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

¿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.

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.

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.

Association of low-dose naltrexone and transcranial direct current stimulation in fibromyalgia: a randomized, double-blinded, parallel clinical trial

Abstract Introduction Fibromyalgia is a complex, generalized, and diffuse chronic musculoskeletal pain. Pharmacological approaches are widely used to relieve pain and increase quality of life. Low-Dose Naltrexone (LDN) was shown to increase the nociceptive threshold in patients with fibromyalgia. Transcranial Direct Current Stimulation (tDCS) is effective for pain management. Objective The purpose of this study was to evaluate the analgesic and neuromodulatory effects of a combination of LDN and tDCS in patients with fibromyalgia. Methods This was a randomized, double-blinded, parallel, placebo/sham-controlled trial (NCT04502251; RBR-7HK8N) in which 86 women with fibromyalgia were included, and written informed consent was obtained from them. The patients were allocated into four groups: LDN + tDCS (n = 21), LDN + tDCS Sham (n = 22), placebo + tDCS (n = 22), and placebo+tDCS Sham (n = 21). The LDN or placebo (p.o.) intervention lasted 26 days; in the last five sessions, tDCS was applied (sham or active, 20 min, 2 mA). The following categories were assessed: sociodemographic, Visual Analog Pain Scale (VAS), Pain Catastrophizing Scale (PCS), State-Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI-II), Profile of Chronic Pain Scale (PCP:S), Pain Pressure Threshold (PPT), and Conditioned Pain Modulation (CPM). Blood samples were collected to analyze BDNF serum levels. Results At baseline, no significant difference was found regarding all measurements. VAS pain was significantly reduced in the LDN + tDCS (p = 0.010), LDN + tDCS Sham (p= 0.001), and placebo+tDCS Sham (p= 0.009) groups. In the PCP:S, the LDN+tDCS group showed reduced pain frequency and intensity (p= 0.001), effect of pain on activities (p= 0.014) and emotions (p= 0.008). Depressive symptoms reduced after all active interventions (p > 0.001). Conclusion Combined LDN+tDCS has possible benefits in reducing pain frequency and intensity; however, a placebo effect was observed in pain using VAS, and further studies should be performed to analyze the possible association.

Relación entre fibromialgia y sarcopenia: el papel del abordaje nutricional / Fibromyalgia and sarcopenia relation: the role of nutritional approach

Introducción: la fibromialgia (FM) es un síndrome caracterizado por la presencia de dolor musculoesquelético crónico y generalizado, de origen no articular, que puede llegar a ser invalidante y afectar la esfera biológica, psicológica y social del paciente. Estado del arte: no se han publicado recomendaciones nutricionales específicas para las personas con FM y también existe un vago conocimiento acerca de los parámetros relacionados con la evaluación de la composición corporal (masa musculoesquelética, masa grasa, agua corporal, etc.) y la alteración en la fuerza muscular (p. ej., dinapenia, por dinamometría de mano, flexión de la rodilla, entre otras), así como la evaluación en términos de sarcopenia. Discusión: pocos estudios publicados hasta el momento describen en profundidad la composición corporal de las personas con FM. La mayoría se centran casi exclusivamente en la descripción del peso y el índice de masa corporal (IMC), por lo que existe poco conocimiento acerca de otros parámetros de relevancia, como por ejemplo aquellos relacionados con masa y fuerza muscular o masa grasa. La alimentación se menciona en varias publicaciones, pero no existen guías o pautas específicas de recomendaciones nutricionales para esta población. Algunos pacientes adoptan diversas dietas, estrategias o planes alimentarios sin ningún tipo de orientación de los profesionales de la salud, e incluso a veces, siguiendo fuentes de información no fiables, poniendo en riesgo su salud. Las publicaciones científicas no evalúan la asociación o el impacto del estado nutricional y la inadecuada alimentación en la calidad de vida. Conclusiones: en las personas con FM, conocer el estado nutricional, más allá del peso, determinando la composición corporal y la prevalencia de dinapenia o sarcopenia o ambas permitiría realizar un abordaje nutricional más adecuado. Este conocimiento podría ser coadyuvante en la terapéutica, logrando una mejoría en su desempeño físico y una mejor calidad de vida. (AU)

Introduction: fibromyalgia (FM) is a syndrome charcaterized by the presence of chronic, and generalized musculoskeletal pain, not articular in origin, which can become disabling and affect the biological, psychological, and social sphere of the patient. State of the art: no specific nutritional recommendations have been published for people with FM and there is also a vague knowledge regarding parameters related to body composition assessment (skeletal muscle mass, body fat mass, water, etc.) and loss of muscle strength (for example, dynapenia, by handgrip, knee flexion, among others), as well as assessment in terms of sarcopenia. Discussion: there are few studies published so far that completely describe the body composition in people with FM. Most of them focus almost exclusively on weight and body mass index (BMI), so there is a lack of knowledge about other descriptive parameters, such as those related to muscle mass and strength or fat mass. Diet is mentioned in several publications, but there are no specific guidelines for nutritional recommendations for this population. Some patients follow several diets, strategies or eating plans without health care professionals' guidance, and sometimes even following unreliable sources of information, putting themselves at risk. Scientific publications do not evaluate the association or impact of nutritional status and inadequate nutrition on quality of life in FM. Conclusions: in people with FM, knowledge of the nutritional status, beyond weight, determining body composition and the prevalence of dynapenia and/or sarcopenia would allow a more accurate nutritional approach. This knowledge could be helpful for the treatment, achieving an improvement in their physical performance and a better quality of life. (AU)

