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Fibromyalgia
Impact Questionnaire (FIQ) References with Abstracts from 1991
to 2010
(1) Choy E,
Perrot S, Leon T, Kaplan J, Petersel D, Ginovker A et al. A
patient survey of the impact of fibromyalgia and the journey to
diagnosis. BMC Health Serv Res 2010; 10(1):102.
Abstract: ABSTRACT: BACKGROUND: Fibromyalgia is a painful,
debilitating illness with a prevalence of 0.5-5.0% that affects
women more than men. It has been shown that the diagnosis of
fibromyalgia is associated with improved patient satisfaction
and reduced healthcare utilization. This survey examined the
patient journey to having their condition diagnosed and studied
the impact of the condition on their life. METHODS: A
questionnaire survey of 800 patients with fibromyalgia and 1622
physicians in 6 European countries, Mexico and South Korea.
Patients were recruited via their physician. RESULTS: Over half
the patients (61%) were aged 36-59 years, 84% were women, and
the mean time since experiencing fibromyalgia symptoms was 6.5
years. Patients had experienced multiple fibromyalgia symptoms
(mean of 7.3 out of 14), with pain, fatigue, sleeping problems
and concentration difficulties being the most commonly reported.
Most patients rated their chronic widespread pain as moderate or
severe and fibromyalgia symptoms were on average "fairly" to
"very" disruptive, and had a "moderate" to "strong" impact on
patients' lives. 22% were unable to work and 25% were not able
to work all the time because of their fibromyalgia. Patients
waited on average almost a year after experiencing symptoms
before presenting to a physician, and it took an average of 2.3
years and presenting to 3.7 different physicians before
receiving a diagnosis of fibromyalgia. Patients rated receiving
a diagnosis as somewhat difficult on average and had
difficulties communicating their symptoms to the physician. Over
one third (35%) felt their chronic widespread pain was not well
managed by their current treatment. CONCLUSIONS: This survey
provides further evidence that fibromyalgia is characterized by
multiple symptoms and has a notable impact on quality of life
and function. The diagnosis of fibromyalgia is delayed. Patients
wait a significant period of time before presenting to a
physician, adding to the prolonged time to diagnosis. Patients
typically present with a multitude of symptoms, all resulting in
a delay in diagnosis and eventual management. Helping clinicians
to diagnose and manage patients with fibromyalgia should benefit
both patients and funders of healthcare
(2) Kelley GA,
Kelley KS, Hootman JM, Jones DL. Exercise and global well-being
in community-dwelling adults with fibromyalgia: A systematic
review with meta-analysis. BMC Public Health 2010; 10(1):198.
Abstract: ABSTRACT: BACKGROUND: Exercise has been recommended
for improving global-well being in adults with fibromyalgia.
However, no meta-analysis has determined the effects of exercise
on global well-being using a single instrument and when analyzed
separately according to intention-to-treat and per-protocol
analyses. The purpose of this study was to fill that gap.
Methods: Studies were derived from six electronic sources,
cross-referencing from retrieved studies and expert review. Dual
selection of randomized controlled exercise training studies
published between January 1, 1980 and January 1, 2008 and in
which global well-being was assessed using the Fibromyalgia
Impact Questionnaire (FIQ) were included. Dual abstraction of
data for study, subject and exercise program characteristics as
well as assessment of changes in global well-being using the
total score from the FIQ was conducted. Risk of bias was
assessed using the Cochrane bias assessment tool. Random-effects
models and Hedge's standardized effect size (g) were used to
pool results according to per-protocol and intention-to-treat
analyses. Results: Of 1,025 studies screened, 7 representing 5
per-protocol and 5 intention-to-treat outcomes in 473 (280
exercise, 193 control) primarily female (99%) participants 18-73
years of age were included. Small, statistically significant
improvements in global well-being were observed for per-protocol
(g and 95% confidence interval, -0.39, -0.69 to -0.08) and
intention-to-treat (-0.34, -0.53 to -0.14) analyses. No
statistically significant within-group heterogeneity was found
(per-protocol, Qw = 6.04, p = 0.20, I-squared = 33.8%;
intention-to-treat, Qw = 3.19, p = 0.53, I-squared = 0%) and no
between-group differences for per-protocol and
intention-to-treat outcomes were observed (Qb = 0.07, p = 0.80).
Changes were equivalent to improvements of 8.2% for per-protocol
analyses and 7.3% for intention-to-treat analyses. Conclusions:
The results of this study suggest that exercise improves global
well-being in community-dwelling women with fibromyalgia.
However, additional research on this topic is needed, including
research in men as well as optimal exercise programs for
improving global well-being in adults
(3) Iannuccelli
C, Di FM, Alessandri C, Guzzo MP, Croia C, Di SF et al.
Pathophysiology of fibromyalgia: a comparison with the
tension-type headache, a localized pain syndrome. Ann N Y Acad
Sci 2010; 1193(1):78-83.
Abstract: Fibromyalgia (FM) is thought to occur because of the
combination of interactions among neurotransmitters, such as
neuropeptide Y (NPY), stressors, hormones, cytokines, and both
the immune and sympathetic nervous systems. The aim of this
study was to evaluate serum concentrations of cytokines,
antipolymer antibodies (APA), and NPY in 51 patients with FM, 25
with tension-type headache (TTH), and 15 healthy controls. Serum
concentrations of eight different cytokines, APA and NPY, were
measured. Interleukin (IL)-1RA, IL-6, IL-10, and tumor necrosis
factor-alpha were higher in serum of FM patients compared with
TTH patients and a significant correlation between IL-10 and
Fibromyalgia Impact Questionnaire score was observed. There was
a significant difference between FM and TTH versus controls in
NPY levels, but not in APA levels. Cytokines and NPY take part
in pain modulation and even if they are altered in FM they
cannot be considered as measurable biomarkers of disease
(4) Rodero B,
Garcia-Campayo J, Casanueva B, Lopez-Del-Hoyo Y, Serrano-Blanco
A, Luciano JV. Validation of the Spanish version of the Chronic
Pain Acceptance Questionnaire (CPAQ) for the assessment of
acceptance in Fibromyalgia. Health Qual Life Outcomes 2010;
8(1):37.
Abstract: ABSTRACT: BACKGROUND: The aim of this study was to
validate a Spanish version of the Chronic Pain Acceptance
Questionnaire (CPAQ). Pain acceptance is the process of giving
up the struggle with pain and learning to live a worthwhile life
despite it. The Chronic Pain Acceptance Questionnaire (CPAQ) is
the questionnaire most often used to measure pain acceptance in
chronic pain populations. METHODS: A total of 205 Spanish
patients diagnosed with fibromyalgia syndrome who attended our
pain clinic were asked to complete a battery of psychometric
instruments: the Pain Visual Analogue Scale (PVAS) for pain
intensity, the Hospital Anxiety and Depression Scale (HADS), the
Medical Outcome Study Short Form 36 (SF-36), the Pain
Catastrophising Scale (PCS) and Fibromyalgia Impact
Questionnaire (FIQ). RESULTS: Analysis of results showed that
the Spanish CPAQ had good test-retest reliability (intraclass
correlation coefficient 0.83) and internal consistency
reliability (Cronbach's : 0.83). The Spanish CPAQ score was
significantly correlated with pain intensity, anxiety,
depression, pain catastrophising, health status and physical and
psychosocial disability. The Scree plot and a Principal
Components Factor analysis confirmed the same two-factor
construct as the original English CPAQ. CONCLUSION: The Spanish
CPAQ is a reliable clinical assessment tool with valid construct
validity for the acceptance measurement among a sample of
Spanish fibromyalgia patients. This study will make it easier to
assess pain acceptance in Spanish populations with fibromyalgia
(5) Stuifbergen
AK, Blozis SA, Becker H, Phillips L, Timmerman G, Kullberg V et
al. A randomized controlled trial of a wellness intervention for
women with fibromyalgia syndrome. Clin Rehabil 2010;
24(4):305-18.
Abstract: OBJECTIVE: To examine the effects of a wellness
intervention, Lifestyle Counts, for women with fibromyalgia
syndrome on the level of self-efficacy for health-promoting
behaviours, health-promoting activity and perceived quality of
life. DESIGN: A randomized controlled single-blinded trial with
treatment and attention-control groups. SETTING: Community in
the southwestern United States. SUBJECTS: Convenience sample of
187 women (98 treatment, 89 attention control) with fibromyalgia
syndrome (mean age = 53.08 years, SD 9.86). INTERVENTION: The
two-phase Lifestyle Counts intervention programme included
lifestyle change classes for eight weeks, with goal-setting and
telephone follow-up for three months. Participants in the
attention-control group were offered an equivalent amount of
contact in classes on general disease-related information and
health education topics and unstructured follow-up phone calls.
Participants were followed for a total of eight months after
baseline. OUTCOME MEASURES: Self-report instruments measuring
self-efficacy for health behaviours, health-promotion behaviours
and health-related quality of life (SF-36 and the Fibromyalgia
Impact Questionnaire) were completed at baseline, two months
(after the classes), five months (after telephone follow-up) and
at eight months. RESULTS: Both groups improved significantly
(P<0.05) over time on the measures of self-efficacy, health
behaviours, fibromyalgia impact and quality of life. There were
significant group x time interactions for scores on the Health
Promoting Lifestyle II subscales of physical activity and stress
management. CONCLUSIONS: The Lifestyle Counts wellness
intervention holds promise for improving health-promoting
behaviours and quality of life of women with fibromyalgia
syndrome
(6) Tishler M,
Levy O, Amit-Vazina M. Can fibromyalgia be associated with
whiplash injury? A 3-year follow-up study. Rheumatol Int 2010.
Abstract: The objective of this study is to assess the long-term
outcome and natural history of a cohort of patients with
whiplash injury regarding the development of fibromyalgia. Of
the 153 patients who were admitted to the emergency room after
whiplash injury in 2004, 126 were reassessed 3 years later.
Also, 33 of 53 patients from the original control group of
hospitalized patients with fractures were reevaluated. Patients
were interviewed by phone and by written forms using a detailed
questionnaire. Patients who complained of musculoskeletal
symptoms were invited and examined. The study group included 68
men and 58 women, with a mean age of 50.1 +/- 9.7. The control
group included 19 men and 14 women with a mean age of 44.2 +/-
10.3. Follow-up period did not differ significantly between the
groups 38.3 +/- 2.3 vs. 36.4 +/- 4.2 months. At the end of the
follow-up period, three patients in the study group compared
with one patient in the control group were diagnosed as having
fibromyalgia; all of them were women. The rate of new onset
widespread pain increased with time in both groups. Symptoms of
dizziness, headaches, fatigue and sleep disturbances improved,
as well as the quality of life (QOL) and the Fibromyalgia Impact
Questionnaire (FIQ) scores. Insurance claims continued to be
more prevalent in the control group. The results of this
extended follow-up study confirm previous short-term results
showing that whiplash injury and road accident trauma are not
associated with an increased risk of fibromyalgia
(7) Thomas EN,
Blotman F. Aerobic exercise in fibromyalgia: a practical review.
Rheumatol Int 2010.
Abstract: The objective of the study was to determine the
current evidence to support guidelines for aerobic exercise (AE)
and fibromyalgia (FM) in practice, and to outline specific
research needs in these areas. Data sources consisted of a
PubMed search, 2007 Cochrane Data Base Systematic review, 2008
Ottawa panel evidence-based clinical practice guidelines, as
well as additional references found from the initial search.
Study selection included randomized clinical trials that
compared an aerobic-only exercise intervention (land or pool
based) with an untreated control, a non-exercise intervention or
other exercise programs in patients responding to the 1990
American College of Rheumatology criteria for FM. The following
outcome data were obtained: pain, tender points, perceived
improvement in FM symptoms such as the Fibromyalgia Impact
Questionnaire total score (FIQ), physical function, depression
(e.g., Beck Depression Inventory, FIQ subscale for depression),
fatigue and sleep were extracted from 19 clinical trials that
considered the effects of aerobic-only exercise in FM patients.
Data synthesis shows that there is moderate evidence of
important benefit of aerobic-only exercise in FM on physical
function and possibly on tender points and pain. It appears to
be sufficient evidence to support the practice of AE as a part
of the multidisciplinary management of FM. However, future
studies must be more adequately sized, homogeneously assessed,
and monitored for adherence, to draw definitive conclusions
(8) Dogan SK,
Aytur YK, Atbasoglu C. Assessment of the relatives or spouses
cohabiting with the fibromyalgia patients: is there a link
regarding fibromyalgia symptoms, quality of life, general health
and psychologic status? Rheumatol Int 2010.
Abstract: It was aimed to investigate the existence of the
symptoms related to fibromyalgia in the first-degree relatives
or spouses of the patients and to assess the psychologic and
general health status of these individuals and the correlation
of these with the patients' status. Thirty-seven patients with
FS, 32 first-degree relatives or spouses of the patients and 30
healthy subjects as a control group were included. Symptoms
related to FS were recorded in all subjects. Fibromyalgia Impact
Questionnaire and Nottingham Health Profile were used to assess
the components of functional status and quality of life. General
health status was evaluated by General Health Questionnaire.
Beck Depression Inventory and Beck Anxiety Inventory were used
to assess the psychologic status. There were significant
differences in the frequency of the symptoms between three
groups (P < 0.05). Symptoms and signs related to of
relatives/spouses of the patients and healthy controls were
found to be significantly lower than those of the patients. GHQ,
BAI and BDI scores of patients were found to be significantly
higher than relative/spouses and control groups (P < 0.05).
There were statistically significant differences between three
groups in energy level, pain, sleep and physical abilities
subscores of NHP (P < 0.05). No significant differences were
detected in NHP subscores between relative/spouses of the
patients and controls (P > 0.05). No fibromyalgia symptoms or
signs were detected in the relatives/spouses. The general health
status, psychologic status and quality of life were found to be
not impaired in relatives/spouses of the patients with FS
(9) Itoh K,
Kitakoji H. Effects of acupuncture to treat fibromyalgia: A
preliminary randomised controlled trial. Chin Med 2010; 5:11.
Abstract: ABSTRACT: BACKGROUND: Acupuncture is often used to
treat fibromyalgia (FM), but it remains unclear whether
acupuncture is effective. This study aims to evaluate the
effects of acupuncture on pain and quality of life (QoL) in FM
patients. METHODS: Sixteen patients (13 women and 3 men aged
25-63 years) suffering from FM were randomised into two groups:
group A (n = 8) received five acupuncture treatments after the
fifth week and group B received ten acupuncture treatments.
Outcome measures used in this study were pain intensity (visual
analogue scale, VAS) and the fibromyalgia impact questionnaire
(FIQ). RESULTS: After the fifth week, pain intensity (U = 25.0;
P = 0.022) in group B decreased and QoL (U = 24.5; P = 0.026)
improved compared to group A. CONCLUSION: The present study
suggests that acupuncture treatment is effective to relieve pain
for FM patients in terms of QoL and FIQ
(10) Lommel K,
Kapoor S, Bamford J, Melguizo MS, Martin C, Crofford L. Juvenile
primary fibromyalgia syndrome in an inpatient adolescent
psychiatric population. Int J Adolesc Med Health 2009;
21(4):571-9.
Abstract: The purpose of this study was to identify the clinical
and demographic characteristics of adolescent females admitted
to a psychiatric hospital who meet the criteria for Juvenile
Primary Fibromyalgia Syndrome (JPFS). METHODS: Participants (n =
62) were adolescent females, ages 12 to 18 years who were
admitted to an inpatient psychiatric unit. The participants
completed four questionnaires: The Achenbach Youth Self-Report (YSR),
the Children's Somatization Inventory (CSI), the Fibromyalgia
Impact Questionnaire modified for children (FIQ-C) and the Pain
Symptom Questionnaire (PSQ). Then participants were interviewed
to assess the Yunus and Masi JPFS criteria. The interview
included an examination of 21 (18 bilateral and 3 control)
tender points. RESULTS: Of the 62 adolescent females enrolled,
52% (n = 32) met criteria for JPFS (i.e. JPFS cases). Both the
FIQ and CSI scores were significantly elevated for JPFS cases as
compared with non-cases (p = .0001 and p = .0012 respectively).
Cases of JPFS also scored significantly higher on the anxiety,
depression, and conduct disorder scales of the YSR. No
between-group differences were found in reports of physical or
sexual abuse. However, a consistently higher percentage of JPFS
cases reported physical or sexual abuse as a child. CONCLUSIONS:
Juvenile primary fibromyalgia is highly prevalent in an
adolescent inpatient psychiatric unit. This possibility should
be taken into consideration when chronic complaints of pain are
expressed by patients in this setting, especially in those who
have conduct-related issues. The connection between JPFS and
abuse history requires further investigation
(11) Salaffi F,
Sarzi-Puttini P, Ciapetti A, Atzeni F. Assessment instruments
for patients with fibromyalgia: properties, applications and
interpretation. Clin Exp Rheumatol 2009; 27(5 Suppl 56):S92-105.
Abstract: A comprehensive assessment of the multiple symptom
domains associated with fibromyalgia (FM) and the impact of FM
on multidimensional aspects of function should form a routine
part of the care of FM patients. Clinical trials and long-term
clinical registries have used various outcome measures, but the
key domains include pain, fatigue, disturbed sleep, physical
functioning, emotional functioning, patient global ratings of
satisfaction, and their health-related quality of life (HRQL). A
number of measures have been ''borrowed'' from the fields of
rheumatoid arthritis, psoriatic arthritis, ankylosing
spondylitis and adapted to FM, and others are being developed
specifically for FM. However, despite the burgeoning theoretical
literature and the proliferation of instruments for measuring
various health status domains, no unified approach has been
developed and there is little agreement concerning the meaning
of the results. There is, therefore, still a need for further
consensus and the development of a core set of measures and
response criteria, more refined measuring instruments,
standardised assessor training, cross-cultural adaptations of
health status questionnaires, electronic data capture, and the
introduction of standardised quantitative measurements into
routine clinical care. This article discusses the advantages and
limitations of a selection of both newly developed and
well-established and validated distress screening instruments
that underlines the continuing challenge of assessing FM
(12) Salaffi F,
Sarzi-Puttini P, Girolimetti R, Atzeni F, Gasparini S, Grassi W.
Health-related quality of life in fibromyalgia patients: a
comparison with rheumatoid arthritis patients and the general
population using the SF-36 health survey. Clin Exp Rheumatol
2009; 27(5 Suppl 56):S67-S74.
Abstract: OBJECTIVES: To compare health-related quality of life
(HRQL) in fibromyalgia (FM) patients with that of patients with
rheumatoid arthritis (RA) and the general population, and
investigate if the factors are associated with the greater
impact of FM. METHODS: This cross-sectional study involved 380
patients with FM, 693 patients with RA and 1579 healthy
controls. HRQL was evaluated using the Medical Outcome Study
Short-Form 36 (SF-36), and the measures included disease-related
characteristics, demographic variables and comorbidities.
S-scores were calculated for comparisons with the norm, and
multivariate analyses were used to assess the relationships
between HRQL and clinical and demographic variables. RESULTS: In
comparison with the general population, the FM patients showed
significant impairment in relation to all of the eight scales of
the SF-36 (p<0.0001), as well as the physical and mental
component summary scores (PCS and MCS) (p<0.0001). The mean PCS
and MCS of the FM patients were 38.5 (SD=6.9) and 32.8
(SD=10.9), whereas those of the RA patients were 33.5 (SD=6.4)
(p<0.01) and 40.2 (SD=11.9) (p<0.001). The dimensions typically
affected by FM were vitality (s-score -1.61), mental health
(s-score -1.46) and general health (s-score-1.47), whereas
physical functioning (s-score-1.63) and role limitations due to
physical function (s -score -0.94) were more impaired in the RA
patients; the bodily pain scores were similar in the two groups.
The PCS was lower than the MCS in the RA patients (s-scores
-1.80 vs. -0.62), but the two scores were similar in the FM
patients (s-scores -1.20 vs. -1.08). Multiple regression models
showed that the physical component of the SF-36 was associated
with widespread pain (the SAPS score) (p<0.0001), educational
level (p=0.0017), and the body mass index (p=0.007), and the
mental component was associated with the widespread pain
(p=0.0005), sleep abnormalities (p=0.0033), physical function
(p=0.015), fatigue (p=0.029), gender (p=0.014) and a low
educational level (p=0.0007). CONCLUSION: Patients with FM see
the disease as having a worse health than RA patients and the
general population, especially in terms of mental health
(13) Sanudo B,
Galiano D. Using cardiovascular parameters and symptom severity
to prescribe physical activity in women with fibromyalgia. Clin
Exp Rheumatol 2009; 27(5 Suppl 56):S62-S66.
Abstract: OBJECTIVES: This study has two main aims, firstly to
define subgroups of women affected by fibromyalgia syndrome
(FMS) based on symptoms and secondly to determine cardiovascular
parameters in treadmill exercises in order to prescribe physical
activity. METHODS: Thirty-two women (age= 53.26+/-6.61 yr) were
assigned to two different groups based on their functional
capacity and symptoms as measured by the Fibromyalgia Impact
Questionnaire and pain. Subjects were submitted twice to a
maximum treadmill incremental test until participants achieved
volitional exhaustion (VO2max). Expired respiratory gases,
ventilator parameters and heart rate (HR) were measured
continuously through exercise, and rate perceived exertion (RPE)
was assessed once a minute during the test. RESULTS: Peak VO2
values for the moderately affected group (Group 1) were
significantly different from those of severely affected group
(Group 2) (26.2+/-2.1 ml x kg(-1) x min(-1) (Group 1) and
22.1+/-2.5 ml x kg(-1) x min(-1) (Group 2)). Additionally taking
into account VO2 at ventilatory threshold (VO2VT), significant
differences between groups were found in both tests. Some
notable differences in all parameters evaluated were also found.
CONCLUSION: This study has demonstrated that the aerobic
capacity of patients with FMS was different according to how
severely affected they were by the condition; therefore,
physical activity of the same intensity should not be prescribed
for both groups. According to these results, health
professionals could prescribe physical activity with confidence
to this patient group
(14) Dell'Osso L,
Bazzichi L, Consoli G, Carmassi C, Carlini M, Massimetti E et
al. Manic spectrum symptoms are correlated to the severity of
pain and the health-related quality of life in patients with
fibromyalgia. Clin Exp Rheumatol 2009; 27(5 Suppl 56):S57-S61.
Abstract: OBJECTIVES: We aimed at investigating the impact of
lifetime manic spectrum symptoms on the severity of pain and the
health-related quality of life (HRQoL) in patients with
fibromyalgia (FM). METHODS: One hundred and sixty-seven patients
with FM, assessed according to the ACR criteria, were
consecutively enrolled. Psychiatric diagnoses were carried out
following the Diagnostic and Statistical Manual for Mental
Disorders (DSM-IV-TR). The severity of pain and the HRQoL of FM
patients was measured by means of the Fibromyalgia Impact
Questionnaire (FIQ) and the Medical Outcomes Study Short Form-36
Health Survey (MOS SF-36); the mood spectrum symptomatology by
means of the Mood Spectrum-Self Report (MOODS-SR). RESULTS: A
high rate of lifetime manic symptoms was detected and resulted
as related to the Pain Visual Analogic Scale ("pain VAS") of the
FIQ and the FIQ total scores as well as to the "bodily pain",
and to the physical and mental component summary scores of the
MOS SF-36, both in the whole sample (n=167) and in FM patients
without bipolar disorder (n=160). CONCLUSION: Our results
highlight the need to pay more attention to manic spectrum
symptoms and features in FM patients, because of their
relationship with the severity of pain and with a worse HRQoL
(15) Rasmussen LB,
Mikkelsen K, Haugen M, Pripp AH, Forre OT. Treatment of
fibromyalgia at the Maharishi Ayurveda Health Centre in Norway.
A six-month follow-up study. Clin Exp Rheumatol 2009; 27(5 Suppl
56):S46-S50.
Abstract: BACKGROUND: Treatments offered at the Maharishi
Ayurveda Health Centre in Norway are based on Maharishi Vedic
medicine, which is also known as Maharishi Ayurveda. It is a
consciousness based revival of the ancient Ayurvedic medicine
tradition in India and is established by Maharishi Mahesh Yogi,
the founder of the Transcendental Meditation (TM) technique.
OBJECTIVE: To conduct a pilot study of the effect of the
treatment program at the Health Centre on fibromyalgia patients.
METHODS: Thirty-one women with diagnosed fibromyalgia received
an individually designed Maharishi Vedic physiological
purification therapy. All subjects received personal advice on
diet based on Ayurvedic principles, including a novel approach
to food into-lerance, and daily routines. In addition they were
offered instruction in TM (for stress and pain management and
personal development) (four subjects started), and recommended
Ayurvedic herbal food products for home treatment. MAIN OUTCOME
MEASURES: A modified Fibromyalgia Impact Questionnaire included
a visual analogue scale for each of the seven outcomes: working
ability, generalised pain, tiredness, stiffness, tiredness on
arising, anxiety and depression. Pre-treatment scores were
compared with scores at six-month follow-up for levels of
statistical significance. RESULTS: Twenty-eight subjects (90%)
completed the follow-up. The outcome measures were reduced by 25
to 46% by the study's endpoint: working ability (p<0.002), pain
(p<0.001), tiredness (p<0.001), morning tiredness (p<0.001),
stiffness (p<0.005), anxiety (p<0.136), and depression
(p<0.001). A group of five excellent responders including all
four participants who started to practise TM, had almost no
symptoms by the endpoint. Compared to the non-meditating control
group the TM-subgroup showed statistically significant
improvements for all outcome measures except depression.
CONCLUSIONS: In this pilot study fibromyalgia patients
undergoing treatment at Maharishi Ayurveda Health Centre in
Norway showed significant improvements six months post
treatment. Because fibromyalgia is considered a
treatment-resistant condition, these encouraging results warrant
further research
(16) Calandre EP,
Rodriguez-Claro ML, Rico-Villademoros F, Vilchez JS, Hidalgo J,
Delgado-Rodriguez A. Effects of pool-based exercise in
fibromyalgia symptomatology and sleep quality: a prospective
randomised comparison between stretching and Ai Chi. Clin Exp
Rheumatol 2009; 27(5 Suppl 56):S21-S28.
Abstract: OBJECTIVE: To evaluate the effectiveness and
tolerability of two pool-based physical therapies, stretching
and Ai Chi, in fibromyalgia symptomatology and sleep quality.
METHODS: Eighty-one patients, randomly assigned to stretching
(n=39) or Ai Chi (n=42), received 18 physiotherapy sessions and
were evaluated at baseline, at treatment termination, and after
4 and 12 weeks of follow-up. Main outcome measures were the
Fibromyalgia Impact Questionnaire (FIQ) and the Pittsburgh Sleep
Quality Index (PSQI). Secondary outcome measures included the
Beck Depression Inventory (BDI), the State and Trait Anxiety
Inventory (STAI), and the SF-12 Health Survey (SF-12). Data
analysis was done with repeated measures ANOVA and effect size
estimation. RESULTS: No differences were found between groups
but significant reduction in the FIQ and the PSQI scores were
observed in Ai Chi but not in stretching group, with larger
effect sizes and longer effect duration on sleep measures. BDI
scores decreased in stretching but not in Ai Chi group with
small effect sizes. Trait-anxiety scores decreased in both
groups also with small effect sizes. The mental component
summary of the SF-12 increased only in stretching group with
effect sizes moderate to large. CONCLUSIONS: Although no global
differences were found between groups, Ai Chi significantly
improved fibromyalgia symptomatology and sleep quality, whereas
stretching only improved subjects' psychological well-being
(17) Rico-Villademoros
F, Hidalgo J, Morillas-Arques P, Vilchez JS, Delgado-Rodriguez
A, Calandre EP. An open-label study of levopromazine (methotrimeprazine)
as an add-on therapy in fibromyalgia management. Clin Exp
Rheumatol 2009; 27(5 Suppl 56):S16-S20.
Abstract: OBJECTIVES: To assess the potential efficacy and
tolerability of levopromazine(methotrimeprazine) in the
treatment of fibromyalgia. METHODS: Unicentre, open-label study
conducted in thirty-five outpatients, aged 18 years or older,
who met the ACR criteria for fibromyalgia and had not
satisfactorily responded to previous fibromyalgia treatment.
Levopromazine, flexibly dosed (12.5-100 mg/d), was added to the
outpatients' original treatment regimens for 12 weeks. The
primary outcome measure was the mean change from baseline to
endpoint in the Fibromyalgia Impact Questionnaire (FIQ) total
score in the intent-to-treat sample. Secondary outcomes included
the Clinical Global Impression (CGI) of Severity scale,
Pittsburgh Sleep Quality Index (PSQI), Beck Depression
Inventory, State-Trait Anxiety Inventory, 12-Item Short Form
Health Survey, and individual items of the FIQ. RESULTS: The
mean FIQ total score did not decrease significantly at the study
endpoint (63.37 SD 11.32 vs. 61.19 SD 9.32, p=0.73). Pain
intensity, as evaluated by the Visual Analogue Scale, remained
unchanged at study endpoint (8.5 SD 1.6 vs. 8.2 SD 1.2, p=0.49).
A statistically significant reduction was observed in the PSQI
score (15.65 SD 3.33 vs. 12.23 SD 3.79, p<0.001, effect size:
1.03) and the CGI-severity score (4.71 SD 0.64 vs. 4.03 SD 1.01,
p<0.002, effect size: 1.06). No significant or relevant changes
were seen in the remaining fibromyalgia symptoms,
psychopathological scales or quality-of-life. The drug was well
tolerated. CONCLUSIONS: Despite its efficacy in improving sleep
quality, levopromazine does not appear to be a useful
alternative treatment for fibromyalgia
(18) Le GM,
Mainguy Y, Le LK, Nadjar A, Allain D, Galissie M. Linguistic
validation of six patient-reported outcomes instruments into 12
languages for patients with fibromyalgia. Joint Bone Spine 2010;
77(2):165-70.
Abstract: CONTEXT: The multidimensional nature of the
fibromyalgia syndrome means that different instruments need to
be used to assess the patients' perception of this constellation
of physical and psychological symptoms and their impact on their
daily lives. Six questionnaires (Multidimensional Fatigue
Inventory MFI, Fibromyalgia Impact Questionnaire FIQ, Multiple
Ability Self-report Questionnaire MASQ, State-Trait Anxiety
Inventory STAI, Beck Depression Inventory-II BDI-II and Patient
Global Impression of Change PGIC) were linguistically validated
into 12 languages. METHODS: The standardized cross-cultural
adaptation process includes the following steps: forward
translation, backward translation, and review of the version by
a clinician and comprehension tests on subjects in the target
country. RESULTS: Regardless of the instruments and dimensions
studied, the same translation and cultural adaptation issues
arose: (1) an issue that is strictly related to translation, for
example, the word "things" was translated as "something"; (2)
literal translation is possible but culturally irrelevant, for
example the expression "to walk several blocks", which is a
completely abstract concept in Europe, was translated as "to
walk for more than one kilometre"; (3) the translation needed to
be reformulated or the tense needed to be changed for idiomatic
reasons. For example, the present perfect does not exist in
German and so the present simple was used in the first version.
The imperfect was eventually used with adverbs such as "lately".
CONCLUSIONS: Linguistic adaptation was completed according to a
recognized and rigorous method allowing for the wide-scale use
of these patient-reported outcomes instruments in international
studies
(19) Cho KI, Lee
JH, Lee HG, Kim SM, Kim TI. Assessment of myocardial function in
patients with fibromyalgia and the relationship to chronic
emotional and physical stress. Korean Circ J 2010; 40(2):74-80.
Abstract: BACKGROUND AND OBJECTIVES: An association between
emotional or physical stressful triggers and adverse
cardiovascular events, such as death and myocardial infarction,
has been recognized for many years. The clinical features of
transient left apical ballooning syndrome have been clearly
described, but the effect of chronic stress on the myocardium is
unknown. Our objective was to assess left ventricular (LV)
function in patients with fibromyalgia (FM) with chronic
emotional and physical stress. SUBJECTS AND METHODS: We
investigated 30 consecutive postmenopausal women (mean age,
48+/-8 years) satisfying the criteria for FM with atypical chest
pain and 20 age-matched healthy controls by means of standard
and 2-dimensional strain (2DS) echocardiography. Patients with
hypertension, coronary heart disease, or diabetes were excluded.
Global and segmental longitudinal deformation parameters of LV
function from 3 apical views were analyzed, and patients
underwent a manual tender point survey for the number of tender
points and tender point counts, and completed the Fibromyalgia
Impact Questionnaire (FIQ), which was comprised of physical and
feel scores, the Brief Fatigue Inventory (BFI), and the Beck
Depression Inventory (BDI). RESULTS: Both global and segmental
longitudinal LV strains were significantly reduced in FM
patients with high FIQ scores (>50) compared to FM patients with
low FIQ scores (-18.98% vs. -22.72%). Various emotional and
physical stress indexes were significantly correlated with
global LV strain. CONCLUSION: Global and segmental LV strains
were negatively associated with fatigue, tender point count, and
FIQ score. However, there was no significant association between
depression and LV strain. This study demonstrated that chronic
emotional or physical stress in FM patients might reduce
myocardial longitudinal deformation
(20) Choy E,
Richards S, Bowrin K, Watson P, Lloyd A, Sadosky A et al. Cost
effectiveness of pregabalin in the treatment of fibromyalgia
from a UK perspective. Curr Med Res Opin 2010; 26(4):965-75.
Abstract: BACKGROUND: Fibromyalgia is a chronic condition
associated with widespread pain, sleep disturbance and
disability. Disease related costs are high and effective
treatment options few. OBJECTIVES: To evaluate the cost
effectiveness of pregabalin in the treatment of fibromyalgia.
METHODS: A decision-analytic model was developed comparing
pregabalin 300 mg or 450 mg against placebo, duloxetine 60 mg or
120 mg, gabapentin, tramadol and amitriptyline. After a 12 week
treatment phase patients who responded to treatment entered an
ongoing treatment phase using a Markov model in which patients
maintained response, lost response or dropped out. The base case
considered patients with severe fibromyalgia defined as a
Fibromyalgia Impact Questionnaire score of >or=59 and a pain
score of >or=6.5 at baseline. Response rates for pregabalin and
placebo were taken from three randomised trials, and a 1 year
open-label extension study was used for long-term parameters.
Response was defined as a >or=30% improvement over baseline in
pain score and a patient global impression of change rating of
much improved or very much improved. Relative rates of response
for other comparators over placebo were extracted from a
systematic review of published randomised controlled studies.
The primary effectiveness endpoint was Quality Adjusted Life
Years (QALYs). Utilities gained over baseline were estimated by
applying the SF-6D utility algorithm to SF-36 data collected in
the pregabalin trials. Resource use associated with fibromyalgia
management was estimated from published studies and costs were
estimated from the UK NHS perspective at 2008 prices. Costs and
QALYs were discounted at 3.5%. Non-parametric bootstrapping
analysis was used to generate confidence intervals. RESULTS: In
the base case, pregabalin 300 mg and 450 mg increased cost per
patient by pound601 (95% CI: 532, 669) and pound653 (587, 727)
and improved QALYs per patient by 0.03 (-0.03, 0.06) and 0.03
(-0.04, 0.08) respectively compared to placebo. The cost per
QALY gained (CQG) was pound23,166 and pound22,533. In the base
case population CQG for pregabalin 450 mg against duloxetine 60
mg and 120 mg was pound19,224 and pound14,096, against
gabapentin pound35,737, against tramadol pound98,072, and was
dominated by amitriptyline. Sensitivity analysis found the cost
effectiveness of pregabalin to be most sensitive to drug price
and response rates. Limitations of the analysis include
different definitions of response used and lack of subgroup data
reported in the published studies synthesised, and limited data
on long-term effect of therapies in fibromyalgia. Although the
analysis was based on the best available evidence, the
comparisons against amitriptyline and tramadol rely on old
studies that were not designed to meet current quality criteria.
CONCLUSION: This model found pregabalin 300 mg and 450 mg to be
cost effective compared with placebo and, within the limits of
available evidence, against duloxetine using standard UK
criteria in patients with fibromyalgia experiencing severe pain
(21) Branco JC,
Zachrisson O, Perrot S, Mainguy Y. A European multicenter
randomized double-blind placebo-controlled monotherapy clinical
trial of milnacipran in treatment of fibromyalgia. J Rheumatol
2010; 37(4):851-9.
Abstract: OBJECTIVE: This randomized, double-blind,
placebo-controlled, multicenter study investigated the efficacy
and safety of milnacipran in the treatment of fibromyalgia (FM)
in a European population. METHODS: Outpatients diagnosed with FM
according to 1990 American College of Rheumatology criteria (N =
884) were randomized to placebo (n = 449) or milnacipran 200
mg/day (n = 435) for 17 weeks (4-week dose escalation, 12-week
stable dose, 9-day down-titration), followed by a 2-week
posttreatment period. The primary efficacy criterion was a
2-measure composite responder analysis requiring patients to
achieve simultaneous improvements in pain (>or= 30% improvement
from baseline in visual analog scale, 24-hour morning recall)
and a rating of "very much" or "much" improved on the Patient
Global Impression of Change scale. If responder analysis was
positive, Fibromyalgia Impact Questionnaire (FIQ) was included
as an additional key primary efficacy measure. RESULTS: At the
end of the stable dose period (Week 16), milnacipran 200 mg/day
showed significant improvements from baseline relative to
placebo in the 2-measure composite responder criteria (p =
0.0003) and FIQ total score (p = 0.015). Significant
improvements were also observed in multiple secondary efficacy
endpoints, including Short-Form 36 Health Survey (SF-36)
Physical Component Summary (p = 0.025), SF-36 Mental Component
Summary (p = 0.007), Multidimensional Fatigue Inventory (p =
0.006), and Multiple Ability Self-Report Questionnaire (p =
0.041). Milnacipran was safe and well tolerated; nausea,
hyperhidrosis, and headache were the most common adverse events.
CONCLUSION: Milnacipran is an effective and safe treatment for
pain and other predominant symptoms of FM. Registered as trial
no. NCT00436033
(22) Kim JS, Lee
SS, Kim TJ, Park YW. Serum hyaluronic acid levels do not explain
morning stiffness in patients with fibromyalgia. Clin Rheumatol
2010; 29(5):535-9.
Abstract: To investigate the serum levels of hyaluronic acid
(HA) in Korean female patients with fibromyalgia (FM) and
correlate these levels with variables of disease severity
including morning stiffness, we measured HA serum levels in 69
FM patients, 72 rheumatoid arthritis (RA) patients, and 71
healthy controls by enzyme-linked binding protein assay. The
serum levels of HA in FM patients did not differ from those in
the age-matched controls, whereas HA levels were significantly
higher in RA patients than in FM patients and controls (both P <
0.001). With a cut-off value of 75 ng/mL, the prevalence of
seropositivity was higher in RA patients (59.7%) than in FM
patients (26.1%) or controls (14.1%; both P < 0.001). There were
no differences in seropositivity between FM patients and
controls, or between FM patients with severe symptoms and those
with mild symptoms. The HA levels in FM patients were
significantly correlated with age, age at diagnosis, age at
symptom development, disease duration, symptom duration, and
level of education. There were no correlations between HA levels
and morning stiffness, tender point counts and scores, or
Fibromyalgia Impact Questionnaire, State-Trait Anxiety
Inventory, and Beck Depression Inventory scores. In our
patients, the serum HA levels were not increased and did not
reflect disease severity. These results suggest that serum HA is
not a useful laboratory marker for diagnosis and assessment of
FM
(23) Oh TH, Stueve
MH, Hoskin TL, Luedtke CA, Vincent A, Moder KG et al. Brief
interdisciplinary treatment program for fibromyalgia: six to
twelve months outcome. Am J Phys Med Rehabil 2010; 89(2):115-24.
Abstract: OBJECTIVE: To evaluate the impact and long-term
benefit of a brief 1(1/2)-day fibromyalgia treatment program.
DESIGN: We assessed 6-12-mo outcome of 521 participants who
underwent a 1(1/2)-day interdisciplinary fibromyalgia treatment
program in a tertiary medical center. We administered three
self-reported instruments: the Fibromyalgia Impact
Questionnaire, the Short Form-36 Health Status Questionnaire,
and a satisfaction survey, at baseline, and 6-12 mos after
completing the fibromyalgia treatment program. The difference in
the Fibromyalgia Impact Questionnaire and Short Form-36 scores
before and after the fibromyalgia treatment program was the main
outcome measure. RESULTS: Compared with baseline, the
Fibromyalgia Impact Questionnaire total score was decreased by a
mean (SD) of 7.2 (17.7) points at follow-up (P < 0.001). All
Fibromyalgia Impact Questionnaire subscales improved
significantly at follow-up (all P < 0.001), except depression
score (P = 0.67). The Short Form-36 scores improved
significantly in all areas at follow-up (all P < 0.001), except
general health perception (P = 0.58) and role emotional (P =
0.13). CONCLUSIONS: A brief 1(1/2)-day fibromyalgia treatment
program improves symptoms and quality of life in patients with
fibromyalgia for 6-12 mos. Further clinical investigations are
needed to compare this fibromyalgia treatment program with other
programs and interventions
(24) Vallejo MA,
Rivera J, Esteve-Vives J. Development of a self-reporting tool
to obtain a combined index of severity of fibromyalgia (ICAF).
Health Qual Life Outcomes 2010; 8(1):2.
Abstract: BACKGROUND: Fibromyalgia is a syndrome with
heterogeneous symptoms. The evaluation in the clinical setting
usually fails to cover the complexity of the syndrome. This
study aims to determine how different aspects of fibromyalgia
are inter-related when measured by means of a self-reporting
tool. The objective is to develop a more complete evaluation
model adjusted to the complexity and multi-dimensional nature of
the syndrome. METHODS: Application was made of the Fibromyalgia
Impact Questionnaire, the Hospital Anxiety and Depression Scale,
the Brief Pain Inventory, the Fatigue Assessment Scale, the
Health Assessment Questionnaire, the General Health
Questionnaire (GHQ-28), the Chronic Pain Coping Inventory, the
Arthritis Self-efficacy Scale and the Sleep Quality Scale. An
assessment was made, on the basis of clinical interviews, case
histories and specific tests, of the patient sociodemographic
data, comorbidity, physical exploration and other clinical
indexes. An exploratory factor analysis was made, with
comparisons of the clinical index scores in extreme groups of
patients. RESULTS: The ICAF composed of 59 items was obtained,
offering four factors that explain 64% of the variance, and
referred to as Emotional Factor (33.7%), Physical-Activity
(15%), Active Coping (9%) and Passive Coping (6.3%). A t-test
between the extreme scores of these factors in the 301 patients
revealed statistically significant differences in occupational
status, medically unexplained syndromes, number of tender
points, the six-minutes walk test, comorbidity and health care
costs. CONCLUSIONS: This study offers a tool allowing more
complete and rapid evaluation of patients with fibromyalgia. The
test intrinsically evaluates the emotional aspects: anxiety and
depression, and their impact upon social aspects. It also
evaluates patient functional capacity, fatigue, sleep quality,
pain, and the way in which the patient copes with the disease.
This is achieved by means of a self-assessment questionnaire
based on elements from well known tests
(25) Distler O,
Eich W, Dokoupilova E, Dvorak Z, Fleck M, Gaubitz M et al.
Evaluation of the efficacy and safety of terguride in patients
with fibromyalgia syndrome: results of a twelve-week,
multicenter, randomized, double-blind, placebo-controlled,
parallel-group study. Arthritis Rheum 2010; 62(1):291-300.
Abstract: OBJECTIVE: To assess the efficacy and safety of
terguride, a partial dopamine agonist, in patients with
fibromyalgia syndrome (FMS). METHODS: In a 12-week, multicenter,
double-blind, placebo-controlled, parallel-group study, 99
patients were randomized at a ratio of 2 to 1 to receive
terguride or placebo. Over 21 days, the dosage was titrated to a
maximum daily dose of 3 mg of terguride or placebo, and this
fixed dosage was continued over 9 weeks. The primary efficacy
variable was the intensity of pain (100-mm visual analog scale).
Secondary efficacy variables included the Fibromyalgia Impact
Questionnaire (FIQ) score, the tender point score (TPS), and the
Hamilton Depression Scale (HDS) score. During the study,
patients were evaluated for the presence of cervical spine
stenosis by magnetic resonance imaging (MRI). RESULTS: No
significant differences in the change in pain intensity, FIQ
score, TPS, or HDS score between baseline and 12 weeks were
observed in the terguride group as compared with the placebo
group. Cervical spine stenosis was detected in 22% of the
patients. Only patients with cervical spine stenosis responded
to terguride treatment. FIQ scores improved significantly
(per-protocol analysis), and pain intensity, the TPS score, and
the HDS score showed a trend toward improvement in the terguride
group as compared with the placebo group. Terguride treatment
was safe. Only those adverse events already known to be side
effects of terguride were observed. Premature termination of the
study in patients receiving terguride (26%) occurred
predominantly during up-titration and in the absence of
comedication for treatment of nausea. CONCLUSION: Terguride
treatment did not improve pain, the FIQ score, the TPS, or the
HDS score in the total study population. However, a subgroup of
patients with cervical spine stenosis seemed to benefit from
terguride treatment
(26) Chwieduk CM,
McCormack PL. Milnacipran: in fibromyalgia. Drugs 2010;
70(1):99-108.
Abstract: Milnacipran is an orally administered selective
serotonin and norepinephrine (noradrenaline) reuptake inhibitor
indicated for the management of fibromyalgia in adults. In
adults, milnacipran was generally effective in the treatment of
fibromyalgia in four well designed trials of 3 or 6 months'
duration. Composite responder rates for the treatment of
fibromyalgia and fibromyalgia pain (co-primary efficacy
variables) were generally higher with milnacipran 100 or 200
mg/day (in two divided doses) than with placebo after 12 weeks
of fixed-dose treatment. In one study, the composite responder
rate for fibromyalgia pain (co-primary efficacy variable) was
also higher with milnacipran 200 mg/day than with placebo after
24 weeks of fixed-dose treatment. Furthermore, the benefits of
milnacipran therapy were sustained in a 6-month extension of an
initial double-blind trial. Improvements from baseline in mean
24-hour recall pain scores, mean weekly recall pain scores,
Patient Global Impression of Change scores and in several items
of the Fibromyalgia Impact Questionnaire were observed in
patients receiving continuous milnacipran for up to 12 months,
as well as in patients who switched from placebo to milnacipran
therapy at the start of the extension phase. Milnacipran was
generally well tolerated in adults with fibromyalgia, with most
adverse events being mild to moderate in severity. Nausea was
the most common adverse event reported in milnacipran recipients
(27) Goldenberg
DL, Clauw DJ, Palmer RH, Mease P, Chen W, Gendreau RM.
