Osteomielitis, perimplantitis y fractura vertical radicular mandibular en un paciente con fibromialgia: presentación de caso / Osteomyelitis, Peri-implantitis and Mandibular Root Vertical Fracture in a Patient with Fibromyalgia: Case Report / Osteomielite, peri-implantite e fratura vertical da raiz mandibular em um paciente com fibromialgia: relato de caso

Introducción: se considera la osteomielitis mandibular un proceso patológico poco frecuente. La mayor parte de los casos presentados involucran pacientes con osteorradionecrosis y aquellos pacientes con ingesta de algunos medicamentos antirresortivos. El objetivo es informar un caso inusual de una paciente con osteomielitis, perimplantitis y fractura vertical radicular con antecedentes de fibromialgia. Presentación del caso: mujer de 70 años de edad, no fumadora ni consumidora de alcohol, que acudió con un dolor posteroinferior izquierdo de un año de evolución. Presentaba una profundidad de son-deo mayor de 12 mm en el órgano dental (od) 37, sangrado a la palpación, dolor y movilidad grado ii. En el od 36 fue notoria la exposición clínica del tercio superior del implante dental, sin movilidad, con una profundidad de 4 mm. El tratamiento consistió en una exodoncia atraumática del od 37, donde se identificó una fractura radicular vertical. Discusión: actualmente, los implantes dentales permiten restablecer la salud bucodental. Sin embargo, ellos también pueden inducir una osteomielitis en los maxilares. La terapia instaurada redujo ostensiblemente la morbilidad del implante dental implicado y regeneró la zona intervenida.

Introduction: Mandibular osteomyelitis is considered a rare pathological process. Most of the cases pre-sented involve patients with osteoradionecrosis and those patients with intake of some antiresorptive drugs. The objective of this report is to report an unusual case of a patient with osteomyelitis, peri-im-plantitis and vertical root fracture with a history of fibromyalgia. Case presentation: A 70-year-old female patient, non-smoker or alcohol consumer, who presented with lower left postero-pain of one year's evolution. She presented a probing depth greater than 12 mm in dental organ (od) 37, bleeding on palpation, pain and grade II mobility. At the level of do 36, the clinical exposure of the upper third of the dental implant was notorious, without mobility, with a depth of 4 mm. The treatment consisted of an atraumatic extraction of do 37, where a vertical root fracture was identified. Discussion: Currently, dental implants make it possible to restore oral health. However, they can also induce osteomyelitis in the jaws. The established therapy ostensibly reduced the morbidity of the involved dental implant and regeneration of the intervened area

Introdução: a osteomielite mandibular é considerada um processo patológico raro. A maioria dos casos apresentados envolve pacientes com osteorradionecrose e aqueles pacientes com uso de alguns medi-camentos antirreabsortivos. O objetivo deste relato é relatar um caso incomum de um paciente com osteomielite, periimplantite e fratura radicular vertical com histórico de fibromialgia. Apresentação do caso: paciente do sexo feminino, 70 anos, não fumante ou etilista, que apresentou dor póstero-infe-rior esquerda com um ano de evolução. Apresentava profundidade de sondagem maior que 12 mm no órgão dentário (od) 37, sangramento à palpação, dor e mobilidade grau ii. Ao nível de do 36, foi notória a exposição clínica do terço superior do implante dentário, sem mobilidade, com profundidade de 4 mm. O tratamento consistiu em uma extração atraumática de do 37, onde foi identificada uma fratura vertical da raiz. Discussão: atualmente, os implantes dentários possibilitam o restabelecimento da saúde bucal. No entanto, eles também podem induzir osteomielite nos maxilares. A terapia instituída reduziu ostensivamente a morbidade do implante dentário envolvido e a regeneração da área intervencionada

The (in)visibility of fibromyalgia through its symptoms and the challenges of its diagnosis and therapy / La (in)visibilidad de la fibromialgia a través de sus síntomas y los desafíos de su diagnóstico y terapia / A (in)visibilidade da fibromialgia por seus sintomas e os desafios do seu diagnóstico e terapêutica

ABSTRACT Objective: To analyze the social representations of fibromyalgia based on its symptoms and their influences on diagnosis and therapy. Methods: Qualitative research with the application of the Theory of Social Representations and snowball sampling method. Semi-structured interviews were conducted with 30 adults diagnosed with fibromyalgia in the city of Rio de Janeiro, Brazil, between April 2020 and January 2021. Statistical and lexicographical analysis was performed using Alceste software. Results: Pain, as a subjective phenomenon, complicates its legitimacy, diagnosis, and therapy, enhancing suffering. Insufficient information generates judgments, stereotypes, and prejudices. Final Considerations: Stigmas, prejudices, the variety and invisibility of symptoms make it difficult to objectify the disease within the Cartesian-biomedical frameworks, generating diagnostic pilgrimage, mistakes, and challenges in treatment. Such representations hinder relationships and the management of the disease. Deconstructing them is a way to better care for those with fibromyalgia. Raising awareness and spreading qualified information are important allies.

RESUMEN Objetivo: Analizar las representaciones sociales de la fibromialgia basadas en sus síntomas y sus influencias en el diagnóstico y la terapia. Métodos: Investigación cualitativa con la aplicación de la Teoría de las Representaciones Sociales y método de muestreo en bola de nieve. Se realizaron entrevistas semiestructuradas con 30 personas adultas, diagnosticadas con fibromialgia, en la ciudad de Río de Janeiro, Brasil, entre abril de 2020 y enero de 2021. Se llevó a cabo un análisis estadístico y lexicográfico mediante el software Alceste. Resultados: El dolor, como fenómeno subjetivo, dificulta su legitimidad, el diagnóstico y la terapia, intensificando el sufrimiento. La información insuficiente genera juicios, estereotipos y prejuicios. Consideraciones finales: Los estigmas, prejuicios, la variedad y la invisibilidad sintomática dificultan la objetivación de la enfermedad en los modelos cartesianos-biomédicos, generando una peregrinación diagnóstica, errores y desafíos en el tratamiento. Tales representaciones obstaculizan las relaciones y el manejo de la enfermedad. Desconstruirlas es un camino para mejorar el cuidado de quienes tienen fibromialgia. Sensibilizar a las personas y difundir información cualificada son aliados importantes.