Fibromialgia en la nueva era de la infección por SARS-CoV-2 y el síndrome post-COVID-19: una revisión exploratoria / no

Introducción: La fibromialgia es un síndrome caracterizado por dolor crónico generalizado, rigidez articular, trastornos del sueno, fatiga, ansiedad y episodios depresivos, cuyas manifestaciones clínicas comienzan después de un trauma físico o emocional. Pese a ello, son escasas las publicaciones que describen el impacto clínico de la COVID-19 en los síntomas de fibromialgia. Objetivo: Mapear la evidencia médica disponible sobre el impacto de la COVID-19 y el síndrome post-COVID en pacientes con y sin diagnóstico de fibromialgia previo a la infección. Materiales y métodos: Revisión sistemática exploratoria en PubMed y Scopus, considerando artículos en inglés y en español, con datos sobre la fibromialgia en población sobreviviente a la infección por SARS-CoV-2. Se revisaron los registros de ensayos clínicos de las bases de datos de la Organización Mundial de la Salud. Resultados: Se incluyeron 12 artículos publicados: estudios retrospectivos (n = 4), transversales (n = 2), casos y controles (n = 2), estudios cualitativos (n = 2), cohorte prospectiva (n = 1) y corte longitudinal (n = 1). La población total fue de 3.060 pacientes. Además, se incluyeron registros de un ensayo clínico controlado aleatorizado, un estudio observacional tipo transversal y uno de casos y controles. La suma total de la población estudiada fue de 173 participantes. Conclusión: Los pacientes sobrevivientes a la COVID-19 con o sin diagnóstico previo de fibromialgia pueden presentar un aumento del dolor crónico, insomnio, rigidez articular y deterioro en la calidad de vida. La población con antecedente de fibromialgia puede verse más afectada por estrés psicológico, lesión tisular a estructuras neuromusculares e inflamación por la infección por SARS-CoV-2.

Introduction: Fibromyalgia is a syndrome characterized by chronic generalized pain, joint stiffness, sleep disorders, fatigue, anxiety and depressive episodes, whose clinical manifestations begin after a physical or emotional trauma. However, few publications describe the clinical impact of COVID-19 on fibromyalgia symptoms. Objective: To map the available medical evidence on the impact of COVID-19 and PCS in patients with and without a diagnosis of fibromyalgia prior to infection. Materials and methods: Exploratory systematic review in PubMed and Scopus, considering COVID-19 Fibromyalgia SARS-CoV-2 articles in English and Spanish, with data on fibromyalgia in the population surviving SARS-CoV-2 infection. The clinical trial records of the World Health Organization databases were reviewed. Results: Twelve published articles were included: retrospective studies (n = 4), cross-sectional (n = 2), cases and controls (n = 2), qualitative studies (n = 2), a prospective cohort (n = 1) and a longitudinal section study (n = 1). The total study population of the included publications was 3,060 patients. In addition, one randomized controlled clinical trial and two observational cross-sectional and case-control studies were included. The total sum of the study population was 173 participants. Conclusion: Survivors of COVID-19 with or without a previous diagnosis of fibromyalgia may present an increase in chronic pain, insomnia, joint stiffness, and deterioration in quality of life. The population with a history of fibromyalgia may be more affected by psychological stress, tissue damage to neuromuscular structures, and inflammation due to SARS-CoV-2 infection.

Self-perceived cognitive function and neuropsychological performance in women with fibromyalgia

BACKGROUND: Cognitive dysfunction is a common complain in patients with fibromyalgia (FM). Aim: To assess the perceived cognitive function and cognitive performance in women with FM. MATERIAL AND METHODS: Cross-sectional study including 100 women with FM (FMG) and 100 healthy controls (CG). Self-perceived cognitive functioning was evaluated using the Functional Assessment of Cancer Therapy Cognition scale (FACT-Cogv3). The neuropsychological performance was assessed with the Trail Making Test (TMT-A, TMT-B), Digit Span test (DS), Barcelona test (DS-F/B) and the Frontal Assessment Battery (FAB-E), Spanish version test. Results: The mean scores of all cognitive self-perception factors and all neuropsychological tests were lower in the FMG (p < 0.001). Over 90% of the FMG took longer than the population mean (P50) to complete the TMT-A and TMT-B tests, while in the CG, 1/3 took longer than the P50 in both tests. The minimum expected scores for the DS-F and DS-B tests were not achieved by 40 and 9% of FMG participants, respectively. According to FAB-E, 54% and 24% of FMG were categorized as fronto-subcortical deficit and fronto-subcortical dementia, respectively. CONCLUSIONS: Women with FM have a higher perception of cognitive dysfunction and lower cognitive performance in objective tests than healthy women. More research is needed to explore the clinical, psychosocial, and sociodemographic characteristics that predispose to cognitive deficits in this group of patients.