Durability of therapeutic response to milnacipran treatment for
fibromyalgia. Results of a randomized, double-blind, monotherapy
6-month extension study. Pain Med 2010; 11(2):180-94.
Abstract: OBJECTIVE: To evaluate the durability of improvement
and long-term efficacy of milnacipran treatment in fibromyalgia,
to assess efficacy in patients re-randomized from placebo to
milnacipran, and to collect additional information on the
tolerability and efficacy of long-term treatment with
milnacipran. DESIGN: A total of 449 patients who successfully
completed a 6-month lead-in study enrolled in this 6-month
extension study (87.7% of eligible subjects). Patients initially
receiving milnacipran 200 mg/day during the lead-in study were
maintained at 200 mg/day (n = 209); patients initially assigned
to placebo or milnacipran 100 mg/day were re-randomized (1:4) to
either 100 mg/day (n = 48) or 200 mg/day (n = 192) of
milnacipran for an additional 6 months of treatment. Efficacy
assessments included visual analog scale pain ratings,
Fibromyalgia Impact Questionnaire (FIQ) total score, and Patient
Global Impression of Change (PGIC). RESULTS: Patients continuing
on milnacipran demonstrated a sustained reduction in pain over
the full 12-month period. Additional beneficial effects were
also maintained, as indicated by the PGIC and FIQ. Patients
initially assigned to either placebo or milnacipran 100 mg/day
in the lead-in study and subsequently re-randomized to
milnacipran 200 mg/day in the extension study experienced
further improvements in their mean pain scores, FIQ total
scores, and PGIC ratings at 1 year. Milnacipran treatment was
generally well tolerated. The most commonly reported newly
emergent adverse event was nausea. CONCLUSIONS: In addition to
confirming that milnacipran safely and effectively improves the
multiple symptoms of fibromyalgia, these data indicate that
milnacipran provides 1-year durable efficacy in this patient
population
(28) Cherry BJ,
Weiss J, Barakat BK, Rutledge DN, Jones CJ. Physical performance
as a predictor of attention and processing speed in
fibromyalgia. Arch Phys Med Rehabil 2009; 90(12):2066-73.
Abstract: Cherry BJ, Weiss J, Barakat BK, Rutledge DN, Jones CJ.
Physical performance as a predictor of attention and processing
speed in fibromyalgia. OBJECTIVE: To explore the associations
between physical (both self-report and objective measures) and
cognitive function for persons with fibromyalgia (FM). DESIGN:
Correlational study. SETTING: An exercise testing laboratory in
southern California. PARTICIPANTS: Community-residing and
functionally independent (not wheelchair-bound) adults meeting
the American College of Rheumatology 1990 criteria for FM (N=51)
with a mean age of 54 years and no history of stroke.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite
Physical Function Scale, Fibromyalgia Impact Questionnaire,
adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit
Symbol Substitution Test, a composite index of TMT-A, TMT-B, and
Digit Symbol Substitution Test combined, and physical
performance assessments. RESULTS: Hierarchical regression
analyses indicated that better objective physical performance
predicted increased cognitive function for TMT-A and the
composite cognitive score after controlling for age and symptom
burden. That is, as the physical performance level decreased,
cognitive performance levels decreased. CONCLUSIONS: Findings
suggest that research is needed to determine whether patterns of
physical activity participation, through their effects on
physical fitness and performance, can enhance cognitive
performance in persons with FM. Physiologic changes in specific
brain regions in FM (eg, hippocampus, neural pain regions)
suggest that further research is also warranted in determining
specific relationships between biomarkers and cognitive
performance in persons with FM
(29) Altan L,
Korkmaz N, Bingol U, Gunay B. Effect of pilates training on
people with fibromyalgia syndrome: a pilot study. Arch Phys Med
Rehabil 2009; 90(12):1983-8.
Abstract: Altan L, Korkmaz N, Bingol U, Gunay B. Effect of
Pilates training on people with fibromyalgia syndrome: a pilot
study. OBJECTIVE: To investigate the effects of Pilates on pain,
functional status, and quality of life in fibromyalgia, which is
known to be a chronic musculoskeletal disorder. DESIGN:
Randomized, prospective, controlled, and single-blind trial.
SETTING: Physical medicine and rehabilitation department.
PARTICIPANTS: Women (N=50) who had a diagnosis of fibromyalgia
syndrome (FMS) according to the American College of Rheumatology
criteria. INTERVENTION: The participants were randomly assigned
into 2 groups. In group 1, a Pilates exercise program of 1 hour
was given by a certified trainer to 25 participants 3 times a
week for 12 weeks. In group 2, which was designed as the control
group, 25 participants were given a home exercise
(relaxation/stretching) program. In both groups, pre- (week 0)
and posttreatment (week 12 and week 24) evaluation was performed
by one of the authors, who was blind to the group allocation.
MAIN OUTCOME MEASURES: Primary outcome measures were pain
(visual analog scale) and Fibromyalgia Impact Questionnaire
(FIQ). Exploratory outcome measures were number of tender
points, algometric score, chair test, and Nottingham Health
Profile. RESULTS: Twenty-five Pilates exercise and 24
relaxation/stretching exercise participants completed the study.
In group 1, significant improvement was observed in both pain
and FIQ at week 12 but only in FIQ at 24 weeks. In group 2, no
significant improvement was obtained in pain and FIQ at week 12
and week 24. Comparison of the 2 groups showed significantly
superior improvement in pain and FIQ in group 1 at week 12 but
no difference between the 2 groups at week 24. CONCLUSIONS: We
suggest Pilates as an effective and safe method for people with
FMS. Our study is the first clinical study designed to
investigate the role of the Pilates method in FMS treatment. We
believe that further research with more participants and longer
follow-up periods could help assess the therapeutic value of
this popular physical exercise method
(30) Arnold LM,
Clauw DJ, Wohlreich MM, Wang F, Ahl J, Gaynor PJ et al. Efficacy
of duloxetine in patients with fibromyalgia: pooled analysis of
4 placebo-controlled clinical trials. Prim Care Companion J Clin
Psychiatry 2009; 11(5):237-44.
Abstract: OBJECTIVE: To investigate the efficacy of duloxetine
in the treatment of pain and improvement in functional
impairment and quality of life in patients with fibromyalgia
from a pooled analysis of 4 placebo-controlled, double-blind,
randomized trials. METHOD: Patients were eligible for inclusion
in the studies if they were at least 18 years of age, met
criteria for fibromyalgia as defined by the American College of
Rheumatology, and had specified minimum pain severity scores.
Across all studies, 797 patients received duloxetine 60-120 mg/d
and 535 patients received placebo. Pain was assessed by the
Brief Pain Inventory (BPI) 24-hour average pain severity score;
other efficacy measures included the Clinical Global
Impressions-Severity of Illness scale (CGI-S), Patient Global
Impressions-Improvement scale (PGI-I), 17-item Hamilton
Depression Rating Scale (HDRS-17), Fibromyalgia Impact
Questionnaire (FIQ) total score, BPI pain interference items,
Sheehan Disability Scale (SDS), and Medical Outcomes Study
36-Item Short-Form Health Survey (SF-36) mental and physical
components. Changes from baseline to endpoint (last observation
carried forward) for most of the above efficacy measures were
analyzed using an analysis-of-covariance model. RESULTS: After
12 weeks of treatment, pain was significantly reduced in
patients treated with duloxetine (P < .001) compared with
placebo. In addition, duloxetine was superior to placebo in
improving CGI-S (P < .001); PGI-I (P < .001); FIQ total (P <
.001); HDRS-17 total (P = .003); SDS global functioning (P <
.001), work/school (P = .018), and family life (P < .001); SF-36
mental (P < .001) and physical (P = .026) component; and BPI
pain interference (P < .001) scores. Treatment-by-subgroup
interactions were not significant for sex (P = .320), age (P =
.362), or race (P = .180). CONCLUSIONS: This pooled analysis
provides evidence that 12 weeks of treatment with duloxetine
60-120 mg/d effectively improves fibromyalgia symptoms and may
offer benefits beyond pain relief
(31) van KS,
Kraaimaat FW, van LW, van Riel PL, Evers AW. A patient's
perspective on multidisciplinary treatment gain for
fibromyalgia: an indicator for pre-post treatment effects?
Arthritis Rheum 2009; 61(12):1626-32.
Abstract: OBJECTIVE: Increasing attention is devoted to the
patient's perspective in clinical research and practice.
However, the relationship between the patient's view on
treatment progress and standardized pre-post changes in health
outcomes is not well understood. The objective of this study was
to investigate whether the patient's perception of treatment
gain converges with pre-post treatment effects of a
multidisciplinary treatment as assessed by standardized
self-report measures. METHODS: During a tailored
multidisciplinary treatment for fibromyalgia, validated
self-report questionnaires were assessed at baseline and
posttreatment on the outcome measures of pain, functional
disability, fatigue, anxiety, and negative mood. In addition,
the participants were asked to fill in a questionnaire at the
end of the treatment assessing the patient's perception of
improvement on core outcomes, as well as satisfaction and
usefulness of the treatment. RESULTS: Moderate to relatively
high correlations were found between the patient's perception of
improvement and pre-post changes on the physical outcomes, in
contrast to small or nonsignificant correlations for
psychological outcomes. In addition, satisfaction and usefulness
were significantly related to pre-post changes on physical
outcomes, but no relationship was found with respect to
psychological outcomes. CONCLUSION: Results suggest that the
patient's perception of treatment gain and pre-post changes in
outcomes during treatment assess different aspects of the
patient's treatment progress, particularly with regard to
psychological functioning. Future research on clinical
improvements should consider the patient's perception of
treatment gain as an independent and clinically relevant
outcome, in addition to standardized trial data of pre-post
assessments of health outcomes
(32) Sutbeyaz ST,
Sezer N, Koseoglu F, Kibar S. Low-frequency pulsed
electromagnetic field therapy in fibromyalgia: a randomized,
double-blind, sham-controlled clinical study. Clin J Pain 2009;
25(8):722-8.
Abstract: OBJECTIVE: To evaluate the clinical effectiveness of
low-frequency pulsed electromagnetic field (PEMF) therapy for
women with fibromyalgia (FM). METHODS: Fifty-six women with FM,
aged 18 to 60 years, were randomly assigned to either PEMF or
sham therapy. Both the PEMF group (n=28) and the sham group
(n=28) participated in therapy, 30 minutes per session, twice a
day for 3 weeks. Treatment outcomes were assessed by the
fibromyalgia Impact questionnaire (FIQ), visual analog scale
(VAS), patient global assessment of response to therapy, Beck
Depression Inventory (BDI), and Short-Form 36 health survey
(SF-36), after treatment (at 4 wk) and follow-up (at 12 wk).
RESULTS: The PEMF group showed significant improvements in FIQ,
VAS pain, BDI score, and SF-36 scale in all domains at the end
of therapy. These improvements in FIQ, VAS pain, and SF-36 pain
score during follow-up. The sham group also showed improvement
were maintained on all outcome measures except total FIQ scores
after treatment. At 12 weeks follow-up, only improvements in the
BDI and SF-36 scores were present in the sham group. CONCLUSION:
Low-frequency PEMF therapy might improve function, pain,
fatigue, and global status in FM patients
(33) Joshi MN,
Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in
management of fibromyalgia syndrome: What predicts a clinical
benefit? J Postgrad Med 2009; 55(3):185-9.
Abstract: CONTEXT: Fibromyalgia is a chronic disabling
condition, and physicians treat it using a number of different
treatment modalities. It is not known if one or more of such
modalities are better than the others. We compared the efficacy
of physiotherapy and amitriptyline in disability reduction in
patients of fibromyalgia syndrome in a rural tertiary care
hospital in Central India. DESIGN: Open-label alternate patient
treatment allocation. MATERIALS AND METHODS: A six-month
follow-up was done to assess the benefit of amitriptyline and
physiotherapy for disability reduction in patients with
fibromyalgia syndrome. Primary outcome measure was improvement
in fibromyalgia impact questionnaire (FIQ) score. Statistical
Analysis Used : Predictors of benefit were determined using
multivariate logistic regression. RESULTS: A total of 175
outpatients were assigned to either amitriptyline (n=87) or
structured physiotherapy (n=88) treatments. There was a
significant but similar (P=0.82) improvement in disability in
both groups. High FIQ score at baseline and low socioeconomic
status scores were significant predictors of benefit.
CONCLUSIONS: Therapy with amitriptyline or physiotherapy is
equally effective in improving outcome in patients of
fibromyalgia over a period of six months
(34) Lange M,
Krohn-Grimberghe B, Petermann F. [Fibromyalgia: influence of
depressive symptoms on the outcome after rehabilitation].
Rehabilitation (Stuttg) 2009; 48(5):298-305.
Abstract: BACKGROUND: For the therapy of fibromyalgia a
multimodal therapy with patient education is recommended. It
integrates pain management and stress management as well as
cognitive restructuring. It will be examined whether
depressiveness has an influence on rehabilitation outcome
immediately after inpatient rehabilitation. METHODS: Various
questionnaires, i. e. the Hospital Anxiety and Depression Scale
(HADS-D), German Pain Questionnaire (DSF), Cognitive,
Behavioural Coping and Psychological Strains Through Chronic
Pain questionnaire (FESV), German version of the Pain Anxiety
Symptom Scale (PASS-D) and the Patient questionnaire IRES-24,
were distributed to 102 fibromyalgia patients in the framework
of a pre post design. The scores of patients with and without
depressiveness (HADS-D cut-off >or=11) were compared by analysis
of variance at two treatment points. RESULTS AND CONCLUSIONS:
Immediately after therapy, a general improvement was found
regarding depressiveness and pain (strong effect size) as well
as regarding pain-related anxiety (medium effect sizes). Only
"countertraded activity" of coping with pain did not show any
improvement. The "rehabilitation status" improved significantly
whereas, in contrast, the "physical health" aspect did not
improve. A significant increase was found on the "pain" scale.
Additionally, depressive symptoms had a strong impact on the
aspects "physical health", "subjective health" and on
"rehabilitation status". In particular, patients with
fibromyalgia and depressiveness showed poorer outcomes regarding
these aspects than patients with fibromyalgia without
depressiveness. A multimodal therapy with patient education can
have a positive impact on the outcome of rehabilitation
(35)
Vazquez-Rivera S, Gonzalez-Blanch C, Rodriguez-Moya L, Moron D,
Gonzalez-Vives S, Carrasco JL. Brief cognitive-behavioral
therapy with fibromyalgia patients in routine care. Compr
Psychiatry 2009; 50(6):517-25.
Abstract: OBJECTIVE: The purpose of the present study was to
evaluate the effectiveness of a brief cognitive-behavioral
therapy (CBT) group intervention for fibromyalgia syndrome in
routine care. METHOD: Thirty-four female outpatients who
participated in a 5- to 6-week group CBT program were assessed
for depression (Beck Depression Inventory), anxiety (State-Trait
Anxiety Inventory), coping strategies (Coping Questionnaire for
Chronic Pain), physical functioning (Fibromyalgia Impact
Questionnaire), and somatization (Health Attitude Survey) at 3
time points (baseline, pretreatment, and posttreatment) using a
pre-post, quasi-experimental design. RESULTS: Twenty-three
female outpatients (68% of the initial sample) for which data
were available in all 3 time points were included in the
analyses. No changes were found during the waiting period.
During the treatment period, there were significant reductions
in depression (P = .001) and anxiety (P = .006) symptoms and an
increased use of distraction skills (P < .001). The analysis of
rate of change showed a significant correlation between anxiety
and depression (P = .004), but not between these variables and
the use of distraction as a coping strategy. CONCLUSION: Brief
group CBT is effective in reducing emotional distress in female
patients with long-standing fibromyalgia syndrome in the context
of routine care. Attention-distraction skills appear to be
amenable to change by means of brief CBT, but further research
is needed to clarify their contribution to short-term clinical
improvement
(36) Lera S,
Gelman SM, Lopez MJ, Abenoza M, Zorrilla JG, Castro-Fornieles J
et al. Multidisciplinary treatment of fibromyalgia: does
cognitive behavior therapy increase the response to treatment? J
Psychosom Res 2009; 67(5):433-41.
Abstract: OBJECTIVE: Multidisciplinary treatments (MTs) are
usually recommended for reducing fibromyalgia (FM) symptoms and
include physical exercise, drug management, education, and
cognitive behavior therapy (CBT). However, there is no evidence
that CBT adds efficacy to the other therapeutic components. This
randomized controlled trial analyzed the response of FM patients
to two MTs, with and without CBT, according to the presence of
concurrent symptoms. METHODS: Eighty-three women with FM were
randomly assigned to MT or combined MT and CBT. The MT included
medical intervention, physical training, education, and
discussion of the syndrome. The CBT focused on coping with
stress, modifying lifestyles, and changing pain behaviors.
Demographic and clinical data, information regarding tender
points, and questionnaire responses about functional capability
[Fibromyalgia Impact Questionnaire (FIQ)], health status
[36-item Short Form Health Survey (SF-36)], and mental health
[Symptom Checklist-90-Revised (SCL-90-R)] were obtained at the
beginning, at the end of the 15-week treatment, and at 6-month
follow-up. Subgroups are identified in relation to treatment
response. RESULTS: Sixty-six women (80%) completed treatment.
Although the variance of the total sample had changed at
posttreatment (F=2.67, P=.031), there was no significant effect
for the TimexTreatment interaction (F=1.65, P=.16). Univariate
tests detected a significant fall in the FIQ score. The subgroup
of patients with fatigue showed a better response with MT+CBT
than with MT. At 6-month follow-up, the statistical differences
had been maintained. Intention-to-treat analysis ratified these
results. CONCLUSIONS: MT improves functional capability and
reduces symptom impact. CBT increases mildly the effect of MT in
patients with fatigue
(37) Hudson JI,
Arnold LM, Bradley LA, Choy EH, Mease PJ, Wang F et al. What
makes patients with fibromyalgia feel better? Correlations
between Patient Global Impression of Improvement and changes in
clinical symptoms and function: a pooled analysis of 4
randomized placebo-controlled trials of duloxetine. J Rheumatol
2009; 36(11):2517-22.
Abstract: OBJECTIVE: To investigate the relationship between
changes in clinical rating scale items and endpoint Patient
Global Impression of Improvement (PGI-I). METHODS: Data were
pooled from 4 randomized, double-blind, placebo-controlled
studies of duloxetine in patients with fibromyalgia (FM).
Variables included in the analyses were those that assessed
symptoms in FM domains of pain, fatigue, sleep, cognitive
difficulties, emotional well-being, physical function, and
impact on daily living. The association of endpoint PGI-I with
changes from baseline in individual variables was assessed using
Pearson product-moment correlations (r). Stepwise linear
regression was used to identify those variables for which
changes from baseline were statistically significant independent
predictors of the endpoint PGI-I ratings. RESULTS: Changes in
pain variables and interference of symptoms with the ability to
work were highly correlated (r >or= 0.5 or r <or= -0.5) with
endpoint PGI-I. Moderate correlation with endpoint PGI-I (0.30
<or= r < 0.5 or -0.5 < r <or= -0.30) included changes in
variables that assessed physical functioning, depression,
anxiety, fatigue, and several variables related to impact on
daily living. Independent predictor variables of endpoint PGI-I
identified by stepwise linear regression included assessments
for pain, physical function, vitality, anxiety, social function,
and tender point thresholds. CONCLUSION: In addition to pain
reduction, what makes patients with FM feel better may include
improvement in fatigue, physical functioning, mood, and impact
on daily living. An assessment of these domains may be important
in clinical trials of FM and in the management of patients with
FM
(38) Ablin JN,
Odes L, Neumann L, Buskila D. The Hebrew version of the
FibroFatigue scale: validation of a questionnaire for assessment
of fibromyalgia and chronic fatigue syndrome. Rheumatol Int
2009.
Abstract: The objective of this study is to validate a
translated Hebrew version of the FibroFatigue Scale (FFS). The
Hebrew version of the FFS was administered to 100 patients
fulfilling ACR criteria for classification of FM together with
the validated Hebrew version of the Fibromyalgia Impact
Questionnaire (FIQ), the validated Hebrew version of the Short
Form-36 (SF-36) and a Visual Analogue Scale (VAS) measurement of
pain, anxiety, depression, morning stiffness and global well
being. Test-retest reliability was assessed using Spearman
correlations. Internal consistency was evaluated with Cronbach's
alpha of reliability. Construct validity of the FFS was
evaluated by correlations among the FFS, the FIQ and the
subscales of the SF-36. Mean duration of symptoms was 10.7
years, and mean age of participants was 53.5 years. Test-retest
reliability was between 0.46 and 0.85 for the various FFS items.
Internal consistency was 0.89 for the overall FFS. Significant
correlations were obtained between the FFS items and the SF-36.
These results support the reliability and validity of the data
obtained with the Hebrew version of the FSS for detecting and
measuring symptom severity in Hebrew speaking patients with FM
(39) Mannerkorpi
K, Nordeman L, Ericsson A, Arndorw M. Pool exercise for patients
with fibromyalgia or chronic widespread pain: a randomized
controlled trial and subgroup analyses. J Rehabil Med 2009;
41(9):751-60.
Abstract: OBJECTIVE: To evaluate the effects of pool exercise in
patients with fibromyalgia and chronic widespread pain and to
determine characteristics influencing the effects of treatment.
METHODS: A total of 134 women with fibromyalgia and 32 with
chronic widespread pain were randomized to a 20-session pool
exercise and a 6-session education programme or to a control
group undertaking the same education programme. The primary
outcomes were the Fibromyalgia Impact Questionnaire (FIQ) total
score and the 6-minute walk test (6MWT). FIQ Pain and other
health variables were included. RESULTS: The FIQ total (p =
0.04) improved in the intervention group, with an effect size of
0.32. Patients who had participated in at least 60% of the
exercise sessions improved in the FIQ total (effect size 0.44),
the 6MWT (effect size 0.43) and FIQ Pain (effect size 0.69)
compared with controls (p < 0.05). Long-term follow-up revealed
lasting, but small, improvement (effect size < 0.29) in the 6MWT
among the active participants (p < 0.05). Analyses within the
subgroups showed that patients with milder stress, pain or
depression improved most by treatment on the FIQ total (effect
size > 0.50, p < 0.05) compared with controls. CONCLUSION: The
exercise-education programme showed significant, but small,
improvement in health status in patients with fibromyalgia and
chronic widespread pain, compared with education only. Patients
with milder symptoms improved most with this treatment
(40) Bidari A,
Ghavidel-Parsa B, Ghalehbaghi B. Reliability of ACR criteria
over time to differentiate classic fibromyalgia from nonspecific
widespread pain syndrome: a 6-month prospective cohort study.
Mod Rheumatol 2009; 19(6):663-9.
Abstract: American College of Rheumatology (ACR) 1990 criteria,
initially introduced to classify fibromyalgia (FM) syndrome, has
gained popularity in research and clinical grounds for
diagnostic purposes. The objectives of this study were designed
to assess the consistency of ACR criteria against the time in
classifying FM. This was a prospective cohort study performed in
a multidisciplinary pain clinic from October 2002 to June 2005.
Patients who were clinically suspected of having FM and had a
normal screening laboratory evaluation were scheduled for
dolorimetry. Those found to have 6 or more tender points were
considered eligible and labeled as either classic or atypical FM
if they did or did not, respectively, fulfil ACR criteria. The 2
groups were assessed using the Fibromyalgia Impact Questionnaire
(FIQ) and compared using baseline characteristics. We reassessed
dolorimetric exam and FIQ 6 months later. Of 91 patients who
participated in this study,70 completed the follow-up. Of them,
34 (49%) patients were identified as atypical, and 36 (51%) were
labeled as classic FM. At first visit, the classic FM group had
higher scores on sleep quality, stiffness, anxiety, depression,
and total FIQ score (p\0.05) but not for other variables. At 6
months, there was no significant difference between the 2 groups
in all measured variables. Labeling shift from classic to
atypical FM and vice versa occurred at a rate of 36.1 and 32.4%,
respectively. This study showed the ACR 1990 criteria was not
able to consistently classify affected patients with FM syndrome
within a group of patients having nonspecific body pain and
multiple tender points over 6 months of follow-up
(41) Karsdorp PA,
Vlaeyen JW. Active avoidance but not activity pacing is
associated with disability in fibromyalgia. Pain 2009;
147(1-3):29-35.
Abstract: Activity pacing has been suggested as a behavioural
strategy that may protect patients with fibromyalgia (FM)
against activity dysregulation and disability. The aim of the
present study was to empirically test whether the construct of
activity pacing is distinct from other behavioural strategies
assessed with the Chronic Pain Coping Inventory (CPCI), such as
guarding, resting, asking for assistance, relaxation, task
persistence, exercise/stretch, seeking social support, and
coping self-statements. The second objective was to test whether
pacing was associated with physical disability when controlling
for pain catastrophizing, pain severity and the other
behavioural strategies as measured with CPCI. A random sample of
patients with FM (N=409) completed the CPCI, the Pain
Catastrophizing Scale (PCS), the Physical Index of the
Fibromyalgia Impact Questionnaire (FIQ-PH) and the Pain
Disability Index (PDI). The results demonstrated that the Dutch
version of the CPCI including the pacing subscale has adequate
internal consistency and construct validity. Moreover, guarding
and asking for assistance, but not pacing, were associated with
disability. These findings are in line with fear-avoidance
models and suggest that specifically active avoidance behaviours
are detrimental in FM. The authors recommend developing
cognitive-behavioural and exposure-based interventions and
challenge the idea that pacing as an intervention is essential
in pain self-management programs
(42) Salaffi F,
Sarzi-Puttini P, Girolimetti R, Gasparini S, Atzeni F, Grassi W.
Development and validation of the self-administered Fibromyalgia
Assessment Status: a disease-specific composite measure for
evaluating treatment effect. Arthritis Res Ther 2009;
11(4):R125.
Abstract: INTRODUCTION: The Fibromyalgia Impact Questionnaire
(FIQ) is a composite disease-specific measure validated for
fibromyalgia (FM), but it is rarely used in clinical practice.
The objective was to develop and analyse the psychometric
properties of a new composite disease-specific index
(Fibromyalgia Assessment Status, FAS), a simple
self-administered index that combines a patient's assessment of
fatigue, sleep disturbances and pain evaluated on the basis of
the 16 non-articular sites listed on the Self-Assessment Pain
Scale (SAPS) in a single measure (range 0 to 10). METHODS: The
FAS index was constructed using a traditional development
strategy, and its psychometric properties were tested in 226 FM
patients (209 women, 17 men); whose disease-related
characteristics were assessed by means of an 11-numbered
circular numerical rating scale (NRS) for pain, fatigue, sleep
disturbances and general health (GH), the tender point score
(TPS), the SAPS, the FIQ, and the SF-36. A group of 226
rheumatoid arthritis (RA) patients was used for comparative
purposes. Of the 179 FM patients who entered the follow-up
study, 152 completed the three-month period and were included in
the responsiveness analyses. One hundred and fifty-four patients
repeated the FAS questionnaire after an interval of one week,
and its test/re-test reliability was calculated. Responsiveness
was evaluated on the basis of effect size and the standardised
response mean. RESULTS: The FAS index fulfilled the established
criteria for validity, reliability and responsiveness. Factor
analysis showed that SAPS and fatigue contributed most, and
respectively explained 47.4% and 31.2% of the variance; sleep
explained 21.3%. Testing for internal consistency showed that
Cronbach's alpha was 0.781, thus indicating a high level of
reliability. As expected, closer significant correlations were
found when FAS was compared with total FIQ (rho = 0.347; P <
0.0001) and the FIQ subscales, particularly job ability,
tiredness, fatigue and pain (all P < 0.0001), but the
correlation between FAS and the mental component summary scale
score (MCS) of the SF-36 (rho = -0.531; P < 0.0001) was
particularly interesting. Test/re-test reliability was
satisfactory. The FAS showed the greatest effect size. The
magnitude of the responsiveness measures was statistically
different between FAS (0.889) and the FIQ (0.781) (P = 0.038),
and between the SF-36 MCS (0.434) and the SF-36 physical
component summary scale score (PCS) (0.321) (P < 0.01).
CONCLUSIONS: The self-administered FAS is a reliable, valid and
responsive disease-specific composite measure for assessing
treatment effect in patients with FM
(43) Bennett RM,
Friend R, Jones KD, Ward R, Han BK, Ross RL. The Revised
Fibromyalgia Impact Questionnaire (FIQR): validation and
psychometric properties. Arthritis Res Ther 2009; 11(4):R120.
Abstract: INTRODUCTION: The Fibromyalgia Impact Questionnaire
(FIQ) is a commonly used instrument in the evaluation of
fibromyalgia (FM) patients. Over the last 18 years, since the
publication of the original FIQ, several deficiencies have
become apparent and the cumbersome scoring algorithm has been a
barrier to widespread clinical use. The aim of this paper is to
describe and validate a revised version of the FIQ: the FIQR.
METHODS: The FIQR was developed in response to known
deficiencies of the FIQ with the help of a patient focus group.
The FIQR has the same 3 domains as the FIQ (that is, function,
overall impact and symptoms). It differs from the FIQ in having
modified function questions and the inclusion of questions on
memory, tenderness, balance and environmental sensitivity. All
questions are graded on a 0-10 numeric scale. The FIQR was
administered online and the results were compared to the same
patient's online responses to the 36-Item Short Form Health
Survey (SF-36) and the original FIQ. RESULTS: The FIQR was
completed online by 202 FM patients, 51 rheumatoid arthritis
(RA) or systemic lupus erythematosus (SLE) patients (31 RA and
20 SLE), 11 patients with major depressive disorder (MDD) and
213 healthy controls (HC). The mean total FIQR score was 56.6
+/- 19.9 compared to a total FIQ score of 60.6 +/- 17.8 (P <
0.03). The total scores of the FIQR and FIQ were closely
correlated (r = 0.88, P < 0.001). Each of the 3 domains of the
FIQR correlated well with the 3 related FIQ domains (r = 0.69 to
0.88, P < 0.01). The FIQR showed good correlation with
comparable domains in the SF-36, with a multiple regression
analysis showing that the three FIQR domain scores predicted the
8 SF-36 subscale scores. The FIQR had good discriminant ability
between FM and the 3 other groups; total FIQR scores were HC
(12.1 +/- 11.6), RA/SLE (28.6 +/- 21.2) and MDD (17.3 +/- 11.8).
The patient completion time was 1.3 minutes; scoring took about
1 minute. CONCLUSIONS: The FIQR is an updated version of the FIQ
that has good psychometric properties, can be completed in less
than 2 minutes and is easy to score. It has scoring
characteristics comparable to the original FIQ, making it
possible to compare past FIQ results with future FIQR results
(44) Williams DA,
Schilling S. Advances in the assessment of fibromyalgia. Rheum
Dis Clin North Am 2009; 35(2):339-57.
Abstract: Fibromyalgia (FM) has historically been considered a
chronic pain condition. Recent clinical studies, however, reveal
that while pain may be the cardinal symptom of FM, there are
many other symptoms and consequences of having FM that have an
impact on the lives of individuals with this condition. As such,
an area of intense clinical research has focused upon improving
approaches to assessment for FM. This article provides an
overview of how the art of assessing FM has evolved over time,
current methods of assessment, the value of patients'
perspectives in assessment, and emerging advancements
representing the future of for FM
(45) Glattacker M,
Opitz U, Jackel WH. Illness representations in women with
fibromyalgia. Br J Health Psychol 2010; 15(Pt 2):367-87.
Abstract: OBJECTIVE: In the US population, the prevalence of
fibromyalgia is about 3.4% in women. For those who are affected,
fibromyalgia is associated with significant limitations relating
to quality of life, activity, and participation. Furthermore,
fibromyalgia leads to serious socio-economic costs. The
objective of the present paper is to describe the cognitive
illness representations of women with fibromyalgia and to
analyse their relationship to rehabilitation outcomes. METHODS:
The outcome was measured using the SF-36 and fibromyalgia impact
questionnaire. The illness perceptions were assessed using the
Illness Perception Questionnaire - revised. The prediction of
outcome was done using hierarchical multiple regression
analyses. RESULTS: N=245 patients are included in the sample.
The patients attribute a multitude of symptoms to fibromyalgia
and name numerous triggering factors. Illness representations
are correlated with the illness impact at the beginning of
rehabilitation and predict the outcome after the end of
rehabilitation. CONCLUSION: The fact that illness
representations turn out to be predictors of outcome, even when
the baseline health status is statistically controlled,
highlights the relevance of the illness representations of
patients with fibromyalgia. Therefore, effective and efficient
methods should be developed for integrating patient's illness
beliefs into the management of the illness as early as possible
(46) Martin S,
Chandran A, Zografos L, Zlateva G. Evaluation of the impact of
fibromyalgia on patients' sleep and the content validity of two
sleep scales. Health Qual Life Outcomes 2009; 7:64.
Abstract: BACKGROUND: Disturbed sleep is commonly reported in
fibromyalgia (FM). Both the Sleep Quality Numeric Rating Scale
(NRS) and the Medical Outcomes Study Sleep Scale (MOS-Sleep)
have demonstrated positive psychometric properties in patients
with FM. However, these assessments were developed prior to the
current recommendation to include patient input during the
concept elicitation or item generation phases. Therefore, the
objective of this study was to evaluate the impact of FM on
participants, including their sleep, and to test the content
validity of these two sleep measures in FM patients. METHODS:
Qualitative interviews were conducted in Raleigh, North Carolina
and Detroit, Michigan with 20 adults who reported a physician
diagnosis of FM. Sixteen participants were female, 13 were
white, and the average age was 50 years. Two researchers
conducted all interviews using a structured guide. RESULTS:
Participants consistently reported that FM had a debilitating
impact on their lives and their sleep, particularly getting to
sleep and staying asleep. Participants responded positively to
the Sleep Quality NRS as an assessment of their sleep. The
majority of participants stated that they would not change the
response numbering or wording of the item's anchors.
Participants also responded positively to the 24-hour recall
period of the Sleep Quality NRS. Participants found the 12-item
MOS-Sleep to be appropriate and relevant; 19 participants
indicated the measure captured all of their sleep-related
symptoms. However, areas for potential modification were
identified, such as the need to separate the item regarding
awakening short of breath and awakening with a headache into two
separate questions. Participants also questioned the relevance
of the snoring and awakening short of breath items to FM. Half
of participants expressed a preference for a daily rather than a
weekly recall period. CONCLUSION: This study demonstrates the
significant impact that FM has on patients' lives, particularly
sleep. While patients with FM were not part of the development
of the generic sleep assessments that were evaluated, this study
provides evidence of their content validity, supporting their
use in FM studies. Modifications to the MOS-Sleep may improve
the psychometric properties and relevance to patients with FM
(47) Pena M,
Garcia RJ, Olalla JM, Llanos EV, de Miguel AG, Cordero XF.
Impact of the most frequent chronic health conditions on the
quality of life among people aged >15 years in Madrid. Eur J
Public Health 2010; 20(1):78-84.
Abstract: BACKGROUND: This study sought to ascertain to what
degree health-related quality of life (HRQL) in the City of
Madrid was affected by each of the most frequent chronic health
conditions, and the specific quality-of-life (QL) domains on
which such health conditions had the greatest impact, taking
co-morbidity and socio-demographic variables into account.
METHODS: A descriptive, analytical, cross-sectional study was
conducted covering 7341 subjects aged >or=16 years in the City
of Madrid. Data were collected on self-reported diagnosed
morbidity, including hypertension, hypercholesterolaemia,
varicose veins, diabetes, chronic asthma/bronchitis, myocardial
infarction/angina pectoris, stomach problems, allergy,
arthrosis/arthritis or rheumatism, depression/anxiety,
cataracts, cerebrovascular accidents (CVACs), chronic
constipation, osteoporosis and Alzheimer's disease or dementia.
HRQL was measured using the COOP/WONCA questionnaire. The
effects of diagnosis, age, social class, gender and the
co-morbidity were analysed using a multivariate analysis of
covariance (ANCOVA). RESULTS: The chronic health conditions that
registered the worst overall mean scores on the COOP/WONCA
questionnaire were Alzheimer's disease or dementia, Parkinson's
disease, fibromyalgia, CVACs and depression, with scores of over
26 points in all cases. After the introduction of
socio-demographic variables in the model, the highest values of
Snedecor's F-test corresponds to depression (F = 461.63),
'arthrosis/arthritis or rheumatism' (F = 175.41), Alzheimer's
disease or dementia (F = 65.70), gastric disorders (F = 65.17),
cancer (F = 43.08) and CVACs (F = 41.65). CONCLUSIONS:
Depression and 'arthrosis/arthritis or rheumatism' are the two
chronic health conditions, which have the greatest impact on
HRQL in Madrid's citizens, therefore is mandatory to propose and
implement public health strategies that would reduce the
prevalence and morbidity of such disorders
(48)
Slatkowsky-Christensen B, Mowinckel P, Kvien TK. Health status
and perception of pain: a comparative study between female
patients with hand osteoarthritis and rheumatoid arthritis.
Scand J Rheumatol 2009; 38(5):342-8.
Abstract: OBJECTIVE: Osteoarthritis (OA) is the most frequent
rheumatic joint disease and its occurrence is growing due to
prolonged life expectancy and an increasing number of elderly
individuals in the population. The main objective of this study
was to compare the burden of disease, assessed by measures of
pain and health-related quality of life (HRQoL), between female
patients with hand osteoarthritis (HOA) and rheumatoid arthritis
(RA). METHODS: One hundred and ninety female HOA patients were
compared with 194 female RA patients of the same age. HRQoL was
measured with the Arthritis Impact Measurement 2 Scale (Aims2),
the 36-item Short-Form Health Survey (SF-36) and its
preference-based single index measure SF-6D, the Health
Assessment Questionnaire (HAQ), the modified HAQ (MHAQ),
self-efficacy scales, and visual analogue scales (VAS) for pain
and fatigue. We also compared levels of fibromyalgia (FM)-like
symptoms (headache, muscle pain, numbness, and concentration
problems). Scores were compared by a multivariate analysis of
covariance (ANCOVA), adjusted for age, number of comorbidities,
and years of education. Sime's procedure was used to adjust for
multiple testing. RESULTS: RA patients had significantly lower
levels of physical functioning compared to HOA patients, whereas
pain measured on the Arthritis Impact Measurement Scale 2
(AIMS2) was significantly worse in HOA as compared with RA. The
HOA patients also had worse scores for FM-like symptoms. SF-6D
utility scores in HOA and RA were similar (0.63 and 0.64,
respectively). CONCLUSIONS: The overall impact of the disease on
HRQoL was similar between RA and HOA patients, based on the
SF-6D scores. Physical function was worse in RA patients, but
HOA patients reported worse scores in pain measures and FM-like
symptoms
(49)
Vargas-Alarcon G, Fragoso JM, Cruz-Robles D, Vargas A, Martinez
A, Lao-Villadoniga JI et al. Association of adrenergic receptor
gene polymorphisms with different fibromyalgia syndrome domains.
Arthritis Rheum 2009; 60(7):2169-73.
Abstract: OBJECTIVE: Fibromyalgia (FM) patients have signs of
relentless sympathetic hyperactivity associated with
hyporeactivity to stress. Adrenergic receptors (ARs) are parts
of the sympathetic nervous system that are fundamental for
maintenance of homeostasis. We undertook this study to correlate
alpha-AR and beta-AR gene polymorphisms with the presence of FM
and with different domains of the FM syndrome as measured by the
Fibromyalgia Impact Questionnaire (FIQ). METHODS: We studied 78
Mexican FM patients and 48 age-matched controls as well as 78
Spanish FM patients and 71 controls. All subjects studied were
women. Single-nucleotide polymorphisms (SNPs) of alpha(1A)-AR
(rs574584, rs1383914, rs1048101, and rs573542), beta(2)-AR
(rs1042713 and rs1042714), and beta(3)-AR (rs4994) were analyzed
by 5' exonuclease TaqMan polymerase chain reaction. Polymorphic
haplotypes were constructed after linkage disequilibrium
analysis. RESULTS: The beta(2)-AR AC haplotype was a risk factor
for the presence of FM. This haplotype had an increased
frequency in Mexican patients compared with Mexican controls
(42.1% versus 30.5%; P = 0.04). Similarly, 50.4% of Spanish
patients had this haplotype compared with 40.0% of Spanish
controls (P = 0.05). In Spanish patients, the alpha(1A)-AR SNP
rs1383914 was associated with the presence of FM (P = 0.01), and
the alpha(1A)-AR SNP rs1048101 was linked with FIQ disability (P
= 0.02). Mexican patients with the rs574584 GG genotype
presented the highest FIQ score compared with Mexican patients
with other genotypes (P = 0.01), and in Mexicans SNP rs574584
was associated with FIQ morning stiffness (P = 0.04) and with
FIQ tiredness upon awakening (P = 0.02). CONCLUSION: AR gene
polymorphisms are related to the risk of developing FM and are
also linked to different domains of the FM syndrome
(50) Yoshikawa GT,
Heymann RE, Helfenstein M, Jr., Pollak DF. A comparison of
quality of life, demographic and clinical characteristics of
Brazilian men with fibromyalgia syndrome with male patients with
depression. Rheumatol Int 2010; 30(4):473-8.
Abstract: The primary aim of this study was to assess the
quality of life (Qol) in men with fibromyalgia (FM) as compared
to the Qol of depressive patients, using the SF-36
questionnaire. The secondary objectives were as follows: to
describe demographic and clinical characteristics of male
patients with FM; to evaluate basal levels of
dehydroepiandrosterone sulfate (DHEAS) and total testosterone in
both groups; and to investigate the relationship among pain,
tender points, anxiety, and depression in these patients. Fifty
men with FM and 20 depressed males, matched by age and body mass
index entered the study. All participants answered the SF-36,
the Beck Depression Inventory and the State-Trait Anxiety
Inventory questionnaire. Radioimmunoassay was used to determine
serum concentration of DHEAS and total testosterone. Patients
and controls had similar demographic characteristics. The scores
were significantly lower in all domains of the SF-36 in patients
with FM as compared with the depressive controls. No significant
differences were observed among patient and control in the mean
concentration of either DHEAS or total testosterone. Male
patients with FM experience worse Qol than depressive men.
Depression was influential on mental health, whereas FM impacted
on both physical and mental health
(51) Amital D,
Herskovitz C, Fostick L, Silberman A, Doron Y, Zohar J et al.
The premenstrual syndrome and fibromyalgia--similarities and
common features. Clin Rev Allergy Immunol 2010; 38(2-3):107-15.
Abstract: The aim of the study was to assess the clinical
similarities and common features of fibromyalgia syndrome (FM)
and premenstrual dysphoric syndrome (PMDD). Thirty young
patients who met the diagnostic criteria for PMDD were included
in the study and compared to 26 women belonging to the medical
staff of a general psychiatry department. All enrollees were
interviewed and examined by a skilled physician. They completed
the following nine survey items: demographic information,
clinical health assessment questionnaire, fibromyalgia impact
questionnaire, sleep and fatigue questionnaires, Sheehan
disability scales, SF-36 assessment for quality of life, visual
analog scale for pain, Mini International Neuropsychiatric
Interview (MINI) questionnaire (assessment of coexistent
psychiatric conditions), and the premenstrual severity scale.
Additionally, each individual underwent a physical examination
measuring the classical tender points and was asked to describe
the distribution and continuum of her pain or tenderness. The
PMDD group scored significantly higher in the measures pain and
tenderness as well as in severity of premenstrual symptoms
compared to the control group. Five patients in the PMDD group
and none in the control group had FM. Quality of life measured
by the SF-36 was higher in the control group than in the PMDD
group and correlated with the degree of tenderness reported.
Psychiatric comorbidity was significantly more common in the
PMDD group, affecting 16 of the 30 PMDD patients compared to
only three of the 26 control patients. In this study, patients
with PMDD were found to have higher levels of tenderness, higher
psychiatric comorbidity, greater level of physical disabilities,
and a lower quality of life. These parameters were highly
correlated with a lower pain threshold
(52) Shuster J,
McCormack J, Pillai RR, Toplak ME. Understanding the
psychosocial profile of women with fibromyalgia syndrome. Pain
Res Manag 2009; 14(3):239-45.
Abstract: Fibromyalgia syndrome (FMS) is a disease with a
complex etiology characterized by symptoms of widespread pain
and fatigue. FMS is more common in women. Both depression and
anxiety have been found to be independently associated with the
severity of pain in symptoms of FMS. The goal of the present
study was to examine the psychosocial profile of women with FMS
and to see how the attributions, perceived social support and
cognitive biases of women with FMS are related to internalizing
ratings of depression and anxiety. The current study included a
sample of women with FMS from a local support group and a
control group to examine how women with FMS differed from
controls with respect to psychosocial variables, and to
determine the relationship between these variables. Women with
FMS reported a higher external locus of control, lower levels of
adaptive cognitive bias, less perceived family support and lower
mood than controls. Correlations between these variables were
examined within the FMS group, and it was found that an external
locus of control was significantly associated with higher
ratings of anxiety and depressed mood. These results suggest
that beliefs about locus of control and perceived family support
of women with FMS may importantly impact their health outcomes,
and that treatments related to locus of control and advocating
for family support may considerably improve the quality of life
of patients with FMS
(53) Arnold LM,
Hudson JI, Wang F, Wohlreich MM, Prakash A, Kajdasz DK et al.
Comparisons of the efficacy and safety of duloxetine for the
treatment of fibromyalgia in patients with versus without major
depressive disorder. Clin J Pain 2009; 25(6):461-8.