RESUMO Objetivo: Analisar as representações sociais da fibromialgia baseadas em seus sintomas e suas influências no diagnóstico e na terapêutica. Métodos: Pesquisa qualitativa com aplicação da Teoria das Representações Sociais e método de amostragem snowball. Realizaram-se entrevistas semiestruturadas com 30 pessoas adultas, diagnosticadas com fibromialgia, na cidade do Rio de Janeiro, Brasil, entre abril de 2020 e janeiro de 2021. Foi realizada análise estatística e lexicográfica pelo software Alceste. Resultados: A dor, como fenômeno subjetivo, dificulta sua legitimidade, o diagnóstico e a terapêutica, potencializando o sofrimento. Informações insuficientes geram julgamentos, estereótipos e preconceitos. Considerações finais: Estigmas, preconceitos, a variedade e a invisibilidade sintomatológica dificultam a objetivação da doença nos moldes cartesianos-biomédicos, gerando peregrinação diagnóstica, equívocos e desafios no tratamento. Tais representações interditam as relações e o manejo da doença. Desconstruí-las é um caminho para melhor cuidar dos que têm fibromialgia. Sensibilizar as pessoas e difundir informações qualificadas são importantes aliados.

Fibromigraine: a cohort study retrospective / Fibroenxaqueca: um estudo de coorte retrospectivo

OBJECTIVE: To diagnose fibromyalgia in patients with migraine and assess the quality of life of these patients. METHODS: A prospective, cross-sectional study was carried out, comparing groups, in a non-randomized sample, consisting of patients diagnosed with migraine. The sample was evaluated using the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) questionnaires to diagnose fibromyalgia. Quality of life and level of depression were assessed, respectively, using the Headache Impact Test-6 (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: We interviewed 100 patients (5 men and 95 women) diagnosed with migraine, with a mean age of 37.1±11.0 years, ranging from 19 to 64 years. Thirty-four patients (34%) had migraine and fibromyalgia concomitantly. Migraine predominated in females, both in the presence and absence of fibromyalgia. In both groups, there was no difference in headache characteristics. In the group with fibromyalgia, there was a predominance of allodynia and a higher PHQ-9 score (p<0.001). CONCLUSIONS: Patients with migraine are more predisposed to depression when there is an association with fibromyalgia

OBJETIVO: Diagnosticar fibromialgia em pacientes com enxaqueca e avaliar a qualidade de vida desses pacientes. MÉTODOS: Foi realizado um estudo prospectivo, transversal, comparando grupos, em uma amostra não randomizada, composta por pacientes com diagnóstico de enxaqueca. A amostra foi avaliada por meio dos questionários Widespread Pain Index (WPI) e Symptom Severity Scale (SSS) para diagnóstico de fibromialgia. A qualidade de vida e o nível de depressão foram avaliados, respectivamente, por meio do Headache Impact Test-6 (HIT-6) e do Patient Health Questionnaire-9 (PHQ-9). RESULTADOS: Foram entrevistados 100 pacientes (5 homens e 95 mulheres) com diagnóstico de enxaqueca, com idade média de 37,1±11,0 anos, variando de 19 a 64 anos. Trinta e quatro pacientes (34%) apresentavam enxaqueca e fibromialgia concomitantemente. A enxaqueca predominou no sexo feminino, tanto na presença como na ausência de fibromialgia. Em ambos os grupos, não houve diferença nas características da dor de cabeça. No grupo com fibromialgia houve predomínio de alodinia e maior escore no PHQ-9 (p<0,001). CONCLUSÕES: Pacientes com enxaqueca estão mais predispostos à depressão quando há associação com fibromialgia

Low-intensity resistance training promotes a reduction of mechanical hyperalgesia and increase of muscle strength in rats submitted to the diffused chronic muscle pain model / Treinamento resistido de baixa intensidade promove redução da hiperalgesia mecânica e aumento da força muscular em ratos submetidos ao modelo de dor crônica muscular difusa

