Clinical Diagnosis Of Fibromyalgia Research Articles

Tender to touch-Prevalence and impact of concomitant fibromyalgia and enthesitis in spondyloarthritis: An ancillary analysis of the ASAS PerSpA study.

The primary objective was to evaluate the co-existence of fibromyalgia (FM) & enthesitis in individuals with spondyloarthritis (SpA). Secondary objectives were to identify clinical features associated with the presence of FM in enthesitis and analyse sex-specific differences. This was an ancillary analysis of the Assessment of SpondyloArthritis International Society Peripheral Involvement in SpA (PerSpA) study. Enthesitis was defined as the presence of enthesitis ever. Clinical FM was defined as the rheumatologist's confirmation of the presence of FM. A score of≥5/6 on the Fibromyalgia Rapid Screening Test (FiRST) defined a positive screening test for FM. Enthesitis ever and FM (EFM) co-existed in 10.3% (n=425) of the cohort using FiRST criteria and 5.3% using clinical diagnosis of FM. More individuals with FM by clinical diagnosis had imaging-confirmed enthesitis ever than by FiRST criteria. More females had EFM than males, defined clinically (76.9% vs 23.1%) or by FiRST criteria (62.6% vs 37.4%). Individuals with EFM had more severe disease across all measures compared to those with enthesitis only, with no significant difference between sexes. EFM was significantly associated with age, female sex, BMI, BASDAI and region. FM is an important comorbidity in the setting of enthesitis in SpA. While EFM is more common in females, it is not a rare condition in males. EFM is associated with worse disease severity measures in SpA in both males and females. Recognition of FM in the setting of enthesitis is essential to prevent overtreatment and optimise patient outcomes.

Multivariate classification techniques and mass spectrometry as a tool in the screening of patients with fibromyalgia

Fibromyalgia is a rheumatological disorder that causes chronic pain and other symptomatic conditions such as depression and anxiety. Despite its relevance, the disease still presents a complex diagnosis where the doctor needs to have a correct clinical interpretation of the symptoms. In this context, it is valid to study tools that assist in the screening of this disease, using chemical work techniques such as mass spectroscopy. In this study, an analytical method is proposed to detect individuals with fibromyalgia (n = 20, 10 control samples and 10 samples with fibromyalgia) from blood plasma samples analyzed by mass spectrometry with paper spray ionization and subsequent multivariate classification of the spectral data (unsupervised and supervised), in addition to the treatment of selected variables with possible associations with metabolomics. Exploratory analysis with principal component analysis (PCA) and supervised analysis with successive projections algorithm with linear discriminant analysis (SPA-LDA) showed satisfactory results with 100% accuracy for sample prediction in both groups. This demonstrates that this combination of techniques can be used as a simple, reliable and fast tool in the development of clinical diagnosis of Fibromyalgia.

Performance of the 2016 diagnostic criteria for fibromyalgia in a tertiary care pain rehabilitation setting: a diagnostic accuracy study

With the International Classification of Diseases 11th revision (classifying fibromyalgia as a primary pain disorder) soon to be implemented, the importance of pain physicians being able to identify patients with fibromyalgia is emphasized. The diagnostic criteria proposed in 2016 are based on self-reported pain distribution and symptom severity. The study aimed to evaluate the diagnostic accuracy of the 2016 diagnostic criteria for fibromyalgia applied in a population of patients with high impact chronic pain referred for pain rehabilitation. The study was performed as a diagnostic accuracy study at two Danish interdisciplinary pain rehabilitation centers, including 215 participants. All participants were evaluated clinically to identify patients with fibromyalgia. The diagnosis was based on expert opinion, but the minimum requirements were: (1) pain in all four body quadrants and axially for at least three months and (2) minimum 8 of 18 positive tender points. Participants filled in the fibromyalgia survey questionnaire, the patient version of the 2016 diagnostic criteria. Sensitivity, specificity, likelihood ratios, and positive and negative post-test probabilities were calculated using a clinical diagnosis of fibromyalgia as the reference standard. Based on clinical diagnosis 45% of the participants were diagnosed with fibromyalgia; of these, only 19% had been diagnosed previously. The 2016 diagnostic criteria demonstrated a sensitivity of 88.5%, a specificity of 81.5%, a positive likelihood ratio of 4.79, a negative likelihood ratio of 0.14, a positive post-test probability of 79.4%, and a negative post-test probability of 10.2%. Fibromyalgia was severely under-diagnosed among patients with high impact chronic pain referred to tertiary care in two pain rehabilitation centers in Denmark. The 2016 diagnostic criteria showed sufficient discriminatory properties suggesting that the fibromyalgia survey questionnaire can be used as a screening tool assisting the identification of fibromyalgia in this patient population.

