Possible repercussions of the COVID-19 pandemic on women with fibromyalgia: longitudinal study / Possíveis repercussões da pandemia da COVID-19 em mulheres com fibromialgia: estudo longitudinal

ABSTRACT BACKGROUND AND OBJECTIVES: In the context of the pandemic caused by COVID-19, individuals with chronic pain, as in fibromyalgia, experienced the impact of social isolation. Tus, considering the scarcity of studies that contemplate initial assessments of women with fibromyalgia before the pandemic period and that compare them with the pandemic context moment, the objective was to analyze the possible repercussions of the pandemic resulting from COVID-19 on the psychological symptoms, quality of life and pain. METHODS: A descriptive, cross-sectional, observational research with an exploratory and quantitative approach. Te sample was composed of 15 women with fibromyalgia for at least three months, aged between 43 and 55 years and with pain level above four on the Visual Analog Scale (VAS). Te Sociodemographic and Clinical Questionnaire, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Health Assessment Questionnaire (HAQ) were used. RESULTS: On average, pain intensity during social isolation (8,40±1,50) and anxiety level (29,80±13,97) were higher than before the pandemic (6,06±1,62, p=0,001) and (22,33±9,69, p=0,006), respectively. In other words, the participants showed higher levels of anxiety and pain during the period of social isolation. Mean depressive symptoms and quality of life difered minimally, showing no statistical significance, with p=0.94 and p=0.46, respectively. CONCLUSION: The COVID-19 pandemic may have contributed to the increase in pain and anxiety levels during the pandemic period. However, other uncontrolled variables may have infuenced this result, such as resilience and family support, for example.

RESUMO JUSTIFICATIVA E OBJETIVOS: Diante do contexto da pandemia ocasionada pela COVID-19, os indivíduos com dor crônica, como na fibromialgia, experimentaram o impacto do isolamento social. Assim, considerando a escassez de estudos que contemplem avaliações iniciais de mulheres com fibromialgia antes do período de pandemia e que as comparem com o momento de contexto pandêmico, objetivou-se analisar as possíveis repercussões da pandemia decorrentes da COVID-19 em sintomas psicológicos, qualidade de vida e dor. MÉTODOS: Trata-se de uma pesquisa observacional descritiva, longitudinal, com abordagem exploratória e quantitativa. A amostra foi composta por 15 mulheres com fibromialgia a pelo menos três meses, com idades entre 43 e 55 anos e com nível de dor acima de quatro na Escala Analógica Visual (EAV). Foram utilizados o Questionário Sociodemográfico e Clínico, o Inventário Beck de Ansiedade (IBA), o Inventário Beck de Depressão (IBD) e o Health Assessment Questionnaire (HAQ). RESULTADOS: Em média, a intensidade da dor durante o isolamento social (8,40±1,50) e o nível de ansiedade (29,80±13,97) foram maiores do que antes da pandemia (6,06±1,62, p=0,001) e (22,33±9,69, p=0,006), respectivamente. Ou seja, as participantes mostraram maiores níveis de ansiedade e dor durante o período de isolamento social. A média dos sintomas depressivos e qualidade de vida diferiram minimamente, não demostrando significância estatística, com p=0,94 e p=0,46, respectivamente. CONCLUSÃO: A pandemia da COVID-19 pode ter contribuído para o aumento das queixas de dor e ansiedade durante o período pandêmico. Entretanto, outras variáveis não controladas podem ter infuenciado nesse resultado, como resiliência e suporte familiar, por exemplo.

Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: randomized, double-blind and controlled placebo clinical trial.

INTRODUCTION: Autism Spectrum Disorder is characterized by persistent deficits in social communication, social interaction, and restricted and repetitive patterns of behavior. Some studies have shown that substances derived from Cannabis sativa improve the quality of life of autistic children without causing serious adverse effects, thus providing a therapeutic alternative. METHOD: This was a randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of a cannabis extract rich in cannabidiol (CBD) in autistic children. Sixty children, aged between 5 and 11 years, were selected and divided into two groups: the treatment group, which received the CBD-rich cannabis extract, and the control group, which received the placebo, both used the product for a period of 12 weeks. Statistical analysis was done by two-factor mixed analysis of variance (ANOVA two way). RESULTS: Significant results were found for social interaction [F(1,116)=14.13, p=0.0002)], anxiety [F(1,116)=5.99, p=0.016], psychomotor agitation [F(1,116)=9.22, p=0.003)], number of meals a day [F(1,116)=4.11, p=0.04)] and concentration [F (1,48)=6.75, p=0.01], the latter being significant only in mild autism spectrum disorder. Regarding safety, it was found that only three children in the treatment group (9.7%) had adverse effects, namely dizziness, insomnia, colic and weight gain. CONCLUSION: CBD-rich cannabis extract was found to improve one of the diagnostic criteria for ASD (social interaction), as well as often co-existing features, and to have few serious adverse effects.

