the value of self-management strategies. This is the first study that uses an established and transparent methodology to engage all FM stakeholders to help inform researchers and funding bodies of clinically relevant research priorities.
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Affiliation(s)
- Mary-Ann Fitzcharles
- Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Ruth Dubin
- Department of Family Medicine, Queen’s University, Kingston, Canada
| | | | - Kerstin Gerhold
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Winfried Häuser
- Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | | | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto and Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Nicole Szajcz-Keller
- Canadian Institutes for Health Research, Institute of Musculoskeletal Health and Arthritis, Winnipeg, MB, Canada
| | - Janice Sumpton
- Department of Pharmacy, London Health Sciences Centre, London, ON, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Hani El-Gabalawy
- Canadian Institutes for Health Research, Institute of Musculoskeletal Health and Arthritis, Winnipeg, MB, Canada
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Abstract
BACKGROUND Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems and fatigue. People often report high disability levels and poor health-related quality of life (HRQoL). Drug therapy focuses on reducing key symptoms and disability, and improving HRQoL. Anticonvulsants (antiepileptic drugs) are drugs frequently used for the treatment of chronic pain syndromes. OBJECTIVES To assess the benefits and harms of anticonvulsants for treating FM symptoms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2013), MEDLINE (1966 to August 2013), PsycINFO (1966 to August 2013), SCOPUS (1980 to August 2013) and the reference lists of reviewed articles for published studies and www.clinicaltrials.gov (to August 2013) for unpublished trials. SELECTION CRITERIA We selected randomised controlled trials of any formulation of anticonvulsants used for the treatment of people with FM of any age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion. MAIN RESULTS We included eight studies: five with pregabalin and one study each with gabapentin, lacosamide and levetiracetam. A total of 2480 people were included into anticonvulsants groups and 1099 people in placebo groups. The median therapy phase of the studies was 13 weeks. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM. The amount and quality of evidence was sufficient to draw definite conclusions on the efficacy and safety of pregabalin in FM. Therefore, we focused on our interpretation of the evidence for pregabalin due to our greater certainty about its effects and its greater relevance to clinical practice. All pregabalin studies had a low risk of bias. Reporting a 50% or greater reduction in pain was more frequent with pregabalin use than with a placebo (risk ratio (RR) 1.59; 95% confidence interval (CI) 1.33 to 1.90; number needed to treat for an additional beneficial outcome (NNTB) 12; 95% CI 9 to 21). The number of people who reported being 'much' or 'very much' improved was higher with pregabalin than with placebo (RR 1.38; 95% CI 1.23 to 1.55; NNTB 9; 95% CI 7 to 15). Pregabalin did not substantially reduce fatigue (SMD -0.17; 95% CI -0.25 to -0.09; 2.7% absolute improvement on a 1 to 50 scale) compared with placebo. Pregabalin had a small benefit over placebo in reducing sleep problems by 6.2% fewer points on a scale of 0 to 100 (standardised mean difference (SMD) -0.35; 95% CI -0.43 to -0.27). The dropout rate due to adverse events was higher with pregabalin use than with placebo use (RR 1.68; 95% CI 1.36 to 2.07; number needed to treat for an additional harmful outcome (NNTH) 13; 95% CI 9 to 23). There was no significant difference in serious adverse events between pregabalin and placebo use (RR 1.03; 95% CI 0.71 to 1.49). Dizziness was reported as an adverse event more frequently with pregabalin use than with placebo use (RR 3.77; 95% CI 3.06 to 4.63; NNTH 4; 95% CI 3 to 5). AUTHORS' CONCLUSIONS The anticonvulsant, pregabalin, demonstrated a small benefit over placebo in reducing pain and sleep problems. Pregabalin use was shown not to substantially reduce fatigue compared with placebo. Study dropout rates due to adverse events were higher with pregabalin use compared with placebo. Dizziness was a particularly frequent adverse event seen with pregabalin use. At the time of writing this review, pregabalin is the only anticonvulsant drug approved for treating FM in the US and in 25 other non-European countries. However, pregabalin has not been approved for treating FM in Europe. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM.
