Background Fibromyalgia(FM)is a chronic rheumatic disorder characterised by musculoskeletal pain,fatigue,and psychoemotional symptoms.Virtual reality(VR)has proven to be an innovative and motivating tool for managing ...Background Fibromyalgia(FM)is a chronic rheumatic disorder characterised by musculoskeletal pain,fatigue,and psychoemotional symptoms.Virtual reality(VR)has proven to be an innovative and motivating tool for managing FM,with several studies indicating that it can improve quality of life indices and reduce psychoemotional symptoms.However,studies on immersive VR-based exercise(iVRE)are limited.Methods The aim of this study was to evaluate the effects of iVRE on quality of life,stress,anxiety,depression,and handgrip strength in patients with FM.A single-arm pre-post-test pilot study was conducted.Individuals diagnosed with FM were recruited using convenience sampling.The iVRE protocol consisted of 12 sessions of 10 min warm-up and 15 min exercises applied with the Oculus Quest 2TM device.The impact on quality of life was assessed using the Revised Fibromyalgia Impact Questionnaire,and the effects on stress,anxiety,and depression were determined using the Depression Anxiety Stress Scale-21 questionnaire.Handgrip strength was evaluated using the Baseline®dynamometer.The normality assumption was evaluated,and the pre-post means were compared using Student's ttest(p<0.05).Results Eleven individuals(40.6±11.2 years)completed the protocol(10 women).There were significant differences in favour of iVRE in quality of life impact(p<0.001,Cohen's d:1.48),handgrip strength(p<0.05,Cohen's d:0.26),depression(p<0.05,Cohen's d:0.73),and anxiety(p<0.05,Cohen's d:0.73).Conclusions A six-week iVRE program significantly reduces the impact on quality of life,anxiety,and depression and improves handgrip strength in people with FM.Future studies should investigate the physiological effects using systemic biomarkers to explain the scope of this therapeutic modality.展开更多
Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects w...Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.展开更多
Objective:Acupuncture has demonstrated efficacy as a treatment for fibromyalgia;however,predictors of short-and long-term analgesic response in this population are not well understood.Methods:This manuscript describes...Objective:Acupuncture has demonstrated efficacy as a treatment for fibromyalgia;however,predictors of short-and long-term analgesic response in this population are not well understood.Methods:This manuscript describes a secondary analysis of a single-center,blinded,sham-controlled,randomized longitudinal acupuncture clinical trial in fibromyalgia.Baseline characterization included pressure pain threshold and pain interference,while residualized change in pain intensity from baseline to follow-up served as the primary outcome measure.Participants were randomized into groups that received verum(n=36)or sham(n=29)acupuncture treatment over a 12-week period(18 treatments)and were followed for 37 weeks from the initiation of treatment.Results:Lower pressure pain thresholds at baseline were associated with greater analgesia only in the sham treatment group immediately following treatment,while those with higher pressure pain thresholds had greater analgesia with verum treatment(B=–13.43,P=0.001).Additionally,greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment.Pressure pain threshold was not found to be predictive of long-term differential treatment response(B=–1.71,P=0.66).There was a significant difference in the relationship between perceived impact of pain at baseline and subsequent long-term analgesia between groups where those with greater perceived impact of pain displayed improved long-term analgesia for verum acupuncture compared to the sham group(B=–11.37,P=0.004).Conclusion:Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia.展开更多
Background:Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS);however,high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.Obje...Background:Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS);however,high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.Objective:Craniosacral therapy (CST),Bowen therapy and exercises have been found to influence the autonomic nervous system,which plays a crucial role in sleep physiology.Given the paucity of evidence concerning these effects in individuals with FMS,our study tests the effectiveness of CST,Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.Design,setting,participants and intervention:A placebo-controlled randomized trial was conducted on132 FMS participants with poor sleep at a hospital in Bangalore.The participants were randomly allocated to one of the four study groups,including CST,Bowen therapy,standard exercise program,and a manual placebo control group that received static touch.CST,Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks;the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks.After 12 weeks,all study participants performed the standard exercises at home for another 12 weeks.Main outcome measures:Sleep quality,pressure pain threshold (PPT),quality of life and fibromyalgia impact,physical function,fatigue,pain catastrophizing,kinesiophobia,and positive–negative affect were recorded at baseline,and at weeks 12 and 24 of the intervention.Results:At the end of 12 weeks,the sleep quality improved significantly in the CST group (P=0.037) and Bowen therapy group (P=0.023),and the PPT improved significantly in the Bowen therapy group(P=0.002) and the standard exercise group (P<0.001),compared to the static touch group.These improvements were maintained at 24 weeks.No between-group differences were observed for other secondary outcomes.Conclusion:CST and Bowen therapy improved sleep quality,and Bowen therapy and standard exercises improved pain threshold in the short term.These improvements were retained within the groups in the long term by adding exercises.CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.展开更多
Introduction: Intramuscular depot betamethasone treatment had resulted in a significant improvement among fibromyalgia patients with elevated C-reactive protein (C-RP) levels. Here, we wanted to evaluate the same regi...Introduction: Intramuscular depot betamethasone treatment had resulted in a significant improvement among fibromyalgia patients with elevated C-reactive protein (C-RP) levels. Here, we wanted to evaluate the same regimen of treatment among fibromyalgia patients with normal C-RP levels. These patients represent the overwhelming majority of fibromyalgia patients. Patients and Methods: Consecutive patients with fibromyalgia attending the outpatient rheumatology clinic, with normal C-RP level and negative serology, who had failed different medical treatment, were asked to participate in our study. All patients have qualified the American College of Rheumatology (ACR) criteria from 2010. After consent, patients had an intra-muscular injection of 14 mg depot betamethasone at the gluteal area. Just prior to the injection, 1 week and 1 month later, patients were interviewed by phone and asked to answer the Fibromyalgia Revised Questionnaire (FIQR). Wilcoxon’s signed ranked test was used to compare the results 1 week and 1 month following the injection, compared to the base line scores. Results: Seventeen (17) patients completed the study. Favorable effects were seen regarding 13 out of 19 parameters one week following the injection, including functional parameters, mood and anxiety, tenderness to touch and intolerance to noise and light. No significant favorable effect was seen 1 month following the injection except for one parameter: ability of walking for twenty minutes. Conclusions: IM depot betamethasone injection had very limited and transient favorable effects on fibromyalgia patients with normal C-RP levels. Such a treatment is not a recommended modality of routine treatment, among fibromyalgia patients with normal C-RP levels.展开更多