Relationship between handgrip strength, peripheral muscle strength, and respiratory muscle endurance in women with fibromyalgia: a cross-sectional study

Fibromyalgia (FM) is a disease characterized by generalized and chronic musculoskeletal pain. It is common, the presence of other symptoms such as fatigue, depression, sleep disorders, leading patients to adopt a sedentary lifestyle. Objective: Verify the muscular and respiratory strength of women with FM. Method: Is a cross-sectional study that evaluated 41 women with clinical diagnosis of FM. We analyzed handgrip strength (HS), the strength of the lower limbs, and respiratory muscle endurance using the spirometric maneuver. Results: Patients with FM had a significant reduction in HS, both in the dominant and non-dominant upper limb. Furthermore, peripheral muscle strength in the lower limbs was reduced because on average, participants exceeded the normative five-repetition sit-to-stand test times stipulated for the age groups. Approximately two-thirds of the sample had maximal voluntary ventilation values below the lower limit of normality. We detected inverse and moderate correlation between peripheral muscle strength and HS of non-dominant upper limb (r= −0.472; p= 0.002) and inverse and weak correlation with the HS of dominant upper limb (r= −0.374; p= 0.016); weak correlations between respiratory muscle endurance and HS of dominant upper limb (r= 0.299; p= 0.058), HS of non-dominant upper limb (r= −0.317; p= 0.043), and peripheral muscle strength (r= −0.372, p= 0.017); and strong correlation between HS of dominant upper limb and non-dominant upper limb (r= 0.899; p<0.001). Conclusion: Women with FM present with reduced muscle strength in the upper and lower limbs, as well as lower respiratory muscle resistance.

AB0878-HPR EFFECT OF AQUATIC PHYSIOTHERAPY ON PAIN AND QUALITY OF LIFE IN ELDERLY WOMEN WITH FIBROMYALGIA

Background:Fibromyalgia is defined as a chronic non-articular rheumatic disease, characterized by generalized, diffuse bilateral pain and the presence of tender points in specific anatomical regions. Its symptoms are characterized by a very varied picture and the etiology is considered multifactorial. Today, with difficult treatment, fibromyalgia has been a major challenge for healthcare professionals. Aquatic physiotherapy is currently one of the most commonly used forms of intervention in the management of fibromyalgia, and for this reason it has been used in interdisciplinary rehabilitation programs to promote health.Objectives:To evaluate the effects of aquatic physiotherapy on pain and quality of life in patients with fibromyalgia.Methods:This is an interventional, quasi-experimental study carried out at the Physiotherapy School Clinic of Universidade Cesumar in the city of Maringá, PR, Brazil. The study was approved by the Human Research Ethics Committee of Unicesumar under opinion No. 1,025,567. Participated in the study, elderly women aged 60 years, with clinical diagnosis of fibromyalgia. To assess the quality of life, the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) instrument was used and to verify the intensity of the pain, the Visual Analogue Scale was used. The aquatic physiotherapy intervention protocol was to perform 10 Watsu sessions, performed twice a week, lasting 40 minutes each. To perform the Watsu method, the following steps of the technique were followed: before starting, opening, delivering the water, dancing the breath in the water, breathing balance and to finish releasing the spine. For data analysis, the Shapiro-Wilk test was initially applied to verify the normality of the variables under study. As the data presented a normal distribution, mean, standard deviation, minimum and maximum were used to characterize the results. To compare the initial and final variables, the dependent student t test was used. The significance adopted was p <0.05.Results:The study included 17 elderly women with a mean age of 67.5 ± 4.7 years. When comparing the evaluation and the reassessment, a statistically significant improvement was evidenced in the domains of quality of life: functional capacity (p=0.00445), limitation due to physical aspects (p=0.01347), pain (p=0.00861), vitality (p=0.00044), limitation due to emotional aspects (p=0.02019), mental health (p=0.00748). The domains that did not show statistical increase were the general health status (p=0.30663) and the social aspects (p=0.05037). The pain, on the other hand, was statistically less after the intervention (p=0.00059).Conclusion:Aquatic physical therapy provided benefits in reducing pain and improving the quality of life of elderly women with fibromyalgia. It is important to encourage individuals with fibromyalgia to perform non-pharmacological interventions, such as aquatic physiotherapy, to promote their health and quality of life.