ANTECEDENTESA: La disfunción cognitiva es una queja común en pacientes con fibromialgia (FM). Objetivo: Investigar la función cognitiva percibida y el desempeño cognitivo en mujeres chilenas con FM. MATERIAL Y MÉTODOS: Estudio transversal incluyendo a 100 mujeres con FM (GFM) y 100 mujeres como controles sanos (GC). El funcionamiento cognitivo autopercibido se evaluó mediante la prueba Functional Assessment of Cancer Therapy Cognition scale (FACT-Cogv3). El rendimiento neuropsicológico se evaluó mediante las pruebas Trail Making Test (TMT-A, TMT-B) y Digit Span test (DS), Barcelona test (DS-F/B) y la prueba Frontal Assessment Battery, versión española (FAB-E). RESULTADOS: Las puntuaciones medias de todos los factores de autopercepción cognitiva y todas las pruebas neuropsicológicas fueron significativamente menores en el GFM. Para TMT-A y TMT-B, más del 90% del GFM tardó más que la media poblacional (P50) para completar las pruebas, mientras que en el GC aproximadamente 1/3 requirió más tiempo que el P50 en ambas pruebas. Un 40 y 9% del GFM no obtuvo la puntuación mínima esperada para las pruebas DS-F y DS-B, respectivamente. Según FAB-E, el 54% y 24% del GFM se clasificó como déficit fronto-subcortical y demencia fronto-subcortical, respectivamente. Conclusiones: Las mujeres con FM tienen una mayor percepción de disfunción cognitiva y menor rendimiento cognitivo en pruebas objetivas que mujeres sanas. Se necesita más investigación para explorar las características clínicas, psicosociales y sociodemográficas que predisponen a los déficits cognitivos en este grupo de pacientes.

Comorbidity of sleep apnoea syndrome in patients with fibromyalgia in a sleep clinic

Introduction: Fibromyalgia syndrome (FMS) is characterized by chronic musculoskeletal pain, fatigue, and the sense of waking unrefreshed. Obstructive sleep apnoea syndrome (OSAS) and FMS have symptoms in common and the association of OSAS in these patients could confuse the diagnosis and worsen the severity and prognosis of FMS. The objective of this study was to establish the presence of OSAS in patients with FMS and sleep complaints in a sleep clinic. Methods: A cross-sectional study was conducted in patients aged 18 and above with FMS who were referred by rheumatology to a sleep clinic to confirm OSAS with polysomnography from 2015 to 2018. Descriptive statistics tools were applied. Results: Polysomnographic investigations were performed in 51 patients with FMS. OSAS was detected in 82% of patients. The mean age was 65 years. Of the patients studied, 82% were women and 78% of them had OSAS. All the male patients with FM had OSAS. Of the patients, 27.5% were normal weight and 45% were overweight. Of the patients, 23% had severe OSAS, 31% moderate and 45% mild. Conclusion: We found a high frequency of OSAS in this group of FMS patients. Since the 2 diseases share symptoms, it is interesting to delve deeper into the investigation of common pathophysiological mechanisms. The coexistence of the 2 pathologies poses diagnostic and therapeutic challenges that implies the need for further study at local level.

Introducción: La fibromialgia (FM) se caracteriza por dolor crónico, cansancio y sueno no reparador. El síndrome de apnea hipopnea obstructiva del sueño (SAHOS) tiene síntomas en común con la FM y su presencia puede confundir el diagnóstico y empeorar la gravedad y el pronóstico de la FM. El objetivo de este estudio fue establecer la presencia de SAHOS en pacientes con FM y alteraciones del sueño en una clínica de sueño. Métodos: Estudio observacional, de corte transversal, en pacientes mayores de 18 arios con FM remitidos por Reumatología a una clínica de sueño para confirmar SAHOS por medio de polisomnografía, entre el 2015 y el 2018. Se aplicaron herramientas de estadística descriptiva. Resultados: Se realizó polisomnografía completa a 51 pacientes con FM y se confirmó SAHOS en el 82%. La edad media fue de 65 años. El 82% de los pacientes estudiados fueron mujeres y, de estas, el 78% tuvo SAHOS. Al 100% de los hombres con FM se les diagnosticó SAHOS. El 27,5% tuvo un peso normal y el 45% sobrepeso. El 23% de los pacientes tuvo SAHOS grave, el 31% moderado y el 45% leve. Conclusiones: Encontramos una alta frecuencia de SAHOS en este grupo de pacientes con FM. Las 2 enfermedades comparten síntomas, por lo que es interesante profundizar más en la investigación de mecanismos fisiopatológicos comunes. La coexistencia de las 2 patologías plantea retos diagnósticos y terapéuticos que vislumbran la necesidad de estudios más profundos a escala local.

Ejercicios físicos terapéuticos domiciliarios en la atención a pacientes con fibromialgia durante la COVID-19 / Home therapeutic physical exercises in the care of patients with fibromyalgia during COVID-19

Introducción: El ejercicio físico sistemático constituye una herramienta indispensable para el tratamiento de los pacientes con fibromialgia, y más aún en la etapa de COVID-19. Objetivo: Constatar la eficacia de los ejercicios físicos terapéuticos domiciliarios en la atención a pacientes con fibromialgia durante la COVID-19. Métodos: Se realizó un prexperimento, con una muestra intencional de 20 pacientes con fibromialgia. Se utilizó el cuestionario de impacto de fibromialgia para conocer el impacto general de la enfermedad y la escala analógica visual del dolor para determinar la intensidad del dolor. Se conoció por medio de los exámenes físicos la condición física de los pacientes. Se aplicó la prueba no paramétrica de McNemar y Wilcoxon para identificar cambios producidos en los pacientes mediante la aplicación de ejercicios físicos terapéuticos domiciliarios. Resultados: El promedio de edad fue de 47,85 años, con predominio del sexo femenino (95,0 por ciento). Al inicio de la investigación las puntuaciones del cuestionario de impacto de fibromialgia determinaron que el 85,0 por ciento de los pacientes tenían un impacto moderado y severo de la enfermedad. La escala analógica visual del dolor evidenció que los pacientes padecían dolor moderado y severo. La evaluación de los exámenes físicos demostró que en su mayoría los pacientes tenían una condición física inadecuada. Después de implementado los ejercicios físicos terapéuticos domiciliarios se demostró una mejoría de los parámetros evaluados, evidenciado mediante la estadística inferencial a través de la prueba McNemar ya que los resultados estuvieron a un nivel inferior (p = 0,005). Los resultados de Z de Wilcoxon tuvieron una significación bilateral de 0,000. Conclusiones: Se evidenciaron cambios significativos en los pacientes con fibromialgia. Los ejercicios físicos terapéuticos domiciliarios fueron efectivos en los pacientes con fibromialgia durante el aislamiento por la COVID-19(AU)

