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Úbeda-D’Ocasar E, González-Gerstner D, Cimadevilla-Fernández-Pola E, Ojedo-Martín C, Hernández-Lougedo J, Hervás-Pérez JP. Effects of Diathermy on Pain in Women with Fibromyalgia: A Randomized Controlled Trial. Biomedicines 2024; 12:1465. [PMID: 39062038 PMCID: PMC11275016 DOI: 10.3390/biomedicines12071465] [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: 04/22/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: The main characteristic of fibromyalgia (FM) is generalized musculoskeletal pain. This may be accompanied by muscle and joint stiffness, sleep and mood disorders, anxiety and depression, cognitive dysfunction, and chronic fatigue. It is endemic in developed countries, with a higher prevalence among women than men, and its etiology is still unknown. Diagnosis is made based on chronic generalized pain and through the presence of tender points. The objective of this study was to analyze the efficacy of diathermy on pain in patients with fibromyalgia. (2) Methods: A single, blind, randomized experimental study was developed with a sample of 31 participants. Measurements were taken and recorded at three different intervals using the following measurement tools: the pressure pain threshold (PPT) at the tender points (TP) of the right and left trochanteric prominence with an algometer, the pain measurement scale, the Fibromyalgia Impact Questionnaire, the sleep quality index (PSQI, Pittsburgh), the Multidimensional Fatigue Inventory (MFI-S), and the scale for anxiety and depression (Hospital Anxiety and Depression Scale). Sociodemographic data were collected through Google Forms (age, height, weight, Body Mass Index). The intervention took place twice weekly across four weeks of sessions. (3) Results: Statistically significant results were obtained in the right and left trochanter PPT, as well as for anxiety and fatigue in the experimental group. The results obtained show that this treatment has managed to improve the quality of sleep, the impact of disease, chronic fatigue, and anxiety in patients with FM. (4) Conclusions: Diathermy is a tool that can help reduce pain. It can also improve the baseline levels of chronic fatigue, anxiety, the impact of the disease, and sleep quality in patients with fibromyalgia.
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Affiliation(s)
- Edurne Úbeda-D’Ocasar
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
| | - Daniela González-Gerstner
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
| | - Eduardo Cimadevilla-Fernández-Pola
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
| | - Cristina Ojedo-Martín
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
| | - Juan Hernández-Lougedo
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
| | - Juan Pablo Hervás-Pérez
- Faculty of Health Sciences-HM Hospitals, University Camilo José Cela, Urb. Villafranca del Castillo, 49, 28692 Madrid, Spain; (E.Ú.-D.); (D.G.-G.); (E.C.-F.-P.); (C.O.-M.); (J.H.-L.)
- Instituto de Investigación Sanitaria HM Hospitales, 28015 Madrid, Spain
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Tiwari VK, Kumar A, Nanda S, Chaudhary S, Sharma R, Kumar U, Kumaran SS, Bhatia R. Effect of neuronavigated repetitive Transcranial Magnetic Stimulation on pain, cognition and cortical excitability in fibromyalgia syndrome. Neurol Sci 2024; 45:3421-3433. [PMID: 38270728 DOI: 10.1007/s10072-024-07317-x] [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: 11/16/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Fibromyalgia syndrome is a widespread chronic pain condition identified by body-wide pain, fatigue, cognitive fogginess, and sleep issues. In the past decade, repetitive transcranial magnetic stimulation has emerged as a potential management tool.. In the present study, we enquired whether repetitive transcranial magnetic stimulation could modify pain, corticomotor excitability, cognition, and sleep. METHODS Study is a randomized, sham-controlled, double-blind, clinical trial; wherein after randomizing thirty-four fibromyalgia patients into active or sham therapy (n = 17 each), each participant received repetitive transcranial magnetic stimulation therapy. In active therapy was given at 1 Hz for 20 sessions were delivered on dorsolateral prefrontal cortex (1200 pulses, 150 pulses per train for 8 trains); while in sham therapy coil was placed at right angle to the scalp with same frequency. Functional magnetic resonance imaging was used to identify the therapeutic site. Pain intensity, corticomotor excitability, cognition, and sleep were examined before and after therapy. RESULTS Baseline demographic and clinical parameters for both active and sham groups were comparable. In comparison to sham, active repetitive transcranial magnetic stimulation showed significant difference in pain intensity (P < 0.001, effect size = 0.29, large effect) after intervention. Other parameters of pain perception, cognition, and sleep quality also showed a significant improvement after the therapy in active therapy group only, as compared to sham. CONCLUSIONS Findings suggest that repetitive transcranial magnetic stimulation intervention is effective in managing pain alongside cognition and sleep disturbances in patients of fibromyalgia. It may prove to be an important tool in relieving fibromyalgia-associated morbidity.
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Affiliation(s)
- Vikas Kumar Tiwari
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Aasheesh Kumar
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Srishti Nanda
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Shefali Chaudhary
- Department of Nuclear Magnetic Resonance and MRI Facility, New Delhi, India
| | - Ratna Sharma
- Stress and Cognition Electroimaging Laboratory, Department of Physiology, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences (AIIMS), New Delhi, India, 110029
| | - Senthil S Kumaran
- Department of Nuclear Magnetic Resonance and MRI Facility, New Delhi, India
| | - Renu Bhatia
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, 110029.
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Alter BJ, Moses M, DeSensi R, O’Connell B, Bernstein C, McDermott S, Jeong JH, Wasan AD. Hierarchical Clustering Applied to Chronic Pain Drawings Identifies Undiagnosed Fibromyalgia: Implications for Busy Clinical Practice. THE JOURNAL OF PAIN 2024; 25:104489. [PMID: 38354967 PMCID: PMC11180596 DOI: 10.1016/j.jpain.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
Currently-used assessments for fibromyalgia require clinicians to suspect a fibromyalgia diagnosis, a process susceptible to unintentional bias. Automated assessments of standard patient-reported outcomes (PROs) could be used to prompt formal assessments, potentially reducing bias. We sought to determine whether hierarchical clustering of patient-reported pain distribution on digital body map drawings predicted fibromyalgia diagnosis. Using an observational cohort from the University of Pittsburgh's Patient Outcomes Repository for Treatment registry, which contains PROs and electronic medical record data from 21,423 patients (March 17, 2016-June 25, 2019) presenting to pain management clinics, we tested the hypothesis that hierarchical clustering subgroup was associated with fibromyalgia diagnosis, as determined by ICD-10 code. Logistic regression revealed a significant relationship between the body map cluster subgroup and fibromyalgia diagnosis. The cluster subgroup with the most body areas selected was the most likely to receive a diagnosis of fibromyalgia when controlling for age, gender, anxiety, and depression. Despite this, more than two-thirds of patients in this cluster lacked a clinical fibromyalgia diagnosis. In an exploratory analysis to better understand this apparent underdiagnosis, we developed and applied proxies of fibromyalgia diagnostic criteria. We found that proxy diagnoses were more common than ICD-10 diagnoses, which may be due to less frequent clinical fibromyalgia diagnosis in men. Overall, we find evidence of fibromyalgia underdiagnosis, likely due to gender bias. Coupling PROs that take seconds to complete, such as a digital pain body map, with machine learning is a promising strategy to reduce bias in fibromyalgia diagnosis and improve patient outcomes. PERSPECTIVE: This investigation applies hierarchical clustering to patient-reported, digital pain body maps, finding an association between body map responses and clinical fibromyalgia diagnosis. Rapid, computer-assisted interpretation of pain body maps would be clinically useful in prompting more detailed assessments for fibromyalgia, potentially reducing gender bias.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mark Moses
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rebecca DeSensi
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Brian O’Connell
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Cheryl Bernstein
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sean McDermott
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jong-Hyeon Jeong
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ajay D. Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Pfalzgraf AR, Friend R, Jones KD. Do FIQR Severity Categories and Symptoms, Differentiate Between Continuous, Intermittent and Non-Opioid Users in the Treatment of Fibromyalgia? Pain Manag Nurs 2024; 25:181-188. [PMID: 37993311 PMCID: PMC11016416 DOI: 10.1016/j.pmn.2023.10.005] [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] [Received: 03/27/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Many fibromyalgia patients utilize opioids to treat symptoms. It is important to better understand nuances regarding this treatment option and any stigma associated with this treatment modality. AIM This study: (1) assessed the prevalence of opioid use among continuous, intermittent, and non-opioid users in fibromyalgia patients; (2) determined whether the Revised Fibromyalgia Impact Questionnaire (FIQR) was useful in distinguishing opioid use and symptom burden; and (3) assessed whether fibromyalgia patients encountered stigma and/or invalidation. DESIGN A cross-sectional, observational study of 1,105 participants' responses to validated fibromyalgia and invalidation scales and demographic questions. METHODS The study employed online survey methodology. RESULTS A total of 45% of patients reported utilizing opioids (27% continuous, 18% intermittent, 55% non-users). FIQR disease categories (mild to most severe) strongly distinguished between opioid and non-opioid users with 59% of users falling in the most severe category and 68% of non-users falling in mild disease category (p < .0001). Interestingly, intermittent users were similar to non-users on FIQR severity (65.9 versus 65.7; p <0.60, 0-100) while continuous users reported greater severity than the former (73.9, p < .0001). Continuous users particularly reported more problems with daily activities (p < .0001), being overwhelmed (p < .0001), and being unable to accomplish goals (p < .0001). Stigma related to being 'drug seeking' and being 'judged'. Invalidation was infrequent. CONCLUSIONS Opioid use is common in fibromyalgia and increases monotonically with FIQR severity. Multidisciplinary approaches which help patients perform daily activities, decrease feelings of overwhelm, accomplish goals, and reduce stigma may be beneficial.
