Functional connectivity associated with attention networks differs among subgroups of fibromyalgia patients: an observational case-control study.

Fibromyalgia is a heterogenous chronic pain disorder diagnosed by symptom-based criteria. The aim of this study was to clarify different pathophysiological characteristics between subgroups of patients with fibromyalgia. We identified subgroups with distinct pain thresholds: those with a low pressure pain threshold (PL; 16 patients) and those with a normal pressure pain threshold (PN; 15 patients). Both groups experienced severe pain. We performed resting-state functional MRI analysis and detected 11 functional connectivity pairs among all 164 ROIs with distinct difference between the two groups (p < 0.001). The most distinctive one was that the PN group had significantly higher functional connectivity between the secondary somatosensory area and the dorsal attention network (p < 0.0001). Then, we investigated the transmission pathway of pain stimuli. Functional connectivity of the thalamus to the insular cortex was significantly higher in the PL group (p < 0.01 - 0.05). These results suggest that endogenous pain driven by top-down signals via the dorsal attention network may contribute to pain sensation in a subgroup of fibromyalgia patients with a normal pain threshold. Besides, external pain driven by bottom-up signals via the spinothalamic tract may contribute to pain sensations in another group of patients with a low pain threshold. Trial registration: UMIN000037712.

Reduced sympathetic activity is associated with the development of pain and muscle atrophy in a female rat model of fibromyalgia.

Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective ß2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a ß2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.

S100 proteins: a new frontier in fibromyalgia research.

Fibromyalgia (FM) is a chronic condition that causes widespread pain, fatigue, and other symptoms that significantly affect quality of life. The underlying mechanisms of fibromyalgia involve both the immune system and the central nervous system. It has been proposed that changes in multiple ascending and descending pathways in the central nervous system may contribute to increased pain sensitivity in individuals with this condition. Recent research has identified S100 proteins as a new area of interest in fibromyalgia studies. These proteins are a group of small molecular weight proteins involved in inflammation and various functions inside and outside of cells, and they may play a critical role in the development and progression of FM. Although S100B has been the most studied in FM patients, other studies have reported that S100A7, S100A8, S100A9, and S100A12 may also be useful as potential biomarkers or for a deeper understanding of FM pathophysiology. The potential role of S100 proteins in the pathophysiology of fibromyalgia could be mediated by RAGE and TLR4, which signal through JNK, ERK, and p38 to activate AP-1 and NF-κB and induce the release of proinflammatory cytokines, thereby producing the inflammation, fatigue, and chronic pain characteristic of fibromyalgia. To gain new perspectives on targeted therapeutic approaches, it is crucial to understand how S100 proteins could impact the pathophysiology of fibromyalgia. This review examines the potential role of S100 proteins in fibromyalgia and their impact on improving our comprehension of the condition, as well as facilitating further research on this interesting topic.

The efficacy of heart rate variability biofeedback training on sleep disorders and impact of fibromyalgia: Results of a phase II randomized controlled trial.

OBJECTIVE: Fibromyalgia syndrome (FMs) is a chronic, musculoskeletal pain disorder characterized by sleep disturbances, fatigue, and cognitive dysfunction. Heart rate variability biofeedback (HRV-BF) aiming to improve self-regulation and strengthen the parasympathetic nervous system has been shown to be effective in several pain syndromes, but its efficacy in FMs has not been adequately investigated. This Phase II trial aimed to assess the feasibility and preliminary measurement of the improvement induced by HRV-BF in FMs. METHODS: Sixty-four patients with FMs were recruited. Patients were randomly assigned to either the experimental group (EG) or the control group (CG). The EG received 10 HRV-BF training sessions in addition to pharmacological standard therapy. The CG received standard therapies for 10 weeks. The FMs impact on daily life, sleep regularity, sense of coherence, depression symptoms and pain has been assessed as primary outcomes, quality of life as secondary. RESULT: 23 (71.9%) of EG patients completed the intervention and 20 (62.5%) of the CG were re-evaluated at time T1. No side effects were reported. It was not found any statistical differences between groups over time in primary and secondary outcomes. CONCLUSIONS: The HRV-BF intervention did not demonstrate efficacy in both primary and secondary outcomes. However, it is quite feasible in terms of drop-out rate and side effects. Further studies with larger sample sizes are needed to determine its actual efficacy. CLINICALTRIALS: gov with code: NCT04121832.