Introduction: Fibromyalgia is a common chronic pain syndrome, associated with different risk factors, including trauma. Many patients with the current or past history of manual labor attend our rheumatology clinic/s. ...Introduction: Fibromyalgia is a common chronic pain syndrome, associated with different risk factors, including trauma. Many patients with the current or past history of manual labor attend our rheumatology clinic/s. Should manual labor be considered a risk factor for the development of fibromyalgia? Patients and Methods: A prospective study, where all male patients seen at the rheumatology clinic/s with the diagnosis of fibromyalgia were asked about their present and past type of job/s. Manual job was defined as a job where the participant had a strenuous physical activity of more than 2 hours during the working day. A similar number of Ethnic- and age-matched female patients from the same clinic/s were recruited as a control group. Results: 69 and 40 Arab and Jewish male participants were recruited, respectively. 54% of the Arab male patients and 20% of the Jewish male patients were considered manual laborers. Construction and renovation accounted for 46% of the type of jobs practiced by Arab patients. Only 4% of Arab female patients were considered manual laborers. Conclusion: Manual labor seems to be a risk factor for the development of fibromyalgia among male laborers.展开更多
BACKGROUND： Fibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels ...BACKGROUND： Fibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels in patients with fibromyalgia and have found negative correlation between magnesium levels and fibromyalgia symptoms.OBJECTIVE： To gather preliminary data on whether transdermal magnesium can improve quality of life for women who have fibromyalgia. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a patient questionnaires and survey in a fibremyalgia clinic at a tertiary medical center. Forty female patients with the diagnosis of fibremyalgia were enrolled. Each participant was provided a spray bottle containing a transdermal magnesium chloride solution and asked to apply 4 sprays per limb twice daily for 4 weeks. Participants were asked to complete the Revised Fibromyalgia Impact Questionnaire, SF-36v2 Health Survey, and a quality-of-life analog scale at baseline, week 2, and week 4. MAIN OUTCOME MEASURE： Questionnaire and survey scores, evaluated through intent-to-treat and per-protocol analyses. RESULTS： Twenty-four patients completed the study （mean [SD] age, 57.2 [7.6] years; white, 95%; mean body mass index, 31.3 kg/m2）. With intention-to-treat analysis, Revised Fibromyalgia Impact Questionnaire subscale and total scores were significantly improved at week 2 and week 4 （total score, P = 0.001）. Per-protocol analysis results were similar： all subscales of the Revised Fibremyalgia Impact Questionnaire were significantly improved at week 2 and week 4 （total score, P = 0.001）. CONCLUSION： This pilot study suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients with fibromyalgia.展开更多
Fibromyalgia(FM) is a complex pathology described as persistent hyperalgesia including somatic and mood dysfunctions, depression and anxiety. Although the etiology of FM is still unknown, a significant decrease in bio...Fibromyalgia(FM) is a complex pathology described as persistent hyperalgesia including somatic and mood dysfunctions, depression and anxiety. Although the etiology of FM is still unknown, a significant decrease in biogenic amines is a common characteristic in its pathogenesis. Here, our main objective was to investigate the role of dopamine D3/D2 receptor during the reserpine-induced pain in mice. Our results showed that pramipexole(PPX) – a dopaminergic D3/D2 receptor agonist – inhibited mechanical allodynia and thermal sensitivity induced by reserpine. Relevantly, PPX treatment decreased immobility time and increased the number of grooming in the forced swimming test and splash test, respectively. Animals that received PPX remained longer in the open arms than the reserpine group using elevated plusmaze apparatus. The repeated PPX administration, given daily for 4 days, significantly blocked the mechanical and thermal allodynia during FM model, similarly to pregabalin, although it failed to affect the reserpine-induced thermal nociception. Reserpine administration induced significant downregulation of dopamine concentration in the central nervous system, and repeated treatment with PPX restored dopamine levels in the frontal cortex and spinal cord tissues. Moreover, PPX treatment inhibited oxidants production such as DCFH(2′,7′-dichlorodihydrofluorescein) and nitrite, also decreased oxidative damage(carbonyl), and upregulated the activity of superoxide dismutase in the spinal cord. Together, our findings demonstrated the ability of dopamine D3/D2 receptor-preferring agonist in reducing pain and mood dysfunction allied to FM in mice. All experimental protocols were approved by the Universidade Federal de Santa Catarina(UFSC) Ethics Committee(approval No. 2572210218) on May 10, 2018.展开更多
OBJECTIVE:To comprehensively evaluate the effectiveness of acupuncture as a treatment for fibromyalgiasyndrome.METHODS: Two review authors independently selected the trials for the Meta-analysis, assessed their method...OBJECTIVE:To comprehensively evaluate the effectiveness of acupuncture as a treatment for fibromyalgiasyndrome.METHODS: Two review authors independently selected the trials for the Meta-analysis, assessed their methodological quality and extracted relevant data. A quality assessment was conducted according to the Cochrane Review Handbook 5.0.RevMan 5.0.20 software was used in the statistical analysis.RESULTS: A total of 523 trials were reviewed and 9trials were selected for Meta-analysis.(a) Compared acupuncture with sham acupuncture, there was a significant difference in the visual analogue scale,but no difference in the pressure pain threshold.Additionally,and there was a difference in the fibromyalgia impact questionnaire and the multidisciplinary pain inventory after 4 weeks of treatment,but no difference after 7 weeks of therapy. There was no difference in the numerical rating scale in weeks 3, 8 and 13.(b) Acupuncture versus drugs.There were differences in the VAS after 20 days of acupuncture and moxibustion treatment comparing with the drug amitriptyline, and after 4 weeks of acupuncture and moxibustion treatment comparing with the drug fluoxetine and amitriptyline.There were also differences in the number of tender points when comparing acupuncture with amitriptyline or fluoxetine. There was no difference in total efficiency when comparing acupuncture with amitriptyline after 4 weeks of treatment, but there were differences between the two groups 45 days after treatment.There were also differences in total efficiency comparing acupuncture with fluoxetine,and when comparing 4 weeks post-treatment of acupuncture with a combination of amitriptyline,oryzanol and vitamin B.(c) A comparison of acupuncture, drugs and exercise with drugs and exercise showed PPT differences in months 3 and 6.There was no difference between the two comparison groups after follow-up visits in months 12 and 24.CONCLUSION: Compared with sham acupuncture,there was not enough evidence to prove the efficacy of acupuncture therapy for the treatment of fibromyalgia. Some evidence testified that the effectiveness of acupuncture therapy for fibromyalgia was superior to drugs; however, the included trials were not of high quality or had high bias risks.Acupuncture combined with drugs and exercise could increase pain thresholds in the short term, but there is a need for higher quality randomized controlled trials to further confirm this.展开更多