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Affiliation(s)
- Andrea R Pfalzgraf
- From the National University of Natural Medicine, Helfgott Research Institute, Portland, OR.
| | - Ronald Friend
- Department of Psychology, College of Arts and Sciences, Stony Brook University, Stony Brook, NY (emeritus); Fibromyalgia Research Unit, Oregon Health & Science University, Portland, OR
| | - Kimberly Dupree Jones
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Oregon Health & Science University, Division of Neurology, Portland, OR
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Mamo N, Tak LM, van de Klundert MAW, Olde Hartman TC, Rosmalen JGM, Hanssen DJC. Quality indicators for collaborative care networks in persistent somatic symptoms and functional disorders: a modified delphi study. BMC Health Serv Res 2024; 24:225. [PMID: 38383395 PMCID: PMC10882926 DOI: 10.1186/s12913-024-10589-w] [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] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Care for persistent somatic symptoms and functional disorders (PSS/FD) is often fragmented. Collaborative care networks (CCNs) may improve care quality for PSS/FD. Effectiveness likely depends on their functioning, but we lack a straightforward quality evaluation system. We therefore aimed to develop quality indicators to evaluate CCNs for PSS/FD. METHOD Using an online three-round modified Delphi process, an expert panel provided, selected and ranked quality indicators for CCNs in PSS/FD. Recruited experts were diverse healthcare professionals with relevant experience in PSS/FD care in the Netherlands. RESULTS The expert panel consisted of 86 professionals representing 15 disciplines, most commonly physiotherapists, psychologists and medical specialists. 58% had more than 10 years experience in PSS/FD care. Round one resulted in 994 quotations, which resulted in 46 unique quality indicators. These were prioritised in round two and ranked in round three by the panel, resulting in a final top ten. The top three indicators were: "shared vision of care for PSS/FD", "pathways tailored to the individual patient", and "sufficiently-experienced caregivers for PSS/FD". CONCLUSIONS The identified quality indicators to evaluate CCNs in the field of PSS/FD can be implemented in clinical practice and may be useful in improving services and when assessing effectiveness.
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Affiliation(s)
- Nick Mamo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Lineke M Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Manouk A W van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Denise J C Hanssen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Otón T, Carmona L, Rivera J. Patient-journey of fibromyalgia patients: A scoping review. REUMATOLOGIA CLINICA 2024; 20:96-103. [PMID: 38395498 DOI: 10.1016/j.reumae.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system. OBJECTIVES The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up. METHODS A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on "patient journey". Results were organized using a deductive classification of themes. RESULTS Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor-patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment. CONCLUSIONS This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Javier Rivera
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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7
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Otón T, Messina OD, Fernández Ávila DG, Robles San Román M, Mata D, Arguissain C, Galindo Guzmán JM, Pérez M, Carmona L. The patient journey of fibromyalgia in Latin America. REUMATOLOGIA CLINICA 2024; 20:32-42. [PMID: 38182526 DOI: 10.1016/j.reumae.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain.
| | - Osvaldo Daniel Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Unidad Docente de postgrado en Reumatología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel G Fernández Ávila
- Unidad de Reumatología, Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Darío Mata
- DOM Centro de Reumatología, Buenos Aires, Argentina
| | | | | | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain
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Turcotte K, Oelke ND, Whitaker G, Holtzman S, O'Connor B, Pearson N, Teo M. Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial. Rheumatol Int 2023; 43:2201-2210. [PMID: 37566253 PMCID: PMC10587329 DOI: 10.1007/s00296-023-05403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.
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Affiliation(s)
- Kara Turcotte
- Department of Nursing, Western University, London, ON, Canada
| | - Nelly D Oelke
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Gina Whitaker
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Brian O'Connor
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Neil Pearson
- Faculty of Medicine, School of Physical Therapy, University of British Columbia, Kelowna, BC, Canada
| | - Michelle Teo
- Department of Medicine, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
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Horita M, Yasuhira A, Hirakawa M, Watanabe A, Higaki N, Nishihara T, Yorozuya T. Efficacy of high-frequency spinal cord stimulation for fibromyalgia syndrome in two cases: case reports. JA Clin Rep 2023; 9:68. [PMID: 37864610 PMCID: PMC10590350 DOI: 10.1186/s40981-023-00660-6] [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: 09/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Reports on the effectiveness of spinal cord stimulation (SCS) for the alleviation of fibromyalgia syndrome (FMS) pain are scarce. We report two cases of effective high-frequency SCS at 1000 Hz against upper- and lower-limb pain in patients with FMS. CASE PRESENTATION Two women with widespread pain were diagnosed with FMS and the pain gradually worsened. A 1-week SCS trial was conducted in each patient. In both cases, the patients complained of unpleasant sensations during 10-Hz SCS. However, the pain was alleviated after 1000-Hz stimulation without irritation. Therefore, leads and a generator were implanted, after which they felt almost no pain. Moreover, the dose of the oral medication could be reduced and the patients returned to their daily lives. CONCLUSION SCS at 1000 Hz may effectively treat pain associated with FMS. Therefore, performing an SCS trial for patients with FMS with intractable pain might be worthwhile.
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Affiliation(s)
- Mikiko Horita
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Ayumi Yasuhira
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Mikako Hirakawa
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Aisa Watanabe
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Nobuhiro Higaki
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Tasuku Nishihara
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan.
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
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Lee CH, Lee EY, Yang M, Won HS, Kim YD. The current status of fibromyalgia in Korea: an electronic population health data study in Korea. Korean J Pain 2023; 36:458-464. [PMID: 37752664 PMCID: PMC10551395 DOI: 10.3344/kjp.23204] [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: 07/11/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Background Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population. Methods Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study. Results The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties. Conclusions The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.
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Affiliation(s)
- Cheol-Hyeong Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Lee
- Health Insurance Review and Assessment Service, Gwangju, Korea
| | - Miyoung Yang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
- Sarcopenia Total Solution Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon-Dong Kim
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
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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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Lage-Hansen PR, Chrysidis S, Amris K, Fredslund-Andersen S, Christensen R, Ellingsen T. Prevalence of survey-based criteria for fibromyalgia and impact on hospital burden: a 7 year follow-up study from an outpatient clinic. Scand J Rheumatol 2023; 52:539-548. [PMID: 36503382 DOI: 10.1080/03009742.2022.2145703] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the prevalence of survey-based criteria for fibromyalgia (FM) among newly referred patients in a rheumatic outpatient clinic, and to compare the use of secondary healthcare services between survey-based FM and non-FM cases. METHOD Newly referred patients to an outpatient clinic were screened for the fulfilment of the 2011 FM survey criteria during a 6 month period in 2013 in this observational cohort study. Demographic data were obtained at baseline. Patients' medical files were evaluated and comparisons between groups were made regarding the use of hospital healthcare facilities during the 7 year observation period. RESULTS Out of 300 invited patients, 248 (83%) completed the questionnaire; 90 patients (36%) fulfilled survey-based criteria for FM at enrolment. FM cases were primarily women (80% vs 54% of non-FM cases), and received more medications (median 4 vs 3 drugs) and public economic support (62% vs 20%). At the 7 year follow-up, crude analyses showed that FM cases had a higher number of hospital courses (median 10 vs 8) and had undergone more invasive procedures (78% vs 60%). Neurologists (42% vs 28%), gastroenterologists (30% vs 13%), endocrinologists (40% vs 21%), pain specialists (13% vs 3%), psychiatrists (20% vs 7%), and abdominal surgeons (43% vs 30%) were consulted more often by FM than by non-FM cases. CONCLUSION Fulfilment of FM survey criteria among newly referred patients to a rheumatic outpatient clinic is frequent. Our study findings show that FM continues to present a challenge for healthcare professionals as well as for patients. RESEARCH HIGHLIGHTS ● Fulfilment of FM survey criteria among newly referred patients to a rheumatic outpatient clinic is frequent.● The burden on the secondary healthcare system for these patients is significant.● This study suggests the need for increased awareness about the diagnosis of FM among certain medical and surgical specialties.
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Affiliation(s)
- P R Lage-Hansen
- Department of Rheumatology, Southern West Hospital, Esbjerg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - S Chrysidis
- Department of Rheumatology, Southern West Hospital, Esbjerg, Denmark
| | - K Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - R Christensen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - T Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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13
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Zanetti CB, Pontes MAG, de Moura EGH, Domiciano DS. High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients. REUMATOLOGIA CLINICA 2023; 19:374-378. [PMID: 37661115 DOI: 10.1016/j.reumae.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/15/2022] [Indexed: 09/05/2023]
Abstract
INTRODUCTION/OBJECTIVES Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. MATERIAL AND METHODS Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. RESULTS 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. CONCLUSION Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.
