Physical activity and quality of life of patients with fibromyalgia

Background: Fibromyalgia Syndrome (FMS) has been linked to decreased social functioning, poor mental health, and quality of life (QOL). Increased physical functioning and activity can result in improvements in social, mental and overall health, as well as lowered depression and anxiety levels. Objectives: The aim of this study was to determine physical activity levels and QOL amongst patients diagnosed with fibromyalgia in the Johannesburg region of South Africa. Methods: The research design was cross-sectional. Descriptive and quantitative data were collected. FMS patients (n=38) completed an online questionnaire on the Google Forms platform. The questionnaire was comprised of four components, namely Demographics, the Global Physical Activity Questionnaire (GPAQ), the Fibromyalgia Impact Questionnaire (FIQR), and the Short Form-36 (SF-36). During data analysis, descriptive characteristics and correlations were computed. The significance level was set at p ≤ 0.05. Results: Results revealed high FIQR scores (67%) accompanied with low QOL scores (<50% in all domains). There was no correlation between physical activity and FIQR, and physical activity and QOL. Conclusion: High scores on the impact of FMS were associated with lower overall QOL scores. However, the relationship between physical activity, and the impact of FMS and QOL remain inconclusive.

The current situation of the diagnosis of fibromyalgia syndrome / 中华风湿病学杂志

Objective:To investigate the currentstatus of the diagnosis of fibromyalgia syndrome (FMS), and analyze the related factors in order to improve the diagnostic level of the disease.Methods:A survey was carried out, A "FMS diagnosis table" was developed. The demographic data and past medical experience of patients were recorded. The rates of misdiagnosis and missed diagnosis were calculated. The specific misdiagnosed cases were recorded and analyzed. According to the previous diagnosis history, patients were divided into misdiagnosed group, missed diagnosis group and correct diagnosis group. The demographic characteristics, medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed, and compared with the correct diagnosis group. The reasons for missed diagnosis or misdiagnosis were explored.Results:A total of 277 patients were included in the survey. Only 19.1%(53 cases) of patients were correctly diagnosed, 22.7%(63 cases) of patients were misdiagnosed, 58.1% of patients were missed. The mean time from first symptom to disease diagnosis was (51.0±81.2) months. They were often misdiagnosed as osteoarthritis ( n=21, 33.3%), rheumatoid arthritis ( n=13, 20.6%), lumbar disease ( n=12, 19.0%), and anxiety and depression ( n=11, 17.4%). Patients' social and economic status such as age, income, educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate. In terms of demographic characteristics, the correctly diagnosed group had a lower average age of (44±13) years ( t=8.64/9.20, P<0.05), a higher proportion of employees, a higher monthly income ( χ2=7.10/6.87, P<0.05), and a higher education level ( χ2=7.12, P<0.05). In terms of visits, the rate of visits to other medical institutions (private hospitals) in the missed diagnosis group was higher, and the number of doctors visited was also lower. In terms of illness, the diffuse pain index (WPI) score and FMS symptom severity (SSS) score were lower in the missed diagnosis group. Conclusion:The current situation of the diagnosis of FMS in China is not optimistic, and the diagnosis should be differentiated from osteoarthritis, rheumatoid arthritis, cervical and lumbar diseases, and cardiac diseases. In order to reduce the misdiagnosis and missed diagnosis of this disease, it is necessary to strengthen the public education, improve the understanding of this disease in primary care doctors, and physicians in orthopedics, acupuncture and pain departments.

Functioning in the fibromyalgia syndrome: validity and reliability of the WHODAS 2.0

Abstract Background: Fibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals' functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS. Methods: Methodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0-100), Fibromyalgia Impact Questionnaire (FIQ) (0-10) and Beck Depression Inventory instrument (BDI) (0-63). The construct validity, internal consistency, and test-retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%. Results: Most participants were female (92.27%), aged 45 (± 15) years. The test-retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test-retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS. Conclusions: WHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.