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome (FMS) is characterized by different factors, such as chronic diffuse muscle pain (CDMP), fatigue and psycho-emotional changes. Among the animal models that mimic FMS, the acid saline model is consolidated in the development and maintenance of CDMP. Resistance training (RT) has been an effective method for reducing pain in FMS. Thus, the aim of the present study was to evaluate the effects of resistance training on nociceptive and motor responses in an animal model of chronic diffuse muscular pain. METHODS: Twenty-four male Wistar rats were allocated into four groups: resistance training, RT control, amitriptyline (AMITRIP) and AMITRIP control; all treatment protocols lasted 4 weeks. CDMP was induced in all mice. Then, the animals were treated with low-intensity RT (40% 1 maximum repetition) and AMITRIP (10 mg/kg/day). The mechanical paw withdrawal threshold, locomotor activity and muscle strength were evaluated. RESULTS: Animals treated with both RT and AMITRIP showed an increase in the mechanical paw withdrawal threshold (p<0.05) compared to their controls, suggesting a reduction in mechanical hyperalgesia. There was no improvement in locomotor activity in all groups (p>0.05). Animals with CDMP that underwent RT showed an increase in hindlimb muscle strength (p<0.0001) compared to the RT control group. CONCLUSION: Low-intensity resistance training resulted in antihyperalgesic effects and improved muscle strength in animals submitted to the CDMP model.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome da fibromialgia (SFM) é caracterizada por diferentes fatores, como dor crônica muscular difusa (DCMD), fadiga e alterações psicoemocionais. Dentre os modelos animais que mimetizam a SFM, o modelo de salina ácida é consolidado no desenvolvimento e na manutenção da DCMD. O treinamento resistido (TR) tem sido um método eficaz para redução da dor na SFM. Assim, o objetivo do presente estudo foi avaliar os efeitos do TR na resposta nociceptiva e motora em modelo animal de dor crônica muscular difusa. MÉTODOS: Vinte e quatro ratos machos Wistar foram alocados em quatro grupos: treinamento resistido (TR), controle do TR, amitriptilina (AMITRIP) e controle da AMITRIP, todos os protocolos de tratamento tiveram duração de 4 semanas. A DCMD foi induzida em todos os ratos. Em seguida, os animais foram tratados com TR de baixa intensidade (40% 1 repetição máxima) e AMITRIP (10 mg/kg/dia). Foram avaliados o limiar mecânico de retirada de pata, a atividade locomotora e a força muscular. RESULTADOS: Animais tratados tanto com TR quanto com AMITRIP apresentaram aumento do limiar mecânico de retirada de pata (p<0,05) em relação aos seus controles, sugerindo redução da hiperalgesia mecânica. Não foi observada melhora da atividade locomotora em todos os grupos (p>0,05). Animais com DCMD que realizaram TR obtiveram aumento da força muscular dos membros posteriores (p<0,0001) em comparação ao grupo controle do TR. CONCLUSÃO: Treinamento resistido de baixa intensidade resultou em efeitos anti-hiperalgésicos e melhora da força muscular em animais submetidos ao modelo de DCMD.

Intervención fisioterapéutica en fibromialgia / Physiotherapeutic intervention in fibromyalgia

Introducción: La fibromialgia afecta el movimiento corporal. Provoca dolor en puntos claves, causa molestias musculoesqueléticas y limita la actividad de las personas. Se ha descrito que la fisioterapia mejora de calidad de vida de estos pacientes. Objetivo: Identificar los test de evaluación y los procesos de intervención fisioterapéutica utilizados en la fibromialgia. Métodos: Se realizó una revisión de literatura en PubMed, ScientsDirect, SciELO y LILLACS, con la terminología MeSH y DeCS, entre 2017 y 2022. Resultados: La escala visual análoga y la algometría por presión son los test utilizados para el dolor. La hidroterapia, el cupping, la punción seca, el masaje sueco, los ejercicios respiratorios y los aeróbicos resultan los métodos de intervención con más uso. Conclusiones: Los procesos de intervención se deben plantear según las evaluaciones del dolor y la funcionalidad en la persona. El tratamiento fisioterapéutico de la fibromialgia debe tener un componente de ejercicio físico aérobico y fuerza para disminuir la fatiga; devolverle al músculo su funcionalidad y aumentar la capacidad aeróbica(AU)

Introduction: Fibromyalgia affects body movement. It causes pain in key points, it causes musculoskeletal discomfort and it limits the persons's activity. It has been described that physiotherapy improves the quality of life of these patients. Objective: To identify the evaluation tests and physiotherapy intervention processes used in fibromyalgia. Methods: A literature review was carried out in PubMed, ScientsDirect, Scielo and LILLACS, with the terminology MeSH and DeCS, from 2017 to 2022. Results: The visual analogue scale and pressure algometry are the tests used for pain. Hydrotherapy, cupping, dry needling, Swedish massage, breathing exercises and aerobics are the most commonly used intervention methods. Conclusions: Intervention processes should be planned according to the evaluations of pain and functionality in the person. The physiotherapy treatment of fibromyalgia must have a component of aerobic physical exercise and strength to reduce fatigue, to return the muscle to its functionality and increase aerobic capacity(AU)

Prevalence of fibromyalgia in a Brazilian series of patients with multiple sclerosis / Prevalência de fibromialgia em uma série brasileira de pacientes com esclerose múltipla

Abstract Background The prevalence of pain in patients with multiple sclerosis is remarkable. Fibromyalgia has been considered as one of the forms of chronic pain encompassed in multiple sclerosis, but data are restricted to studies from Europe and North America. Objective To assess the prevalence of fibromyalgia in a series of Brazilian patients with multiple sclerosis and the characteristics of this comorbidity. Methods The present cross-sectional study included 60 consecutive adult patients with multiple sclerosis. Upon consent, participants underwent a thorough evaluation for disability, fatigue, quality of life, presence of fibromyalgia, depression, and anxiety. Results The prevalence of fibromyalgia was 11.7%, a figure similar to that observed in previous studies. Patients with the comorbidity exhibited worse scores on fatigue (median and interquartile range [IQR]: 68 [48-70] versus 39 [16.5-49]; p < 0.001), quality of life (mean ± standard deviation [SD]: 96.5 ± 35.9 versus 124.8 ± 28.8; p = 0.021), anxiety (mean ± SD: 22.7 ± 15.1 versus 13.8 ± 8.4; p = 0.021), and depression (median and IQR: 23 [6-28] versus 6 [3-12.5]; p = 0.034) indices than patients without fibromyalgia. There was a strong positive correlation between depression and anxiety scores with fatigue (r = 0.773 and r = 0.773, respectively; p < 0.001). Conversely, a moderate negative correlation appeared between the Expanded Disability Status Scale (EDSS), fatigue, and depression scores with quality of life (r= −0.587, r= −0.551, r= −0.502, respectively; p < 0.001). Conclusion Fibromyalgia is a comorbidity of multiple sclerosis that can enhance fatigue and decrease quality of life, although depression, anxiety, and disability are factors that can potentiate the impact of the comorbidity.

