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Psicol. reflex. crit ; 34: 5, 2021. tab, graf
Article in English | LILACS, INDEXPSI | ID: biblio-1155190


Abstract This study evaluated the effects in the pain and sleep, and the clinic significance after an analytic-behavioral intervention to manage the condition of the physical and interpersonal environment related to pain. Four women with fibromyalgia and insomnia participated in a study with intervention withdrawal multiple baseline design and initial, intermediate, final, and follow-up assessments. Self-report instruments were used to assess pain intensity and disability, sleep quality, and insomnia severity, besides the actigraphy. Data showed that the intervention (20 sessions) was effective in reducing the sleep and pain problems in all participants by shifting two participants from clinical to non-clinical status in sleep indicators. The gains were maintained or increased in follow-up measures. However, the results should take into consideration the clinical condition and other variables that may have individually impacted the results.

Humans , Female , Middle Aged , Behavior Therapy , Fibromyalgia/complications , Chronic Pain/therapy , Pain Management/methods , Sleep Initiation and Maintenance Disorders/complications , Treatment Outcome , Actigraphy
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 128-134, dic. 2019.
Article in Spanish | LILACS | ID: biblio-1099754


Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Primary Health Care/trends , Depression/diagnosis , Psychiatry/trends , Signs and Symptoms , Somatoform Disorders/diagnosis , Citalopram/adverse effects , Citalopram/therapeutic use , Fibromyalgia/complications , Fatigue Syndrome, Chronic/complications , Fluoxetine/adverse effects , Fluoxetine/therapeutic use , Serotonin Uptake Inhibitors/adverse effects , Low Back Pain/complications , Cholinergic Antagonists/adverse effects , Medical Errors , Sertraline/adverse effects , Sertraline/therapeutic use , Depression/classification , Depression/complications , Depression/therapy , Depression/epidemiology , General Practice , Chronic Pain/complications , Venlafaxine Hydrochloride/adverse effects , Venlafaxine Hydrochloride/therapeutic use , Duloxetine Hydrochloride/adverse effects , Duloxetine Hydrochloride/therapeutic use , Serotonin and Noradrenaline Reuptake Inhibitors/adverse effects , Headache/complications , Amitriptyline/adverse effects , Amitriptyline/therapeutic use , Antidepressive Agents/administration & dosage
Rev. Assoc. Med. Bras. (1992) ; 65(10): 1265-1274, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041035


SUMMARY OBJECTIVE We reported our multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our aim was to verify the effectiveness of a proprioceptive training program as a complementary therapy for a traditional protocol of education, mindfulness, and exercise training for the management of fibromyalgia associated with imbalance. METHODS Retrospective cohort study on 84 women, with primary fibromyalgia associated to imbalance. A group of patients performed traditional exercise training; in a second group the training was supplemented with proprioception exercises. Each session lasted from 40 to 60 minutes and was performed three times a week for 12 weeks. RESULTS After three months of training and eight months after the end of the training, the balance evaluation revealed significant differences in the comparison of the Timed Up and Go test, Berg Balance Scale, and Tinetti scale with the baseline, there was a better improvement in the proprioceptive training group (p<0.05). A reduction in pain and improvement in functional and muscular performance and quality of life were observed in both groups (p<0.05), but with no significant differences between them in the Numeric Pain Rating Scale, Fibromyalgia Impact Questionnaire, and Short Form Health Survey (p>0.05). Fifteen months after the end of the program, the effects of training were not maintained. CONCLUSION The present study revealed that training supplemented with proprioception exercises has beneficial effects on clinical findings and improves balance in patients with fibromyalgia, even if the positive results did not persist after the interruption of the rehabilitative program in the long term.

RESUMO OBJETIVO Relatamos nosso protocolo multidisciplinar para o manejo da fibromialgia associada ao desequilíbrio. Nosso objetivo foi verificar a eficácia do programa de treinamento proprioceptivo como terapia complementar de um protocolo tradicional (exercícios aeróbicos, de resistência e flexibilidade). MÉTODOS Estudo retrospectivo em 84 mulheres com fibromialgia primária associada a desequilíbrio. Um grupo de pacientes realizou o treinamento tradicional; em um segundo grupo o treinamento foi complementado com exercícios de propriocepção. Cada sessão durou de 40 a 60 minutos e foi realizada três vezes por semana durante 12 semanas. RESULTADOS Após três meses de treinamento e oito meses após o término do treinamento, a avaliação do equilíbrio revelou diferenças significativas nos testes Timed Up and Go, Escala de Equilíbrio de Berg e Escala de Tinetti em comparação com a linha de base, com uma melhora maior no grupo de treinamento proprioceptivo (p<0,05). Redução da dor e melhora do desempenho funcional e muscular e da qualidade de vida foram observadas em ambos os grupos (p<0,05), mas sem diferenças significativas entre eles na Escala Numérica de Dor, Fibromyalgia Impact Questionnaire e Short Form Health Survey (p>0,05). Quinze meses após o final do programa, os efeitos do treinamento não foram mantidos. CONCLUSÃO O presente estudo revelou que o treinamento suplementado com exercícios de propriocepção tem efeitos benéficos sobre os achados clínicos e melhora o equilíbrio em pacientes com fibromialgia, mesmo que os resultados positivos não tenham persistido após a interrupção do programa de reabilitação no longo prazo.

Humans , Female , Fibromyalgia/therapy , Sensation Disorders/therapy , Postural Balance , Exercise Therapy/methods , Fibromyalgia/complications , Clinical Protocols , Surveys and Questionnaires , Retrospective Studies , Sensation Disorders/etiology
Rev. bras. reumatol ; 57(5): 403-411, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-899453


Abstract Objective: To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups. Methods: A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups. Results: 256 RA patients (32 with FM) were followed for 6.2 ± 2.0 (mean ± SD) years comprising 2986 visits. At baseline, RA duration was 11.1 ± 7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p < 0.001). Conclusions: RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.