Depresión, ansiedad, apoyo interpersonal y dolor autopercibido en pacientes con síndrome de fibromialgia / Depression, Anxiety, Interpersonal Support, and Self-Perceived Pain in Fibromyalgia Syndrome Patients

Resumen El síndrome de fibromialgia (sf) es una patología que genera gran dificultad en los movimientos, fatiga y dolor en partes del cuerpo, afectando severamente la calidad de vida. El objetivo de este estudio fue determinar los indicadores de depresión, ansiedad, apoyo interpersonal, dolor autopercibido y su relación, en una muestra de pacientes con sfen Colombia. A 100 pacientes se les aplicaron las siguientes pruebas: Inventario de Ansiedad Rasgo Estado, Escala de depresión de Zung, Cuestionario para evaluación del apoyo interpersonal, y la Escala analógica del dolor. Se reportaron niveles moderados de depresión y ansiedad, dificultades específicas en el apoyo social y niveles altos en dolor autopercibido. Las puntuaciones en la escala de depresión se asociaron positivamente con la ansiedad estado y rasgo, pero se asociaron negativamente con el apoyo social. En conclusión, la salud mental, el apoyo interpersonal y el dolor autopercibido se encuentran afectados en los pacientes. Se requiere ajustar los protocolos de atención clínica con el propósito de conservar y potenciar la salud integral en los afectados.

Abstract The fibromyalgia syndrome (fs) is a pathology that generates great difficulty in movements, fatigue, and pain in different parts of the body, affecting severely the quality of life. This study was aimed to determine the indicators of depression, anxiety, interpersonal support, self-perceived pain, and their relationship in a sample of patients with fsin Colombia. The following tests were applied to 100 patients: State Trait Anxiety Inventory, Zung's Depression Scale, Interpersonal Support Evaluation List, and Analogue Pain Scale. Moderate levels of depression and anxiety were reported, specific difficulties in social support, and high levels of self-perceived pain. Depression scores were positively associated with state and trait anxiety scores but negatively associated with social support. In conclusion, mental health, interpersonal support, and self-perceived pain are affected in fs patients. It is necessary to adjust the clinical care protocols to preserve and enhance the integral health of those affected.

Determination of the increased risk of developing atrial fibrillation in fibromyalgia syndrome

Abstract Introduction: Atrial fibrillation (AF) is the leading cause of ischemic stroke and is one of the most common arrhythmias. Previous studies have shown that impaired diastolic functions, P wave dispersion (Pd), and prolonged atrial conduction times (ACT) are associated with increased incidence of atrial fibrillation (AF). The aim of this study was to evaluate diastolic functions, Pd, and ACT in fibromyalgia syndrome (FMS) patients to determine whether there is an increase in the risk of developing AF. Methods: The study included a total of 140 female patients (70 FMS group, 70 healthy control group). Pd was evaluated using 12 lead electrocardiography (ECG), and diastolic functions and ACT with echocardiography. The ECG and echocardiographic evaluations were performed by different cardiologists blinded to the clinical information of the subjects. Results: There was no difference between the two groups in laboratory and clinical parameters. Patients with FMS had significantly higher echocardiographic parameters of ACT known as left-sided intra-atrial (13.9 ± 5.9 vs. 8.1 ± 1.8, p < 0.001), right-sided intra-atrial (21.9 ± 8.2 vs. 10.4 ± 3.5, p < 0.001) and interatrial [40 (25-64) ms vs. 23 (14-27) ms p < 0.001] electromechanical interval (EMI) compared with the control group. Pd was significantly greater in the FMS group compared with the control group [46 (29-62) ms vs. 32 (25-37) ms, p < 0.001]. In the FMS group, there was no significant relationship of the echocardiographic parameters of ACT, Pmax and Pd with age, E/A ratio and deceleration time (DT); while all these five parameters were significantly correlated with left atrial dimension, isovolumetric relaxation time (IVRT), fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS). There was a strong correlation between FIQ and VAS and echocardiographic parameters of ACT, Pmax and Pd. Conclusions: Impaired diastolic functions, an increase in Pd, and prolongation of ACT were observed in FMS. Current disorders are thought to be associated with an increased risk of AF in FMS. The risk of developing AF increases with the severity of FMS and clinical progression.(AU)

The prevalence of fibromyalgia in Brazil - a population-based study with secondary data of the study on chronic pain prevalence in Brazil / A prevalência da fibromialgia no Brasil - estudo de base populacional com dados secundários da pesquisa de prevalência de dor crônica brasileira