BACKGROUND Fibromyalgia(FM)and myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)are devastating metabolic neuroimmune diseases that are difficult to diagnose because of the presence of numerous symptoms and a...BACKGROUND Fibromyalgia(FM)and myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)are devastating metabolic neuroimmune diseases that are difficult to diagnose because of the presence of numerous symptoms and a lack of specific biomarkers.Despite patient heterogeneity linked to patient subgroups and variation in disease severity,anomalies are found in the blood and plasma of these patients when compared with healthy control groups.The seeming specificity of these“plasma factors”,as recently reported by Ron Davis and his group at Stanford University,CA,United States,and observations by our group,have led to the proposal that induced pluripotent stem cells(iPSCs)may be used as metabolic sensors for FM and ME/CFS,a hypothesis that is the basis for this indepth review.AIM To identify metabolic signatures in FM and/or ME/CFS supporting the existence of disease-associated plasma factors to be sensed by iPSCs.METHODS A PRISMA(Preferred Reported Items for Systematic Reviews and Meta-analysis)-based systematic review of the literature was used to select original studies evaluating the metabolite profiles of FM and ME/CFS body fluids.The MeSH terms“metabolomic”or“metabolites”in combination with FM and ME/CFS disease terms were screened against the PubMed database.Only original studies applying omics technologies,published in English,were included.The data obtained were tabulated according to the disease and type of body fluid analyzed.Coincidences across studies were searched and P-values reported by the original studies were gathered to document significant differences found in the disease groups.RESULTS Eighteen previous studies show that some metabolites are commonly altered in ME/CFS and FM body fluids.In vitro cell-based assays have the potential to be developed as screening platforms,providing evidence for the existence of factors in patient body fluids capable of altering morphology,differentiation state and/or growth patterns.Moreover,they can be further developed using approaches aimed at blocking or reversing the effects of specific plasma/serum factors seen in patients.The documented high sensitivity and effective responses of iPSCs to environmental cues suggests that these pluripotent cells could form robust,reproducible reporter systems of metabolic diseases,including ME/CFS and FM.Furthermore,culturing iPSCs,or their mesenchymal stem cell counterparts,in patient-conditioned medium may provide valuable information to predict individual outcomes to stem-cell therapy in the context of precision medicine studies.CONCLUSION This opinion review explains our hypothesis that iPSCs could be developed as a screening platform to provide evidence of a metabolic imbalance in FM and ME/CFS.展开更多
Objective: To evaluate the impact of fibromyalgia in daily and associated factors in women treated at the polyclinic in Paraná. Method: A descriptive, cross-sectional study was conducted with individualized data ...Objective: To evaluate the impact of fibromyalgia in daily and associated factors in women treated at the polyclinic in Paraná. Method: A descriptive, cross-sectional study was conducted with individualized data for 52 women ≥ 50 years from the policlinic of the Curitiba of Paraná State, Brazil. Data were collected an online survey and the quality of life was assessed by one specific instrument, the Fibromyalgia Impact Questionnaire (FIQ). Verbal or written informed consent was obtained from all participants. Results: A total of 157 patients completed the survey. The average age was approximately 50 years (range 29 - 77 years). The most frequent comorbidities were depression (61.5%) and (19%) arthrosis. Conclusion: The understanding of the commodities associated with fibromyalgia helps health professionals to reach the patient efficiently in their orientations about nursing care in women with fibromyalgia.展开更多
Fibromyalgia(FM) has been described as a chronic clinical condition related to multisensory hypersensitivitypresenting with a complex of symptoms dominated by chronic widespread pain associated with the existence of a...Fibromyalgia(FM) has been described as a chronic clinical condition related to multisensory hypersensitivitypresenting with a complex of symptoms dominated by chronic widespread pain associated with the existence of a range of co-morbidities, such as fatigue, sleep disturbance, cognitive impairment, anxiety and depression. Current treatments include drugs that target serotonin and noradrenaline levels within the central nervous system, e.g., tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, and voltage-gated calcium channel subunit ligands, e.g., gabapentin and pregabalin. Investigation of a range of novel targets, such as melatoninergic, cannabinoid, dopamine, NMDA, angiotensin, orexin and opioid receptors, and ion channels, in addition revisiting bioamine modulation and subunits has provided efficacy outcomes that improve the health status of patients with FM. Nevertheless, modest and limited efficacy is often observed reflecting the heterogeneity of FM with existence of subpopulations of patients, the contribution of peripheral and central components to the pathophysiology, and the extensive range of accompanying co-morbidities. The complexity and multidimensional nature of FM is emphasized by the diversity of pharmacological targets gaining interest. Clues to underlying mechanisms which offer themselves as novel and potential targets for new medications are being provided by advances in the understanding of the pathophysiology of FM.展开更多
Objective: to investigate how therapeutic mas-sage, combined with stretching, can really con-tribute to the treatment of fibromyalgia (FM) symptoms. Design: Feasibility study. Setting: A single center. Participants: T...Objective: to investigate how therapeutic mas-sage, combined with stretching, can really con-tribute to the treatment of fibromyalgia (FM) symptoms. Design: Feasibility study. Setting: A single center. Participants: Twenty women having a preexisting diagnosis of FM based on American College of Rheumatology criteria were recruited. Intervention: Subjects received a total of 18 sessions of light massage administered by a physical therapist twice a week and then performed passive stretching exercises. Main out-come measures: heart rate (HR) and Heart Rate variability (HRV), the assessment of joint flexi-bility through elettrogoniometer, the Fibromyal-gia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and the Borg scale or Rating of Perceived exertion (RPE). Evalua-tions were conducted at the screening visit (T0), immediately at the end of the session of mas-sage (T1) and after completion of 18 sessions (T2). Results: HRV showed an improvement in terms of decreased sympathetic tone and in-crease of parasympathetic tone at the end of treatment. Also joint flexibility showed a sig-nificant improvement at T2 compared with the screening. FIQ, PSQI, RPE did not change. Conclusions: the findings highlight the excellent compliance of FM patients to the combined therapy of massage and stretching, showing an amelioration of muscle stiffness and an improvement of autonomic nervous system with a decrease of sympathetic tone and an increase of parasympathetic tone. The questionnaires did not show any ameliorations, probably because in these patients the perception of quality of life is distorted compared with more objective pa-rameters, such as muscle rigidity, the articular mobility and the autonomic nervous system.展开更多
Juvenile fibromyalgia (JFM) is often diagnosed at a later stage. Therefore, little is known about its early phase. A 12-year-old girl with persistent lumbago without fever consulted an orthopedist, but imaging studies...Juvenile fibromyalgia (JFM) is often diagnosed at a later stage. Therefore, little is known about its early phase. A 12-year-old girl with persistent lumbago without fever consulted an orthopedist, but imaging studies showed no abnormalities and analgesics were ineffective. She therefore visited our pediatric clinic. On digital palpation, she had pain in 13 of the 18 tender point sites of fibromyalgia. The blood test results were unremarkable. A medical interview revealed character tendencies often seen in patients with JFM;she was serious-minded, uncompromising, and showed excessive concern for others. Furthermore, psychological stress for the approaching annual sports day might have built up. All factors considered, early-stage JFM was the probable diagnosis. The patient accepted the diagnosis and understood that the disease may be psychogenic. Getting through the sports day cured her symptoms. This case highlights the importance of initial care, including a detailed explanation, in those with JFM.展开更多