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Affiliation(s)
- Nurcan Üçeyler
- University of WürzburgDepartment of NeurologyWürzburgGermany97080
| | - Claudia Sommer
- University of WürzburgDepartment of NeurologyWürzburgGermany97080
| | - Brian Walitt
- National Institutes of HealthNational Center for Complementary and Integrative Health10 Center DriveBethesdaMDUSA20892
- National Institutes of HealthNational Institute of Nursing Research10 Center DriveBethesdaMDUSA20892
| | - Winfried Häuser
- Technische Universität MünchenDepartment of Psychosomatic Medicine and PsychotherapyLangerstr. 3MünchenGermanyD‐81675
- Klinikum SaarbrückenInternal Medicine 1Winterberg 1SaarbrückenGermanyD‐66119
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Fitzcharles MA, Shir Y. Another Nasty Effect of Opioids: Attenuating the Benefits of Motivational Interviewing in Fibromyalgia? J Rheumatol Suppl 2017; 44:407-409. [PMID: 28604346 DOI: 10.3899/jrheum.170076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mary-Ann Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, and Division of Rheumatology, McGill University;
| | - Yoram Shir
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada
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Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep 2017; 2:e598. [PMID: 29392213 PMCID: PMC5741304 DOI: 10.1097/pr9.0000000000000598] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022] Open
Abstract
Although chronic widespread pain is the defining feature of fibromyalgia, a myriad of other conditions may present with similar pain complaint leading to misdiagnosis. Conditions that may mimic fibromyalgia may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. In this review, we examine these various conditions that should be considered in a differential diagnosis and provide direction that will help the clinician differentiate these conditions from fibromyalgia. Introduction: Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis. Objectives: To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM. Methods: A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP. Results: Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented. Conclusion: Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.
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Littlejohn G, Guymer E. Modulation of NMDA Receptor Activity in Fibromyalgia. Biomedicines 2017; 5:biomedicines5020015. [PMID: 28536358 PMCID: PMC5489801 DOI: 10.3390/biomedicines5020015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 01/15/2023] Open
Abstract
Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer–term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia.
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Affiliation(s)
- Geoffrey Littlejohn
- Departments of Medicine, Monash University and Rheumatology, MonashHealth, Melbourne 3168, Australia.
| | - Emma Guymer
- Departments of Medicine, Monash University and Rheumatology, MonashHealth, Melbourne 3168, Australia.
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Choy EH. Current treatments to counter sleep dysfunction as a pathogenic stimulus of fibromyalgia. Pain Manag 2016; 6:339-46. [PMID: 27312978 DOI: 10.2217/pmt-2016-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fibromyalgia is characterized by chronic widespread pain, fatigue and nonrestorative sleep. Polysomnography showed reduced short-wave sleep and abnormal alpha rhythms during nonrapid eye movement sleep in patients with fibromyalgia. However, sleep dysfunction might be pathogenic in fibromyalgia since myalgia and fatigue could be induced in healthy individuals by disrupting sleep. Poor sleep quality was a major risk factor for the subsequent development of chronic widespread pain in healthy pain-free individuals. Sleep disruption leads to impairment of the descending pain inhibition pathways. Aside from good sleep, hygiene, exercise can promote sleep. Among currently available pharmacological treatments, evidence suggests amitriptyline and pregabalin can improve sleep in fibromyalgia.
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Affiliation(s)
- Ernest H Choy
- Section of Rheumatology, Institute of Infection & Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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26
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Lacasse A, Bourgault P, Choinière M. Fibromyalgia-related costs and loss of productivity: a substantial societal burden. BMC Musculoskelet Disord 2016; 17:168. [PMID: 27084363 PMCID: PMC4833946 DOI: 10.1186/s12891-016-1027-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/08/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study aimed at describing pain-related health care resource use, direct costs, and productivity loss among patients suffering from fibromyalgia syndrome (FMS). METHODS A cost-of-illness study with a sample of 57 adults having a diagnosis of FMS was conducted in the province of Quebec (Canada). Data regarding FMS-related direct costs and productivity loss from paid and unpaid work over a three-month period were collected using a standardized structured telephone interview protocol. Direct costs were valued in 2009 Canadian dollars using a societal perspective. RESULTS Results showed that average direct costs over a three-month period added up to $951 per patient (SD: $710), which could be translated in a mean annual cost of $3804. The purchase of prescribed medications led to the highest costs (mean: $329, SD: $321), followed by consultations to health care professionals other than physicians (mean: $129, SD: $222) and physicians consultations (mean: $98, SD: $116). Results further showed a high economic burden for patients themselves, aside from costs covered by public or private insurers. Among the subsample of participants who had a paid job (45.6%), an average of 5.6 days (SD: 13.2) were lost due to pain during the past three months. Among those who were not employed (54.4%), an average of 25.1 days in household productivity (SD: 24.8) were lost. CONCLUSIONS FMS is associated with a substantial socioeconomic burden. Further research is clearly needed to improve the management of this type of disorder and make better decisions regarding resource allocation.