ABSTRACT BACKGROUND AND OBJECTIVES: The prevalence of the fibromyalgia syndrome has been estimated in some Brazilian cities and regions, and previous population-based studies investigating this prevalence, as well as the profile of medical consultations are unknown. METHODS: This study used the database constructed by a previous study of authors to identify the prevalence of chronic pain in Brazil. The cases that reported pain for more than 6 months and with a diagnosis of fibromyalgia were selected. The studied descriptive variables were age, intensity and frequency of pain, pain interference in self-care, walking, working, social life, sexual life, sleep quality, if pain causes sadness or depression or influences the emotional aspects. The total sample was evaluated by rheumatologists and pain-expert doctors. RESULTS: Thirteen cases from the initial database were selected since they reported the diagnosis of the prevalence of the fibromyalgia syndrome representing 2% of the initial study population, average age 35.8 years (9.8). The predominance of the fibromyalgia syndrome was in females (n=11). Pain intensity was 7.3 (2.4), the frequency and duration of pain were constant in the majority of the sample (n=9). Most of the cases report a serious pain interference with sleep (n=8), many said that pain interferes with the work (n=5), irritability (5) and finally, some report that pain has a moderate interference in self-care (n=5), walking (n=6), social life (n=6), sexual life (n=5) and causes moderate sadness or depression (n=5). CONCLUSION: The prevalence of the fibromyalgia syndrome was estimated in 2% of the Brazilian population, based on secondary data of a study on chronic pain prevalence in Brazil. The data was collected in 2015-2016. The most reported complaints were intense and daily pain that interferes with sleep.

RESUMO JUSTIFICATIVA E OBJETIVOS: A prevalência de síndrome de fibromialgia já foi estimada em cidades e regiões pontuais do Brasil, desconhece-se estudos anteriores de base populacional que investiguem a prevalência, assim como o perfil de consultas médicas. MÉTODOS: Este estudo utilizou dados secundários ao banco de dados construído por uma pesquisa prévia para identificar a prevalência de dor crônica no Brasil. Foram selecionados os casos que responderam sentir dores há mais de 6 meses e com diagnóstico de fibromialgia. As variáveis analisadas de forma descritiva foram: idade, intensidade e frequência da dor, interferência da dor no autocuidado, na caminhada, no trabalho, na vida social, na vida sexual, na qualidade do sono, se dor causa tristeza ou deprime ou influencia os aspectos emocionais. A totalidade da amostra foi avaliada tanto por reumatologistas como por especialistas em dor. RESULTADOS: Treze casos do banco de dados inicial foram selecionados por afirmarem ter recebido o diagnóstico de síndrome de fibromialgia, representando 2% da população do estudo inicial, idade média de 35,8 anos (9,8). A predominância de síndrome de fibromialgia foi no gênero feminino (n=11). Intensidade de dor de 7,3 (2,4), a frequência e duração da dor é constante na maioria da amostra (n=9). A maioria dos casos relata muita interferência da dor no sono (n=8), alguns classificam que a dor interfere muito no trabalho (n=5), irritabilidade (5) e finalmente, alguns relatam que a dor interfere moderadamente no autocuidado (n=5), caminhada (n=6), vida social (n=6), vida sexual (n=5) e causa moderamente tristeza ou deprime (n=5). CONCLUSÃO: A prevalência da síndrome de fibromialgia foi estimada em 2% da população brasileira pelo viés de dados secundários de um estudo de prevalência de dor crônica no Brasil cujo dados foram coletados em 2015-2016. As queixas relatadas pela maioria dos casos foram de dor intensa e diária e com interferência da dor no sono.

Association of synaptosomal-associated protein 25 (SNAP-25) gene polymorphism with temperament and character traits in women with fibromyalgia syndrome

Abstract Background: Synaptosomal-associated protein 25 (SNAP-25) may be contribute to the pathogenesis of fibromyalgia Syndrome (FMS) by affecting the release of neurotransmitters. Objectives: We aimed to investigate the relationship between the SNAP-25 gen (DdeI = rs1051312 and MnlI = rs3746544) polymorphism and the temperament and character traits. Methods: A total of 85 female patients diagnosed with FMS and 70 age-matched healthy female subjects were enrolled into the study. The Temperament and Character Inventory (TCI) were performed on all the patients. SNAP-25 gene polymorphism was determined in the patients group and controls group. Results: No significant difference between groups was found regarding the distribution of SNAP-25 MnlI polymorphism (p > 0.05), but it was seen that the frequency of TC genotype for DdeI gene was higher in the patients group (p < 0.05). Increased hazard avoidance was found in the patients group (p < 0.05). When TCI scores were assessed in terms of SNAP-25 gene polymorphism, no statistically significant relationship was detected between the TT, TG, GG genotypes for MnlI gen and TCI scores (p > 0.05). However, increased hazard avoidance was detected in patients with TC genotype for DdeI gene compared to patients without such genotype. Discussion: SNAP-25 might be an etiological factor in FMS pathogenesis and might affect personality traits of FMS patients by mediating neurotransmitter release.