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Affiliation(s)
- Caio Bosquiero Zanetti
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Antônio Gonçalves Pontes
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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14
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Maddali Bongi S, Vitali Rosati G, Bonaccorsi G, Lorini C. Prevalence and Contextual Factors of Juvenile Fibromyalgia in a Population-Based Italian Sample of Children and Adolescents. Biomedicines 2023; 11:1583. [PMID: 37371677 DOI: 10.3390/biomedicines11061583] [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: 05/09/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Juvenile Fibromyalgia (JFM) is poorly known, leading to delay in the identification of the syndrome. On the other hand, early diagnosis in children is important to prevent the worsening of the disease. This study aims to estimate the prevalence of JFM in an Italian population-based convenience sample, using different criteria (2010 and 2016 ACR, Yunus and Masi), by involving family pediatricians. It also aims to assess the relationships between JFM and contextual factors of the children and their parents, as well as to raise awareness of JFM among pediatricians. Children's data were collected using an ad hoc electronic questionnaire. Overall, 7275 questionnaires were collected (48.5% females; mean age: 8.2 ± 3.6 years). Thirty-eight children (0.5%) met the 2010 ACR criteria, and 4 (0.1%) met the 2016 ACR criteria. The likelihood of meeting the 2010 ACR criteria was significantly higher for children older than 8 years (OR: 2.42), those who had injuries during the leisure time that caused persistent pain (OR: 6.49), whose parents (at least one) had a diagnosis of fibromyalgia (OR: 2.54) or diffuse pain (OR: 9.09). In conclusion, 2010 ACR criteria are confirmed as the more appropriate for children and adolescents and the analysis of contextual factors suggests the need for family pediatricians to pay particular attention to the most important predictors of JFM.
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Affiliation(s)
- Susanna Maddali Bongi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | | | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
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15
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Moshrif A, Mosallam A, Abu-Zaid MH, Gouda W. Evaluating the Effect of Delayed Diagnosis on Disease Outcome in Fibromyalgia: A Multi-Center Cross-Sectional Study. J Pain Res 2023; 16:1355-1365. [PMID: 37123049 PMCID: PMC10132293 DOI: 10.2147/jpr.s381314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/25/2022] [Indexed: 05/02/2023] Open
Abstract
Background The impact of delayed diagnosis (DD) on fibromyalgia (FM) patients' symptomatology and disease outcome has not yet been systematically studied. Objective To analyze the predictors of DD and the influence of DD on FM aggravation and disease evaluation measures. Methods 370 FM patients were interviewed prospectively for this study. The following information was obtained: DD, widespread pain index (WPI), symptom severity scale (SSS), polysymptomatic distress scale (PDS) scale (SSS + WPI), and tender points. We identified three groups of patients: early diagnosis (ED: 2 years; 83 patients), late diagnosis (LD: > 2-7 years; 198 patients), and very late diagnosis (VLD: > 7 years; 89 patients). Results The patients' average age was 33.9 (9.8) years, and 79% were female. The SSS, PDS, and tender point means were 7.8 (1.6), 16.46 (4.1), and 14.31 (2.3), respectively. The correlation between DD and SSS (r = 0.14), the PDS scale (r = 0.37), and FM tender points (r = 0.16) was significant, but not with WPI (r = 0.06). When the three groups were examined, the SSS mean was 7.54 (1.6), 7.73 (1.4), and 8.25 (1.7), respectively (P 0.008), while the PDS mean was 15 (3.8), 15.95 (3.8), and 18.96 (4.4), respectively (P 0.008). (P 0.001). Conclusion Early FM diagnosis is associated with lower SSS, total severity scale, and FM tender points, indicating a less severe condition.
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Affiliation(s)
- Abdelhfeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
- Correspondence: Abdelhfeez Moshrif, Rheumatology Department, Faculty of Medicine, Al Azhar University, Al-Azhar University Square, King Faysal, Assiut, 71524, Egypt, Tel +201062930120, Email
| | - Ahmed Mosallam
- Rheumatology Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | | | - Wesam Gouda
- Rheumatology Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
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16
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Comparative characteristics of ACR 1990, mACR 2010, ACR 2016 and AAPT 2019 criteria for diagnosing fibromyalgia in patients with ankylosing spondylitis. Rheumatol Int 2023; 43:69-77. [PMID: 35869993 DOI: 10.1007/s00296-022-05168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/25/2022] [Indexed: 02/02/2023]
Abstract
Despite many approaches, diagnosis of fibromyalgia (FM) remains a difficult clinical task, especially in the case of comorbidity of FM with other rheumatic diseases, such as ankylosing spondylitis (AS). The prevalence of FM among the population is 2.9-4.7%; whereas in patients with AS, it increases to 12.6-28.5%. The aim of the study was to evaluate the prevalence of FM in AS patients according to different criteria and to characterize them. 143 patients with AS, according to the modified New York Criteria, were examined. The FiRST used for screening of a possible FM. The FM was detected using the ACR 1990 criteria, mARC 2010, ACR 2016 and AAPT 2019 diagnostic criteria. All data were analyzed using IBM Statistics SPSS 22 software. The study was carried out in compliance with bioethical standards. According to ACR 1990, mACR 2010, ACR 2016, and AAPT 2019, the prevalence of FM in patients with AS ranged from 21.0% to 35.7%. The strongest correlation was observed in the mACR 2010 and ACR 2016 criteria (Cohen's κ = 0.871, p < 0.001); ACR 1990 and mACR 2010 as well as ACR 2016 criteria also demonstrated quite a strong level of agreement (Cohen's κ = 0.675 and 0.684, p < 0.001). Our results showed a high prevalence of FM in AS patients. mACR 2010 and ACR 2016 criteria are optimal for clinical practice to diagnose FM in AS patients.
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17
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Zinchuk MS, Turchinets AM, Tumurov DA, Zhuravlev DV, Bryzgalova JE, Guekht AB. [Modern ideas about the relationship between fibromyalgia and mental disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:7-16. [PMID: 37966434 DOI: 10.17116/jnevro20231231017] [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] [Indexed: 11/16/2023]
Abstract
Fibromyalgia (FM) is a pain syndrome with a high burden and an understudied etiology and pathogenesis. There is now considerable evidence that FM has a strong bidirectional relationship with psychiatric disorders and is associated with certain personality traits that contribute to the severity of key somatic symptoms and affect overall prognosis. In this article, the authors present data from recent epidemiological and neurobiological studies, discuss the multilevel relationship between FM and psychiatric disorders, and briefly review approaches to the treatment of co-morbid conditions.
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Affiliation(s)
- M S Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A M Turchinets
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - D A Tumurov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - D V Zhuravlev
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - J E Bryzgalova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A B Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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18
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Oxidative Stress Index and Vitamin C in The Diagnosis of Fibromyalgia Syndrome. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1173658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim: Still there is no any specific laboratory marker for diagnosis of FMS and it mainly depends on clinical examination. So that we aimed to evaluate whether serum Vitamin C levels and oxidative stress index (OSI) can be used in the diagnosis of Fibromyalgia Syndrome (FMS).
Material and Method: 53 female patients and 35 healthy female controls were enrolled to our cross-sectional study. VAS, BDI and FIQ were applied to the patients. Vitamin C levels were measured by HPLC. Total Antioxidant Capacity (TAC) and Total Oxidant Status (TOS) levels were determined by Spectrophotometric Assay method.
Results: While vitamin C and TAC levels of FMS patients were significantly lower than those of the controls, OSI was significantly higher in patients (p= 0.004, p= 0.009 and p= 0.048, respectively). There was a moderate positive and significant relationship between the tender points and FIQ, (r = 0.505; p
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19
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Droppert KM, Knowles SR. The Role of Pain Acceptance, Pain Catastrophizing, and Coping Strategies: A Validation of the Common Sense Model in Females Living with Fibromyalgia. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09873-w. [PMID: 35505201 DOI: 10.1007/s10880-022-09873-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 02/08/2023]
Abstract
This study aimed to examine the extent to which illness beliefs, coping styles, pain acceptance, pain catastrophizing, and psychological distress mediate the relationship between fibromyalgia symptoms and quality of life (QoL) in a female cohort diagnosed with Fibromyalgia (n = 151). Measures used included the Revised Fibromyalgia Impact Questionnaire, Carver Brief COPE scale, Chronic Pain Acceptance Questionnaire Revised, Pain Catastrophizing Scale, Brief Illness Perceptions Questionnaire, Depression and Anxiety Stress Scales, and European Health Interview Survey Quality of Life 8-item Index. Using structural equation modelling, the final model indicated that fibromyalgia symptom severity had a significant direct influence on illness perceptions and psychological distress. In turn, illness perceptions had a significant direct influence on maladaptive coping, pain catastrophizing, pain acceptance, and QoL. Pain catastrophizing and maladaptive coping influenced psychological distress, and in turn distress impacted QoL. Acceptance of pain was found to be influenced by maladaptive coping and in turn acceptance of pain influenced QoL.
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Affiliation(s)
- Kathryn M Droppert
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, PO Box 218, Melbourne, 3122, Australia
| | - Simon Robert Knowles
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, PO Box 218, Melbourne, 3122, Australia. .,Faculty of Medicine, Dentistry, & Health Sciences, The University of Melbourne, Melbourne, Australia. .,Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia.