Cannabis and cannabinoid use in autism spectrum disorder: a systematic review.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction, associated with the presence of restricted and repetitive patterns of behavior, interests, or activities. Cannabis has been used to alleviate symptoms associated with ASD. METHOD: We carried out a systematic review of studies that investigated the clinical effects of cannabis and cannabinoid use on ASD, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist). The search was carried out in four databases: MEDLINE/PubMed, Scientific Electronic Library Online (SciELO), Scopus, and Web of Science. No limits were established for language during the selection process. Nine studies were selected and analyzed. RESULTS: Some studies showed that cannabis products reduced the number and/or intensity of different symptoms, including hyperactivity, attacks of self-mutilation and anger, sleep problems, anxiety, restlessness, psychomotor agitation, irritability, aggressiveness perseverance, and depression. Moreover, they found an improvement in cognition, sensory sensitivity, attention, social interaction, and language. The most common adverse effects were sleep disorders, restlessness, nervousness and change in appetite. CONCLUSION: Cannabis and cannabinoids may have promising effects in the treatment of symptoms related to ASD, and can be used as a therapeutic alternative in the relief of those symptoms. However, randomized, blind, placebo-controlled clinical trials are necessary to clarify findings on the effects of cannabis and its cannabinoids in individuals with ASD. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO), code 164161.

Cannabis and cannabinoid use in autism spectrum disorder: a systematic review

Abstract Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction, associated with the presence of restricted and repetitive patterns of behavior, interests, or activities. Cannabis has been used to alleviate symptoms associated with ASD. Method We carried out a systematic review of studies that investigated the clinical effects of cannabis and cannabinoid use on ASD, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist). The search was carried out in four databases: MEDLINE/PubMed, Scientific Electronic Library Online (SciELO), Scopus, and Web of Science. No limits were established for language during the selection process. Nine studies were selected and analyzed. Results Some studies showed that cannabis products reduced the number and/or intensity of different symptoms, including hyperactivity, attacks of self-mutilation and anger, sleep problems, anxiety, restlessness, psychomotor agitation, irritability, aggressiveness perseverance, and depression. Moreover, they found an improvement in cognition, sensory sensitivity, attention, social interaction, and language. The most common adverse effects were sleep disorders, restlessness, nervousness and change in appetite. Conclusion Cannabis and cannabinoids may have promising effects in the treatment of symptoms related to ASD, and can be used as a therapeutic alternative in the relief of those symptoms. However, randomized, blind, placebo-controlled clinical trials are necessary to clarify findings on the effects of cannabis and its cannabinoids in individuals with ASD. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), code 164161.

Association between pain, anxiety, and alpha2 frontal activity in women with fibromyalgia

Fibromyalgia is a disorder of the central nervous system, with the presence of chronic generalized pain, fatigue, morning stiffness, anxiety and depression symptoms. Higher amplitudes of the frequency band alpha2 have been associated with higher relaxationin this population. In the present study, we analysed the association between pain, anxiety, and the spectral power of alpha2 frontal in women with fibromyalgia. Thirty-one women diagnosed with fibromyalgia, for at least three months, took part in the study. Results revealed a statistically significant positive relationship between pain and anxiety levels. However, we found no association between the spectral power of alpha2 in the frontal cortex and the measures between anxiety and pain in the patients. Present findings emphasize the importance of understanding the cortical activity and the central control mechanisms in fibromyalgia.

Long-term memory of haptic and visual information in older adults.

The present study examined haptic and visual memory capacity for familiar objects through the application of an intentional free-recall task with three-time intervals in a sample of 78 healthy older adults without cognitive impairment. A wooden box and a turntable were used for the presentation of haptic and visual stimuli, respectively. The procedure consisted of two phases, a study phase that consisted of the presentation of stimuli, and a test phase (free-recall task) performed after one hour, one day or one week. The analysis of covariance (ANCOVA) indicated that there was a main effect only for the time intervals (F (2,71) = 12.511, p = .001, η2 = 0.261), with a lower recall index for the interval of one week compared to the other intervals. We concluded that the memory capacity between the systems (haptic and visual) is similar for long retrieval intervals (hours to days).

Comparison of two tDCS protocols on pain and EEG alpha-2 oscillations in women with fibromyalgia.

Transcranial Direct Current Stimulation (tDCS) has been used as an alternative treatment for pain reduction in fibromyalgia. In this study, in addition to behavioral measures, we analyzed oscillations in alpha 2 frequency band in the frontal, occipital, and parietal regions, in response to the application of two neuromodulation protocols in fibromyalgia. The study was a randomized, double-blind, placebo-controlled clinical trial with 31 women diagnosed with fibromyalgia. The participants were allocated to three groups with the anodic stimulation applied on the left motor cortex: Group 1, for five consecutive days; Group 2, for 10 consecutive days; and Group 3, sham stimulation for five consecutive days. Statistical analysis showed a reduction in pain intensity after treatment for groups in general [F (1.28) = 8.02; p = 0.008; η2 = 0.223], in addition to a reduction in alpha 2 in the frontal (p = 0.039; d = 0.384) and parietal (p = 0.021; d = 0.520) regions after the treatment on five consecutive days. We conclude that neuromodulation protocols produced similar effects on pain reduction, but differed with respect to the changes in the alpha 2 frequency band in the frontal and parietal regions.