Comparison of the Medication Effects between Milnacipran and Pregabalin in Fibromyalgia Syndrome Using a Functional MRI: a Follow-up Study

PURPOSE: In this study, the medication effects of Milnacipran and Pregabalin, as well known as fibromyalgia treatment medicine, in fibromyalgia syndrome patients were compared through the change of BOLD signal in pain related functional MRI. MATERIALS AND METHODS: Twenty fibromyalgia syndrome patients were enrolled in this study and they were separated into two groups according to the treatment medicine: 10 Milnacipran (MLN) treatment group and 7 Pregabalin (PGB) treatment group. For accurate diagnosis, all patients underwent several clinical tests. Pre-treated and post-treated fMRI image with block-designed pressure-pain stimulation for each group were obtained to conduct the statistical analysis of paired t-test and two sample t-test. All statistical significant level was less than 0.05. RESULTS: In clinical tests, the clinical scores of the two groups were not significantly different at pre-treatment stage. But, PGB treatment group had lower Widespread Pain Index (WPI) and Brief Fatigue Inventory (BFI) score than those of MLN treatment group at post-treatment stage. In functional image analysis, BOLD signal of PGB treatment group was higher BOLD signal at several regions including anterior cingulate and insula than MLN treatment group at post-treatment stage. Also, paired t-test values of the BOLD signal in MLN group decreased in several regions including insula and thalamus as known as 'pain network'. In contrast, size and number of regions in which the BOLD signal decreased in PGB treatment group were smaller than those of MLN treatment group. CONCLUSION: This study showed that MLN group and PGB group have different medication effects. It is not surprising that MLN and PGB have not the same therapeutic effects since these two drugs have different medicinal mechanisms such as antidepressants and anti-seizure medication, respectively, and different detailed target of fibromyalgia syndrome treatment. Therefore, it is difficult to say which medicine will work better in this study.

Ansiedade associada a fatores sociodemográficos e clínicos de mulheres com síndrome da fibromialgia / Anxiety associated to sociodemographic and clinical factors of females with fibromyalgia syndrome

BACKGROUND AND OBJECTIVES: To characterize anxiety of females with fibromyalgia syndrome (FMS) and to observe the association of trait and state anxiety with pain and non-restorative sleep. METHODS: Participated in the study 61 females with clinical diagnosis of FMS, living in Greater Florianópolis. Socio-Demographic and Clinical Questionnaire (SDCQ) and Trait-State Anxiety Inventory (TSAI) were used as research tools. RESULTS: Mean age of participants was 49 ± 9.2 years. Widespread pain was present in 88.5% (n = 54) of participants and non-restorative sleep was present in 54 females (88.5%). State anxiety showed moderate level of anxiety in 57.4% of participants (n = 35); in trait anxiety, the level of moderate anxiety was present in 85.2% of females (n = 52). There has been significant correlation between non-restorative sleep and trait anxiety (p = 0.03). There has been no correlation between widespread pain and trait anxiety (p = 0.53), widespread pain (p = 0.98) and non-restorative sleep (p = 0.10) and state anxiety. CONCLUSION: Moderate level of anxiety has predominated in this population of females with FMS both for state and trait anxiety. No worsening of pain has been observed in all groups; however there has been correlation between females with trait anxiety and non-restorative sleep.

JUSTIFICATIVA E OBJETIVOS: Caracterizar a ansiedade de mulheres com síndrome da fibromialgia e verificar a associação dos níveis de ansiedade traço e estado com dor e sono não restaurador. MÉTODOS: Participaram do estudo 61 mulheres com diagnóstico clínico de síndrome da fibromialgia, residentes na Grande Florianópolis. Foram usados, como instrumentos de pesquisa, o Questionário Sociodemográfico e Clínico (QSDC) e o Inventário de Ansiedade Traço-Estado (IDATE). RESULTADOS: A média de idade das pacientes do estudo foi de 49 ± 9,2 anos. A dor generalizada predominou em 88,5% (n = 54) das participantes, assim como o sono não restaurador estava presente em 54 mulheres (88,5%). No perfil de ansiedade estado, observou-se o nível de ansiedade média em 57,4% das participantes (n = 35). Já no perfil de ansiedade traço, o nível de ansiedade média ocorreu em 85,2% das mulheres (n = 52). Houve correlação significante entre o sono não restaurador e ansiedade traço (p = 0,03). Não houve correlação entre as variáveis dor generalizada e ansiedade traço (p = 0,53), dor generalizada (p = 0,98) e sono não restaurador (p = 0,10) e ansiedade estado. CONCLUSÃO: Nesta população de mulheres com síndrome da fibromialgia, houve o predomínio do nível médio de ansiedade tanto para o estado quanto para o traço de ansiedade. Não foi observada correlação da dor com ansiedade traço nem estado, entretanto, foi observada uma correlação entre mulheres com ansiedade traço e sono não restaurador.