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20
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Gota CE. Fibromyalgia: Recognition and Management in the Primary Care Office. Rheum Dis Clin North Am 2022; 48:467-478. [PMID: 35400372 DOI: 10.1016/j.rdc.2022.02.006] [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: 10/18/2022]
Abstract
Fibromyalgia is a chronic pain condition manifested by chronic generalized pain, fatigue, disordered sleep, and cognitive difficulties, persistent for at least 3 months. Other common complaints/conditions include symptoms of irritable bowel syndrome, headaches, intermittent paresthesias, and various mood disorders. Women are more commonly affected than men. The treatment approach should be individualized and focused on associated mood disorders, sleep, exercise, correction of maladaptive responses to pain, and coping with stress.
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Affiliation(s)
- Carmen E Gota
- Case Western Reserve Cleveland Clinic School of Medicine, Cleveland, OH, USA.
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21
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Yoo SA, Kim CY, Kim HD, Kim SW. Effects of progressive muscle relaxation therapy with home exercise on pain, fatigue, and stress in subjects with fibromyalgia syndrome: A pilot randomized controlled trial. J Back Musculoskelet Rehabil 2022; 35:289-299. [PMID: 34151818 DOI: 10.3233/bmr-191703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fibromyalgia is accompanied by symptoms of fatigue, depression, sleep disorders, and physical and mental stress [1]. It is a difficult-to-treat disorder because its exact causes are unknown. OBJECTIVE This study aimed to examine the effect of progressive muscle relaxation therapy (PMRT) on pain, fatigue, and stress in patients with fibromyalgia syndrome. METHODS Thirty-seven patients with fibromyalgia syndrome (age: 20-65 years) were randomly allocated to the PMRT group (n1= 18, 2 men and 16 women) or non-PMRT group (n2= 19, 2 men and 17 women). The PMRT group received PMRT twice a week for 8 weeks and the non-PMRT group received conventional physical therapies such as electro-stimulation and heat therapies during this period. The outcome was evaluated before and after 8 week sofintervention using the Visual Analogue Scale, Multidimensional Assessment of Fatigue, Perceived Stress Scale, and measurement of the blood pressure and pulse rate. RESULTS Pain and fatigue significantly decreased in the PMRT group compared with the non-PMRT group (both P< 0.001). In addition, perceived stress (P< 0.001), systolic blood pressure (P< 0.001), diastolic blood pressure (P< 0.05), and pulse rate (P< 0.001) significantly decreased in the PMRT group compared with the non-PMRT group. CONCLUSIONS The findings indicate that progressive muscle relaxation therapy is a viable rehabilitative therapy for pain, fatigue, and stress symptoms in patients with fibromyalgia syndrome.
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Affiliation(s)
- Seoung-A Yoo
- Department of Health Science, The Graduate School, Korea University, Seoul, Korea.,Department of Health Science, The Graduate School, Korea University, Seoul, Korea
| | - Chang-Yong Kim
- Department of Pharmaceutical and Bio-Pharmaceutical Industry, Pharma and Bio Pharma Industry Team, Korea Health Industry Development Institute, Cheongju-si, Korea.,Department of Health Science, The Graduate School, Korea University, Seoul, Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy, School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
| | - Suhng-Wook Kim
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, Korea
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22
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Loftus CG, Ebbert JO, Aakre CA, Caine NA, DeZutter MA, Eastman RJ, Fischer SM, Gilman EA, Johnson MG, Luedtke CA, Mohabbat AB, Reinschmidt KJ, Roellinger DL, Sanchez W, Philpot LM. Creation of a Multispecialty Clinic for Patients with Central Sensitization-Based Chronic Pain Conditions. Mayo Clin Proc Innov Qual Outcomes 2022; 6:45-54. [PMID: 35005437 PMCID: PMC8715289 DOI: 10.1016/j.mayocpiqo.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To design and evaluate, through a human-centered design approach, a multispeciality clinic for patients with central sensitization syndromes that combined virtual previsit consultations, traditional face-to-face appointments, and technology-enabled educational programming. Patients and Methods Patients with suspected fibromyalgia and chronic abdominal pain were seen in a multispecialty practice, and the performance of the clinic was evaluated against a contemporary cohort. Quantitative and qualitative evaluation measures included team estimates of time spent on care-related tasks, physician rank of alignment of patient need with clinic design, major appointment changes, and nonvisit care tasks. Members of the care team also evaluated strengths, weaknesses, opportunities, and threats to the success of the clinic. Results The pilot clinic was operated from April 1, 2020, to April 30, 2021, and included 34 patients with suspected fibromyalgia/chronic abdominal pain. During the pilot period, physicians ranked the value of the virtual previsit consultations in providing care as 7.5 on a scale of 0 to 10 and reported an average of 50 minutes in preparation for the appointment, execution of the appointment, and postvisit documentation. We did not observe substantial differences in the number of added appointments or messages received within the patient portal when compared with a comparison cohort. Patients who participated in the combination nurse educator–led and digital education program provided positive feedback about their experience. Conclusion Our clinic model provides a framework for the treatment of patients with debilitating centrally sensitized conditions and future expansion of virtual care delivery models to better meet patient care and educational needs.
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Abstract
OBJECTIVES This study aimed to compare the demographic characteristics, disease activity, functional status, and quality of life between patients with axial spondyloarthritis and fibromyalgia and patients with axial spondyloarthritis without fibromyalgia. METHODS We searched MEDLINE via PubMed, Cochrane, Scopus, and Embase databases, from the earliest available indexing date to March 30, 2019, for comparative studies evaluating fibromyalgia in patients with axial spondyloarthritis. Two authors extracted data independently, and all discrepancies were resolved through consensus. RESULTS Seven comparative studies were identified. No statistically significant differences were observed in terms of age, levels of inflammatory markers, and prevalence of extra-articular manifestations such as uveitis, psoriasis, and inflammatory bowel disease between patients with Axial spondyloarthritis fibromyalgia and those without it. Sex ratios (female to male) were approximately 3:2 and 1:3 in patients with and without fibromyalgia, respectively. The ratios concerning human leukocyte antigen B27-positive patients with and without fibromyalgia were 45.1% and 65.6%, respectively. Patients with fibromyalgia had significantly higher Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life scores. CONCLUSIONS Our meta-analysis showed that patients with Axial spondyloarthritis fibromyalgia had considerably higher pain severity, disease activity, and worse quality of life than patients without fibromyalgia. The sex ratios (female to male) were approximately 3:2 and 1:3, and ratios for human leukocyte antigen B27-positive patients were 45.1% and 65.6% in patients with and without fibromyalgia, respectively. Further well-designed studies are needed to substantiate our results.
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Affiliation(s)
- Seung Min Son
- From the Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan
| | - Dong Suk Kim
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Ahmed R, Soliman N, Abo El Gheit R, Elwan S. Serum interleukin-6 in primary fibromyalgia syndrome patients: Impact on disease burden, severity, quality of life and sleep. THE EGYPTIAN RHEUMATOLOGIST 2022. [DOI: 10.1016/j.ejr.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Diagnostic difficulty, delayed diagnosis, and increased tendencies of surgical treatment in fibromyalgia syndrome. Clin Rheumatol 2021; 41:831-837. [PMID: 34671855 DOI: 10.1007/s10067-021-05970-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aimed to evaluate the time elapsed between the onset of early symptoms and the diagnosis of fibromyalgia syndrome (FMS), the delays in diagnosis and frequent physician visits, increased tendencies of surgical treatment, and the effects of FMS symptoms on the post-surgical result. PATIENTS AND METHODS While there were 101 patients diagnosed with FMS in the 1st group, there were 100 patients in the 2nd group who presented with musculoskeletal complaints but were not diagnosed with FMS. In both groups, information on duration of complaints, time until diagnosis, and number of evaluating physicians were included. They were questioned in terms of whether they had undergone elective surgery before and after FMS diagnosis, and in terms of operation sites. Among these operations, the ones regarding the musculoskeletal system were evaluated, and the preoperative and postoperative, before and after FMS diagnosis. RESULTS It was determined that the diagnosis of FMS was made late; the number of doctor visits increased in the period until the diagnosis, and the rate of surgical treatment was higher than in patients without FMS. It was determined that the patients who were operated on after being diagnosed with FMS gained from the operation while the rate of gaining from surgery was lower in patients with FMS symptoms who were operated on before the diagnosis was made. CONCLUSION The diagnosis of FMS reduces healthcare use, including referrals and examinations. Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Key Points • Early detection of FMS reduces healthcare utilization and expenditure, including referrals and examinations. • Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Therefore, it is important to understand why the diagnosis of FMS is made in a delayed manner. • Providing pragmatic tools to improve the methodology of primary care providers may help with diagnosing FMS accurately. • Early diagnosis and treatment of FMS may lead to a decrease in the number of operations and an improvement in the results of the operation.