Como mulheres avaliam expressões faciais de alegria e dor? / How do women evaluate facial expressions of happiness and pain? / ¿Cómo evalúan las mujeres las expresiones faciales de alegría y dolor?

A expressão facial de dor pode provocar diferentes reações comportamentais. Todavia, ainda não está claro se a face de dor evoca respostas motoras mais lentas ou mais rápidas, quando comparada à expressão com valência positiva, e sua interação com o sexo da pessoa que demonstra a expressão facial. O objetivo desse trabalho foi avaliar o padrão de resposta motora de mulheres em uma tarefa de reconhecimento de expressões faciais de alegria e dor em faces femininas e masculinas. Na tarefa experimental, 32 estudantes classificaram emoções faciais dinâmicas de homens e mulheres entre as opções de alegria e dor, sendo registradas as respostas de tempo de reação manual (TRM). A ANOVA indicou uma diferença entre faces masculinas e femininas apenas para a identificação da dor (p = 0,001), mas não da alegria (p = 0,064). Neste caso, a dor foi reconhecida mais rapidamente na face masculina (TRM = 625,1 ms) que na face feminina (TRM = 668,0 ms). Considera-se que este padrão de resposta motora pode estar relacionado à detecção de situações potencialmente ameaçadoras no ambiente, com possibilidade de ser estudado em pessoas com dor crônica.

The facial expression of pain can provoke different behavioral reactions. However, it is not clear whether the face of pain evokes slower or faster motor responses when compared with positive valence expression and its interaction with the gender of the person who demonstrates facial expression. The objective of this work was to evaluate the motor response pattern of women in a task of recognizing facial expressions of happiness and pain in female and male faces. In the experimental task, 32 students classified dynamic facial emotions of men and women among the options of happiness and pain, and manual reaction time (MRT) responses were recorded. The ANOVA indicated a difference between male and female faces only for the identification of pain (p = 0.001), but not happiness (p = 0.064). In this case, the pain was recognized more quickly on the male face (TRM = 625.1 ms) compared to the female face (TRM = 668.0 ms). It is considered that this pattern of motor response may be related to the detection of potentially threatening situations in the environment, with the possibility of being studied in people with chronic pain.

La expresión facial del dolor puede provocar diferentes reacciones conductuales. Sin embargo, aún no está claro si el rostro de dolor evoca respuestas motoras más lentas o más rápidas, en comparación con la expresión con valencia positiva, y su interacción con el sexo de la persona que demuestra expresión facial. El objetivo de este trabajo fue evaluar el patrón de respuesta motora de las mujeres en una tarea de reconocimiento de expresiones faciales de alegría y dolor en rostros femeninos y masculinos. En la tarea experimental, 32 estudiantes clasificaron las emociones faciales dinámicas de hombres y mujeres entre las opciones de alegría y dolor, y se registraron las respuestas de tiempo de reacción manual (TRM). El ANOVA indicó una diferencia entre los rostros masculinos y femeninos solo para la identificación del dolor (p = 0.001), pero no alegría (p = 0.064). En este caso, el dolor se reconoció más rápidamente en el rostro masculino (TRM = 625.1 ms) comparado al rostro femenino (TRM = 668.0 ms). Se considera que este patrón de respuesta motora puede estar relacionado con la detección de situaciones potencialmente amenazantes en el entorno, con posibilidad de ser estudiado en personas con dolor crónico.

Facial expressions and eye tracking in individuals with social anxiety disorder: a systematic review.

Social anxiety disorder (SAD) is characterized by the fear of being judged negatively in social situations. Eye-tracking techniques have been prominent among the methods used in recent decades to investigate emotional processing in SAD. This study offers a systematic review of studies on eye-tracking patterns in individuals with SAD and controls in facial emotion recognition tasks. Thirteen articles were selected from the consulted databases. It was observed that the subjects with SAD exhibited hypervigilance-avoidance in response to emotions, primarily in the case of negative expressions. There was avoidance of conspicuous areas of the face, particularly the eyes, during observations of negative expressions. However, this hypervigilance did not occur if the stimulus was presented in virtual reality. An important limitation of these studies is that they use only static expressions, which can reduce the ecological validity of the results.

Facial expressions and eye tracking in individuals with social anxiety disorder: a systematic review

Abstract Social anxiety disorder (SAD) is characterized by the fear of being judged negatively in social situations. Eye-tracking techniques have been prominent among the methods used in recent decades to investigate emotional processing in SAD. This study offers a systematic review of studies on eye-tracking patterns in individuals with SAD and controls in facial emotion recognition tasks. Thirteen articles were selected from the consulted databases. It was observed that the subjects with SAD exhibited hypervigilance-avoidance in response to emotions, primarily in the case of negative expressions. There was avoidance of conspicuous areas of the face, particularly the eyes, during observations of negative expressions. However, this hypervigilance did not occur if the stimulus was presented in virtual reality. An important limitation of these studies is that they use only static expressions, which can reduce the ecological validity of the results.