Introduction: Systematic physical exercise constitutes an indispensable tool for the treatment of patients with fibromyalgia: and even more so in the COVID-19 stage. Objective: To verify the effectiveness of home therapeutic physical exercises in the care of patients with fibromyalgia during COVID-19. Methods: A pre-experiment was conducted with a purposive sample of 20 patients with fibromyalgia. A general characterization of the sample was performed. The Fibromyalgia Impact Questionnaire was used to know the general impact of the pathology and the Visual Analog Scale to determine the intensity of the patients' pain. Physical tests were used to determine the physical condition of the sample. The McNemar and Wilcoxon non-parametric test was applied to identify changes produced in the patients through the application of home therapeutic physical exercises. Results: The average age was 47.85 years with a predominance of the female sex (95.0 percent). At the beginning of the research, the Fibromyalgia Impact Questionnaire scores showed that 85.0 percent of the patients were in moderate and severe impact of the disease, as well as the Visual Analog Scale, which showed that the patients were in moderate and severe pain. The evaluation of the physical tests showed that most of the patients were in inadequate physical condition. After implementing the home therapeutic physical exercises, an improvement of the evaluated parameters was demonstrated, thus evidenced by the contracting of inferential statistics through McNemar since the results were at a lower level for p=0.005 and the Wilcoxon Z results resulted in a bilateral significance of 0.000. Conclusions: It is concluded that the results obtained evidenced significant changes in fibromyalgia patients, which can be said that home therapeutic physical exercises were effective in fibromyalgia patients during isolation by COVID-19(AU)

Effects of resistant exercise and aerobic exercise on people with fibromyalgia syndrome: a systematic review of randomized clinical trials / Efeitos do exercício resistido e do exercício aeróbico em pessoas com síndrome de fibromialgia: uma revisão sistemática de ensaios clínicos randomizados

INTRODUCTION: Fibromyalgia syndrome (FMS) is characterized as a condition of chronic and generalized muscle pain, resulting primarily in decreased functional capacity and emotional changes of the patient. Physical exercise (PE) can promote different effects in FMS depending on the chosen method: aerobic training (AT) alone, resistance training (RT) alone or the combination of both in concurrent training (CT). OBJECTIVE: To synthesize data from clinical trials on the effects of resistance training and aerobic training in people with FMS. METHODS: Searches were performed in the Pubmed, Scielo, Virtual Health Library, Scopus and Web of Science databases. Articles published between 2009 and 2020 were analyzed. RESULTS: Eighteen randomized clinical trials were included to compose the discussion of this review. Altogether 1,136 individuals with FMS who participated in interventions with PE were analyzed; 10 studies used RT as an intervention method; 8 applied AT and 3 used CT. In 3 studies more than one method was used. Studies pointed out that there were significant improvements in biological and psychophysiological aspects at the end of the interventions. CONCLUSION: The analyzed articles suggested that PE through both RT and AT, alone or combined, is an alternative treatment for the population with FMS, being a low-cost intervention and providing significant improvements for these patients.

INTRODUÇÃO: A síndrome de fibromialgia (SFM) é caracterizada como um quadro de dor muscular crônica e generalizada, que causa principalmente diminuição da capacidade funcional e alterações no aspecto emocional do paciente. O exercício físico (EF) pode promover efeitos distintos na SFM a depender do método aplicado: treinamento aeróbico (TA) isolado, treinamento resistido (TR) isolado, ou a combinação de ambos como treinamento concorrente (TC). OBJETIVO: Sintetizar os dados de ensaios clínicos sobre os efeitos do treinamento resistido e do treinamento aeróbico em pessoas com SFM. MÉTODOS: As buscas foram realizadas nos bancos de dados PubMed, SciELo, Virtual Health Library, Scopus e Web of Science. Foram analisados artigos publicados entre 2009 e 2020. RESULTADOS: Foram incluídos 18 ensaios clínicos randomizados para compor a discussão desta revisão. Ao todo foram analisadas 1.136 pessoas com SFM que participaram das intervenções com EF; 10 estudos utilizaram TR como método de intervenção; 8 aplicaram TA e 3 empregaram o TC. Em 3 estudos foram utilizados mais de um método como estratégia. Os estudos apontaram que ao final das intervenções, houve melhoras significativas em aspectos biológicos e psicofisiológicos. CONCLUSÃO: Os artigos analisados sugeriram que o EF por meio tanto do TR quanto do TA, isolado ou combinado, é uma alternativa de tratamento para a população com SFM, por serem intervenções de baixo custo financeiro e proporcionarem melhoras significativas para esses pacientes.