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Hsu WH, Han DS, Ku WC, Chao YM, Chen CC, Lin YL. Metabolomic and proteomic characterization of sng and pain phenotypes in fibromyalgia. Eur J Pain 2021; 26:445-462. [PMID: 34608709 PMCID: PMC9298249 DOI: 10.1002/ejp.1871] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/16/2021] [Accepted: 10/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is characterized by chronic widespread pain. Its pathophysiological mechanisms remain poorly understood, and effective diagnosis and treatments are lacking. This study aimed to identify significantly changed biosignatures in FM and propose a novel classification for FM based on pain and soreness (sng) symptoms. METHODS Urine and serum samples from 30 FM patients and 25 controls underwent metabolomic and proteomic profiling. RESULTS Compared with controls, FM patients showed significant differential expression of three metabolites in urine and five metabolites and eight proteins in serum. Of them, DETP, 4-guanidinobutanoic acid, SM(d18:1/18:0), PC(20:1(11Z)/18:0), S100A7, SERPINB3, galectin-7 and LYVE1 were first reported as potential biomarkers for FM. Furthermore, lactate, 2-methylmaleate and cotinine in urine and lactate, SM(d18:1/25:1), SM(d18:1/26:1) and prostaglandin D2 (PGD2) and PCYOX1, ITIH4, PFN1, LRG1, C8G, C8A, CP, CDH5 and DBH in serum could differentiate pain- (PG) and sng-dominant groups (SG). Lactate, 2-methylmaleate, cotinine, PCYOX1, ITIH4, PFN1 and DBH have a higher level in SG. SM(d18:1/25:1), SM(d18:1/26:1), PGD2, LRG1, C8G, C8A, CP and CDH5 in SG are lower than PG. The omics results indicated disordered free radical scavenging, and lipid and amino acid metabolism networks and resulting NF-κB-dependent cytokine generation in FM. Lactate level was altered simultaneously in urine and serum and significantly higher in sng-dominant patients than others. CONCLUSIONS In this study, we identified potential biomarkers from FM patients. The selected biomarkers could discriminate sng and pain phenotypes in FM patients. These results could help elucidate the underlying pathological mechanisms for more effective diagnosis and therapy for FM.
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Affiliation(s)
- Wei-Hsiang Hsu
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.,Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
| | - Wei-Chi Ku
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yen-Ming Chao
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung, Taiwan
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Neuroscience Program of Academia Sinica, Academia Sinica, Taipei, Taiwan.,Taiwan Mouse Clinic, Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
| | - Yun-Lian Lin
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung, Taiwan.,Department of Pharmacy, National Taiwan University, Taipei, Taiwan
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Qureshi AG, Jha SK, Iskander J, Avanthika C, Jhaveri S, Patel VH, Rasagna Potini B, Talha Azam A. Diagnostic Challenges and Management of Fibromyalgia. Cureus 2021; 13:e18692. [PMID: 34786265 PMCID: PMC8580749 DOI: 10.7759/cureus.18692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
The World Health Organization regards chronic pain to be a public health concern. In clinical medicine, fibromyalgia (FM) is the most prevalent chronic widespread pain disease. In terms of impairment, consumption of health and social resources, and impact on primary and speciality care systems, it has reached worrisome proportions. This disease is frequently managed by primary care providers. Because of its intricacy, fibromyalgia diagnosis and treatment can be difficult. Fibromyalgia is a controversial condition. It might appear ill-defined in comparison to other pain conditions, with no clear knowledge of pathophysiology and hence no particular targeted therapy. This invariably sparks debates and challenges. There is no obvious cut-off point that distinguishes FM from non-FM. The diagnosis of fibromyalgia has been complicated by several factors, including patients' health-seeking behaviour, symptom identification, and physician labelling of the disease. Fibromyalgia is currently considered a centralized pain condition, according to research that has improved our understanding of its etiopathology. A multidisciplinary strategy combining pharmacological and non-pharmacological therapies based on a biopsychosocial paradigm can result in effective therapy. Cultural and psychosocial variables appear to be a recent development in fibromyalgia, and they appear to have a larger influence on physician diagnosis than severe symptom levels in FM patients. Although physicians rely on FM criteria as the only way to classify FM patients in research and clinical settings, some crucial elements of the diagnostic challenge of fibromyalgia remain unsolved - invalidation, psychosocial variables, and diverse illness manifestation are some examples. Beyond the existing constructional scores, physicians' judgment gained in real communicative contexts with patients, appears to be the only dependable route for a more accurate diagnosis for fibromyalgia. We have performed an exhaustive review of the literature using the keywords "Fibromyalgia", "challenges" and "diagnosis" in PubMed and Google Scholar indexes up to September 2021. This article aims to examine the causes, diagnosis, and current treatment protocols of FM, as well as discuss some continuing debates and diagnostic challenges which physicians face in accurately diagnosing fibromyalgia.
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Affiliation(s)
- Aniqa G Qureshi
- Medicine and Surgery, Jinggangshan Medical University, Jian, CHN
| | - Saurav K Jha
- Internal Medicine, Kankai Hospital, Birtamode, NPL
| | - John Iskander
- Family Medicine, American University of Antigua, St. John's, ATG
| | - Chaithanya Avanthika
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
- Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Sharan Jhaveri
- Medicine, Smt Nathiba Hargovandas Lakhmichand Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Vithi Hitendra Patel
- Family Medicine, GMERS Medical College and Hospital, Valsad, IND
- Internal Medicine, Gujarat Cancer Society Medical College and Research Center, Ahmedabad, IND
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Metin Ökmen B, Ayar K, Altan L, Yeşilöz Ö. Central sensitisation in primary Sjögren Syndrome and its effect on sleep quality. Mod Rheumatol 2021; 32:908-914. [PMID: 34918134 DOI: 10.1093/mr/roab075] [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: 05/25/2021] [Revised: 07/05/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the presence and frequency of central sensitisation (CS) in primary Sjögren Syndrome (pSS) and to determine the effect of CS on sleep quality. MATERIALS AND METHODS In this cross-sectional study, 50 patients diagnosed with pSS between the ages of 18 and 75 were included. The healthy control group was composed of 43 healthcare workers. Each participant underwent a physical examination, and demographic data and the medications they used were recorded. Central sensitisation inventory and Pittsburgh Sleep Quality Index questionnaires were filled in to garner data on CS and sleep quality, respectively, from all participants. RESULTS While central sensitisation inventory >40 was detected in 74% of pSS patients, it was 25.6% in healthy controls, and there is a statistically significant difference between the groups (p < .05). A correlation analysis of the central sensitisation inventory and Pittsburgh Sleep Quality Index values of all participants revealed a statistically significant correlation between all parameters other than the duration of sleep (p < .05). CONCLUSIONS CS was found to have a negative effect on sleep quality in patients with pSS. We suggest that the cause of widespread pain seen in patients with pSS as the possible development of CS should be considered.
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Affiliation(s)
- Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Koray Ayar
- Department of Rheumatology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Özgür Yeşilöz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Aguirre Cárdenas C, Oñederra MC, Esparza Benavente C, Durán J, González Tugas M, Gómez-Pérez L. Psychometric Properties of the Fibromyalgia Survey Questionnaire in Chilean Women With Fibromyalgia. J Clin Rheumatol 2021; 27:S284-S293. [PMID: 32897990 DOI: 10.1097/rhu.0000000000001547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the psychometric properties of the Chilean version of the Fibromyalgia Survey Questionnaire (FSQ). METHODS Women with fibromyalgia (FM; n = 214), women with rheumatoid arthritis (RA; n = 97), and women without chronic pain (being followed by Gynecology, G; n = 117) from the Red de Salud UC CHRISTUS (Santiago, Chile) participated. Women with FM completed the FSQ, Fibromyalgia Impact Questionnaire (Revised Version), Numerical Pain Rating Scale, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Patient Health Questionnaire 15, and Short-Form Health Survey. Two weeks later, they completed the FSQ again by phone (n = 120). RESULTS The FSQ total scale showed excellent to good internal consistency at T1 (α = 0.91, ω = 0.91) and T2 (α = 0.78, ω = 0.78), and good test-retest reliability (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.72-0.85). It showed medium to large correlations with the other measures. Discriminant analysis between the FM group and the control group (RA and G) revealed that the FSQ total scale reached a classification accuracy of 81.3%. Receiver operating characteristic curve (adjusted area under the curve, 0.88; 95% CI, 0.85-0.92) showed that the best FSQ cutoff was 17, resulting in sensitivity of 89% (95% CI, 0.84-0.93) and specificity of 75% (95% CI, 0.69-0.80). Considering the FM diagnosis performed by a rheumatologist as the criterion standard, sensitivity and specificity of the modified 2010 American College of Rheumatology preliminary criteria for FM were 92.8% (95% CI, 0.88-0.96) and 63.4% (95% CI, 0.57-0.70), respectively. CONCLUSIONS The Chilean version of the FSQ presents good psychometric properties and is a useful tool in clinical settings to assist in FM diagnosis and symptom assessment. A cutoff score of 17 or higher seems to be the most appropriate for Chilean population.