Resumo Objetivo: Comparar o uso de fármacos antirreumáticos modificadores da doença (DMARD) em pacientes com e sem fibromialgia (FM) ao longo do tempo, incluindo as taxas de tratamento excessivo e subtratamento em ambos os grupos. Métodos: Estudo de coorte prospectiva com pacientes atendidos em um ambulatório de artrite reumatoide (AR). Os participantes foram recrutados consecutivamente entre março de 2006 e junho de 2007 e foram seguidos até dezembro de 2013. Compararam-se os dados de uso de DMARD (prevalências, doses e taxas de escalonamento), 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) e progressão radiográfica entre pacientes com e sem FM. Os cenários clínicos de tratamento supostamente incorreto foram identificados e comparados entre os grupos. Resultados: Seguiram-se 256 pacientes com AR (32 com FM) por 6,2 ± 2,0 (média ± DP) anos, período que abrangeu 2.986 consultas. No início do estudo, a duração da AR era de 11,1 ± 7,4 anos. O DAS28 e o HAQ foram maiores no grupo AR com FM e estavam mais próximos do grupo AR sem FM no fim do estudo. Os pacientes com AR com FM usaram doses mais altas de antidepressivos tricíclicos, leflunomida e prednisona e doses mais baixas de metotrexato. Quando comparados com os pacientes com AR sem FM, os participantes com AR e FM usaram mais frequentemente antidepressivos tricíclicos, leflunomida, prednisona e analgésicos contínuos e menos frequentemente metotrexato. Os grupos apresentaram sobrevida em sete anos sem agentes biológicos e livres de progressão radiográfica semelhantes na regressão Cox. Os pacientes com AR com FM apresentaram uma maior proporção de consultas em cenários de tratamento supostamente incorreto quando comparados com os pacientes com AR sem FM (28,4 vs. 19,8%, p < 0,001). Conclusões: Os pacientes com AR e FM usaram mais leflunomida e prednisona e o tratamento supostamente incorreto na AR foi mais frequente em pacientes com FM. Os pacientes com AR com FM certamente se beneficiarão de uma estratégia personalizada de tratamento por metas (T2 T), incluindo ultrassonografia (quando apropriado) e controle da FM.

Humans , Male , Female , Adult , Aged , Arthritis, Rheumatoid/drug therapy , Practice Patterns, Physicians'/statistics & numerical data , Fibromyalgia/complications , Antirheumatic Agents/therapeutic use , Inappropriate Prescribing/statistics & numerical data , Clinical Decision-Making , Arthritis, Rheumatoid/complications , Severity of Illness Index , Brazil , Drug Administration Schedule , Case-Control Studies , Proportional Hazards Models , Prospective Studies , Follow-Up Studies , Disease Progression , Kaplan-Meier Estimate , Middle Aged
Rev. bras. reumatol ; 57(3): 197-203, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-899415


ABSTRACT We aimed to assess the impact of social support on symptoms in Brazilian women with FM. An observational, descriptive study enrolling 66 women who met the 1990 American College of Rheumatology (ACR) criteria. Social support was measured by the Social Support Survey (MOS-SSS), functionality was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), depression was assessed using the Beck Depression Inventory (BDI), anxiety was measured using the Hamilton Anxiety Scale (HAS), affectivity was measured by Positive and Negative Affect Schedule (PANAS), and algometry was carried out to record pressure pain threshold (PPth) and tolerance (PPTo) at 18 points recommended by the ACR. Patients were divided into normal (NSS) or poor social support (PSS) groups with PSS defined as having a MOS-SSS score below the 25th percentile of the entire sample. Mann-Whitney or Unpaired t-test were used to compare intergroup variables and Fisher's for categorical variables. Analysis of covariance and Pearson correlation test were used. No differences in sociodemographic variables between PSS and NSS were found. Differences between NSS and PSS groups were observed for all four subcategories of social support and MOS-SSS total score. Significant differences between NSS and PSS on depression (p = 0.007), negative affect (p = 0.025) and PPTh (p = 0.016) were found. Affectionate subcategory showed positive correlation between pain and positive affect in PSS. Positive social interaction subcategory showed a negative correlation between FIQ and depression state. Therefore social support appears to contribute to ameliorate mental and physical health in FM.

RESUMO Objetivou-se avaliar o impacto do apoio social sobre os sintomas de mulheres brasileiras com fibromialgia (FM). Trata-se de um estudo observacional descritivo que selecionou 66 mulheres que atendiam aos critérios do Colégio Americano de Reumatologia (ACR) de 1990. O apoio social foi medido com o Social Support Survey (MOS-SSS), a funcionalidade com o Questionário do Impacto da Fibromialgia (FIQ), a depressão com o Inventário de Depressão de Beck (BDI), a ansiedade com a Escala de Ansiedade de Hamilton (HAS), a afetividade com o Positive and Negative Affect Schedule (Panas) e foi feita algometria para registrar o limiar da dor à pressão (LDP) e a tolerância álgica à pressão (TAP) nos 18 pontos recomendados pelo ACR. Os pacientes foram divididos nos grupos apoio social normal (ASN) ou ruim (ASR); o ASR foi definido como uma pontuação nos MOS-SSS abaixo do percentil 25 da amostra total. Usou-se o teste de Mann-Whitney ou o teste t não pareado para comparar variáveis intergrupos e o de Fisher para as variáveis categóricas. Usaram-se a análise de covariância e o teste de correlação de Pearson. Não houve diferença nas variáveis sociodemográficas entre os grupos ASN e ASR. Observaram-se diferenças entre os grupos ASN e ASR para todas as quatro subcategorias de apoio social e pontuação total do MOS-SSS. Encontraram-se diferenças significativas entre o ASN e o ASR na depressão (p = 0,007), afeto negativo (p = 0,025) e LDP (p = 0,016). A subcategoria apoio afetivo mostrou correlação positiva entre a dor e o afeto positivo no grupo ASR. A subcategoria interação social positiva mostrou uma correlação negativa entre o FIQ e o estado de depressão. Portanto, o apoio social parece contribuir para a melhoria na saúde mental e física na FM.

Humans , Female , Adult , Aged , Social Support , Fibromyalgia/psychology , Anxiety/etiology , Anxiety/prevention & control , Psychiatric Status Rating Scales , Quality of Life/psychology , Severity of Illness Index , Brazil , Fibromyalgia/complications , Fibromyalgia/diagnosis , Pain Threshold/psychology , Depression/etiology , Depression/prevention & control , Middle Aged
Arq. bras. oftalmol ; 80(1): 4-8, Jan.-Feb. 2017. tab
Article in English | LILACS | ID: biblio-838772


ABSTRACT Purpose: To ınvestigate frequency of fibromyalgia syndrome (FMS) among patients with central serous chorioretinopathy (CSCR). Methods: The study included 83 patients with CSCR and 201 age- and sex-matched healthy controls; the mean age was 47.5 ± 11.3 years in the CSCR group (18 women; 21.7%) and 47.2 ± 11.2 years in the control group (44 women; 21.9%). All participants were assessed for FMS based on 2010 American College of Rheumatology diagnostic criteria and for depression and anxiety with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Results: FMS was diagnosed in 35 patients (42.2%) from the CSCR group and in 21 individuals (10.4%) from the control group (p<0.001). It was found in 77.77% of the women (14/18) and 32.3% of the men (21/65) in the CSCR group and in 22.7% of the women (10/44) and 7.0% of the men (11/157) in the control group. Familial stress, BDI and BAI scores were higher in the patients with FMS than in those without. When independent risk factors were evaluated by logistic regression analysis, it was found that only the presence of familial stress was a significant risk factor for FMS. Conclusions: Patients with CSCR should be assessed for the presence of FMS, and this should be taken into consideration when developing a treatment plan. Further studies with a larger sample size are needed to clarify the relationship between FMS and CSCR.