Abstract: OBJECTIVES: To investigate whether comorbid major
depressive disorder (MDD) influenced the efficacy and safety of
duloxetine in treating fibromyalgia (FM). METHODS: This was a
post-hoc analysis using pooled data from 4 double-blind,
placebo-controlled studies of patients with American College of
Rheumatology-defined primary FM with or without MDD. Patients
were randomized to duloxetine [60 or 120 mg/d (N=797)] or
placebo (N=535) for approximately 3 months. Efficacy measures
included the Brief Pain Inventory average pain score, 17-item
Hamilton Depression Rating Scale, Fibromyalgia Impact
Questionnaire, and Patient's/Clinician's Global Impressions of
Improvement/Severity scales. RESULTS: At baseline, 26% of
patients met diagnostic criteria for MDD. At endpoint (3 mo or
last observation), duloxetine showed significantly (P<0.05)
greater improvement versus placebo on the Brief Pain Inventory,
Fibromyalgia Impact Questionnaire, Patient's Global Impressions
of Improvement scale, and Clinician's Global Impressions of
Severity scale in patients with and without comorbid MDD. The
effect of duloxetine on these efficacy measures was consistent
across FM patients with or without MDD (P>0.1 for
treatment-by-strata interaction). On the 17-item Hamilton
Depression Rating Scale, duloxetine showed significantly
(P<0.05) greater improvement versus placebo in patients with
comorbid MDD. The safety profile of duloxetine versus placebo
with respect to serious adverse events and discontinuation owing
to adverse events was similar for FM patients with versus
without MDD (P>0.1 treatment-by-strata interaction). DISCUSSION:
Duloxetine was effective in reducing pain and other symptoms in
FM patients with and without MDD and demonstrated a similar
safety profile for both groups
(54) Cimen OB,
Cimen MY, Yapici Y, Camdeviren H. Arginase, NOS activities, and
clinical features in fibromyalgia patients. Pain Med 2009;
10(5):813-8.
Abstract: OBJECTIVES: Fibromyalgia (FM) is a form of
nonarticular rheumatism characterized by chronic widespread
musculoskeletal aching and tender points. The aim of the present
study was to investigate the effect of arginase and nitric oxide
synthase (NOS) enzyme activities in FM with respect to their
importance in pathogenesis, and the relationship with FM-related
clinical parameters. METHODS: After obtaining informed consent,
25 female FM patients were compared with 23 healthy female
controls. NOS and arginase enzyme activities were measured
spectrophometrically in sera. Tender points were examined using
the protocol described by Wolfe et al. The health status of
patients was assessed by Fibromyalgia Impact Questionnaire.
Musculoskeletal pain was scored according to visual analog
scale. Health Assessment Questionnaire, Beck depression and Beck
anxiety scales, and dyspnea scores were administered to analyze
functional, psychiatric, and respiratory status of the patients.
RESULTS: We found that NOS activity was significantly higher
whereas arginase activity was lower in patients with FM. In the
correlation analysis, NOS levels showed statistically
significant positive correlation with chest pain and dyspnea
parameters. NOS enzyme activities were higher in subjects with
positive history of migraine, pain, and morning stiffness. On
the other hand, arginase levels were lower in subjects with
positive history of irritable bowel syndrome and morning
stiffness. CONCLUSION: Animal experiments have suggested that
nitric oxide (NO) is an important transmitter in pain pathways.
It can also stimulate cyclooxygenase activity. We observed
increased NOS activity and reduced arginase activity in FM
patients, which may be due to increased cyclooxygenase enzyme
activity and oxidant/antioxidant imbalance. In conclusion, we
think that future studies concerning clinical control of pain
with selective NOS inhibitors are needed in order to determine
new therapeutic approaches and the exact pathophysiologic
mechanisms in FM patients
(55) Assumpcao A,
Cavalcante AB, Capela CE, Sauer JF, Chalot SD, Pereira CA et al.
Prevalence of fibromyalgia in a low socioeconomic status
population. BMC Musculoskelet Disord 2009; 10:64.
Abstract: BACKGROUND: The aim of this study was to estimate the
prevalence of fibromyalgia, as well as to assess the major
symptoms of this syndrome in an adult, low socioeconomic status
population assisted by the primary health care system in a city
in Brazil. METHODS: We cross-sectionally sampled individuals
assisted by the public primary health care system (n = 768,
35-60 years old). Participants were interviewed by phone and
screened about pain. They were then invited to be clinically
assessed (304 accepted). Pain was estimated using a Visual
Analogue Scale (VAS). Fibromyalgia was assessed using the
Fibromyalgia Impact Questionnaire (FIQ), as well as screening
for tender points using dolorimetry. Statistical analyses
included Bayesian Statistics and the Kruskal-Wallis Anova test
(significance level = 5%). RESULTS: From the phone-interview
screening, we divided participants (n = 768) in three groups: No
Pain (NP) (n = 185); Regional Pain (RP) (n = 388) and Widespread
Pain (WP) (n = 106). Among those participating in the clinical
assessments, (304 subjects), the prevalence of fibromyalgia was
4.4% (95% confidence interval [2.6%; 6.3%]). Symptoms of pain
(VAS and FIQ), feeling well, job ability, fatigue, morning
tiredness, stiffness, anxiety and depression were statically
different among the groups. In multivariate analyses we found
that individuals with FM and WP had significantly higher
impairment than those with RP and NP. FM and WP were similarly
disabling. Similarly, RP was no significantly different than NP.
CONCLUSION: Fibromyalgia is prevalent in the low socioeconomic
status population assisted by the public primary health care
system. Prevalence was similar to other studies (4.4%) in a more
diverse socioeconomic population. Individuals with FM and WP
have significant impact in their well being
(56) Henriksen M,
Lund H, Christensen R, Jespersen A, Dreyer L, Bennett RM et al.
Relationships between the fibromyalgia impact questionnaire,
tender point count, and muscle strength in female patients with
fibromyalgia: a cohort study. Arthritis Rheum 2009; 61(6):732-9.
Abstract: OBJECTIVE: To test the hypothesis that fibromyalgia
(FM) patients with reduced lower extremity strength are more
symptomatic and tender than FM patients with normal muscle
strength. METHODS: A total of 840 FM patients and 122 healthy
subjects were evaluated between 1998 and 2005. All of the
patients completed version 1 of the Fibromyalgia Impact
Questionnaire (FIQ) and were assessed for tender points and knee
muscle strength. All subjects underwent bilateral isokinetic
knee muscle strength testing in flexion and extension. Normative
knee muscle strength values were calculated from the healthy
subjects, and the FM cohort was divided in 2 groups: 1) patients
with normal muscle strength and 2) patients with low muscle
strength (2 SDs below normal). The clinical characteristics of
these 2 groups were compared. RESULTS: Significantly reduced
knee muscle strength was found in 52% of the patients. There
were no clinically significant differences between patients with
low versus normal muscle strength. There were no clinically
significant correlations between total FIQ score, tender point
count, and muscle strength. Only 4.6% of the FIQ scores and 5.1%
of the tender point counts were explained by muscle strength.
CONCLUSION: Significantly reduced knee muscle strength was found
in more than half of the patients. Patients with subnormal
muscle strength were not more symptomatic or tender than
patients with normal muscle strength. There were no clinically
significant correlations between FIQ, tender point count, and
muscle strength; therefore, reduced knee muscle strength appears
to be a common objective abnormality in FM that is independent
of measurements of disease activity. The implication of this
finding in regard to the clinical assessment of FM needs further
study
(57) Reitblat T,
Zamir D, Polishchuck I, Novochatko G, Malnick S, Kalichman L.
Patients treated by tegaserod for irritable bowel syndrome with
constipation showed significant improvement in fibromyalgia
symptoms. A pilot study. Clin Rheumatol 2009; 28(9):1079-82.
Abstract: The symptoms of irritable bowel syndrome (IBS) are
commonly seen in fibromyalgia (FM) patients. This study aimed to
evaluate the effect of 5-hydroxytryptamin-4 receptor partial
agonist (tegaserod) on the symptoms of FM among the patients who
receive the medicine because of IBS. Forty-one female patients
with IBS and constipation, which were subjects to tegaserod
treatment, were examined by rheumatologist and 14 were found to
suffer from FM. The fibromyalgia impact questionnaire (FIQ) and
clinical examination were done before tegaserod treatment and 1
month after. The IBS status, the total FIQ score, the number of
tender points and pain in tender points were lowered
significantly after the treatment (p < 0.001 for all variables).
The results of this pilot study provide the preliminary evidence
that FM patients can benefit from treatment by
5-hydroxytryptamin-4 receptor partial agonist. Additional
studies are needed to support this conclusion
(58) Giske L,
Bautz-Holter E, Sandvik L, Roe C. Relationship between pain and
neuropathic symptoms in chronic musculoskeletal pain. Pain Med
2009; 10(5):910-7.
Abstract: OBJECTIVE: The present study aimed to assess
neuropathic symptoms, their stability over time and relationship
to pain intensity, pain distribution, and emotional distress in
patients with musculoskeletal disorders. DESIGN: This is a
prospective study. SETTING: The study was done at the Department
of Physical Medicine and Rehabilitation at Ulleval University
Hospital. PATIENTS: Eighty-six subjects between 18 years and 70
years with chronic musculoskeletal pain participated. Forty-nine
subjects had widespread pain and 39 subjects fulfilled the
American College of Rheumatology (ACR) criteria for
fibromyalgia. OUTCOME MEASURES: McGill pain drawing, pain
intensity (visual analog scales), emotional distress (Hopkins
Symptom Checklist v 25), and fibromyalgia impact questionnaire
were the recorded predictors, and neuropathic symptoms (Leeds
assessment of neuropathic symptoms and signs-LANSS) were the
main outcome variable which was assessed over 4 months. RESULTS:
The mean LANSS score was 6.7 (standard deviation 5.6). Thirteen
percent of the subjects had a score of 12 or more. Self-reported
LANSS symptoms did not change over the 4 months follow-up, and
the reliability of measurements as evaluated by intraclass
correlation coefficient was 0.78. In a backward multiple
regression analysis, the presence of fibromyalgia diagnosis and
emotional distress remained the final predictors for neuropathic
symptoms. CONCLUSIONS: Our study demonstrates that neuropathic
symptoms are prominent features of chronic musculoskeletal pain
and are stable over time. These symptoms were closely related to
emotional distress and to the diagnosis of fibromyalgia. The
results lend support to the theory that neuropathic symptoms
represent an underlying sensitization
(59) Pae CU,
Masand PS, Marks DM, Krulewicz S, Peindl K, Mannelli P et al.
History of depressive and/or anxiety disorders as a predictor of
treatment response: a post hoc analysis of a 12-week,
randomized, double-blind, placebo-controlled trial of paroxetine
controlled release in patients with fibromyalgia. Prog
Neuropsychopharmacol Biol Psychiatry 2009; 33(6):996-1002.
Abstract: BACKGROUND: Despite of a high comorbidity of
depressive and/or anxiety disorders with fibromyalgia,
information on the clinical implications of this comorbidity is
limited but antidepressants are commonly prescribed to treat
fibromyalgia in clinical practice. We investigated whether a
history of depressive and/or anxiety disorders was associated
with response to paroxetine controlled release (CR) in the
treatment of fibromyalgia. METHODS: One hundred sixteen (116)
fibromyalgia subjects were randomized to receive paroxetine CR
or placebo for 12 weeks. The primary outcome was treatment
response defined as >or=25% reduction in the Fibromyalgia Impact
Questionnaire (FIQ) score. In multivariate logistic regression,
we determined if a history of depression and/or anxiety
disorders was an independent predictor of response to paroxetine
CR. RESULTS: In logistic regression, the history of depression
and/or anxiety did not predict treatment response as measured by
>or=25% reduction in Fibromyalgia Impact Questionnaire (FIQ)
score (OR=0.66, 95% CI=.29-1.49, Wald=0.97, p=0.32), while the
drug status (paroxetine CR) was significantly associated with
treatment response (OR=2.57, CI=1.2-5.61, Wald=5.5, p=0.02).
CONCLUSION: A significant proportion of patients with
fibromyalgia had a history of anxiety and or depressive
disorders. However response to treatment of fibromyalgia
symptoms with paroxetine CR was not associated with a history of
depressive and/or anxiety disorders. Our findings need to be
confirmed in more adequately-powered and well-designed
subsequent studies
(60) Kroese M,
Schulpen G, Bessems M, Nijhuis F, Severens J, Landewe R. The
feasibility and efficacy of a multidisciplinary intervention
with aftercare meetings for fibromyalgia. Clin Rheumatol 2009;
28(8):923-9.
Abstract: The objective of this study is to examine the
feasibility and long-term results of a 12-week multidisciplinary
part-time daycare intervention with five aftercare meetings in
fibromyalgia (FM) patients. One hundred and five patients
diagnosed with FM started with a multidisciplinary intervention
and were assessed for feasibility, functional status
(Fibromyalgia Impact Questionnaire [FIQ]), and quality of life
(EuroQol-5D [EQ-5D]) until 9 months after completion. The
program consisted of sociotherapy, physiotherapy, psychotherapy,
and creative arts therapy. Drop-out rate was 4.8%. The
attendance rate of 100 patients who completed the 12-week
program and five aftercare meetings was high (97.4%), just like
patient and therapist satisfaction (8.2 on a 10 points scale).
After the 12-week program, statistically significant improvement
was seen in both FIQ and EQ-5D. This improvement was maintained
after 9 months of follow-up. On average, moderate improvements
were observed. Our 12-week multidisciplinary part-time daycare
intervention with five aftercare meetings for FM patients is
feasible and it is indicated that it can lead to sustained
improvement in functional status and quality of life
(61)
Garcia-Campayo J, Serrano-Blanco A, Rodero B, Magallon R, Alda
M, Andres E et al. Effectiveness of the psychological and
pharmacological treatment of catastrophization in patients with
fibromyalgia: a randomized controlled trial. Trials 2009; 10:24.
Abstract: BACKGROUND: Fibromyalgia is a prevalent and disabling
disorder characterized by widespread pain and other symptoms
such as insomnia, fatigue or depression. Catastrophization is
considered a key clinical symptom in fibromyalgia; however,
there are no studies on the pharmacological or psychological
treatment of catastrophizing. The general aim of this study is
to assess the effectiveness of cognitive-behaviour therapy and
recommended pharmacological treatment for fibromyalgia
(pregabalin, with duloxetine added where there is a comorbid
depression), compared with usual treatment at primary care
level. METHOD/DESIGN: DESIGN: A multi-centre, randomized
controlled trial involving three groups: the control group,
consisting of usual treatment at primary care level, and two
intervention groups, one consisting of cognitive-behaviour
therapy, and the other consisting of the recommended
pharmacological treatment for fibromyalgia. SETTING: 29 primary
care health centres in the city of Zaragoza, Spain. SAMPLE: 180
patients, aged 18-65 years, able to understand and read Spanish,
who fulfil criteria for primary fibromyalgia, with no previous
psychological treatment, and no pharmacological treatment or
their acceptance to discontinue it two weeks before the onset of
the study. INTERVENTION: Psychological treatment is based on the
manualized protocol developed by Prof. Escobar et al, from the
University of New Jersey, for the treatment of somatoform
disorders, which has been adapted by our group for the treatment
of fibromyalgia. It includes 10 weekly sessions of
cognitive-behaviour therapy. Pharmacological therapy consists of
the recommended pharmacological treatment for fibromyalgia:
pregabalin (300-600 mg/day), with duloxetine (60-120 mg/day)
added where there is a comorbid depression). MEASUREMENTS: The
following socio-demographic data will be collected: sex, age,
marital status, education, occupation and social class. The
diagnosis of psychiatric disorders will be made with the
Structured Polyvalent Psychiatric Interview. Other instruments
to be administered are the Pain Catastrophizing Scale, the
Hamilton tests for Anxiety and for Depression, the Fibromyalgia
Impact Questionnaire (FIQ), the EuroQuol-5 domains (EQ-5D), and
the use of health and social services (CSRI). Assessments will
be carried out at baseline, 1, 3, and 6 months. MAIN VARIABLE:
Pain catastrophizing. ANALYSIS: The analysis will be per intent
to treat. We will use the general linear models of the SPSS
version 15 statistical package, to analyse the effect of the
treatment on the result variable (pain catastrophizing).
DISCUSSION: It is necessary to assess the effectiveness of
pharmacological and psychological treatments for pain
catastrophizing in fibromyalgia. This randomized clinical trial
will determine whether both treatments are effective for this
important prognostic variable in patients with fibromyalgia.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN10804772
(62) Kiyak EK. A
new nonpharmacological method in fibromyalgia: the use of wool.
J Altern Complement Med 2009; 15(4):399-405.
Abstract: OBJECTIVES: The aim was to assess the effect of wool
use in patients with fibromyalgia. BACKGROUND: Various studies
concerning the treatment of patients with fibromyalgia using
nonpharmacological methods have been carried out. There are,
however, no reports on the use of wool clothing and bedding in
treating these patients. DESIGN AND METHODS: The study employed
two-group, experimental design. A total of 50 patients with
fibromyalgia, based on the criteria of the American College of
Rheumatology, were selected for the study. They were distributed
equally into two groups: a control group and a treatment group.
The 25 patients in each group were randomly selected and the
compositions of the two groups were statistically identical. The
patients in the treatment group wore woolen underwear (which
covered the body from the shoulders to the thighs) and used
woolen bedding such as woolen bed liner, woolen quilt and pillow
during the experimental period of 6 weeks. All patients were
assessed at the beginning the trial (pre-test) and the end of
6th (post-test) week. Data were collected using the visual
analogue scale (0-10), tender points count, and Fibromyalgia
Impact Questionnaire. RESULTS: Patients in the treatment group
reported significant improvements in their conditions including
a reduction in pain levels, tender point counts, and all scores
of the Fibromyalgia Impact Questionnaire (p <or= 0.001).
CONCLUSIONS: The use of woolen underwear and woolen bedding were
effective in reducing the symptoms of patients suffering from
fibromyalgia. The use of wool is recommended as a means of
treatment for alleviating the pain of fibromyalgia. RELEVANCE TO
CLINICAL PRACTICE: Nurses provide professional support to
patients with fibromyalgia. They select suitable clothes and
sleeping materials for their patients with this object in mind:
to keep their patients warm and to protect them from the cold
(63) Pae CU,
Masand PS, Marks DM, Krulewicz S, Han C, Peindl K et al. History
of early abuse as a predictor of treatment response in patients
with fibromyalgia: a post-hoc analysis of a 12-week, randomized,
double-blind, placebo-controlled trial of paroxetine controlled
release. World J Biol Psychiatry 2009; 10(4 Pt 2):435-41.
Abstract: OBJECTIVES: We conducted a post-hoc analysis to
determine whether a history of physical or sexual abuse was
associated with response to treatment in a double-blind,
randomized, placebo-controlled trial of paroxetine controlled
release (CR) in fibromyalgia. METHODS: A randomized,
double-blind, placebo-controlled trial of paroxetine controlled
release (CR) (dose 12.5-62.5 mg/day) was conducted in patients
with fibromyalgia for 12 weeks. A total of 112 subjects provided
complete information on childhood history of abuse that was
recorded using the Sexual and Physical Abuse Questionnaire and
randomized to treatments. Outcome evaluations in the abuse
subgroup were identical to those in the entire sample. Health
Status was determined using the 36-Item Short Form Health Survey
(SF-36), the Sheehan Disability Scale (SDS), and the Perceived
Stress Scale (PSS). Fibromylagia symptom severity was determined
using the Fibromyalgia Impact Questionnaire (FIQ) and the Visual
Analogue Scale for Pain (VAS). The primary outcome was treatment
response defined as > or = 25% reduction in the FIQ-total score.
Secondary outcomes include changes in scores on the Clinical
Global Impression-Severity and Improvement (CGI-S and CGI-I
respectively) and SF-36. RESULTS: The rate of childhood physical
and/or sexual abuse was 52.7% (n=59). The baseline
characteristics (health status, perceived stress, symptom
severity) were not associated with abuse history. In logistic
regression, the history of abuse did not predict treatment
response as measured by > or = 25% reduction in FIQ-total score
(OR = 1.16, 95% CI = 1.18-1.60, P = 0.35), while the drug status
(paroxetine CR) was significantly associated with treatment
response (OR = 2.51, 95% CI = 1.12-5.64, P = 0.02). Abuse
history did not predict CGI-I (P = 0.32) or CGI-S (P = 0.74)
improvements during treatment. After 12 weeks of treatment,
subjects with sexual abuse history showed significantly lower
mean change in health status (SF-36) than those without sexual
abuse history (P = 0.04). CONCLUSIONS: Although, a significant
proportion of patients with fibromyalgia reported a history of
abuse, it does not appear to have any significant clinical
correlates at baseline. History of abuse did not predict
response to treatment in patients with fibromyalgia
participating in a controlled trial of paroxetine controlled
release. Prospective, well-designed studies are needed to
confirm whether selective serotonin uptake inhibitors are
effective in patients with fibromyalgia irrespective of their
abuse history
(64) Bennett RM,
Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. Minimal
clinically important difference in the fibromyalgia impact
questionnaire. J Rheumatol 2009; 36(6):1304-11.
Abstract: OBJECTIVE: The Fibromyalgia Impact Questionnaire (FIQ)
is a disease-specific composite instrument that measures the
effect of problems experienced by patients with fibromyalgia
(FM). Utilization of the FIQ in measuring changes due to
interventions in FM requires derivation of a clinically
meaningful change for that instrument. Analyses were conducted
to estimate the minimal clinically important difference (MCID),
and to propose FIQ severity categories. METHODS: Data from 3
similarly designed, 3-month placebo-controlled, clinical
treatment trials of pregabalin 300, 450, and 600 mg/day in
patients with FM were modeled to estimate the change in the mean
FIQ total and stiffness items corresponding to each category on
the Patient Global Impression of Change. FIQ severity categories
were modeled and determined using established pain severity
cutpoints as an anchor. RESULTS: A total of 2228 patients, mean
age 49 years, 93% women, with a mean baseline FIQ total score of
62 were treated in the 3 studies. Estimated MCID on a given
measure were similar across the studies. In a pooled analysis
the estimated MCID (95% confidence interval) was 14% (13; 15)
and for FIQ stiffness it was 13% (12; 14). In the severity
analysis a FIQ total score from 0 to <39 was found to represent
a mild effect, >or= 39 to <59 a moderate effect, and >or=59 to
100 a severe effect. CONCLUSION: The analysis indicates that a
14% change in the FIQ total score is clinically relevant, and
results of these analyses should enhance the clinical utility of
the FIQ in research and practice
(65) Bazzichi L,
Dini M, Rossi A, Corbianco S, De FF, Giacomelli C et al. Muscle
modifications in fibromyalgic patients revealed by surface
electromyography (SEMG) analysis. BMC Musculoskelet Disord 2009;
10:36.
Abstract: BACKGROUND: Several studies have been carried out in
order to investigate surface electromyography (SEMG) response on
fibromyalgic (FM) patients. Some studies failed to demonstrate
differences between FM patients and healthy individuals while
others found differences in SEMG parameters. Different muscular
region have been analyzed in FM patients and heterogeneity is
also produced because of the different ways in which the SEMG
technique is used. The aims of this study were to evaluate
muscle modifications by SEMG analysis in FM women with respect
to a sample of healthy controls and to investigate the
relationships between SEMG parameters and the clinical aspects
of the disease. METHODS: SEMG was recorded in 100 FM women
(48.10 +/- 11.96 yr) and in 50 healthy women (48.60 +/- 11.18
yr), from the tibialis anterior and the distal part of vastus
medialis muscle during isometric contraction. Initial values and
rate of change of median spectral frequency (MDF) and conduction
velocity (CV) of the SEMG signal were calculated.The clinical
parameters "Fibromyalgia Impact Questionnaire", pain, tender
points, tiredness were evaluated and the relationships between
these data and the SEMG results were also studied. For the
statistical analysis Mann-Whitney test, chi-square test and
Spearman correlation were used. RESULTS: MDF absolute values and
the so-called Fatigue Index (FI) were significantly lower (p <
0.001) in both muscles studied in FM patients (MDF: 93.2 microV;
FI: 1.10, 0.89) with respect to healthy controls (MDF: 138.2
microV; FI: 2.41, 1.66) and a smaller reduction in the
percentage values of MDF was observed in FM patients vs controls
(22% vs 38%). A significant correlation was found between the
SEMG parameter decrement of normalized median frequency (MNF)
(%) and seriousness of FM (evaluated by means of tender points).
CONCLUSION: We have found some interesting muscle modifications
in FM patients with respect to healthy controls, regarding MDF,
CV and FI values which resulted significantly lower in FM.
Patients might have a different fiber recruitment or a possible
atrophy of type II fibers suggesting that they are not able to
reach muscle relaxation
(66) Arvold DS,
Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC et al.
Correlation of symptoms with vitamin D deficiency and symptom
response to cholecalciferol treatment: a randomized controlled
trial. Endocr Pract 2009; 15(3):203-12.
Abstract: OBJECTIVE: To examine the association of symptoms with
vitamin D deficiency and symptom response to cholecalciferol
treatment in a randomized, double-blind, placebo-controlled
trial. METHODS: Adult primary care patients in Duluth,
Minnesota, were screened for vitamin D deficiency in February
2007. Participants completed questionnaires pertaining to a
variety of symptoms, vitamin D intake, and selected medical
conditions. Patients with mild to moderate vitamin D deficiency
(25-hydroxyvitamin D [25(OH)D], 10-25 ng/mL) participated in a
randomized controlled trial (RCT) of vitamin D replacement and
its effect on symptoms. Participants were randomly assigned to
receive 50 000 units of cholecalciferol (vitamin D3) weekly or
placebo for 8 weeks. Patients with severe vitamin D deficiency
(25[OH]D <10 ng/mL) were treated in an unblinded fashion, and
symptoms were reevaluated post treatment. RESULTS: A total of
610 patients underwent initial screening, and 100 patients with
mild to moderate vitamin D deficiency participated in the RCT.
Thirty-eight severely deficient patients were treated in an
unblinded fashion. On initial screening, 46.2% of participants
were deficient in vitamin D. Self-reported vitamin D
supplementation, milk intake, celiac disease, gastric bypass,
and chronic pancreatitis were predictive of vitamin D status.
Severely deficient participants reported increased
musculoskeletal symptoms, depression (including seasonal), and
higher (worse) scores on a fibromyalgia assessment
questionnaire. In the RCT, the treated group showed significant
improvement in fibromyalgia assessment scores (P = 0.03),
whereas the placebo-treated participants did not. Severely
deficient patients did not show symptom improvement over the
8-week trial period or when followed up 1 year later.
CONCLUSIONS: Compared with participants in the placebo group,
patients in the treatment group showed mild short-term
improvement in the overall fibromyalgia impact score, but did
not show significant improvement in most musculoskeletal
symptoms or in activities of daily living
(67) Relton C,
Smith C, Raw J, Walters C, Adebajo AO, Thomas KJ et al.
Healthcare provided by a homeopath as an adjunct to usual care
for Fibromyalgia (FMS): results of a pilot Randomised Controlled
Trial. Homeopathy 2009; 98(2):77-82.
Abstract: OBJECTIVES: To assess the feasibility of a Randomised
Controlled Trial (RCT) design of usual care compared with usual
care plus adjunctive care by a homeopath for patients with
Fibromyalgia syndrome (FMS). METHODS: In a pragmatic parallel
group RCT design, adults with a diagnosis of FMS (ACR criteria)
were randomly allocated to usual care or usual care plus
adjunctive care by a homeopath. Adjunctive care consisted of
five in depth interviews and individualised homeopathic
medicines. The primary outcome measure was the difference in
Fibromyalgia Impact Questionnaire (FIQ) total score at 22 weeks.
RESULTS: 47 patients were recruited. Drop out rate in the usual
care group was higher than the homeopath care group (8/24 vs
3/23). Adjusted for baseline, there was a significantly greater
mean reduction in the FIQ total score (function) in the
homeopath care group than the usual care group (-7.62 vs 3.63).
There were significantly greater reductions in the homeopath
care group in the McGill pain score, FIQ fatigue and tiredness
upon waking scores. We found a small effect on pain score (0.21,
95% CI -1.42 to 1.84); but a large effect on function (0.81, 95%
CI -8.17 to 9.79). There were no reported adverse events.
CONCLUSIONS: Given the acceptability of the treatment and the
clinically relevant effect on function, there is a need for a
definitive study to assess the clinical and cost effectiveness
of adjunctive healthcare by a homeopath for patients with FMS
(68) Solano C,
Martinez A, Becerril L, Vargas A, Figueroa J, Navarro C et al.
Autonomic dysfunction in fibromyalgia assessed by the Composite
Autonomic Symptoms Scale (COMPASS). J Clin Rheumatol 2009;
15(4):172-6.
Abstract: BACKGROUND: It has been suggested that autonomic
nervous system dysfunction may explain all of fibromyalgia (FM)
multisystem features. Such proposal is based mostly on the
results of diverse heart rate variability analyses. The
Composite Autonomic Symptom Scale (COMPASS) is a different
validated method to recognize dysautonomia. OBJECTIVES: The main
objective of our study was to investigate symptoms of autonomic
dysfunction in FM patients by means of COMPASS. A secondary
objective was to define whether there is a correlation between
COMPASS and Fibromyalgia Impact Questionnaire (FIQ) scores in FM
patients. METHODS: Design, analytical cross-sectional study. Our
study population included 3 different groups of women: 30
patients with FM, 30 patients with rheumatoid arthritis, and 30
women who considered themselves healthy. All participants filled
out COMPASS and FIQ questionnaires. RESULTS: FM patients had
significantly higher values in all COMPASS domains. COMPASS
total score (54.6 +/- 20.9; mean +/- standard deviation) clearly
differentiated FM patients from the other 2 groups (21.6 +/-
16.5 and 9.5 +/- 10.2, respectively). P < 0.0001. The majority
of FM patients gave affirmative answers to questions related to
orthostatic, digestive, sleep, sudomotor, or mucosal
dysfunction. There was a significant correlation between COMPASS
and FIQ scores (Spearman r = 0.5, P < 0.005). CONCLUSIONS:
Patients with FM have multiple nonpain symptoms related to
different expressions of autonomic dysfunction. There is a
correlation between a questionnaire that measures FM severity
(FIQ) and an autonomic dysfunction questionnaire (COMPASS). Such
correlation suggests that autonomic dysfunction is inherent to
FM
(69) Boomershine
CS, Crofford LJ. A symptom-based approach to pharmacologic
management of fibromyalgia. Nat Rev Rheumatol 2009; 5(4):191-9.
Abstract: Fibromyalgia is a prevalent disorder that is
characterized by widespread pain along with numerous other
symptoms, including fatigue, poor sleep, mood disorders, and
stiffness. Previous guidelines for the management of
fibromyalgia recommended an approach that integrates
pharmacologic and nonpharmacologic therapies selected according
to the symptoms experienced by individual patients. However,
they offered no recommendations for a system of patient
assessment that would provide a basis for individualized
treatment selection. We present a simple, rapid and easily
remembered system for symptom quantitation and pharmacologic
management of fibromyalgia that combines visual analogue scale
symptom scores from a modified form of the disease-neutral
Fibromyalgia Impact Questionnaire, with a review of medications
that can be used to treat the individual symptoms. This
symptom-based approach is amenable to caring for patients with
fibromyalgia in a busy clinical practice
(70) Smith AK,
Togeiro SM, Tufik S, Roizenblatt S. Disturbed sleep and
musculoskeletal pain in the bed partner of patients with
obstructive sleep apnea. Sleep Med 2009; 10(8):904-12.
Abstract: BACKGROUND: Obstructive sleep apnea (OSA) has been
recognized as a distressing experience to the female partner,
but a causal association remains controversial. Furthermore, a
growing body of evidence supports a relationship of distress and
sleep disruptions with musculoskeletal pain, also prevalent in
middle-aged women. To test the hypothesis that sharing a bed
with an OSA man may contribute to manifestations of distress and
impaired sleep, we conducted a case-control study of 17 OSA
wives and 17 wives of healthy sleepers. METHODS: Clinical
outcome variables were scores of the Fibromyalgia Impact
Questionnaire (FIQ) and visual analog scales (VAS), tender point
(TP) count and algometric index. Sleep outcome parameters were
VAS scores for sleep quality and polysomnographic (PSG)
parameters. Secondary outcomes were VAS scores for distress and
marital relationship and coping strategies adopted by OSA wives.
Clinical assessment and PSG scoring were conducted blindly.
RESULTS: After controlling for age and menopausal status, OSA
wives exhibited lower sleep quality and higher distress scores
than controls (p<0.05, all). Increase in pain threshold (TP
count and algometric index) and in FIQ score were also observed,
and in their PSG, there was an increase in awaken period and
stage 1 amount during sleep, as well as in alpha power during
slow wave sleep (p<0.05, all). These sleep parameters had
substantial correlation with tiredness and poor sleep quality
and were moderately correlated to pain assessments and distress
scores. CONCLUSION: Thus, independently of age and menopausal
status of the group, wives of OSA patients exhibited an increase
in pain threshold, distress and impaired sleep in comparison to
controls
(71) Eyigor S,
Karapolat H, Korkmaz OK, Eyigor C, Durmaz B, Uslu R et al. The
frequency of fibromyalgia syndrome and quality of life in
hospitalized cancer patients. Eur J Cancer Care (Engl ) 2009;
18(2):195-201.
Abstract: To explore the frequency of fibromyalgia syndrome
(FMS) among hospitalized cancer patients and address the
relationships between pain, fatigue and quality of life with
regard to the extent of pain, a cross-sectional and descriptive
study was carried out in the Oncology Supportive Care Unit on
122 hospitalized cancer patients. Pain, sleep, disease impact
(Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue
Inventory), quality of life (Short Form 36 and European
Organization for Research on Treatment of Cancer questionnaires
Quality of Life-C30) were gathered using standardized measures.
Thirteen of the hospitalized cancer patients (10.7%) included in
the study were diagnosed with FMS. There were no statistically
significant differences among three pain groups with respect to
demographic characteristics (P > 0.05). There were significant
differences among groups with regard to the presence of
metastasis, fatigue, sleep disorder, pain, Brief Fatigue
Inventory, Fibromyalgia Impact Questionnaire, most of subscores
of Short Form 36 and European Organization for Research on
Treatment of Cancer questionnaires Quality of Life-C30 scores (P
< 0.05). In the present study, we have calculated the frequency
of FMS among patients admitted to the oncology hospital in
addition to establishing the relationships between pain, fatigue
and quality of life with regard to the extent of pain. We
believe that the descriptive data presented in this study would
be helpful in future studies and therapeutic approaches
(72) Stutts LA,
Robinson ME, McCulloch RC, Banou E, Waxenberg LB, Gremillion HA
et al. Patient-centered outcome criteria for successful
treatment of facial pain and fibromyalgia. J Orofac Pain 2009;
23(1):47-53.
Abstract: AIMS: To define treatment success from the facial pain
and fibromyalgia pain patient perspective across four domains
(pain, fatigue, emotional distress, interference with daily
activities) through the use of the Patient-Centered Outcomes
(PCO) Questionnaire. METHODS: Participants included 53 facial
pain (46 women, seven men) and 52 fibromyalgia (49 women, three
men) patients who completed the PCO Questionnaire. The PCO
assesses four relevant domains of chronic pain: pain, fatigue,
distress, and interference in daily activities. Participants
rated their usual levels, expected levels, levels they
considered successful improvements, and how important
improvements were in each of the four domains following
treatment. Repeated-measures analyses of variance were performed
to determine whether differences existed across domains and
across pain groups. RESULTS: Both groups of participants defined
treatment success as a substantial decrease in their pain,
fatigue, distress, and interference ratings (all approximately
60%). Fibromyalgia participants reported high levels of pain
(mean = 7.08, SD = 2.04), fatigue (mean = 7.82, SD = 1.71),
distress (mean = 6.35, SD = 2.46), and interference (mean =
7.35, SD = 2.21). Facial pain participants' ratings of these
domains were significantly lower for pain (mean = 5.62, SD =
2.38), fatigue (mean = 5.28, SD = 2.64), distress (mean = 4.34,
SD = 2.78), and interference (mean = 4.10, SD = 3.06).
CONCLUSION: These results demonstrate the high expectations of
individuals with facial pain and fibromyalgia regarding
treatment of their symptoms. Health care providers should
incorporate these expectations into their treatment plans and
discuss realistic treatment goals with their pain patients
(73)
Hincapie-Zapata ME, Suarez-Escudero JC, Pineda-Tamayo R, Anaya
JM. [Quality of life in multiple sclerosis and other chronic
autoimmune and non-autoimmune diseases]. Rev Neurol 2009;
48(5):225-30.
Abstract: INTRODUCTION: Diseases that involve the nervous system
and the musculoskeletal system are particularly likely to
produce different limitations and deficits, and to affect the
individual conception of quality of life. AIM: To determine the
impact on quality of life generated by chronic autoimmune
diseases like multiple sclerosis (MS), rheumatoid arthritis
(RA), systemic lupus erythematosus (SLE), Sjogren's syndrome
(SS), ankylosing spondylitis (AS) and chronic musculotendinous
diseases like osteoarthritis (OA) and fibromyalgia (FM), using
the Short Form 36-item (SF-36) health questionnaire. PATIENTS
AND METHODS: A descriptive cross-sectional study was conducted
between January 2004 and June 2006 and included 509 individuals,
of whom 56 had MS, 36 SS, 24 AS, 200 RA, 65 SLE, 54 OA and 74
FM. Guided interviews were conducted to evaluate each sphere of
the SF-36 health questionnaire. The statistical analysis was
performed using the general lineal model, with means differences
according to each diagnosis. RESULTS: Compared to patients with
RA, those with MS showed significant differences in the physical
functioning and social functioning dimensions. The lowest score
was recorded in those with FM, except in physical functioning,
where MS had the lowest mean. No differences were found in the
mean scores on general conception of the state of health in each
condition analysed. CONCLUSIONS: Different neurological
functions deteriorate progressively in MS, which has
repercussions on the musculoskeletal system; this leads to a
poorer quality of life, mainly in the physical and social
functions. The disability generated is not only defined by
deficit but also by the degrees of functional limitation within
the context of personal health. Quality of life thus becomes a
global biopsychosocial phenomenon
(74) Schafranski
MD, Malucelli T, Machado F, Takeshi H, Kaiber F, Schmidt C et
al. Intravenous lidocaine for fibromyalgia syndrome: an open
trial. Clin Rheumatol 2009; 28(7):853-5.
Abstract: Fibromyalgia is a disorder characterized by chronic
widespread pain. In this study, we investigated the effect of
intravenous infusions of lidocaine in pain and quality of life
of patients with fibromyalgia. Twenty-three consecutive patients
were included in the study, which consisted on five sequential
intravenous 2% lidocaine infusions with rising dosages (2-5
mg/kg, days 1-5). Fibromyalgia Impact Questionnaire (FIQ),
Health Assessment Questionnaire, and a visual analog scale (VAS)
for pain were applied before the first lidocaine infusion,
immediately after the fifth infusion and 30 days after the fifth
infusion. A significant improvement was observed in the FIQ
scores after the fifth infusion (73.52 +/- 16.56 vs 63.29 +/-
21.21, p = 0.02), which was maintained after 30 days (73.52 +/-
16.56 vs 63.85 +/- 24.59, p = 0.04). Similar results were seen
concerning the VAS: 8.19 +/- 1.76 vs 6.84 +/- 2.44, p = 0.01 and
8.19 +/- 1.76 vs 7.17 +/- 2.35, p = 0.05, respectively.
Intravenous lidocaine infusions are safe and effective in the
management of fibromyalgia
(75) Ali A, Njike
VY, Northrup V, Sabina AB, Williams AL, Liberti LS et al.
Intravenous micronutrient therapy (Myers' Cocktail) for
fibromyalgia: a placebo-controlled pilot study. J Altern
Complement Med 2009; 15(3):247-57.
Abstract: OBJECTIVES: Intravenous micronutrient therapy (IVMT),
and specifically the Myers' Cocktail, is a popular approach for
treating fibromyalgia syndrome (FMS) among complementary and
alternative medicine practitioners, but its efficacy is
uncertain. This trial assessed the feasibility, safety, and
provided insights into the efficacy of this therapy. DESIGN:
This was a randomized, double-blind, placebo-controlled pilot
study. LOCATIONS: The study locations were an academic research
center, teaching hospital, and affiliated Integrative Medicine
Center in Derby, CT. SUBJECTS: The subjects were 34 adults with
American College of Rheumatology (ACR)-defined FMS.
INTERVENTION: Subjects were randomly assigned either to
treatment (weekly infusions of IVMT) or to placebo (weekly
infusions of lactated Ringer's solution) for 8 weeks. OUTCOME
MEASURES: Primary outcome was change in the Tender Point Index,
assessed 8 and 12 weeks after initiation. Secondary measures
included a Visual Analog Scale to assess global pain, and
validated measures of physical function (Fibromyalgia Impact
Questionnaire), mood (Beck Depression Index), and quality of
life (Health Status Questionnaire 2.0). RESULTS: Clinically
significant improvements were noted (of a magnitude similar to
other effective interventions). However, in part because of the
high placebo response and the small sample size, no
statistically significant differences were seen between groups,
in any outcome measure, at 8 and 16 weeks. Statistically
significant within-group differences were seen in both the
intervention and placebo groups, demonstrating a treatment
effect for both IVMT and placebo. At 8 weeks, the IVMT group
experienced significantly improved tender points, pain,
depression, and quality of life directly following treatment
(all p < or = 0.02), while the placebo group experienced
significantly improved tender points only (p < or = 0.05). The
treatment effects of IVMT persisted at 4 weeks postintervention
for tender points, pain, and quality of life, while placebo
effects persisted only for tender points. A single minor adverse
event was noted in one subject in the intervention group.
CONCLUSIONS: This first controlled pilot study established the
safety and feasibility of treating FMS with IVMT. Most subjects
experienced relief as compared to baseline, but no statistically
significant differences were seen between IVMT and placebo. The
efficacy of IVMT for fibromyalgia, relative to placebo, is as
yet uncertain
(76) Panton LB,
Figueroa A, Kingsley JD, Hornbuckle L, Wilson J, St JN et al.
Effects of resistance training and chiropractic treatment in
women with fibromyalgia. J Altern Complement Med 2009;
15(3):321-8.
Abstract: OBJECTIVE: The objective of this study was to evaluate
resistance training (RES) and RES combined with chiropractic
treatment (RES-C) on fibromyalgia (FM) impact and functionality
in women with FM. DESIGN: The design of the study was a
randomized control trial. SETTING: Testing and training were
completed at the university and chiropractic treatment was
completed at chiropractic clinics. PARTICIPANTS: Participants
(48 +/- 9 years; mean +/- standard deviation) were randomly
assigned to RES (n = 10) or RES-C (n = 11). INTERVENTION: Both
groups completed 16 weeks of RES consisting of 10 exercises
performed two times per week. RES-C received RES plus
chiropractic treatment two times per week. OUTCOME MEASURES:
Strength was assessed using one repetition maximum for the chest
press and leg extension. FM impact was measured using the FM
impact questionnaire, myalgic score, and the number of active
tender points. Functionality was assessed using the 10-item
Continuous Scale Physical Functional Performance test. Analyses
of variance with repeated measures compared groups before and
after the intervention. RESULTS: Six (6) participants
discontinued the study: 5 from RES and 1 from RES-C. Adherence
to training was significantly higher in RES-C (92.0 +/- 7.5%)
than in RES (82.8 +/- 7.5%). Both groups increased (p < or =
0.05) upper and lower body strength. There were similar
improvements in FM impact in both groups. There were no group
interactions for the functionality measures. Both groups
improved in the strength domains; however, only RES-C
significantly improved in the pre- to postfunctional domains of
flexibility, balance and coordination, and endurance.
CONCLUSIONS: In women with FM, resistance training improves
strength, FM impact, and strength domains of functionality. The
addition of chiropractic treatment improved adherence and
dropout rates to the resistance training and facilitated greater
improvements in the domains of functionality
(77) Ekici G,
Bakar Y, Akbayrak T, Yuksel I. Comparison of manual lymph
drainage therapy and connective tissue massage in women with
fibromyalgia: a randomized controlled trial. J Manipulative
Physiol Ther 2009; 32(2):127-33.
Abstract: OBJECTIVE: This study analyzed and compared the
effects of manual lymph drainage therapy (MLDT) and connective
tissue massage (CTM) in women with primary fibromyalgia (PFM).
METHODS: The study design was a randomized controlled trial.
Fifty women with PFM completed the study. The patients were
divided randomly into 2 groups. Whereas 25 of them received
MLDT, the other 25 underwent CTM. The treatment program was
carried out 5 times a week for 3 weeks in each group. Pain was
evaluated by a visual analogue scale and algometry. The
Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health
Profile were used to describe health status and health-related
quality of life (HRQoL). Wilcoxon signed rank test and
Mann-Whitney U test were used to analyze the data. RESULTS: In
both groups, significant improvements were found regarding pain
intensity, pain pressure threshold, and HRQoL (P < .05).
However, the scores of FIQ-7 (P = .006), FIQ-9 (P = .006), and
FIQ-total (P = .010) were significantly lower in the MLDT group
than they were in the CTM group at the end of treatment.
CONCLUSIONS: For this particular group of patients, both MLDT
and CTM appear to yield improvements in terms of pain, health
status, and HRQoL. The results indicate that these manual
therapy techniques might be used in the treatment of PFM.
However, MLDT was found to be more effective than CTM according
to some subitems of FIQ (morning tiredness and anxiety) and FIQ
total score. Manual lymph drainage therapy might be preferred;
however, further long-term follow-up studies are needed
(78) Okifuji A,
Bradshaw DH, Olson C. Evaluating obesity in fibromyalgia:
neuroendocrine biomarkers, symptoms, and functions. Clin
Rheumatol 2009; 28(4):475-8.
Abstract: The aim of this study was to investigate the
associations between obesity and fibromyalgia syndrome (FMS).
This study was conducted at the University of Utah Pain
Management and Research Center, Salt Lake City, Utah.
Thirty-eight FMS patients were included in this study.
Neuroendocrine indices (catecholamines, cortisol, C-reactive
protein [CRP], and interleukin-6), symptom measures
(Fibromyalgia Impact Questionnaire), sleep indices (Actigraph),
and physical functioning (treadmill testing) were measured. Body
mass index (BMI) provided the primary indicator of obesity.
Approximately 50% of the patients were obese and an additional
21% were overweight. Strong positive associations were found
between BMI and levels of IL-6 (r=0.52) and epinephrine
(r=0.54), and somewhat weaker associations with cortisol
(r=0.32) and CRP (r=0.37). BMI was also related to maximal heart
rate (r=0.33) and inversely related to distance walked (r=
-0.41). BMI was associated with disturbed sleep: total sleep
time (r= -0.56) and sleep efficiency (r= -0.44). No associations
between self-reported symptoms and BMI were found. This study
provides preliminary evidence suggesting that obesity plays a
role in FMS-related dysfunction
(79) de TM,
Sardaro M, Serpino C, Costantini F, Vecchio E, Prudenzano MP et
al. Fibromyalgia comorbidity in primary headaches. Cephalalgia
2009; 29(4):453-64.