Pain education to women with fibromyalgia using the DolorÔmetro game

ABSTRACT BACKGROUND AND OBJECTIVES: Doubts and questions about the general aspects of pain, maladaptive beliefs, knowledge about pain neurophysiology, and its impact on exercise are common in fibromyalgia patients. This study aimed to evaluate the knowledge about pain in women with fibromyalgia through the DolorOmetro game. METHODS: A quasi-experimental study with a qualitative and quantitative approach. Twenty women with a clinical diagnosis of fibromyalgia and aged 18 to 60 years were evaluated. The patients answered two questions at the beginning and end of the game. The intervention consisted of the use of 9 cards from the six domains of the game DolorOmetro to motivate discussions about the theme. RESULTS: The sample had a mean age of 50.6±9.6 years and a diagnostic time of 6.5±4.6 years. The number of hits and errors in each domain was observed. In the “acceptance” domain, four errors were found in statement 1 and twelve in statement 2. In the “attitudes” domain, only two in statement 4 and one in statement 8. In the “kinesiophobia” domain, all errors were only in statement 2. In the “knowledge” domain, nineteen women missed statement 3. In the “anxiety” domain, fifteen women missed statement 1. Finally, in the “catastrophic” domain, ten women missed statement 2. CONCLUSION: Conducting an education in pain, lasting in one hour in a single moment, contributed to the participants expressing their doubts and previous questions and after the moment of education, however doubts persisted in the domains of acceptance, kinesiophobia, knowledge and anxiety.

Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care.

To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied. All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST). In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria. FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.

The Problematic Nature of Fibromyalgia Diagnosis in the Community.

BackgroundRecently, some studies suggested that clinical diagnosis of fibromyalgia is inaccurate and does not reflect current definitions. However, this hypothesis has not been tested. We examined whether fibromyalgia was accurately diagnosed in the community.MethodsWe surveyed 3276 primary care patients to determine current fibromyalgia status by criteria (CritFM). We also determined whether the patients had a physician's diagnosis of fibromyalgia (MDFM) and the level of symptom severity as measured by the polysymptomatic distress scale (PSD).ResultsThe prevalence of MDFM and CritFM was 6.1% (95% confidence interval [CI] 5.3%, 6.9%) and 5.5% (95% CI 4.8%, 6.3%), respectively. However, only 32.2% with MDFM met 2016 criteria (CritFM), and only 35.4% with CritFM also had MDFM. The kappa statistic for diagnostic agreement was 0.296 (minimal agreement). The mean PSD score was 12.4 and 18.4 in MDFM and CritFM, respectively. The odds ratio for being a woman compared with being a man was 3.2 for MDFM versus 1.9 for CritFM, P = 0.023. Of the patients with MDFM, 68.3% received specific fibromyalgia pharmacotherapy.ConclusionsThere is little agreement between MDFM and CritFM. Only one‐third of MDFM satisfy fibromyalgia criteria, and only one‐third of patients who meet the criteria have a clinical diagnosis of fibromyalgia. Physician diagnosis is biased and more likely in women. Fibromyalgia treatment is common in MDFM (70.7%). Overall, MDFM appears subjective and unrelated to fibromyalgia criteria. There appears to be no common definition of fibromyalgia in the community.

Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress.