RESUMO Objetivo: Investigar a frequência da fibromialgia (FMS) entre os pacientes com coriorretinopatia serosa central (CSCR). Métodos: O estudo incluiu 83 pacientes com CSCR e 201 controles saudáveis pareados por idade e sexo. Todos os participantes foram avaliados com base nos critérios de diagnóstico de FMS do American College of Rheumatology de 2010 (ACR), Beck Anxiety Inventory (BAI) e Beck Depression Inventory (BDI). Resultados: A idade média foi 47,53 ± 11,33 anos no grupo CSCR (18 mulheres; 21,7%) e 47,19 ± 11,19 anos (44 mulheres; 21,9%) no grupo controle. FMS foi diagnosticada em 35 pacientes (42,2%) do grupo CSCR e em 21 indivíduos (10,4%) do grupo controle (p<0,001). FMS foi encontrado em 77,77% das mulheres (14/18) e 32,3% dos homens (21/65) no grupo CSCR e em 22,7% das mulheres controles (10/44) e 7,0% dos homens controles (11/157). Estresse familiar, BDI e BAI foram maiores nos pacientes com FMS em comparação com aqueles sem FMS. Quando os fatores de risco independentes foram avaliados por análise de regressão logística, verificou-se que apenas a presença de estresse familiar foi um fator de risco significativo para FMS. Conclusões: Os pacientes com CSCR devem ser avaliados para presença de FMS e a FMS deve ser levada em consideração durante o desenvolvimento de um plano de tratamento. São necessários mais estudos com maior tamanho da amostra para esclarecer relações entre FMS e CSCR.

Humans , Male , Female , Adult , Middle Aged , Fibromyalgia/diagnosis , Central Serous Chorioretinopathy/complications , Socioeconomic Factors , Fibromyalgia/complications , Fibromyalgia/physiopathology , Case-Control Studies , Sex Factors , Prospective Studies , Risk Factors
Arq. neuropsiquiatr ; 74(11): 863-868, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-827992


ABSTRACT Fibromyalgia (FM) is characterized by chronic pain and comorbidities. Objective To investigate sexuality and depression in women with FM compared with controls and to correlate the findings with hematological parameters. Methods 33 women with FM and 19 healthy women were included and evaluated with the following instruments: Female Sexual Function Index, Beck Inventory, Visual Analogue Scale, medical history and laboratory exams. Results The prevalence of sexual dysfunction (P = 0.007) and depression (P < 0.001) were higher in the study group than in the control group; they were positively correlated (P = 0.023). The study group showed lower serum concentrations of testosterone, free T4, antinuclear factor, and lower blood hemoglobin and hematocrit. Conclusions FM was associated with high scores of sexual dysfunction and depression, and there were correlations with hematological parameters. We suggest the involvement of immune-inflammatory mediators and FM, which need further investigation to understand their role in FM syndrome and its comorbidities.

RESUMO Fibromialgia (FS) é caracterizada por dor e comorbidades. Objetivo investigar depressão e sexualidade em mulheres com FS comparadas a controles, e correlacionar os achados com parâmetros hematológicos. Métodos 33 mulheres com FS e 19 controles saudáveis foram incluídas e avaliadas através dos seguintes instrumentos: Índice de Função Feminina Sexual, Inventário de Beck, escala visual analógica, história médica e exames laboratoriais. Resultados A prevalência de disfunção sexual (P = 0,007) e depressão (P < 0,001) foram maiores no grupo de estudo do que nos controles; também houve correlação positiva (P = 0,023). O grupo de estudo apresentou menor concentração sérica de testosterona, T4 livre, fator antinuclear e menos concentração de hemoglobina e hematócrito. Conclusões A FS associou-se com altos índices de disfunção sexual e depressão, e houve correlação com os parâmetros hematológicos estudados. Sugere-se o envolvimento de mediadores imuno-inflamatórios na FS, que necessita de maior investigação para a compreensão dos mecanismos tanto na FS e quanto em suas comorbidades.

Humans , Female , Adult , Middle Aged , Sexual Dysfunction, Physiological/complications , Fibromyalgia/complications , Depression/complications , Testosterone/blood , Thyroxine/blood , Hemoglobins/analysis , Fibromyalgia/physiopathology , Fibromyalgia/blood , Antibodies, Antinuclear/blood , Surveys and Questionnaires , Sexual Dysfunctions, Psychological/complications , Hematocrit
Arq. neuropsiquiatr ; 74(3): 195-200, Mar. 2016. tab
Article in English | LILACS | ID: lil-777132


ABSTRACT Objective To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). Cross-sectional study design: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. Clinical assessment Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. Results Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. Conclusion All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

RESUMO Objetivo Identificar sintomas de disfunção temporomandibular (DTM) em dois grupos de pacientes fibromiálgicas, segundo a relação temporal entre o início da dor facial (DF) e das dores generalizadas no corpo (DGC). Estudo transversal: 53 pacientes consecutivas com fibromialgia e DF foram divididas de acordo com o início da dor orofacial: Grupo A (média de idade 47,30 ± 14,20anos), o início da DF precedeu o da DGC; Grupo-B (idade média 51,33 ± 11,03anos), a DF iniciou concomitantemente ou após a DGC. Avaliação clínica: Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e escala visual analógica (EVA). Resultados Dor miofascial com limitação de abertura bucal (p = 0,038); deslocamento de disco à direita com redução (p = 0,012) e rigidez mandibular (p = 0,004) foram predominantes no Grupo A. Dor miofascial sem limitação de abertura bucal (p = 0,038) e dormência/queimação foram mais comuns no Grupo-B. Conclusão Todos os pacientes tiveram sintomas de DTM, principalmente disfunção muscular. A prevalência de dor miofascial com limitação de abertura bucal e deslocamento de disco à direita com redução foi maior no Grupo A.