Introduction: Fatigue is an important fibromyalgia (FM) symptom, but existing measures of fatigue are unlikely to meet regulatory standards for clinical trial use. We describe the development and validation of the Dai...Introduction: Fatigue is an important fibromyalgia (FM) symptom, but existing measures of fatigue are unlikely to meet regulatory standards for clinical trial use. We describe the development and validation of the Daily Diary of Fatigue Symptoms—Fibromyalgia (DFS-Fibro), a 24-hour recall, patient-reported outcome (PRO) measure of fatigue in FM that is administered electronically (ePRO). Methods: There were 3 phases of work: 1) item generation based on concept elicitation interviews with FM patients, with clinical relevance confirmed by expert clinician review;2) pilot testing/cognitive debriefing interviews with FM patients;and 3) psychometric validation using data from a methodology study with 145 FM patients. The measure was finalised based on both qualitative and quantitative findings. Results: Twenty-three items were generated in phase 1, some minor revisions were made following the pilot testing and cognitive debriefing (phase 2) but none were deleted. All patients found the measure easy to understand and use. Item reduction was conducted taking into account both the initial psychometric data and the earlier qualitative research, resulting in a final 5 item measure of the “symptom” of fatigue. The 5-item DFS-Fibro had very high internal consistency (alpha = 0.99), and strong test-re-test reliability (r > 0.84), convergent validity and known-groups validity. Conclusion: The DFS-Fibro has strong psychometric properties and strong face and content validity for the measurement of fatigue in FM.展开更多
Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic...Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic referral pattern. Furthermore, pain arising from structures in the orofacial region may be a presentation of fibromyalgia and treatment directed at temporomandibular disorders fails to alleviate the pain. Similarly, patients with fibromyalgia may present with pain in the orofacial region. The physician in this case should be aware of temporomandibular disorders, its characteristic findings and treatment approaches that might be included in the treatment plan.展开更多
Fibromyalgia (FM) is a complex, chronic condition, which causes widespread musculoskeletal pain, fatigue and a variety of other symptoms. Many polymorphisms related to neuroendocrine system function as the ApoE isofor...Fibromyalgia (FM) is a complex, chronic condition, which causes widespread musculoskeletal pain, fatigue and a variety of other symptoms. Many polymorphisms related to neuroendocrine system function as the ApoE isoforms, Val158Met polymorphism in COMT, as well as a 44 bp deletion located in 5-HTTLPR, have been studied. Other polymorphisms have been related to inflammatory response such as the 70 bp VNTR in IL-4 or to citokine levels. Furthermore, some studies focused on finding out new FM related SNPs, have been performed by genome wide association scan (GWAS). The target of this work was to study a possible linkage of a collagen type I polymorphism (COL1A1 rs180012 SNP) affecting bone mineralization, with fibromyalgia. Results obtained show a clear association of ss homozygous genotype with FM patients no dependent on bone mineralization.展开更多
The purpose of this qualitative study was to assess perspectives on the acceptability and the potential applicability of a forgiveness education in patients with fibromyalgia. The concept and tools of forgiveness were...The purpose of this qualitative study was to assess perspectives on the acceptability and the potential applicability of a forgiveness education in patients with fibromyalgia. The concept and tools of forgiveness were presented to thirteen women (age: 40 - 54 years) with a previous diagnosis of fibromyalgia. Subjects participated in 1 of 2 focus groups following a 90-minute education session in which forgiveness was presented as an emotion-focused coping strategy to deal with interpersonal stressors. Qualitative assessment of focus group discussions reveals 3 themes: 1) forgiveness is healthy and reduces pain, 2) forgiveness is within a patient’s personal control, and 3) forgiveness education is similar to other types of patient education and is well received. Our results suggest that forgiveness education is acceptable and feasible in patients with fibromyalgia. This justifies further exploration of forgiveness as an emotion-focused self- management strategy to decrease psychological distress.展开更多
Fibromyalgia is characterized by the primary symptomsof persistent diffuse pain, fatigue, sleep disturbance and cognitive dysfunction. Persistent pain conditions, such as fibromyalgia, are often refractory to current ...Fibromyalgia is characterized by the primary symptomsof persistent diffuse pain, fatigue, sleep disturbance and cognitive dysfunction. Persistent pain conditions, such as fibromyalgia, are often refractory to current available therapies. An involvement of K^+ channels in the pathophysiology of fibromyalgia is emerging and supported by drug treatments for this condition exhibiting action at these molecular processes. K^+ channels constitute potential novel target candidates for pain therapy offering peripheral and/or central actions. The Kv7 channel activators, flupirtine and retigabine, have exhibited pharmacological profiles compatible to the requirements needed for use as a therapeutic approach to fibromyalgia. Clinical trials to address the multidimensional challenges of fibromyalgia with flupirtine and retigabine will provide important insight to the role of K^+ channels in this condition.展开更多
BACKGROUND Fibromyalgia(FM)patients are treated with antidepressants,and in most cases,these drugs lose efficacy or present side effects.Intravenous lidocaine(IL)is an anesthetic drug used in some FM trials.AIM To sys...BACKGROUND Fibromyalgia(FM)patients are treated with antidepressants,and in most cases,these drugs lose efficacy or present side effects.Intravenous lidocaine(IL)is an anesthetic drug used in some FM trials.AIM To systematically review the safety and efficacy of IL in FM patients.METHODS To systematically search PubMed for articles in English,Spanish,and Japanese with English Abstracts on FM and lidocaine between 1966 and February 2021.This study was registered at PROSPERO.RESULTS We found only ten articles published in this field,with a total of 461 patients.Females predominated varying from 95%to 100%in the studies.Age varied from 40.9 to 55 years old.Disease duration varied from 1 mo to 6.4 years.Lidocaine dose varied from 2 to 7.5 mg/kg via intravenous infusion.Follow-up period varied from 65.7 to 90 days.Regarding outcomes,most studies used the visual analogue scale(VAS)for pain;before short-term lidocaine administration,VAS was between 6.1 and 8.1 and after treatment was between 1.7 and 4.5 mm.Concerning long term lidocaine,VAS varied from 30%to 35.4%after lidocaine infusion.Side effects were observed in 0%to 39.6%of cases,they were usually mild or moderate.CONCLUSION This study demonstrates the short-term effectiveness and safety of intravenous lidocaine in FM patients.However,more studies,including long-term follow-up,are still needed.展开更多
基金Supported by collaborative project(ID3003)of the Vice-Rectors Office for University Outreach(VCM,Spanish acronym)of the Universidad San Sebastián Concepción,Republic of Chile.