Nutritional Status, Dietary Intake, Quality of Life, and Dysphagia in Women With Fibromyalgia.

BACKGROUND: Fibromyalgia syndrome (FMS) is an idiopathic chronic disease characterized by widespread musculoskeletal pain, hyperalgesia, and allodynia that has been recently associated with risk of dysphagia. OBJECTIVE: We aimed to analyze the association between nutritional status, micro- and macronutrient intake, and quality of life (QoL) in a cohort of women with FMS and risk of dysphagia compared to women with FMS without risk of dysphagia. METHODS: A cross-sectional study was conducted in 46 women with FMS. Risk of dysphagia was assessed by the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST). The Food Frequency Questionnaire and the Swallowing Quality of Life Questionnaire were used to assess dietary intake and QoL, respectively. RESULTS: Thirty women with FMS were at risk for dysphagia (65.21%), assessed by the EAT-10. Based on the V-VST, the frequency of risk of dysphagia was 63.04%. Significant differences in body mass index (BMI) were found between women at risk for dysphagia and those without risk. Women at risk for dysphagia had significantly lower overall QoL scores than those women without risk. No significant differences were found for dietary intake and dysphagia risk. DISCUSSION: Women with FMS at risk for dysphagia have significantly lower BMI values and worse QoL than women without dysphagia risk, supporting the importance of assessing dysphagia in clinical practice in persons with FMS.

Surveying the International Prevalence and Nature of Eating, Drinking and Swallowing Difficulties in Adults Presenting with Fibromyalgia.

Fibromyalgia is a centralized pain syndrome characterized by widespread pain, fatigue, sleep and sensory issues. Fibromyalgia is present in up to 8% of the global population, disproportionally affecting females. Research acknowledges that patients with similar rheumatic/neurological disorders experience eating, drinking and swallowing difficulties. There are also anecdotal reports regarding dysphagia among the fibromyalgia community. However, there is limited research exploring these issues, with potential impact on care delivery and patient outcomes. This study investigated the nature and prevalence of dysphagia in an international sample of adults with fibromyalgia. An online cross-sectional survey design was used to gather data. Questions were adapted from a criterion-based assessment and available evidence. The survey focused on demographics, dysphagia symptoms, and symptom experiences. Results were analyzed using descriptives and correlational analysis. 1983 individuals participated (age range: 18-94), located: Australia (n = 18), Ireland (n = 63), Canada (n = 174), New Zealand (n = 253), the UK (n = 434) and the USA (n = 1024). Many eating, drinking and swallowing symptoms were reported, including food sticking in the throat during swallowing (89%), and pills taking extra effort to swallow (88%), and dry mouth (85%). This study identified previously under-explored eating, drinking and swallowing difficulties among adults with fibromyalgia. These difficulties were self-reported across age, gender, and location, highlighting the potential prevalence of these concerns among a wide range of people, despite having not been explored in depth in previous studies. Timely and accurate dysphagia identification is vital given the its' potential impact on nutrition, prognosis and quality of life. This study highlighted the importance of honoring patient experiences in fibromyalgia management while also recommending input from allied health professionals such as SLTs and dietitians to improve therapeutic relationships and clinical outcomes. As such, continued research into the cause, implications, and management of these issues beyond is required to inform and optimise future patient-centred service delivery and care provision.

Patient-Reported Impact of Symptoms in Fibromyalgia (PRISM-FM).