Abstract: Fibromyalgia syndrome (FMS) is a chronic pain
condition of unknown aetiology characterized by diffuse pain and
tenderness at tender points. The aim of the study was to assess
the prevalence and clinical features of FMS in the different
forms of primary headaches, in a tertiary headache centre.
Primary headache patients (n = 217) were selected and submitted
to the Total Tenderness Score, anxiety and depression scales,
Migraine Disability Assessment, allodynia questionnaire, Short
Form 36 Health Survey and the Medical Outcomes Study-Sleep
Scale. In patients with FMS, the Multidimensional Assessment of
Fatigue, the Pain Visual Analog Scale, the Manual Tender Point
Survey and the Fibromyalgia Impact Questionnaire were employed.
FMS was present in 36.4% of patients and prevailed significantly
in tension-type headache and in patients with higher headache
frequency. Headache frequency, pericranial muscle tenderness,
anxiety and sleep inadequacy were especially associated with FMS
comorbidity. In the FMS patients, fatigue and pain at tender
points were significantly correlated with headache frequency.
FMS seems increasingly prevalent with increased headache
frequency, for the facilitation of central sensitization
phenomena favoured by anxiety and sleep disturbances
(80) Pamuk ON,
Donmez S, Cakir N. Increased frequencies of hysterectomy and
early menopause in fibromyalgia patients: a comparative study.
Clin Rheumatol 2009; 28(5):561-4.
Abstract: The objective was to determine the relationship
between symptoms of fibromyalgia (FM) and early menopause and
hysterectomy. We included 115 postmenopausal patients with FM
(mean age 54.6 +/- 7.6) and 67 rheumatoid arthritis (RA)
patients (mean age 55.5 +/- 9) into our study. All patients were
questioned about the severity of their symptoms of FM, anxiety,
and depression by using a visual analog scale and FM impact
questionnaire. Patients' history of menopause and hysterectomy
were recorded. Menopause (<or=45 years) was accepted to be
early. The frequencies of early menopause (38.3% vs. 13.4%, p =
0.001) and hysterectomy (16.5% vs. 6%, p = 0.039) in FM patients
were significantly higher than in RA patients. While chronic
widespread pain and other FM-related symptoms started after
menopause in 58.3% of FM patients, the disease started after
menopause in 64.2% of RA patients (p > 0.05). FM-related
symptoms started in 30 patients (26.1%) with FM with menopause
or within the first postmenopausal year. When the clinical
features of FM patients whose symptoms started within the first
menopausal year were compared to other FM patients; it was
observed that the frequency of early menopause was higher in the
former group (p = 0.048). Duke anxiety and depression score was
higher in patients with hysterectomy whose FM symptoms started
within the first year of post-hysterectomy than other FM
patients (9.1 +/- 2.7 vs. 6.7 +/- 2.7, p = 0.022). Early
menopause and hysterectomy may be one of the factors
contributing to the development of FM
(81) Heredia
Jimenez JM, Aparicio Garcia-Molina VA, Porres Foulquie JM,
Delgado FM, Soto Hermoso VM. Spatial-temporal parameters of gait
in women with fibromyalgia. Clin Rheumatol 2009; 28(5):595-8.
Abstract: The aim of the present study was to determine if there
are differences in such parameters among patients affected by
fibromyalgia (FM) and healthy subjects and whether the degree of
affectation by FM can decrease the gait parameters. We studied
55 women with FM and 44 controls. Gait analysis was performed
using an instrumented walkway for measurement of the kinematic
parameters of gait (GAITRite system), and patients completed a
Spanish version of Fibromyalgia Impact Questionnaire (FIQ).
Significant differences (p < 0.001) between FM and control
groups were found in velocity, stride length, cadence, single
support ratio, double support ratio, stance phase ratio, and
swing phase ratio. There were significant inverse correlations
between FIQ and velocity, stride length, swing phase, and single
support, whereas significant direct correlations were found with
stance phase and double support. Gait parameters of women
affected by FM were severely impaired when compared to those of
healthy women. Different factors such as lack of physical
activity, bradikinesia, overweight, fatigue, and pain together
with a lower isometric force in the legs can be responsible for
the alterations in gait and poorer life quality of women with FM
(82) Weingarten
TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH.
Impact of tobacco use in patients presenting to a
multidisciplinary outpatient treatment program for fibromyalgia.
Clin J Pain 2009; 25(1):39-43.
Abstract: OBJECTIVES: This study examined the relationship
between the severity of fibromyalgia symptoms and current
tobacco use in patients evaluated at a specialized fibromyalgia
treatment program. METHODS: Demographic and clinical data from
984 consecutive patients evaluated at the Mayo Clinic
Fibromyalgia Treatment Program including the Fibromyalgia Impact
Questionnaire (FIQ) were prospectively collected and stored in
an electronic medical record and an electronic database.
Univariate analyses were performed comparing tobacco users and
nonusers. A post-hoc analysis of covariance was conducted for
tobacco use, using group differences of confounding clinical and
demographic variables. A P value < or = 0.05 was accepted as the
level of significance. RESULTS: One hundred and forty-five
patients were identified as tobacco users (14.7%). Tobacco use
was associated with greater pain intensity as measured by pain
scales and the pain component of the FIQ. Tobacco users had a
greater FIQ composite score 70.0(15.1) versus 61.8(16.8),
P<0.001. By univariate analysis, tobacco users had higher scores
on all the FIQ components and fewer good days and more days of
work missed per week. Tobacco use was associated with several
confounding clinical and demographic variables including lower
education, higher unemployment, not being married or widowed,
and history of abuse. After adjusting for these confounding
variables, tobacco users continued to have greater pain
intensity, a higher total and component FIQ scores except for
fatigue. Smoking was not associated with a higher number of
tender points. DISCUSSION: Current tobacco use was associated
with more severe fibromyalgia symptoms in patients presenting to
a specialized fibromyalgia treatment program
(83) Pamuk ON,
Donmez S, Cakir N. The frequency of smoking in fibromyalgia
patients and its association with symptoms. Rheumatol Int 2009;
29(11):1311-4.
Abstract: The objective of the study was to determine the
frequency of smoking in fibromyalgia (FM) and rheumatoid
arthritis (RA) patients and investigate its association with the
symptoms of FM. We included age-matched 302 FM (289 F, 13 M),
and 115 (105 F, 10 M) RA patients. All patients were questioned
about smoking and the severity of their chronic widespread pain
(CWP) and symptoms of FM by using a visual analog scale (VAS,
0-10) and FM impact questionnaire. In addition, patients were
asked questions about depression and anxiety. The frequency of
smoking in FM patients (77 subjects, 25.5%) tended to be higher
than in RA patients (19 subjects, 16.5%) (P = 0.05). When the
features of smoker FM patients were compared to others, it was
observed that the frequencies of subjects with an education
duration >9 years (P < 0.001) and subjects with an history of
psychiatric therapy (P = 0.01) and alcohol consumption (P =
0.013) were higher. The mean age of FM patients with smoking (P
= 0.002) was lower; the duration of FM (P = 0.024) was shorter;
and the scores of CWP severity (P = 0.05), unrestorative
sleepiness (P = 0.017), paresthesia (P = 0.038) and
anxiety-depression (P = 0.007) were higher. An important
proportion of FM patients, nearly one-fourth, were re-smokers.
Smoker FM patients had higher education level, and the severity
of their FM-related symptoms like CWP and their
anxiety-depression scores were higher
(84) Almansa C,
Rey E, Sanchez RG, Sanchez AA, Diaz-Rubio M. Prevalence of
functional gastrointestinal disorders in patients with
fibromyalgia and the role of psychologic distress. Clin
Gastroenterol Hepatol 2009; 7(4):438-45.
Abstract: BACKGROUND & AIMS: Fibromyalgia is a rheumatologic
disorder associated with somatic and psychologic conditions.
Although fibromyalgia is associated with irritable bowel
syndrome, its relationship with other functional
gastrointestinal disorders (FGID) is unclear. We evaluated the
prevalence of FGID in patients with fibromyalgia and the role of
psychologic factors in this relationship. METHODS: From a
Spanish population, 100 patients with fibromyalgia and 100
matched controls completed the Rome II Integrative Questionnaire
to assess the prevalence of FGID and the Symptom Checklist-90
Revised (SCL-90R) to evaluate psychologic distress. Patients
completed the Fibromyalgia Impact Questionnaire to evaluate the
overall impact of fibromyalgia and controls filled out the
Chronic Widespread Pain Questionnaire to detect potential cases
of fibromyalgia. RESULTS: Ninety-three percent of the total
study population was female, with a mean age of 50 years. We
identified 6 cases of widespread pain among controls. The
average Fibromyalgia Impact Questionnaire score for patients was
67.28 +/- 14.25. All gastrointestinal symptoms except for
vomiting were more frequent in patients. Ninety-eight percent of
patients with fibromyalgia had at least one FGID, compared with
only 39% of controls. Fibromyalgia was correlated most highly
with irritable bowel syndrome. Patients presented with
significantly higher scores of psychologic distress than
controls, especially those with fecal incontinence. CONCLUSIONS:
There is a prevalence of FGID in patients with fibromyalgia and
a wider distribution of such symptoms along the gastrointestinal
tract compared with controls. We propose that an increased
degree of psychologic distress in these patients predisposes
them to FGID, especially significant for anorectal syndromes
(85) Jones KD,
Horak FB, Winters-Stone K, Irvine JM, Bennett RM. Fibromyalgia
is associated with impaired balance and falls. J Clin Rheumatol
2009; 15(1):16-21.
Abstract: BACKGROUND/OBJECTIVE: The purpose of this study was to
determine whether fibromyalgia (FM) patients differ from matched
healthy controls in clinical tests of balance ability and fall
frequency. METHODS: Thirty-four FM patients and 32 age-matched
controls were administered the Balance Evaluation-Systems Test
(BESTest), rated their balance confidence with the
Activities-Specific Balance Confidence (ABC) Scale, and reported
the number of falls in the last 6 months. The Fibromyalgia
Impact Questionnaire was used to assess FM severity. RESULTS: FM
patients had significantly impaired balance in all components of
the BESTest compared with controls. They also scored more poorly
on balance confidence. Overall FM severity (Fibromyalgia Impact
Questionnaire) correlated significantly with the BESTest and the
ABC scale. The BESTest and ABC correlated significantly with 6
commonly reported FM symptoms (excluding pain). FM patients
reported a total of 37 falls over the last 6-months compared
with 6 falls in healthy controls. CONCLUSION: FM is associated
with balance problems and increased fall frequency. Patients
were aware of their balance problems. These results suggest that
FM may affect peripheral and/or central mechanisms of postural
control. Further objective study is needed to identify the
relative contributions of various neural and musculoskeletal and
other impairments to postural stability in FM to provide
clinicians with methods to maximize postural stability and help
fall prevention
(86) McParland JL,
Knussen C. Just world beliefs moderate the relationship of pain
intensity and disability with psychological distress in chronic
pain support group members. Eur J Pain 2010; 14(1):71-6.
Abstract: The impact of pain beliefs on coping and adjustment is
well established. However, less is known about how beliefs
unrelated to pain might impact upon this experience. In
particular, just world beliefs could impact upon and be
influenced by chronic pain, given that pain is not experienced
in a vacuum but instead is experienced in a social context where
justice issues are potentially salient. The focus of this study
was the ability of personal and general just world beliefs to
moderate the relationships psychological distress held with pain
intensity and disability in chronic pain. The sample (N=95) was
recruited from members of arthritis and fibromyalgia support
groups to investigate these social beliefs in a controlled
community pain context. A cross-sectional, questionnaire design
was adopted. The personal just world belief was endorsed
significantly more than the general just world belief, and
endorsement of the personal just world belief was negatively
correlated with pain intensity, disability and psychological
distress, while the general just world belief was unrelated to
these variables. When interaction terms relating to personal and
general just world beliefs were entered simultaneously into
regression analyses, the personal just world belief did not
predict psychological distress. However, pain intensity
positively predicted psychological distress at low but not high
levels of the general just world belief, while disability
predicted psychological distress at low and high levels of this
belief. This suggests that a strong general just world belief
has implications for psychological well-being in chronic pain,
and as such this belief may occupy a potential coping function
in this context
(87) Russell IJ,
Perkins AT, Michalek JE. Sodium oxybate relieves pain and
improves function in fibromyalgia syndrome: a randomized,
double-blind, placebo-controlled, multicenter clinical trial.
Arthritis Rheum 2009; 60(1):299-309.
Abstract: OBJECTIVE: To evaluate the safety and efficacy of
sodium oxybate for management of the symptoms of fibromyalgia
syndrome (FMS). METHODS: Patients with FMS (according to the
American College of Rheumatology 1990 criteria) were randomized,
after discontinuing their prestudy medications for FMS, to
receive 4.5 gm or 6 gm of sodium oxybate or matching placebo
once per night for 8 weeks. The primary outcome variable (POV)
was a composite score for changes from baseline in 3 coprimary
self-report measures: patient's pain rating (in daily electronic
diaries) on a visual analog scale (PVAS), the Fibromyalgia
Impact Questionnaire (FIQ) score, and the Patient Global
Impression of Change (PGI-C). A beneficial response rate for the
POV composite score was defined as >or=20% improvement in the
PVAS and FIQ scores plus a rating of "much better" or "very much
better" on the PGI-C. Secondary measures included subjective
sleep outcomes (on the Jenkins Scale for Sleep) and
quality-of-life measures. The analyses were based on an
intent-to-treat (ITT) population. RESULTS: The ITT population
included 188 patients with FMS, 78% of whom completed the trial.
Significant benefit was observed with both dosages of sodium
oxybate, according to changes in the POV and subjective sleep
quality. Improvements in the PVAS score were significantly
correlated with sleep outcomes. Sodium oxybate was well
tolerated overall; dose-related nausea (<or=28% of patients) and
dizziness (<or=18% of patients) tended to resolve with continued
therapy. CONCLUSION: Sodium oxybate therapy was well tolerated
and significantly improved the symptoms of FMS. Further study of
sodium oxybate as a novel therapeutic option for FMS is
warranted
(88) Chappell AS,
Bradley LA, Wiltse C, Detke MJ, D'Souza DN, Spaeth M. A
six-month double-blind, placebo-controlled, randomized clinical
trial of duloxetine for the treatment of fibromyalgia. Int J Gen
Med 2009; 1:91-102.
Abstract: OBJECTIVE: Assess the efficacy of duloxetine 60/120 mg
(N = 162) once daily compared with placebo (N = 168) in the
treatment of patients with fibromyalgia, during six months of
treatment. METHODS: This was a phase-III, randomized,
double-blind, placebo-controlled, parallel-group study assessing
the efficacy and safety of duloxetine. RESULTS: There were no
significant differences between treatment groups on the
co-primary efficacy outcome measures, change in the Brief Pain
Inventory (BPI) average pain severity from baseline to endpoint
(P = 0.053) and the Patient's Global Impressions of Improvement
(PGI-I) at endpoint (P = 0.073). Duloxetine-treated patients
improved significantly more than placebo-treated patients on the
Fibromyalgia Impact Questionnaire pain score, BPI least pain
score and average interference score, Clinical Global
Impressions of Severity scale, area under the curve of pain
relief, Multidimensional Fatigue Inventory mental fatigue
dimension, Beck Depression Inventory-II total score, and 36-item
Short Form Health Survey mental component summary and mental
health score. Nausea was the most common treatment-emergent
adverse event in the duloxetine group. Overall discontinuation
rates were similar between groups. CONCLUSIONS: Although
duloxetine 60/120 mg/day failed to demonstrate significant
improvement over placebo on the co-primary outcome measures, in
this supportive study, duloxetine demonstrated significant
improvement compared with placebo on numerous secondary measures
(89) Chung CP,
Titova D, Oeser A, Randels M, Avalos I, Milne GL et al.
Oxidative stress in fibromyalgia and its relationship to
symptoms. Clin Rheumatol 2009; 28(4):435-8.
Abstract: Oxidative stress is thought to play a role in the
pathogenesis of fibromyalgia. We examined the hypothesis that
oxidative stress was increased in patients with fibromyalgia and
related to the severity of symptoms. Urinary F(2)-isoprostane
excretion was measured in 48 patients with fibromyalgia and
compared to those of 96 control subjects. In patients, we
examined the association between oxidative stress and symptoms.
Patients with fibromyalgia were significantly more symptomatic
than control subjects, but urinary F(2)-isoprostane excretion
did not differ significantly (2.3+/-1.9 vs. 2.8+/-2.2 ng/mg
creatinine, p=0.16). In patients with fibromyalgia,
F(2)-isoprostane excretion was associated with fatigue visual
analog scale (rho=0.30, p=0.04) but not with pain, quality of
life, functional capacity, depression, number of tender points,
or overall impact of fibromyalgia. Oxidative stress is not
increased in patients with fibromyalgia, but as was previously
found in patients with systemic lupus erythematosus, oxidative
stress was associated with fatigue
(90) Altomonte L,
Atzeni F, Leardini G, Marsico A, Gorla R, Casale R et al.
Fibromyalgia syndrome: preventive, social and economic aspects.
Reumatismo 2008; 60 Suppl 1:70-8.
Abstract: There many open questions concerning the concept of
primary prevention in FM. Diagnostic or classification criteria
are not universally accepted, and this leads to difficulties in
establishing the onset and duration of the disease. In the case
of FM, primary prevention may consist of the immediate care of
acute pain or treatment for affective disturbances as we do not
have any specific laboratory or instrumental tests to determine
risk factors of the disease. The goal of secondary prevention is
early detection of the disease when patients are largely
asymptomatic and intervention improves outcome. Screening allows
for identification of an unrecognized disease or risk factor,
which, for potential FM patients, includes analysis of tender
points, Fibromyalgia Impact Questionnaire (FIQ), pain location
and intensity, and fatigue and sleep complaints. Tertiary
prevention inhibits further deterioration or reduces
complications after the disease has developed. In FM the aim of
treatment is to decrease pain and increase function via
multimodal therapeutic strategies, which, in most cases,
includes pharmacological and non-pharmacological interventions.
Patients with FM are high consumers of health care services, and
FM is associated with significant productivity-related costs.
The degree of disability and the number of comorbidities are
strongly associated with costs. An earlier diagnosis of FM can
reduce referral costs and investigations, thus, leading to a net
savings for the health care sector. However, every social
assessment is closely related to the socio-economic level of the
general population and to the legislation of the country in
which the FM patient resides
(91)
Munguia-Izquierdo D, Legaz-Arrese A. Assessment of the effects
of aquatic therapy on global symptomatology in patients with
fibromyalgia syndrome: a randomized controlled trial. Arch Phys
Med Rehabil 2008; 89(12):2250-7.
Abstract: OBJECTIVES: To evaluate the effects of a 16-week
exercise therapy in a chest-high pool of warm water through
applicable tests in the clinical practice on the global
symptomatology of women with fibromyalgia (FM) and to determine
exercise adherence levels. DESIGN: A randomized controlled
trial. SETTING: Testing and training were completed at the
university. PARTICIPANTS: Middle-aged women with FM (n=60) and
healthy women (n=25). INTERVENTION: A 16-week aquatic training
program, including strength training, aerobic training, and
relaxation exercises. MAIN OUTCOME MEASURES: Tender point count
(syringe calibrated), health status (Fibromyalgia Impact
Questionnaire); sleep quality (Pittsburgh Sleep Quality Index);
physical (endurance strength to low loads tests), psychologic
(State Anxiety Inventory), and cognitive function (Paced
Auditory Serial Addition Task); and adherence 12 months after
the completion of the study. RESULTS: For all the measurements,
the patients showed significant deficiencies compared with the
healthy subjects. Efficacy analysis (n=29) and intent-to-treat
analysis (n=34) of the exercise therapy was effective in
decreasing the tender point count and improving sleep quality,
cognitive function, and physical function. Anxiety remained
unchanged during the follow-up. The exercise group had a
significant improvement of health status, not associated
exclusively with the exercise intervention. There were no
changes in the control group. Twenty-three patients in the
exercise group were exercising regularly 12 months after
completing the program. CONCLUSIONS: An exercise therapy 3 times
a week for 16 weeks in a warm pool could improve most of the
symptoms of FM and cause a high adherence to exercise in unfit
women with heightened FM symptomatology. The therapeutic
intervention's effects can be assessed through applicable tests
in the clinical practice
(92) Nicholl BI,
Macfarlane GJ, Davies KA, Morriss R, Dickens C, McBeth J.
Premorbid psychosocial factors are associated with poor
health-related quality of life in subjects with new onset of
chronic widespread pain - results from the EPIFUND study. Pain
2009; 141(1-2):119-26.
Abstract: Chronic widespread pain (CWP) is associated with poor
health-related quality of life (HRQoL). It is unclear whether
pain itself is the cause of poor HRQoL or other factors play a
role. We hypothesised that new onset of CWP was associated with
poor physical and mental HRQoL but that psychosocial risk
markers for CWP onset would explain this relationship. A
prospective population-based survey measured pain and
psychosocial status at baseline. Subjects free of CWP at
baseline were followed up 15 months later, when pain status,
threatening life events and HRQoL (SF-12) were assessed. The
risk associated with the new onset of CWP and reporting poor
SF12-MCS and SF12-PCS was quantified using multinomial logistic
regression (relative risk ratios (RRRs) with 95% confidence
intervals (95% CI)), adjusted for age and gender. 3000 subjects
(77%) free of CWP at baseline participated at follow-up. 2650
subjects (88%) provided full SF-12 and pain data and formed the
cohort for this analysis. 9.4% of subjects (n=248) reported new
CWP. New CWP was associated with an increased risk of having the
poorest SF12-MCS (RRR=2.3; 95% CI 1.6-3.2) and SF12-PCS
(RRR=8.0; 95% CI 5.4-11.8) scores. After adjusting for baseline
psychosocial status, the relationship between CWP onset and
SF12-MCS was attenuated (RRR=1.2; 95% CI 0.8-1.8), although the
association with SF12-PCS remained (RRR=4.8% CI 3.1-7.47). New
onset of CWP is associated with poor mental and physical HRQoL.
However, the relationship with mental HRQoL is explained by
psychosocial risk markers
(93)
Wahner-Roedler DL, Thompson JM, Luedtke CA, King SM, Cha SS,
Elkin PL et al. Dietary Soy Supplement on Fibromyalgia Symptoms:
A Randomized, Double-blind, Placebo-controlled, Early Phase
Trial. Evid Based Complement Alternat Med 2008.
Abstract: Most patients with fibromyalgia use complementary and
alternative medicine (CAM). Properly designed controlled trials
are necessary to assess the effectiveness of these practices.
This study was a randomized, double-blind, placebo-controlled,
early phase trial. Fifty patients seen at a fibromyalgia
outpatient treatment program were randomly assigned to a daily
soy or placebo (casein) shake. Outcome measures were scores of
the Fibromyalgia Impact Questionnaire (FIQ) and the Center for
Epidemiologic Studies Depression Scale (CES-D) at baseline and
after 6 weeks of intervention. Analysis was with standard
statistics based on the null hypothesis, and separation test for
early phase CAM comparative trials. Twenty-eight patients
completed the study. Use of standard statistics with
intent-to-treat analysis showed that total FIQ scores decreased
by 14% in the soy group (P = 0.02) and by 18% in the placebo
group (P<0.001). The difference in change in scores between the
groups was not significant (P = 0.16). With the same analysis,
CES-D scores decreased in the soy group by 16% (P = 0.004) and
in the placebo group by 15% (P = 0.05). The change in scores was
similar in the groups (P = 0.83). Results of statistical
analysis using the separation test and intent-to-treat analysis
revealed no benefit of soy compared with placebo. Shakes that
contain soy and shakes that contain casein, when combined with a
multidisciplinary fibromyalgia treatment program, provide a
decrease in fibromyalgia symptoms. Separation between the
effects of soy and casein (control) shakes did not favor the
intervention. Therefore, large-sample studies using soy for
patients with fibromyalgia are probably not indicated
(94) Alentorn-Geli
E, Padilla J, Moras G, Lazaro HC, Fernandez-Sola J. Six weeks of
whole-body vibration exercise improves pain and fatigue in women
with fibromyalgia. J Altern Complement Med 2008; 14(8):975-81.
Abstract: OBJECTIVE: The aim of this study was to investigate
the effectiveness of a 6-week traditional exercise program with
supplementary whole-body vibration (WBV) in improving health
status, physical functioning, and main symptoms of fibromyalgia
(FM) in women with FM. METHODS: Thirty-six (36) women with FM
(mean +/- standard error of the mean age 55.97 +/- 1.55) were
randomized into 3 treatment groups: exercise and vibration
(EVG), exercise (EG), and control (CG). Exercise therapy,
consisting of aerobic activities, stretching, and relaxation
techniques, was performed twice a week (90 min/day). Following
each exercise session, the EVG underwent a protocol with WBV,
whereas the EG performed the same protocol without vibratory
stimulus. The Fibromyalgia Impact Questionnaire (FIQ) was
administered at baseline and 6 weeks following the initiation of
the treatments. Estimates of pain, fatigue, stiffness, and
depression were also reported using the visual analogue scale.
RESULTS: A significant 3 x 2 (group x time)-repeated measures
analysis of variance interaction was found for pain (p = 0.018)
and fatigue (p = 0.002) but not for FIQ (p = 0.069), stiffness
(p = 0.142), or depression (p = 0.654). Pain and fatigue scores
were significantly reduced from baseline in the EVG, but not in
the EG or CG. In addition, the EVG showed significantly lower
pain and fatigue scores at week 6 compared to the CG, whereas no
significant differences were found between the EG and CG (p >
0.05). CONCLUSION: Results suggest that a 6-week traditional
exercise program with supplementary WBV safely reduces pain and
fatigue, whereas exercise alone fails to induce improvements
(95) van Wilgen
CP, van Ittersum MW, Kaptein AA, van WM. Illness perceptions in
patients with fibromyalgia and their relationship to quality of
life and catastrophizing. Arthritis Rheum 2008; 58(11):3618-26.
Abstract: OBJECTIVE: In the last decade, illness perceptions
have been identified as important in the treatment of
fibromyalgia (FM). The aim of the present study was to examine
illness perceptions and use of the revised Illness Perception
Questionnaire in patients with FM (IPQ-R-FM) and their
relationship to quality of life and catastrophizing. METHODS: A
domain with specific causal attributions related to FM was added
to the IPQ-R-FM. The psychometric properties of the IPQ-R-FM
dimensions and attribution scales were examined. The causal
domain, in which patients describe the most important perceived
causes for their FM, was analyzed. To analyze the relationship
with quality of life and catastrophizing, the Fibromyalgia
Impact Questionnaire and the Pain Catastrophizing Scale were
used. RESULTS: Fifty-one outpatients completed the
questionnaires on 2 occasions, 3 weeks apart. FM was considered
to be chronic and to have serious consequences; patients
perceived little personal control and did not expect medical
treatment to be effective. The psychometric properties of the
IPQ-R-FM were found to be adequate. Patients most frequently
attributed the causes of FM to an external somatic source (58%).
Quality of life was related to experiencing more consequences
attributable to FM. Catastrophizing was related to a limited
understanding of the symptoms of FM, the more cyclical nature of
FM, and an emotional representation. CONCLUSION: The IPQ-R-FM is
a useful tool to assess illness perceptions in patients with FM.
Illness perceptions are related to quality of life and
catastrophizing; therefore, it seems important to assess and
integrate illness perceptions into the management of patients
with FM
(96) Guedj E,
Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP et al.
Clinical correlate of brain SPECT perfusion abnormalities in
fibromyalgia. J Nucl Med 2008; 49(11):1798-803.
Abstract: The purpose of this study was to investigate the
specific clinical correlate of brain SPECT perfusion
abnormalities reported in fibromyalgia. METHODS: We performed a
whole-brain voxel-based correlation analysis involving regional
cerebral blood flow and various parameters related to pain
(Visual Analog Scale, Tubingen Pain Behavior Scale, and
Questionnaire Douleur de Saint-Antoine Scale), disability
(Fibromyalgia Impact Questionnaire [FIQ]), and anxiety and
depression status (Hospital Anxiety and Depression scale) in 20
patients with fibromyalgia (P voxel < 0.005). Ten healthy
control women were also included, in order to determine areas of
significant hypo- and hyperperfusions in patients. RESULTS: FIQ
total score was positively correlated with bilateral parietal
perfusion, including postcentral cortex. These clusters of
correlation were included in the areas of significant
hyperperfusion. FIQ total score was also negatively correlated
with perfusion of a left anterior temporal cluster, included in
the areas of significant hypoperfusions. No other clinical
correlation was observed with regional cerebral blood flow.
CONCLUSION: These results show that brain perfusion
abnormalities in patients with fibromyalgia are correlated with
the clinical severity of the disease
(97) Sendur OF,
Turan Y, Tastaban E, Yenisey C, Serter M. Serum antioxidants and
nitric oxide levels in fibromyalgia: a controlled study.
Rheumatol Int 2009; 29(6):629-33.
Abstract: We proposed to assess antioxidant status and nitric
oxide in fibromyalgia (FM) patients in comparison to healthy
controls. Additionally, the association between the serum
antioxidant levels and clinical findings in FM patients was also
investigated. Thirty-seven FM patients and 37 healthy controls
were enrolled in this study. Severity of fatigue and pain were
determined by Visual Analogue Scale. Functional capacity in
daily living activities was evaluated by fibromyalgia impact
questionnaire. Serum NO, catalase and glutathione were measured.
Serum glutathione and catalase levels were significantly lower
in FM patients than controls. However, no significant difference
was seen in serum NO levels between the two groups. A
significant correlation was evident between serum NO level and
pain. Additionally, the correlation between glutathione level
and morning stiffness was found to be significant. These
findings support other studies, we assume that these two
antioxidants might have impact on the pathogenesis of FM disease
(98) Ryan S, Hill
J, Thwaites C, Dawes P. Assessing the effect of fibromyalgia on
patients' sexual activity. Nurs Stand 2008; 23(2):35-41.
Abstract: AIMS: The primary aim of this study was to investigate
whether a questionnaire developed for patients with rheumatoid
arthritis (RA) could also be used with patients who have
fibromyalgia. A secondary aim was to assess the impact of
fibromyalgia on sexuality. METHOD: In the first of two phases
the face and content validity of a sexuality questionnaire
already being used in patients with RA were assessed in a
qualitative, audio-taped, interview study of five patients with
fibromyalgia. The second phase consisted of a self-report
questionnaire distributed to 60 patients with fibromyalgia.
FINDINGS: The interview data confirmed that the content of the
RA sexuality questionnaire was relevant to patients with
fibromyalgia. A total of 43 (72%) questionnaires were returned
and, of these, 41 (95%) were usable. Patients reported that
fibromyalgia had altered their sexual relationship. They cited
pain, stiffness, fatigue, reduced sexual drive and the impact of
drug therapy as the main reasons. CONCLUSION: The symptoms
associated with fibromyalgia had a negative effect on sexual
enjoyment. The questionnaire appears to be useful in addressing
sexuality in patients with fibromyalgia
(99) de Souza JB,
Goffaux P, Julien N, Potvin S, Charest J, Marchand S.
Fibromyalgia subgroups: profiling distinct subgroups using the
Fibromyalgia Impact Questionnaire. A preliminary study.
Rheumatol Int 2009; 29(5):509-15.
Abstract: The main goal of this project was to identify the
presence of fibromyalgia (FM) subgroups using a simple and
frequently used clinical tool, the Fibromyalgia Impact
Questionnaire (FIQ). A total of 61 women diagnosed with FM
participated in this study. FM subgroups were created by
applying a hierarchical cluster analysis on selected items of
the FIQ (pain, fatigue, morning tiredness, stiffness, anxiety
and depressive symptoms). We also tested for group differences
on experimental pain, psychosocial functioning and demographic
characteristics. Two cluster profiles best fit our data. FM-Type
I was characterized by the lowest levels of anxiety, depressive
and morning tiredness symptoms, while FM-Type II was
characterized by elevated levels of pain, fatigue, morning
tiredness, stiffness, anxiety and depressive symptoms. Both FM
subgroups showed hyperalgesic responses to experimental pain.
These results suggest that pain and stiffness are universal
symptoms of the disorder but that psychological distress is a
feature present only in some patients
(100) Orellana C,
Casado E, Masip M, Galisteo C, Gratacos J, Larrosa M. Sexual
dysfunction in fibromyalgia patients. Clin Exp Rheumatol 2008;
26(4):663-6.
Abstract: OBJECTIVE: To investigate the prevalence of sexual
dysfunction in female patients with fibromyalgia (FM), the
impact of FM on sexual activity and the factors associated with
sexual dysfunction in these patients. METHODS: Thirty-one
consecutive women with FM were enrolled; two groups of 20
aged-matched healthy women and 26 patients with rheumatoid
arthritis (RA) were used as controls. Demographic features were
recorded in all patients. A cross-sectional analysis of pain
(100-mm VAS scale), anxiety and depression (as determined by the
STAI and Beck Depression Inventory scales, respectively) was
performed. Sexual function was assessed by the Changes in Sexual
Functioning Questionnaire (CSFQ). RESULTS: FM and RA patients
showed a significantly higher rate of sexual dysfunction
compared to healthy controls. Sexual dysfunction was more
frequent among FM patients (97%) than in RA patients (84%) but
without statistical differences. A univariate analysis showed
that age (p=0.0002), marital (p=0.036) and work status
(p=0.048), pain intensity (p=0.007), level of anxiety (p=0.002),
level of depression (p=0.0005), were significantly associated
with sexual dysfunction in FM. However, only the intensity of
depression was associated with the sexual dysfunction in
patients with FM in the multivariate analysis (p=0.012).
CONCLUSIONS: Sexual function was very frequently and severely
affected in patients with FM and this impairment appeared to be
particularly associated with the degree of depression. The
recognition of this dysfunction and its inclusion for the
multidisciplinary management of FM may contribute to improve
quality of life of these patients
(101) Wood PB,
Ledbetter CR, Glabus MF, Broadwell LK, Patterson JC. Hippocampal
metabolite abnormalities in fibromyalgia: correlation with
clinical features. J Pain 2009; 10(1):47-52.
Abstract: Although the pathology of fibromyalgia is poorly
understood, a growing body of evidence suggests involvement of
the central nervous system. The hippocampus is a brain center
that is sensitive to the effects of stress exposure and has been
demonstrated to be affected in a variety of disorders whose
onset, like fibromyalgia, are associated with stressful
experience. We therefore interrogated the bilateral hippocampus
of 16 female fibromyalgia patients in comparison to 8 age- and
gender-matched healthy control subjects using single voxel
proton magnetic resonance spectroscopy. Our results demonstrate
a significant reduction in the ratio of N-acetylaspartate to
creatine (NAA/Cr) in fibromyalgia patients versus matched
control subjects specifically in the right temporal lobe from a
voxel centered on the right hippocampus (patient vs control,
mean +/- standard deviation: 1.20 +/- 0.13 vs 1.34 +/- 0.10, P =
.03). Moreover, correlation analysis demonstrated a significant
negative correlation between patient scores on the Fibromyalgia
Impact Questionnaire and NAA/Cr ratio within the right
hippocampus (Spearman rank correlation, rho = -0.681, P = .018).
Our results indicate that fibromyalgia is associated with brain
metabolite abnormalities within the right hippocampus that
correlate with patient symptoms. PERSPECTIVE: We have
demonstrated an abnormality in hippocampal brain metabolites in
premenopausal female fibromyalgia patients with no psychiatric
comorbidity. A significant negative correlation between patient
subjective experience of symptoms and a reduced NAA/Cr ratio
suggests a role for hippocampal pathology in fibromyalgia
(102) Ablin JN,
Beilinson N, Aloush V, Elkayam O, Finkelstein A. Association
between fibromyalgia and coronary heart disease and coronary
catheterization. Clin Cardiol 2009; 32(6):E7-11.
Abstract: BACKGROUND: Fibromyalgia (FM) has been associated with
physical and emotional trauma including invasive medical
procedures. Both FM and ischemic heart disease have been linked
with depression. The purpose of this study was to
retrospectively investigate the frequency of FM symptoms and
physical findings among patients undergoing coronary
catheterization. METHODS: Consecutive patients who underwent
coronary angiography during the previous 6 mo were recruited.
Patients with major depression, bi-polar disorder,
schizophrenia, or malignancy were excluded. Patients underwent
dolorimetry for tender-point assessment and completed the
fibromyalgia impact questionnaire (FIQ). Group A included
patients with significant coronary pathology (n = 43), group B
included patients with normal coronary arteries (n = 50), and
group C included patients with normal controls (n = 51). A
cardiological score incorporated the number of coronary arteries
with significant pathology and left ventricular function.
Chi-square or Fisher's exact test was used for categorical data
and a one-way analysis of variance for continuous variables; a
multivariate linear regression was performed to compare groups.
RESULTS: Significantly increased levels of tenderness were
discovered among patients with coronary pathology compared with
healthy controls. Significantly increased levels of depression
were also found, as well as higher scores on the FIQ scale. On
multivariate analysis, a positive correlation was demonstrated
between tenderness/FIQ scores and a composite cardiological
score. CONCLUSION: Coronary angiography is associated with a
significantly increased frequency of pain, tenderness, and
depression after 6 mo, apparent in both patients undergoing
coronary procedures and patients with normal coronaries. This
association may impact the outcome of patients with significant
coronary disease
(103) Matsushita K,
Masuda A, Tei C. Efficacy of Waon therapy for fibromyalgia.
Intern Med 2008; 47(16):1473-6.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) is a chronic
syndrome characterized by widespread pain with tenderness in
specific areas. We examined the applicability of Waon therapy
(soothing warmth therapy) as a new method of pain treatment in
patients with FMS. METHODS: Thirteen female FMS patients (mean
age, 45.2+/-15.5 years old; range, 25-75) who fulfilled the
criteria of the American College of Rheumatology participated in
this study. Patients received Waon therapy once per day for 2 or
5 days/week. The patients were placed in the supine or sitting
position in a far infrared-ray dry sauna maintained at an even
temperature of 60 degrees C for 15 minutes, and then transferred
to a room maintained at 26-27 degrees C where they were covered
with a blanket from the neck down to keep them warm for 30
minutes. Reductions in subjective pain and symptoms were
determined using the pain visual analog scale (VAS) and
fibromyalgia impact questionnaire (FIQ). RESULTS: All patients
experienced a significant reduction in pain by about half after
the first session of Waon therapy (11-70%), and the effect of
Waon therapy became stable (20-78%) after 10 treatments. Pain
VAS and FIQ symptom scores were significantly (p<0.01) decreased
after Waon therapy and remained low throughout the observation
period. CONCLUSION: Waon therapy is effective for the treatment
of fibromyalgia syndrome
(104) Thompson EA,
Mathie RT, Baitson ES, Barron SJ, Berkovitz SR, Brands M et al.
Towards standard setting for patient-reported outcomes in the
NHS homeopathic hospitals. Homeopathy 2008; 97(3):114-21.
Abstract: INTRODUCTION: We report findings from a pilot data
collection study within a programme of quality assurance,
improvement and development across all five homeopathic
hospitals in the UK National Health Service (NHS). AIMS: (1) To
pilot the collection of clinical data in the homeopathic
hospital outpatient setting, recording patient-reported outcome
since first appointment; (2) to sample the range of medical
complaints that secondary-care doctors treat using homeopathy,
and thus identify the nature and complexity of complaints most
frequently treated nationally; (3) to present a cross section of
outcome scores by appointment number, including that for the
most frequently treated medical complaints; (4) to explore
approaches to standard setting for homeopathic practice outcome
in patients treated at the homeopathic hospitals. METHODS: A
total of 51 medical practitioners took part in data collection
over a 4-week period. Consecutive patient appointments were
recorded under the headings: (1) date of first appointment in
the current series; (2) appointment number; (3) age of patient;
(4) sex of patient; (5) main medical complaint being treated;
(6) whether other main medical complaint(s); (7)
patient-reported change in health, using Outcome Related to
Impact on Daily Living (ORIDL) and its derivative, the ORIDL
Profile Score (ORIDL-PS; range, -4 to +4, where a score <or=-2
or >or=+2 indicates an effect on the quality of a patient's
daily life); (8) receipt of other complementary medicine for
their main medical complaint. RESULTS: The distribution of
patient age was bimodal: main peak, 49 years; secondary peak, 6
years. Male:female ratio was 1:3.5. Data were recorded on a
total of 1797 individual patients: 195 first appointments, 1602
follow-ups (FUs). Size of clinical service and proportion of
patients who attended more than six visits varied between
hospitals. A total of 235 different medical complaints were
reported. The 30 most commonly treated complaints were (in
decreasing order of frequency): eczema; chronic fatigue syndrome
(CFS); menopausal disorder; osteoarthritis; depression; breast
cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel
syndrome; multiple sclerosis; psoriasis; allergy (unspecified);
fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis;
headache; vitiligo; seasonal allergic rhinitis; chronic
intractable pain; insomnia; ulcerative colitis; acne; psoriatic
arthropathy; urticaria; ovarian cancer; attention-deficit
hyperactivity disorder (ADHD); epilepsy; sinusitis. The
proportion of patients with important co-morbidity was higher in
those seen after visit 6 (56.9%) compared with those seen up to
and including that point (40.7%; P<0.001). The proportion of FU
patients reporting ORIDL-PS>or=+2 (improvement affecting daily
living) increased overall with appointment number: 34.5% of
patients at visit 2 and 59.3% of patients at visit 6, for
example. Amongst the four most frequently treated complaints,
the proportion of patients that reported ORIDL-PS>or=+2 at visit
numbers greater than 6 varied between 59.3% (CFS) and 73.3%
(menopausal disorder). CONCLUSIONS: We have successfully piloted
a process of national clinical data collection using
patient-reported outcome in homeopathic hospital outpatients,
identifying a wide range and complexity of medical complaints
treated in that setting. After a series of homeopathy
appointments, a high proportion of patients, often representing
"effectiveness gaps" for conventional medical treatment,
reported improvement in health affecting their daily living.
These pilot findings are informing our developing programme of
standard setting for homeopathic care in the hospital outpatient
context
(105) van Uden-Kraan
CF, Drossaert CH, Taal E, Seydel ER, van de Laar MA.
Self-reported differences in empowerment between lurkers and
posters in online patient support groups. J Med Internet Res
2008; 10(2):e18.
Abstract: BACKGROUND: Patients who visit online support groups
benefit in various ways. Results of our earlier study indicated
that participation in online support groups had a profound
effect on the participants' feelings of "being empowered."
However, most studies of online patient support groups have
focused on the members of these groups who actively contribute
by sending postings (posters). Thus far, little is known about
the impact for "lurkers" (ie, those who do not actively
participate by sending postings). OBJECTIVE: In the present
study, we explored if lurkers in online patient support groups
profit to the same extent as posters do. METHODS: We searched
the Internet with the search engine Google to identify all Dutch
online support groups for patients with breast cancer,
fibromyalgia, and arthritis. Invitations to complete an online
survey were sent out by the owners of 19 groups. In the online
questionnaire, we asked questions about demographic and health
characteristics, use of and satisfaction with the online support
group, empowering processes, and empowering outcomes. The online
questionnaire was completed by 528 individuals, of which 109
(21%) identified themselves as lurkers. RESULTS: Lurkers (mean
age 47 years) were slightly older than active participants (mean
age 43 years, P = .002), had a shorter disease history (time
since diagnosis 3.7 years vs 5.4 years, P = .001), and reported
lower mental well-being (SF 12 subscore 37.7 vs 40.5, P = .004).
No significant differences were found in other demographic
variables. Posters indicated visiting the online support groups
significantly more often for social reasons, such as curiosity
about how other members were doing, to enjoy themselves, as a
part of their daily routine (all P < .001), and because other
members expected them to be there (P = .003). Lurkers and
posters did not differ in their information-related reasons for
visiting the online support group. Lurkers were significantly
less satisfied with the online support group compared to posters
(P < .001). With regard to empowering processes such as
"exchanging information" and "finding recognition," lurkers
scored significantly lower than posters. However, lurkers did
not differ significantly from posters with regard to most
empowering outcomes, such as "being better informed," "feeling
more confident in the relationship with their physician,"
"improved acceptance of the disease," "feeling more confident
about the treatment," "enhanced self-esteem," and "increased
optimism and control." The exception was "enhanced social
well-being," which scored significantly lower for lurkers
compared to posters (P < .001). CONCLUSION: Our study revealed
that participation in an online support group had the same
profound effect on lurkers' self-reported feelings of being
empowered in several areas as it had on posters. Apparently,
reading in itself is sufficient to profit from participation in
an online patient support group
(106) Bigatti SM,
Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in
fibromyalgia syndrome: relationship to pain and depression.
Arthritis Rheum 2008; 59(7):961-7.
Abstract: OBJECTIVE: This study is an examination of sleep,
pain, depression, and physical functioning at baseline and
1-year followup among patients with fibromyalgia syndrome (FMS).
Although it is clear that these symptoms are prevalent among FMS
patients and that they are related, the direction of the
relationship is unclear. We sought to identify and report sleep
problems in this population and to examine their relationship to
pain, depression, and physical functioning. METHODS: Patients
diagnosed with fibromyalgia were recruited from a Southern
California health maintenance organization and evaluated
according to American College of Rheumatology criteria in the
research laboratory. Six hundred patients completed the baseline
assessment and 492 completed the 1-year assessment. Measures
included the Center for Epidemiologic Studies Depression Scale,
the McGill Pain Questionnaire, the Pittsburgh Sleep Quality
Index, and the Fibromyalgia Impact Questionnaire. RESULTS: The
majority of the sample (96% at baseline and 94.7% at 1 year)
scored within the range of problem sleepers. Path analyses
examined the impact of baseline values on 1-year values for each
of the 4 variables. No variable of interest predicted sleep,
sleep predicted pain (beta = 0.13), pain predicted physical
functioning (beta = -0.13), and physical functioning predicted
depression (beta = -0.10). CONCLUSION: These findings highlight
the high prevalence of sleep problems in this population and
suggest that they play a critical role in exacerbating FMS
symptoms. Furthermore, they support limited existing findings
that sleep predicts subsequent pain in this population, but also
extend the literature, suggesting that sleep may be related to
depression through pain and physical functioning
(107) Mease PJ,
Arnold LM, Crofford LJ, Williams DA, Russell IJ, Humphrey L et
al. Identifying the clinical domains of fibromyalgia:
contributions from clinician and patient Delphi exercises.