文摘Background Fibromyalgia(FM)is a chronic rheumatic disorder characterised by musculoskeletal pain,fatigue,and psychoemotional symptoms.Virtual reality(VR)has proven to be an innovative and motivating tool for managing FM,with several studies indicating that it can improve quality of life indices and reduce psychoemotional symptoms.However,studies on immersive VR-based exercise(iVRE)are limited.Methods The aim of this study was to evaluate the effects of iVRE on quality of life,stress,anxiety,depression,and handgrip strength in patients with FM.A single-arm pre-post-test pilot study was conducted.Individuals diagnosed with FM were recruited using convenience sampling.The iVRE protocol consisted of 12 sessions of 10 min warm-up and 15 min exercises applied with the Oculus Quest 2TM device.The impact on quality of life was assessed using the Revised Fibromyalgia Impact Questionnaire,and the effects on stress,anxiety,and depression were determined using the Depression Anxiety Stress Scale-21 questionnaire.Handgrip strength was evaluated using the Baseline®dynamometer.The normality assumption was evaluated,and the pre-post means were compared using Student's ttest(p<0.05).Results Eleven individuals(40.6±11.2 years)completed the protocol(10 women).There were significant differences in favour of iVRE in quality of life impact(p<0.001,Cohen's d:1.48),handgrip strength(p<0.05,Cohen's d:0.26),depression(p<0.05,Cohen's d:0.73),and anxiety(p<0.05,Cohen's d:0.73).Conclusions A six-week iVRE program significantly reduces the impact on quality of life,anxiety,and depression and improves handgrip strength in people with FM.Future studies should investigate the physiological effects using systemic biomarkers to explain the scope of this therapeutic modality.
文摘Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.
基金supported by National Institutes of Health(NCCAM)grant R01 AT00004Department of Defense DAMD-17002-0018+1 种基金Georgetown University GCRC grant 98-186supported by National Institutes of Health(NCCAM)K01AT01111-01 and National Institutes of Health grant R01-AT-00755。
文摘Objective:Acupuncture has demonstrated efficacy as a treatment for fibromyalgia;however,predictors of short-and long-term analgesic response in this population are not well understood.Methods:This manuscript describes a secondary analysis of a single-center,blinded,sham-controlled,randomized longitudinal acupuncture clinical trial in fibromyalgia.Baseline characterization included pressure pain threshold and pain interference,while residualized change in pain intensity from baseline to follow-up served as the primary outcome measure.Participants were randomized into groups that received verum(n=36)or sham(n=29)acupuncture treatment over a 12-week period(18 treatments)and were followed for 37 weeks from the initiation of treatment.Results:Lower pressure pain thresholds at baseline were associated with greater analgesia only in the sham treatment group immediately following treatment,while those with higher pressure pain thresholds had greater analgesia with verum treatment(B=–13.43,P=0.001).Additionally,greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment.Pressure pain threshold was not found to be predictive of long-term differential treatment response(B=–1.71,P=0.66).There was a significant difference in the relationship between perceived impact of pain at baseline and subsequent long-term analgesia between groups where those with greater perceived impact of pain displayed improved long-term analgesia for verum acupuncture compared to the sham group(B=–11.37,P=0.004).Conclusion:Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia.
文摘Background:Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS);however,high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.Objective:Craniosacral therapy (CST),Bowen therapy and exercises have been found to influence the autonomic nervous system,which plays a crucial role in sleep physiology.Given the paucity of evidence concerning these effects in individuals with FMS,our study tests the effectiveness of CST,Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.Design,setting,participants and intervention:A placebo-controlled randomized trial was conducted on132 FMS participants with poor sleep at a hospital in Bangalore.The participants were randomly allocated to one of the four study groups,including CST,Bowen therapy,standard exercise program,and a manual placebo control group that received static touch.CST,Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks;the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks.After 12 weeks,all study participants performed the standard exercises at home for another 12 weeks.Main outcome measures:Sleep quality,pressure pain threshold (PPT),quality of life and fibromyalgia impact,physical function,fatigue,pain catastrophizing,kinesiophobia,and positive–negative affect were recorded at baseline,and at weeks 12 and 24 of the intervention.Results:At the end of 12 weeks,the sleep quality improved significantly in the CST group (P=0.037) and Bowen therapy group (P=0.023),and the PPT improved significantly in the Bowen therapy group(P=0.002) and the standard exercise group (P<0.001),compared to the static touch group.These improvements were maintained at 24 weeks.No between-group differences were observed for other secondary outcomes.Conclusion:CST and Bowen therapy improved sleep quality,and Bowen therapy and standard exercises improved pain threshold in the short term.These improvements were retained within the groups in the long term by adding exercises.CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.