OBJECTIVE: To identify the frequency and relative importance of symptoms experienced by adults with fibromyalgia (FM) and determine factors associated with a higher disease burden. METHODS: We conducted semistructured interviews with 15 participants with FM, collecting 1479 quotes regarding the symptomatic burden of FM. We then performed an international cross-sectional study involving 1085 participants with FM to determine the prevalence and relative importance (scale 0-4) of 149 symptoms representing 14 symptomatic themes. We performed subgroup analysis to determine how age, sex, disease duration, medication use, employment status, change in employment status, missing work due to FM, and ability level are related to symptomatic theme prevalence. RESULTS: The symptomatic themes with the highest prevalence in FM were pain (99.8%), muscle tenderness (99.8%), and fatigue (99.3%). The symptomatic themes that had the greatest effect on patients' lives were related to fatigue (2.88), pain (2.85), muscle tenderness (2.79), and impaired sleep and daytime sleepiness (2.70). Symptomatic theme prevalence was most strongly associated with the modified Rankin Scale level of disability, disability status, and change in employment status (on disability vs not on disability). CONCLUSION: Participants with FM identify a variety of symptoms that significantly affect their daily lives. Many of these symptoms, such as fatigue, sleep disturbance, and activity limitation, are life-altering and not related to traditional diagnostic criteria. Symptom prevalence in this population varies across subgroups based on demographic categories and disability status.

Influence of Transcutaneous Electrical Nerve Stimulation (TENS) on Pressure Pain Thresholds and Conditioned Pain Modulation in a Randomized Controlled Trial in Women With Fibromyalgia.

Transcutaneous electrical nerve stimulation (TENS) effectively reduces pain in fibromyalgia (FM). The purpose of this study was to examine the influence of TENS use on pressure pain thresholds (PPT) and conditioned pain modulation (CPM) in individuals with FM using data from the Fibromyalgia Activity Study with TENS trial (NCT01888640). Individuals with FM were randomly assigned to receive active TENS, placebo TENS, or no TENS for 4 weeks. A total of 238 females satisfied the per-protocol analysis among the active TENS (n = 76), placebo TENS (n = 68), and no TENS (n = 94) groups. Following 4 weeks of group allocation, the active TENS group continued for an additional 4 weeks of active TENS totaling 8 weeks (n = 66), the placebo and no TENS groups transitioned to receive 4 weeks of active TENS (delayed TENS, n = 161). Assessment of resting pain, movement-evoked pain (MEP), PPT, and CPM occurred prior to and following active, placebo, or no TENS. There were no significant changes in PPT or CPM among the active TENS, placebo TENS, or no TENS groups after 4 weeks. Individuals who reported clinically relevant improvements in MEP (≥30% decrease) demonstrated increases in PPT (P < .001), but not CPM, when compared to MEP non-responders. There were no significant correlations among the change in PPT or CPM compared to MEP and resting pain following active TENS use (active TENS + delayed TENS). PPT and CPM may provide insight to underlying mechanisms contributing to pain; however, these measures may not relate to self-reported pain symptoms. PERSPECTIVE: Pressure pain threshold increased in individuals with clinically relevant improvement (≥30%) in MEP, indicating the clinical relevance of PPT for understanding mechanisms contributing to pain. CPM was not a reliable indicator of treatment response in MEP responders.

Efectos de la estimulación transcraneal por corriente directa y de la estimulación magnética transcraneal en pacientes con fibromialgia. Revisión sistemática / Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review

ntroducción: La fibromialgia (FM) es una patología crónica caracterizada por la presenciade dolor musculoesquelético generalizado que se asocia a trastornos psicológicos que afectana la calidad de vida. En los últimos a˜nos, la estimulación transcraneal con corriente directa(tDCS) y la estimulación magnética transcraneal (TMS) se han estudiado para el abordaje deldolor crónico. El objetivo de esta revisión es determinar los efectos de la tDCS y la TMS en lossíntomas característicos de los pacientes con FM.Desarrollo: Se realizó una revisión sistemática acorde a los criterios PRISMA. Se realizaronbúsquedas en las bases de datos Medline, Scopus, PEDro y Cochrane Library. Se seleccionaronensayos clínicos aleatorizados que analizaran los efectos de estas intervenciones en el dolor, elumbral de dolor a la presión, la fatiga, la ansiedad y depresión, el catastrofismo y la calidad devida en pacientes con FM. Se incluyeron 14 estudios.Conclusiones: La aplicación de tDCS en el córtex motor es la única intervención que ha mos-trado disminuir el dolor a corto y medio plazo en pacientes con FM. La aplicación de ambasintervenciones ha mostrado mejoras en el umbral de dolor a la presión, el catastrofismo y lacalidad de vida cuando se aplica en el córtex motor, y de la fatiga cuando se aplica en la cortezadorsolateral prefrontal. Los efectos de estas intervenciones en la ansiedad y depresión no sonconcluyentes.(AU)