Resumo Antecedentes A prevalência de dor em pacientes com esclerose múltipla é significativa. A fibromialgia é considerada uma forma de dor crônica encontrada na esclerose múltipla, mas os dados são restritos a estudos europeus e da América do Norte. Objetivo Avaliar a prevalência de fibromialgia em uma série de pacientes com esclerose múltipla e as características desta comorbidade. Métodos O presente estudo transversal incluiu consecutivamente 60 pacientes adultos com esclerose múltipla. Após o consentimento, os participantes foram submetidos à avaliação para determinação de incapacidade, fadiga, qualidade de vida, presença de fibromialgia, depressão e ansiedade. Resultados A prevalência de fibromialgia foi de 11,7%, similar ao observado em estudos prévios. Pacientes com a comorbidade apresentaram piores escores de fadiga (mediana e intervalo interquartil [IIQ]: 68 [48-70] versus 39 [16,5-49]; p < 0,001], qualidade de vida (média ± desvio padrão [DP]: 96,5 ± 35,9 versus 124,8 ± 28,8; p = 0,021), ansiedade (média ± DP: 22,7 ± 15,1 versus 13,8 ± 8,4; p = 0,021) e depressão (mediana e IIQ: 23 (6-28) versus 6 (3-12,5); p = 0,034] do que pacientes sem fibromialgia. Houve correlação positiva forte dos escores de depressão e de ansiedade com a fadiga (r = 0,773 e r = 0,773, respectivamente; p < 0,001). Concomitantemente, houve correlação negativa moderada entre os escores de escala de estado de incapacidade expandida, fadiga e depressão com a qualidade de vida (r = - 0,587, r = - 0,551, r = - 0,502, respectivamente; p < 0,001). Conclusão A fibromialgia é uma comorbidade de esclerose múltipla que pode aumentar a fadiga e diminuir a qualidade de vida, embora depressão, ansiedade e incapacidade sejam fatores potencializadores dessa morbidade associada.

Etiologia e fisiopatologia da fibromialgia / Etiology and pathophysiology of fibromyalgia

A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia.

¿Qué nos ofrece la comunidad para el tratamiento de la fibromialgia? reporte de una experiencia en la región metropolitana de Santiago / What the community has to offer for the fibromyalgia treatment? a report of an experience in the metropolitan region of Santiago

La fibromialgia es un síndrome polisintomático caracterizado por dolor crónico generalizado no articular e idiopático, cuya terapia, tanto farmacológica como no farmacológica, debe ser individualizada a cada paciente e involucrar equipos multidisciplinarios de trabajo. Objetivo del Estudio: Realizar una base de datos para agrupar los recursos comunitarios disponibles para llevar a cabo las terapias no farmacológicas con evidencia en el tratamiento del dolor crónico no oncológico en las comunas de San Joaquín, Macul, Puente Alto, La Florida, La Pintana y San Miguel, Región Metropolitana, Chile. Materiales y Métodos: Se llevó a cabo una búsqueda en internet mediante palabras clave de recursos comunitarios dentro de las comunas antes mencionadas que cumplieran criterios de evidencia en el tratamiento de fibromialgia, además de contactar a servicios municipales y fundaciones orientadas al manejo del dolor no oncológico en la Región Metropolitana, para la confección de una base de datos y un mapa interactivo de fácil acceso y uso con los recursos encontrados. Resultados: Nuestra búsqueda arrojó un total de 78 recursos comunitarios, tanto públicos como privados, que ofrecen alternativas de tratamiento no farmacológico para el manejo del dolor crónico no oncológico y fibromialgia en las cinco comunas descritas. Conclusiones: La fibromialgia es un síndrome polisintomático de difícil manejo frecuente en nuestro país, que incluye como parte de su tratamiento integral diversas medidas no farmacológicas con evidencia reciente, que gracias a la confección de las herramientas creadas para este estudio se espera facilitar el acceso a los recursos disponibles en una zona determinada del Gran Santiago, tanto a los pacientes que padecen estas dolencias como a los profesionales de la salud que indican este tipo de terapias.

Fibromyalgia is a polysymptomatic syndrome characterizedby chronic generalized non-articular and idiopathic pain, whose pharmacological and non-pharmacological therapy must be individualized for each patient and involve multidisciplinary work teams. Objective of the study: To create a database to group the community resources available to carry out non- pharmacological therapies with evidence in the treatment of chronic non-cancer pain in the communes of San Joaquín, Macul, Puente Alto, La Florida, La Pintana and San Miguel, from Metropolitan Region, Chile. Materials and Methods: An internet search was carried out using keywords of community resources within the aforementioned communes that met evidence criteria in the treatment of fibromyalgia, in addition to contacting municipal services and foundations oriented to non- oncological pain management in the Metropolitan Region, for the preparation of a database and an interactive map of easy access and use with the resources found. Results: Our search yielded a total of 78 community resources, both public and private, that offer non- pharmacological treatment alternatives for the management of chronic non-cancer pain and fibromyalgia in the five districts described. Conclusions: Fibromyalgia is a polysymptomatic syndrome of difficult management, common in our country, which includes as part of its comprehensive treatment various non-pharmacological measures with recent evidence, which, thanks to the preparation of the tools created for this study, is expected to facilitate access to resources available in a given area of Santiago de Chile, both to patients suffering from these ailments and to health professionals who indicate this type of therapy.