文摘Introduction: Intramuscular depot betamethasone treatment had resulted in a significant improvement among fibromyalgia patients with elevated C-reactive protein (C-RP) levels. Here, we wanted to evaluate the same regimen of treatment among fibromyalgia patients with normal C-RP levels. These patients represent the overwhelming majority of fibromyalgia patients. Patients and Methods: Consecutive patients with fibromyalgia attending the outpatient rheumatology clinic, with normal C-RP level and negative serology, who had failed different medical treatment, were asked to participate in our study. All patients have qualified the American College of Rheumatology (ACR) criteria from 2010. After consent, patients had an intra-muscular injection of 14 mg depot betamethasone at the gluteal area. Just prior to the injection, 1 week and 1 month later, patients were interviewed by phone and asked to answer the Fibromyalgia Revised Questionnaire (FIQR). Wilcoxon’s signed ranked test was used to compare the results 1 week and 1 month following the injection, compared to the base line scores. Results: Seventeen (17) patients completed the study. Favorable effects were seen regarding 13 out of 19 parameters one week following the injection, including functional parameters, mood and anxiety, tenderness to touch and intolerance to noise and light. No significant favorable effect was seen 1 month following the injection except for one parameter: ability of walking for twenty minutes. Conclusions: IM depot betamethasone injection had very limited and transient favorable effects on fibromyalgia patients with normal C-RP levels. Such a treatment is not a recommended modality of routine treatment, among fibromyalgia patients with normal C-RP levels.
文摘Introduction: Fibromyalgia is a common chronic pain syndrome, associated with different risk factors, including trauma. Many patients with the current or past history of manual labor attend our rheumatology clinic/s. Should manual labor be considered a risk factor for the development of fibromyalgia? Patients and Methods: A prospective study, where all male patients seen at the rheumatology clinic/s with the diagnosis of fibromyalgia were asked about their present and past type of job/s. Manual job was defined as a job where the participant had a strenuous physical activity of more than 2 hours during the working day. A similar number of Ethnic- and age-matched female patients from the same clinic/s were recruited as a control group. Results: 69 and 40 Arab and Jewish male participants were recruited, respectively. 54% of the Arab male patients and 20% of the Jewish male patients were considered manual laborers. Construction and renovation accounted for 46% of the type of jobs practiced by Arab patients. Only 4% of Arab female patients were considered manual laborers. Conclusion: Manual labor seems to be a risk factor for the development of fibromyalgia among male laborers.
文摘BACKGROUND： Fibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels in patients with fibromyalgia and have found negative correlation between magnesium levels and fibromyalgia symptoms.OBJECTIVE： To gather preliminary data on whether transdermal magnesium can improve quality of life for women who have fibromyalgia. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a patient questionnaires and survey in a fibremyalgia clinic at a tertiary medical center. Forty female patients with the diagnosis of fibremyalgia were enrolled. Each participant was provided a spray bottle containing a transdermal magnesium chloride solution and asked to apply 4 sprays per limb twice daily for 4 weeks. Participants were asked to complete the Revised Fibromyalgia Impact Questionnaire, SF-36v2 Health Survey, and a quality-of-life analog scale at baseline, week 2, and week 4. MAIN OUTCOME MEASURE： Questionnaire and survey scores, evaluated through intent-to-treat and per-protocol analyses. RESULTS： Twenty-four patients completed the study （mean [SD] age, 57.2 [7.6] years; white, 95%; mean body mass index, 31.3 kg/m2）. With intention-to-treat analysis, Revised Fibromyalgia Impact Questionnaire subscale and total scores were significantly improved at week 2 and week 4 （total score, P = 0.001）. Per-protocol analysis results were similar： all subscales of the Revised Fibremyalgia Impact Questionnaire were significantly improved at week 2 and week 4 （total score, P = 0.001）. CONCLUSION： This pilot study suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients with fibromyalgia.
基金supported by grants from Programa de Pos-graduacao em Neurociencias(PGN),Programa INCT-INOVAMED(grant No.465430/2014-7)Fundacao de Apoio à Pesquisa e Inovacao do Estado de Santa Catarina(FAPESC)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior(CAPES)。
文摘Fibromyalgia(FM) is a complex pathology described as persistent hyperalgesia including somatic and mood dysfunctions, depression and anxiety. Although the etiology of FM is still unknown, a significant decrease in biogenic amines is a common characteristic in its pathogenesis. Here, our main objective was to investigate the role of dopamine D3/D2 receptor during the reserpine-induced pain in mice. Our results showed that pramipexole(PPX) – a dopaminergic D3/D2 receptor agonist – inhibited mechanical allodynia and thermal sensitivity induced by reserpine. Relevantly, PPX treatment decreased immobility time and increased the number of grooming in the forced swimming test and splash test, respectively. Animals that received PPX remained longer in the open arms than the reserpine group using elevated plusmaze apparatus. The repeated PPX administration, given daily for 4 days, significantly blocked the mechanical and thermal allodynia during FM model, similarly to pregabalin, although it failed to affect the reserpine-induced thermal nociception. Reserpine administration induced significant downregulation of dopamine concentration in the central nervous system, and repeated treatment with PPX restored dopamine levels in the frontal cortex and spinal cord tissues. Moreover, PPX treatment inhibited oxidants production such as DCFH(2′,7′-dichlorodihydrofluorescein) and nitrite, also decreased oxidative damage(carbonyl), and upregulated the activity of superoxide dismutase in the spinal cord. Together, our findings demonstrated the ability of dopamine D3/D2 receptor-preferring agonist in reducing pain and mood dysfunction allied to FM in mice. All experimental protocols were approved by the Universidade Federal de Santa Catarina(UFSC) Ethics Committee(approval No. 2572210218) on May 10, 2018.
基金Supported by the State Key Program of National Natural Science of China(No.81330088)
文摘OBJECTIVE:To comprehensively evaluate the effectiveness of acupuncture as a treatment for fibromyalgiasyndrome.METHODS: Two review authors independently selected the trials for the Meta-analysis, assessed their methodological quality and extracted relevant data. A quality assessment was conducted according to the Cochrane Review Handbook 5.0.RevMan 5.0.20 software was used in the statistical analysis.RESULTS: A total of 523 trials were reviewed and 9trials were selected for Meta-analysis.(a) Compared acupuncture with sham acupuncture, there was a significant difference in the visual analogue scale,but no difference in the pressure pain threshold.Additionally,and there was a difference in the fibromyalgia impact questionnaire and the multidisciplinary pain inventory after 4 weeks of treatment,but no difference after 7 weeks of therapy. There was no difference in the numerical rating scale in weeks 3, 8 and 13.(b) Acupuncture versus drugs.There were differences in the VAS after 20 days of acupuncture and moxibustion treatment comparing with the drug amitriptyline, and after 4 weeks of acupuncture and moxibustion treatment comparing with the drug fluoxetine and amitriptyline.There were also differences in the number of tender points when comparing acupuncture with amitriptyline or fluoxetine. There was no difference in total efficiency when comparing acupuncture with amitriptyline after 4 weeks of treatment, but there were differences between the two groups 45 days after treatment.There were also differences in total efficiency comparing acupuncture with fluoxetine,and when comparing 4 weeks post-treatment of acupuncture with a combination of amitriptyline,oryzanol and vitamin B.(c) A comparison of acupuncture, drugs and exercise with drugs and exercise showed PPT differences in months 3 and 6.There was no difference between the two comparison groups after follow-up visits in months 12 and 24.CONCLUSION: Compared with sham acupuncture,there was not enough evidence to prove the efficacy of acupuncture therapy for the treatment of fibromyalgia. Some evidence testified that the effectiveness of acupuncture therapy for fibromyalgia was superior to drugs; however, the included trials were not of high quality or had high bias risks.Acupuncture combined with drugs and exercise could increase pain thresholds in the short term, but there is a need for higher quality randomized controlled trials to further confirm this.