Fibromyalgia Syndrome

Fibromyalgia is a chronic pain syndrome of unknown etiology that is characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, memory disturbance, and exaggerated tenderness over particular paired locations. Fibromyalgia is found in 2% to 4% of the general population and more common in women, with symptoms usually appearing between 20 and 55 years of age. The diagnostic criteria for fibromyalgia syndrome established in 1990 by the American College of Rheumatology (ACR), includes widespread pain for at least 3 months and point tenderness upon the application of a 4 kg weight at 11 or more of the 18 characteristic tender points. The 2010 ACR preliminary diagnostic criteria have been developed, which are strongly correlated with the 1990 ACR criteria and provide an alternative approach to diagnosis. Patients with fibromyalgia syndrome have lower pain thresholds and experience an altered temporal summation to pain stimuli. The sensitization of pain perception occurs in the dorsal horn of patients with fibromyalgia. However, it is unknown whether sensitization is due to increased pain fiber facilitation, or decreased inhibition. Pregabalin is approved by the United States Food and Drug Administration for the management of fibromyalgia patients. Tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy and patient education are also effective in reducing the pain experienced by fibromyalgia patients. This article provides an overview of fibromyalgia syndrome, which is currently thought to be partly responsible for chronic diffuse pain.

Multiple chemical sensitivity caused by exposure to ignition coal fumes: a case report

BACKGROUND: Although multiple chemical sensitivity (MCS) is a well-known disorder caused by environmental exposures, MCS caused by occupational exposure has been reported in Korea. Therefore, we report a MCS case caused by environmental exposure to ignition coal after a differential diagnosis to exclude other diseases. CASE REPORT: Since 2011, a 55-year-old woman had experienced edema, myalgia, and other symptoms when she smelled ignition coal near her workplace. She had been diagnosed with fibromyalgia syndrome(FMS) and was treated, with no improvement of symptoms. Since then, she showed the same symptoms after exposure to city gas, the smell of burning, and exhaust gas. To avoid triggering substances, she moved to a new house and used an air purifier. She quit her job in November 2012. After visiting our hospital, she underwent a differential diagnosis for FMS, chronic fatigue syndrome, and somatization disorder. She was diagnosed with MCS by the Korean version of the Quick Environment Exposure Sensitivity Inventory (QEESI). She was educated about the disease and to avoid triggering substances. She received ongoing treatment for her symptoms. CONCLUSION: This case showed that symptoms began after smelling ignition coal. After that, her triggers was increased such as the smell of city gas, burning, and exhaust gas. This case is the first reported in Korea of MCS due to environmental exposure after ruling out other diseases.

Diagnosis and Treatment of Fibromyalgia Syndrome / 대한내과학회지

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain and various accompanying symptoms including fatigue, sleep disturbances, and cognitive dysfunction. While the etiology of fibromyalgia is unclear, accumulating data suggest that disordered central pain processing likely plays a role in the pathogenesis of symptoms. Although the 1990 American College of Rheumatology (ACR) classification criteria for FMS were originally developed for research purposes and were not intended for clinical diagnosis, the criteria have become the de facto diagnostic criteria in clinical settings. Recently, an improved clinical case definition for FMS was proposed by ACR in 2010 to overcome several limitations of 1990 ACR criteria. Further studies are needed to assess the acceptance, reliability, and validity of the new criteria in epidemiologic and clinical studies. Many randomized controlled trials and meta-analyses confirm the therapeutic efficacy of pregabalin, duloxetine, and milnacipran, in the treatment of FMS. In view of the currently available evidence, a combination of pregabalin, duloxetine, or milnacipran as pharmacological interventions and aerobic exercise or CBT as non-pharmacological interventions seems most promising.

Abnormality of Circadian Rhythm of Serum Melatonin and Other Biochemical Parameters in Fibromyalgia Syndrome.