Cross-sectional evaluation of socioeconomic and clinical factors and the impact of fibromyalgia on the quality of life of patients during the COVID-19 pandemic

Abstract BACKGROUND: The fibromyalgia impact questionnaire (FIQ) relates to the functional capacity, professional situation, psychological disorders, and physical symptoms, and can identify the factors that determine the impact of the syndrome and characteristics of its carriers; the higher the score, the greater the impact of fibromyalgia on the quality of life. OBJECTIVE: To evaluate the impact of fibromyalgia on the quality of life of individuals with fibromyalgia, who were categorized according to the FIQ during the coronavirus disease pandemic. DESIGN AND SETTING: A cross-sectional study was conducted at an institution of higher education in Taquara, RS, Brazil. METHODS: A quantitative study was carried out, with the application of a sociodemographic and clinical questionnaire, and the FIQ in 163 Brazilian individuals with a medical diagnosis of fibromyalgia. Data were collected using SurveyMonkey software. RESULTS: Of the female carriers, 98.2% were living in urban areas, working, and under pharmacological and complementary treatment. The FIQ results showed that seven of the 10 items had the maximum score. The items "physical function" and "feel good" had intermediate scores, and the item "missed work" had a low score. The average total score was 79.9 points, indicating that fibromyalgia had a severe impact on the participants' lives. A severe impact of fibromyalgia was observed in 61.3% of the participants, a moderate impact in 30.7%, and a low impact in 8%. CONCLUSION: The survey findings suggest a severe impact in the majority of the Brazilian fibromyalgic population.

Diagnosis of fibromyalgia: diagnostic feasibility and accuracy of thermography

INTRODUCTION: Studies have suggested using thermography as a resource to diagnose fibromyalgia, although there has been no evidence confirming this hypothesis so far. OBJECTIVE: To evaluate the sensitivity and specificity of computerized infrared thermography as an auxiliary method for diagnosing fibromyalgia. METHODS: It is a diagnostic accuracy studywith cross-sectional design. One hundred and three individuals were evaluated for global pain using the Visual Analogue Scale. The measurement of pain at tender points was assessed by algometry, and skin temperature was assessed by thermography. To evaluate sensitivity and specificity, the analysis was performed using the Receiver Operating Characteristic Curve, measured by the area under the curve with their respective confidence intervals. RESULTS: Thermography has not been very sensitive or specific for pain (tender points) and diagnosis of fibromyalgia, according to the evaluation of the Receiver Operating Characteristic Curve, with an area under the curve equal to or lower than 0.75. CONCLUSION: In this study the thermography was not sensitive and specific as a tool for diagnosing the fibromyalgia syndrome. This study highlights important clinical implications concerning the current methods for diagnosing it, which, despite all efforts, are still subjective and poorly reproducible.

Relationship between the Widespread Pain Index and the PainMAP software for pain sites measurement in patients with Widespread Pain / Relação entre o Índice de Dor Espalhada e o software PainMAP para medida de localização da dor em pacientes com dor espalhada

ABSTRACT BACKGROUND AND OBJECTIVES: Identifying pain sites is essential to managing patients with Widespread Pain. Several instruments have been developed, including pain drawings, a grid system and computerized methods. However, it is not yet known whether the Widespread Pain Index matches an automated method (painMAP) for quantifying the number of pain areas. Therefore, this study aimed to identify the relationship between the Widespread Pain Index and the painMAP software to measure pain sites in participants with Widespread Pain. METHODS: A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was conducted. The Widespread Pain Index and the painMAP software assessed pain sites. Spearman's correlation coefficient investigated the correlation between the Widespread Pain Index and the painMAP software. RESULTS: A total of 98 participants with Widespread Pain were included in this study. Most participants were female (67; 83.7%), with a mean age of 57,7±11,5 years, mean height of 1.6 (0.1) meters and mean weight of 73.2 (11.8) kilograms. The mean pain intensity was 6.7 (2.0), and the pain duration was 92.3 (96.3) months. The mean number of pain sites in the Widespread Pain Index was 10.1 (3.7), and in the painMAP software, it was 11.7 (8.8). A weak positive correlation (rho = 0.26, 95% CI 0.45 to 0.04, p = 0.022) between the Widespread Pain Index and the painMAP software was found. CONCLUSION: The Widespread Pain Index and the painMAP software showed a weak correlation for assessing pain sites in participants with Widespread Pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A identificação dos locais de dor é um aspecto essencial no manejo de pacientes com Dor Espalhada. Vários instrumentos foram desenvolvidos, incluindo desenhos de dor, um sistema de grade e métodos computadorizados. No entanto, ainda não se sabe se o Índice de Dor Espalhada coincide com um método automatizado (painMAP) para quantificar o número de áreas de dor. Portanto, este estudo teve como objetivo identificar a relação entre o Índice de Dor Espalhada e o painMAP para medir as áreas doloridas em participantes com esse quadro de dor. MÉTODOS: Uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética foi realizada. O Índice de Dor Espalhada e o painMAP avaliaram as áreas de dor. O coeficiente de correlação de Spearman foi utilizado para investigar a correlação entre o Índice de Dor Espalhada e o software painMAP. RESULTADOS: Um total de 98 participantes com Dor Espalhada foram incluídos neste estudo. A maioria dos participantes era do sexo feminino (67;83,7%), com média de idade de 57,7±11,5 anos, média de altura de 1,6 (0,1) metros e média de peso de 73,2 (11,8) quilogramas. A média de intensidade da dor foi de 6,7 (2,0) e da duração da dor de 92,3 (96,3) meses. O número médio de áreas de dor no Índice de Dor Espalhada foi de 10,1(3,7) e no software painMAP foi de 11,7 (8,8). Uma correlação positiva fraca (rho=0,26, IC de 95% 0,45-0,04, p=0,022) entre o Índice de Dor Espalhada e o painMAP foi encontrada. CONCLUSÃO: O Índice de Dor Espalhada e o painMAP mostraram correlação positiva fraca para avaliar as áreas de dor em participantes com dor espalhada.