Polysymptomatic distress (PSD) is the underlying metric of fibromyalgia (FM), and levels of PSD can identify criteria-positive FM with > 90% accuracy. We used levels of the PSD scale to test whether symptom levels in primary FM (PFM) and secondary FM (SFM) were the same and whether symptoms were equivalent in persons not meeting FM criteria. We studied 1525 patients with a clinical diagnosis of FM and 12,037 patients with rheumatoid arthritis (RA). We used regression models to compare patients with potential and actual PFM to RA patients with potential and actual SFM for 17 key clinical variables. When controlled for PSD values, the widespread pain index, symptom severity scale, and pain, global, quality of life, and physical and mental component scores were essentially the same or only slightly different in PFM and SFM. Health Assessment Questionnaire-Disability Index scores were slightly higher in SFM (0.21 units), as was the painful joint count (1.6 joints). Overall, higher PSD scores were associated with more severe symptoms or abnormal status. PSD scores in patients not satisfying FM criteria and in patients satisfying criteria operated similarly. PFM and SFM are equivalent regarding symptom burden. PSD scores are more informative about severity and severity within diagnosis than dichotomization into FM/non-FM. Studies of FM versus "healthy individuals," or FM versus other diseases, are inherently defective, while studies of FM and PSD in RA offer the opportunity to have meaningful comparison groups, because there are no readily available unbiased appropriate controls for PFM.

The psychosocial diagnosis of gender in public health: propos and application through a case study

Abstract In this article, we present the development of a methodological diagnostic tool for the field of public health from an interdisciplinary perspective that articulates the biological, psychological, and social dimensions of human health from a post-structuralist and feminist perspective and epistemology. In prior research, we have developed a methodology for the study of chronic pain without an organic cause, or fibromyalgia (FM), that we call the psychosocial diagnosis of gender. That work addresses the analysis of the research object itself and, above all, a critical reconceptualization of health in general. We have also used qualitative fieldwork methods (life stories, discussion groups, and documentary material) in our study of people diagnosed with FM. Here, we present the actual tool we use in the Psychosocial Diagnosis of Gender, using a case study that enacts a displacement of the clinical diagnosis of FM towards its articulation with the psychosocial diagnosis of gender.

Validation of the Greek Version of the Fibromyalgia Rapid Screening Tool

The Fibromyalgia Rapid Screening Tool (FiRST) is a brief, simple, and straightforward self-administered questionnaire that was developed by Perrot etal. for the detection of fibromyalgia syndrome in patients with diffuse chronic pain. The aim of our study was to develop and validate the Greek version of FiRST. The study was set up as a prospective observational study. The original French version of FiRST was adapted into Greek using forward and backward translation. Patients with chronic diffuse pain with a clinical diagnosis of fibromyalgia and osteoarthritis based on the criteria of the American College of Rheumatology were invited to participate to the study. Of the 101 patients who met our inclusion criteria, 42 were diagnosed with fibromyalgia and 59 with osteoarthritis. The 2 groups did not differ significantly regarding gender and pain characteristics (duration, intensity). Cronbach's alpha coefficient was 0.79. Receiver operating characteristic analysis showed an area under the curve of 89% (95% confidence interval=83 to 95%; SE: 0.032, P<0.001). At a cutoff score of ≥5, FiRST showed a sensitivity of 86%, a specificity of 83%, a positive predictive value of 78%, and a negative predictive value of 89%. The intraclass coefficient for the test-retest reliability was 0.96. The Greek version of FiRST is a valid screening tool for fibromyalgia in daily practice.

Three-Quarters of Persons in the US Population Reporting a Clinical Diagnosis of Fibromyalgia Do Not Satisfy Fibromyalgia Criteria: The 2012 National Health Interview Survey.

ObjectivesAlthough fibromyalgia criteria have been in effect for decades, little is known about how the fibromyalgia diagnosis is applied and understood by clinicians and patients. We used the National Health Interview Survey (NHIS) to determine the prevalence of self-reported clinician diagnosed fibromyalgia and then compared demographics, symptoms, disability and medical utilization measures of persons with a clinical diagnosis of fibromyalgia that did not meet diagnostic criteria (false-positive or prior [F/P] fibromyalgia) to persons with and without criteria-positive fibromyalgia.MethodsThe National Health Interview Survey (NHIS) collected information about both clinical diagnosis and symptoms of fibromyalgia that was appropriately weighted to represent 225,726,257 US adults. Surrogate NHIS diagnostic criteria for fibromyalgia were developed based on the level of polysymptomatic distress (PSD) as characterized in the 2011 modified American College of Rheumatology criteria (ACR) for fibromyalgia. Persons with F/P fibromyalgia were compared with persons who do not have fibromyalgia and those meeting surrogate NHIS fibromyalgia criteria.ResultsOf the 1.78% of persons reporting a clinical diagnosis, 73.5% did not meet NHIS fibromyalgia criteria. The prevalence of F/P fibromyalgia is 1.3%. F/P fibromyalgia is associated with a mild degree of polysymptomatic distress (NHIS PSD score 6.2) and characterized by frequent but not widespread pain and insomnia. Measures of work disability and medical utilization in F/P fibromyalgia were equal to that seen with NHIS criteria positive fibromyalgia and were 6-7x greater in F/P fibromyalgia than in non-fibromyalgia persons. F/P fibromyalgia was best predicted by being female (Odds Ratio [OR] 8.81), married (OR 3.27), and white (OR 1.96). In contrast, being a white, married woman was only modestly predictive of NHIS (criteria positive) fibromyalgia (OR 2.1).ConclusionsThe majority of clinically diagnosed fibromyalgia cases in the US do not reach levels of severity necessary and sufficient for diagnosis. The clinical diagnosis of fibromyalgia is disproportionally dependent on demographic and social factors rather than the symptoms themselves. Diagnostic criteria for fibromyalgia appear to be used as a vague guide by clinicians and patients, and allow for substantial diagnostic expansion of fibromyalgia.