Práticas integrativas e complementares e suas repercussões na qualidade de vida e desempenho laboral para o portador de fibromialgia / Integrative and complementary practices and their impact on quality of life and work performance for people with fibromyalgia

A fibromialgia pode ser definida como uma síndrome dolorosa crônica, não inflamatória, de etiologia desconhecida, que se manifesta no sistema músculo esquelético, podendo apresentar sintomas em outros aparelhos, provocando impacto negativo na qualidade de vida e atividades da vida diária dos seus portadores. Trata-se de uma doença que provoca restrição de movimentos, sendo a dor o sintoma marcante, assim como a insônia, fadiga e depressão, afetando assim o trabalhador, sendo necessário o afastamento de suas atividades laborativas, reduzindo sua qualidade de vida. Nesta compreensão de que a fibromialgia engloba sintomas relacionados a corpo e mente, sugere-se então a utilização das Práticas Integrativas e Complementares (PICS) como opção terapêutica, que aborda o indivíduo como um todo, integrando sentidos, sinais e sensações de conforto e bem-estar. O presente estudo está inserido no Núcleo de Pesquisa em Trabalho, Saúde e Educação, da Escola de Enfermagem Aurora de Afonso Costa, Universidade Federal Fluminense, desenvolvido no Mestrado Acadêmico em Ciências do Cuidado em Saúde, tendo como questão norteadora: O conhecimento e a adoção de práticas integrativas e complementares possibilitam a melhoria da qualidade de vida e o desempenho laboral do portador de fibromialgia? Objetivo: Avaliar as repercussões da adoção das práticas integrativas e complementares para o tratamento da dor crônica não transmissível, sob a ótica dos trabalhadores participantes de um grupo extensionista. Estudo de campo, realizado por meio de um questionário eletrônico, disponibilizado nas redes sociais do Grupo de Práticas Integrativas e Complementares em Saúde ­ UFF. O projeto de pesquisa foi submetido ao Comitê de Ética da Faculdade de Medicina da Universidade Federal Fluminense, por meio da Plataforma Brasil, sendo aprovado sob nº 4.666.509. Os participantes do referido grupo fizeram parte do estudo, mediante a assinatura eletrônica do Termo de Consentimento Livre e Esclarecido (TCLE). Utilizou-se a Análise temática, proposta por Bardim, de onde surgiram as categorias temáticas denominadas: "Fibromialgia, mulher e situação laboral: a dialética de associações"; "Dor e distanciamento: dificuldades enfrentadas pelos trabalhadores portadores de fibromialgia" e "efeitos clínicos e psicossociais das PICS: o impacto na qualidade de vida do trabalhador". Concluiu-se que a carga de trabalho, a dinâmica rígida de controle de atividades e os fatores ergonômicos contribuem como fatores de risco para o aparecimento e a cronificação das restrições impostas pela dor crônica, e recomenda-se que as ações educativas desenvolvidas pelo projeto de extensão, sejam divulgadas e ampliadas, tendo em vista que os participantes apontaram para a importância do conhecimento adquirido no que tange a sua inserção nas atividades com PICS, auxiliando assim, na promoção da saúde do trabalhador e prevenção de danos decorrentes da Fibromialgia. Propõe-se que a classe de trabalhadores da saúde tenha um enfoque especial, tanto em pesquisas, estudos de risco ocupacional e estabelecimento de ações de promoção, prevenção e educação em saúde do trabalhador, com vistas a melhoria de sua qualidade de vida.

Fibromyalgia can be defined as a chronic, non-inflammatory pain syndrome of unknown etiology, which manifests itself in the skeletal muscle system, and may present symptoms in other apparatuses, causing negative impact on the quality of life and activities of daily living of its carriers. It is a disease that causes restriction of movements, pain being the main symptom, as well as insomnia, fatigue and depression, thus affecting the worker, being necessary to take time off from their work activities, reducing their quality of life. In this understanding that fibromyalgia encompasses symptoms related to body and mind, it is then suggested the use of Integrative and Complementary Practices (PICS) as a therapeutic option, which addresses the individual as a whole, integrating senses, signs and sensations of comfort and well-being. The present study is inserted in the Research Nucleus in Work, Health and Education, of the Aurora de Afonso Costa Nursing School, Universidade Federal Fluminense, developed in the Academic Master's Degree in Health Care Sciences, having as its guiding question: Does the knowledge and adoption of integrative and complementary practices improve the quality of life and work performance of patients with fibromyalgia? Objective: To assess the impact of the adoption of integrative and complementary practices for the treatment of chronic non-communicable pain on the ethics of workers participating in an outreach group. Field study, carried out by means of an electronic questionnaire, on the social networks of the Integrative and Complementary Practices in Health Group - UFF. The research project was submitted to the Ethics Committee of the Faculdade de Medicina da Universidade Federal Fluminense, through Plataforma Brasil, and approved with the number 4.666.509. The participants of the aforementioned group participated in the study by electronically signing the free and informed consent form. The Thematic Analysis, proposed by Bardim, was used, from which the following thematic categories emerged: "Fibromyalgia, women and work situation: the dialectic of associations"; "Dor and distancing: difficulties faced by workers with fibromyalgia" and "clinical and psychosocial effects of CIP: the impact on the worker's quality of life". It was concluded that workload, rigid dynamics of activity control and ergonomic factors contribute as risk factors for the onset and chronification of restrictions imposed by chronic pain, and it is recommended to disseminate and expand the educational actions developed by the extension project, considering that the participants pointed out the importance of the knowledge acquired in relation to their insertion in the activities with PICS, thus helping the promotion of workers' health and the prevention of damages derived from Fibromyalgia. It is proposed that the class of health workers has a special focus, both in research, occupational risk studies and the establishment of actions for promotion, prevention and health education of workers in order to improve their quality of life.