Evaluation of sexual function and depression in female patients with fibromyalgia

SUMMARY OBJECTIVE: Fibromyalgia is one of the most important problems, especially for women. Studies point to disorders in the sexual functions of fibromyalgia patients that reduce their quality of life. The aim of this study was to investigate sexual dysfunction and its relationship with disease severity and depression in women with fibromyalgia. METHODS: This study included 98 female patients diagnosed with fibromyalgia and 54 healthy women. The Female Sexual Function Index was used to assess sexual dysfunction. Fibromyalgia disease severity was measured with the Fibromyalgia Impact Questionnaire. Hamilton Depression Scale was filled in to evaluate the depression status of the patients. RESULTS: According to the female sexual function index data, female sexual dysfunction was found in 78 (79.6%) patients with fibromyalgia and only in 12 (22.2%) controls. When the female sexual function index scores of fibromyalgia patients with and without depression were compared, patients with additional depression had lower female sexual function index scores, and this difference was statistically significant (p=0.002). In the correlation analysis, the female sexual function index score showed a significant negative correlation with the hamilton depression scale (rho=-0.235, p=0.020) and fibromyalgia impact questionnaire (rho=-0.215, p=0.033) scores. CONCLUSION: This study highlights the high prevalence of sexual dysfunction in female fibromyalgia patients and the significant correlation between sexual dysfunction and both disease severity and depression.

Prevalence of migraine in patients with fibromyalgia / Prevalência de enxaqueca em pacientes com fibromialgia

Objective: To evaluate the prevalence of migraine in patients with fibromyalgia and the impacts of these comorbidities on the daily life of patients. Methods: Questionnaires were applied to fibromyalgia patients. The questionnaires were applied through a Google forms application link and in person, printed. We used FIQ, PHQ-9, and ID migraine. And for patients with a positive ID migraine, we applied the Midas subsequently. Results: Seventy fibromyalgia patients were recruited, age of 47.31 ± 14.5 years. Sixty-five (92.86%) were female and 5 (7.14%) were male. We obtained a prevalence of 60% (n = 42) of migraine associated with fibromyalgia. Among the analyzed variables, severity of depression (p = 0.007), aggregate severity of depression (p = 0.004), and impact of fibromyalgia (p = 0.008) were significantly associated. Among the migraine patients, the vast majority, 34/42 (80.95%), were classified as having severe disability. Conclusion: There is a high prevalence of migraine in patients with fibromyalgia that has an associated impact on patients' lives, which makes clinical and psychosocial management of these patients necessary.

Objetivo: Avaliar a prevalência de enxaqueca em pacientes com fibromialgia e os impactos dessas comorbidades no cotidiano dos pacientes. Métodos: Questionários foram aplicados a pacientes com fibromialgia. Os questionários foram aplicados por meio de link de aplicativo Google Forms e presencialmente, impressos. Usamos FIQ, PHQ-9 e enxaqueca ID. E para pacientes com enxaqueca ID positiva, aplicamos o Midas posteriormente. Resultados: Foram recrutados 70 pacientes com fibromialgia, idade de 47,31 ± 14,5 anos. Sessenta e cinco (92,86%) eram do sexo feminino e 5 (7,14%) do sexo masculino. Obtivemos uma prevalência de 60% (n = 42) de enxaqueca associada à fibromialgia. Entre as variáveis ​​analisadas, a gravidade da depressão (p = 0,007), a gravidade agregada da depressão (p = 0,004) e o impacto da fibromialgia (p = 0,008) foram significativamente associadas. Entre os pacientes com enxaqueca, a grande maioria, 34/42 (80,95%), foi classificada como portadora de incapacidade grave. Conclusão: Existe uma elevada prevalência de enxaqueca em pacientes com fibromialgia que tem impacto associado na vida dos pacientes, o que torna necessário o manejo clínico e psicossocial destes pacientes.

Acompanhamento psicoeducacional online: a experiência de um grupo de autoapoio para mulheres com fibromialgia / Online psychoeducational accompaniment: the experience of a self-support group for women with fibromyalgia / Seguimiento psicoeducativo online: la experiencia de un grupo de autoapoyo para mujeres con fibromialgia

A fibromialgia (FM) chama a atenção por ser uma síndrome que causa uma dor crônica ao indivíduo, além de não ter sua fisiopatologia definida e está presente em 2,5% da população brasileira . O objetivo deste trabalho é discutir sobre o papel e o apoio da psicoeducação junto as mulheres com fibromialgia. Trata-se de um relato de experiência de estágio Supervisionado em Saúde Mental/Projeto de extensão realizado no formato on-line, via plataforma Google Meet. O suporte foi construído através dos encontros semanais entre estagiárias de psicologia e profissionais de diferentes subáreas da saúde como reumatologia, educação física, fisioterapia e nutrição, bem como da cocriação ocorrida na troca de saberes e experiências entre as participantes e profissionais. Destacamos que os encontros configuraram-se com momentos informativos e também psicoterapêuticos embasados na Gestalt-terapia. Dentro desta área do conhecimento, foi possível promover para as participantes do grupo informações de grande relevância, que muitas não teriam condições de adquirir sem a mediação do grupo.

