Literature linking FM to Weight and Diabetes
Doron Y, Peleg R, Peleg A, Neumann L, Buskila D. The clinical
and economic burden of fibromyalgia compared with diabetes
mellitus and hypertension among Bedouin women in the Negev. Fam
Pract 2004; 21(4):415-419.
Abstract: BACKGROUND: Fibromyalgia (FM) is a common idiopathic
chronic, widespread pain syndrome with tenderness in
anatomically defined tender points. OBJECTIVES: The purpose of
the present study was to describe and characterize the economic
and daily work burden of FM compared with diabetes mellitus and
hypertension. METHODS: A retrospective study was conducted in
2001 in a primary care clinic, the Kuseife clinic of the Clalit
Health Services. Data for the three study groups were obtained
from the computerized database of the Kuseife clinic and the
Negev District, Israel. The study group included 102 FM
patients. The control groups included 102 diabetes patients and
103 patients with hypertension. RESULTS: Hospitalization and
hospital day care services were the main expenses incurred by
patients in this study. There were no differences among the
study groups in any cost parameter examined except for the cost
of diagnostic tests (P < 0.01), which was less for FM patients.
FM patients were referred to specialists and diagnostic
procedures more frequently than the control groups. No
statistical difference was found in the total number of clinic
visits, but FM patients visited physicians more frequently and
visited nurses less frequently than patients in the other two
groups (P < 0.05). CONCLUSIONS: FM patients consume health care
resources to a similar extent to patients with other chronic
diseases such as diabetes mellitus and hypertension, but the
latter usually receive much more attention from the health care
system. Greater awareness of this disorder can improve
management and facilitate planning of health care resources,
thus improving quality of care.
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) 2006;
Abstract: Objective:To determine the point prevalence of painful
musculoskeletal (MSK) conditions in obese subjects before and
after weight loss following bariatric
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((R)) 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((R)) 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((R)) on the WOMAC pain subscale score was evaluated.
SF-36((R)) 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.
Shapiro JR, Anderson DA, noff-Burg S. A pilot study of the
effects of behavioral weight loss treatment on fibromyalgia
symptoms. J Psychosom Res 2005; 59(5):275-282.
Abstract: OBJECTIVE: Previous studies have found a relation
between weight loss and pain severity in various chronic pain
populations. However, there has been little research examining
the relation between body mass index (BMI) and fibromyalgia
syndrome (FMS). The purpose of this pilot study was to
investigate the relationship between BMI and FMS symptoms and to
determine if FMS symptoms would decrease following weight loss.
METHODS: Overweight and obese women participated in a 20-week
behavioral weight loss treatment. RESULTS: Participants, on
average, lost 9.2 lbs (4.4% of their initial weight), and there
were significant pre-postimprovements on several outcome
measures. Although weight was not significantly related to pain
at baseline, weight loss significantly predicted a reduction in
FMS, pain interference, body satisfaction, and quality of life (QOL).
CONCLUSION: Findings suggest that behavioral weight loss
treatment could be included in the treatment for
overweight/obese women with FMS.
Tishler M, Smorodin T, Vazina-Amit M, Ramot Y, Koffler M, Fishel
B. Fibromyalgia in diabetes mellitus. Rheumatol Int 2003;
Abstract: OBJECTIVE. The aim of this study was to evaluate the
prevalence of fibromyalgia (FM) in patients with diabetes
mellitus (DM). SUBJECTS. The study included 100 consecutive
unselected patients with DM attending our diabetes clinic.
Patients were divided into two groups: 45 patients with type 1
diabetes and 55 patients with type 2 diabetes. A group of 50
healthy hospital staff members served as controls. The FM was
diagnosed according to the 1990 American College of Rheumatology
criteria. Counts of 18 tender points were performed by thumb
palpation and assessed by dolorimeter. Routine biochemical tests
and levels of HbA(1c) were recorded in each patient. RESULTS.
The main outcome measure was the association of FM with DM.
Fibromyalgia was diagnosed in 17 patients (17%) with DM and in
only one (2%) healthy control ( P=0.008). No differences in
patients were noted in the prevalence of FM between type 1 and
type 2 diabetes (18.5% vs 15.5%, respectively). Patients with
both FM and DM had significantly higher levels of HbA(1c) than
DM patients without FM (9.2+/-1.1% vs 6.4+/-1.5%) ( P<0.05).
Similarly, the numbers of tender points, pain scores, and the
prevalence of sleep disturbances, fatigue, and headaches were
higher in this group of patients. A significant correlation was
observed between the numbers of tender points and HbA(1c) levels
in the DM patients with FM ( r=0.72, P=0.027). CONCLUSION.
Fibromyalgia is a common finding in patients with types 1 and 2
diabetes, and its prevalence could be related to control of the
disease. As with other diabetes complications, FM might be
prevented by improved control of blood glucose levels.
Wolak T, Weitzman S, Harman-Boehm I, Friger M, Sukenik S.
Prevalence of fibromyalgia in type 2 diabetes mellitus. Harefuah
2001; 140(11):1006-9, 1120, 1119.
Abstract: This study aimed to assess the prevalence of
fibromyalgia and other pain characteristics among patients with
type 2 diabetes mellitus. We assessed 137 patients with type 2
diabetes mellitus and a control group of 139 patients matched
for age and sex that do not suffer from diabetes mellitus. We
examined 9 of 18 typical tender points and 4 control points with
a dolorimeter. There was no difference in the prevalence of
fibromyalgia among men in both groups. However, diabetic men had
more tender points than men in the control group and their
threshold for pain at the corresponding tender points was
significantly lower compared to that of the men in the control
group. The diabetic men also reported more pain than patients in
the control group. Diabetic women, on the other hand, had a
significantly higher prevalence of fibromyalgia than women in
the control group: 23.3% versus 10.6% respectively (p = 0.043).
There was no significant difference in the number of tender
points and the pain threshold in the two groups of women.
Diabetic women reported more pain than the women in the control
group. In both diabetic men and women the number of tender
points and dolorimeter count directly correlated with the
duration of diabetes.