Arthritis Rheum 2008; 59(7):952-60.
Abstract: OBJECTIVE: In evaluating the effectiveness of
fibromyalgia (FM) therapies, it is important to assess the
impact of those therapies on the full array of domains
considered important by both clinicians and patients. The
objective of this research was to identify and prioritize the
key clinically relevant and important domains impacted by FM
that should be evaluated by outcome assessment instruments used
in FM clinical trials, and to approach consensus among
clinicians and patients on the priority of those domains to be
assessed in clinical care and research. METHODS: Group consensus
was achieved using the Delphi method, a structured process of
consensus building via questionnaires together with systematic
and controlled opinion feedback. The Delphi exercises involved
23 clinicians with expertise in FM and 100 patients with FM as
defined by American College of Rheumatology criteria. RESULTS:
The Delphi exercise revealed that the domains ranked most highly
by patients were similar to the domain rankings by clinicians.
Pain was consistently ranked highest by both panels. Fatigue,
impact on sleep, health-related quality of life, comorbid
depression, and cognitive difficulty were also ranked highly.
Stiffness was ranked highly by patients but not clinicians. In
contrast, side effects was important to clinicians but was not
identified as important in the patient Delphi exercise.
CONCLUSION: The clinician and patient Delphi exercises
identified and ranked key domains that need to be assessed in FM
research. Based on these results, a conceptual framework for
measuring patient-reported outcomes is proposed
(108) Arnold LM,
Russell IJ, Diri EW, Duan WR, Young JP, Jr., Sharma U et al. A
14-week, randomized, double-blinded, placebo-controlled
monotherapy trial of pregabalin in patients with fibromyalgia. J
Pain 2008; 9(9):792-805.
Abstract: The purpose of the study was to assess the efficacy
and safety of pregabalin monotherapy in patients with
fibromyalgia in a randomized, double-blinded, placebo-controlled
trial. After 1 week of single-blinded administration of placebo,
750 patients meeting American College of Rheumatology criteria
for fibromyalgia were randomly assigned to pregabalin (300 mg/d,
450 mg/d, 600 mg/d) or placebo, administered twice daily for 14
weeks. The primary outcome variable was comparison of end point
mean pain scores, derived from daily diary ratings of pain
intensity (0 to 10 scale), between each of the pregabalin groups
and the placebo group. If positive, additional primary efficacy
parameters included the Patient Global Impression of Change
(PGIC) and the Fibromyalgia Impact Questionnaire (FIQ) total
score. Compared with placebo-treated patients, mean changes in
pain scores at the end point in pregabalin-treated patients were
significantly greater (P < .001: 300 mg/d, -0.71; 450 mg/d,
-0.98; 600 mg/d, -1.00). Compared with placebo, significantly
more pregabalin-treated patients reported improvement on PGIC (P
< .01 for all 3 pregabalin doses) and significant improvements
in total FIQ score for the 450 mg/d (P = .004) and the 600 mg/d
(P = .003) doses. Compared with placebo, all 3 doses of
pregabalin were associated with significant improvement in
sleep. The most commonly reported pregabalin-related adverse
events were dizziness and somnolence, which tended to be
dose-related. PERSPECTIVE: This randomized, placebo-controlled
trial of 300, 450, and 600 mg/d of pregabalin monotherapy
demonstrated that all 3 doses were efficacious for up to 14
weeks for the treatment of fibromyalgia and were well tolerated
by most patients. These results provide evidence that pregabalin
is an important treatment option for patients with fibromyalgia
(109) Staud R, Koo
EB. Are cannabinoids a new treatment option for pain in patients
with fibromyalgia? Nat Clin Pract Rheumatol 2008; 4(7):348-9.
Abstract: Preliminary studies suggest that the synthetic
cannabinoid nabilone might be an effective therapy in patients
with fibromyalgia. Skrabek et al. performed a double-blind,
randomized, placebo-controlled clinical trial to analyze the
effects of nabilone on pain and quality of life in patients with
fibromyalgia. After 4 weeks of treatment (0.5 mg once daily in
week 1, 0.5 mg twice daily in week 2, 0.5 mg in the morning and
1 mg in the evening in week 3, and 1 mg twice daily in week 4),
patients who received nabilone (n = 15) experienced significant
improvements in clinical pain, measured on a visual analog scale
(P <0.02), Fibromyalgia Impact Questionnaire score (P <0.02) and
the 10-point anxiety scale of the Fibromyalgia Impact
Questionnaire (P <0.02). After a 4-week wash-out period at the
end of the trial, all benefits were lost in the nabilone cohort,
which returned to their baseline levels of pain and quality of
life. Patients who received placebo (n = 18) experienced no
change throughout the study. Although nabilone was not
associated with serious adverse effects, some patients did
experience drowsiness, dry mouth, vertigo and ataxia as a result
of treatment
(110) Sendur OF,
Tastaban E, Turan Y, Ulman C. The relationship between serum
trace element levels and clinical parameters in patients with
fibromyalgia. Rheumatol Int 2008; 28(11):1117-21.
Abstract: We examined the association between serum trace
elements and clinical findings such as number of sensitive
tender points, severity of fatigue and functional status in
patients with fibromyalgia (FM). Thirty-two patients diagnosed
as having FM according to the ACR 1990 criteria and 32 normal
healthy controls (NHC) were included in this study. The
demographic data, disease duration, number of tender points and
accompanying symptoms (fatigue, sleep disorders, headache,
paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud's
phenomena) of the patients were noted. Visual analog scale (10
cm) was implemented to estimate daily severity of pain and
fatigue. Fibromyalgia impact questionnaire was used for
functional assessment. Serum selenium (microg/dL) and serum zinc
(microg/dL) levels were measured by atomic absorption
spectrometer. Serum magnesium (mmol/L) level was measured by the
original kits of Abbott Aeroset auto-analyzer. The mean age of
patients in FM group and NHC were calculated as 42.9 (SD = 7.7)
years and 41.3 (SD = 9.7) years, respectively. Serum levels of
zinc (P = 0.001) and magnesium (P = 0.002) were significantly
decreased by FM groups, whereas there was no considerable
difference with selenium levels of both groups (P > 0.05).
Association between serum zinc level and number of tender points
(P = 0.008) and that between fatigue and magnesium level (P =
0.003) was found as meaningful. According to the results of this
study, it was asserted that serum magnesium and zinc levels may
play an important role in the pathophysiology of FM
(111) Emad Y, Ragab
Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. Hippocampus
dysfunction may explain symptoms of fibromyalgia syndrome. A
study with single-voxel magnetic resonance spectroscopy. J
Rheumatol 2008; 35(7):1371-7.
Abstract: OBJECTIVE: (1) To investigate dysfunction of
hippocampus in patients with fibromyalgia syndrome (FM) using
proton magnetic resonance spectroscopy (1H-MRS), and to compare
these findings with healthy controls. (2) To correlate levels of
metabolites obtained with aspects of cognition, depression, and
sleep symptoms in the patient group. METHODS: The case-control
study was performed in 15 female patients, who met American
College of Rheumatology criteria for classification of FM, and
10 healthy age-matched female controls. Patients and controls
were receiving no medications known to affect cognitive
functioning or central nervous system metabolites before their
participation in the study. In all patients and controls, 1H-MRS
was used to assess N-acetylaspartate (NAA), choline (Cho),
creatine (Cr), and their ratios from both hippocampi. Levels of
metabolites and their ratios were determined and the findings
compared between the groups. All patients and controls underwent
psychological assessment to assess cognitive function,
depression, and structured sleep interview with sleep diary;
Fibromyalgia Impact Questionnaire (FIQ), number of tender
points, and visual analog scale (VAS) for pain were assessed in
all patients. RESULTS: NAA levels of right and left hippocampi
differed significantly between patients and controls (p < 0.05).
Cho levels in the right hippocampus were higher in the patient
group than in controls (p = 0.005), while no differences were
found with respect to Cr levels in both hippocampi. NAA/Cho and
NAA/Cr ratios differed significantly between patients and
controls (p <0.05), while the Cho/Cr ratio showed no
differences. Significant correlations were found between
language score and right Cho and right Cr levels (p = 0.041, p =
0.006, respectively), while no significant correlations were
found between metabolites and their ratios with FIQ, VAS for
pain, or number of tender points. CONCLUSION: The hippocampus
was dysfunctional in patients with FM, as shown by lower NAA
levels compared to controls, representing neuronal or axonal
metabolic dysfunction. As the hippocampus plays crucial roles in
maintenance of cognitive functions, sleep regulation, and pain
perception, we suggest that metabolic dysfunction of hippocampus
may be implicated in the appearance of these symptoms associated
with this puzzling syndrome
(112) Rau J,
Ehlebracht-Konig I, Petermann F. [Impact of a motivational
intervention on coping with chronic pain: results of a
controlled efficacy study]. Schmerz 2008; 22(5):575.
Abstract: BACKGROUND: For effective self-management of chronic
pain changes of cognitive and behavioral attitudes are required.
The readiness to change can be described within the framework of
the transtheoretical model (TTM) and is facilitated through
motivational interviewing. This prospective study evaluated the
effectiveness of brief motivational interviewing by telephone
for the variables self-efficacy, cognitive and behavioral coping
and psychological strain through chronic pain over a period of 9
months. METHODS: Different questionnaires, the self-efficacy
expectations (ASES-D), cognitive, behavioral coping and
psychological strain through chronic pain (FESV) and the German
version of the pain stages of change questionnaires (PSOCQ), the
FF-STABS were distributed to 147 patients at a rehabilitation
clinic (indications: fibromyalgia syndrome, rheumatoid
arthritis, ankylosing spondylitis). The intervention group
participants received 3 telephone calls at intervals of 2 months
with a follow-up time of 9 months after first study admission.
At the end of the study 91 patients were enrolled for analysis
(drop out rate 38%). To evaluate the effects of treatment
nonparametric-analysis for longitudinal data was used. RESULTS
AND CONCLUSION: The analysis showed significant positive effects
in the intervention group for cognitive coping (U-value -2.423;
p=0.015 group x time-effect) and for coping with emotional
strains of chronic pain (subscale anxiety: U-value -2.3618;
p=0.018; subscale anger: U-value 2.8638; p=0.004; group x
time-effect). No significant effects were shown for
self-efficacy expectations and behavioral coping with pain.
Further explorative analysis of subgroups revealed slightly
better treatment effects for patients with rheumatoid arthritis
and ankylosing spondylitis than for those with fibromyalgia
syndrome
(113) Rodero B,
Garcia J, Casanueva B, Sobradiel N. [Imagined exposure as
treatment of catastrophizing in fibromyalgia: a pilot study].
Actas Esp Psiquiatr 2008; 36(4):223-6.
Abstract: INTRODUCTION: We want to assess the effectiveness of a
new approach (imagined exposure) for the Cognitive Behavioural
Treatment (CBT) in fibromyalgia. STUDY DESIGN:
Quasi-experimental design of a temporary nature in a single
group with pre and post and with/without treatment. SUBJECTS AND
METHODS: Fibromyalgia (FM) patients, who met the American
College of Rheumatology's criteria for FM. In this study eight
people took part, seven females and one male, selected from FM
Cantabria Association. The CBT consisted of 11 group sessions
and lasted 15 weeks. All patients were evaluated before and
after the program. The data were based on the following scales:
visual-analog scale (VAS) for pain intensity, the Fibromyalgia
Impact Questionnaire (FIQ), the Pain Catastrophizing Scale (PCS)
and the Hospital Anxiety and Depression Scale (HADS). RESULTS:
Despite finding improvements in every variable, no significant
differences were found between pre and postreatment in VAS, HADS
and FIQ. However, after treatment, significant differences were
found in PCS (p 0.05), and its three subscales. Moreover, rate
decrease in rumination was higher after imagined exposure.
CONCLUSION: These results suggest that CBT is effective either
in catastrophizing decreasing or in rumination. Imagined
exposure may enhance the results in particular cases. Further
studies with larger samples are needed to confirm these results
(114) Miller A, Doll
H, David J, Wass J. Impact of musculoskeletal disease on quality
of life in long-standing acromegaly. Eur J Endocrinol 2008;
158(5):587-93.
Abstract: OBJECTIVE: To provide rheumatological assessment of
patients with long-standing acromegaly and investigate the
impact of musculoskeletal disease on quality of life. DESIGN:
Cross-sectional observational study. METHODS: Fifty-eight
patients diagnosed with acromegaly at least 5 years previously
were interviewed and examined by a rheumatologist. Each patient
completed the short form-36 (SF-36), arthritis impact
measurement scales 2 (AIMS2) and acromegaly quality of life
questionnaires (AcroQol). RESULTS: Fifty-two out of 58 (90%)
reported musculoskeletal pain, with 29 (50%) reporting neck
pain. Hip osteoarthritis was present in 49 (84%) and knee
osteoarthritis in 20 (34%). Half the patients (52%) reported
sleep disturbance, but only 2 (3.5%) had fibromyalgia. Ten
(17.2%) had previously undergone carpal tunnel decompression.
Fifty-one (88%) patients had consulted their general practioner
and 31 (54%) complementary therapists. SF-36, AIMS2 and AcroQol
scores were lower in patients with musculoskeletal pain.
CONCLUSIONS: This study of musculoskeletal problems in patients
with acromegaly reports systematic rheumatological examination,
use of medical services and quality of life scores.
Musculoskeletal problems should be routinely addressed in
acromegaly by both endocrinologist and rheumatologist and a
multidisciplinary approach taken to management
(115) Pamuk GE,
Pamuk ON, Set T, Harmandar O, Yesil N. An increased prevalence
of fibromyalgia in iron deficiency anemia and thalassemia minor
and associated factors. Clin Rheumatol 2008; 27(9):1103-8.
Abstract: In this study, we evaluated the prevalence of
fibromyalgia (FM) in iron deficiency anemia (IDA) and
thalassemia minor (TM) patients and associated factors. In
addition, we investigated the prevalence of IDA in outpatients
with fibromyalgia, and its effect on clinical findings. The
study included 205 IDA, 40 TM patients and 100 healthy controls.
FM was diagnosed according to 1990 ACR criteria. Whole blood
count, biochemical tests, and serum iron parameters were
determined. Pain, fatigue, and FM Impact Questionnaire (FIQ)
functional item scores were assessed in FM subjects. In
addition, the prevalence of IDA in FM patients diagnosed at the
Rheumatology Outpatient Clinic was determined. The prevalences
of FM in IDA (17.6%) and TM (20%) groups were higher than in
controls (6%; p values 0.006 and 0.025, respectively). When IDA
patients with FM were compared to those without FM, it was seen
that a higher percentage were females, married, and a higher
percentage had history of pica (all p values < 0.05). Serum
hemoglobin and iron parameters did not differ between IDA
patients with and without FM. IDA was detected in 48 (24.5%) of
196 FM patients. FM patients without IDA had higher sleep
disturbance scores (p = 0.012) and longer duration of FM (p =
0.045). FM was a common finding in patients with IDA and TM. FM
was associated with female sex and history of pica in IDA
patients, and not associated with serum hemoglobin and selected
iron parameters. The presence of FM in TM had no association
with any of the above-mentioned parameters
(116) Eyigor S,
Ozdedeli S, Durmaz B. The prevalence of generalized soft tissue
rheumatic conditions in Turkish medical students. J Clin
Rheumatol 2008; 14(2):65-8.
Abstract: OBJECTIVE: To assess the prevalence of generalized
soft tissue rheumatism (GSTR) in medical students in Izmir,
Turkey. METHODS: Medical students from each grade of Medical
School of Ege University, Izmir, Turkey, were evaluated by a
survey and physical examination for GSTR including fibromyalgia
(FM) syndrome, myofascial pain syndrome (MPS), benign joint
hypermobility syndrome (BJHS), and chronic fatigue syndrome. FM
Impact Questionnaire was assessed in FM diagnosed students.
Short Form-36 (SF-36) was obtained from each student to
determine the quality of life. RESULTS: Among the participants
(n = 306), 191 were women (62.4%) and 115 were men (37.6%) and
mean age was 20.23 +/- 1.56. Fifty-eight students (19%) were
diagnosed with a GSTR. The distributions of the diagnoses were:
6 (2%) FM, 21 (6.9%) MPS, 28 (9.2%) BJHS, 1 (0.3%) chronic
fatigue syndrome, and 2 students (0.7%) had both BJHS and MPS.
Fifty-three (27.7%) women and 5 (4.3%) men were diagnosed with a
GSTR (P < 0.01). Mean FM Impact Questionnaire score was 50.8 in
FM diagnosed students. Physical role, vitality, and mental
subscores of SF-36 were significantly lower in the students
having a GSTR (P < 0.05). CONCLUSION: This is the first study
performed in medical students to find out the prevalence of
generalized soft tissue rheumatic conditions. Although medical
students are under high stress due to hard training, the
prevalence of GSTR in medical students was found similar to
previous reports in the general population
(117) Tomas-Carus P,
Gusi N, Hakkinen A, Hakkinen K, Leal A, Ortega-Alonso A. Eight
months of physical training in warm water improves physical and
mental health in women with fibromyalgia: a randomized
controlled trial. J Rehabil Med 2008; 40(4):248-52.
Abstract: OBJECTIVE: To evaluate the feasibility of 8 months of
supervised exercise therapy in warm water and its effects on the
impact of fibromyalgia on physical and mental health and
physical fitness in affected women. METHODS: Thirty women with
fibromyalgia were randomly assigned to an exercise therapy group
(n = 15) or a control group (inactive) (n = 15). The impact of
fibromyalgia on physical and mental health was assessed using
the Fibromyalgia Impact Questionnaire and the anxiety state with
State-Trait Anxiety Inventory. Physical fitness was measured
using the following tests: Canadian Aerobic Fitness; hand-grip
dynamometry; 10-metre walking; 10-step stair-climbing and blind
1-leg stance. RESULTS: After 8 months of training, the exercise
therapy group improved compared with the control group in terms
of physical function (20%), pain (8%), stiffness (53%), anxiety
(41%), depression (27%), Fibromyalgia Impact Questionnaire total
scores (18%), State-Trait Anxiety Inventory score (22%), aerobic
capacity (22%), balance (30%), functional capacity for walking
(6%), stair-climbing with no extra weight (14%) and
stair-climbing 10 kg-weighted (25%). CONCLUSION: Eight months of
supervised exercise in warm water was feasible and led to
long-term improvements in physical and mental health in patients
with fibromyalgia at a similar magnitude to those of shorter
therapy programmes
(118) Holtgrefe K,
McCloy C, Rome L. Changes associated with a quota-based approach
on a walking program for individuals with fibromyalgia. J Orthop
Sports Phys Ther 2007; 37(12):717-24.
Abstract: STUDY DESIGN: Single-subject, multiple-baseline design
across 3 subjects. OBJECTIVE: To investigate the use of a
quota-based approach to prescribing a walking program for
individuals with fibromyalgia (FM). BACKGROUND: Exercise has
been found to be beneficial for individuals with FM. What has
not been determined is the best way to implement an exercise
program that does not increase FM symptoms. METHODS AND
MEASURES: Three women with FM were randomly assigned a baseline
period of 5, 6, or 7 weeks, which served as the control phase,
followed by an intervention period consisting of an 8-week
walking program. The walking program progression was prescribed
using a quota-based approach. Weekly outcome measures were the
Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy
Scale (ASES), and SF-36v2 (acute). A 6-minute walk test was
recorded twice: at the start of the baseline phase (after a
trial phase) and at the end of the intervention phase. RESULTS:
Subjects 1 and 3 had a significant decrease in the symptoms
associated with FM during the intervention phase (FIQ, P<.05),
but no significant increase in self-efficacy (ASES). They
increased their walking distances used for exercise by 640 and
480 m, respectively. Subject 2 had no significant improvements
in her symptoms of FM. Despite a significant decrease in ASES
(P<.05), walking distance used for exercise by subject 2
increased by 2080 m. Six-minute walk test distances increased
76, 32, and 106 m for subjects 1, 2, and 3, respectively.
CONCLUSIONS: Prescribing a walking program using a quota-based
exercise prescription resulted in increasing the distance walked
for 3 subjects. It also decreased symptoms associated with FM in
2 of the 3 subjects, but did not increase self-efficacy
(119) Tander B,
Cengiz K, Alayli G, Ilhanli I, Canbaz S, Canturk F. A
comparative evaluation of health related quality of life and
depression in patients with fibromyalgia syndrome and rheumatoid
arthritis. Rheumatol Int 2008; 28(9):859-65.
Abstract: The aim of this study was to compare health related
quality of life (HRQoL) and assess functional and psychological
status in rheumatoid arthritis (RA), fibromyalgia syndrome (FS)
patients and controls (each 30 subjects). Demographic
characteristics, pain and sleep disturbance by Visual Analog
Scale, depression by Beck Depression Inventory (BDI), disease
impact by fibromyalgia impact questionnaire, DAS-28, and HRQoL
by SF-36 were gathered. The FS group scored significantly worser
than the RA group with respect to physical role, social
functioning and bodily pain subscales of SF-36. The scores of
all SF-36 subscales were significantly lower in FS and RA
patients than controls except mental health score. All of the
subscales of SF-36 were negatively correlated with BDI scores in
FS patients. In RA group, the DAS-28 scores were inversely
correlated with all of SF-36 subscales. In conclusion, presence
of comorbid depression must be taken into account when
determining HRQoL in FS and RA. Essentials improving the HRQoL
are management of depression in FS and control of disease
activity in RA
(120) Mease PJ,
Russell IJ, Arnold LM, Florian H, Young JP, Jr., Martin SA et
al. A randomized, double-blind, placebo-controlled, phase III
trial of pregabalin in the treatment of patients with
fibromyalgia. J Rheumatol 2008; 35(3):502-14.
Abstract: OBJECTIVE: To evaluate the efficacy and safety of
pregabalin for symptomatic relief of pain associated with
fibromyalgia (FM) and for management of FM. METHODS: This
multicenter, double-blind, placebo-controlled trial randomly
assigned 748 patients with FM to receive placebo or pregabalin
300, 450, or 600 mg/day (dosed twice daily) for 13 weeks. The
primary outcome variable for study objective 1, symptomatic
relief of pain associated with FM, was comparison of endpoint
mean pain scores between each pregabalin group and placebo. The
outcome variable for study objective 2, management of FM,
included endpoint mean pain scores, Patient Global Impression of
Change (PGIC), and Fibromyalgia Impact Questionnaire (FIQ)-Total
Score. Secondary outcomes included assessments of sleep,
fatigue, and mood disturbance. RESULTS: Patients in all
pregabalin groups showed statistically significant improvement
in endpoint mean pain score and in PGIC response compared with
placebo. Improvements in FIQ-Total Score for the pregabalin
groups were numerically but not significantly greater than those
for the placebo group. Compared with placebo, all pregabalin
treatment groups showed statistically significant improvement in
assessments of sleep and in patients' impressions of their
global improvement. Dizziness and somnolence were the most
frequently reported adverse events. CONCLUSION: Pregabalin at
300, 450, and 600 mg/day was efficacious and safe for treatment
of pain associated with FM. Pregabalin monotherapy provides
clinically meaningful benefit to patients with FM
(121) Evcik D, Yigit
I, Pusak H, Kavuncu V. Effectiveness of aquatic therapy in the
treatment of fibromyalgia syndrome: a randomized controlled open
study. Rheumatol Int 2008; 28(9):885-90.
Abstract: The aim of this study was to investigate the efficacy
of aquatic exercises in fibromyalgia syndrome (FMS). A total of
63 patients were included and allocated to two groups. Group I
(n = 33) received an aquatic exercise program and Group II (n =
30) received a home-based exercise program for 60 min, 3x a
week, over 5 weeks. Patients were evaluated for pain (visual
analogue scale, VAS), number of tender points (NTP), Beck
depression inventory (BDI), and functional capacity
(fibromyalgia impact questionnaire, FIQ). All assessment
parameters were measured at baseline, and at weeks 4, 12, and
24. There were statistically significant differences in FIQ and
NTP in both groups at the end and during follow-up (P < 0.05).
Group I showed a statistically significant decrease in BDI
scores after 4 and 12 weeks (P < 0.05) that remained after 24
weeks (P < 0.001). In Group II, a significant decrease in BDI
scores was observed at the end and during follow-up (P < 0.001).
Also, a significant improvement was found in VAS at weeks 4 and
12 in both groups (P < 0.001). The average of reduction in pain
scores was 40% in Group1 and 21% in Group II. However, this was
still significant at week 24 only in the aquatic therapy group.
A comparison of the two groups showed no statistically
significant difference for FIQ, NTP, and BDI scores except VAS
(P < 0.001) Our results showed that both aquatic therapy and
home-based exercise programs have beneficial effects on FIQ,
BDI, and NTP. In pain management, only aquatic therapy seems to
have long-term effects
(122) Couto CI,
Natour J, Carvalho AB. Fibromyalgia: its prevalence and impact
on the quality of life on a hemodialyzed population. Hemodial
Int 2008; 12(1):66-72.
Abstract: Fibromyalgia syndrome (FMS) is characterized by
widespread musculoskeletal pain. It has negative effects on
quality of life and has been poorly investigated in specific
populations. Our aim was to determine the prevalence of FMS in
Brazilian hemodialysis (HD) patients and to investigate its
effects on the quality of life. We investigated 311 patients on
HD who were submitted to physical examination towards the
classification of FMS. All subjects from FMS and control groups
were submitted to laboratorial investigation and completed
questionnaires of quality of life. The prevalence of FMS was
3.9%, which was close to that of the general population. Most
patients were females and from non-Caucasian races. No
difference between FMS and control groups was observed regarding
race, dialysis adequacy, nutritional status and level of
schooling. Ionized calcium was higher in the FMS group than in
the control group. There was no association between FMS and
secondary hyperparathyroidism. On the other hand, FMS was
associated with worse quality of life, depression and anxiety.
In conclusion, the prevalence of FMS in HD patients was similar
to that of the general population. It was associated with
decreasing quality of life in HD patients, in addition to higher
degrees of depression and anxiety. No laboratory tests could
identify FMS patients on HD. Fibromyalgia syndrome subsequently
follows without a well-established mechanism of pathogenesis,
and seems to be due to multifactorial causes. Its true impact on
the quality of life of HD patients deserves more attention by
nephrologists
(123) Jones KD,
Burckhardt CS, Deodhar AA, Perrin NA, Hanson GC, Bennett RM. A
six-month randomized controlled trial of exercise and
pyridostigmine in the treatment of fibromyalgia. Arthritis Rheum
2008; 58(2):612-22.
Abstract: OBJECTIVE: A subset of fibromyalgia (FM) patients have
a dysfunctional hypothalamic-pituitary-insulin-like growth
factor 1 (IGF-1) axis, as evidenced by low serum levels of IGF-1
and a reduced growth hormone (GH) response to physiologic
stimuli. There is evidence that pyridostigmine (PYD) improves
the acute response of GH to exercise in FM patients. The purpose
of this study was to evaluate the clinical effectiveness of 6
months of PYD and group exercise on FM symptoms. METHODS: FM
patients were randomized to 1 of the following 4 groups: PYD
plus exercise, PYD plus diet recall but no exercise, placebo
plus exercise, and placebo plus diet recall but no exercise. The
primary outcome measures were the visual analog scale (VAS)
score for pain, tender point count, and total myalgic score.
Secondary outcome measures were the total score on the
Fibromyalgia Impact Questionnaire (FIQ) and FIQ VAS scores for
individual symptoms (fatigue, poor sleep, stiffness, and
anxiety), as well as quality of life (QOL) and physical fitness
(lower body strength/endurance, upper and lower body
flexibility, balance, and time on the treadmill). RESULTS: A
total of 165 FM patients completed baseline measurements; 154
(93.3%) completed the study. The combination of PYD and exercise
did not improve pain scores. PYD groups showed a significant
improvement in sleep and anxiety in those who completed the
study and in QOL in those who complied with the therapeutic
regimen as compared with the placebo groups. Compared with the
nonexercise groups, the 2 exercise groups demonstrated
improvement in fatigue and fitness. PYD was generally well
tolerated. CONCLUSION: Neither the combination of PYD plus
supervised exercise nor either treatment alone yielded
improvement in most FM symptoms. However, PYD did improve
anxiety and sleep, and exercise improved fatigue and fitness. We
speculate that PYD may have improved vagal tone, thus benefiting
sleep and anxiety; this notion warrants further study
(124) Huber A, Suman
AL, Biasi G, Carli G. Predictors of psychological distress and
well-being in women with chronic musculoskeletal pain: two sides
of the same coin? J Psychosom Res 2008; 64(2):169-75.
Abstract: OBJECTIVE: To date, few results on well-being in
chronic-pain patients have been published, while several studies
in patients without pain have indicated that well-being may not
be equivalent to absence of psychological distress. The aim of
the present study was to investigate the relationship between
psychological distress and well-being and to identify the
predictors of each in patients with chronic nonmalignant pain.
METHODS: Sixty-nine women with chronic multiregional
musculoskeletal pain, 41 of whom met American College of
Rheumatology criteria for fibromyalgia, completed questionnaires
on pain, fatigue, stiffness, physical disability (Fibromyalgia
Impact Questionnaire), psychological distress [Multidimensional
Affect and Pain Survey (MAPS), Symptom Check List-90 (SCL-90),
State-Trait Anxiety Inventory Form Y2 (STAI-Y2)], and hedonic
and eudaimonic well-being (MAPS). RESULTS: Patients reported
increased amounts of psychological distress (STAI-Y2 and SCL-90)
compared to healthy people. Multiple regression analysis of
patient data demonstrated that higher psychological distress was
related to higher age, more intense pain, a higher positive
tender point count, and more physical disability. Well-being
(both hedonic and eudaimonic aspects) decreased with higher
disability, but was independent of age, pain intensity, and
number of positive tender points. Bivariate correlations showed
that psychological distress was moderately related to eudaimonic
well-being and strongly related to positive affect, an aspect of
hedonic well-being. CONCLUSION: In patients with chronic
musculoskeletal pain, self-reports of well-being and low
psychological distress only partially overlap with each other
and are differently related to major patient symptoms,
supporting the relevance of the concept of well-being to
chronic-pain research and a need for further studies in this
field
(125) Sarzi-Puttini
P, Atzeni F, Di FM, Lama N, Batticciotto A, Iannuccelli C et al.
Anti-polymer antibodies are correlated with pain and fatigue
severity in patients with fibromyalgia syndrome. Autoimmunity
2008; 41(1):74-9.
Abstract: OBJECTIVE: To investigate the prevalence of
antipolymer antibody (APA) in patients with fibromyalgia (FM)
and to examine its association with FM severity symptoms.
METHODS: The study population consisted of 79 FM patients and 75
controls: 32 with psoriatic arthritis and 43 with rheumatoid
arthritis APA levels were indirectly assayed using a commercial
ELISA kit from Corgenix (Westmister, Colorado, USA). Optical
density (OD) values were recorded on duplicates of each of the
reference and patient samples. Among clinical variables we
investigated pain, measured according to visual analog scales
(VAS: 0-100), fatigue, stiffness, anxiety, depression, all
measured by VAS (0-100), and health status measured by
Fibromyalgia Impact Questionnaire (FIQ). RESULTS: Sixteen of the
79 FM patients (20.3%) and 12/78 controls (15.4%) were positive
for APAs (P = 0.536). Following ROC analysis, area under curve
(AUC) was 0.49 (95% CI: 0.40, 0.58). Focusing on FM patients, we
observed a correlation between APA titre and pain (tau: - 0.221;
P = 0.020) and fatigue (tau: - 0.205; P = 0.032) at univariate
analysis. Binomial regression analysis, controlling for clinical
and demographic variables, showed that pain (PPR: 0.923; P =
0.007) and fatigue (PPR: 0.948; P = 0.024) were significantly
associated with APA test sensitivity. CONCLUSIONS: APA test
exhibited a low sensitivity in FM patients and it did not
distinguish this group of patients from the controls enrolled in
this study. Interestingly, positive APA test prevalence
increased with less severe pain or fatigue
(126) Naring GW, van
LW, Geenen R. Somatoform dissociation and traumatic experiences
in patients with rheumatoid arthritis and fibromyalgia. Clin Exp
Rheumatol 2007; 25(6):872-7.
Abstract: OBJECTIVE: Trauma and dissociation tend to be
interrelated. The objective of this study was to examine the
frequency of traumatic experiences and somatoform dissociation
in patients with fibromyalgia syndrome (FMS) or rheumatoid
arthritis (RA), two conditions that are both characterized by
pain and disability. METHODS: Patients with a diagnosis of FMS
(2 male, 26 female; mean age 42 +/- 11 years) or RA (5 male, 46
female; mean age 46 +/- 10 years) completed the Fibromyalgia
Impact Questionnaire (FIQ), the Somatoform Dissociation
Questionnaire (SDQ), and the Traumatic Experience Checklist
(TEC). RESULTS: Patients with FMS reported significantly higher
levels of various forms of traumatization and dissociation than
patients with RA. In patients with FMS, but not in patients with
RA, there was a significant correlation between traumatization
and dissociative symptoms. A possible dissociative disorder was
indicated in 10% of the patients with FMS and 2% of the patients
with RA. CONCLUSION: Traumatization experiences are frequent in
FMS, but as compared to conversion disorder or dissociative
identity disorder only a small subgroup of patients with FMS or
RA shows the combination of traumatization and somatoform
dissociation. The observation of somatoform dissociation calls
for a broad treatment approach with a special role of the
psychologist or psychiatrist
(127)
Munguia-Izquierdo D, Legaz-Arrese A. Exercise in warm water
decreases pain and improves cognitive function in middle-aged
women with fibromyalgia. Clin Exp Rheumatol 2007; 25(6):823-30.
Abstract: OBJECTIVES: To compare the cognitive function
performance in patients with fibromyalgia (FM) with respect
healthy controls and to evaluate the short-term efficacy of
exercise therapy in a warm, chest-high pool on pain and
cognitive function in women with FM. METHODS: Sixty middle-aged
women with FM were randomly assigned to either an exercise
training group (n = 35) to perform 3 sessions per week of
aquatic training (32 degrees C) including mobility, aerobic,
strengthening, and relaxation exercises for 16 weeks, or a
control group (n = 25). Twenty-five healthy women matched for
age, weight, body mass index, and educational and physical
activity levels were recruited. Pain was assessed in patients
using a syringe calibrated like a pressure dolorimeter, and a
visual analog scale. The severity of FM was evaluated using the
Fibromyalgia Impact Questionnaire. Cognitive function was
measured in healthy individuals and patients using several
standardized neuropsychological tests. All patients were
measured at baseline and post-treatment. RESULTS: At baseline,
the healthy group evidenced cognitive performance that was
significantly superior to the group of patients with FM in all
of the neuropsychological tests. The exercise group
significantly improved their pain threshold, tender point count,
self-reported pain, severity of FM, and cognitive function,
while in the control group the differences were not significant.
CONCLUSION: An exercise therapy three times per week for 16
weeks in a warm-water pool is an adequate treatment to decrease
the pain and severity of FM well as to improve cognitive
function in previously unfit women with FM and heightened
painful symptomatology
(128) da Silva GD,
Lorenzi-Filho G, Lage LV. Effects of yoga and the addition of
Tui Na in patients with fibromyalgia. J Altern Complement Med
2007; 13(10):1107-13.
Abstract: OBJECTIVES: This study aimed to verify whether
techniques of yoga with and without the addition of Tui Na might
improve pain and the negative impact of fibromyalgia (FMS) on
patients' daily life. DESIGN: Forty (40) FMS women were
randomized into two groups, Relaxing Yoga (RY) and Relaxing Yoga
plus Touch (RYT), for eight weekly sessions of stretching,
breathing, and relaxing yogic techniques. RYT patients were
further submitted to manipulative techniques of Tui Na. OUTCOME
MEASURE: Outcome measures comprised the Fibromyalgia Impact
Questionnaire (FIQ), pain threshold at the 18 FMS tender points,
and a verbal graduation of pain assessed before treatment and on
the followup. The visual analog scale (VAS) for pain was
assessed before and after each session and on the follow-up.
RESULTS: Seventeen (17) RYT and 16 RY patients completed the
study. Both RY and RYT groups showed improvement in the FIQ and
VAS scores, which decreased on all sessions. The RYT group
showed lower VAS and verbal scores for pain on the eighth
session, but this difference was not maintained on the
follow-up. Conversely, RY VAS and verbal scores were
significantly lower just on the follow-up. CONCLUSIONS: These
study results showed that yogic techniques are valid therapeutic
methods for FMS. Touch addition yielded greater improvement
during the treatment. Over time, however, RY patients reported
less pain than RYT. These results suggest that a passive therapy
may possibly decrease control over FMS symptoms
(129) Duncan B,
White A, Rahman A. Acupuncture in the treatment of fibromyalgia
in tertiary care--a case series. Acupunct Med 2007;
25(4):137-47.
Abstract: AIMS: Fibromyalgia is a common cause of chronic
widespread pain. The benefit of medication is often limited by
its side effects, and the improvements obtained with exercise
and education are inconsistent. Many patients seek acupuncture
treatment, which is reported to be helpful in some cases. This
study aimed to explore the acceptability and benefits of
acupuncture offered in the setting of a tertiary referral
clinic. METHODS: An open, uncontrolled observational study was
conducted among patients who met the usual fibromyalgia criteria
and who had a pain score of at least 30 on a 100mm Visual
Analogue Scale (VAS). Patients were allowed to continue other
treatments but not to introduce new ones. Acupuncture was given
using a Western approach according to a protocol developed by
consensus. Patients were offered eight treatments in eight
weeks. Outcome measures included VAS of pain intensity and
Fibromyalgia Impact Questionnaire (range 0 - 100), and were
taken before and after treatment, and at 14, 20 and 34 weeks
from enrolment. RESULTS: Twenty four eligible patients were
enrolled in a 12 month period. Baseline mean pain VAS score for
these 24 patients was 74 (SD 18) and mean Fibromyalgia Impact
Questionnaire score 78 (SD 12.4). Only 14 patients completed the
course of treatment within about 10 weeks. Compliance was poor
in the remaining patients because of difficulty attending
clinic, and in two cases because of exacerbation of pain.
Completion of outcome measures was variable and therefore the
analysis of data is limited. Five patients scored at least 20%
reduction in Fibromyalgia Impact Questionnaire score which is a
clinically relevant improvement. Two of these scored at least
50% reduction. CONCLUSION: Acupuncture appears to offer
symptomatic improvement to some patients with fibromyalgia in a
tertiary clinic who have failed to respond to other treatments.
In view of its safety, further acupuncture research is justified
in this population
(130) Nieddu ME,
Menza L, Baldi F, Frediani B, Marcolongo R. [Efficacy of
Cellfood's therapy (deutrosulfazyme) in fibromyalgia].
Reumatismo 2007; 59(4):316-21.
Abstract: OBJECTIVE: To assess the efficacy of Cellfood's
therapy in the treatment of fibromyalgia. METHODS: This study
was a single-blind, cross-over, randomized placebo-controlled
trial. Forty female were selected from 320 cases investigated in
the period 2003-2005 of June. To be included in this study, it
was required that the diagnosis of fibromyalgia was made by a
specialist in according to the ACR classification criteria of
1990. The patient's age was between 35-47 years, the choice of
criteria were the absence of improvements with the conventional
therapy and the normality of medical check-up. The patients were
divided into two different-groups of thirty-one and nine
subjects, each-one (group A) treated with Cellfood for six
months in according to the Eurodream's scheme, and each-other
(group B) treated with placebo for three months and successively
with Cellfood for three months. Besides we have estimated the
tender points with algometer and the health status of women with
the Fibromyalgia Impact Questionnaire (FIQ) at the baseline (T0)
and at three (T1) and six month (T2). RESULT: The group A had an
appreciable improvement of the parameters at T1 statistically
significant compared to the group B, while we observed a
stability of they at T2 on the group A and an improvement of the
parameters of the group B statistically non significant compared
to each-one. CONCLUSION: Our result suggest that the Cellfood's
therapy improve fibromyalgia symptoms and health-related quality
of life
(131) Ribel-Madsen
S, Christgau S, Gronemann ST, Bartels EM, Danneskiold-Samsoe B,
Bliddal H. Urinary markers of altered collagen metabolism in
fibromyalgia patients. Scand J Rheumatol 2007; 36(6):470-7.
Abstract: OBJECTIVE: To assess the metabolism of collagen in
fibromyalgia (FM) patients, and to compare the occurrence of
collagen metabolism markers to the severity of FM symptoms.
METHODS: Morning urine was collected from 27 FM women fulfilling
the American College of Rheumatology (ACR) criteria for FM, and
from seven controls. FM patients completed the Fibromyalgia
Impact Questionnaire (FIQ). Bone mineral density (BMD),
isokinetic muscle strength in knee and elbow, and hand-grip
strength were measured. Urinary concentrations of collagen type
I cross-linked C-telopeptide (CTX-I) and collagen type II
cross-linked C-telopeptide (CTX-II) were determined by
enzyme-linked immunosorbent assay (ELISA). Pyridinoline (Pyd)
and deoxypyridinoline (Dpd) were determined by liquid
chromatography, and hydroxyproline (Hyp) by spectrophotometry.
All concentration data were normalized to creatinine. RESULTS:
Mean values in the FM group and the control group, respectively,
were: urinary CTX-I 246.8 and 337.5 microg/mmol (p = 0.060);
CTX-II 110.4 and 185.1 ng/mmol (p = 0.035); Pyd 56.1 and 52.3
nmol/mmol (NS); Dpd 15.1 and 14.0 nmol/mmol (NS); Pyd : Dpd
ratio 4.05 and 3.96 (NS); Hyp 26.1 and 21.1 micromol/mmol (NS).
Significant inverse correlations were seen between CTX-I and the
intensity of fatigue, and between CTX-II and anxiety. An inverse
correlation between CTX-I and muscle strength was apparent, but
relied on extreme values from one patient, and no significant
correlation was found between CTX-I or CTX-II and tender points
or BMD in the FM group. CONCLUSIONS: Low urinary concentrations
of CTX-II and CTX-I and normal levels of Pyd and Dpd were found
in FM, but their relationship to the intensity of FM symptoms
was unclear
(132) Cuatrecasas G,
Riudavets C, Guell MA, Nadal A. Growth hormone as concomitant
treatment in severe fibromyalgia associated with low IGF-1 serum
levels. A pilot study. BMC Musculoskelet Disord 2007; 8:119.
Abstract: BACKGROUND: There is evidence of functional growth
hormone (GH) deficiency, expressed by means of low insulin-like
growth factor 1 (IGF-1) serum levels, in a subset of
fibromyalgia patients. The efficacy of GH versus placebo has
been previously suggested in this population. We investigated
the efficacy and safety of low dose GH as an adjunct to standard
therapy in the treatment of severe, prolonged and well-treated
fibromyalgia patients with low IGF-1 levels. METHODS:
Twenty-four patients were enrolled in a randomized, open-label,
best available care-controlled study. Patients were randomly
assigned to receive either 0.0125 mg/kg/d of GH subcutaneously
(titrated depending on IGF-1) added to standard therapy or
standard therapy alone during one year. The number of tender
points, the Fibromyalgia Impact Questionnaire (FIQ) and the
EuroQol 5D (EQ-5D), including a Quality of Life visual analogic
scale (EQ-VAS) were assessed at different time-points. RESULTS:
At the end of the study, the GH group showed a 60% reduction in
the mean number of tender points (pairs) compared to the control
group (p < 0.05; 3.25 +/- 0.8 vs. 8.25 +/- 0.9). Similar
improvements were observed in FIQ score (p < 0.05) and EQ-VAS
scale (p < 0.001). There was a prompt response to GH
administration, with most patients showing improvement within
the first months in most of the outcomes. The concomitant
administration of GH and standard therapy was well tolerated,
and no patients discontinued the study due to adverse events.
CONCLUSION: The present findings indicate the advantage of
adding a daily GH dose to the standard therapy in a subset of
severe fibromyalgia patients with low IGF-1 serum levels. TRIAL
REGISTRATION: NCT00497562 (ClinicalTrials.gov)
(133) Ayan C, Martin
V, Alonso-Cortes B, Alvarez MJ, Valencia M, Barrientos MJ.
Relationship between aerobic fitness and quality of life in
female fibromyalgia patients. Clin Rehabil 2007; 21(12):1109-13.
Abstract: OBJECTIVE: To determine whether there is a direct link
between quality of life and aerobic capacity among female
fibromyalgia patients. DESIGN: Cross-section study. SETTING:
University of Leon.Subjects: Twenty-nine women belonging to the
Leon Fibromyalgia and Chronic Fatigue Association. MAIN
MEASUREMENTS: Aerobic capacity and quality of life were measured
by means of the Six-Minute Walk Test and the Fibromyalgia Impact
Questionnaire. Outcome measures included heart rate and rate of
perceived fatigue and dypsnoea. RESULTS: The average distance
walked was 432.8 (61.2) m and the total average Fibromyalgia
Impact Questionnaire score was 47.5 (18.9). Only item 1 of the
Fibromyalgia Impact Questionnaire, physical function, showed any
statistically significant link with the distance walked, which
had no statistically significant relationship with any of the
variables studied. CONCLUSION: The physical fitness of women
with fibromyalgia, as determined by the Six-Minute Walk Test and
the Fibromyalgia Impact Questionnaire, has no direct relation
with quality of life as the patients perceive it
(134) Walitt B,
Roebuck-Spencer T, Bleiberg J, Foster G, Weinstein A. Automated
neuropsychiatric measurements of information processing in
fibromyalgia. Rheumatol Int 2008; 28(6):561-6.
Abstract: Aberrant central neurological functioning is believed
to contribute to the abnormal sensations of fibromyalgia (FM).
Most patients with FM complain of diminished cognitive function.
This study sought to compare objective cognitive function
between FM and healthy controls at baseline and to determine if
symptomatic improvement was related to objective cognitive
improvement. Automated neuropsychological assessment metrics
(ANAM) was used to quantify neurocognitive function. Performance
on ANAM was compared between subjects with FM, musculoskeletal
pain, and pain-free controls. Ten separate FM subjects completed
an 8-week comprehensive treatment program. Serial testing with
ANAM and the Fibromyalgia Impact Questionnaire was conducted.