Humans , Female , Middle Aged , Facial Pain/physiopathology , Temporomandibular Joint Disorders/complications , Fibromyalgia/complications , Pain Measurement , Temporomandibular Joint Disorders/physiopathology , Fibromyalgia/physiopathology , Cross-Sectional Studies , Range of Motion, Articular
Clinics ; 70(11): 733-737, Nov. 2015. tab, graf
Article in English | LILACS | ID: lil-766149


OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.

Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Fibromyalgia/complications , Mastodynia/etiology , Fibromyalgia/physiopathology , Mastodynia/diagnosis , Mastodynia/physiopathology , Severity of Illness Index , Surveys and Questionnaires , Syndrome , Somatoform Disorders/physiopathology
Rev. bras. reumatol ; 55(4): 334-339, jul.-ago. 2015. tab
Article in Portuguese | LILACS | ID: lil-757468


RESUMOObjetivoInvestigar a presença de síndrome pré-menstrual (SPM), dismenorreia primária (DP) e depressão em mulheres com fibromialgia (FM) e mulheres saudáveis e determinar possíveis fatores relacionados com a SPM e a DP na FM.MétodoEste estudo foi feito com 98 pacientes do sexo feminino com diagnóstico de FM e 102 controles saudáveis pareados por idade e sexo. Todas as pacientes foram avaliadas à procura de síndrome pré-menstrual (SPM) e dismenorreia primária (DP). A síndrome pré-menstrual foi determinada pela presença de um ou mais sintomas afetivos ou somáticos nos cinco dias anteriores à menstruação. O diagnóstico de dismenorreia primária foi definido como a presença de dor abdominal ou lombar com duração mínima de dois dias durante o período menstrual. A dismenorreia foi avaliada pela escala visual analógica. A dismenorreia foi classificada pelo Sistema de Pontuação Multidimensional. A Escala de Depressão de Hamilton foi aplicada a todas as pacientes.ResultadosA dismenorreia primária foi encontrada em 41% das pacientes com FM e 28% do grupo controle. Encontrou-se diferença estatisticamente significativa na DP entre os dois grupos (p = 0,03). A SPM foi detectada em 42% das pacientes com FM e 25% do grupo controle. Houve diferença estatisticamente significativa na SPM entre os dois grupos (p = 0,03).ConclusãoHá um aumento na frequência de síndrome pré-menstrual e dismenorreia em pacientes com FM. Aquelas com escore de gravidade dos sintomas elevado e altas pontuações de depressão entre as pacientes com FM estão em risco de SPM e DP.

ABSTRACTObjectiveIn this study, we aimed to investigate the presence of premenstrual syndrome (PMS), primary dysmenorrhea (PD) and depression among women with fibromyalgia (FM) and healthy females and to determine possible factors related with PMS and PD in FM.MethodThe present study was conducted on 98 female patients diagnosed with FM and 102 age and sex-matched healthy controls. All patients were evaluated for premenstrual syndrome (PMS) and primary dysmenorrhea (PD). Premenstrual syndrome was assessed among the patients for the presence of one or more affective or somatic symptoms within the five days preceding menses. The diagnosis of primary dysmenorrhea was defined as having abdominal pain or lower back pain lasting at least two days during a menstrual period. Dysmenorrhea was assessed via visual analog scale. Dysmenorrhea was rated via Multidimensional Scoring System. The Hamilton depression scale was applied to all patients.ResultsPrimary dysmenorrhea was established in 41% of FM patients and 28% of the control group. A statistically significant difference was found in PD between the two groups (p = 0.03). PMS was established in 42% of the FM patients and 25% of the control group. A statistically significant difference was found in PMS between the two groups (p = 0.03).ConclusionThere is an increased frequency of premenstrual syndrome and dysmenorrhea in FM patients. The patients with high symptom severity scores and high depression scores among the FM patients are at risk of PMS and PD.

Humans , Female , Adult , Depression/complications , Dysmenorrhea/complications , Fibromyalgia/complications , Premenstrual Syndrome/complications , Dysmenorrhea/epidemiology , Premenstrual Syndrome/epidemiology , Risk Assessment
Rev. bras. reumatol ; 55(1): 37-42, Jan-Feb/2015. tab
Article in Portuguese | LILACS | ID: lil-744670


Introdução A associação da fibromialgia (FM) e de lúpus eritematoso sistêmico (LES) tem sido investigada com resultados conflitantes em relação ao impacto de uma condição na outra. Objetivos Determinar a frequência de FM em uma amostra de pacientes com LES atendidos no Conjunto Hospitalar de Sorocaba (CHS) e o impacto da FM na atividade do LES e na qualidade de vida, bem como do LES na FM. Material e métodos Estudo descritivo e transversal. Incluíram-se pacientes que preenchem os critérios de classificação para LES e/ou de FM do Colégio Americano de Reumatologia (ACR). A amostra total foi dividida em três grupos: FM/LES (pacientes com associação LES e FM), LES (somente pacientes com LES) e FM (somente pacientes com FM). As seguintes variáveis foram Questionário de Impacto da Fibromialgia (FIQ), Índice de Atividade do Lúpus Eritematoso Sistêmico (Sledai), Índices dos Critérios Diagnósticos de Fibromialgia de 2010 (IGS E IDG) e o SF-36. Resultados A prevalência de pacientes com FM entre os pacientes com LES foi de 12%. O FIQ não apontou diferença entre os grupos e indicou que o LES não interferiu no impacto causado pela FM isoladamente. A presença da FM em pacientes com LES não influenciou a atividade clínica dessa doença. Observou-se um forte impacto da FM na qualidade de vida nos pacientes com LES e não foi observado o contrário. Conclusões A prevalência de FM observada nos pacientes com LES é de 12%. A presença de FM afeta adversamente a qualidade de vida dos pacientes com LES. .