Introduction: Fibromyalgia syndrome (FM) is a chronic pathology characterized by widespreadpain commonly associated with psychological distress affecting quality of life. In recent years,transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) havebeen investigated to treat chronic pain. The aim of the current review is to determine theeffects of tDCS and TMS on the main symptoms of patients with FM.Development: A systematic review based on PRISMA guidelines was carried out. The searchstrategy was performed in Medline, Scopus, PEDro and Cochrane Library. Randomized controlledtrials based on the effects of tDCS and TMS on pain, pressure pain threshold, fatigue, anxietyand depression, catastrophizing and quality of life in patients with FM were analysed. Fourteenstudies were included.Conclusions: The application of tDCS to the motor cortex is the only intervention shown todecrease pain in the short and medium-term in patients with FM. The application of bothinterventions showed improvements in pressure pain threshold, catastrophizing and quality oflife when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontalcortex. The effects of these interventions on anxiety and depression are unclear.(AU)

Impact of being physically active on the brain electrocortical activity, brain volumetry and performance in the Stroop color and word test in women with fibromyalgia.

Physical exercise is one of the treatment approaches with the most robust evidence against fibromyalgia (FM) symptoms. This study aimed to investigate the impact of being physically active on the Stroop Color and Word Test (SCWT) performance as well as to investigate and compare the brain electrocortical activity during SCWT. A total of 31 women completed the SCWT while EEG was recorded. People with FM were divided into two groups (physically and non-physically active) according to the WHO guidelines. Furthermore, magnetic resonance imaging was acquired and health-related quality of life, the impact of the disease, and the six-minute walking test were administered. Physically active group showed better performance in the SCWT, exhibiting less error in name different color patches condition (C), more correct responses in named color-word condition (CW) and higher interference score than non-physically active group. Moreover, a significantly higher theta power spectrum in the Fp1 during the condition C in the SCWT and a higher volume in the right rostral middle frontal gyrus have been found in the physically active group. Furthermore, physically active women with FM showed positively correlations between correct responses in names of colors printed in black condition (W) in the SCWT and theta power in the F3, Fz, Fp2 and F4 scalp positions. Regarding non-physically active women with FM, errors in condition CW negatively correlated with the volume of left superior frontal gyrus, left rostral middle frontal gyrus, right rostral middle frontal gyrus, left caudal middle frontal gyrus and right caudal middle frontal gyrus. Furthermore, physically active group showed increased performance in the 6 min walking test and lower disease impact. Fulfil the physical activity recommendation seems to protect brain health since better SCWT performance, greater frontal theta power and higher volume in the right rostral middle frontal gyrus have been found in physically active women with FM.

Laser evoked potentials in fibromyalgia with peripheral small fiber involvement.

OBJECTIVE: To evaluate multichannel laser evoked potentials (LEPs) in patients with fibromyalgia (FM) and small fiber impairment. METHODS: We recorded LEPs using 65 electrodes in 22 patients with FM and proximal denervation, 18 with normal skin biopsy, and 7 with proximal and distal intraepidermal nerve fiber density (IENFD) reduction. We considered the amplitude and topographical distribution of N1, N2 and P2 components, and habituation of N2 and P2 waves. The sLORETA dipolar analysis was also applied. We evaluated 15 healthy subjects as controls. RESULTS: We observed reduced amplitude of the P2 component in FM group, without a topographic correspondence with the prevalent site of denervation. Decreased habituation of P2 prevailed in patients with reduced IENFD. The cingulate cortex and prefrontal cortex, were activated in the FM group, without correlation between the degree of denervation and the strength of late wave dipoles. A correlation was noted between anxiety, depression, fibromyalgia invalidity, and pain diffusion. CONCLUSIONS: The amplitude and topography of LEPs were not coherent with epidermal nerve fiber density loss. They supposedly reflected the clinical expression of pain and psychopathological factors. SIGNIFICANCE: Multichannel LEPs are not the expression of small fiber impairment in FM. Rather, they reflect the complexity of the disease.