Statistical analysis was performed using repeated Wilcoxon
signed rank tests. No differences were noted on ANAM between
controls and subjects with pain disorders. A clinical
improvement (FIQ median change 33.9, P = 0.002) was noted with
treatment without concomitant change in ANAM scores. No
cognitive impairment in FM was demonstrated using ANAM
(135) Arnold LM,
Crofford LJ, Martin SA, Young JP, Sharma U. The effect of
anxiety and depression on improvements in pain in a randomized,
controlled trial of pregabalin for treatment of fibromyalgia.
Pain Med 2007; 8(8):633-8.
Abstract: OBJECTIVE: To assess symptoms of anxiety and
depression in a large cohort of fibromyalgia patients and to
determine the impact of these symptoms on response of pain to
pregabalin treatment. DESIGN: Patients completed the Hospital
Anxiety and Depression Scale at the baseline visit in a
randomized, controlled trial of pregabalin for treatment of
fibromyalgia. Mean anxiety and depression subscale scores were
calculated, and proportions of patients by symptom severity were
determined. The difference between the proportion of patients
reporting anxiety and depression at baseline was tested using
McNemar's test. Baseline anxiety and depression were evaluated
as covariates by including them-as interaction terms with
treatment-in an ancova model. A path analysis evaluated the
association between improvements in anxiety and depression and
pain relief. RESULTS: In total, 529 patients were enrolled.
Significantly more patients reported anxiety symptoms (71%) than
depressive symptoms (56%) (P < 0.0001). Improvement in pain
symptoms with pregabalin compared with placebo did not depend
linearly on baseline anxiety or depression scores. By path
analysis, 75% of the pain reduction was not explained by
improvements in anxiety and depressive symptoms. CONCLUSIONS:
Anxiety symptoms were more common than depressive symptoms in
this cohort. Our results suggest patients with fibromyalgia
should be routinely assessed for the presence of both anxiety
and depression. The pain treatment effect of pregabalin did not
depend on baseline anxiety or depressive symptoms, suggesting
pregabalin improves pain in patients with or without these
symptoms. Much of the pain reduction appears to be independent
of improvements in anxiety or mood symptoms
(136) Rooks DS,
Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B et al.
Group exercise, education, and combination self-management in
women with fibromyalgia: a randomized trial. Arch Intern Med
2007; 167(20):2192-200.
Abstract: BACKGROUND: Self-management has increasingly been
recommended as part of standard care for fibromyalgia, a common,
poorly understood condition with limited treatment options. Data
that assess popular self-management recommendations are scarce.
We evaluated and compared the effectiveness of 4 common
self-management treatments on function, symptoms, and
self-efficacy in women with fibromyalgia. METHODS: A total of
207 women with confirmed fibromyalgia were recruited from
September 16, 2002, through November 30, 2004, and randomly
assigned to 16 weeks of (1) aerobic and flexibility exercise
(AE); (2) strength training, aerobic, and flexibility exercise
(ST); (3) the Fibromyalgia Self-Help Course (FSHC); or (4) a
combination of ST and FSHC (ST-FSHC). The primary outcome was
change in physical function from baseline to completion of the
intervention. Secondary outcomes included social and emotional
function, symptoms, and self-efficacy. RESULTS: Improvements in
the mean Fibromyalgia Impact Questionnaire score in the 4 groups
were -12.7 for the ST-FSHC group, -8.2 for the AE group, -6.6
for the ST group, and -0.3 for the FSHC group. The ST-FSHC group
demonstrated greater improvement than the FSHC group (mean
difference, -12.4; 95% confidence interval [CI], -23.1 to -1.7).
The ST-FSHC (mean difference, 13.6; 95% CI, 2.3 to 24.9) and AE
(mean difference, 13.1; 95% CI, 1.6 to 25.6) groups had similar
improvements in physical function scores on the 36-Item
Short-Form Health Survey. Bodily pain scores on the 36-Item
Short-Form Health Survey improved in the ST-FSHC (14.8), AE
(13.2), and ST (5.7) groups. Social function, mental health,
fatigue, depression, and self-efficacy also improved. The
beneficial effect on physical function of exercise alone and in
combination with education persisted at 6 months. CONCLUSIONS:
Progressive walking, simple strength training movements, and
stretching activities improve functional status, key symptoms,
and self-efficacy in women with fibromyalgia actively being
treated with medication. The benefits of exercise are enhanced
when combined with targeted self-management education. Our
findings suggest that appropriate exercise and patient education
be included in the treatment of fibromyalgia
(137) Roizenblatt S,
Fregni F, Gimenez R, Wetzel T, Rigonatti SP, Tufik S et al.
Site-specific effects of transcranial direct current stimulation
on sleep and pain in fibromyalgia: a randomized, sham-controlled
study. Pain Pract 2007; 7(4):297-306.
Abstract: OBJECTIVE: To investigate whether active anodal
transcranial direct current stimulation (tDCS) (of dorsolateral
prefrontal cortex [DLPFC] and primary motor cortex [M1]) as
compared to sham treatment is associated with changes in sleep
structure in fibromyalgia. METHODS: Thirty-two patients were
randomized to receive sham stimulation or active tDCS with the
anode centered over M1 or DLPFC (2 mA, 20 minutes for five
consecutive days). A blinded evaluator rated the clinical
symptoms of fibromyalgia. All-night polysomnography was
performed before and after five consecutive sessions of tDCS.
RESULTS: Anodal tDCS had an effect on sleep and pain that was
specific to the site of stimulation: such as that M1 and DLPFC
treatments induced opposite effects on sleep and pain, whereas
sham stimulation induced no significant sleep or pain changes.
Specifically, whereas M1 treatment increased sleep efficiency
(by 11.8%, P = 0.004) and decreased arousals (by 35.0%, P =
0.001), DLPFC stimulation was associated with a decrease in
sleep efficiency (by 7.5%, P = 0.02), an increase in rapid eye
movement (REM) and sleep latency (by 47.7%, P = 0.0002, and
133.4%, P = 0.02, respectively). In addition, a decrease in REM
latency and increase in sleep efficiency were associated with an
improvement in fibromyalgia symptoms (as indexed by the
Fibromyalgia Impact Questionnaire). Finally, patients with
higher body mass index had the worse sleep outcome as indexed by
sleep efficiency changes after M1 stimulation. INTERPRETATION:
Our findings suggest that one possible mechanism to explain the
therapeutic effects of tDCS in fibromyalgia is via sleep
modulation that is specific to modulation of primary M1 activity
(138) Peleg R, Ablin
JN, Peleg A, Neumann L, Rabia RA, Buskila D. Characteristics of
fibromyalgia in Muslim Bedouin women in a primary care clinic.
Semin Arthritis Rheum 2008; 37(6):398-402.
Abstract: BACKGROUND: Fibromyalgia (FM) has been described and
studied in various sociocultural settings in both developed and
developing countries. OBJECTIVES: To study the clinical
manifestations of FM and to describe its effect on quality of
life in the unique setting of Muslim Bedouin women in the
southern Israel Negev desert area. METHODS: One hundred two
Bedouin women were recruited from a primary health care clinic
in the Negev area. All patients fulfilled American College of
Rheumatology criteria for the diagnosis of FM. Tenderness was
assessed by manual dolorimetry and the fibromyalgia impact
questionnaire was utilized to estimate the severity of FM
symptoms. Anxiety and depression were assessed by the Arthritis
Impact Measurement Scales subscales and quality of life was
evaluated by the SF-36 questionnaire. RESULTS: The study
population was characterized by a low educational level, a high
rate of consanguinity, a high number of children per mother, and
a high rate of polygamy. There was a high frequency of classic
FM symptoms such as pain and fatigue, as well as anxiety and
depression. The overall impact of FM on quality of life was
exceedingly high (8.9 on a scale of 0 to 10). CONCLUSIONS: FM is
relatively common in the unique setting of Muslim Bedouin women
and has a very significant impact on their quality of life as
well as on their dependents. Physicians involved in the primary
care of this population should be attentive to the
manifestations of FM and related disorders
(139) Skrabek RQ,
Galimova L, Ethans K, Perry D. Nabilone for the treatment of
pain in fibromyalgia. J Pain 2008; 9(2):164-73.
Abstract: A randomized, double-blind, placebo-controlled trial
was conducted to determine the benefit of nabilone in pain
management and quality of life improvement in 40 patients with
fibromyalgia. After a baseline assessment, subjects were
titrated up on nabilone, from 0.5 mg PO at bedtime to 1 mg BID
over 4 weeks or received a corresponding placebo. At the 2- and
4-week visits, the primary outcome measure, visual analog scale
(VAS) for pain, and the secondary outcome measures, number of
tender points, the average tender point pain threshold, and the
Fibromyalgia Impact Questionnaire (FIQ), were evaluated. After a
4-week washout period, subjects returned for reassessment of the
outcome measures. There were no significant differences in
population demographics between groups at baseline. There were
significant decreases in the VAS (-2.04, P < .02), FIQ (-12.07,
P < .02), and anxiety (-1.67, P < .02) in the nabilone treated
group at 4 weeks. There were no significant improvements in the
placebo group. The treatment group experienced more side effects
per person at 2 and 4 weeks (1.58, P < .02 and 1.54, P < .05),
respectively. Nabilone appears to be a beneficial,
well-tolerated treatment option for fibromyalgia patients, with
significant benefits in pain relief and functional improvement.
PERSPECTIVE: To our knowledge, this is the first randomized,
controlled trial to assess the benefit of nabilone, a synthetic
cannabinoid, on pain reduction and quality of life improvement
in patients with fibromyalgia. As nabilone improved symptoms and
was well-tolerated, it may be a useful adjunct for pain
management in fibromyalgia
(140) Vargas-Alarcon
G, Fragoso JM, Cruz-Robles D, Vargas A, Vargas A,
Lao-Villadoniga JI et al. Catechol-O-methyltransferase gene
haplotypes in Mexican and Spanish patients with fibromyalgia.
Arthritis Res Ther 2007; 9(5):R110.
Abstract: Autonomic dysfunction is frequent in patients with
fibromyalgia (FM). Heart rate variability analyses have
demonstrated signs of ongoing sympathetic hyperactivity.
Catecholamines are sympathetic neurotransmitters.
Catechol-O-methyltransferase (COMT), an enzyme, is the major
catecholamine-clearing pathway. There are several
single-nucleotide polymorphisms (SNPs) in the COMT gene
associated with the different catecholamine-clearing abilities
of the COMT enzyme. These SNPs are in linkage disequilibrium and
segregate as 'haplotypes'. Healthy females with a particular
COMT gene haplotype (ACCG) producing a defective enzyme are more
sensitive to painful stimuli. The objective of our study was to
define whether women with FM, from two different countries
(Mexico and Spain), have the COMT gene haplotypes that have been
previously associated with greater sensitivity to pain. All the
individuals in the study were female. Fifty-seven Mexican
patients and 78 Spanish patients were compared with their
respective healthy control groups. All participants filled out
the Fibromyalgia Impact Questionnaire (FIQ). Six COMT SNPs
(rs2097903, rs6269, rs4633, rs4818, rs4680, and rs165599) were
genotyped from peripheral blood DNA. In Spanish patients, there
was a significant association between three SNPs (rs6269,
rs4818, and rs4680) and the presence of FM when compared with
healthy controls. Moreover, in Spanish patients with the 'high
pain sensitivity' haplotype (ACCG), the disease, as assessed by
the FIQ, was more severe. By contrast, Mexican patients
displayed only a weak association between rs6269 and rs165599,
and some FIQ subscales. In our group of Spanish patients, there
was an association between FM and the COMT haplotype previously
associated with high pain sensitivity. This association was not
observed in Mexican patients. Studies with a larger sample size
are needed in order to verify or amend these preliminary results
(141)
Alvarez-Nemegyei J, Negreros-Castillo A, Nuno-Gutierrez BL,
Alvarez-Berzunza J, Alcocer-Martinez LM. [Ericksonian hypnosis
in women with fibromyalgia syndrome]. Rev Med Inst Mex Seguro
Soc 2007; 45(4):395-401.
Abstract: BACKGROUND: Fibromyalgia syndrome (FS) is a chronic,
painful, generalized musculoskeletal disorder in which some
efficacy for the conventional hypnosis modality has been
claimed. Objective: to assess the efficacy of the Ericksonian
modality hypnosis in FS management. MATERIAL AND METHODS:
Forty-three FS female patients (44 +/- 4.7 years old) were
included. They were randomized to receive for six months:
Ericksonian hypnosis (EH; 20 subjects) or a sham-hypnosis (SH;
23 subjects). Every month, patient and physician global disease
assessment, tender point count and the Fibromyalgia Impact
Questionnaire (FIQ) were measured. RESULTS: During the
follow-up, we did not find inter-group differences for the rate
of change related to the baseline values for the patient and
physician global disease assessment and the FIQ scores. At the
third month (4.0 +/- 4.6 vs. 0.6 +/- 3.1; p = 0.02), and at the
fourth month (5.0 +/- 4.6 vs. 0.8 +/- 4.0; p = 0.03) of
follow-up, the participants who received EH had a significant
reduction of the tender point count after adjustment for
patient's age. CONCLUSIONS: Despite no effect was noted on the
functional status and the patient and physician global
assessment, EH produced a reduction in the number of tender
points in FS. Thus, HE may be an adjuvant treatment for the
management of FS patients
(142) Arnold LM,
Pritchett YL, D'Souza DN, Kajdasz DK, Iyengar S, Wernicke JF.
Duloxetine for the treatment of fibromyalgia in women: pooled
results from two randomized, placebo-controlled clinical trials.
J Womens Health (Larchmt ) 2007; 16(8):1145-56.
Abstract: BACKGROUND: To assess the efficacy (in particular, in
pain, functional impairment, and quality of life) and safety and
tolerability (incidence of adverse events, discontinuation
rates, changes in laboratory findings, and vital signs) of
duloxetine in female patients with fibromyalgia. METHODS: Data
were pooled from two placebo-controlled clinical trials of
similar design (randomized, 12-week, and double-blind),
comparing duloxetine 60 mg a day (q.d.) or 60 mg twice daily
(b.i.d.) (n = 326) with placebo (n = 212), in women who met the
American College of Rheumatology criteria for primary
fibromyalgia. RESULTS: Compared with the patients receiving
placebo, duloxetine-treated female patients demonstrated a
significantly greater improvement in the Brief Pain Inventory
(BPI) average pain severity score and in the Fibromyalgia Impact
Questionnaire (FIQ) total score, beginning at week 1 and
continuing through week 12 (p < 0.001). Duloxetine was superior
to placebo on all efficacy measures, including mean tender point
threshold, Clinical Global Impression of Severity, Patient
Global Impression of Improvement, and average interference from
pain scores. The duloxetine-treated group was superior to
placebo on all quality of life and functional measures,
including each domain of the Medical Outcomes Study Short
Form-36 (SF-36). A direct treatment effect of duloxetine on pain
reduction was demonstrated and shown to be independent of
secondary improvement in mood (based on BPI average pain score).
Significantly more duloxetine-treated patients reported
treatment-emergent adverse events (296 [90.8%]
duloxetine-treated and 165 [77.8%] placebo-treated, p < 0.001).
Rates of serious adverse events were similar between
duloxetine-treated and placebo-treated patients. CONCLUSIONS:
The pooled results of these studies demonstrate that duloxetine
is a safe and efficacious treatment for both the pain and
functional impairment associated with fibromyalgia in female
patients, while significantly improving quality of life
(143) Ubago Linares
MC, Ruiz-Perez I, Bermejo Perez MJ, Olry dL-L, Hernandez-Torres
E, Plazaola-Castano J. Analysis of the impact of fibromyalgia on
quality of life: associated factors. Clin Rheumatol 2008;
27(5):613-9.
Abstract: We analysed the impact of fibromyalgia (FM) on the
functional capacity of patients suffering this syndrome and
identified factors that are associated with greater disease
impact. We performed a cross-sectional descriptive telephone
survey on all patients diagnosed with fibromyalgia during 2003
in a university hospital in Spain. Variables studied were
socio-demographic, job, clinical, health and psycho-social
characteristics of patients diagnosed with FM and impact of FM
on them. Disease impact was measured by means of the
Fibromyalgia Impact Questionnaire (FIQ). The rest of variables
were collected by means of an expressly designed questionnaire.
The relation between FIQ score and the other variables was
performed with a bivariate analysis, using several tests
depending on the variables involved. To analyse the factors
associated with greatest disease impact, a multivariate linear
regression model was designed. The average FIQ score for the
sample was 63.6. Having a larger number of children, being tired
and being in a depressed mood were the symptoms that most
affected activities of daily living. A diagnosis of any mental
illness, reference to repercussion on the family environment, a
lower self-rated health and having consulted more specialists
before FM diagnosis were associated with a higher impact after
adjusting according to all the variables in the model. It can be
confirmed that the FIQ is a useful instrument for measuring the
impact of FM on quality of life. Identifying factors that
determine the extent of its impact will enable more effective
therapeutic strategies to be designed
(144) Gursoy S,
Erdal E, Sezgin M, Barlas IO, Aydeniz A, Alasehirli B et al.
Which genotype of MAO gene that the patients have are likely to
be most susceptible to the symptoms of fibromyalgia? Rheumatol
Int 2008; 28(4):307-11.
Abstract: The objective of this study was to analyze the
genotype distributions and allele frequencies for the MAO-A and
MAO-B polymorphism of the MAO gene among the patients with
fibromyalgia syndrome (FS). One hundred and seven fibromyalgia
patients and 90 unrelated healthy subjects were included into
the study. Genomic DNA of 107 FS patients and 90 healthy control
subjects were analyzed by polymerase chain reaction.
Polymorphism of the MAO gene was: 1-1, 1-3, 3-3, 3-4. The
"allele 3" had a 2.7 to 4.8-fold increased transcription
activity than the "allele 1". The frequencies of the genotypes
of the patients with FS and healthy controls were compared.
Although no significant difference was found in genotypes of
patients and controls (P = 0.0559), it is likely that "allele 3"
could be a more riskful factor for FS than "allele 1" (P =
0.033). Fibromyalgia impact questionnaire was administered to FS
group as well as control group. One of our findings is that, the
patients whose genotype 3-3 may be mostly affected by the
symptoms of FS. In conclusion, it seems plausible to say that
MAOA-dependent metabolism of the biological amines may be partly
related to high-activated MAO-A, allele 3, in the occurrence of
FS among Turkish population
(145) Passard A,
Attal N, Benadhira R, Brasseur L, Saba G, Sichere P et al.
Effects of unilateral repetitive transcranial magnetic
stimulation of the motor cortex on chronic widespread pain in
fibromyalgia. Brain 2007; 130(Pt 10):2661-70.
Abstract: Non-invasive unilateral repetitive transcranial
magnetic stimulation (rTMS) of the motor cortex induces
analgesic effects in focal chronic pain syndromes, probably by
modifying central pain modulatory systems. Neuroimaging studies
have shown bilateral activation of a large number of structures,
including some of those involved in pain processing, suggesting
that such stimulation may induce generalized analgesic effects.
The goal of this study was to assess the effects of unilateral
rTMS of the motor cortex on chronic widespread pain in patients
with fibromyalgia. Thirty patients with fibromyalgia syndrome
(age: 52.6 +/- 7.9) were randomly assigned, in a double-blind
fashion, to two groups, one receiving active rTMS (n = 15) and
the other sham stimulation (n = 15), applied to the left primary
motor cortex in 10 daily sessions. The primary outcome measure
was self-reported average pain intensity over the last 24 h,
measured at baseline, daily during the stimulation period and
then 15, 30 and 60 days after the first stimulation. Other
outcome measures included: sensory and affective pain scores for
the McGill pain Questionnaire, quality of life (assessed with
the pain interference items of the Brief Pain Inventory and the
Fibromyalgia Impact Questionnaire), mood and anxiety (assessed
with the Hamilton Depression Rating Scale, the Beck Depression
Inventory and the Hospital Anxiety and Depression Scale). We
also assessed the effects of rTMS on the pressure pain threshold
at tender points ipsi- and contralateral to stimulation.
Follow-up data were obtained for all the patients on days 15 and
30 and for 26 patients (13 in each treatment group) on day 60.
Active rTMS significantly reduced pain and improved several
aspects of quality of life (including fatigue, morning
tiredness, general activity, walking and sleep) for up to 2
weeks after treatment had ended. The analgesic effects were
observed from the fifth stimulation onwards and were not related
to changes in mood or anxiety. The effects of rTMS were more
long-lasting for affective than for sensory pain, suggesting
differential effects on brain structures involved in pain
perception. Only few minor and transient side effects were
reported during the stimulation period. Our data indicate that
unilateral rTMS of the motor cortex induces a long-lasting
decrease in chronic widespread pain and may therefore constitute
an effective alternative analgesic treatment for fibromyalgia
(146) Mannerkorpi K,
Rivano-Fischer M, Ericsson A, Nordeman L, Gard G. Experience of
physical activity in patients with fibromyalgia and chronic
widespread pain. Disabil Rehabil 2008; 30(3):213-21.
Abstract: PURPOSE: Patients with fibromyalgia (FM) and chronic
widespread pain (CWP) find physical activity troublesome. The
purpose was to develop a questionnaire to investigate the
experience of physical activity in FM and CWP populations.
METHOD: A questionnaire was developed from a qualitative study.
After that, a total of 204 patients with FM or CWP completed the
questionnaire. A factor analysis was conducted and the internal
consistency was investigated. The relationship between the
factors and pain, health status (the Fibromyalgia Impact
Questionnaire, FIQ), distress (the Hospital Anxiety and Distress
scale, HAD) and leisure time physical activity (the Leisure Time
Physical Activity Instrument, LTPAI) was investigated. RESULTS:
Five factors were identified: Physical Relaxation (PR),
Well-being (WB), Activity Beliefs (AB), Activity-related
Symptoms (AS) and Activity Habits (AH). Cronbach's alpha ranged
from 0.57 to 0.86. The PR showed a correlation (rho 0.28, p <
0.01) with the FIQ Pain. The AS showed a correlation (rho 0.25,
p < 0.01) with the FIQ total score, while the AH showed a
correlation with the HAD Depression (0.26, p < 0.01) and with
strenuous physical activity (LTPAI) (-0.32, p < 0.01).
CONCLUSION: A new instrument was developed to study the
experience of physical activity in persons with long-lasting
pain. Five factors were identified using factor analysis, and
three of them showed fair associations with FM symptoms,
distress or physical activity
(147) Bazzichi L,
Giacomelli C, De FF, Giuliano T, Rossi A, Doveri M et al.
Antipolymer antibody in Italian fibromyalgic patients. Arthritis
Res Ther 2007; 9(5):R86.
Abstract: The objectives of the present study were to evaluate
the presence of antipolymer antibody (APA) seropositivity in 285
Italian patients affected by primary fibromyalgia (FM) and to
verify whether APA levels correlate with disease severity and
with cytokine levels.APA levels were determined on serum samples
by an indirect ELISA kit that detects IgG APA. Cytokines (IL-1,
IL-6, IL-8, IL-10 and TNFalpha) were measured by ELISA in
plasma. The impact of FM on the quality of life was estimated
using the Fibromyalgia Impact Questionnaire, while pain severity
was evaluated using a visual analogic scale. Patients were also
characterized by the presence of tiredness, stiffness,
nonrestorative sleep, anxiety, depression, tension headache,
irritable bowel syndrome, temporomandibular dysfunction and
Raynaud's phenomena. Using a cut-off value of 30 U, APA-positive
values were detected in 60 FM patients (21.05%) and in 15
healthy control individuals (15.00%) without significant
differences among their levels or the percentage of
seropositivity. FM patients with moderate and severe symptoms
had slightly higher APA levels with respect to patients with
mild symptoms. APA-seropositive patients exhibited significant
correlations between APA levels and the Fibromyalgia Impact
Questionnaire estimate (P = 0.042), tiredness (P = 0.003) and
IL-1 levels (P = 0.0072). In conclusion, APA cannot be
considered a marker of disease in Italian FM patients. The
presence of APA, however, might permit the identification of a
subset of FM patients with more severe symptoms and of patients
who may respond differently to different therapeutic strategies
(148) Al-Allaf AW.
Work disability and health system utilization in patients with
fibromyalgia syndrome. J Clin Rheumatol 2007; 13(4):199-201.
Abstract: BACKGROUND: Fibromyalgia syndrome (FMS) usually
affects women of working age. We expect significant work-related
disability in association with FMS. Because of the variety of
symptoms, these patients often have multiple visits to their
general practitioners with many referrals and visits to various
specialists. OBJECTIVE: To investigate the impact of
fibromyalgia on working disability and health system
utilization. METHOD: This was a case-control study comparing
fibromyalgia outpatient attendees with controls attending
nonrheumatology outpatient clinics in Eastern Scotland. One
hundred thirty-six patients with FMS and 152 age- and
sex-matched controls completed a postal questionnaire about
their working history and attendance at various outpatient
clinics and general practitioners' visits. RESULTS: Significant
number of patients with FMS (46.8%) reported that they lost
their job because of the disease, compared with only 14.1% of
controls (P < 0.00001). There was no significant difference in
health system utilization between patients with FMS and other
clinic controls in a subset of patients surveyed. CONCLUSION:
Fibromyalgia is significantly associated with reports of working
disability. Reasons for this decreased employment need to be
investigated. The impact on the health system appeared to be the
same as for patients with known specific organic diseases with
regard to the number of general practitioner or hospital visits
(149) Tander B,
Atmaca A, Aliyazicioglu Y, Canturk F. Serum ghrelin levels but
not GH, IGF-1 and IGFBP-3 levels are altered in patients with
fibromyalgia syndrome. Joint Bone Spine 2007; 74(5):477-81.
Abstract: INTRODUCTION: Both hypothalamo-pituitary-insulin-like
growth factor-1 (IGF-1) axis and ghrelin levels may be altered
in fibromyalgia syndrome (FMS) due to increased somatostatin
tone. The aim of this study is to compare
hypothalamo-pituitary-IGF-1 axis, ghrelin concentrations and
their relations in premenopausal women with FMS and
premenopausal healthy controls. METHODS: Seventy-five women (47
FMS and 28 healthy women) were enrolled in the study. Fasting
plasma glucose, serum growth hormone (GH), insulin, C-peptide,
IGF-1, insulin-like growth factor binding protein-3 (IGFBP-3)
and ghrelin levels were measured. Depressive symptoms were
assessed using beck depression inventory. Pain intensity and
sleep disturbance were recorded on a visual analog scale. The
activity of daily living was assessed by fibromyalgia impact
questionnaire. RESULTS: There were no significant differences in
GH, IGF-1, IGFBP-3, glucose, insulin, and C-peptide levels
between patients and controls (p>0.05), whereas ghrelin levels
were significantly lower in patients than controls (p<0.05).
Ghrelin levels were not correlated with GH, IGF-1, IGFBP-3,
glucose, insulin, and C-peptide levels while they were
positively correlated with tender point score and sleep
disturbance score and negatively correlated with pain intensity
score. CONCLUSION: Our results suggest that low levels of
ghrelin in FMS are not related to the changes in
hypothalamo-pituitary-IGF-1 axis but may be related to some
symptoms of FMS. Our results need to be clarified by further
studies
(150) Babu AS,
Mathew E, Danda D, Prakash H. Management of patients with
fibromyalgia using biofeedback: a randomized control trial.
Indian J Med Sci 2007; 61(8):455-61.
Abstract: OBJECTIVE: Fibromyalgia syndrome (FMS) is a chronic
rheumatological condition which could be characterized by
generalized pain and fatigue. Cognitive and behavioral therapy
has been found to be a suitable technique in the management of
FMS. This study intends to evaluate the efficacy of
electromyography (EMG) biofeedback to reduce pain in patients
with FMS. MATERIALS AND METHODS: A randomized controlled trial
involving two groups of FMS patients, one receiving EMG
biofeedback and the other a sham biofeedback, was carried out.
The assessment tools included in the study were fibromyalgia
impact questionnaire (FIQ), visual analogue scale (VAS),
six-minute walk test (SMWT) and number of tender points; and
tenderness of each tender point was done for both the groups.
STATISTICS: A Student's 't' test was used to study the test for
significance. RESULTS: After using biofeedback, the mean VAS
scores and the mean number of tender points were found to be 3
out of 10 and 6 out of 18 respectively. Subjective analysis from
both groups showed improvement in physical and psychological
realms. Statistical significance. CONCLUSION: Biofeedback as a
treatment modality reduces pain in patients with FMS, along with
improvements in FIQ, SMWT and the number of tender points
(151) Yazici Y.
Monitoring outcomes of arthritis and longitudinal data
collection in routine care using a patient questionnaire that
incorporates a clinical note on one piece of paper. Best Pract
Res Clin Rheumatol 2007; 21(4):629-36.
Abstract: Patient questionnaires are the quantitative tools
available to rheumatologists to monitor their patients' health
status and responses to therapy. The Health Assessment
Questionnaire (HAQ) and its derivatives have been shown to be
the most significant predictors of functional and work
disability, costs, joint replacement surgery, and mortality;
generally at higher levels of significance than joint counts,
radiographs, and laboratory tests. Every encounter of a patient
with a rheumatologist provides an opportunity to collect data.
Yet patient questionnaires, which can be used in all rheumatic
diseases, including osteoarthritis, systemic lupus
erythematosus, fibromyalgia, scleroderma, and ankylosing
spondylitis, are not included in routine care by most
rheumatologists. Questionnaires can be adapted to include a
simple subjective-objective-assessment-plan (SOAP) clinical
encounter note that helps with data entry and also provides all
the necessary information for clinical decision making in one
sheet of paper. Data that are feasible to collect in clinical
care provide the optimal approach to assessing quantitatively
how patients are doing. If data are not collected and recorded,
that opportunity, on that day, is lost forever. Rheumatologists
would find it valuable to adapt questionnaires to the care they
provide for all their patients, to document and improve the care
they provide, and add quantitative data to standard clinical
care
(152) van Wilgen CP,
Bloten H, Oeseburg B. Results of a multidisciplinary program for
patients with fibromyalgia implemented in the primary care.
Disabil Rehabil 2007; 29(15):1207-13.
Abstract: PURPOSE: Fibromyalgia is a syndrome of unknown origin
with a high prevalence. Multimodal approaches seem to be the
treatment of choice in fibromyalgia. A multidisciplinary program
was developed and implemented for patients with fibromyalgia in
the primary care setting. The program included education (seven
sessions) and physical therapy (25 sessions). METHOD: Patients
were referred to the program by their general practitioner or by
a medical specialist. A prospective non-controlled treatment
study was performed, patients were evaluated before, after and
three months after the program (single group time series
design). The following measurements were performed: The
Fibromyalgia Impact Questionnaire, RAND 36, the Pain Coping and
Cognition List, the Tampa scale for kinesiophobia, two physical
tests and a qualitative evaluation. Data of 65 patients with
fibromyalgia were analysed, of whom 97% were female. The mean
age was 44 and the mean duration of pain was nine years.
RESULTS: Data of 65 patients with fibromyalgia were analysed,
patients significantly improved on the domains feeling good,
pain, fatigue, stiffness, quality of life, catastrophizing and
on the physical tests. CONCLUSION: The multidisciplinary program
fibromyalgia implemented in primary care seems feasible and the
results are promising
(153) Carville SF,
Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D et
al. EULAR evidence-based recommendations for the management of
fibromyalgia syndrome. Ann Rheum Dis 2008; 67(4):536-41.
Abstract: OBJECTIVE: To develop evidence-based recommendations
for the management of fibromyalgia syndrome. METHODS: A
multidisciplinary task force was formed representing 11 European
countries. The design of the study, including search strategy,
participants, interventions, outcome measures, data collection
and analytical method, was defined at the outset. A systematic
review was undertaken with the keywords "fibromyalgia",
"treatment or management" and "trial". Studies were excluded if
they did not utilise the American College of Rheumatology
classification criteria, were not clinical trials, or included
patients with chronic fatigue syndrome or myalgic
encephalomyelitis. Primary outcome measures were change in pain
assessed by visual analogue scale and fibromyalgia impact
questionnaire. The quality of the studies was categorised based
on randomisation, blinding and allocation concealment. Only the
highest quality studies were used to base recommendations on.
When there was insufficient evidence from the literature, a
Delphi process was used to provide basis for recommendation.
RESULTS: 146 studies were eligible for the review. 39
pharmacological intervention studies and 59 non-pharmacological
were included in the final recommendation summary tables once
those of a lower quality or with insufficient data were
separated. The categories of treatment identified were
antidepressants, analgesics, and "other pharmacological" and
exercise, cognitive behavioural therapy, education, dietary
interventions and "other non-pharmacological". In many studies
sample size was small and the quality of the study was
insufficient for strong recommendations to be made. CONCLUSIONS:
Nine recommendations for the management of fibromyalgia syndrome
were developed using a systematic review and expert consensus
(154) McVeigh JG,
Finch MB, Hurley DA, Basford JR, Sim J, Baxter GD. Tender point
count and total myalgic score in fibromyalgia: changes over a
28-day period. Rheumatol Int 2007; 27(11):1011-8.
Abstract: Tender point count (TPC) is central to fibromyalgia
syndrome (FMS), and with total myalgic score (TMS) is often used
to monitor the patient's condition. This study aimed to
determine the stability of TPC and TMS over time, and to examine
how well these measures reflected patients' perceptions of their
condition. Twenty-four patients with FMS completed the
Fibromyalgia Impact Questionnaire (FIQ) and a visual analogue
scale (VAS) measuring well-being, at entrance into the study,
and 7 and 28 days later. There was no significant change in TPC
(P = 0.074), FIQ score (P = 0.291) or VAS (P = 0.079) of
well-being with time. However, mean TMS score did change over
time (P = 0.021). There was no correlation between total FIQ
score and the other measures (all P-values > 0.05). The
significant change in TMS over time may reflect the natural
fluctuation in the clinical presentation of FMS
(155) Walitt B,
Roebuck-Spencer T, Esposito G, Atkins F, Bleiberg J, Foster G et
al. The effects of multidisciplinary therapy on positron
emission tomography of the brain in fibromyalgia: a pilot study.
Rheumatol Int 2007; 27(11):1019-24.
Abstract: Aberrant central neurological functioning is believed
to contribute to the abnormal sensations of fibromyalgia (FM).
This pilot study sought to determine if alterations in regional
brain metabolism from baseline occur in FM after undergoing a
multidisciplinary therapeutic regimen. Regional brain metabolic
activity was estimated using (18)F-fluorodeoxyglucose positron
emission tomography ((18)FDG PET). Nine participants with FM
received an 8-week comprehensive treatment program. Serial
testing with (18)FDG PET and the Fibromyalgia Impact
Questionnaire were performed. Statistical analysis was performed
using repeated Wilcoxon signed rank tests. A clinical
improvement (FIQ median change 20.68, P = 0.005) was noted with
treatment. With treatment, increases in brain metabolism were
noted in various components of the limbic system (P =
0.004-0.1). An increase in limbic metabolism was noted with
concomitant symptomatic improvement, suggesting that the limbic
system attenuates FM symptoms
(156) Matsutani LA,
Marques AP, Ferreira EA, Assumpcao A, Lage LV, Casarotto RA et
al. Effectiveness of muscle stretching exercises with and
without laser therapy at tender points for patients with
fibromyalgia. Clin Exp Rheumatol 2007; 25(3):410-5.
Abstract: OBJECTIVE: To assess the efficiency of a treatment
composed of muscle stretching exercises, associated or not to
laser therapy at tender points, for patients with fibromyalgia
(FM), in view of bettering their quality of life. METHODS:
Twenty FM patients were randomly assigned to two groups: one
submitted to laser therapy and stretching (LSG, n=10), and the
other only to stretching exercises (SG, n=10). The visual analog
scale of pain (VAS) and dolorimetry at tender points were used
to assess pain; life quality was evaluated by means of the
Fibromyalgia Impact Questionnaire (FIQ) and the 36-item
Short-Form Health Survey (SF-36). RESULTS: After the treatment
program, both in LSG and SG were detected pain reduction, higher
pain threshold at tender points (all p<0.01), lower mean FIQ
scores, and higher SF-36 mean scores (all p<0.05). No
significant differences were found between both groups.
CONCLUSION: The stretching exercises program proposed is
efficient to reduce pain and painful sensibility at tender
points, thus enhancing patients' quality of life. Laser therapy
has not shown advantages when added to muscle stretching
exercises
(157) Tomas-Carus P,
Hakkinen A, Gusi N, Leal A, Hakkinen K, Ortega-Alonso A. Aquatic
training and detraining on fitness and quality of life in
fibromyalgia. Med Sci Sports Exerc 2007; 39(7):1044-50.
Abstract: PURPOSE: To evaluate the effects of a 12-wk period of
aquatic training and subsequent detraining on health-related
quality of life (HRQOL) and physical fitness in females with
fibromyalgia. METHODS: Thirty-four females with fibromyalgia
were randomly assigned into two groups: an exercise group, who
exercised for 60 min in warm water, three times a week (N = 17);
and a control group, who continued their habitual leisure-time
activities (N = 17). HRQOL was assessed using the Short Form 36
questionnaire and the Fibromyalgia Impact Questionnaire.
Physical fitness was measured using the following tests:
Canadian Aerobic Fitness, hand grip dynamometry, 10-m walking,
10-step stair climbing, and blind one-leg stance. Outcomes were
measured at baseline, after treatment, and after 3 months of
detraining. RESULTS: After 12 wk of aquatic exercise,
significant positive effects of aquatic training were found in
physical function, body pain, general health perception,
vitality, social function, role emotional problems and mental
health, balance, and stair climbing. After the detraining
period, only the improvements in body pain and role emotional
problems were maintained. CONCLUSION: The present water exercise
protocol improved some components of HRQOL, balance, and stair
climbing in females with fibromyalgia, but regular exercise and
higher intensities may be required to preserve most of these
gains
(158) Fioravanti A,
Perpignano G, Tirri G, Cardinale G, Gianniti C, Lanza CE et al.
Effects of mud-bath treatment on fibromyalgia patients: a
randomized clinical trial. Rheumatol Int 2007; 27(12):1157-61.
Abstract: The efficacy of balneotherapy in fibromyalgia syndrome
(FS) has been well demonstrated, while controlled studies using
mud packs are lacking. We performed a randomized clinical trial
to evaluate the effects and the tolerability of mud-bath
treatment in FS patients, who are poor responders to
pharmacological therapy. Eighty patients with primary FS,
according to ACR criteria, were randomly allocated to two
groups: 40 were submitted to a cycle of 12 mud packs and thermal
baths, and 40 were considered as controls. At baseline, after
thermal treatment and after 16 weeks, patients were evaluated by
FIQ, tender points count, VAS for "minor" symptoms, AIMS1 and
HAQ. Control patients were assessed at the same time periods. A
significant improvement of all evaluation parameters after
mud-bath therapy and after 16 weeks was observed. Mud packs were
well tolerated and no drop-outs were recorded. Our results
suggest the efficacy and the tolerability of mud-bath treatment
in primary FS
(159) Bazzichi L,
Rossi A, Giuliano T, De FF, Giacomelli C, Consensi A et al.
Association between thyroid autoimmunity and fibromyalgic
disease severity. Clin Rheumatol 2007; 26(12):2115-20.
Abstract: Our objectives were to investigate thyroid
abnormalities and autoimmunity in 120 patients affected by
fibromyalgia (FM) and to study their relationships with clinical
data and symptoms. Thyroid assessment by means of
antithyroglobulin antibodies, antithyroid peroxidase antibodies,
free triiodo-thyronine, free thyroxine, and thyroid stimulating
hormone analyses was carried out. The clinical parameters
"Fibromyalgia Impact Questionnaire", pain, tender points,
fatigue, and other symptoms, and the presence of depression or
anxiety disorders were evaluated. The basal thyroid hormone
levels of FM patients were in the normal range, while 41% of the
patients had at least one thyroid antibody. Patients with
thyroid autoimmunity showed a higher percentage of dry eyes,
burning, or pain with urination, allodynia, blurred vision, and
sore throat. Correlations found between thyroid autoimmunity and
age or with the presence of depression or anxiety disorders were
not significant. However, in the cohort of post-menopausal
patients, the frequency of thyroid autoimmunity was higher with
respect to pre-menopausal patients. In conclusion, autoimmune
thyroiditis is present in an elevated percentage of FM patients,
and it has been associated with the presence of typical symptoms
of the disease
(160) Brand K,
Littlejohn G, Kristjanson L, Wisniewski S, Hassard T. The
fibromyalgia bladder index. Clin Rheumatol 2007;
26(12):2097-103.
Abstract: The aim of this study was to determine whether an
existing outcome measure, the Interstitial Cystitis Symptom and
Problem Index (ICSI/ICPI), is a valid, reliable, and clinically
relevant instrument to assess the sensory urinary symptoms in
women with fibromyalgia syndrome (FM). Ninety women with
American College of Rheumatology 90 FM and who had at least two
sensory bladder symptoms participated in the study. All
underwent urological screening to exclude lower urinary tract
pathology. All participants completed the following: ICSI/ICPI,
Fibromyalgia Impact Questionnaire (FIQ), Medical Outcome Study
Short Form 36, King's Health Questionnaire (KHQ), and Vulval
Symptom Assessment Scale. Assessment was made for internal
consistency reliability, test-retest reliability, and concurrent
validity. Factor analysis was used to assess the internal
structure of the scale. Factor analysis displayed two separate
components of symptom and problem combinations as distinct from
the original ICSI/ICPI developed for the interstitial cystitis
population. The eight items of the index configured differently
and formed two subscales of a newly developed Fibromyalgia
Bladder Index. The two subscales of this index include the
Bladder Urgency and Pain Subscale and the Bladder Frequency and
Nocturia Subscale. This index has high internal consistency
reliability (Cronbach's alpha coefficient of 0.81), test-retest
reliability showing intraclass correlation of 0.85, and high
concurrent validity through correlations between the
Fibromyalgia Bladder Index and the KHQ (0.735, p = 0.000) and
the FIQ (0.433, p = 0.000). This more specific configuration of
the ICSI/ICPI better reflects FM bladder symptomatology. The
Fibromyalgia Bladder Index is a validated FM-specific instrument
that captures information about the sensory bladder symptoms and
their impact in this fibromyalgia population. This instrument
should allow for better understanding and management of this
important fibromyalgia-associated problem
(161) Aloush V,
Ablin JN, Reitblat T, Caspi D, Elkayam O. Fibromyalgia in women
with ankylosing spondylitis. Rheumatol Int 2007; 27(9):865-8.
Abstract: Fibromyalgia (FM), pre-dominantly found in women, may
accompany other pre-existing rheumatic diseases. The association
between FM and ankylosing spondylitis (AS) is uncertain. We
evaluated FM in women with AS. Eighteen women with AS were
compared with 18 men with AS (controls) for age, duration of
symptoms, time to diagnosis, degree of sacroiliac involvement,
history of peripheral arthritis, patient global assessment,
Health Assessment Questionnaire, Fibromyalgia Impact
Questionnaire, level of diffuse pain, Bath Ankylosing
Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing
Spondylitis Functional Index (BASFI). Physical examination
included the number of tender points and enthesitis sites,
Schober test, distance between occiput and wall, chest
expansion, lateral spinal flexion, and intermalleolar distance.
Inflammatory activity was measured by the erythrocyte
sedimentation rate (ESR). Of all tested parameters, the ones
with significant differences between the groups were time
between symptom onset and AS diagnosis (longer for women), FM
incidence and the number of tender points and enthesitis sites
(higher for women), BASDAI (higher in women and correlated with
FM and the number of tender points but not with ESR), and BASFI
and BASDAI scores (increased in FM patients). FM was present in
50% of women with AS and associated with higher disease activity
indices (BASDAI and BASFI) and not related to severity of
physical findings or ESR. The reliability of well-accepted
assessment tools of AS, such as BASDAI and BASFI, in evaluating
AS activity in women may be called into question due to a
confounding effect of FM
(162) Patkar AA,
Masand PS, Krulewicz S, Mannelli P, Peindl K, Beebe KL et al. A
randomized, controlled, trial of controlled release paroxetine
in fibromyalgia. Am J Med 2007; 120(5):448-54.
Abstract: PURPOSE: We investigated the efficacy and tolerability
of paroxetine controlled release, a selective serotonin reuptake
inhibitor in fibromyalgia. METHODS: After excluding patients
with current major depression and anxiety disorders, 116
subjects with fibromyalgia were enrolled in a 12-week,
randomized, double-blind, placebo-controlled, trial of
paroxetine controlled release (12.5-62.5 mg/day). The primary
outcome measure was proportion of responders as defined as a> or
=25% reduction in scores on the Fibromyalgia Impact
Questionnaire (FIQ) from randomization to end of treatment.
Secondary outcome measures included changes in FIQ scores,
Clinical Global Impression -Improvement (CGI-I) and Severity
(CGI-S) scores, Visual Analogue Scale for pain scores, number of
tender points, and scores on the Sheehan Disability Scale (SDS).
RESULTS: Significantly more patients in paroxetine controlled
release group (57%) showed a> or =25% reduction in FIQ compared
to placebo (33%) (P=.016). Paroxetine controlled release was
significantly superior to placebo in reducing the FIQ total
score (P =.015). The CGI-I ratings significantly favored the
drug over placebo (P<.005). The improvements on other secondary
outcome measures between the 2 groups were not statistically
significant. Drowsiness, dry mouth, blurred vision, genital
disorders, and anxiety were reported more frequently with
paroxetine controlled release. The mean dose of paroxetine
controlled release was 39.1 mg/day. CONCLUSIONS: Paroxetine
controlled release appears to be well-tolerated and improve the
overall symptomatology in patients with fibromyalgia without
current mood or anxiety disorders. However, its effect on pain
measures seems to be less robust
(163) Iverson GL, Le
PJ, Koehler BE, Shojania K, Badii M. Test of Memory Malingering
(TOMM) scores are not affected by chronic pain or depression in
patients with fibromyalgia. Clin Neuropsychol 2007;
21(3):532-46.