Validation of the Pollard' s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the sensitivity and specificity of Pollard' s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting.@*METHODS@#Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People' s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group.@*RESULTS@#There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard' s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P < 0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P < 0.001) and lower SF-36 (28.63 vs. 58.22, P < 0.001). Fatigue was more common in RA-FM patients (88. 1% vs. 50.6%, P < 0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P < 0.001). RA-FM patients also had higher anxiety (10 vs.4, P < 0.001) and depression scores (12 vs.6, P < 0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups.@*CONCLUSION@#The Pollard' s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard' s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity, worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.

Dysfunctional eating behavior in fibromyalgia and its association with serum biomarkers of brain plasticity (BDNF and S100B): an exploratory study

ABSTRACT Objectives: To assess disordered eating, hunger and satiety perceptions in women with fibromyalgia (FM) compared to healthy controls (HC) and their association with biomarkers of brain plasticity (brain-derived neurotrophic factor (BDNF) and S100 calcium-binding protein B (S100B)). Subjects and methods: Cross-sectional exploratory study. The sample included FM (n = 20) and HC (n = 19), matched to age and waist perimeter. Dysfunctional eating was assessed through the Three Factor Eating Questionnaire and Eating Disorders Examination with a questionnaire. Hunger and satiety levels were rated by a Numerical Scale. Serum leptin, S100B and BDNF were analyzed. Results: The MANCOVA analysis showed that the mean of Emotional Eating rates was 30.65% higher in FM compared to HC ( p = 0.015). Eating, shape and weight concerns were 77.77%, 57.14% and 52.22% higher in FM ( p = <0.001) compared to HC, respectively. Moreover, the FM group reported higher scores for feeling of hunger "[5.2 (±2.9) vs. 4.8 (±2.0); p = 0.042] and lower scores for satiety [7.0 (±1.7) vs . 8.3 (±1.0); p = 0.038]. In the FM group, serum BDNF was negatively associated with hunger (r = - 0.52; p = 0.02), while S100B was positively associated with hunger scores (r = 0.463; p = 0.004). Conclusion: The present findings support the hypothesis that the association between FM and obesity can be mediated by a hedonistic pathway. Further research is needed.

Efficacy of cannabinoids in fibromyalgia: a literature review / Eficacia de los cannabinoides en la fibromialgia: revisión de la literatura

Abstract Fibromyalgia is a chronic disease of unclear etiology, involving a neural oversensitization and impaired pain modulation, in addition to a clinical deficiency of the endocannabinoid system. Fibromyalgia is associated with a number of somatic and psychological disorders and hence multiple pharmacological approaches have been used, including opioids, antidepressants, antiepileptics, and more recently medical cannabis. This narrative review comprises a review of the current literature on the efficacy of cannabinoids in fibromyalgia. The studies describe a possible influence of cannabis on pain control in patients with fibromyalgia, with positive effects on quality of life and sleep. The use of cannabis seems to be beneficial in patients with fibromyalgia; however, more robust studies are still needed to establish is actual efficacy in pain management, quality of life and improvement of associated symptoms.

Resumen La fibromialgia es una enfermedad crónica, cuya etiología no es clara, en la que se involucra una sobresensibilización neural y disminución de la modulación del dolor, así como una deficiencia clínica del sistema endocannabinoide. Está asociada a una variedad de trastornos somáticos y psicológicos, por lo cual se han utilizado múltiples abordajes farmacológicos, entre ellos opioides, antidepresivos, antiepilépticos y, recientemente, cannabis medicinal. En esta revisión narrativa se hace una reseña de la literatura actual relacionada con la eficacia de los cannabinoides en la fibromialgia. Los estudios describen una posible influencia del cannabis sobre el control del dolor en pacientes con fibromialgia, con efectos positivos sobre la calidad de vida y el sueño. El uso del cannabis parece tener beneficios en los pacientes con fibromialgia; sin embargo, aún se requieren estudios más robustos para establecer su verdadera eficacia en el manejo del dolor, calidad de vida y mejoría de los síntomas asociados.

COVID-19 pandemic and exercising: a cross-sectional study with 1156 patients with fibromyalgia

SUMMARY OBJECTIVE: The aim of this study was to analyze the effects of pandemic in the exercising practice and impact of the disease in patients with Fibromyalgia. METHODS: This is a cross-sectional, Internet-based survey answered by 1156 individuals with Fibromyalgia diagnosis. Questions were on epidemiology, social distancing habits, and exercise practice before and after COVID-19 pandemic, including subtypes of exercises (for resistance, flexibility, balance, and strength). The Fibromyalgia Impact Questionnaire was applied. RESULTS: In the whole sample, 57.7% of individuals practiced exercises before pandemic; during pandemic, only 34.8% practiced and 39.6% left this practice. Among those taking quarantine (n=440), 52.9% used to do exercises prior to pandemic; in the pandemic, 28.1% (reduction of 53.2%). The median Fibromyalgia Impact Questionnaire among those who practiced exercises in the pandemic was 73.6 (61.1-83.2) and that among those who did not was 80.4 (71.9-86.9), with p<0.0001. The Fibromyalgia Impact Questionnaire did not change according to the type of physical exercise (p=0.27). CONCLUSION: A high proportion of patients with Fibromyalgia stopped exercising during COVID-19 pandemic; as a result, the impact of the disease during this period was worse among those not practicing exercises.