文摘BACKGROUND Fibromyalgia(FM)and myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)are devastating metabolic neuroimmune diseases that are difficult to diagnose because of the presence of numerous symptoms and a lack of specific biomarkers.Despite patient heterogeneity linked to patient subgroups and variation in disease severity,anomalies are found in the blood and plasma of these patients when compared with healthy control groups.The seeming specificity of these“plasma factors”,as recently reported by Ron Davis and his group at Stanford University,CA,United States,and observations by our group,have led to the proposal that induced pluripotent stem cells(iPSCs)may be used as metabolic sensors for FM and ME/CFS,a hypothesis that is the basis for this indepth review.AIM To identify metabolic signatures in FM and/or ME/CFS supporting the existence of disease-associated plasma factors to be sensed by iPSCs.METHODS A PRISMA(Preferred Reported Items for Systematic Reviews and Meta-analysis)-based systematic review of the literature was used to select original studies evaluating the metabolite profiles of FM and ME/CFS body fluids.The MeSH terms“metabolomic”or“metabolites”in combination with FM and ME/CFS disease terms were screened against the PubMed database.Only original studies applying omics technologies,published in English,were included.The data obtained were tabulated according to the disease and type of body fluid analyzed.Coincidences across studies were searched and P-values reported by the original studies were gathered to document significant differences found in the disease groups.RESULTS Eighteen previous studies show that some metabolites are commonly altered in ME/CFS and FM body fluids.In vitro cell-based assays have the potential to be developed as screening platforms,providing evidence for the existence of factors in patient body fluids capable of altering morphology,differentiation state and/or growth patterns.Moreover,they can be further developed using approaches aimed at blocking or reversing the effects of specific plasma/serum factors seen in patients.The documented high sensitivity and effective responses of iPSCs to environmental cues suggests that these pluripotent cells could form robust,reproducible reporter systems of metabolic diseases,including ME/CFS and FM.Furthermore,culturing iPSCs,or their mesenchymal stem cell counterparts,in patient-conditioned medium may provide valuable information to predict individual outcomes to stem-cell therapy in the context of precision medicine studies.CONCLUSION This opinion review explains our hypothesis that iPSCs could be developed as a screening platform to provide evidence of a metabolic imbalance in FM and ME/CFS.
文摘Objective: To evaluate the impact of fibromyalgia in daily and associated factors in women treated at the polyclinic in Paraná. Method: A descriptive, cross-sectional study was conducted with individualized data for 52 women ≥ 50 years from the policlinic of the Curitiba of Paraná State, Brazil. Data were collected an online survey and the quality of life was assessed by one specific instrument, the Fibromyalgia Impact Questionnaire (FIQ). Verbal or written informed consent was obtained from all participants. Results: A total of 157 patients completed the survey. The average age was approximately 50 years (range 29 - 77 years). The most frequent comorbidities were depression (61.5%) and (19%) arthrosis. Conclusion: The understanding of the commodities associated with fibromyalgia helps health professionals to reach the patient efficiently in their orientations about nursing care in women with fibromyalgia.
文摘Fibromyalgia(FM) has been described as a chronic clinical condition related to multisensory hypersensitivitypresenting with a complex of symptoms dominated by chronic widespread pain associated with the existence of a range of co-morbidities, such as fatigue, sleep disturbance, cognitive impairment, anxiety and depression. Current treatments include drugs that target serotonin and noradrenaline levels within the central nervous system, e.g., tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, and voltage-gated calcium channel subunit ligands, e.g., gabapentin and pregabalin. Investigation of a range of novel targets, such as melatoninergic, cannabinoid, dopamine, NMDA, angiotensin, orexin and opioid receptors, and ion channels, in addition revisiting bioamine modulation and subunits has provided efficacy outcomes that improve the health status of patients with FM. Nevertheless, modest and limited efficacy is often observed reflecting the heterogeneity of FM with existence of subpopulations of patients, the contribution of peripheral and central components to the pathophysiology, and the extensive range of accompanying co-morbidities. The complexity and multidimensional nature of FM is emphasized by the diversity of pharmacological targets gaining interest. Clues to underlying mechanisms which offer themselves as novel and potential targets for new medications are being provided by advances in the understanding of the pathophysiology of FM.
文摘Objective: to investigate how therapeutic mas-sage, combined with stretching, can really con-tribute to the treatment of fibromyalgia (FM) symptoms. Design: Feasibility study. Setting: A single center. Participants: Twenty women having a preexisting diagnosis of FM based on American College of Rheumatology criteria were recruited. Intervention: Subjects received a total of 18 sessions of light massage administered by a physical therapist twice a week and then performed passive stretching exercises. Main out-come measures: heart rate (HR) and Heart Rate variability (HRV), the assessment of joint flexi-bility through elettrogoniometer, the Fibromyal-gia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and the Borg scale or Rating of Perceived exertion (RPE). Evalua-tions were conducted at the screening visit (T0), immediately at the end of the session of mas-sage (T1) and after completion of 18 sessions (T2). Results: HRV showed an improvement in terms of decreased sympathetic tone and in-crease of parasympathetic tone at the end of treatment. Also joint flexibility showed a sig-nificant improvement at T2 compared with the screening. FIQ, PSQI, RPE did not change. Conclusions: the findings highlight the excellent compliance of FM patients to the combined therapy of massage and stretching, showing an amelioration of muscle stiffness and an improvement of autonomic nervous system with a decrease of sympathetic tone and an increase of parasympathetic tone. The questionnaires did not show any ameliorations, probably because in these patients the perception of quality of life is distorted compared with more objective pa-rameters, such as muscle rigidity, the articular mobility and the autonomic nervous system.