Abstract: Neuropsychologists routinely give effort tests, such
as the Test of Memory Malingering (TOMM). When a person fails
one of these tests, the clinician must try to determine whether
the poor performance was due to suboptimal effort or to chronic
pain, depression, or other problems. Participants were 54
community-dwelling patients who met American College of
Rheumatology criteria for fibromyalgia (FM). In addition to the
TOMM, they completed the Beck Depression Inventory-Second
Edition, Multidimensional Pain Inventory-Version 1, Oswestry
Disability Index-2.0, British Columbia Cognitive Complaints
Inventory, and the Fibromyalgia Impact Questionnaire. The
majority endorsed at least mild levels of depressive symptoms
(72%), and 22% endorsed "severe" levels of depression. The
average scores on the TOMM were 48.8 (SD = 1.9, range = 40-50)
for Trial 1, 49.8 (SD = 0.5, range = 48-50) for Trial 2, and
49.6 (SD = 0.9, range = 45-50) for Retention. Despite relatively
high levels of self-reported depression, chronic pain, and
disability, not a single patient failed the TOMM. In this study,
the TOMM was not affected by chronic pain, depression, or both
(164) Calandre EP,
Morillas-Arques P, Rodriguez-Lopez CM, Rico-Villademoros F,
Hidalgo J. Pregabalin augmentation of quetiapine therapy in the
treatment of fibromyalgia: an open-label, prospective trial.
Pharmacopsychiatry 2007; 40(2):68-71.
Abstract: INTRODUCTION: Quetiapine has been shown to improve
fibromyalgia symptoms, especially sleep disturbance, fatigue,
morning stiffness, and mental well-being, but lacks an effect on
pain. The purpose of this study was to evaluate if pregabalin,
which has shown antialgic activity in fibromyalgia, added to
quetiapine treatment additionally improved fibromyalgia
symptomatology. METHODS: This was an open-label, 12-week study.
Pregabalin was administered to 19 female fibromyalgia patients
at a starting dose of 75 mg/day subsequently adjusted in
according to the drug's efficacy and tolerability. Outcome
measures included the Fibromyalgia Impact Questionnaire (FIQ),
the Pittsburgh Sleep Quality Index, the Beck Depression
Inventory, the State and Trait Anxiety Inventory, and the SF-12
Health Survey. RESULTS: Data analysis was done on the
Intention-To-Treat sample which included 18 patients. Pregabalin
significantly improved the pain and tiredness after awakening
subscales of the FIQ as well as the physical component of the
SF-12. Six patients withdrew from the study, 3 because of side
effects. CONCLUSIONS: Our results suggest that the use of
pregabalin can be a useful augmentation strategy in fibromyalgia
patients partially responding to quetiapine
(165) Arnold LM,
Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE, Jr.
et al. Gabapentin in the treatment of fibromyalgia: a
randomized, double-blind, placebo-controlled, multicenter trial.
Arthritis Rheum 2007; 56(4):1336-44.
Abstract: OBJECTIVE: To assess the efficacy and safety of
gabapentin in patients with fibromyalgia. METHODS: A 12-week,
randomized, double-blind study was designed to compare
gabapentin (1,200-2,400 mg/day) (n=75 patients) with placebo
(n=75 patients) for efficacy and safety in treating pain
associated with fibromyalgia. The primary outcome measure was
the Brief Pain Inventory (BPI) average pain severity score
(range 0-10, where 0=no pain and 10=pain as bad as you can
imagine). Response to treatment was defined as a reduction of
>or=30% in this score. The primary analysis of efficacy for
continuous variables was a longitudinal analysis of the
intent-to-treat sample, with treatment-by-time interaction as
the measure of effect. RESULTS: Gabapentin-treated patients
displayed a significantly greater improvement in the BPI average
pain severity score (P=0.015; estimated difference between
groups at week 12=-0.92 [95% confidence interval -1.75, -0.71]).
A significantly greater proportion of gabapentin-treated
patients compared with placebo-treated patients achieved
response at end point (51% versus 31%; P=0.014). Gabapentin
compared with placebo also significantly improved the BPI
average pain interference score, the Fibromyalgia Impact
Questionnaire total score, the Clinical Global Impression of
Severity, the Patient Global Impression of Improvement, the
Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS
Short Form 36 vitality score, but not the mean tender point pain
threshold or the Montgomery Asberg Depression Rating Scale.
Gabapentin was generally well tolerated. CONCLUSION: Gabapentin
(1,200-2,400 mg/day) is safe and efficacious for the treatment
of pain and other symptoms associated with fibromyalgia
(166) Bennett RM,
Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of
2,596 people with fibromyalgia. BMC Musculoskelet Disord 2007;
8:27.
Abstract: BACKGROUND: This study explored the feasibility of
using an Internet survey of people with fibromyalgia (FM), with
a view to providing information on demographics, sources of
information, symptoms, functionality, perceived aggravating
factors, perceived triggering events, health care utilization,
management strategies, and medication use. METHODS: A survey
questionnaire was developed by the National Fibromyalgia
Association (NFA) in conjunction with a task force of "experts
in the field". The questionnaire underwent several rounds of
testing to improve its face validity, content validity, clarity
and readability before it was mounted on the internet. The
questionnaire consisted of 121 items and is available online at
the website of the National Fibromyalgia Association. RESULTS:
The questionnaire was completed by 2,569 people. Most were from
the United States, with at least one respondent from each of the
50 states. Respondents were predominantly middle-aged Caucasian
females, most of whom had FM symptoms for > or = 4 years. The
most common problems were morning stiffness, fatigue,
nonrestorative sleep, pain, concentration, and memory.
Aggravating factors included: emotional distress, weather
changes, insomnia, and strenuous activity. Respondents rated the
most effective management modalities as rest, heat, pain
medications, antidepressants, and hypnotics. The most commonly
used medications were: acetaminophen, ibuprofen, naproxen,
cyclobenzaprine, amitriptyline, and aspirin. The medications
perceived to be the most effective were: hydrocodone
preparations, aprazolam, oxycodone preparations, zolpidem,
cyclobenzaprine, and clonazepam. CONCLUSION: This survey
provides a snap-shot of FM at the end of 2005, as reported by a
self-selected population of people. This descriptive data has a
heuristic function, in that it identifies several issues for
further research, such as the prescribing habits of FM health
care providers, the role of emotional precipitants, the impact
of obesity, the significance of low back pain and the nature of
FM related stiffness
(167) Wigers SH,
Finset A. [Rehabilitation of chronic myofascial pain disorders].
Tidsskr Nor Laegeforen 2007; 127(5):604-8.
Abstract: BACKGROUND: Chronic musculoskeletal pain of diffuse
origin affects many, and at a significant cost. Evidence-based
guidelines for therapeutic interventions are presented and
exemplified. MATERIAL AND METHODS: 200 patients with chronic
myofascial pain and/or fibromyalgia who participated in a 4-week
multidimensional rehabilitation programme, were included in the
study. The programme included education and pain management in a
cognitive setting, various forms of aerobic exercises,
myofascial pain treatment, relaxation and medication as needed.
The patients filled in questionnaires on arrival, at follow-up
after six and 12-months and at discharge. They completed visual
analogue scales (pain, fatigue, sleep problems, depression), the
Nottingham Health Profile, the Fibromyalgia Impact
Questionnaire, global subjective improvement, and during the
follow-up period also the physical activity level, changes in
quality of life and occupational workload. Work capacity, a
tender point count and whether patients met the diagnostic
criteria for fibromyalgia were assessed at baseline and at
discharge. RESULTS: Significant improvements were seen in all
variables throughout the follow-up period. 30% of the
fibromyalgia patients no longer met the diagnostic criteria at
discharge. There was a significant increase in quality of life
over time. After one year, more patients had returned to work
and fewer were off sick, but there was also an increased number
on disability pensions. The majority did exercise training on a
regular basis. INTERPRETATION: Our findings confirm the existing
evidence-based guidelines by showing that multidimensional
rehabilitation is an effective intervention for patients with
widespread chronic pain. It is a challenge for health
politicians to change today's common practice towards that
described in evidence-based guidelines
(168) Ang D,
Kesavalu R, Lydon JR, Lane KA, Bigatti S. Exercise-based
motivational interviewing for female patients with fibromyalgia:
a case series. Clin Rheumatol 2007; 26(11):1843-9.
Abstract: The objective of the study is to determine the effects
of motivational interviewing (MI), a novel technique of
behavioral counseling to promote exercise, on pain and physical
function in patients with fibromyalgia (FMS). Patients who met
the American College of Rheumatology criteria for FMS and had a
visual analog pain score of > or =6 were enrolled in a single
group intervention pilot study. Participants received two
supervised exercise sessions and an exercise prescription.
Thereafter, six exercise-based MI phone calls were made over a
10-week period. Assessments were done at baseline, week 12
(immediate postintervention) and week 30 (follow-up). The
primary endpoints were changes from baseline in the fibromyalgia
impact questionnaire (FIQ)-pain and physical impairment at week
30. Secondary measures were brief pain inventory (BPI)-pain
severity and BPI-pain interference, the number of exercise
minutes (NEM) per week, and the arthritis impact measurement
scale (AIMS)-depression. The 19 enrolled female participants had
a mean age of 52.2 +/- 9.1 years, mean disease duration of 7.5
+/- 5.0 years, and a mean FIQ-pain score of 7.7 +/- 1.4. By week
30, there was significant improvement in both FIQ-pain (-2.6 +/-
2.6, p < 0.001) and FIQ-physical impairment (-1.3 +/- 2.1, p =
0.01). Likewise, BPI-pain severity and pain interference were
reduced by -2.4 +/- 2.1 (p < 0.001) and -2.4 +/- 2.0 (p <
0.001), respectively. While the median NEM per week increased
from 0 to 32 min (p = 0.001) at week 30, AIMS-depression score
was unchanged. In this pilot study, we conclude that
telephone-delivered MI to promote exercise was associated with
an improvement in patient's level of pain and physical
impairment
(169) Jespersen A,
Dreyer L, Kendall S, Graven-Nielsen T, Arendt-Nielsen L, Bliddal
H et al. Computerized cuff pressure algometry: A new method to
assess deep-tissue hypersensitivity in fibromyalgia. Pain 2007;
131(1-2):57-62.
Abstract: The aim of this study was to evaluate the use of
computerized cuff pressure algometry (CPA) in fibromyalgia (FM)
and to correlate deep-tissue sensitivity assessed by CPA with
other disease markers of FM. Forty-eight women with FM and 16
healthy age-matched women were included. A computer-controlled,
pneumatic tourniquet cuff was placed over the gastrocnemius
muscle. The cuff was inflated, and the subject rated the pain
intensity continuously on an electronic Visual Analogue Scale
(VAS). The subject stopped the inflation at the pressure-pain
tolerance and the corresponding VAS-score was determined
(pressure-pain limit). The pressure at which VAS firstly
exceeded 0 was defined as the pressure-pain threshold. Other
disease markers (FM only): Isokinetic knee muscle strength,
tenderpoint-count, myalgic score, Beck Depression Inventory, and
Fibromyalgia Impact Questionnaire. Student's T-test was used to
compare pressure-pain threshold and pressure-pain tolerance and
the Mann-Whitney test to compare pressure-pain limit. Pearson's
correlation was used to detect linear relationships.
Pressure-pain threshold and pressure-pain tolerance assessed by
CPA were significantly lower in FM compared to healthy controls.
There was no difference in pressure-pain limit. CPA-parameters
were significantly correlated to isokinetic muscle strength
where more hypersensitivity resulted in lower strength.
Pressure-pain threshold and pressure-pain tolerance assessed by
CPA were significantly lower in patients with FM indicating
muscle hyperalgesia. CPA was associated with knee muscle
strength but not with measures thought to be influenced by
psychological distress and mood
(170) Stuifbergen
AK, Phillips L, Voelmeck W, Browder R. Illness perceptions and
related outcomes among women with fibromyalgia syndrome. Womens
Health Issues 2006; 16(6):353-60.
Abstract: PURPOSE: Fibromyalgia syndrome (FMS) is characterized
by widespread musculoskeletal pain, multiple tender points, and
fatigue, and affects 3-6 million Americans, 75% of whom are
female. The purpose of the present study was to examine the
illness perceptions of women with FMS using Leventhal's common
sense self-regulation model. DESIGN: Ninety-one women with FMS
took part in this study. Pearson correlations and stepwise
multiple regressions were used to assess relationships among
variables and explanation of variance in the outcomes of health
behaviors, FMS impact, and subjective physical and mental
health. RESULTS: Participants viewed their FMS as chronic with a
somewhat fluctuating course, having serious consequences in
their lives, and difficult to understand in a coherent fashion.
The women tended to find their FMS emotionally distressing and
unamenable to personal control or efficacious treatment.
Emotional representations explained 41% of the variance in
mental health scores and 17% in reported health behaviors.
CONCLUSIONS: Overall, this sample of women with FMS had fairly
negative perceptions of their illness. As suggested by
Leventhal's model, cognitive and emotional representations
predicted different outcomes. Interventions that address
psychological as well as the physical components of the illness
experience may offer benefits for women with FMS
(171) Vargas A,
Vargas A, Hernandez-Paz R, Sanchez-Huerta JM, Romero-Ramirez R,
Amezcua-Guerra L et al. Sphygmomanometry-evoked allodynia--a
simple bedside test indicative of fibromyalgia: a multicenter
developmental study. J Clin Rheumatol 2006; 12(6):272-4.
Abstract: BACKGROUND: One of the 2 classification criteria for
fibromyalgia (FM) is the presence of tender points on specific
anatomic sites. It has been established that these tender points
reflect a state of generalized allodynia (defined as pain
resulting from a stimulus that does not normally provoke pain).
Patients with FM often describe pain elicitation during blood
pressure testing (sphygmomanometry). OBJECTIVE: The objective of
this study was to define if a universally used clinical test,
sphygmomanometry, is helpful in the identification of patients
with FM. METHODS: The authors conducted a prospective
multicenter study in 3 different public rheumatology outpatient
services. Each center studied 20 patients with FM, 20 with
rheumatoid arthritis, 20 with osteoarthritis, and 20 healthy
individuals. The following question was asked of each
participant: "When I take your blood pressure, tell me if the
cuff's pressure brings forth pain." The blood pressure cuff was
inflated at an approximate rate of 10 mm Hg per second up to 180
mm Hg or to the point when pain was elicited. RESULTS:
Sixty-nine percent of patients with FM had
sphygmomanometry-evoked allodynia in contrast to 10% of patients
with osteoarthritis, 5% with rheumatoid arthritis, and 2% of
healthy individuals (P < 0.001). The mean blood pressure value
at which allodynia was elicited was lower in patients with FM
(143 +/- 40 mm Hg) when compared with the other 3 groups (176
+/- 11 mm Hg) or higher (P < 0.001). In patients with FM, there
was a significant negative correlation between the blood
pressure value at which allodynia developed and total
Fibromyalgia Impact Questionnaire (FIQ) score, number of tender
points, and the FIQ visual analog scales for pain intensity and
fatigue (P < 0.05). The test yields a diagnostic sensitivity for
FM of 0.7, specificity 0.96, positive predictive value 0.86, and
negative predictive value 0.91. CONCLUSIONS: In this
developmental study of patients attending rheumatology clinics,
the generation of pain during blood pressure testing was
strongly associated with the diagnosis of FM. This robust
linkage probably reflects a tautologic phenomenon. A sine qua
nonelement for FM diagnosis is the presence of tender points in
discrete anatomic sites. These tender points in turn reflect a
state of generalized mechanical allodynia that can be locally
elicited by the cuff pressure during blood pressure testing.
Sphygmomanometry is a simple bedside test that may be useful in
the recognition of patients with FM. Blood pressure testing is a
universal procedure in all clinical environments. Based on our
results, we suggest searching for FM features in any person who
has sphygmomanometry-evoked allodynia
(172) Fregni F,
Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L et al. A
randomized, sham-controlled, proof of principle study of
transcranial direct current stimulation for the treatment of
pain in fibromyalgia. Arthritis Rheum 2006; 54(12):3988-98.
Abstract: OBJECTIVE: Recent evidence suggests that fibromyalgia
is a disorder characterized by dysfunctional brain activity.
Because transcranial direct current stimulation (tDCS) can
modulate brain activity noninvasively and can decrease pain in
patients with refractory central pain, we hypothesized that tDCS
treatment would result in pain relief in patients with
fibromyalgia. METHODS: Thirty-two patients were randomized to
receive sham stimulation or real tDCS with the anode centered
over the primary motor cortex (M1) or the dorsolateral
prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive
days). A blinded evaluator rated the patient's pain, using the
visual analog scale for pain, the clinician's global impression,
the patient's global assessment, and the number of tender
points. Other symptoms of fibromyalgia were evaluated using the
Fibromyalgia Impact Questionnaire and the Short Form 36 Health
Survey. Safety was assessed with a battery of neuropsychological
tests. To assess potential confounders, we measured mood and
anxiety changes throughout the trial. RESULTS: Anodal tDCS of
the primary motor cortex induced significantly greater pain
improvement compared with sham stimulation and stimulation of
the DLPFC (P < 0.0001). Although this effect decreased after
treatment ended, it was still significant after 3 weeks of
followup (P = 0.004). A small positive impact on quality of life
was observed among patients who received anodal M1 stimulation.
This treatment was associated with a few mild adverse events,
but the frequency of these events in the active-treatment groups
was similar to that in the sham group. Cognitive changes were
similar in all 3 treatment groups. CONCLUSION: Our findings
provide initial evidence of a beneficial effect of tDCS in
fibromyalgia, thus encouraging further trials
(173) Chen KW,
Hassett AL, Hou F, Staller J, Lichtbroun AS. A pilot study of
external qigong therapy for patients with fibromyalgia. J Altern
Complement Med 2006; 12(9):851-6.
Abstract: OBJECTIVES: Although qigong is an important part of
Traditional Chinese medicine (TCM) based on a philosophy similar
to acupuncture, few studies of qigong exist in the Western
medicine literature. To evaluate qigong therapy as a modality in
treating chronic pain conditions such as fibromyalgia syndrome
(FMS), we report a pilot trial of 10 women with severe FMS who
experienced significant improvement after external qigong
therapy (EQT). DESIGN: Ten patients with FMS completed five to
seven sessions of EQT over 3 weeks with pre- and posttreatment
assessment and a 3-month follow-up. Each treatment lasted
approximately 40 minutes. OUTCOME MEASURES: Tender point count
(TPC) and Fibromyalgia Impact Questionnaire (FIQ) were the
primary measures. McGill Pain Questionnaire (MPQ), Beck
Depression Inventory (BDI), anxiety, and self-efficacy were the
secondary outcomes. RESULTS: Subjects demonstrated improvement
in functioning, pain, and other symptoms. The mean TPC was
reduced from 136.6 to 59.5 after EQT treatment; mean MPQ
decreased from 27.0 to 7.2; mean FIQ from 70.1 to 37.3; and mean
BDI from 24.3 to 8.3 (all p < 0.01). Many subjects reported
reductions in other FMS symptoms, and two reported they were
completely symptom-free. Results from the 3-month follow-up
indicated some slight rebound from the post-treatment measures,
but still much better than those observed at baseline.
CONCLUSIONS: Treatment with EQT resulting in complete recovery
for some FMS patients suggests that TCM may be very effective
for treating pain and the multiplicity of symptoms associated
with FMS. Larger controlled trials of this promising
intervention are urgently needed
(174) Amital D,
Fostick L, Polliack ML, Segev S, Zohar J, Rubinow A et al.
Posttraumatic stress disorder, tenderness, and fibromyalgia
syndrome: are they different entities? J Psychosom Res 2006;
61(5):663-9.
Abstract: OBJECTIVES: Many features of fibromyalgia syndrome
(FMS) resemble those of posttraumatic stress disorder (PTSD).
The goal of this study was to investigate the comorbidity of FMS
and PTSD in a cohort of men following an intensive, initial,
defined traumatic event. METHODS: One hundred twenty-four males
(55 patients with PTSD, 20 patients with major depression, and
49 controls) were evaluated for the presence of FMS. The major
traumatic events in all PTSD patients were combat-related. Each
individual completed questionnaires characterizing his disease,
disabilities, and quality of life. RESULTS: Forty-nine percent
of PTSD patients, compared to 5% of major depression patients
and none of normal controls, fulfilled the American College of
Rheumatology criteria for FMS (P<.0001). Significant
correlations were detected between tender points and measured
parameters in the PTSD group. CONCLUSIONS: In male patients,
PTSD is highly associated with FMS. The degree and impact of
these disorders are also highly related
(175) Rosado ML,
Pereira JP, da Fonseca JP, Branco JC. [Cultural adaptation and
validation of the "Fibromyalgia Impact
Questionnaire"--Portuguese version]. Acta Reumatol Port 2006;
31(2):157-65.
Abstract: The aim of this study was to translate the
Fibromyalgia Impact Questionnaire (FIQ) into Portuguese
(Portugal) and to evaluate its reliability and validity by use
with Portuguese--speaking patients with Fibromyalgia. After
translating the FIQ into Portuguese we administered it to 68
patients with Fibromyalgia together with an informed consent, a
Portuguese version of the Health Assessment Questionnaire (HAQ)
and a formulary with the socio-demographic characteristics and
duration of the complaints. The content validity was assessed
with a panel of experts, with high consensus. In the concurrent
validity, we obtained significant correlations between the FIQ
first item and the HAQ [r = 0,531 (p = 0,001)]. Cronbach's alpha
was 0,814, indicating an acceptable level of internal
consistency. In conclusion, the Portuguese version of the FIQ is
a reliable and valid instrument for measuring health status and
physical functioning in Portuguese patients with Fibromyalgia.
This instrument is available for use in the clinical practice
(176) Katz RS, Heard
AR, Mills M, Leavitt F. The prevalence and clinical impact of
reported cognitive difficulties (fibrofog) in patients with
rheumatic disease with and without fibromyalgia. J Clin
Rheumatol 2004; 10(2):53-8.
Abstract: Cognitive dysfunction in patients with rheumatic
disease encompasses a range of impairment. Their prevalence,
co-occurrence, and impact on symptom severity were assessed in
57 patients with fibromyalgia (FMS) and 57 patients with
rheumatic disease without FMS. Information pertaining to memory
decline, mental confusion, and speech difficulty was extracted
from questions embedded in a health questionnaire and a blind
retrospective chart review. Pain, morning stiffness, fatigue,
and sleep difficulty were established on a 0- to 100-mm visual
analog scale. Variables of mental confusion, fatigue, tension,
depression, anger, and vigor were assessed using the Profile of
Mood States.Compared with the non-FMS sample, patients with FMS
complained more often of memory decline (70.2-24.6%), mental
confusion (56.1-12.3%), and speech difficulty (40.4-3.5%).
Memory decline and mental confusion were coupled more often in
patients with FMS (50.9-8.8%). Patients with FMS with this
combination of cognitive problems reported more pain
(76.0-45.4%), stiffness (79.7-43.7%), fatigue (79.6-52.6%), and
disturbed sleep (59.2-36.6%) compared with patients with FMS
with memory problems alone. Patients with rheumatic disease
substantially differ in cognitive vulnerability, with patients
with FMS at considerably higher risk for cognitive difficulty.
More importantly, the prevalence of a combined disturbance in
memory and mental clarity is high and closely associated with
the perception of increased illness severity and diminished
mental health in FMS. That this linkage has the possibility of
having a great deal to do with an important clinical variant of
FMS underscores the need for greater clinical recognition of
this underrecognized pattern and for further research.Patients
with fibromyalgia frequently report memory and concentration
problems, especially if asked about them. Clinicians could judge
these complaints as similar to adult attention deficit syndrome
and reassure the patient. Trying medication to improve attention
and concentration is sensible but untested in fibromyalgia
(177) Calandre EP,
Hidalgo J, Rico-Villademoros F. Use of ziprasidone in patients
with fibromyalgia: a case series. Rheumatol Int 2007;
27(5):473-6.
Abstract: Atypical antipsychotics may be useful in chronic pain
treatment. The objective of the present study was to assess the
effect of ziprasidone in fibromyalgia management. Ziprasidone
was administered to 32 fibromyalgia patients at a dose of 20
mg/day, subsequently adjusted according to clinical response and
tolerability. Fibromyalgia Impact Questionnaire (FIQ),
Pittsburgh Sleep Quality Index (PSQI), a Clinical Global
Impression improvement scale (CGIi), and a scale evaluating the
severity of fibromyalgia symptoms were administered at 4 week
intervals for 12 weeks. Drug adverse reactions were recorded.
Ten patients withdrew from the study. The CGIi showed 32% of
responders. FIQ and PSQI scores showed a non-statistically
significant decrease. The conditions of stiffness, anxiety and
sadness improved significantly. Most frequent side effects
included sleep disturbances, headache, tremor, and rigidity.
Although ziprasidone does not seem an especially useful adjunct
drug in fibromyalgia, it could be tried on patients who are
markedly anxious and/or depressed
(178) Berglund B,
Nordstrom G. Symptoms and functional health status of
individuals with Ehlers-Danlos syndrome (EDS). J Clin Rheumatol
2001; 7(5):308-14.
Abstract: Ehlers-Danlos syndrome (EDS) is an inherited
connective tissue disorder that can have a substantial impact on
daily life. The aims of this study were to describe the symptoms
reported in a group of individuals with EDS and to investigate
the impact on functional health status by means of the Sickness
Impact Profile (SIP). Seventy-seven individuals, members of the
Swedish EDS Association, completed 2 mailed questionnaires. The
most frequent symptoms were related to activity, e.g., joint
problems (75%), to pain (71%), and to skin/tissue (52%). Pain
was reported by 37 individuals (48%) as their most severe
symptom. The SIP results showed an overall mean score of 13.0
(females 13.9, males 5.6), compared with a Swedish reference
group with a SIP score 1.3. Women with EDS reported a better
functional health status than females with rheumatoid arthritis
(overall SIP score 13.9 versus 21.4). In comparison with women
with fibromyalgia, the EDS females rated their functional health
status as worse on the physical dimension (p <0.05) and the
subscale home management (p <0.05), and as better on the
subscale work (p <0.05). Impact of EDS on the individual's daily
life needs to be acknowledged, assessed, and evaluated in
healthcare
(179) Ardic F, Ozgen
M, Aybek H, Rota S, Cubukcu D, Gokgoz A. Effects of
balneotherapy on serum IL-1, PGE2 and LTB4 levels in
fibromyalgia patients. Rheumatol Int 2007; 27(5):441-6.
Abstract: The purpose of this study was to investigate the
clinical effects of balneotherapy in the treatment of
Fibromyalgia Syndrome (FMS) and to determine if balneotherapy
influences serum levels of inflammation markers, IL-1, PGE2 and
LTB4. 24 primary fibromyalgia female patients diagnosed
according to American College of Rheumatology criteria were
included to the study. Their ages ranged between 33 and 55
years. FMS patients were randomly assigned in two groups as,
group 1 (n = 12) and group 2 (n = 12). Group 1 received 20-min
bathing, once in a day for five days per week. Patients
participated in the study for 3 weeks (total of 15 sessions) in
Denizli. Group 2 did not receive balneotherapy. FMS patients
were evaluated by tenderness measurements (tender point count
and algometry), Visual Analogue Scale, Beck's Depression Index,
Fibromyalgia Impact Questionnaire. Ten healthy women recruited
group three as the controls. Serum PGE2, LTB4 and IL1-alpha
levels were measured in all three groups. The biochemical
measurements and clinical assessments were performed before and
at the end of general period of therapy. Statistically
significant alterations in algometric score, Visual Analogue
score, Beck's Depression Index and PGE2 levels (P < 0.001),
numbers of tender points (P < 0.01) and Fibromyalgia Impact
Questionnaire score (P < 0.05) were found after the
balneotherapy between group 1 and 2. Mean PGE2 level of FMS
patients were higher compared to healthy control group (P <
0.0001) and decreased after the treatment period, only in group
1 (P < 0.05). As in the group 2 and 3, detectable IL-1 and LTB4
measurements were insufficient, statistical analysis was
performed, only in group 1. After balneotherapy IL-1 and LTB4
significantly decreased in group 1 (P < 0.05). In conclusion,
balneotherapy is an effective choice of treatment in patients
with FMS relieving the clinical symptoms, and possibly
influencing the inflammatory mediators
(180) Tastekin N,
Birtane M, Uzunca K. Which of the three different tender points
assessment methods is more useful for predicting the severity of
fibromyalgia syndrome? Rheumatol Int 2007; 27(5):447-51.
Abstract: Digital palpation, myalgic scoring and dolorimetry are
frequently used to count tender points in fibromyalgia syndrome.
We aimed to investigate the probable relation between tender
points count and fibromyalgia impact questionnaire and to assess
which of the tender point counting methods is the most
successful in predicting the severity of the disease. Tender
point areas of 36 patients with fibromyalgia syndrome were
assessed with three methods which are myalgic scoring, digital
and dolorimetric tender points counting methods. Fibromyalgia
impact questionnaire was used to measure the disease severity.
The correlation between each of the assessment methods and
fibromyalgia impact questionnaire was investigated. The mean
count of digitally evaluated tender points was 14.86 +/- 2.67
and by dolorimetry was 11.81 +/- 4.48. The mean total myalgic
score was found to be 24.61 +/- 8.91. All of the tender point
evaluation methods correlated positively with each other (P <
0.01). Fibromyalgia impact questionnaire score was also
correlated with only digital palpation tender point count of
these three evaluation methods (r = 0.427, P < 0.05). Digital
tender point count seemed to be sufficient for assessment, and
there is no need for an additional instrument for tender point
evaluation
(181) Zucker DR,
Ruthazer R, Schmid CH, Feuer JM, Fischer PA, Kieval RI et al.
Lessons learned combining N-of-1 trials to assess fibromyalgia
therapies. J Rheumatol 2006; 33(10):2069-77.
Abstract: OBJECTIVE: Applying population research to individual
treatment requires understanding the connections between
patient-specific characteristics, population-based studies, and
treatment responses. Conducting practice-based research using
individual-focused (N-of-1) trials may aid this process. We
combined N-of-1 trials to compare fibromyalgia therapies and to
assess the feasibility and outcomes of this approach for
practice-based effectiveness research. METHODS: Community- and
center-based rheumatologists enrolled patients with fibromyalgia
syndrome in randomized, double-blind, multi-crossover, N-of-1
trials comparing amitriptyline and the combination amitriptyline
and fluoxetine. Fibromyalgia Impact Questionnaire outcomes were
used for the individuals' treatment and combined across patients
for sample-based analyses. Outcomes were compared with results
from more standard trial designs. RESULTS: Eight rheumatologists
enrolled 58 patients in N-of-1 trials. Most physicians and
patients had not previously participated in clinical trials.
Using several analytic methods, the pooled results showed a
better outcome score (mean difference: -6.1 +/- 2.0 to -8.0 +/-
3.7 points) in patients taking combination therapy. These
population results are similar to published outcomes from a more
traditional crossover trial. Neither practice type nor patient
characteristics were significantly associated with the observed
treatment-effect variation. Most participants, irrespective of
selected treatment, felt their individual N-of-1 trials were
helpful. CONCLUSION: Implementation of the combined N-of-1
methodology is feasible in rheumatology practices and results
confirm greater fibromyalgia improvement with combination
therapy. This research approach broadens participation, although
our trials' specifics likely influenced enrollment eligibility.
In addition to individual benefits, combining N-of-1 trial data
provides population research benefits. This patient-focused
approach should be further explored to bridge research and
practice
(182) Cacace E,
Ruggiero V, Anedda C, Denotti A, Minerba L, Perpignano G.
[Quality of life and associated clinical distress in
fibromyalgia]. Reumatismo 2006; 58(3):226-9.
Abstract: OBJECTIVES: Fibromyalgia (FM) is a syndrome
characterized by chronic, diffuse musculoskeletal pain and by a
low pain threshold at specific anatomical points (tender
points). Numerous other conditions (Irritable bowel syndrome,
tension-type headache, migraine headaches, etc.) may overlap
with FM. Aim of this study was to evaluate the quality of life
and associated clinical distress in patients with FM. METHODS:
53 females affected by primary fibromyalgia and 40 healthy
females were examined were examined by an experienced
rheumatologist and interviewed using the Fibromyalgia Impact
Questionnaire (FIQ). Clinical monitoring included Visual
Analogue Scale for pain and pain pressure threshold
measurements. RESULTS: Mean FIQ scores were 66.39+/-14.94 in FM
patients and 13.15+/-5.37 in control subjects and the difference
was statistically significant. Among associated clinical
distress higher frequencies have been found for paraesthesia
(87%), sleep disturbance (72%), tension type headache (70%),
oto-vestibule syndrome (72%) and irritable colon (60%). An
R.O.C. bend was developed in the presence of paraesthesias and
oto-vestibule syndromes at the same time. This allowed us to
identify a FIQ cut off value of 66.85 so FM patients were
divided into 2 groups according to their FIQ scores: severe
degree and mild or slight degree. CONCLUSIONS: Based on our
data, it would appear possible to use a FIQ value equal to or
higher than 66.85 for the clinical picture of FM to be
classified as severe
(183) Hammond A,
Freeman K. Community patient education and exercise for people
with fibromyalgia: a parallel group randomized controlled trial.
Clin Rehabil 2006; 20(10):835-46.
Abstract: OBJECTIVE: To evaluate the effects of a community
patient education -exercise programme, using a
cognitive-behavioural approach, for people with fibromyalgia.
DESIGN: A randomized, parallel group trial with assessments at
0, 4 and 8 months. SETTING: Community leisure centres. SUBJECTS:
People with fibromyalgia (n=183) attending a rheumatology
outpatient department at a large district general hospital.
INTERVENTIONS: Participants were randomized to a patient
education-exercise group (n=97) or relaxation (attention
control) group (n=86). MAIN MEASURES: The Fibromyalgia Impact
Questionnaire (0-80; lower score means better health). Secondary
outcomes included: the Arthritis Self-Efficacy Scale(pain and
other symptoms subscales: 1 -10 scale; higher scores mean
greater self-efficacy) and self-reported improvement. RESULTS:
Fifty participants withdrew or were unable to attend and 133
completed and returned baseline questionnaires: patient
education group (n=71); relaxation group (n=62); 120/133
participants were women. Average age was 48.53 (SD 10.89) years.
Follow-up ranged between 73 and 82% of questionnaires returned.
At four months, there was a difference in average changes in
total Fibromyalgia Impact Questionnaire scores between the two
groups: patient education group--3.38 (SD 9.35); relaxation
group 0.3 (SD 8.85); P=0.02. Arthritis Self-Efficacy Scale
scores were significantly higher in the patient education group:
pain 0.59 (SD 1.45)compared to the relaxation group's--0.12 (SD
1.22); P=0.003; other symptoms (patient education group 0.72 (SD
1.33); relaxation group 0.03 (SD 1.16); P=0.002). At eight
months these differences were no longer apparent. Forty-seven
per cent in the patient education group self-reported
improvement compared with 13% in the relaxation group
(chi2=13.65; P=0.0001). CONCLUSION: Short-term improvements
resulted from the education -exercise programme but were not
sustained. Appropriate selection may improve efficacy
(184) Liedberg GM,
Burckhardt CS, Henriksson CM. Young women with fibromyalgia in
the United States and Sweden: perceived difficulties during the
first year after diagnosis. Disabil Rehabil 2006;
28(19):1177-84.
Abstract: PURPOSE: The major symptoms of fibromyalgia
(FM)--pain, tiredness, disrupted sleep, and muscle
weakness--severely impact everyday activities, including the
paid work role of women who have had FM for a long time. There
are no prospective studies on young and newly diagnosed women
with FM. The aim of the present study was to describe and
compare difficulties young and newly diagnosed women in Sweden
and the United States experienced during their first year after
diagnosis. METHOD: Three interviews, 6 months apart, were
conducted, with 49 Swedish and 45 US women between the ages of
18 and 39. Five open-ended questions were asked concerning
physical, psychological and social difficulties and limitations,
and factors that increased or decreased their difficulties and
limitations. At interviews 2 and 3 the women were also asked
about ways of preventing their difficulties. The answers were
written down and analysed by a content analysis approach.
RESULTS: Consistent categories of difficulties were reported:
symptoms, movements, activities, moods, social network, external
factors and coping strategies. More US women were working
outside their homes than were their Swedish counterparts and
they expressed more difficulties compared with the Swedish
women. CONCLUSIONS: In general, difficulties decreased and
coping strategies increased over the 1-year period in both
groups of newly diagnosed, young women
(185) Mielenz T,
Jackson E, Currey S, DeVellis R, Callahan LF. Psychometric
properties of the Centers for Disease Control and Prevention
Health-Related Quality of Life (CDC HRQOL) items in adults with
arthritis. Health Qual Life Outcomes 2006; 4:66.
Abstract: BACKGROUND: Measuring health-related quality of life
(HRQOL) is important in arthritis and the SF-36v2 is the current
state-of-the-art. It is only emerging how well the Centers for
Disease Control and Prevention (CDC) HRQOL measures HRQOL for
people with arthritis. This study's purpose is to assess the
psychometric properties of the 9-item CDC HRQOL (4-item Healthy
Days Core Module and 5-item Healthy Days Symptoms Module) in an
arthritis sample using the SF-36v2 as a comparison. METHODS: In
Fall 2002, a cross-sectional study acquired survey data
including the CDC HRQOL and SF-36v2 from 2 North Carolina
populations of adult patients reporting osteoarthritis,
rheumatoid arthritis, and fibromyalgia; 2182 (52%) responded.
The first item of both the CDC HRQOL and the SF-36v2 was general
health (GEN). All 8 other CDC HRQOL items ask for the number of
days in the past 30 days that respondents experienced various
aspects of HRQOL. Exploratory principal components analyses
(PCA) were conducted on each sample and the combined samples of
the CDC HRQOL. The multitrait-multimethod matrix (MTMM) was used
to compute correlations between each trait (physical health and
mental health) and between each method of measurement (CDC HRQOL
and SF36v2). The relative contribution of the CDC HRQOL in
predicting the physical component summary (PCS) and the mental
component summary (MCS) was determined by regressing the CDC
HRQOL items on the PCS and MCS scales. RESULTS: All 9 CDC HRQOL
items loaded primarily onto 1 factor (explaining 57% of the item
variance) representing a reasonable solution for capturing
overall HRQOL. After rotation a 2 factor interpretation for the
9 items was clear, with 4 items capturing physical health
(physical, activity, pain, and energy days) and 3 items
capturing mental health (mental, depression, and anxiety days).
All of the loadings for these two factors were greater than
0.70. The CDC HRQOL physical health factor correlated with PCS
(r = -.78, p < 0.0001) and the mental health factor correlated
with MCS (r = -.71, p < 0.0001). The relative contribution of
the CDC HRQOL in predicting PCS was 73% (R2 = .73) when GEN was
included in the CDC HRQOL score and 65% (R2 = .65) when GEN was
removed. The relative contribution of the CDC HRQOL in
predicting MCS was 56% (R2 = .56) when GEN was included and
removed. CONCLUSION: The CDC HRQOL appears to have strong
psychometric properties in individuals with arthritis in both
community-based and subspecialty clinical settings. The 9 item
CDC HRQOL is a reasonable measure for overall HRQOL and the two
subscales, representing physical and mental health, are
reasonable when the goal is to examine those aspects
(186) Okumus M,
Gokoglu F, Kocaoglu S, Ceceli E, Yorgancioglu ZR. Muscle
performance in patients with fibromyalgia. Singapore Med J 2006;
47(9):752-6.
Abstract: INTRODUCTION: Fibromyalgia (FMS) is a syndrome
expressed by chronic widespread body pain which leads to reduced
physical function and frequent use of healthcare services. This
study was performed to examine the muscle performance comprising
abdominal and lumbar muscle strength, and measurement of chest
expansion in osteoporotic patients with FMS; to evaluate the
relation between muscle performance, pain severity, clinical
findings and physical activity; and to compare the results with
the osteoporotic control group. METHODS: 44 osteoporotic women
with FMS and 46 osteoporotic women who were physically inactive
underwent measurements of three parameters: abdominal and lumbar
muscle strength, and chest expansion. Student's t-test was used
for statistical analysis. RESULTS: The strength of lumbar
muscles and measurement of chest expansion were significantly
decreased in the FMS patients as compared to the controls
(p-value is less than 0.001). However, lumbar and abdominal
muscles strength was low in both patients and controls.
CONCLUSION: Our results indicate that osteoporotic patients with
FMS have impairment in strength of lumbar and abdominal muscles
and in measurement of chest expansion. Further studies are
needed to investigate the mechanism of reduced muscle
performance and the effects of aerobic exercise in this patient
group
(187) Havermark AM,
Langius-Eklof A. Long-term follow up of a physical therapy
programme for patients with fibromyalgia syndrome. Scand J
Caring Sci 2006; 20(3):315-22.
Abstract: The purpose of this study was to evaluate, in a
long-term perspective, the impact of a physical therapy-based
educational programme on patients with fibromyalgia syndrome
(FMS). The programme includes information about the syndrome,
information about pain and muscle physiology, training in warm
water, stretching, body awareness therapy and relaxation in
groups of 15 patients twice weekly, 2 hours during 10 weeks. A
total of 240 patients with FMS participated in the study before
and immediately after the programme and at a follow up with a
mean of 35 months after the programme. Health status as measured
with the Fibromyalgia Impact Questionnaire was answered by the
patients at all three measurement points. Questionnaires
concerning self-care, self-motivation and sense of coherence
(SOC) were distributed at the follow up. The results showed a
significant improvement on several symptoms when comparing
before and after the programme, and at the time of follow up the
patients' rated well-being was still improved. The results also
showed that the patients' pretreatment perception of symptoms,
well-being and SOC are predictors to the perception of general
health at the follow up of a physical therapy programme. The
conclusion is that a physical therapy programme for patients
with FMS may have a positive impact on patients' general
well-being but not on other symptoms
(188) Birtane M,
Uzunca K, Tastekin N, Tuna H. The evaluation of quality of life
in fibromyalgia syndrome: a comparison with rheumatoid arthritis
by using SF-36 Health Survey. Clin Rheumatol 2007; 26(5):679-84.
Abstract: Musculoskeletal disorders are the most common causes
of deterioration in quality of life (QOL). We in this study
aimed to assess (1) the impact of fibromyalgia syndrome (FS) on
QOL comparing with that of rheumatoid arthritis (RA) patients
and control subjects and (2) the impact of these two
musculoskeletal disorders on various components of QOL using
SF-36 Health Survey. Thirty-five patients with RA, 30 patients
with FS, and 30 voluntary control subjects were included in the
study. The groups were comparable in terms of demographic
characteristics. QOL was evaluated by using Short-Form (SF)-36
Health Survey in all study participants, and Fibromyalgia Impact
Questionnaire (FIQ), which is a specific health-status
instrument for FS, was used in FS patients. Physical
functioning, physical role, social functioning, bodily pain,
general health, vitality, emotional role, and mental health
scores were significantly lower in RA and FS patients than in
control subjects (p<0.05). The between-groups comparisons
revealed that FS patients had significantly lower mental health
scores than RA patients (49.87 vs 62.51, respectively),
(p<0.001). Total FIQ score correlated significantly with
physical functioning, physical role, and bodily pain in FS
patients. All parameters of SF-36 Health Survey except for
social functioning correlated significantly with some of the
variables of FIQ. FS has a negative impact on QOL, like RA.
Furthermore, mental health was more severely affected in FS
patients when compared with RA patients
(189) Eksioglu E,
Yazar D, Bal A, Usan HD, Cakci A. Effects of Stanger bath
therapy on fibromyalgia. Clin Rheumatol 2007; 26(5):691-4.
Abstract: The purpose of this study was to assess the
effectiveness of Stanger bath on the treatment of fibromyalgia
(FM). Fifty women with FM were randomly divided into two groups.
The first group (n=25) was treated with amitriptyline, 10 mg/day
for 8 weeks, and Stanger bath, 20 min daily for ten sessions.
The second group (n=25) only had amitriptyline, 10 mg/day for 8
weeks. In the first group the assessment parameters were
measured before (t1), at the end (t2), and 2 months after the
hydrotherapy (t3). In the second group these parameters were
examined before (T1) and 2 months after the treatment (T2).
Patients were evaluated by number of tender points and
Fibromyalgia Impact Questionnaire (FIQ) scores. There was
significant improvement in number of tender points between t1
and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath
group. In addition, there was significant improvement in FIQ
scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the
Stanger bath group. In the second group we observed significant
improvement in FIQ scores and tender point numbers between T1
and T2 (P=0.00). We did not find any difference between groups
in tender point number percent change (p=0.074). However, we
observed statistically significant improvement in percent change
of FIQ scores in Stanger bath group (-30+/-16.7) when compared
to group 2 (-19.3+/-13) (p=0.016). We conclude that Stanger bath
therapy when combined with amitriptyline has a long lasting
effect and better outcome in FM patients
(190) Lee SS, Yoon
HJ, Park YW. Antipolymer antibody is not associated with
fibromyalgia in Korean female patients. Rheumatol Int 2006;
27(1):73-7.
Abstract: To examine the levels of antipolymer antibody (APA) in
Korean female patients with fibromyalgia (FM) and to determine
whether the levels of APA correlate with FM severity. Serum
samples from patients with FM (n = 69), patients with rheumatoid
arthritis (RA) (n = 71), and controls (n = 75) were assayed for
APA. All of the subjects were female, and the controls were
age-matched healthy volunteers. FM tender point counts and
scores were examined, and FM patients were asked to complete a
Korean version of the Fibromyalgia Impact Questionnaire (FIQ),
the State-Trait Anxiety Inventory (STAI), and the Beck
Depression Inventory (BDI). APA-positive samples were detected
in five (7.2%) of the 69 FM patients, seven (9.9%) of the 71 RA
patients, and four (5.3%) of the 75 controls. The prevalence of
seropositivity and the level of APA in FM patients did not
differ from those in RA patients and controls. The proportion
positive for APA was not higher for FM patients with severe
symptoms than for FM patients with mild symptoms. There was a
negative association between the APA level and age. The APA
level in FM patients was not correlated with age at diagnosis,
age at symptom onset, disease duration, education, tender point
counts and scores, FIQ, STAI, or BDI. The prevalence of APA in
Korean FM patients was quite low. Owing to the low prevalence of
APA in this study, the APA assay did not distinguish FM patients
with severe symptoms from those with mild symptoms
(191) Hidalgo J,
Rico-Villademoros F, Calandre EP. An open-label study of
quetiapine in the treatment of fibromyalgia. Prog
Neuropsychopharmacol Biol Psychiatry 2007; 31(1):71-7.
Abstract: The aim of this exploratory study was to
systematically assess the potential effectiveness and
tolerability of quetiapine, an atypical antipsychotic, for the
treatment of patients with fibromyalgia. This was a unicentre,
open-label study conducted in thirty-five outpatients, 18 years
or older, who met the ACR criteria for fibromyalgia and who had
not satisfactorily responded to their previous fibromyalgia
treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added
to their original treatment regimen for 12 weeks. The primary
outcome measure was the mean change from baseline to endpoint in
the Fibromyalgia Impact Questionnaire (FIQ) total score.