Fibromyalgia (FM) draws attention for being a syndrome that causes chronic pain to the individual, besides not having its pathophysiology defined and is present in 2.5% of the Brazilian population. The objective of this paper is to discuss the role and support of psychoeducation for women with fibromyalgia. This is an experience report of the Supervised Internship in Mental Health/Extension Project conducted online, via the Google Meet platform. The support was built through weekly meetings between trainees of psychology and professionals from different subareas of health as rheumatology, physical education, physiotherapy and nutrition, as well as the co-creation occurred in the exchange of knowledge and experiences between participants and professionals. We emphasize that the meetings consisted of informative and psychotherapeutic moments based on Gestalt-therapy. Within this area of knowledge, it was possible to provide the group participants with information of great relevance, which many of them would not have been able to acquire without the mediation of the group. KEYWORDS: Fibromyalgia; Support Group; Psychoeducation.

La fibromialgia (FM) llama la atención por ser un síndrome que causa dolor crónico al individuo, además de no tener su fisiopatología definida y está presente en el 2,5% de la población brasileña. El objetivo de este trabajo es discutir el papel y el apoyo de la psicoeducación con mujeres con fibromialgia. Se trata de un informe de experiencia de Prácticas Supervisadas en Salud Mental/Proyecto de Extensión realizado en línea, a través de la plataforma Google Meet. El apoyo se construyó a través de reuniones semanales entre estudiantes de psicología y profesionales de diferentes subáreas de la salud como reumatología, educación física, fisioterapia y nutrición, así como la co- creación se produjo en el intercambio de conocimientos y experiencias entre los participantes y profesionales. Destacamos que los encuentros se configuraron con momentos informativos y también psicoterapéuticos basados en la terapia Gestalt. Dentro de esta área de conocimiento, fue posible promover a los participantes del grupo informaciones de gran relevancia, que muchos de ellos no habrían podido adquirir sin la mediación del grupo.

"Zooming" in the association between rosacea and fibromyalgia syndrome: ıs it worth mentioning?

SUMMARY OBJECTIVE: We aimed to detect the frequency of fibromyalgia syndrome in patients with rosacea and determine whether this frequency was affected by the severity of rosacea and the quality of life. METHODS: In this prospective, controlled, cross-sectional study, a total of 94 consecutive rosacea cases and 87 age- and sex-matched controls were enrolled. The severity of rosacea was assessed in light of the findings of the National Rosacea Society Ethics Committee. Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument had been applied to the cases of rosacea. The diagnosis of fibromyalgia syndrome was established according to the 2016 revised fibromyalgia diagnostic criteria, and the Fibromyalgia Impact Questionnaire was used to determine the functional disability. RESULTS: The frequency of fibromyalgia syndrome was higher in the rosacea group than in the control group (p=0.01), and Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument were higher in patients with rosacea with fibromyalgia syndrome (p=0.006 and p=0.004, respectively). A statistically significant weak positive correlation was observed between Dermatology Quality-of-Life Index, Rosacea-specific Quality-of-Life instrument, and Fibromyalgia Impact Questionnaire; symptom severity scale scores; and fibromyalgia score (r=0.35, r=0.259, and r=0.32 and r=0.376, r=0.305, and r=0.312, respectively). CONCLUSION: The patients with rosacea have higher rates and disability scores of fibromyalgia syndrome than healthy controls, independent of rosacea severity, and quality of life is correlated with fibromyalgia scores. We might point out that fibromyalgia syndrome accompanying rosacea has more restrictions in their daily routine activities than rosacea alone. As such, physicians should be aware of the possible coexistence of rosacea and fibromyalgia syndrome.

Correlation between levels of perceived stress and depressive symptoms in the functional disability of patients with fibromyalgia

SUMMARY OBJECTIVE: The aim of this study was to evaluate the factors that are most correlated with the levels of functional disability in patients with fibromyalgia. METHODS: This is a cross-sectional descriptive study in which 42 patients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology reported their status using the following questionnaires: the Beck Depression Inventory, the Perceived Stress Scale 14, the Revised Fibromyalgia Impact Questionnaire, the Visual Analog Pain Scale, and the Health Assessment Questionnaire. RESULTS: Moderate to severe levels of depression (Beck Depression Inventory: 22.35±10.39), moderate to severe functional disability (Health Assessment Questionnaire: 1.28±0.58), and high levels of stress (Perceived Stress Scale 14: 31.59±10.02) were found. The correlation adjusted by multiple regression as a function of the Health Assessment Questionnaire indicated a negligible to weak positive correlation with perceived stress (r=0.11), while a moderately strong positive correlation was observed with the Visual Analog Pain Scale (r=0.55). Regarding physical exercise, one of the pillars of the treatment, a moderate negative correlation was found with the Health Assessment Questionnaire (r=-0.4). CONCLUSION: The pain levels were moderately influenced by depression severity. The factors most linked to functional disability are due to the pain levels but not to the perception of stress.

The relationship between serum leptin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 levels and clinical parameters in primary fibromyalgia patients

SUMMARY OBJECTIVE: The aim of this study was to investigate the levels of leptin, growth hormone, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 and their relations with clinical parameters in patients with primary fibromyalgia and healthy controls. METHODS: Our study was performed on 30 female patients with primary fibromyalgia and 30 healthy controls. The levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 were measured by a two-site immunoradiometric assay. The serum level of leptin was measured by the ELISA kit. RESULTS: The serum level of leptin was significantly higher, but the serum levels of insulin-like growth factor-1 were significantly lower in patients with fibromyalgia syndrome than healthy controls (p<0.001). The leptin level was positively correlated with the Visual Analog Scale, Fibromyalgia Impact Questionnaire score, Beck Depression Inventory score, tender point count, age, and duration of disease (p<0.001), but it was negatively correlated with insulin-like growth factor-1 (p<0.001). The insulin-like growth factor-1 level was negatively correlated with age, Visual Analog Scale, Fibromyalgia Impact Questionnaire and Beck Depression Inventory scores, duration of disease, and tender point count (p<0.001). CONCLUSION: Our results indicate that high levels of serum leptin and low levels of serum insulin-like growth factor-1 may play a role in the physiopathogenesis of fibromyalgia and may be related to some symptoms.