Introduction The association of fibromyalgia (FM) and systemic lupus erythematosus (SLE) has been investigated, with conflicting results regarding the impact of a condition on the other. Objectives To determine the frequency of FM in a sample of patients with SLE treated at the Hospital Complex of Sorocaba (CHS) and the impact of FM in SLE activity and quality of life, as well as of SLE in FM. Materials and Methods Descriptive and correlational study. Patients who met the American College of Rheumatology (ACR) criteria for SLE and/or FM were included. The total sample was divided into three groups: FM/SLE (patients with association of SLE and FM), SLE (SLE patients only) and FM (FM patients only). The following variables were used: Fibromyalgia Impact Questionnaire (FIQ), activity index of SLE (SLEDAI), Indices of Diagnostic Criteria for Fibromyalgia 2010 (SSI end GPI) and SF-36. Results The prevalence of patients with FM among SLE patients was 12%. FIQ showed no difference between groups, indicating that SLE did not affect the impact caused by FM alone. The presence of FM in SLE patients did not influence the clinical activity of this disease. A strong impact of FM on the quality of life in patients with SLE was observed; the opposite was not observed. Conclusions The prevalence of FM observed in SLE patients is 12%. The presence of FM adversely affects the quality of life of patients with SLE. .

Humans , Female , Adult , Fibromyalgia/complications , Fibromyalgia/diagnosis , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Cross-Sectional Studies , Quality of Life , Self Report , Severity of Illness Index
Rev. bras. reumatol ; 54(1): 27-32, Jan-Feb/2014. tab
Article in Portuguese | LILACS | ID: lil-704278


Introdução: A depressão tem se apresentado como o transtorno mental mais prevalente em pacientes com fibromialgia. O estresse, cujas fases são alarme, resistência, quase-exaustão e exaustão, constitui importante reação do organismo frente a uma situação ameaçadora. Objetivo: Investigar os índices de estresse, ansiedade e depressão em mulheres com fibromialgia, comparando-os com os de mulheres saudáveis. Pacientes e métodos: Participaram 50 mulheres, 25 com o diagnóstico de fibromialgia, segundo os critérios do American College of Rheumatology, e 25 sem o diagnóstico, pareadas por idade. Instrumentos utilizados: Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Ansiedade Traço-Estado (IDATE) e Inventário de Depressão Beck (BDI). Resultados: Idade média de 49,36 anos para o grupo com fibromialgia (FM) e 49,20 anos para o grupo sem fibromialgia (não FM). O FM apresentou maior incidência de estresse (96%) quando comparado com o não FM (5%). A fase de resistência foi predominante nos dois grupos, FM (42%) e não FM (100%). No FM verificou-se distribuição nas quatro fases (alerta, resistência, quase-exaustão e exaustão). As diferenças entre as fases nos grupos analisados foram significativas (p<0,001). O FM apresentou predominância de sintomas psicológicos (54%), o não FM apresentou a mesma frequência de sintomas psicológico e físico/psicológico (40%). Os sintomas de ansiedade estado e traço e depressão do FM foram significativamente superiores, quando comparados com o não FM (p<0,01). Conclusão: Constatou-se índice de estresse (96%), traço de ansiedade (superior a 50) e depressão clinicamente (superior a 20) relevantes no FM. O entendimento das variáveis ...

Introduction: Depression has emerged as the most prevalent mental disorder in patients with fibromyalgia. Stress, whose stages are alarm, resistance, near-exhaustion and exhaustion, constitutes a physical reaction to a threatening situation. Objective: To investigate the levels of stress, anxiety and depression in women with fibromyalgia, comparing them with those of healthy women. Patients and methods: Participants were 50 women, 25 with a diagnosis of fibromyalgia according to the criteria of the American College of Rheumatology, and 25 without this diagnosis, matched for age. Instruments used: Lipp Inventory of Stress Symptoms for Adults (LISS), State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). Results: The mean age was 49.36 years for the group with fibromyalgia (FM) and 49.20 years for the group without fibromyalgia (non-FM). FM showed a higher incidence of stress (96%) compared with non-FM (5%). The resistance phase was predominant in both groups, FM (42%) and non-FM (100%). In FM there was distribution of the four stages (alarm, resistance, near-exhaustion and exhaustion). The differences between phases in the analyzed groups were significant (p < 0.001). FM showed predominance of psychological symptoms (54%); non-FM did show the same frequency of psychological and physical/psychological (40%) symptoms. Symptoms of state and trait anxiety and of depression in FM were significantly higher, when compared with non-FM (p < 0.01). Conclusion: Stress index (96%), trait anxiety (over 50) and clinically relevant depression (greater than 20) in FM were relevant. The understanding of the emotional variables involved in fibromyalgia is important to define the therapeutic strategy. .

Female , Humans , Middle Aged , Anxiety/etiology , Depression/etiology , Fibromyalgia/complications , Stress, Psychological/etiology , Cross-Sectional Studies , Fibromyalgia/psychology
Rev. bras. reumatol ; 53(6): 460-463, nov.-dez. 2013. tab
Article in Portuguese | LILACS | ID: lil-699274


INTRODUÇÃO: A fibromialgia (FM) é uma condição reumatológica que se caracteriza por um quadro de dor crônica generalizada, hiperalgesia e alodinia. Podem estar presentes sintomas como fadiga, distúrbios do sono, rigidez matinal, cefaleia e parestesias. Também está associada a outras comorbidades, como depressão, ansiedade, síndrome do intestino irritável, síndrome miofascial e síndrome uretral inespecífica. Poucos trabalhos têm abordado a evolução da FM, em especial em relação a médio e longo prazo. Por que alguns pacientes se saem melhor do que outros, apesar de serem submetidos ao mesmo tratamento? OBJETIVO: Determinar se há correlação entre variáveis demográficas e clínicas, e a gravidade da FM. MATERIAL E MÉTODOS: Sessenta mulheres que preencheram os critérios de classificação para FM do American College of Rheumatology de 1990 foram divididas em três grupos, de acordo com a gravidade estabelecida pelo Questionário de Impacto da Fibromialgia (FIQ): severa (70-100); moderada (50-70) e leve (0-50). RESULTADOS: Foram analisadas nove variáveis demográficas e clínicas, sendo observada diferença significativa (P < 0,05) apenas nos grupos de maiores escores do FIQ, com a presença de depressão e interesses trabalhistas. CONCLUSÃO: O impacto da FM medido pelo FIQ se correlaciona diretamente com a intensidade da depressão e a presença de interesses trabalhistas.