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Affiliation(s)
- Anaïs Lacasse
- />Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec Canada
| | - Patricia Bourgault
- />Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec Canada
- />École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Manon Choinière
- />Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, Québec Canada
- />Centre de recherche du Centre hospitalier de l’Université de Montréal, Tour Saint-Antoine 850, rue Saint-Denis, Bureau S03-428, Montréal, Québec Canada
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Lerma C, Martinez-Martinez LA, Ruiz N, Vargas A, Infante O, Martinez-Lavin M. Fibromyalgia beyond reductionism. Heart rhythm fractal analysis to assess autonomic nervous system resilience. Scand J Rheumatol 2015; 45:151-7. [PMID: 26375423 DOI: 10.3109/03009742.2015.1055299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The prevailing linear reductionist medical model seems unable to explain complex multisymptomatic illnesses such as fibromyalgia (FM) and similar maladies. Paradigms derived from the complexity theory may provide a coherent framework for these elusive illnesses. Along these lines is the proposal that FM represents a degradation of our main complex adaptive system (the autonomic nervous system, ANS), in a failed effort to adjust to a hostile environment. Healthy complex systems have fractal structures. Heart rate fractal-like variability reflects resilient ANS performance. Our aim was to measure the heart rate variability (HRV) fractal scaling index in FM patients and to correlate this index with clinical symptoms. METHOD We studied 30 women with FM and 30 controls. All participants filled out questionnaires assessing the severity of FM. The HRV fractal scaling index was estimated during 24 h using detrended fluctuation analysis (DFA). RESULTS The fractal scaling index alpha-1 was higher in FM patients than in controls (mean ± sd: 1.22 ± 0.10 vs. 1.16 ± 0.09; p = 0.031). There was a positive correlation between the fractal scaling index alpha-1 and the visual analogue scale (VAS) for depression (Spearman's ρ = 0.36, p = 0.04). CONCLUSIONS The heart rate fractal exponent alpha-1 is altered in FM patients, suggesting a rigid ANS performance. This tangible non-linear finding supports the notion that FM may represent a degradation of our main complex adaptive system, namely the ANS.
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Affiliation(s)
- C Lerma
- a National Institute of Cardiology , Mexico City , Mexico
| | | | - N Ruiz
- a National Institute of Cardiology , Mexico City , Mexico
| | - A Vargas
- a National Institute of Cardiology , Mexico City , Mexico
| | - O Infante
- a National Institute of Cardiology , Mexico City , Mexico
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Schaefer C, Mann R, Masters ET, Cappelleri JC, Daniel SR, Zlateva G, McElroy HJ, Chandran AB, Adams EH, Assaf AR, McNett M, Mease P, Silverman S, Staud R. The Comparative Burden of Chronic Widespread Pain and Fibromyalgia in the United States. Pain Pract 2015; 16:565-79. [PMID: 25980433 DOI: 10.1111/papr.12302] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND/PURPOSE Little information exists on the comparative patient and economic burden of chronic widespread pain (CWP) and fibromyalgia (FM) in the United States. METHODS This multistage, observational study included an online screening survey of a large geographically diverse US sample to assess CWP status, a physician/site visit to determine FM diagnosis, and an online subject questionnaire to capture clinical characteristics, pain, health status, functioning, sleep, healthcare resource use (HRU), productivity, and costs. Based on the screener and physician evaluation, mutually exclusive groups of subjects without CWP (CWP-), with CWP but without FM (CWP+), and with confirmed FM were identified. RESULTS Disease burden was examined in 472 subjects (125 CWP-, 176 CWP+, 171 FM). Age, race, and ethnicity were similar across groups. Mean body mass index and number of comorbidities increased from CWP- to CWP+ to FM (P = 0.0044, P < 0.0001, respectively). From CWP- to CWP+ to FM, there were reductions in health status (EQ-5D, SF-12) and sleep outcomes (MOS-SS, SSQ) (all P < 0.05). Pain severity, interference with function (BPI-SF), and overall work impairment (WPAI:SHP) increased from CWP- to CWP+ to FM (all P < 0.0001). Higher proportions of CWP+ (52.8%) and FM subjects (62.6%) were taking pain-related prescription medications relative to CWP- subjects (32.8%; P < 0.0001). Significant differences in total direct and indirect costs across the three groups (both P < 0.0001) were observed, with highest costs among FM subjects. CONCLUSION Fibromyalgia subjects were characterized by the greatest disease burden with more comorbidities and pain-related medications, poorer health status, function, sleep, lower productivity, and higher costs.