Fibromyalgia syndrome (FMS) is a complex chronic condition causing widespread pain and variety of other symptoms. It produces pain in the soft tissues located around joints throughout the body. FMS has unknown etiology and its pathophysiology is not fully understood. However, abnormality in circadian rhythm of hormonal profiles and cytokines has been observed in this disorder. Moreover, there are reports of deficiency of serotonin, melatonin, cortisol and cytokines in FMS patients, which are fully regulated by circadian rhythm. Melatonin, the primary hormone of the pineal gland regulates the body’s circadian rhythm and normally its levels begin to rise in the mid-to-late evening, remain high for most of the night, and then decrease in the early morning. FMS patients have lower melatonin secretion during the hours of darkness than the healthy subjects. This may contribute to impaired sleep at night, fatigue during the day and changed pain perception. Studies have shown blunting of normal diurnal cortisol rhythm, with elevated evening serum cortisol level in patients with FMS. Thus, due to perturbed level of cortisol secretion several symptoms of FMS may occur. Moreover, disturbed cytokine levels have also been reported in FMS patients. Therefore, circadian rhythm can be an important factor in the pathophysiology, diagnosis and treatment of FMS. This article explores the circadian pattern of abnormalities in FMS patients, as this may help in better understanding the role of variation in symptoms of FMS and its possible relationship with circadian variations of melatonin, cortisol, cytokines and serotonin levels.

Women with Fibromyalgia Have Lower Levels of Calcium, Magnesium, Iron and Manganese in Hair Mineral Analysis

Little is known about hair mineral status in fibromyalgia patients. This study evaluated the characteristics of hair minerals in female patients with fibromyalgia compared with a healthy reference group. Forty-four female patients diagnosed with fibromyalgia according to the American College of Rheumatology criteria were enrolled as the case group. Age- and body mass index-matched data were obtained from 122 control subjects enrolled during visit for a regular health check-up. Hair minerals were analyzed and compared between the two groups. The mean age was 43.7 yr. General characteristics were not different between the two groups. Fibromyalgia patients showed a significantly lower level of calcium (775 microg/g vs 1,093 microg/g), magnesium (52 microg/g vs 72 microg/g), iron (5.9 microg/g vs 7.1 microg/g), copper (28.3 microg/g vs 40.2 microg/g) and manganese (140 ng/g vs 190 ng/g). Calcium, magnesium, iron, and manganese were loaded in the same factor using factor analysis; the mean of this factor was significantly lower in fibromyalgia group in multivariate analysis with adjustment for potential confounders. In conclusion, the concentrations of calcium, magnesium, iron, and manganese in the hair of female patients with fibromyalgia are lower than of controls, even after adjustment of potential confounders.

Clinical Characteristics of Patients with Medically Unexplained Chronic Widespread Pain: A Primary Care Center Study / 가정의학회지

BACKGROUND: Chronic widespread pain (CWP) is known as a common symptom of several organic and psychological disorders. Although medically unexplained CWP (MUE) has lots of clinical distress symptoms, there were no distinct symptoms or signs. Therefore, we conducted this study to investigate clinical distress symptoms of MUE distinct from those of medically explained CWP (ME). METHODS: One hundred nine patients with CWP were enrolled in the study. We classified the study subjects into three groups depending on their medical problems associated with CWP: organic group (ORG), psychological group (PSY), and MUE. All subjects were asked to fill out self-report questionnaires consisting of clinical distress scales including the Korean version of the Fibromyalgia Impact Questionnaire (FIQ-K), fatigue scale, depression scale, and stress scale. And physicians examined 18 tender points over their entire body of the subjects. RESULTS: MUE patients had higher FIQ-K and fatigue severity scores than ORG patients (all P < 0.05). The average number of tender points were 11.33 in MUE patients, 6.48 in ORG patients and 5.02 in PSY patients and statistically significant (P < 0.0001). There were no statistically different factors between MUE and PSY patients with exception for the number of tender points. Depressive symptom was the highest in PSY patients but not statistically different from MUE patients. CONCLUSION: MUE patients had higher physical impairments, fatigue severity and more number of tender points than ORG patients, but had no different clinical characteristics from PSY patients except for the number of tender points.