INTRODUCTION: Fibromyalgia (FM) is a rheumatic condition characterized by a picture of generalized chronic pain, hyperalgesia and allodynia. Symptoms such as fatigue, sleep disorders, morning stiffness, headache and paresthesia can also be present. It is also associated with other comorbidities, such as depression, anxiety, irritable bowel syndrome, myofascial pain syndrome and nonspecific urethral syndrome. Few studies have addressed the evolution of FM, especially regarding medium and long-term evolution, such as why some patients do better than others, despite the fact of being submitted to the same treatment. OBJECTIVE: To determine whether there is a correlation between demographic and clinical variables and FM severity. MATERIAL AND METHODS: Sixty women who met the classification criteria for FM of the American College of Rheumatology of 1990 were divided into three groups, according to the severity established by the Fibromyalgia Impact Questionnaire (FIQ): severe (70-100), moderate (50 to 70) and mild (0 to 50). RESULTS: Nine demographic and clinical variables were assessed, with a significant difference (P <0.05) being observed only in the groups showing higher FIQ scores with the presence of depression and workers' compensation interests. Conclusion: The impact of FM measured by the FIQ is directly correlated with the severity of depression and the presence of workers' compensation interests.

Female , Humans , Middle Aged , Fibromyalgia/diagnosis , Fibromyalgia/epidemiology , Cross-Sectional Studies , Demography , Fibromyalgia/complications , Severity of Illness Index , Surveys and Questionnaires
Rev. bras. reumatol ; 53(6): 494-500, nov.-dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-699279


OBJETIVOS: Analisar os efeitos do tratamento hidrocinesioterapêutico na qualidade de vida, percepção de dor e gravidade de episódios depressivos em um grupo de pacientes com fibromialgia. MATERIAIS E MÉTODOS: Foram avaliados 64 indivíduos do sexo feminino, separados em dois grupos: hidrocinesioterapia (n = 33; 58,2 ± 10,6 anos) e grupo controle (n = 31; 59,6 ± 9,4 anos), com diagnóstico de fibromialgia. Os indivíduos foram avaliados através da Escala Analógica Visual de Dor (EVA), o Fibromyalgia Impact Questionnaire (FIQ), e o Inventário de Beck. Os participantes foram submetidos a um tratamento hidrocinesioterápico numa piscina aquecida a 33ºC com duas sessões de 45 minutos por semana, ao longo 15 semanas, num total de 30 sessões. Os exercícios subaquáticos foram: de condicionamento cardiovascular, de força, de mobilidade, de coordenação, de equilíbrio, de alongamento e de relaxamento muscular. Utilizou-se a ANOVA 2×2 e Kruskal-Wallis para análise estatística. RESULTADOS: Foram observadas melhorias estatisticamente significativas na percepção da intensidade da dor (Δ% = -28,2%, p < 0,01), na qualidade de vida (Δ% = -32,4%, p < 0,05) e nos sintomas de depressão (Δ% = -35,4%, p < 0,05) favoráveis ao grupo hidrocinesioterapia comparado ao grupo controle. CONCLUSÕES: O estudo sugere que a hidrocinesioterapia mostrou-se eficaz como terapia alternativa da fibromialgia. No entanto, recomenda novos estudos que testem as associações existentes entre as variáveis analisadas e os programas de intervenção, utilizando as atividades aquáticas, bem como a modificabilidade dos parâmetros de saúde física e psíquica quando estes indivíduos são submetidos a programas de curta, média e longa duração.

OBJECTIVES: The aim of this study was to analyze the effects of treatment by hydrotherapy on quality of life, perception of pain and the severity of depression in a group of patients with fibromyalgia. MATERIALS AND METHODS: We evaluated 64 females divided into two groups: hydrocinesiotherapy (n = 33, 58.2 ± 10.6 years) and control group (n = 31 with 59.6 ± 9.4 years) with clinical diagnosis of fibromyalgia. Individuals were assessed by Visual Analog Scale of Pain (VAS), the Fibromyalgia Impact Questionnaire (FIQ) and the Beck Depression Inventory. Participants underwent a treatment in a hydrotherapy pool heated to 33ºC over a period of 15 weeks, two sessions per week of 45 minutes, a total of 30 sessions. The exercises were underwater: cardiovascular conditioning, strength training, mobility, coordination, balance and still, stretching exercises and muscle relaxation. The ANOVA 2×2 and Kruskall-Wallis was used for statistical analysis RESULTS: There were statistically significant improvements in the perception of pain intensity (Δ% = -28.2%, p < 0, 01), quality of life (Δ% = -32.4%, p < 0, 05) and depression symptoms (Δ% = -35.4%, p < 0, 05) in favor of the Hydrotherapy group compared to the control group. CONCLUSIONS: The study suggests that hydrocinesiotherapy was effective as an alternative therapy for fibromyalgia, however further studies are recommended to test the associations between the variables and intervention programs and using the water activities, and the modifiability of the parameters of physical and mental health when these individuals undergo programs of short, medium and long duration.

Female , Humans , Middle Aged , Attitude to Health , Depression/etiology , Exercise Therapy , Fibromyalgia/complications , Fibromyalgia/therapy , Hydrotherapy , Quality of Life , Self Concept , Pain Measurement , Surveys and Questionnaires
Rev. bras. reumatol ; 53(4): 335-340, ago. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-690714


OBJETIVO: Determinar a frequência de entesopatia na fibromialgia (FM) utilizando um método de ultrassonografia (US) recém-desenvolvido, o escore Madrid Sonography Enthesitis Index (MASEI). MÉTODOS: Este estudo foi realizado em 38 pacientes com FM consecutivos e 48 controles saudáveis pareados para idade e sexo. Seis sítios de ênteses (tuberosidade do olécrano, polos superior e inferior da patela, tuberosidade tibial, polos superior e inferior do calcâneo) nos dois membros inferiores foram avaliados. Todos os achados da US foram identificados de acordo com o escore MASEI. Os escores de pacientes e controles foram comparados usando-se o teste t de Student e o teste U de Mann-Whitney. A validade foi analisada pela curva receiver operating characteristic (ROC). Valores de P < 0,05 foram considerados significativos. RESULTADOS: O escore total de entesite foi 7,39 ± 4,99 (média ± DP) para os pacientes com FM e 3,7 ± 3,22 para os controles saudáveis (P < 0,001). A curva ROC estabeleceu um escore de US > 3,5 no grupo de FM como o melhor ponto de corte para diferenciar casos de controles. Não houve correlação estatisticamente significativa entre o escore MASEI e a duração da FM, e a localização dos pontos dolorosos. CONCLUSÕES: Erros no diagnóstico de FM são prejudiciais aos pacientes e à comunidade, e a presença de entesopatia entre pacientes com FM é crescente. Sua detecção por meio do escore MASEI pode ser útil para discriminar pacientes com FM, cujos sintomas e sinais são mal definidos, para evitar equívoco de tratamento.