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Affiliation(s)
| | | | | | | | - Matías González Tugas
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Ariani A, Bazzichi L, Sarzi-Puttini P, Salaffi F, Manara M, Prevete I, Bortoluzzi A, Carrara G, Scirè CA, Ughi N, Parisi S. The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia Best practices based on current scientific evidence. Reumatismo 2021; 73:89-105. [PMID: 34342210 DOI: 10.4081/reumatismo.2021.1362] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Fibromyalgia or fibromyalgia syndrome (FMS) is defined as a central sensitization syndrome characterized by the dysfunction of neurocircuits detecting, transmitting and processing nociceptive stimuli; the prevalent manifestation is musculoskeletal pain. In addition to pain, there are multiple accompanying symptoms, in common with other algo-dysfunctional syndromes, which are reflected in a broad spectrum of somatic, neurocognitive and neuro-vegetative manifestations. An evidence-based approach is essential in FMS management, in order to improve patient health and to reduce its social burden. Since in the last ten years new international guidelines for clinical practice (Clinical Practice Guidelines or CPGs) concerning FMS diagnosis and pharmacological/ non-pharmacological management have been published, the Italian Society of Rheumatology (SIR) has decided to adapt them to the Italian national setting. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the most recent CPGs on FMS to the needs of the Italian healthcare context. A working group of rheumatologists from SIR epidemiology unit and FMS experts identified relevant clinical questions to guide the systematic review of the literature. The target audience of these CPGs included physicians and healthcare professionals who manage FMS. The adapted recommendations were finally assessed by an external multidisciplinary panel. From the systematic search in databases (Pubmed/Medline, Embase) and grey literature, 6 CPGs were selected and appraised by two independent raters. The combination of the scientific evidence underlying the original CPGs with expert opinion lead to the development of 17 recommendations. The quality of evidence for each recommendation was reported and their potential impact on clinical practice was assessed. These SIR recommendations are expected to be a valuable aid in the diagnosis and treatment of FMS, as they will contribute to disseminate the best practice on the basis of the current scientific evidence.
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Affiliation(s)
- A Ariani
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Medicina, Unità di Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma.
| | - L Bazzichi
- Unità di Reumatologia, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - P Sarzi-Puttini
- Unità di Reumatologia, ASST Fatebenefratelli-Sacco, Università di Milano.
| | - F Salaffi
- Clinica Reumatologica, Ospedale 'Carlo Urbani', Università Politecnica delle Marche, Jesi (AN).
| | - M Manara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Reumatologia Clinica, Centro Specialistico Ortopedico-Traumatologico Gaetano Pini CTO, ASST Gaetano Pini, Milano.
| | - I Prevete
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Unità di Reumatologia, Azienda Ospedaliera San Camillo-Forlanini, Roma.
| | - A Bortoluzzi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Scienze Mediche, Sezione di Reumatologia, Università di Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (FE).
| | - G Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan.
| | - C A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Dipartimento di Scienze Mediche, Sezione di Reumatologia, Università di Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (FE).
| | - N Ughi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Division of Rheumatology, ASST Grande Ospedale Metropolitano Niguarda, Milano.
| | - S Parisi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy; Unità di Reumatologia, Azienda Ospedaliera Città della Salute e della Scienza di Torino.
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Gill H, Perez CD, Gill B, El-Halabi S, Lee Y, Lipsitz O, Park C, Mansur RB, Rodrigues NB, McIntyre RS, Rosenblat JD. The Prevalence of Suicidal Behaviour in Fibromyalgia Patients. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110078. [PMID: 32853715 DOI: 10.1016/j.pnpbp.2020.110078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is a condition associated with chronic pain in muscles and soft tissues. Extant literature has demonstrated an association between FM, mood symptoms and suicidal behaviour. This systematic review aims to synthesize available literature assessing the prevalence of suicidality in FM populations and qualitatively review the included articles. METHODS PsycINFO, Google Scholar and PubMed databases were systematically searched for studies published from database inception to 15 February 2020. Studies were included that assessed FM as a primary or co-primary disease condition, as well as an assessment of suicidal behaviour (suicidal ideations (SI), suicide attempts (SA) and death by suicide (SC)). The quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS 699 unique articles were reviewed for eligibility. Data were derived from nine studies (cross-sectional: k = 5; retrospective cohort: k = 4) that assessed suicidal behaviour in FM participants (SI: k = 5, SC: k = 3, SA: k = 3). Four studies assessing SI found elevated rates of SI among FM participants. Three studies found elevated risk for SC and three studies found increased SA in FM participants relative to the general population. In two studies, this association was no longer significant after adjusting for depression and other psychiatric comorbidities. CONCLUSION Preliminary findings suggest that FM is associated with significantly higher risks for SI, SA and SC compared to the general population. There may be unique risk factors underlying suicidal behaviour in FM patients and the interaction between FM and other known risk factors (i.e., mental illness) require further investigation.
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Affiliation(s)
- Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Carlos D Perez
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Barjot Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Sabine El-Halabi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Caroline Park
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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Abstract
Fibromyalgia is a chronic pain condition manifested by chronic generalized pain, fatigue, disordered sleep, and cognitive difficulties, persistent for at least 3 months. Other common complaints/conditions include symptoms of irritable bowel syndrome, headaches, intermittent paresthesias, and various mood disorders. Women are more commonly affected than men. The treatment approach should be individualized and focused on associated mood disorders, sleep, exercise, correction of maladaptive responses to pain, and coping with stress.
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Affiliation(s)
- Carmen E Gota
- Case Western Reserve Cleveland Clinic School of Medicine, Cleveland, OH, USA.
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Zhang X, Xu H, Zhang Z, Li Y, Pauer L, Liao S, Zhang F. Efficacy and Safety of Pregabalin for Fibromyalgia in a Population of Chinese Subjects. J Pain Res 2021; 14:537-548. [PMID: 33658841 PMCID: PMC7920593 DOI: 10.2147/jpr.s281483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Fibromyalgia (FM) may go underdiagnosed and untreated in China in part due to a lack of awareness and understanding of the condition, and limited available treatments. PATIENTS AND METHODS This randomized, double-blind, Phase III local registration trial compared the efficacy and safety of pregabalin (flexibly dosed 300-450 mg/day) versus placebo for the management of pain in Chinese adults diagnosed with FM according to American College of Rheumatology 1990 criteria, across 22 centers within China. Patients reported pain score of ≥40 mm on 100-mm scale (from 0 "no pain" to 100 "worst possible pain"). The primary efficacy endpoint was change from baseline to Week 14 in mean pain score (MPS). Secondary endpoints included measures of sleep and sleep interference. Safety and tolerability were monitored throughout. RESULTS Median pregabalin dose was 335 mg/day. A significant reduction from baseline to Week 14 in weekly MPS was seen for patients treated with pregabalin (n=170) versus placebo (n=164) (least-squares mean difference [95% confidence interval]: -0.73 [-1.10 to -0.36]; P=0.0001). Significantly greater proportions of patients experienced ≥30% and ≥50% reductions in MPS at Week 14 with pregabalin versus placebo. Pregabalin-treated subjects demonstrated improvements in measures of sleep and sleep interference. Pregabalin was generally well tolerated. The most common adverse events were dizziness and somnolence; no serious adverse events (SAEs) occurred in pregabalin-treated subjects. Nine placebo-treated subjects experienced SAEs. CONCLUSION Pregabalin (300-450 mg/day) is a safe and effective treatment for reducing pain and improving sleep in native Chinese subjects with FM. CLINICALTRIALSGOV IDENTIFIER NCT01387607.
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Affiliation(s)
- Xiao Zhang
- Department of Rheumatology, Guangdong General Hospital, Guangdong, People’s Republic of China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Affiliated to Second Military Medical University, Shanghai, People’s Republic of China
| | - Zhiyi Zhang
- School of Clinical Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Yang Li
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Lynne Pauer
- Global Research and Development, Pfizer, Groton, CT, USA
| | - Shanmei Liao
- Pfizer China Statistics Department, Global Innovative Pharma Business, Shanghai, People’s Republic of China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Beijing, People’s Republic of China
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Tiwari VK, Nanda S, Arya S, Kumar U, Sharma R, Kumaran SS, Bhatia R. Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study. Adv Rheumatol 2021; 61:10. [PMID: 33602339 DOI: 10.1186/s42358-021-00163-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality - all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. METHODS Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. RESULTS Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. CONCLUSIONS Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.
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Affiliation(s)
- Vikas Kumar Tiwari
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Srishti Nanda
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Suvercha Arya
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Sharma
- Stress and Cognition Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Senthil S Kumaran
- Department of Nuclear Magnetic Resonance and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Bhatia
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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Alteration of Postural Balance in Patients with Fibromyalgia Syndrome-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11010127. [PMID: 33467458 PMCID: PMC7830486 DOI: 10.3390/diagnostics11010127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/11/2023] Open
Abstract
Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.
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Abstract
Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2-5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria. Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature. Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.
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Affiliation(s)
- Kevin Hackshaw
- Division Chief of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Dell Medical School, the University of Texas , Austin, TX, USA
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Clark S, Martin F, McGowan RTS, Smidt J, Anderson R, Wang L, Turpin T, Langenfeld-McCoy N, Bauer B, Mohabbat AB. The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia. Mayo Clin Proc 2020; 95:2442-2461. [PMID: 32819740 DOI: 10.1016/j.mayocp.2020.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the direct physiological and emotional impact of an animal-assisted activity (AAA) session (a form of complementary and integrative medicine) in patients with fibromyalgia (FM). PATIENTS AND METHODS The study population consisted of 221 participants with FM who were attending Mayo Clinic's Fibromyalgia Treatment Program between August 5, 2017, and September 1, 2018. This was a randomized controlled trial. Participants were randomly assigned to either the treatment group (a 20-minute session with a certified therapy dog and handler) or the control group (a 20-minute session with a handler only). To gain a better understanding of the direct physiological and emotional effects of AAA in patients with FM, we used multiple noninvasive physiologic-emotional biomarkers, including salivary cortisol and oxytocin concentrations, tympanic membrane temperatures, and various cardiac parameters, in addition to standardized pain and mood-based questionnaires. RESULTS Results show a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants in the treatment group were in a more positive emotional-physiologic state as a result of the AAA session compared with the control group. CONCLUSION Our results suggest that a 20-minute therapy dog visit in an outpatient setting can significantly and positively impact the physical and mental health of patients with FM.