Representações da relação entre exercício físico e saúde por pacientes fibromiálgicos / Representations of the relationship between physical exercise and health for patients with fibromyalgia

Fibromialgia (FM) é uma síndrome caracterizada por dor músculo esquelética crônica generalizada, fadiga, distúrbio do sono e sintomas associados. Preocupação com o controle da síndrome justifica-se por sua crescente prevalência e pelo impacto negativo na qualidade de vida dos afetados. Das opções de tratamento não-medicamentoso, o exercício físico (EF) é elemento terapêutico relevante. Há preocupação como o impacto da síndrome e sua terapêutica sobre a saúde, aqui entendida como um conjunto de dimensões - física, emocional, social, espiritual, intelectual e profissional - de uma pessoa. O objetivo do estudo foi identificar a percepção de pacientes com FM sobre a relação entre EF e saúde. Utilizou-se o referencial teórico-metodológico das Representações Sociais numa amostra de 22 mulheres de um projeto multidisciplinar: Educação Física, Nutrição, Medicina e Psicologia. A análise dos dados foi realizada a partir do conteúdo transcrito das gravações de entrevista semiestruturada e interpretação de ilustrações feitas pelas pacientes. Houve melhora na dimensão física, demonstrada pelo alívio da dor nas falas; houve também melhora na dimensão emocional, evidenciada pela melhora da autoestima indicada nas ilustrações. Com base na teoria utilizada, as pacientes reconhecem a relação positiva entre EF e saúde.

The fibromyalgia syndrome (FMS) is characterized by widespread chronic musculoskeletal pain, fatigue, disturbed sleep and associated symptoms. Its increasing prevalence and life quality impairment of patients justify researches for its control. Physical exercise (PE) is a relevant therapeutic tool among nonpharmachologic treatments options. It is important to mind the impact of FMS and different therapeutics on health, here understood as a set of dimensions: physical, emotional, social, spiritual, intellectual and professional. This study aimed to identify FMS patients' perception of relationship between PE and health. It used the theoretical methodological reference of Social Representation to study 22 women of a multidisciplinary project: Physical Education, Nutrition, Medicine and Psychology. Data analysis considered transcription of recorded semi-structured interview, and interpretation of patients' illustrations. There were improvements in physical dimension evidenced by pain relief. Positive effects were also observed in emotional dimension, evidenced by self-esteem improvement, which appeared in the pictures. Based on the theory adopted, it was possible to identify that patients recognize a positive relationship between PE and health.

Síndrome fibromiálgico: tratamiento multidisciplinario según evidencia / Fibromyalgia syndrome: Treatment multidisciplinary according to evidence

El síndrome fibromiálgico es un síndrome clínico caracterizado por dolor crónico generalizado y reducción de los umbrales del dolor a la palpación. La fisiopatología sigue siendo desconocida, pero cada vez hay más evidencia de que la sensibilización periférica y central provocan una amplificación de los impulsos sensoriales que puede alterar la percepción del dolor en los pacientes. En su tratamiento resulta fundamental el abordaje multidisciplinario en contraposición a un abordaje biomédico tradicional, dada la enorme complejidad que suelen presentar estos pacientes. El tratamiento debe ser dirigido por el médico, quien hace el diagnóstico y coordina el equipo interdisciplinario, en el que el fisioterapeuta hace la evaluación inicial y realiza el tratamiento de rehabilitación integral y el psicólogo lleva a cabo la evaluación inicial y el tratamiento cognitivo conductual. En esta revisión, encontraremos las tres áreas más importantes del tratamiento del síndrome fibromiálgico, profundizando en el tratamiento farmacológico y fisioterapéutico, según análisis bibliográfico de la evidencia científica más actual.Palabras clave:síndrome fibromiálgico, farmacoterapia, fisioterapia.

The Fibromyalgia Syndrome is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in Fibromyalgia Syndrome patients. The multidisciplinary approach for its treatment is very important, against the traditional biomedical approach, because of the high complexity of the patients. Treatment should be directed by the physician, who makes the diagnosis and coordinates the interdisciplinary team, in which the psychologist conducting the initial assessment and cognitive behavioral therapy and the therapist makes the initial assessment and performs comprehensive rehabilitation treatment. In this review, we find the three most important areas of treatment of fibromyalgia syndrome, furthering the pharmacological treatment and physiotherapy, as literature review the most current scientific evidence. Key words: fibromyalgia syndrome, pharmacotherapy, physiotherapy.