Secondary efficacy measures included mean changes from baseline
to endpoint in the scores of the Clinical Global Impression
(CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI),
Beck Depression Inventory (BDI), State-Trait Anxiety Inventory
(STAI), 12-Item Short Form Health Survey (SF-12), and individual
items of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9,
93.3% females) had a postbaseline evaluation and constituted the
intent-to-treat efficacy sample. Mean FIQ total score decreased
significantly by 10.2 points from a baseline of 63.2 to 53.0 at
study endpoint (p<0.001). A statistically significant reduction
was observed in FIQ stiffness and FIQ fatigue subscores but not
in FIQ pain subscore. Large effect sizes were observed for the
FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while
moderate effect sizes (i.e.> or =0.50) were encountered in the
FIQ fatigue, FIQ stiffness and SF-12 mental component summary.
Quetiapine was safely administered and well tolerated. Despite
the lack of effect on pain, the significant and relevant
improvement in overall efficacy measures and quality of life
suggests that quetiapine may be a valuable drug for treatment of
patients with fibromyalgia that should be further tested in
double-blind, placebo-controlled trials
(192) Wennemer HK,
Borg-Stein J, Gomba L, Delaney B, Rothmund A, Barlow D et al.
Functionally oriented rehabilitation program for patients with
fibromyalgia: preliminary results. Am J Phys Med Rehabil 2006;
85(8):659-66.
Abstract: OBJECTIVE: To evaluate function and disability in
patients with fibromyalgia before and after participation in a
functionally oriented, multidisciplinary, 8-wk treatment
program. DESIGN: A total of 23 patients who met American College
of Rheumatology criteria for the diagnosis of fibromyalgia were
enrolled in the study. Outcome measures included: range of
motion, 6-min walk test, a modified Fibromyalgia Impact
Questionnaire, a modified SF-36 Physical Functioning Scale, and
the Fibromyalgia Health Assessment Questionnaire. Pretreatment
and posttreatment scores were analyzed using paired t tests.
RESULTS: All subjects completed the program, and there were no
reported injuries. Three subjects failed to complete the survey
instruments at the conclusion of the study. Intention to treat
analysis including these subjects was carried out but did not
significantly change results. For the remaining subjects (n =
20), a significant improvement was found on the Physical
Functioning Scale (P = 0.01). Trends toward improvement on the
Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia
Health Assessment Questionnaire (P = 0.14) were seen but did not
achieve statistical significance. Range of motion testing
revealed significant improvements in lumbar spine extension (P <
0.001), straight-leg raise (P < 0.001), cervical spine flexion
(P < 0.01), cervical spine rotation (P < 0.05), and cervical
spine side bending (P < 0.05). Distance traveled during the
6-min walk test increased significantly (P < 0.01), whereas
perceived exertion as measured by the Borg scale did not change.
There were no injuries or other adverse consequences of the
program. CONCLUSIONS: This study utilized multiple functional
outcome measures to demonstrate improved function and decreased
disability in patients with fibromyalgia. Our patients reported
significantly improved physical function after participation in
the 8-wk intensive multidisciplinary treatment program. This
progressive, functionally based exercise training program was
well tolerated by all participants and outlines an effective
exercise prescription for patients with fibromyalgia.
Fibromyalgia patients in this study responded favorably to a
treatment program that focused on function instead of pain
(193) Armstrong DJ,
Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB. Vitamin D
deficiency is associated with anxiety and depression in
fibromyalgia. Clin Rheumatol 2007; 26(4):551-4.
Abstract: Fibromyalgia is a complex problem in which symptoms of
anxiety and depression feature prominently. Low levels of
vitamin D have been frequently reported in fibromyalgia, but no
relationship was demonstrated with anxiety and depression.
Seventy-five Caucasian patients who fulfilled the ACR criteria
for fibromyalgia had serum vitamin D levels measured and
completed the Fibromyalgia Impact Questionnaire (FIQ) and
Hospital Anxiety and Depression Score (HADS). Deficient levels
of vitamin D was found in 13.3% of the patients, while 56.0% had
insufficient levels and 30.7% had normal levels. Patients with
vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR,
31.0 (23.8-36.8] than patients with insufficient levels [25-50
nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal
levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5);
Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship
with global measures of disease impact or musculoskeletal
symptoms. Vitamin D deficiency is common in fibromyalgia and
occurs more frequently in patients with anxiety and depression.
The nature and direction of the causal relationship remains
unclear, but there are definite implications for long-term bone
health
(194) Schley M,
Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R. Delta-9-THC
based monotherapy in fibromyalgia patients on experimentally
induced pain, axon reflex flare, and pain relief. Curr Med Res
Opin 2006; 22(7):1269-76.
Abstract: OBJECTIVE: Fibromyalgia (FM) is a chronic pain
syndrome characterized by a distinct mechanical hyperalgesia and
chronic pain. Recently, cannabinoids have been demonstrated as
providing anti-nociceptive and anti-hyperalgesic effects in
animal and human studies. Here, we explored in nine FM patients
the efficacy of orally administered delta-9-tetrahydrocannabinol
(THC) on electrically induced pain, axon reflex flare, and
psychometric variables. RESEARCH DESIGN AND METHods: Patients
received a daily dose of 2.5-15 mg of delta-9-THC, with a weekly
increase of 2.5 mg, as long as no side effects were reported.
Psychometric variables were assessed each week by means of the
West Haven-Yale Multidimensional Pain Inventory (MPI),
Pittsburgh Sleep Quality Index (PSQI), Medical outcome
survey-short form (MOS SF-36), the Pain Disability Index (PDI),
and the Fibromyalgia Impact Questionnaire (FIQ). In addition,
patients recorded daily, in a diary, their overall pain
intensity on a numeric scale. Each week, pain and axon reflex
flare was evoked experimentally by administration of high
intensity constant current pulses (1 Hz, pulse width 0.2 ms,
current increase stepwise from 2.5-12.5 mA every 3 minutes)
delivered via small surface electrodes, attached to the volar
forearm skin. MAIN OUTCOME MEASURES: Daily pain recordings by
the patient, experimentally induced pain, and axon reflex flare
recorded by a laser Doppler scanner. RESULTS: Five of nine FM
patients withdrew during the study due to adverse side effects.
Delta-9-THC had no effect on the axon reflex flare, whereas
electrically induced pain was significantly attenuated after
doses of 10-15 mg delta-9-THC (p < 0.05). Daily-recorded pain of
the FM patients was significantly reduced (p < 0.01).
CONCLUSIONS: This pilot study demonstrated that a generalized
statement that delta-9-THC is an analgetic drug cannot be made.
However, a sub-population of FM patients reported significant
benefit from the delta-9-THC monotherapy. The unaffected
electrically induced axon reflex flare, but decreased pain
perception, suggests a central mode of action of the cannabinoid
(195) Bazzichi L,
Giannaccini G, Betti L, Mascia G, Fabbrini L, Italiani P et al.
Alteration of serotonin transporter density and activity in
fibromyalgia. Arthritis Res Ther 2006; 8(4):R99.
Abstract: The aim of the study was to evaluate the kinetic
parameters of a specific serotonin transporter (SERT) and
serotonin uptake in a mentally healthy subset of patients with
fibromyalgia. Platelets were obtained from 40 patients and 38
healthy controls. SERT expression and functionality were
evaluated through the measurement of [3H]paroxetine binding and
the [3H]serotonin uptake itself. The values of maximal membrane
binding capacity (Bmax) were statistically lower in the patients
than in the healthy volunteers, whereas the dissociation
constant (Kd) did not show any statistically significant
variations. Moreover, a decrease in the maximal uptake rate of
SERT (Vmax) was demonstrated in the platelets of patients,
whereas the Michaelis constant (Km) did not show any
statistically significant variations. Symptom severity score
(tiredness, tender points index and Fibromyalgia Impact
Questionnaire) were negatively correlated with Bmax and with
Vmax, and positively correlated with Km. A change in SERT seems
to occur in fibromyalgic patients, and it seems to be related to
the severity of fibromyalgic symptoms
(196) Martin DP,
Sletten CD, Williams BA, Berger IH. Improvement in fibromyalgia
symptoms with acupuncture: results of a randomized controlled
trial. Mayo Clin Proc 2006; 81(6):749-57.
Abstract: OBJECTIVE: To test the hypothesis that acupuncture
improves symptoms of fibromyalgia. PATIENTS AND METHODS: We
conducted a prospective, partially blinded, controlled,
randomized clinical trial of patients receiving true acupuncture
compared with a control group of patients who received simulated
acupuncture. All patients met American College of Rheumatology
criteria for fibromyalgia and had tried conservative symptomatic
treatments other than acupuncture. We measured symptoms with the
Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional
Pain Inventory at baseline, immediately after treatment, and at
1 month and 7 months after treatment. The trial was conducted
from May 28, 2002, to August 18, 2003. RESULTS: Fifty patients
participated in the study: 25 in the acupuncture group and 25 in
the control group. Total fibromyalgia symptoms, as measured by
the FIQ, were significantly improved in the acupuncture group
compared with the control group during the study period (P =
.01). The largest difference in mean FIQ total scores was
observed at 1 month (42.2 vs 34.8 in the control and acupuncture
groups, respectively; P = .007). Fatigue and anxiety were the
most significantly improved symptoms during the follow-up
period. However, activity and physical function levels did not
change. Acupuncture was well tolerated, with minimal adverse
effects. CONCLUSION: This study paradigm allows for controlled
and blinded clinical trials of acupuncture. We found that
acupuncture significantly improved symptoms of fibromyalgia.
Symptomatic improvement was not restricted to pain relief and
was most significant for fatigue and anxiety
(197) Zijlstra TR,
Taal E, van de Laar MA, Rasker JJ. Validation of a Dutch
translation of the fibromyalgia impact questionnaire.
Rheumatology (Oxford) 2007; 46(1):131-4.
Abstract: OBJECTIVES: To validate a Dutch translation of the
fibromyalgia impact questionnaire (FIQ). Materials and METHODS:
Data were taken from two randomized clinical trials on Spa
treatment and venlafaxine in fibromyalgia (FM). Participants
completed the Dutch FIQ and a set of validated questionnaires
for general health (RAND-36), depression (Beck depression
inventory, BDI), pain (McGill pain questionnaire, MPQ) and
fatigue (checklist individual strength, CIS). Internal
consistency within the FIQ item 'physical functioning' was
studied using Cronbach's alpha. Test-retest reliability was
studied with intra-class-correlation (ICC) in a subsample of 76
control subjects over a 3 month period without specific
intervention. Construct validity was evaluated by correlating
the FIQ to other questionnaires. Sensitivity to change was
studied using standardized response means (SRM). RESULTS: The
study sample consisted of 213 women and 11 men (mean age 47 yrs,
mean disease duration 11 yrs). Cronbach's alpha for the item
'physical functioning' was 0.91, indicating high internal
consistency. Test-retest reliability was acceptable, with ICC
ranging from 0.45 for 'morning tiredness' to 0.71 for 'physical
function'. FIQ correlated significantly with the RAND-36, with
Spearman's rho ranging from -0.60 to -0.70 for items measuring
the same concept. Similar patterns of correlation were seen with
MPQ, BDI and CIS. Sensitivity to change was sufficient, with SRM
after Spa treatment ranging from 0.3 for 'work days missed' to
0.9 for 'days felt good'. Similar SRM were found in the
venlafaxine trial for patients reporting general improvement.
CONCLUSION: The Dutch FIQ is a valid instrument for measuring
health status in FM, showing sufficient reliability, construct
validity and responsiveness
(198) Vandvik PO,
Lydersen S, Farup PG. Prevalence, comorbidity and impact of
irritable bowel syndrome in Norway. Scand J Gastroenterol 2006;
41(6):650-6.
Abstract: OBJECTIVE: To study the prevalence of irritable bowel
syndrome (IBS) and its comorbidity in a Norwegian adult
population. MATERIAL AND METHODS: In 2001, 11,078 inhabitants
(aged 30-75 years) in Oppland County were invited to take part
in a public health survey. A total of 4622 subjects (42%)
completed the questionnaires on symptoms of IBS (Rome II
criteria), comorbidity, health-care visits and medications. The
impact of comorbidity on global health, working disability and
use of health-care resources in subjects with IBS was explored
by stepwise logistic regression. RESULTS: The population
prevalence of IBS was 388/4622 (8.4% (95% CI: 7.6-9.4%)) with a
female predominance and an age-dependent decrease. The
proportion who had consulted for IBS ranged from 51% among
30-year-olds to 79% in 75-year-olds (p=0.05). IBS was associated
with musculoskeletal complaints (OR = 2.4-3.4 for six different
items), fibromyalgia (OR = 3.6 [2.7-4.8]), mood disorder (OR =
3.3 (2.6-4.3)), reduced global health (OR = 2.6 (2.1-3.2)),
working disability (OR = 1.6 (1.2-2.1)), more frequent
health-care visits and use of medications (OR 1.7-2.3). When
controlling for comorbidity, reduced global health (OR = 1.5
(1.1-2.0)) and use of alternative health care (OR = 1.7
(1.3-2.4)) remained associated with IBS. Severity of abdominal
pain/discomfort was a predictor of having to seek a physician
for IBS (OR = 1.3 (1.2-1.5)). CONCLUSIONS: Symptoms of IBS were
reported by 8% of Norwegian adults and had resulted in
consultations with physicians for the majority in the long run.
Subjects with IBS in the community were characterized by
frequent somatic and psychiatric comorbidity. Their observed
reduced health, working disability and increased use of health
resources were largely explained by comorbid symptoms and
disorders
(199) Arguelles LM,
Afari N, Buchwald DS, Clauw DJ, Furner S, Goldberg J. A twin
study of posttraumatic stress disorder symptoms and chronic
widespread pain. Pain 2006; 124(1-2):150-7.
Abstract: Previous studies of the association between
posttraumatic stress disorder (PTSD) and chronic widespread pain
(CWP) or fibromyalgia have not examined the role of familial or
genetic factors. The goals of this study were to determine if
symptoms of PTSD are related to CWP in a genetically informative
community-based sample of twin pairs, and if so, to ascertain if
the association is due to familial or genetic factors. Data were
obtained from the University of Washington Twin Registry, which
contains 1042 monozygotic and 828 dizygotic twin pairs. To
assess the symptoms of PTSD, we used questions from the Impact
of Events Scale (IES). IES scores were partitioned into
terciles. CWP was defined as pain located in 3 body regions
lasting at least 1 week during the past 3 months. Random-effects
regression models, adjusted for demographic features and
depression, examined the relationship between IES and CWP. IES
scores were strongly associated with CWP (P<0.0001). Compared to
those in the lowest IES tercile, twins in the highest tercile
were 3.5 times more likely to report CWP. Although IES scores
were associated with CWP more strongly among dizygotic than
among monozygotic twins, this difference was not significant.
Our findings suggest that PTSD symptoms, as measured by IES, are
strongly linked to CWP, but this association is not explained by
a common familial or genetic vulnerability to both conditions.
Future research is needed to understand the temporal association
of PTSD and CWP, as well as the physiological underpinnings of
this relationship
(200) Fengler RK,
Jacobs JW, Bac M, van Wijck AJ, van Meeteren NL. Action
potential simulation (APS) in patients with fibromyalgia
syndrome (FMS): a controlled single subject experimental design.
Clin Rheumatol 2007; 26(3):322-9.
Abstract: OBJECTIVES: Action potential simulation (APS) is
becoming a popular method of pain reduction. Nevertheless,
little is known about the efficacy of this relatively new
treatment. The aim of this study was to investigate whether APS
helps to reduce pain, improves patients' perception of daily
functioning and social participation in patients with
fibromyalgia syndrome (FMS). MATERIALS AND METHODS: Ten patients
with FMS according to the American College of Rheumatology (ACR)
criteria entered this double blind crossover single-case study.
In a period of 20 weeks, the patients underwent two treatment
periods of 4 weeks, one with verum and one with placebo, at
random, in a double blind fashion. Outcome measures were
evaluated on a weekly basis. Primary outcome measure was pain
measured with the Fibromyalgia Impact Questionnaire (FIQ)
questions 4 and 5, the number of tender points and the total
tender point pain intensity score. Both visual inspection and
statistical analysis were done to analyse the data from this
single-subject design. RESULTS: Performing visual inspection and
statistical analysis, no positive results of the APS treatment
were found in this study. Remarkable is the fact that placebo
APS had significantly better results than verum APS.
CONCLUSIONS: In this single-case study with ten patients (all
female), APS was not a helpful method to reduce pain, to improve
patients' perception of daily functioning and social
participation in patients with FMS
(201) Hooper MM,
Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW.
Musculoskeletal findings in obese subjects before and after
weight loss following bariatric surgery. Int J Obes (Lond) 2007;
31(1):114-20.
Abstract: OBJECTIVE: To determine the point prevalence of
painful musculoskeletal (MSK) conditions in obese subjects
before and after weight loss following bariatric surgery.
DESIGN: Longitudinal, interventional,
unblended.Subjects:Forty-eight obese subjects (47 women, one
man, mean age 44+/-9 years; mean body mass index (BMI) 51+/-8
kg/m(2)) recruited from an academic medical center bariatric
surgery program. MEASUREMENTS: Comorbid medical conditions; MSK
findings; BMI; Western Ontario McMaster Osteoarthritis Index
(WOMAC) for pain, stiffness and function; and SF-36 for quality
of life. METHODS: Consecutive subjects were recruited from the
University Hospitals of Cleveland Bariatric Surgery Program.
Musculoskeletal signs and symptoms and non-MSK comorbid
conditions were documented at baseline and at follow-up.
Subjects completed the SF-36 and the WOMAC questionnaires.
Analyses were carried out for each MSK site, fibromyalgia
syndrome (FMS) and for the cumulative effect on the spine, upper
and lower extremities. The impact of change in comorbid medical
conditions, BMI, physical and mental health domains of the SF-36
on the WOMAC pain subscale score was evaluated. SF-36 outcomes
were compared to normal published controls. RESULTS: Forty-eight
subjects were available for baseline and a follow-up assessment
6-12 months after gastric bypass surgery. They lost an average
of 41+/-15 kg and the mean BMI decreased from 51+/-8 to 36+/-7
kg/m(2). Baseline comorbid medical conditions were present in
96% before surgery and 23% after weight loss. There was an
increased prevalence of painful MSK conditions at baseline
compared to general population frequencies. Musculoskeletal
complaints had been present in 100% of obese subjects before,
and 23% after weight loss. The greatest improvements occurred in
the cervical and lumbar spine, the foot and in FMS (decreased by
90, 83, 83 and 92%, respectively). Seventy-nine percent had
upper extremity MSK conditions before and 40% after weight loss.
Before surgery, 100% had lower extremity MSK conditions and only
37% did after weight loss. The WOMAC subscale and composite
scores all improved significantly, as did the SF-36((R)). Change
in BMI was the main factor impacting the WOMAC pain score.
CONCLUSION: There was a higher frequency of multiple MSK
complaints, including non-weight-bearing sites compared to
historical controls, before surgery, which decreased
significantly at most sites following weight loss and physical
activity. These benefits may improve further, as weight loss may
continue for up to 24 months. The benefits seen with weight loss
indicate that prevention and treatment of obesity can improve
MSK health and function
(202) Unlu E, Ulas
UH, Gurcay E, Tuncay R, Berber S, Cakci A et al. Genital
sympathetic skin responses in fibromyalgia syndrome. Rheumatol
Int 2006; 26(11):1025-30.
Abstract: The study was designed to investigate the autonomic
dysfunction in fibromyalgia syndrome (FMS) by recording
sympathetic skin response (SSR) from palmar, plantar and genital
regions. The second aim was to evaluate the relation between
sexual problems and autonomic dysfunction in FMS. SSR potential
was recorded from palmar, plantar and genital regions in 28
married, female FMS patients and 18 married, healthy females.
Fibromyalgia Impact Questionnaire (FIQ) was used to show the
clinical severity and functional disability in FMS patients.
Glombok Rust Inventory of Sexual Satisfaction (GRISS), a 28-item
questionnaire, was used to assess the existence and severity of
sexual problems. Beck test was used to evaluate anxiety and
depression. The amplitude of SSR recorded from palmar, plantar
and genital regions was lower than in the control subjects (P <
0.05). GRISS (total and subscale), Beck test and FIQ scores of
FMS patients were higher than in the control subjects (P <
0.05). No correlation was found between the SSR potential and
GRISS scores. The results of our study reveal that abnormality
in SSR recorded from palmar, plantar and genital regions
reflects the abnormality in the autonomic nervous system (ANS)
of FMS patients. These patients have more sexual problems than
healthy subjects, and we think this finding is related to
increased anxiety and depression in these patients
(203) Singh BB, Wu
WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP et al.
Effectiveness of acupuncture in the treatment of fibromyalgia.
Altern Ther Health Med 2006; 12(2):34-41.
Abstract: CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent
musculoskeletal disorder associated with pain, mood state
alteration, and disability. A structured and effective treatment
plan for palliative care has not been established. The genesis
of FMS is not clear. FMS occurs primarily in adult women.
DESIGN: Using a quasi-experimental clinical design and following
the criteria of the American College of Rheumatology (ACR), for
FMS, 21 participants completed the study. The mean age was 53.6
years. The data were collected at baseline and at 1 and 2
months. Acupuncture treatments included 17 points for FMS
symptoms, and 8 outcome measures were collected. RESULTS: The
Fibromyalgia Impact Questionnaire (FIQ) showed significant
differences at 1 and 2 months. For the SF-12, 3 subscales showed
significant differences between baseline and 2 months. Four of 6
items were significantly changed. The mean number of general
health symptoms was significantly decreased by 2 months. For the
Catastrophe Index, significant differences were found for
baseline vs 2 months. Pain threshold scores were significantly
different at end of treatment for 5 bilateral tender points.
There was significant improvement in Beck Depression items for
both 1- and 2-month periods. In a multivariate regression model,
5 covariates were included--age, number of weeks in treatment,
number of doctors treating, number of general symptoms, and
baseline FIQ score. The results indicated significant age
effect. This analysis showed that the higher the FIQ score, the
more positive the change experienced by study participants.
Number of weeks in treatment, number of doctors who treated, and
total number of general health symptoms did not have a
significant effect on outcomes. CONCLUSIONS: Significant
improvement was experienced by participants at 8 weeks of
treatment. Acupuncture treatment as delivered was effective at
reducing FMS symptoms in this outcome study
(204) Pamuk ON,
Cakir N. The frequency of thyroid antibodies in fibromyalgia
patients and their relationship with symptoms. Clin Rheumatol
2007; 26(1):55-9.
Abstract: We determined the frequency of thyroid autoantibodies
in fibromyalgia (FM) patients and the relationship between FM
symptoms and these antibodies. Euthyroid 128 FM patients, 64
rheumatoid arthritis (RA) patients, and 64 healthy control
subjects were included in the study. The sociodemographic
features and the clinical features of FM patients were
determined. By using a visual analog scale, patients were
questioned about the severity of FM-related symptoms. All
patients were administered with Duke-Anxiety Depression
(Duke-AD) scale, the physical function items of the fibromyalgia
impact questionnaire scale. Thyroid autoimmunity was defined as
the presence of detectable antithyroglobulin (TgAb) and/or
antithyroid peroxidase (TPOAb) antibodies by the immunometric
methods. Patients with a connective tissue disorder, hypo- or
hyperthyroidism, and patients who had psychiatric treatment
within the last 6 months were not included into the study. The
frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%)
patients were significantly higher than controls (18.8%)
(p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and
31 (24.2%) had positive TPOAb. When patients with thyroid
autoimmunity were compared to others, it was seen that the mean
age, the percentage of postmenopausal patients, the frequency of
dryness of the mouth, and the percentage of patients with a
previous psychiatric treatment were higher in this group
(p<0.05). FM patients had thyroid autoimmunity similar to the
frequency in RA and higher than controls. Age and postmenopausal
status seemed to be associated with thyroid autoimmunity in FM
patients. The presence of thyroid autoimmunity had no
relationship with the depression scores of FM patients
(205) Garcia-Campayo
J, Pascual A, Alda M, Marzo J, Magallon R, Fortes S. The Spanish
version of the FibroFatigue Scale: validation of a questionnaire
for the observer's assessment of fibromyalgia and chronic
fatigue syndrome. Gen Hosp Psychiatry 2006; 28(2):154-60.
Abstract: OBJECTIVE: To examine some of the psychometric
properties of the Spanish version of the FibroFatigue Scale
(FFS). METHODS: FFS was administered to 120 patients diagnosed
with fibromyalgia and chronic fatigue syndrome. Internal
consistency was evaluated by using Cronbach's alpha, test-retest
reliability with weighted kappa and construct validity by
correlations among FFS, the Fibromyalgia Impact Questionnaire
(FIQ), the EuroQol 5D (EQ-5D) and the Hospital Anxiety and
Depression Scale (HADS). The interrater reliability was tested
using analysis of variance with patients and raters as
independent factors. RESULTS: Internal consistency (alpha) was
.88, test-retest reliability was .91, and interrater reliability
was .93. Significant correlations were obtained between overall
FFS and the FIQ (.55, P<.01), the EQ-5D (-.48, P<.01) and the
HADS depression subscale (.25, P<.01), but not with the HADS
anxiety subscale. CONCLUSION: These results support the
reliability and validity of the data obtained with the Spanish
version of the FSS
(206) Arnold LD,
Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia:
characteristics and associations with comorbidities and quality
of life. Obstet Gynecol 2006; 107(3):617-24.
Abstract: OBJECTIVE: This case-control survey compared health
history and health care use of women with vulvodynia with a
control group reporting absence of gynecologic pain. METHODS:
Women with a clinically assessed diagnosis of vulvodynia and
asymptomatic controls were matched for age and mailed a
confidential survey that evaluated demographics, health history,
use of the health care system, and history of vulvodynia.
Participants were all current or former ambulatory patients
within a university health care system. RESULTS: Of the 512
questionnaires mailed to valid addresses, 70% (n = 91) of cases
and 72% (n = 275) of controls responded, with 77 cases and 208
controls meeting eligibility criteria. Women with vulvodynia
reported a substantial negative impact on quality of life, with
42% feeling out of control of their lives and 60% feeling out of
control of their bodies. Forty-one percent indicated a severe
impact on their sexual lives. When comorbidities were evaluated
individually and adjusted for age, fibromyalgia (odds ratio
3.84, 95% confidence interval 1.54-9.55) and irritable bowel
syndrome (odds ratio 3.11, 95% confidence interval 1.60-6.05)
were significantly associated with vulvodynia. On a multivariate
level, vulvodynia was correlated with a history of chronic yeast
vaginitis and urinary tract infections. CONCLUSION: This survey
highlights the psychological distress associated with vulvodynia
and underscores the need for prospective studies to investigate
the relationship between chronic bladder and vaginal infections
as etiologies for this condition. As well, the association of
vulvodynia with other comorbid conditions, such as fibromyalgia
and irritable bowel syndrome, needs to be further evaluated.
LEVEL OF EVIDENCE: II-2
(207) Menzies V,
Taylor AG, Bourguignon C. Effects of guided imagery on outcomes
of pain, functional status, and self-efficacy in persons
diagnosed with fibromyalgia. J Altern Complement Med 2006;
12(1):23-30.
Abstract: OBJECTIVES: (1) To investigate the effects of a 6-week
intervention of guided imagery on pain level, functional status,
and self-efficacy in persons with fibromyalgia (FM); and (2) to
explore the dose-response effect of imagery use on outcomes.
DESIGN: Longitudinal, prospective, two-group, randomized,
controlled clinical trial. SETTING AND SUBJECTS: The sample
included 48 persons with FM recruited from physicians' offices
and clinics in the mid-Atlantic region. INTERVENTION:
Participants randomized to Guided Imagery (GI) plus Usual Care
intervention group received a set of three audiotaped guided
imagery scripts and were instructed to use at least one tape
daily for 6 weeks and report weekly frequency of use (dosage).
Participants assigned to the Usual Care alone group submitted
weekly report forms on usual care. MEASURES: All participants
completed the Short-Form McGill Pain Questionnaire (SF-MPQ),
Arthritis Self- Efficacy Scale (ASES), and Fibromyalgia Impact
Questionnaire (FIQ), at baseline, 6, and 10 weeks, and submitted
frequency of use report forms. RESULTS: FIQ scores decreased
over time in the GI group compared to the Usual Care group (p =
0.03). Ratings of self-efficacy for managing pain (p = 0.03) and
other symptoms of FM also increased significantly over time (p =
< 0.01) in the GI group compared to the Usual Care group. Pain
as measured by the SF-MPQ did not change over time or by group.
Imagery dosage was not significant. CONCLUSIONS: This study
demonstrated the effectiveness of guided imagery in improving
functional status and sense of self-efficacy for managing pain
and other symptoms of FM. However, participants' reports of pain
did not change. Further studies investigating the effects of
mind-body interventions as adjunctive self-care modalities are
warranted in the fibromyalgia patient population
(208) Assis MR,
Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D et al. A
randomized controlled trial of deep water running: clinical
effectiveness of aquatic exercise to treat fibromyalgia.
Arthritis Rheum 2006; 55(1):57-65.
Abstract: OBJECTIVE: To compare the clinical effectiveness of
aerobic exercise in the water with walking/jogging for women
with fibromyalgia (FM). METHODS: Sixty sedentary women with FM,
ages 18-60 years, were randomly assigned to either deep water
running (DWR) or land-based exercises (LBE). Patients were
trained for 15 weeks at their anaerobic threshold. Visual analog
scale of pain, Fibromyalgia Impact Questionnaire (FIQ), Beck
Depression Inventory, Short Form 36 Health Survey (SF-36), and a
patient's global assessment of response to therapy (PGART) were
measured at baseline, week 8, and week 15. Statistical analysis
included all patients. RESULTS: Four patients dropped out from
each group. Both groups improved significantly at week 15
compared with baseline, with an average 36% reduction in pain
intensity. For PGART, 40% of the DWR group and 30% of the LBE
group answered "much better" at posttreatment. FIQ total score
and FIQ depression improvements in the DWR group were faster
(week 8) than the LBE group and kept improving (week 15; P <
0.05). Only the DWR group showed improvements in SF-36 role
emotional (P = 0.006). No significant between-group differences
were observed for peak oxygen uptake and other outcomes.
CONCLUSION: DWR is a safe exercise that has been shown to be as
effective as LBE regarding pain. However, it has been shown to
bring more advantages related to emotional aspects. Aerobic gain
was similar for both groups, regardless of symptom improvement.
Therefore, DWR could be studied as an exercise option for
patients with FM who have problems adapting to LBE or lower
limbs limitations
(209) Ubago Linares
MC, Ruiz P, I, Bermejo Perez MJ, Olry de Labry LA, Plazaola CJ.
[Clinical and psychosocial characteristics of subjects with
fibromyalgia. Impact of the diagnosis on patients' activities].
Rev Esp Salud Publica 2005; 79(6):683-95.
Abstract: BACKGROUND: Little is known today about the
characteristics of individuals diagnosed with fibromyalgia,
their degree of disability and the health system response system
response to this condition. The objectives of this work include:
to establish the sociodemographic, clinical and psychosocial
profile of male and female patients with fibromyalgia. To
describe the response they receive from the health service, and
to study the repercussions of this syndrome on the daily
activities of subjects who suffer it, including its effects on
their work environment. METHODS: Descriptive cross-sectional
study. The information was received from telephone interviews of
individuals diagnosed with fibromyalgia in the Hospital
Universitario Virgen de las Nieves in Granada during 2003.
RESULTS: 92.1% of those interviewed were women. Fibromyalgia
caused work absenteeism in 31.4% of cases; and 64% regarded
their health as poor or very poor. Fibromyalgia was associated
with other diseases in 52.3% of cases. The family doctor is the
specialist consulted before diagnosis in 92.1% of cases. A total
of 50.5% had a history of psychiatric disorders, these were
still present at the time of interview in 36.4%. Around 71% of
the sample received family support, and 70.1% of cases
considered the disease to seriously affect their environment.
CONCLUSIONS: Fibromyalgia was mainly diagnosed in women.
Subjects with this syndrome have a poor perception of their own
health and work situation, and it negatively affects their
family environment
(210) Mannerkorpi K,
Svantesson U, Broberg C. Relationships between performance-based
tests and patients' ratings of activity limitations,
self-efficacy, and pain in fibromyalgia. Arch Phys Med Rehabil
2006; 87(2):259-64.
Abstract: OBJECTIVE: To investigate the relationship between
performance-based tests, ratings of activity limitations,
self-efficacy, and pain in fibromyalgia. DESIGN: Descriptive.
SETTING: University hospital. PARTICIPANTS: Sixty-nine women
with fibromyalgia (mean age, 45+/-7.8y). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: The patients completed 4
performance-based tests focusing on muscle power function and 3
unloaded arm movements. The patients rated their activity
limitations by means of the subscales of physical function (PF)
and pain on the Fibromyalgia Impact Questionnaire (FIQ), the
Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36),
and the Arthritis Self-Efficacy Scale (ASES). Spearman
correlation coefficient (rho) and multivariate regression
analysis were conducted. RESULTS: The highest correlations were
found between the 6-minute walk test (6MWT) (rho range, -.48 to
.68) and the activity limitations and between hand grip strength
(rho range, -.34 to .57) and the activity limitations. The
regression analysis indicated that hand grip strength explained
25% of the variation in the SF-36 PF scale. The 6MWT plus
endurance of the shoulder muscles explained 24% of the variation
in the FIQ PF scale and the 6MWT plus active abduction of the
shoulder explained 48% of the variation in the ASES function
scale. Correlations between the performance-based tests and the
activity limitations tended to be higher than those between
performance and pain. CONCLUSIONS: The majority of the
performance-based tests and the patients' subjective ratings of
activity limitations showed significant relationships. The 6MWT
and hand grip strength, reflecting activity limitations in the
SF-36, FIQ, and ASES, are recommended for use in clinical
research and in the clinical examination when planning treatment
for patients with fibromyalgia
(211) Gordon C,
Emiliozzi C, Zartarian M. Use of a mechanical massage technique
in the treatment of fibromyalgia: a preliminary study. Arch Phys
Med Rehabil 2006; 87(1):145-7.
Abstract: OBJECTIVE: To investigate how a mechanical massage
technique (LPG technique) could contribute to the treatment of
fibromyalgia. DESIGN: Feasibility study. SETTING: A single
center. PARTICIPANTS: Ten women having a preexisting diagnosis
of fibromyalgia based on American College of Rheumatology
criteria were enrolled. INTERVENTION: Subjects received a total
of 15 sessions of mechanical massage administered by a physical
therapist once a week. MAIN OUTCOME MEASURES: The Fibromyalgia
Impact Questionnaire and a physical examination scoring tender
points (number, pain intensity). Evaluations were conducted at
the screening visit, after 7 sessions (V7), and after completion
of 15 sessions (V15). RESULTS: Most of the parameters (pain
intensity, physical function, number of tender points) showed a
significant improvement at V15 compared with screening.
CONCLUSIONS: The findings suggest the possibility that the
studied intervention might be associated with positive outcomes
in women with fibromyalgia, and support the need for a
controlled clinical trial to determine its efficacy
(212) Arnold LM,
Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S et
al. A randomized, double-blind, placebo-controlled trial of
duloxetine in the treatment of women with fibromyalgia with or
without major depressive disorder. Pain 2005; 119(1-3):5-15.
Abstract: This was a 12-week, randomized, double-blind,
placebo-controlled trial to assess the efficacy and safety of
duloxetine, a selective serotonin and norepinephrine reuptake
inhibitor, in 354 female patients with primary fibromyalgia,
with or without current major depressive disorder. Patients (90%
Caucasian; mean age, 49.6 years; 26% with current major
depressive disorder) received duloxetine 60 mg once daily (QD)
(N=118), duloxetine 60 mg twice daily (BID) (N=116), or placebo
(N=120). The primary outcome was the Brief Pain Inventory
average pain severity score. Response to treatment was defined
as >or=30% reduction in this score. Compared with placebo, both
duloxetine-treated groups improved significantly more (P<0.001)
on the Brief Pain Inventory average pain severity score. A
significantly higher percentage of duloxetine-treated patients
had a decrease of >or=30% in this score (duloxetine 60 mg QD
(55%; P<0.001); duloxetine 60 mg BID (54%; P=0.002); placebo
(33%)). The treatment effect of duloxetine on pain reduction was
independent of the effect on mood and the presence of major
depressive disorder. Compared with patients on placebo, patients
treated with duloxetine 60 mg QD or duloxetine 60 mg BID had
significantly greater improvement in remaining Brief Pain
Inventory pain severity and interference scores, Fibromyalgia
Impact Questionnaire, Clinical Global Impression of Severity,
Patient Global Impression of Improvement, and several
quality-of-life measures. Both doses of duloxetine were safely
administered and well tolerated. In conclusion, both duloxetine
60 mg QD and duloxetine 60 mg BID were effective and safe in the
treatment of fibromyalgia in female patients with or without
major depressive disorder
(213) Brautbar A,
Elstein D, Pines B, Krienen N, Hemmer J, Buskila D et al.
Fibromyalgia and Gaucher's disease. QJM 2006; 99(2):103-7.
Abstract: BACKGROUND: Patients with symptomatic Gaucher's
disease sometimes have non-specific symptoms (such as general
malaise with widespread musculoskeletal pains) that respond
poorly to enzyme replacement treatment. These may indicate
fibromyalgia syndrome; if so, other therapeutic options might be
more appropriate. AIM: To identify patients with Gaucher's
disease for whom fibromyalgia-specific therapy may be
therapeutic. DESIGN: Questionnaire-based survey. METHODS: Adult
patients (n = 109) with non-neuronopathic Gaucher's disease and
adult healthy controls (n = 108) completed health-related
questionnaires including the Fibromyalgia Impact Questionnaire,
and underwent testing with a dolorimeter to ascertain
sensitivity at 22 tender points. RESULTS: Six patients, but no
controls, met the criteria for fibromyalgia. Patients with
fibromyalgia had a significantly greater incidence of
co-morbidities (p = 0.014) relative to other patients with
Gaucher's disease; four suffered from bone involvement and were
receiving enzyme therapy, but two were untreated. DISCUSSION:
The presence of fibromyalgia-specific trigger points may result
from multiple aetiologies, or may be an independently-sorting
predisposition. Our findings cannot distinguish between these
possibilities, but if fibromyalgia were the cause, enzyme
replacement therapy would be expensive and inappropriate
(214) Ozgocmen S,
Ozyurt H, Sogut S, Akyol O, Ardicoglu O, Yildizhan H.
Antioxidant status, lipid peroxidation and nitric oxide in
fibromyalgia: etiologic and therapeutic concerns. Rheumatol Int
2006; 26(7):598-603.
Abstract: We proposed to assess the oxidant/antioxidant status,
lipid peroxidation and nitric oxide (NO) in untreated
fibromyalgia (FM) patients and controls. The effect of
amitriptyline (A, 20 mg daily) and sertraline (S, 100 mg daily)
treatment on patients' superoxide dismutase (SOD), xanthine
oxidase (XO), adenosine deaminase (ADA) enzyme activities,
thiobarbituric acid reactive substances (TBARS) and NO levels
was investigated. Thirty female patients with primary FM and
age-matched 16 healthy female controls were included. Patients
received an 8-week course of treatment with either A or S. FM
patients had higher serum levels of TBARS (particularly
malondialdehyde) and lower levels of nitrite compared to
controls whereas enzyme activities were similar. A and S
significantly improved Fibromyalgia Impact Questionnaire (FIQ)
pain scores, Hamilton anxiety and depression rating scales. But
neither A nor S had significant effects on measured oxidative
stress parameters, except SOD activity that was significantly
reduced after S treatment. Total myalgic scores negatively
correlated with XO activity, and depression scales negatively
correlated with levels of TBARS. Our results indicate that
patients with FM are under oxidative stress. These findings
represent a rationale for further research assessing the effect
of free radical scavengers or antioxidant agents like vitamins
and omega-3 fatty acids on peripheral and central mechanisms in
FM
(215) Bennett R. The
Fibromyalgia Impact Questionnaire (FIQ): a review of its
development, current version, operating characteristics and
uses. Clin Exp Rheumatol 2005; 23(5 Suppl 39):S154-S162.
Abstract: The Fibromyalgia Impact Questionnaire (FIQ) was
developed in the late 1980s by clinicians at Oregon Health &
Science University in an attempt to capture the total spectrum
of problems related to fibromyalgia and the responses to
therapy. It was first published in 1991 and since that time has
been extensively used as an index of therapeutic efficacy.
Overall, it has been shown to have a credible construct
validity, reliable test-retest characteristics and a good
sensitivity in demonstrating therapeutic change. The original
questionnaire was modified in 1997 and 2002, to reflect ongoing
experience with the instrument and to clarify the scoring
system. The latest version of the FIQ can be found at the web
site of the Oregon Fibromyalgia Foundation
(www.myalgia.com/FIQ/FIQ). The FIQ has now been translated into
eight languages, and the translated versions have shown
operating characteristics similar to the English version
(216) Lee SS, Yoon
HJ, Chang HK, Park KS. Fibromyalgia in Behcet's disease is
associated with anxiety and depression, and not with disease
activity. Clin Exp Rheumatol 2005; 23(4 Suppl 38):S15-S19.
Abstract: OBJECTIVE: To determine the prevalence of fibromyalgia
(FM) in Korean patients with Behcet's disease (BD) and to
evaluate the association between FM and clinical and
psychological variables. METHODS: Seventy patients with BD were
examined for FM tender points and asked to complete a Korean
version of the Fibromyalgia Impact Questionnaire (FIQ). Disease
activity was measured using the erythrocyte sedimentation rate
(ESR), C-reactive protein (CRP), and a clinical activity score,
which was calculated by summing the clinical manifestations. The
State-Trait Anxiety Inventory (STAI) and Beck Depression
Inventory (BDI) were used for psychometric scoring. RESULTS:
Twenty-six BD patients (37.1%) met the American College of
Rheumatology criteria for FM. The patients who met the criteria
for FM were more frequently female, less frequently employed,
and less well educated. Age, disease duration, clinical
manifestations, medication, and measures of disease activity did
not differ between BD patients with and without FM.
Nevertheless, BD patients with FM had higher STAI and BDI scores
than did patients without FM (all p < 0.05). FM tender points
were significantly correlated with the STAI and BDI, and not
with disease activity variables. The FIQ scores were also
strongly correlated with the STAI and BDI scores, and not with
disease activity. CONCLUSION: FM was very common among BD
patients and was associated with the presence of anxiety and
depression, and not with disease activity
(217) Lukaczer D,
Darland G, Tripp M, Liska D, Lerman RH, Schiltz B et al. A pilot
trial evaluating Meta050, a proprietary combination of reduced
iso-alpha acids, rosemary extract and oleanolic acid in patients
with arthritis and fibromyalgia. Phytother Res 2005;
19(10):864-9.
Abstract: The aim of this open-label, 8-week observational trial
was to investigate the efficacy of Meta050 (a proprietary,
standardized combination of reduced iso-alpha-acids from hops,
rosemary extract and oleanolic acid) on pain in patients with
rheumatic disease. Osteoarthritis, rheumatoid arthritis and
fibromyalgia patients were given 440 mg Meta050 three times a
day for 4 weeks, which was changed to 880 mg twice a day for the
subsequent 4 weeks in the majority of patients. Pain and
condition-specific symptoms were assessed using a standard
visual analog scale (VAS), an abridged arthritis impact
measurement scale (AIMS2) and the fibromyalgia impact
questionnaire. Fifty-four subjects with rheumatic disease
completed the trial. Following treatment, a statistically
significant decrease in pain of 50% and 40% was observed in
arthritis subjects using the VAS (p < 0.0001; Wilcoxon-ranked
sums) and AIMS2 (p < 0.0001), respectively. Fibromyalgia subject
scores did not significantly improve. A decreasing trend of
C-reactive protein, a marker for inflammation, was also observed
in those subjects who presented with elevated C-reactive
protein. No serious side effects were observed. These
observations suggest that Meta050 at a dosage of 440 mg three
times a day has a beneficial effect on pain in arthritis
subjects
(218) Wood PB,
Kablinger AS, Caldito GS. Open trial of pindolol in the
treatment of fibromyalgia. Ann Pharmacother 2005; 39(11):1812-6.
Abstract: BACKGROUND: Evidence suggests that fibromyalgia is
related to both chronic sympathetic hyperactivity and decreased
levels of serotonin. OBJECTIVE: To examine the efficacy of
pindolol, a mixed serotonin (5-HT)(1A) presynaptic
autoreceptor/beta-adrenergic receptor antagonist, in the
treatment of fibromyalgia. METHODS: An open trial was conducted
using 20 female patients who met the American College of
Rheumatology criteria for fibromyalgia. Treatment was initiated
with pindolol 7.5 mg/day and titrated to a maximum dose of 15
mg/day for a total of 90 days. Primary outcome measures were
tender point analysis and the Fibromyalgia Impact Questionnaire
(FIQ). Anxiety and depression were measured with the Hamilton
Depression and Anxiety Scales and Beck Depression Inventory.
RESULTS: There was significant improvement in primary outcome
measures, including Tender Point Count (mean +/- SD, 16.3 +/-
2.2 vs 12.3 +/- 5.0; F = 8.9; p < 0.001), Tender Point Score
(24.4 +/- 5.7 vs 17.5 +/- 9.4; F = 7.8; p < 0.001), and FIQ
(45.3 +/- 10.8 vs 35.0 +/- 15.0; F = 5.6; p < 0.005). The
depression and anxiety scores did not change significantly among
women who completed the study, while the impact on
cardiovascular parameters was clinically insignificant.
CONCLUSIONS: While the current results are encouraging, further
studies are needed to determine whether pindolol might be
effective in the treatment of fibromyalgia. Limitations of this
study include small group size and lack of placebo control
(219) Dobkin PL,
Abrahamowicz M, Fitzcharles MA, Dritsa M, da CD. Maintenance of
exercise in women with fibromyalgia. Arthritis Rheum 2005;
53(5):724-31.
Abstract: OBJECTIVE: To identify predictors of maintenance of
exercise for women with fibromyalgia (FM). METHODS: Women with
FM who had been randomized to the exercise arm of a clinical
trial were studied prospectively during and 3 months following
treatment. Subjects completed exercise logs weekly and returned
the data via postal mail. Outcome variables were duration of
aerobic and stretching exercises. Two separate multivariate
models for longitudinal data were built with adjustment for
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