The relationship between cervical proprioception and balance in patients with fibromyalgia syndrome.

Proprioceptive abnormalities, balance, and postural disorders have been previously reported in fibromyalgia syndrome (FMS). Unlike previous research, the aim of this study was to compare the proprioception of the cervical region of patients with FMS with a healthy control group. The relationship between cervical proprioception impairment and loss of balance was also examined. A total of 96 female FMS patients and 96 female healthy control subjects were enrolled in this case-control study. The cervical joint position error test (CJPET) was administered to the patient and control groups for cervical proprioception evaluation. FMS patients were assessed with a visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and fatigue severity scale (FSS). Balance tests were applied to both groups. FMS patients had significantly impaired CJPET results in all directions (p < 0.001). There were significant positive correlations between FIQ scores and CJPET results (r = 0.542 and p < 0.001 for right rotation; r = 0.604 and p < 0.001 for left rotation; r = 0.550 and p < 0.001 for flexion; r = 0.612 and p < 0.001 for extension). Significant correlations were found between CJPET measurements and balance tests (for sit-to-stand test; r = 0.510 and p < 0.001 for right rotation; r = 0.431 and p < 0.001 for left rotation; r = 0.490 and p < 0.001 for flexion; r = 0.545 and p < 0.001 for extension), (for timed up and go test; r = 0.469 and p < 0.001 for right rotation; r = 0.378 and p < 0.001 for left rotation; r = 0.410 and p < 0.001 for flexion; r = 0.496 and p < 0.001 for extension) and (for one-legged balance test; r = -0.479 and p < 0.001 for right rotation; r = -0.365 and p < 0.001 for left rotation; r = -0.392 and p < 0.001 for flexion; r = -0.469 and p < 0.001 for extension). Cervical proprioception and balance were impaired in FMS patients. As the disease activity and fatigue level increased, so the deterioration in cervical proprioception became more evident. There were correlations that demonstrated an association between impaired cervical proprioception and poor balance tests. Therefore, proprioception and balance assessments should be integrated into the physical examination processes of FMS patients.

Assessment of sarcopenia in patients with fibromyalgia.

Fibromyalgia is a chronic disorder characterized by persistent widespread musculoskeletal pain. Patients with fibromyalgia have reduced physical activity and increased sedentary rate. The age-associated reduction of skeletal muscle mass and function is called sarcopenia. The European Working Group on Sarcopenia in Older People developed a practical clinical definition and consensus diagnostic criteria for sarcopenia. Loss of muscle function is common in fibromyalgia and in the elderly. The goal of this study is to determine whether the reduction of muscle function in fibromyalgia is related to sarcopenia according to the European Working Group on Sarcopenia in Older People criteria. Forty-five patients with fibromyalgia and thirty-nine healthy control female subjects were included. All the participants were assessed by Fibromyalgia Impact Questionnaire and SARC-F questionnaire. Muscle mass was evaluated by bioimpedance analysis, muscle strength by handgrip strength test and physical performance with the Short Physical Performance Battery. Fibromyalgia Impact Questionnaire and SARC-F scores were statistically significantly higher in the fibromyalgia group than in the control group, showing severe disease and a higher risk of sarcopenia in the fibromyalgia group (p < 0.001). Muscle strength and physical performance were statistically significantly lower in the group with fibromyalgia than in the control group (p < 0.001). There was no statistical difference between fibromyalgia and control groups regarding skeletal muscle mass (p = 0.263). Our study demonstrated a significant reduction in muscle function in fibromyalgia patients without any loss of muscle mass. Loss of muscle function without decrease in muscle mass is called dynapenia.

Structural and functional thalamocortical connectivity study in female fibromyalgia.