OBJECTIVE: The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). METHODS: This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P < 0.05 were considered significant. RESULTS: Total enthesitis score was 7.39 ± 4.99 (mean ± SD) among FM patients and 3.7 ± 3.22 among healthy controls (P < 0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. CONCLUSIONS: Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

Adult , Female , Humans , Male , Middle Aged , Young Adult , Fibromyalgia/complications , Rheumatic Diseases/etiology , Rheumatic Diseases , Rheumatic Diseases/epidemiology
Vertex rev. argent. psiquiatr ; 24(111): 373-91, 2013 Sep-Oct.
Article in Spanish | LILACS, BINACIS | ID: biblio-1176927


We present a description of the Central Sensitivity Syndrome (CSS) and some of its main components such as Multiple Chemical Sensitivity Syndrome, Chronic Fatigue Syndrome and Fibromyalgia. We review the changes in pain perception, describing the physiology and pathophysiology of the painful experience from the medulla horn to the CNS. We explain the theory of central sensitization as the basis to the syndrome. We refer to the differences between fibromyalgia and depressive disorders, is spite of their frequent presentation in comorbidity. We state the main clinical and neurobiological differences. We point out the main psychoneuroimmunoendocrinologic differences such as adrenal activity (hypoactivity vs. hyperactivity, DST hypersuppressive response vs. DST non suppression, hypersensitivity of central glucocorticoid receptors vs. desensitization of these, among others), thyroid (probable reverse T3 vs. flat stimuli TSH response curve) and growth hormone secretion (probable increase vs. disruption of normal circadian rhythm) that makes CSS resemble PTSD. We describe differential changes in sleep patterns (alpha-delta intrusion vs. altered sleep time, REM latency, and stage 3/4) and immunological disturbances almost opposite in each pathological entity. We finally argue which medical specialty should treat these complex syndromes.

Fibromyalgia/complications , Multiple Chemical Sensitivity/complications , Fatigue Syndrome, Chronic/complications , Depressive Disorder/complications , Humans , Syndrome
Rev. bras. reumatol ; 52(6): 851-857, nov.-dez. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-658143


INTRODUÇÃO: A síndrome da fibromialgia acomete 8% da população com mais de 40 anos de idade. Dos pacientes com fibromialgia, 75% queixam-se de má qualidade do sono. OBJETIVO: Avaliar os efeitos da hidrocinesioterapia sobre a capacidade funcional e a qualidade de sono em pacientes com fibromialgia. MÉTODOS: As pacientes foram atendidas na policlínica da UNASP. Foram avaliadas 60 pacientes portadoras de fibromialgia na faixa etária entre 30 e 65 anos. Das pacientes avaliadas, 20 foram excluídas e 10 desistiram devido à impossibilidade de apresentar-se no horário do programa de exercícios. Todas as pacientes responderam aos seguintes questionários: Questionário sobre o Impacto daFibromialgia (QIF), Índice da Qualidade do Sono de Pittsburgh e Escala de Sonolência de Epworth. As sessões foram realizadas duas vezes por semana, com duração de 60 minutos cada, por um período de dois meses. RESULTADOS: A média da idade das pacientes foi de 45 anos; 66% eram trabalhadoras ativas e 34% estavam afastadas do trabalho. Verificouse que imediatamente após participarem do programa da hidrocinesioterapia, as pacientes apresentaram melhora nos seguintes aspectos avaliados por meio do QIF: capacidade funcional, absenteísmo ao trabalho, capacidade de serviço, intensidade da dor, fadiga, cansaço matinal, rigidez (P < 0,0001), ansiedade (P = 0,0013) e depressão (P < 0,0001). Houve também melhora da qualidade do sono (P < 0,0001) e no grau de sonolência diurna (P = 0,0003). CONCLUSÃO: A hidrocinesioterapia promove melhora de qualidade do sono, capacidade funcional, situação profissional, distúrbio psicológicos e sintomas físicos da síndrome em pacientes com fibromialgia.

INTRODUCTION: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fibromyalgia have poor sleep quality. OBJECTIVE: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fibromyalgia. METHODS: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fibromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. RESULTS: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. CONCLUSION: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fibromyalgia.

Adult , Aged , Female , Humans , Middle Aged , Activities of Daily Living , Fibromyalgia/therapy , Hydrotherapy , Quality of Life , Sleep , Fatigue/etiology , Fatigue/therapy , Fibromyalgia/complications , Prospective Studies , Sleep Wake Disorders/etiology , Sleep Wake Disorders/therapy
Rev. bras. reumatol ; 52(5): 672-678, set.-out. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-653721


OBJETIVO: Avaliar a efetividade das orientações para higiene do sono em mulheres portadoras de fibromialgia. MATERIAIS E MÉTODOS: Setenta mulheres completaram o estudo. Na avaliação foram aplicados o Questionário de Impacto da Fibromialgia(FIQ), o Índice de Qualidade do Sono de Pittsburgh (PSQI) e um questionário geral, com dados pessoais e informações de hábitos de vida. Todas as pacientes receberam informações quanto à doença, além de um diário do sono, e apenas o grupo-experimental recebeu orientações para higiene do sono. Foi solicitado às pacientes que realizassem a higiene do sono, e as mesmas foram reavaliadas após três meses. RESULTADOS: A idade média das pacientes do grupo-controle foi 55,2 ± 7,12 anos, e a do grupo-experimental foi 53,5 ± 8,89 anos (P = 0,392). Nessas pacientes foram observadas diminuições da medida de Escala Visual Analógica de dor (P = 0,028), de cansaço (P = 0,021) e do componente 1 do PSQI (P = 0,030). O grupo que recebeu orientações para higiene do sono mostrou redução significativa na dificuldade de retorno ao sono quando acordava de madrugada (P = 0,031). O grupo-experimental apresentou aumento na porcentagem de relatos de "ambiente sem ruído" (variando de 42,9% para 68,6%), diminuição da porcentagem de relatos de "ambiente com pouco ruído" (variando de 40% para 22,9%) e diminuição na porcentagem de relatos de "ambiente com muito ruído" (variando de 17,1% para 8,6%). As alterações facilitaram o retorno ao sono quando as pacientes acordavam durante a madrugada. CONCLUSÃO: Uma cartilha com orientações de higiene do sono permitiu a alteração do comportamento das pacientes, que obtiveram melhora da dor e do cansaço, aumento da qualidade subjetiva do sono, além de facilitação do retorno ao sono após despertar durante a madrugada.