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Affiliation(s)
- Stephanie Clark
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Jessica Smidt
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Lei Wang
- Nestlé Purina Research, St. Louis, MO
| | | | | | - Brent Bauer
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Arya B Mohabbat
- Section of Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
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Maffei ME. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int J Mol Sci 2020; 21:E7877. [PMID: 33114203 PMCID: PMC7660651 DOI: 10.3390/ijms21217877] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules.
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Affiliation(s)
- Massimo E Maffei
- Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy
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Doebl S, Macfarlane GJ, Hollick RJ. "No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence. Pain 2020; 161:1716-1725. [PMID: 32701832 DOI: 10.1097/j.pain.0000000000001870] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Fibromyalgia is a common and complex long-term pain condition. Despite advancements in our understanding and treatment of fibromyalgia, patients report patchy health care provision and frustrating journeys through the health care system. To inform how best to deliver care, we undertook 2 narrative reviews examining existing evidence on (1) models of care for fibromyalgia and (2) patients' experiences, preferences, and unmet needs regarding their health care. Seven databases were systematically searched. Quantitative data was narratively synthesised and qualitative data thematically analysed. No evidence-based model of care covering the patient journey through the entire health care system was identified. Limited evidence suggests no clear benefit for ongoing care in secondary care settings. Patients with fibromyalgia report difficult interactions with the health care system that might equally be expressed by those with other long-term conditions, such as inconsistent and poorly coordinated care. However, they also face unique problems; fibromyalgia was often not viewed as a real condition, resulting in difficult encounters with health care staff, in particular not feeling believed or listened to. Significant delays in diagnosis were commonplace. Positive care experiences such as being listened to and shared decision-making made patients feeling better informed, well supported, and more satisfied. There is little evidence to inform how best to organise health care for patients with fibromyalgia and ensure care is delivered in a coordinated and consistent way. These findings provide a strong rationale for developing a new model of care for fibromyalgia.
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Affiliation(s)
- Stefanie Doebl
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Rosemary J Hollick
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
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Santos E Campos MA, Párraga‐Montilla JA, Aragón‐Vela J, Latorre‐Román PA. Effects of a functional training program in patients with fibromyalgia: A 9‐year prospective longitudinal cohort study. Scand J Med Sci Sports 2020; 30:904-913. [DOI: 10.1111/sms.13640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/03/2020] [Accepted: 02/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
| | | | - Jerónimo Aragón‐Vela
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhague Denmark
| | - Pedro A. Latorre‐Román
- Department of Didactics of Music, Plastic and Corporal Expression University of Jaén Jaén Spain
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Miller JS, Rodriguez-Saona L, Hackshaw KV. Metabolomics in Central Sensitivity Syndromes. Metabolites 2020; 10:E164. [PMID: 32344505 PMCID: PMC7240948 DOI: 10.3390/metabo10040164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
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Affiliation(s)
- Joseph S. Miller
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH 43016, USA;
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, Ohio State University, Columbus, OH 43210, USA;
| | - Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1701 Trinity St, Austin, TX 78712, USA
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Kingsbury C, Karelis AD, Hains-Monfette G, Bernard P. Association between daily level of objective physical activity and C-Reactive protein in a representative national sample of adults with self-reported diagnosed arthritis or fibromyalgia. Rheumatol Int 2020; 40:1463-1471. [PMID: 32266470 DOI: 10.1007/s00296-020-04571-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Examine the association between physical activity and sedentary time with high sensitivity C-Reactive protein levels in adults with arthritis and fibromyalgia. We also investigated the dose of physical activity that was associated with lower clinical levels of high sensitivity C-Reactive protein (< 3 mg/L). MATERIALS AND METHODS Observational design was used to evaluate the variables of interest-based on the Canadian Health Measures Survey cycle 1-3 (2007-2012). Generalized adjusted additive models were used to explore the shape of the association between high sensitivity C-Reactive protein, daily physical activity, step count and sedentary time. High sensitivity C-Reactive protein was measured with blood samples. Physical activity, number of steps and sedentary time were objectively assessed using an Actical accelerometer. RESULTS Daily moderate to vigorous physical activity and step count were significantly associated with lower high sensitivity C-Reactive protein levels, but daily light physical activity and sedentary time were not associated with high sensitivity C-Reactive protein levels, even after controlling for age, sex, daily smoking, body mass index, household income, level of education levels, marital status, work year and accelerometer wear time and season of accelerometer. Non-linear dose-response patterns were observed between daily moderate to vigorous physical activity as well as step count with high sensitivity C-Reactive protein levels. Lower high sensitivity C-Reactive protein levels were associated with 1-150 min of daily moderate to vigorous physical activity and with daily step count starting at 4000 in people with arthritis. Adults with fibromyalgia had lower levels of high sensitivity C-Reactive protein when engaging in 10-35 min of daily moderate to vigorous physical activity and in 5000-9000 daily steps. Optimal and specific doses of daily moderate to vigorous physical activity and steps were independently related to lower high sensitivity C-Reactive protein levels in adults with arthritis and fibromyalgia. CONCLUSIONS Daily moderate to vigorous physical activity and step count were associated with high sensitivity C-Reactive protein levels that were below the clinical threshold. Given the positive outcomes of physical activity on health, adults with arthritis and fibromyalgia may benefit from these specific recommendations.
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Affiliation(s)
- Celia Kingsbury
- Department of Physical Activity Sciences, Faculté des sciences, Université du Québec à Montréal, UQÀM, Complexe des Sciences, Pavillon des Sciences Biologiques (SB), Local: SB-4445, 141, Avenue du Président Kennedy, Montréal, Québec, H2X 1Y4, Canada. .,Research Center, University Institute of Mental Health at Montreal, Montréal, QC, Canada.
| | - Anthony D Karelis
- Department of Physical Activity Sciences, Faculté des sciences, Université du Québec à Montréal, UQÀM, Complexe des Sciences, Pavillon des Sciences Biologiques (SB), Local: SB-4445, 141, Avenue du Président Kennedy, Montréal, Québec, H2X 1Y4, Canada
| | - Gabriel Hains-Monfette
- Department of Physical Activity Sciences, Faculté des sciences, Université du Québec à Montréal, UQÀM, Complexe des Sciences, Pavillon des Sciences Biologiques (SB), Local: SB-4445, 141, Avenue du Président Kennedy, Montréal, Québec, H2X 1Y4, Canada.,Research Center, University Institute of Mental Health at Montreal, Montréal, QC, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Faculté des sciences, Université du Québec à Montréal, UQÀM, Complexe des Sciences, Pavillon des Sciences Biologiques (SB), Local: SB-4445, 141, Avenue du Président Kennedy, Montréal, Québec, H2X 1Y4, Canada.,Research Center, University Institute of Mental Health at Montreal, Montréal, QC, Canada
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Fusco R, Siracusa R, D’Amico R, Peritore AF, Cordaro M, Gugliandolo E, Crupi R, Impellizzeri D, Cuzzocrea S, Di Paola R. Melatonin Plus Folic Acid Treatment Ameliorates Reserpine-Induced Fibromyalgia: An Evaluation of Pain, Oxidative Stress, and Inflammation. Antioxidants (Basel) 2019; 8:antiox8120628. [PMID: 31817734 PMCID: PMC6943570 DOI: 10.3390/antiox8120628] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Fibromyalgia is a chronic condition characterized by increased sensory perception of pain, neuropathic/neurodegenerative modifications, oxidative, and nitrosative stress. An appropriate therapy is hard to find, and the currently used treatments are able to target only one of these aspects. Methods: The aim of this study is to investigate the beneficial effects of melatonin plus folic acid administration in a rat model of reserpine-induced fibromyalgia. Sprague–Dawley male rats were injected with 1 mg/kg of reserpine for three consecutive days and later administered with melatonin, folic acid, or both for twenty-one days. Results: Administration of reserpine led to a significant decrease in the nociceptive threshold as well as a significant increase in depressive-like symptoms. These behavioral changes were accompanied by increased oxidative and nitrosative stress. Lipid peroxidation was significantly increased, as well as nitrotyrosine and PARP expression, while superoxide dismutase, nonprotein thiols, and catalase were significantly decreased. Endogenously produced oxidants species are responsible for mast cell infiltration, increased expression pro-inflammatory mediators, and microglia activation. Conclusion: Melatonin plus acid folic administration is able to ameliorate the behavioral defects, oxidative and nitrosative stress, mast cell infiltration, inflammatory mediators overexpression, and microglia activation induced by reserpine injection with more efficacy than their separate administration.