Dysfunctional thalamocortical interactions have been suggested as putative mechanisms of ineffective pain modulation and also suggested as possible pathophysiology of fibromyalgia (FM). However, it remains unclear which specific thalamocortical networks are altered and whether it is related to abnormal pain perception in people with FM. Here, we conducted combined vertex-wise subcortical shape, cortical thickness, structural covariance, and resting-state functional connectivity analyses to address these questions. FM group exhibited a regional shape deflation of the left posterior thalamus encompassing the ventral posterior lateral and pulvinar nuclei. The structural covariance analysis showed that the extent of regional deflation of the left posterior thalamus was negatively covaried with the left inferior parietal cortical thickness in the FM group, whereas those two regions were positively covaried in the healthy controls. In functional connectivity analysis with the left posterior thalamus as a seed, FM group had less connectivity with the periaqueductal gray compared with healthy controls, but enhanced connectivity between the posterior thalamus and bilateral inferior parietal regions, associated with a lower electrical pain threshold at the hand dorsum (pain-free point). Overall, our findings showed the structural thalamic alteration interacts with the cortical regions in a functionally maladaptive direction, leading the FM brain more responsive to external stimuli and potentially contributing to pain amplification.

Inflammatory Markers in the Diagnosis of Fibromyalgia.

BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain accompanied by various additional symptoms. The prevalence of FMS ranges between 2-8% of the population. The exact pathophysiology of the disease remains unknown, and under certain circumstances it is difficult for the physician to diagnose. Previous studies have shown a correlation between inflammatory biomarkers such as C-reactive protein (CRP) and FMS activity, suggesting that an inflammatory component may play a role in this disease pathogenesis. OBJECTIVES: To investigate the role of certain new inflammatory biomarkers in the diagnosis of patients with FMS. METHODS: In this study data were collected from FMS patients who were admitted to Ziv Medical Center during the period 2013 to 2019 in an attempt to find a connection between inflammatory markers detectable by a traditional complete blood count (CBC) tests such as neutrophil-lymphocytes ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet value (MPV), red cell distribution width (RDW), and C-reactive protein (CRP) and FMS. RESULTS: We found significantly higher CRP levels, MPV, and PLR and lower lymphocyte count in the FMS group compared to the control group. CONCLUSIONS: FMS has certain inflammatory components that may be useful in disease diagnosis.

Spectral Power Density analysis of the resting-state as a marker of the central effects of opioid use in fibromyalgia.

Spectral power density (SPD) indexed by electroencephalogram (EEG) recordings has recently gained attention in elucidating neural mechanisms of chronic pain syndromes and medication use. We compared SPD variations between 15 fibromyalgia (FM) women in use of opioid in the last three months (73.33% used tramadol) with 32 non-users. EEG data were obtained with Eyes Open (EO) and Eyes Closed (EC) resting state. SPD peak amplitudes between EO-EC were smaller in opioid users in central theta, central beta, and parietal beta, and at parietal delta. However, these variations were positive for opioid users. Multivariate analyses of variance (ANOVAs) revealed that EO-EC variations in parietal delta were negatively correlated with the disability due to pain, and central and parietal beta activity variations were positively correlated with worse sleep quality. These clinical variables explained from 12.5 to 17.2% of SPD variance. In addition, central beta showed 67% sensitivity / 72% specificity and parietal beta showed 73% sensitivity/62% specificity in discriminating opioid users from non-users. These findings suggest oscillations in EEG might be a sensitive surrogate marker to screen FM opioid users and a promising tool to understand the effects of opioid use and how these effects relate to functional and sleep-related symptoms.

Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial.

AIM: The aim of this study was to investigate the effectiveness of pain neuroscience education (PNE) in addition to usual treatment in patients with fibromyalgia syndrome. METHODS: Forty patients were randomized into 2 groups. The experimental group underwent PNE sessions over 6 weeks in addition to pharmacological treatment, and the control group was given only pharmacological treatment. The primary outcome measure was functional status and the secondary outcome measures were widespread pain pressure threshold and kinesiophobia level. All assessments were conducted before the intervention and at the end of the 6th and 12th weeks by the same blinded researcher. RESULTS: The intervention group had significantly greater improvement than the control group in terms of the mean total scores in the Fibromyalgia Impact Questionnaire (P = .001) and the Tampa Scale of Kinesiophobia (P = .001) with large effect sizes. The intervention group also had significantly greater improvement in the pain pressure threshold values of the cervical (P = .040), thoracic (P = .001), lumbar (P < .001), elbow (P = .005) and calf (P = .006) regions with moderate-to-large effect sizes. CONCLUSION: This study showed that the addition of 6-week PNE sessions to pharmacological treatment was successful in improving functional status, widespread pain pressure threshold, and level of kinesiophobia in patients with fibromyalgia syndrome during a 12-week follow-up period.