Discapacidad funcional en pacientes con fibromialgia en un hospital en Lima, Perú

Introducción: La fibromialgia es un trastorno reumatológico caracterizado por dolor generalizado de localización imprecisa que afecta principalmente a mujeres. Se asocia a fatiga, ansiedad, depresión y la capacidad funcional de estos pacientes se ve afectada por la coexistencia de dichos trastornos. Métodos: Serie de casos de corte transversal con uso de datos secundarios de 126 pacientes con fibromialgia que acudieron a consultorio externo del servicio de reumatología de un hospital en Lima durante febrero de 2020. Se buscó determinar la frecuencia de discapacidad funcional y explorar factores asociados en pacientes con diagnóstico de fibromialgia con o sin depresión. La capacidad funcional y la presencia de síntomas depresivos fueron medidas mediante uso de escalas validadas. Se realizó un análisis multivariado de regresión logística múltiple para valorar si la depresión es un factor de riego independiente de discapacidad. Resultados: La edad tuvo una mediana de 53,5 (RIQ: 46-60) años y 122 participantes eran mujeres, además 42 (33,33%) pacientes presentaban depresión y 76 (60,32%) presentaban discapacidad funcional. En el análisis multivariado, se encontró que la depresión es un factor de riesgo independiente de discapacidad funcional luego de ajustar a diabetes, presencia de 3 o más comorbilidades, intensidad de fatiga y síntomas asociados [OR de 3.09 (1.24 - 7.70); p: 0.015]. Conclusiones: La depresión es un factor independiente para discapacidad funcional en pacientes con fibromialgia.

Background: Fibromyalgia is a rheumatological disorder characterized by generalized pain of imprecise localization that mainly affects women. It is associated with fatigue, anxiety, depression, and functional capacity is greatly affected by the coexistence of these disorders. Methods: It is a series of cross-sectional cases, using secondary data from 126 patients with fibromyalgia who attended the outpatient clinic of a hospital at Lima at the rheumatology service during February 2020. We try to determine the frequency of functional disability and explore associated factors in patients diagnosed with fibromyalgia with or without depression. Functional capacity and the presence of depressive symptoms were measure by validated scales. A multivariate multiple logistic regression analysis was performed to assess whether depression is an independent risk factor for disability. Results: The age had a median of 53.5 (IQR: 46-60) years, 122 participants were women. In addition, 42 (33.33%) patients had depression and 76 (60.32%) patients had functional disability. In the multivariate analysis, it was found that depression is an independent risk factor for functional disability after adjusting for diabetes, presence of 3 or more comorbidities, intensity of fatigue and associated symptoms [OR 3.09 (1.24 - 7.70); p: 0.015]. Conclusions: Depression is an independent factor for functional incapacity in patients with fibromyalgia.

Fibromialgia e disfunção temporomandibular: uma revisão de escopo / Fibromyalgia and temporomandibular disorder: a scoping review

A fibromialgia é uma síndrome complexa com alterações nociplásticas, caracterizadas por hiperalgesia e alodinia, frequentemente acompanhada pela presença de dor orofacial. Estudos têm demonstrado alta prevalência de disfunção temporomandibular (DTM) em pacientes fibromiálgicos, como fator etiológico ou agravante. O objetivo desta revisão de literatura foi identificar os mecanismos modulatórios comuns à fibromialgia e à DTM, e identificar diferentes modalidades de tratamento para os pacientes fibromiálgicos. Foram utilizados 69 artigos dos últimos 5 anos, além de 4 artigos conceituais anteriores a este período. Identificou-se que os principais fármacos utilizados para os sintomas de fibromialgia são pregabalina, amitriptilina, antidepressivos duais, tramadol, baixas doses de naltrexona e canabinoides. A associação de fármacos pode ser útil para aumentar a eficácia do tratamento e reduzir as doses dos mesmos. Por outro lado, novas terapias não farmacológicas, como as técnicas modulatórias não-invasivas, surgem como opções promissoras, promovendo alterações neuroplásticas importantes no tratamento. Conclusão: Há diversas opções terapêuticas farmacológicas e não-farmacológicas disponíveis no tratamento do paciente fibromiálgico para o especialista em DTM. Portanto, a combinação de diferentes abordagens pode auxiliar na obtenção de um protocolo individualizado, adequado às necessidades do paciente.

Fibromyalgia is a complex syndrome with nociplastic changes, characterized by hyperalgesia and allodynia, often accompanied by the presence of orofacial pain. Studies have shown a high prevalence of temporomandibular disorders (TMD) in fibromyalgia patients, as an etiological or aggravating factor. The aim of this review was to identify the modulatory mechanisms common to fibromyalgia and TMD, and to identify different treatment modalities for fibromyalgia patients. 69 articles from the last five years were included, in addition to 4 conceptual articles prior to this date. The main drugs used for fibromyalgia symptoms are pregabalin, amitriptyline, dual antidepressants, tramadol, low-dose naltrexone and cannabinoids. The combination of drugs may be useful in improving treatment efficacy and for reducing the drug's dose. On the other hand, new non-pharmacological therapies, such as non-invasive modulatory techniques, appear as promising options for treatment, promoting important neuroplastic alterations. Conclusion: Several pharmacological and non-pharmacological therapeutic alternatives are available for specialists in TMD. Therefore, combining therapy approaches can help create individualized protocols that are more effective at meeting the demands of fibromyalgia patients.