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Affiliation(s)
- Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Alessio Filippo Peritore
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Marika Cordaro
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Enrico Gugliandolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Rosalia Crupi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
- Correspondence: (D.I.); (S.C.); Tel.: +39-90-6765208 (D.I. & S.C.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, USA
- Correspondence: (D.I.); (S.C.); Tel.: +39-90-6765208 (D.I. & S.C.)
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres, n 31, 98166 Messina, Italy; (R.F.); (R.S.); (A.F.P.); (M.C.); (E.G.); (R.C.); (R.D.P.)
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Sallinen M, Mengshoel AM, Solbrække KN. "I can't have it; I am a man. A young man!" - men, fibromyalgia and masculinity in a Nordic context. Int J Qual Stud Health Well-being 2019; 14:1676974. [PMID: 31607231 PMCID: PMC6813418 DOI: 10.1080/17482631.2019.1676974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose: Research shows that gender has a substantial impact on the health behaviour such as expression of physical symptoms like persistent pains and aches. However, there is yet little knowledge about the gendered aspect of pain by men who suffer from typical female diseases like fibromyalgia. The purpose of the study was to elucidate the interplay between illness and gender by exploring life-stories of men who suffer from fibromyalgia. Methods: The data were collected through life-story interviews of eight men suffering from fibromyalgia. A narrative methodology for analysis was applied to explore the storytelling and the linguistic and performative aspects of the life-stories. Results: The masculine identity of the participants was re-negotiated by comparisons to other men and life before symptom onset, and by discussing expectations and beliefs of how men should act in contemporary societies. The transition from experiencing a strong, active and reliable body to experiencing a painful, vulnerable and helpless body was perceived as fundamental. Conclusions: Self-management and rehabilitation of fibromyalgia it is not only about learning to manage the symptoms but also about the struggle to find coherence in life through re-constructing gender identity that is acceptable both for the individual and for the community.
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Affiliation(s)
- Merja Sallinen
- Faculty of Health and Wellbeing, Satakunta
University of Applied Sciences, Pori, Finland
- Institute of Health and Society, University
of Oslo, Oslo, Norway
| | - Anne Marit Mengshoel
- Department of interdisciplinary health
sciences, Institute of Health and Society, University of Oslo, Oslo,
Norway
| | - Kari Nyheim Solbrække
- Department of interdisciplinary health
sciences, Institute of Health and Society, University of Oslo, Oslo,
Norway
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Bosco G, Ostardo E, Rizzato A, Garetto G, Paganini M, Melloni G, Giron G, Pietrosanti L, Martinelli I, Camporesi E. Clinical and morphological effects of hyperbaric oxygen therapy in patients with interstitial cystitis associated with fibromyalgia. BMC Urol 2019; 19:108. [PMID: 31690286 PMCID: PMC6833196 DOI: 10.1186/s12894-019-0545-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM. Methods We structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension. Results Twelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner’s ulcers was also noted 6 months after the completion of HBOT. Conclusions Our study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients. Trial registration NCT03693001; October 2, 2018. Retrospectively registered.
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Affiliation(s)
- Gerardo Bosco
- Environmental and Respiratory Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Edoardo Ostardo
- Unità Operativa di Urologia, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Alex Rizzato
- Environmental and Respiratory Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Matteo Paganini
- Environmental and Respiratory Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Giorgio Melloni
- Department of Statistics, Harvard School of Medicine, Boston, MA, USA
| | | | | | - Ivo Martinelli
- OTI Services, Centro di Medicina Iperbarica, Venezia, Italy
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Wan B, Gebauer S, Salas J, Jacobs CK, Breeden M, Scherrer JF. Gender-Stratified Prevalence of Psychiatric and Pain Diagnoses in a Primary Care Patient Sample with Fibromyalgia. PAIN MEDICINE 2019; 20:2129-2133. [PMID: 31009534 DOI: 10.1093/pm/pnz084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Comorbid psychiatric and pain-related conditions are common in patients with fibromyalgia. Most studies in this area have used data from patients in specialty care and may not represent the characteristics of fibromyalgia in primary care patients. We sought to fill gaps in the literature by determining if the association between psychiatric diagnoses, conditions associated with chronic pain, and fibromyalgia differed by gender in a primary care patient population. DESIGN Retrospective cohort. SETTING AND SUBJECTS Medical record data obtained from 38,976 patients, ≥18 years of age with a primary care encounter between July 1, 2008, to June 30, 2016. METHODS International Classification of Diseases-9 codes were used to define fibromyalgia, psychiatric diagnoses, and conditions associated with chronic pain. Unadjusted associations between patient demographics, comorbid conditions, and fibromyalgia were computed using binary logistic regression for the entire cohort and separately by gender. RESULTS Overall, 4.6% of the sample had a fibromyalgia diagnosis, of whom 76.1% were women. Comorbid conditions were more prevalent among patients with vs without fibromyalgia. Depression and arthritis were more strongly related to fibromyalgia among women (odds ratio [OR] = 2.80, 95% confidence interval [CI] = 2.50-3.13; and OR = 5.19, 95% CI = 4.62-5.84) compared with men (OR = 2.16, 95% CI = 1.71-2.71; and (OR = 3.91, 95% CI = 3.22-4.75). The relationship of fibromyalgia and other diagnoses did not significantly differ by gender. CONCLUSIONS Except for depression and arthritis, the burden of comorbid conditions in patients with fibromyalgia is similar in women and men treated in primary care. Fibromyalgia comorbidities in primary care are similar to those found in specialty care.
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Affiliation(s)
- Betsy Wan
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Christine K Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Breeden
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. THE JOURNAL OF PAIN 2019; 20:611-628. [DOI: 10.1016/j.jpain.2018.10.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
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[Neurofeedback to improve attention, chronic pain, and quality of life in patients with fibromyalgia]. Aten Primaria 2019; 51:316-317. [PMID: 30808580 PMCID: PMC6837099 DOI: 10.1016/j.aprim.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 11/24/2022] Open
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Hackshaw KV, Aykas DP, Sigurdson GT, Plans M, Madiai F, Yu L, Buffington CAT, Giusti MM, Rodriguez-Saona L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J Biol Chem 2019; 294:2555-2568. [PMID: 30523152 PMCID: PMC6378985 DOI: 10.1074/jbc.ra118.005816] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Diagnosis and treatment of fibromyalgia (FM) remains a challenge owing to the lack of reliable biomarkers. Our objective was to develop a rapid biomarker-based method for diagnosing FM by using vibrational spectroscopy to differentiate patients with FM from those with rheumatoid arthritis (RA), osteoarthritis (OA), or systemic lupus erythematosus (SLE) and to identify metabolites associated with these differences. Blood samples were collected from patients with a diagnosis of FM (n = 50), RA (n = 29), OA (n = 19), or SLE (n = 23). Bloodspot samples were prepared, and spectra collected with portable FT-IR and FT-Raman microspectroscopy and subjected to metabolomics analysis by ultra-HPLC (uHPLC), coupled to a photodiode array (PDA) and tandem MS/MS. Unique IR and Raman spectral signatures were identified by pattern recognition analysis and clustered all study participants into classes (FM, RA, and SLE) with no misclassifications (p < 0.05, and interclass distances > 2.5). Furthermore, the spectra correlated (r = 0.95 and 0.83 for IR and Raman, respectively) with FM pain severity measured with fibromyalgia impact questionnaire revised version (FIQR) assessments. Protein backbones and pyridine-carboxylic acids dominated this discrimination and might serve as biomarkers for syndromes such as FM. uHPLC-PDA-MS/MS provided insights into metabolites significantly differing among the disease groups, not only in molecular m/z+ and m/z- values but also in UV-visible chromatograms. We conclude that vibrational spectroscopy may provide a reliable diagnostic test for differentiating FM from other disorders and for establishing serologic biomarkers of FM-associated pain.
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Affiliation(s)
- Kevin V Hackshaw
- From the Department of Internal Medicine, Division of Rheumatology and Immunology,
| | | | | | - Marcal Plans
- the Department of Food Science and Technology, and
| | - Francesca Madiai
- From the Department of Internal Medicine, Division of Rheumatology and Immunology
| | - Lianbo Yu
- the Center of Biostatistics and Bioinformatics, Ohio State University, Columbus, Ohio 43210 and
| | - Charles A T Buffington
- the Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California 95616
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50
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Varinen A, Kosunen E, Mattila K, Suominen S, Sillanmäki L, Sumanen M. The association between bullying victimization in childhood and fibromyalgia. Data from the nationwide Finnish health and social support (HeSSup) study based on a sample of 64,797 individuals. J Psychosom Res 2019; 117:48-53. [PMID: 30665596 DOI: 10.1016/j.jpsychores.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood. METHODS The basic study setting is cross-sectional - with focused use of retrospective data - derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe bullying. Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses. RESULTS In our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p = .027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1.35 (95% CI 1.09-1.67) and for severe bullying 1.58 (95% CI 1.21-2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models. CONCLUSIONS Our results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying.
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Affiliation(s)
- Aleksi Varinen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland; Nokia Health Centre, Nokia, Finland.
| | - Elise Kosunen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland; Pirkanmaa Hospital District, Centre for General Practice, Finland
| | - Kari Mattila
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Finland; Department of Public Health, School of Health and Education, University of Skövde, Sweden
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku University Hospital, Finland; Health care services, Welfare Division, Turku, Finland
| | - Markku Sumanen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland
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