Narrativas del dolor entre pacientes con diagnóstico de fibromialgia en Santiago de Chile / Pain narratives among patients with fibromyalgia diagnosis in Santiago de Chile

La presente investigación tuvo como objetivo acceder a las narrativas que configuran la experiencia de dolor de quienes padecen fibromialgia. Se utilizó como método de recolección de datos la realización de cuatro entrevistas en profundidad por un período de cuatro meses a un grupo de ocho pacientes con diagnóstico de fibromialgia. Cada entrevista fue analizada a través del método de análisis de contenido, el cual permitió codificar la información y agruparla en función de las principales categorías temáticas pesquisadas. Los resultados del estudio muestran que en la narrativa de quienes padecen fibromialgia, el dolor se ubica como indicador de una supuesta inadecuación en los modos de vincularse con otras personas, con el propio cuerpo, y con los rendimientos productivos. A su vez, se asume que el camino que tome dicho dolor dependerá siempre de esfuerzos en torno a la adquisición de aprendizajes en un amplio espectro de comportamientos, que estarían vinculados con la mejoría del cuadro clínico. A modo de conclusión, se propone que el diagnóstico de fibromialgia visibiliza una experiencia de sufrimiento, donde el dolor adquiere características que denotan no sólo una anomalía alojada en el cuerpo sino, más ampliamente, el indicador de las características personales de quienes lo padecen.

The present investigation aimed to access the narratives that make up the pain experience of those who suffer from fibromyalgia. The data collection method was used to carry out four in-depth interviews over a period of four months, with a group of eight patients with a diagnosis of fibromyalgia. Each interview was analyzed through the content analysis method, which allowed the information to be codified and grouped according to the main thematic categories investigated. The results of the study show that in the narrative of those who suffer from fibromyalgia, pain is located as an indicator of a supposed inadequacy in the ways of relating to other people, with the body itself, and with productive performance. In turn, it is assumed that the course that this pain takes will always depend on efforts around the acquisition of learning in a wide spectrum of behaviors, which would be linked to the improvement of the clinical picture. By way of conclusion, it is proposed that the diagnosis of fibromyalgia makes visible an experience of suffering where pain acquires characteristics that denote not only an anomaly lodged in the body but, more broadly, the indicator of the personal characteristics of those who suffer from it.

Use of psychotropic drugs in the treatment of fibromyalgia: a systematic review / Uso de psicofármacos no tratamento da fibromialgia: uma revisão sistemática

INTRODUCTION: The treatment of fibromyalgia is evolving, and more and more drugs are available on the marketOBJECTIVE: To verify the response, tolerability, and adverse events of the use of psychotropic drugs in the treatment of fibromyalgiaMETHODS: A systematic review of articles on fibromyalgia and psychotropic medications were carried out, indexed in the MEDLINE database (PUBMED) with the MeSH terms: "fibromyalgia", "psychotropic drugs," and "treatment outcome". Of the 89 studies identified, 23 met the eligibility criteriaRESULTS: It has been seen that some classes of psychotropic medications have significantly improved patients' painful episodes, which have an important positive impact on quality of life. Thus, it was realized that the pharmacological treatment of psychiatric disorders associated with fibromyalgia improves the condition of the patient's acceptance of the disease. Most medications had a good impact on the patient's quality of life without major side effects. It is known that adverse events are proportional to the dose of psychotropics, so for each patient, it is necessary to individualize the conductCONCLUSION: Antidepressants were the best-tolerated drug class, but antipsychotics, anticonvulsants, and other more recent drugs such as agomelatine were part of the study of the main drugs used in clinical practice

INTRODUÇÃO: O tratamento da fibromialgia vem evoluindo, e cada vez mais fármacos estão disponíveis no mercadoOBJETIVO: Verificar a resposta, tolerabilidade e eventos adversos do uso de psicofármacos no tratamento da fibromialgiaMÉTODO: Foi realizada uma revisão sistemática de artigos sobre fibromialgia e medicações psicotrópicas, indexados no banco de dados MEDLINE (PUBMED) com os meSH terms: "fibromyalgia", "psychotropic drugs" e "treatment outcome". Dos 89 estudos identificados, 23 preencheram os critérios de elegibilidadeRESULTADOS: Foi visto que algumas classes de medicações psicotrópicas melhoraram significativamente os episódios dolorosos dos doentes o que causa impacto positivo importante sobre a qualidade de vida. Assim percebeu-se que o tratamento farmacológico dos transtornos psiquiátricos associados à fibromialgia faz melhorar a condição da aceitação da doença pelo paciente. A maioria das medicações causou um bom impacto na qualidade de vida do doente sem grandes efeitos colaterais. Sabe-se que os eventos adversos são proporcionais a dose dos psicotrópicos, logo para cada paciente tem-se que individualizar a condutaCONCLUSÃO: Antidepressivos foram à classe medicamentosa mais bem tolerada, mas antipsicóticos, anticonvulsivantes e outros medicamentos mais recentes como a agomelatina fizeram parte do estudo das principais drogas usadas na prática clínica

Consciência perineal, presença de sintomas urinários e satisfação sexual na fibromialgia / Perineal consciousness, presence of urinary symptoms and sexual satisfaction in fibromyalgia