Os efeitos do método Ai Chi em pacientes portadoras da síndrome fibromiálgica / The effect of Ai Chi method in fybromialgic patients

O objetivo do estudo é demonstrar os efeitos do método Ai Chi como forma alternativa de abordagem hidroterapêutica em pacientes portadoras da síndrome fibromiálgica. Foram estudados dez pacientes; quatro fizeram parte do grupo experimento e cinco, do grupo controle, com uma desistência. As pacientes foram avaliadas através do Questionário de Impacto da Fibromialgia (QIF) e da Escala de Intensidade e Índice de dor nos Pontos Sensíveis. Foram realizadas duas avaliações, uma antes e outra após o tratamento. As pacientes foram submetidas a dez sessões do método Ai Chi, com duração de quarenta minutos. Houve melhora na intensidade da dor, de acordo com a escala da intensidade de dor nos pontos sensíveis, após a intervenção; já a qualidade de vida manteve-se sem alteração. Na qualidade de vida, observou-se que os grupos obtiveram resultados semelhantes; isso se deve ao fato que as pacientes não apresentaram melhora no seu estado depressivo. No índice dos pontos sensíveis, verificou-se diferença entre os grupos. A explicação para essa diferença deve-se possivelmente aos benefícios da imersão em água aquecida e aos efeitos do método Ai Chi. Não houve diferença significativa entre os grupos, o que pode ser atribuído às limitações do estudo. Desta forma, torna-se relevante a realização de novos estudos referentes à aplicação do método Ai Chi em pacientes portadoras da síndrome fibromiálgica.

The objective of this article is to show the effect of the Ai Chi method, as an alternative form of hydrotherapeutic approach in fibromyalgia syndrome patients. Ten patients were studied, four were part of the experiment group and five of the control group, with one desistance. The patients were evaluated through the Fibromyalgia Impact Questionnaire (QIF) and Scale of Intensity and Index of pain in Sensible Points. Two evaluations were performed, before and after the treatment. The patients were submitted to ten sessions of the Ai Chi method during 40 minutes. The scale of intensity of pain in sensible points presented an improvement in the intensity of pain after the intervention, while quality of life remained without alteration. Regarding the quality of life, it was observed that the groups had similar results, because of the fact that patients had not presented improvement at depressive state. It was also verified a difference in the index of the sensible points between the groups; the explanation for this difference might be because of the benefits of the immersion in warm water and the effect of the Ai Chi method. There was no significant difference between the groups, which can be attributed to its limitations. In this way, new studies referring to the application of the Ai Chi method in patients carrying fibromyalgia syndrome become relevant.

A Case of Generalized Pain from Fibromyalgia Successfully Treated with Byakkoto / 日本東洋医学雑誌

We report on a case of severe generalized pain due to fibromyalgia syndrome, which was successfully treated with a variation of byakkoto. A 65-year-old Japanese woman had severe generalized pain which grew worse in warm environments, such as during the summer or when bathing. She also had pollakidipsia. We utilized a variation of byakkoto on the assumption that she was suffered from high inner heat. Her severe generalized pain resolved with this therapy. Although bushi-zai and saiko-zai are common prescriptions for fibromyalgia syndrome, byakkoto-variations may also be effective in cases where conditions are worsened by heat effect.

Two Cases of Fibromyalgia Syndrome Succesfully Treated with Kampo Medicine / 日本東洋医学雑誌

We demonstrated two patients with fibromyalgia syndrome (FMS), successfully treated with Kampo medicine, and considered the resemblance between the clinical manifestation of FMS and SHO for Kanzo-bushi-to.The first case was a 52-year-old women who consulted a local hospital in 2001 due to althralgia and myalgia in the left hand, bilateral elbows, shoulders and foot. Her condition was diagnosed as FMS without abnormal findings in the thorough medical examination. Treatment with NSAIDs was not effective, so she consulted our department in 2004. She was treated with Keishi-ni-eppi-itto-ka-ryojutsu-ka-boi-ogi-kakkon. After two mouths, her symptoms had reduced to 50% by visual analog scale (VAS). By March 2006, her symptoms had significantly decreased to 20% by VAS and NSAIDs became unnecessary.The second case was a 58-year-old woman who had suffered from tolerable pain in her right elbow for 10 years. In 2004, she visited the Department of Orthology at her local hospital due to pain in the neck, bilateral arms and shoulders. There were no findings on cervical X-ray or neurological examination, and NSAIDs were administered. Her symptoms did not resolve, therefore, she consulted our department in 2005. She was diagnosed with FMS, based on fulfilling the diagnostic criteria for FMS of ACR (American college of rheumatology) in 1990. She was treated with Kanzo-bushi-to. After 3 months, her symptoms had reduced to 30% by VAS. By Mar. 2006, her pain had redused to 25% by VAS and she was physically fit enough for a daily life.