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Affiliation(s)
| | - Rachael Mann
- Covance Market Access Services Inc, San Diego, CA, U.S.A
| | | | | | | | | | | | | | - Edgar H Adams
- Covance Market Access Services Inc, Gaithersburg, MD, U.S.A
| | | | | | - Philip Mease
- Swedish Medical Center and University of Washington, Seattle, WA, U.S.A
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Redelmeier DA, Zung JD, Thiruchelvam D, Tibshirani RJ. Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash. J Rheumatol 2015; 42:1502-10. [PMID: 25979716 DOI: 10.3899/jrheum.141315] [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] [Accepted: 03/24/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash. METHODS We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash. RESULTS The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27-2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety. CONCLUSION A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.
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Affiliation(s)
- Donald A Redelmeier
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University.
| | - Jeremy D Zung
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
| | - Deva Thiruchelvam
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
| | - Robert J Tibshirani
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
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Bourgault P, Lacasse A, Marchand S, Courtemanche-Harel R, Charest J, Gaumond I, Barcellos de Souza J, Choinière M. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS One 2015; 10:e0126324. [PMID: 25978402 PMCID: PMC4433106 DOI: 10.1371/journal.pone.0126324] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluated the efficacy of the PASSAGE Program, a structured multicomponent interdisciplinary group intervention for the self-management of FMS. METHODS A mixed-methods randomized controlled trial (intervention (INT) vs. waitlist (WL)) was conducted with patients suffering from FMS. Data were collected at baseline (T0), at the end of the intervention (T1), and 3 months later (T2). The primary outcome was change in pain intensity (0-10). Secondary outcomes were fibromyalgia severity, pain interference, sleep quality, pain coping strategies, depression, health-related quality of life, patient global impression of change (PGIC), and perceived pain relief. Qualitative group interviews with a subset of patients were also conducted. Complete data from T0 to T2 were available for 43 patients. RESULTS The intervention had a statistically significant impact on the three PGIC measures. At the end of the PASSAGE Program, the percentages of patients who perceived overall improvement in their pain levels, functioning and quality of life were significantly higher in the INT Group (73%, 55%, 77% respectively) than in the WL Group (8%, 12%, 20%). The same differences were observed 3 months post-intervention (Intervention group: 62%, 43%, 38% vs Waitlist Group: 13%, 13%, 9%). The proportion of patients who reported ≥ 50% pain relief was also significantly higher in the INT Group at the end of the intervention (36% vs 12%) and 3 months post-intervention (33% vs 4%). Results of the qualitative analysis were in line with the quantitative findings regarding the efficacy of the intervention. The improvement, however, was not reflected in the primary outcome and other secondary outcome measures. CONCLUSION The PASSAGE Program was effective in helping FMS patients gain a sense of control over their symptoms. We suggest including PGIC in future clinical trials on FMS as they appear to capture important aspects of the patients' experience. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number Register ISRCTN14526380.
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Affiliation(s)
- Patricia Bourgault
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Anaïs Lacasse
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Serge Marchand
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de neurochirurgie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roxanne Courtemanche-Harel
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jacques Charest
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Isabelle Gaumond
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Juliana Barcellos de Souza
- Centre de recherche clinique Étienne-Le Bel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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Alpaslan C. Orofacial pain and fibromyalgia pain: Being aware of comorbid conditions. World J Rheumatol 2015; 5:45-49. [DOI: 10.5499/wjr.v5.i1.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/17/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic referral pattern. Furthermore, pain arising from structures in the orofacial region may be a presentation of fibromyalgia and treatment directed at temporomandibular disorders fails to alleviate the pain. Similarly, patients with fibromyalgia may present with pain in the orofacial region. The physician in this case should be aware of temporomandibular disorders, its characteristic findings and treatment approaches that might be included in the treatment plan.