Visual snow syndrome, the spectrum of perceptual disorders, and migraine as a common risk factor: A narrative review.

OBJECTIVE: The aim of this narrative review is to explore the relationship between visual snow syndrome (VSS), migraine, and a group of other perceptual disorders. BACKGROUND: VSS is characterized by visual snow and additional visual and nonvisual disturbances. The clinical picture suggests a hypersensitivity to internal and external stimuli. Imaging and electrophysiological findings indicate a hyperexcitability of the primary and secondary visual areas of the brain possibly due to an impairment of inhibitory feedback mechanisms. Migraine is the most frequent comorbidity. Epidemiological and clinical studies indicate that other perceptual disorders, such as tinnitus, fibromyalgia, and dizziness, are associated with VSS. Clinical overlaps and parallels in pathophysiology might exist in relation to migraine. METHODS: We performed a PubMed and Google Scholar search with the following terms: visual snow syndrome, entoptic phenomenon, fibromyalgia, tinnitus, migraine, dizziness, persistent postural-perceptual dizziness (PPPD), comorbidities, symptoms, pathophysiology, thalamus, thalamocortical dysrhythmia, and salience network. RESULTS: VSS, fibromyalgia, tinnitus, and PPPD share evidence of a central disturbance in the processing of different stimuli (visual, somatosensory/pain, acoustic, and vestibular) that might lead to hypersensitivity. Imaging and electrophysiological findings hint toward network disorders involving the sensory networks and other large-scale networks involved in the management of attention and emotional processing. There are clinical and epidemiological overlaps between these disorders. Similarly, migraine exhibits a multisensory hypersensitivity even in the interictal state with fluctuation during the migraine cycle. All the described perceptual disorders are associated with migraine suggesting that having migraine, that is, a disorder of sensory processing, is a common link. CONCLUSION: VSS, PPPD, fibromyalgia, and chronic tinnitus might lie on a spectrum of perceptual disorders with similar pathophysiological mechanisms and the common risk factor migraine. Understanding the underlying network disturbances might give insights into how to improve these currently very difficult to treat conditions.

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

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

Initial Presentation of Pain in Patients with Fibromyalgia.

BACKGROUND: Fibromyalgia is characterized by diffuse musculoskeletal pain at the time of diagnosis, but many patients report their initial symptoms as being focal or local. OBJECTIVES: To evaluate, prospectively, the initial location of body pain in recently diagnosed patients with fibromyalgia. METHODS: Non-selected patients from the rheumatology clinic who were recently diagnosed with fibromyalgia (≤ 2 years) with symptoms of ≤ 4 years participated in our study. Demographic and clinical parameters were documented, as was the initial location of pain they had experienced. Sub-analysis of data according to gender and ethnicity was conducted using chi-squire test. RESULTS: The study comprised 155 patients. Mean age was 39.8 ± 11.7 years; 85% were female. Mean duration of symptoms was 2.11 years and of diagnosis was 0.78 years. Six patients (3.9%) reported initial symptoms of pain as being diffuse from the start, 10 (6.5%) could not remember the location of their initial symptoms, and 139 (90%) reported initial focal pain. Hands were reported as the initial area of pain for 25.2% of the patients, 19.4% reported the back, and 11% reported both trapezial areas as the initial area of pain. In 90% of the patients (excluding patients with back, abdominal, or chest pain) the initial symptoms were bilateral and symmetrical. No significant difference in initial presentation was found among different gender or ethnic groups. CONCLUSIONS: Pain in fibromyalgia patients usually presents as focal and symmetrical. Bilateral hand pain, followed by back pain, was the most common reported area of initial pain among fibromyalgia patients.