OBJECTIVE: To evaluate the effectiveness of sleep hygiene instructions for women with fibromyalgia. MATERIALS AND METHODS: Seventy women with fibromyalgia completed the study. The assessment comprised the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and a general questionnaire with personal data and lifestyle information. All patients received information about the disease and a sleep diary, but only the experimental group received the sleep hygiene instructions. Patients were asked to practice sleep hygiene, and, after three months, they were reevaluated by use of the same questionnaires. RESULTS: The mean age in the control group was 55.2 ±7.12 years, and, in the experimental group, 53.5 ±8.89 years (P = 0.392). The experimental group showed: a decrease in the pain Visual Analogue Scale values (P = 0.028), in fatigue (P = 0.021), and in the PSQI component 1 (P = 0.030); and a significant reduction in the difficulty falling asleep after waking up in the middle of the night (P = 0.031). The experimental group also showed an increase in the reporting percentage of "silent environment" (ranging from 42.9% to 68.6%), a decrease in the reporting percentage of "fairly quiet environment" (ranging from 40% to 22.9%), and a decrease in the reporting percentage of "noisy environment" (ranging from 17.1% to 8.6%). These changes facilitated falling asleep after waking up in the middle of the night. CONCLUSION: The sleep hygiene instructions allowed changing the patients' behavior, which resulted in pain and fatigue improvement, increased subjective quality of sleep, in addition to facilitating falling asleep after waking up in the middle of the night.

Female , Humans , Middle Aged , Fatigue/therapy , Fibromyalgia/therapy , Pain Management/methods , Sleep , Fatigue/etiology , Fibromyalgia/complications , Surveys and Questionnaires
Rev. Assoc. Paul. Cir. Dent ; 66(3): 206-211, jul.-set. 2012. ilus
Article in Portuguese | LILACS, BBO | ID: lil-667472


Para a correta condução de um tratamento de DTM é necessário que o Cirurgião-Dentista tenha conhecimento sobre doenças relacionadas a quadros álgicos difusos, como a fibromialgia e a otalgia, para que com isso seja capaz de formular o diagnóstico diferencial e estabelecer a conduta terapêutica adequada. O presente artigo relata o caso clínico de uma paciente de 42 anos, portadora de fibromialgia, que procurou o Serviço ATM (FO/UFJF) com queixa principal de tontura intensa, otalgia e zumbido, associada a dores orofaciais. O diagnóstico foi sugestivo de desordem temporomandibular associada à fibromialgia, tendo como fatores relacionados hábitos parafuncionais (bruxismo, apertamento e hábitos posturais inadequados), estresse emocional, ansiedade e quadros depressivos. A proposta terapêutica adotada baseou-se no tratamento odontológico de suporte com uso da placa neuromiorrelaxante e manutenção da terapia medicamentosa que proporcionou diminuição e estabilidade da sintomatologia, mesmo após seis meses de acompanhamento.

For the correct conduct of a treatment of TMD is ímportant that the dentist has knowledge about diseases related about diffuse painful picture, such as ear pain and fibromyalgia, to be able to formulate a differential diagnosis and establish the appropriate therapeutic approach. This article reports a case of a patient 42 years old, with fibromyalgia, who sought the ATM Service (FO/UFJF) complaining of severe dizziness, ear pain and tinnitus associated with orofacial pain. The diagnosis was suggestive of temporomandibular disorders associated with fibromyalgia, and related factors such as parafunctional habits (bruxism, clenching and improper postural habitsl emotional stress, anxiety and depression. Therapeutic proposal adopted was based on the dental treatment with use of the support plate neuromiorrelaxante and drug therapy that provide compensation if reduction and stability of symptoms, even after six months of follow-up.

Humans , Female , Earache , Fibromyalgia/complications , Temporomandibular Joint Dysfunction Syndrome/complications , Therapeutics
Rev. Esc. Enferm. USP ; 46(3): 590-596, jun. 2012. ilus, tab
Article in Portuguese | LILACS, BDENF | ID: lil-640396


Este estudo teve como objetivo identificar a frequência de sintomas ansiosos e depressivos verificando a associação entre a ansiedade-traço, sintomas atuais de depressão e ansiedade nos fibromiálgicos. Foram entrevistados 60 sujeitos com diagnóstico de fibromialgia no Ambulatório de Reumatologia da Universidade Federal de Sergipe, entre agosto de 2007 a março de 2008, sendo aplicados dois questionários: Escala Hospitalar de Ansiedade e Depressão (EHAD) e o Inventário de Ansiedade Traço-Estado (IDATE-T). A frequência de sintomas depressivos e ansiosos foi, respectivamente, de 50% e 86% para os fibromiálgicos e a média do escore do traço ansioso foi de 59,38. Detectou-se associação entre a ansiedade-traço e estado. A ansiedade e a depressão foram sintomas frequentes nos pacientes com fibromialgia. Entretanto, a ansiedade revelou-se um sintoma secundário mais frequente que a depressão, apresentando-se uma forma mais grave, sendo uma comorbidade que deve ser melhor valorizada e estudada.

The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.

Se objetivó identificar la frecuencia de síntomas de ansiedad y depresión y verificar la asociación entre ansiedad-rasgo y síntomas actuales de depresión y ansiedad en fibromiálgicos. Fueron entrevistados 60 sujetos con diagnóstico de fibromialgia en Ambulatorio de Reumatología de Universidad Federal de Sergipe, de agosto 2007 a marzo 2008. Se aplicaron dos cuestionarios: Escala Hospitalaria de Ansiedad y Depresión (EHAD) e Inventario de Ansiedad Rasgo-Estado (IDATE-T). La frecuencia de síntomas depresivos y ansiosos fue, respectivamente, 50% y 86% para los fibromiálgicos y el promedio de puntaje del rasgo ansioso fue de 59,38. Se observó asociación entre ansiedad-rasgo y estado. La ansiedad y la depresión fueron síntomas frecuentes en pacientes con fibromialgia. Entretanto, la ansiedad fue un síntoma secundario más frecuente que la depresión y se presentó de forma más grave, resultando una comorbilidad que necesita ser más valorizada y estudiada.

Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anxiety/diagnosis , Anxiety/etiology , Depression/diagnosis , Depression/etiology , Fibromyalgia/complications , Anxiety/epidemiology , Cross-Sectional Studies , Depression/epidemiology