文摘Juvenile fibromyalgia (JFM) is often diagnosed at a later stage. Therefore, little is known about its early phase. A 12-year-old girl with persistent lumbago without fever consulted an orthopedist, but imaging studies showed no abnormalities and analgesics were ineffective. She therefore visited our pediatric clinic. On digital palpation, she had pain in 13 of the 18 tender point sites of fibromyalgia. The blood test results were unremarkable. A medical interview revealed character tendencies often seen in patients with JFM;she was serious-minded, uncompromising, and showed excessive concern for others. Furthermore, psychological stress for the approaching annual sports day might have built up. All factors considered, early-stage JFM was the probable diagnosis. The patient accepted the diagnosis and understood that the disease may be psychogenic. Getting through the sports day cured her symptoms. This case highlights the importance of initial care, including a detailed explanation, in those with JFM.
文摘Introduction: Fatigue is an important fibromyalgia (FM) symptom, but existing measures of fatigue are unlikely to meet regulatory standards for clinical trial use. We describe the development and validation of the Daily Diary of Fatigue Symptoms—Fibromyalgia (DFS-Fibro), a 24-hour recall, patient-reported outcome (PRO) measure of fatigue in FM that is administered electronically (ePRO). Methods: There were 3 phases of work: 1) item generation based on concept elicitation interviews with FM patients, with clinical relevance confirmed by expert clinician review;2) pilot testing/cognitive debriefing interviews with FM patients;and 3) psychometric validation using data from a methodology study with 145 FM patients. The measure was finalised based on both qualitative and quantitative findings. Results: Twenty-three items were generated in phase 1, some minor revisions were made following the pilot testing and cognitive debriefing (phase 2) but none were deleted. All patients found the measure easy to understand and use. Item reduction was conducted taking into account both the initial psychometric data and the earlier qualitative research, resulting in a final 5 item measure of the “symptom” of fatigue. The 5-item DFS-Fibro had very high internal consistency (alpha = 0.99), and strong test-re-test reliability (r > 0.84), convergent validity and known-groups validity. Conclusion: The DFS-Fibro has strong psychometric properties and strong face and content validity for the measurement of fatigue in FM.
文摘Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic referral pattern. Furthermore, pain arising from structures in the orofacial region may be a presentation of fibromyalgia and treatment directed at temporomandibular disorders fails to alleviate the pain. Similarly, patients with fibromyalgia may present with pain in the orofacial region. The physician in this case should be aware of temporomandibular disorders, its characteristic findings and treatment approaches that might be included in the treatment plan.
文摘Fibromyalgia (FM) is a complex, chronic condition, which causes widespread musculoskeletal pain, fatigue and a variety of other symptoms. Many polymorphisms related to neuroendocrine system function as the ApoE isoforms, Val158Met polymorphism in COMT, as well as a 44 bp deletion located in 5-HTTLPR, have been studied. Other polymorphisms have been related to inflammatory response such as the 70 bp VNTR in IL-4 or to citokine levels. Furthermore, some studies focused on finding out new FM related SNPs, have been performed by genome wide association scan (GWAS). The target of this work was to study a possible linkage of a collagen type I polymorphism (COL1A1 rs180012 SNP) affecting bone mineralization, with fibromyalgia. Results obtained show a clear association of ss homozygous genotype with FM patients no dependent on bone mineralization.
文摘The purpose of this qualitative study was to assess perspectives on the acceptability and the potential applicability of a forgiveness education in patients with fibromyalgia. The concept and tools of forgiveness were presented to thirteen women (age: 40 - 54 years) with a previous diagnosis of fibromyalgia. Subjects participated in 1 of 2 focus groups following a 90-minute education session in which forgiveness was presented as an emotion-focused coping strategy to deal with interpersonal stressors. Qualitative assessment of focus group discussions reveals 3 themes: 1) forgiveness is healthy and reduces pain, 2) forgiveness is within a patient’s personal control, and 3) forgiveness education is similar to other types of patient education and is well received. Our results suggest that forgiveness education is acceptable and feasible in patients with fibromyalgia. This justifies further exploration of forgiveness as an emotion-focused self- management strategy to decrease psychological distress.
文摘Fibromyalgia is characterized by the primary symptomsof persistent diffuse pain, fatigue, sleep disturbance and cognitive dysfunction. Persistent pain conditions, such as fibromyalgia, are often refractory to current available therapies. An involvement of K^+ channels in the pathophysiology of fibromyalgia is emerging and supported by drug treatments for this condition exhibiting action at these molecular processes. K^+ channels constitute potential novel target candidates for pain therapy offering peripheral and/or central actions. The Kv7 channel activators, flupirtine and retigabine, have exhibited pharmacological profiles compatible to the requirements needed for use as a therapeutic approach to fibromyalgia. Clinical trials to address the multidimensional challenges of fibromyalgia with flupirtine and retigabine will provide important insight to the role of K^+ channels in this condition.
文摘BACKGROUND Fibromyalgia(FM)patients are treated with antidepressants,and in most cases,these drugs lose efficacy or present side effects.Intravenous lidocaine(IL)is an anesthetic drug used in some FM trials.AIM To systematically review the safety and efficacy of IL in FM patients.METHODS To systematically search PubMed for articles in English,Spanish,and Japanese with English Abstracts on FM and lidocaine between 1966 and February 2021.This study was registered at PROSPERO.RESULTS We found only ten articles published in this field,with a total of 461 patients.Females predominated varying from 95%to 100%in the studies.Age varied from 40.9 to 55 years old.Disease duration varied from 1 mo to 6.4 years.Lidocaine dose varied from 2 to 7.5 mg/kg via intravenous infusion.Follow-up period varied from 65.7 to 90 days.Regarding outcomes,most studies used the visual analogue scale(VAS)for pain;before short-term lidocaine administration,VAS was between 6.1 and 8.1 and after treatment was between 1.7 and 4.5 mm.Concerning long term lidocaine,VAS varied from 30%to 35.4%after lidocaine infusion.Side effects were observed in 0%to 39.6%of cases,they were usually mild or moderate.CONCLUSION This study demonstrates the short-term effectiveness and safety of intravenous lidocaine in FM patients.However,more studies,including long-term follow-up,are still needed.