Introdução: A fibromialgia é uma síndrome crônica, com etiologia desconhecida, frequente em mulheres e com sintomas que afetam a qualidade de vida. Tem se discutido que essa condição afete inclusive a musculatura do assoalho pélvico. Objetivo: Verificar o conhecimento a respeito do períneo, a presença de sintomas de perdas urinárias e o nível de satisfação sexual em mulheres fibromiálgicas. Métodos: Participaram dessa abordagem 7 fibromiálgicas atendidas semanalmente pela fisioterapia. Para avaliação inicial, utilizamos um Questionário de Consciência Perineal e o Índice de Satisfação Sexual Feminina (FSFI). Durante os dois meses de intervenção, foram realizadas 2 palestras educativas e 8 encontros para a realização de exercícios perineais. Depois da intervenção, o FSFI foi aplicado novamente e os dados foram analisados por estatística simples. Resultados: As participantes demonstraram conhecer a localização das estruturas do sistema urinário, porém 4 das mulheres (57,1%) relataram não saber contrair a musculatura do assoalho pélvico. Todas relataram urgência miccional, raras perdas urinárias ao esforço e insatisfação sexual, antes da intervenção melhorando na reavaliação. Conclusão: As participantes pouco conhecem sobre a musculatura do assoalho pélvico, sua contração adequada e a atuação da fisioterapia nessa condição. A satisfação sexual encontrou-se prejudicada inicialmente apresentando melhora após as intervenções. (AU)

Introduction: Fibromyalgia is a chronic syndrome, with unknown etiology, common in women and with symptoms that affect quality of life. It has been argued that this condition affects even the pelvic floor musculature. Objective: To verify the knowledge about the perineum, the presence of symptoms of urinary loss and the level of sexual satisfaction in fibromyalgia women. Methods: Seven fibromyalgia patients attended weekly by physical therapy participated in this approach. For initial assessment, we used Perineal Awareness Questionnaire and Female Sexual Satisfaction Index (FSFI). During two months of intervention, 2 educational lectures and 8 meetings were held to perform perineal exercises. After intervention, FSFI was applied again, and the data were analyzed using simple statistics. Results: The participants demonstrated to know the location of the structures of the urinary system, however 4 of the women (57.1%) reported not knowing how to contract the pelvic floor muscles. All of them reported urinary urgency, rare urinary losses on exertion and sexual dissatisfaction, before the intervention, improving the reassessment. Conclusion: The participants know little about the musculature of the pelvic floor, its adequate contraction, and the role of physical therapy in this condition. Sexual satisfaction was initially impaired, showing improvement after the interventions. (AU)

Frecuencia y severidad de los síntomas en pacientes con Fibromialgia y Migraña / Frequency and severity of symptoms in patients with Fibromyalgia and Migraine

Objetivos: Estimar la frecuencia de migraña en pacientes con fibromialgia (FM). Describir y comparar características clínicas, socio demográficas y severidad de los síntomas de FM, según presencia o ausencia de migraña. Materiales y métodos: Estudio analítico, observacional, transversal. Incluyó pacientes mayores de 18 años, de ambos sexos con diagnóstico de FM según criterios ACR 2010 de un centro reumatológico público de Argentina entre enero de 2019 y marzo de 2020. Pacientes con otras enfermedades reumatológicas concomitantes fueron excluidos. Se utilizó criterios IHS (International Headache Society) para diagnóstico de migraña, FIQ (Fibromyalgia Impact Questionnaire) para evaluar severidad de los síntomas. Resultados: Se incluyeron 59 pacientes, 99% eran mujeres. El 40.68% de los pacientes presentaba migraña. En los pacientes con migraña, la mediana de puntaje del FIQ fue 70.35 (RIC: 63.16-78.76) vs 53.91 (RIC: 37.93-66.05) en el grupo sin migraña, siendo esta diferencia estadísticamente significativa (p<0.01). El análisis multivariado mostró al mayor puntaje del FIQ y de ansiedad, asociados de forma significativa e independiente con migraña (OR 1.048, IC 95%1.005-1.093); OR 1.189, IC 95%1.033-1.368, respectivamente. Conclusiones: La migraña es frecuente en pacientes con FM, y la severidad de los síntomas y la ansiedad serían más pronunciados en este grupo de pacientes.

Objectives: To estimate the frequency of migraine in patients with fibromyalgia (FM). Describe and compare clinical characteristics, sociodemographic and severity of FM symptoms, according to presence or absence of migraine. Materials and methods: Analytical, observational, cross-sectional study. It included patients over 18 years of age, of both sexes with a diagnosis of FM according to ACR 2010 criteria from a public rheumatology center in Argentina between January 2019 and March 2020. Patients with other concomitant rheumatological diseases were excluded. We used IHS (International Headache Society) criteria for the diagnosis of migraine, FIQ (Fibromyalgia Impact Questionnaire) were used to assess severity of symptoms. Results: 59 patients were included, 99% were women. 40.68% of the patients had migraine. In patients with migraine, the median FIQ score was 70.35 (IQR: 63.16-78.76) vs 53.91 (IQR: 37.93-66.05) in the group without migraine, this difference being statistically significant (p <0.01). The multivariate analysis showed a higher FIQ and anxiety score, significantly and independently associated with migraine (OR 1.048, 95% CI 1.005-1.093); OR 1,189, 95% CI 1,033-1,368, respectively). Conclusions: Migraine is frequent in patients with FM, and the severity of symptoms and anxiety would be more pronounced in this group of patients.