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Fibromialgia: ¿comorbilidad marcadora de vulnerabilidad? Med Clin (Barc) 2014; 142:538-9. [DOI: 10.1016/j.medcli.2013.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/19/2013] [Indexed: 12/30/2022]
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Abstract
Yoga is a popular activity which may be well suited to some individuals with specific rheumatic disorders. Regular yoga practice can increase muscle strength and endurance, proprioception, and balance, with emphasis on movement through a full range of motion to increase flexibility and mobility. Additional beneficial elements of yoga include breathing, relaxation, body awareness, and meditation, which can reduce stress and anxiety and promote a sense of calmness, general well-being, and improved quality of life. Yoga also encourages a meditative focus, increased body awareness and mindfulness; some evidence suggests yoga may help reduce inflammatory mediators including C-reactive protein and interleukin-6. Yoga is best learned under the supervision of qualified teachers who are well informed about the potential musculoskeletal needs of each individual. Here, we briefly review the literature on yoga for healthy, musculoskeletal, and rheumatic disease populations and offer recommendations for discussing ways to begin yoga with patients.
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Affiliation(s)
- Susan J Bartlett
- Divisions of Rheumatology and Clinical Epidemiology, McGill University, Montreal, QC, Canada,
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Abstract
BACKGROUND Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems and fatigue. People often report high disability levels and poor health-related quality of life (HRQoL). Drug therapy focuses on reducing key symptoms and disability, and improving HRQoL. Anticonvulsants (antiepileptic drugs) are drugs frequently used for the treatment of chronic pain syndromes. OBJECTIVES To assess the benefits and harms of anticonvulsants for treating FM symptoms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2013), MEDLINE (1966 to August 2013), PsycINFO (1966 to August 2013), SCOPUS (1980 to August 2013) and the reference lists of reviewed articles for published studies and www.clinicaltrials.gov (to August 2013) for unpublished trials. SELECTION CRITERIA We selected randomised controlled trials of any formulation of anticonvulsants used for the treatment of people with FM of any age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion. MAIN RESULTS We included eight studies: five with pregabalin and one study each with gabapentin, lacosamide and levetiracetam. A total of 2480 people were included into anticonvulsants groups and 1099 people in placebo groups. The median therapy phase of the studies was 13 weeks. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM. The amount and quality of evidence was sufficient to draw definite conclusions on the efficacy and safety of pregabalin in FM. Therefore, we focused on our interpretation of the evidence for pregabalin due to our greater certainty about its effects and its greater relevance to clinical practice. All pregabalin studies had a low risk of bias. Reporting a 50% or greater reduction in pain was more frequent with pregabalin use than with a placebo (risk ratio (RR) 1.59; 95% confidence interval (CI) 1.33 to 1.90; number needed to treat for an additional beneficial outcome (NNTB) 12; 95% CI 9 to 21). The number of people who reported being 'much' or 'very much' improved was higher with pregabalin than with placebo (RR 1.38; 95% CI 1.23 to 1.55; NNTB 9; 95% CI 7 to 15). Pregabalin did not substantially reduce fatigue (SMD -0.17; 95% CI -0.25 to -0.09; 2.7% absolute improvement on a 1 to 50 scale) compared with placebo. Pregabalin had a small benefit over placebo in reducing sleep problems by 6.2% fewer points on a scale of 0 to 100 (standardised mean difference (SMD) -0.35; 95% CI -0.43 to -0.27). The dropout rate due to adverse events was higher with pregabalin use than with placebo use (RR 1.68; 95% CI 1.36 to 2.07; number needed to treat for an additional harmful outcome (NNTH) 13; 95% CI 9 to 23). There was no significant difference in serious adverse events between pregabalin and placebo use (RR 1.03; 95% CI 0.71 to 1.49). Dizziness was reported as an adverse event more frequently with pregabalin use than with placebo use (RR 3.77; 95% CI 3.06 to 4.63; NNTH 4; 95% CI 3 to 5). AUTHORS' CONCLUSIONS The anticonvulsant, pregabalin, demonstrated a small benefit over placebo in reducing pain and sleep problems. Pregabalin use was shown not to substantially reduce fatigue compared with placebo. Study dropout rates due to adverse events were higher with pregabalin use compared with placebo. Dizziness was a particularly frequent adverse event seen with pregabalin use. At the time of writing this review, pregabalin is the only anticonvulsant drug approved for treating FM in the US and in 25 other non-European countries. However, pregabalin has not been approved for treating FM in Europe. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM.
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Affiliation(s)
- Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany, 97080
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