Advancing the screening of fibromyalgia in late-life depression: practical implications for psychiatric settings.

Fibromyalgia (FM) is common in older adults suffering from mood disorders. However, clinical diagnosis of FM is challenging, particularly in psychiatric settings. We examined the prevalence of FM and the sensitivity of three simple screeners for FM. Using cross-sectional data, we evaluated three tests against the American College of Rheumatology (ACR) 1990 Criteria for the Classification of FM: a "Do you often feel like you hurt all over?" question, a pain map score, and the Pope and Hudson (PH) interview for FM. Participants were 185 community-dwelling adults ≥ 60 years old with comorbid depression and chronic low back pain evaluated at a late-life mental health clinic. Fifty three of 185 participants (29%) met the ACR 1990 FM criteria. Compared to those without FM, the FM group had more "yes" answers to the "hurt all over?" question and higher pain map scores. To reach a sensitivity of at least 0.90, the cut-off score for the pain map was 8. The sensitivity of the pain map, "hurt all over?" question, and PH criteria were 0.92 [95%CI 0.82-0.98], 0.91 [95%CI 0.79-0.97], and 0.94 [95%CI 0.843-0.99] respectively. Nearly one in three older adults suffering from depression and chronic low back pain met ACR 1990 FM criteria. Three short screening tests showed high sensitivity when compared to the ACR 1990 FM criteria. Implementation of one of the simple screeners for FM in geriatric psychiatry settings may guide the need for further diagnostic evaluation.

Effects of muscle stretching exercises in the treatment of fibromyalgia: a systematic review

Objectivethis study has the objective to systematize scientific evidences about the use of muscle stretching exercises in the treatment of FM. Methodologyit was performed from retrospective research without chronological and linguistic limits, at databases of MEDLINE, LILACS, SciELO and PEDro, as well as at PubMed search tool. Data collection was performed by two independent reviewers in October 2012, with the search strategy formulated by crossing descriptors and relevant terms to the topic in English, Portuguese and Spanish languages. Randomized clinical trials, only with patients with a clinical diagnosis of fibromyalgia and muscle stretching exercises as a therapeutic measure at least in one of the intervention groups were included. Included studies were assessed for methodological quality using PEDro scale and their references analyzed to highlight additional sources. The search amounted to an average of 6,794 items. Only five articles were selected, one being excluded because of its low methodological quality. Pain was assessed unanimously. The method and timing of interventions varied widely, there was poor mention of the parameters used in the stretches and absence of specific physical examinations. Resultsthere was significant improvement in all studies regarding pain, besides as related to quality of life and physical condition. Conclusionit is clear the importance of muscle stretching in the treatment of FM, however, there is a need for further studies to establish the real benefits of the technique, because the majority of published studies shows low methodological quality and there is a lack of standardization regarding the use of this resource.

Efeitos dos exercícios de alongamento muscular no tratamento da fibromialgia: uma revisão sistemática

ObjectiveThis study has the objective to systematize scientific evidences about the use of muscle stretching exercises in the treatment of FM. MethodologyIt was performed from retrospective research without chronological and linguistic limits, at databases of MEDLINE, LILACS, SciELO and PEDro, as well as at PubMed search tool. Data collection was performed by two independent reviewers in October 2012, with the search strategy formulated by crossing descriptors and relevant terms to the topic in English, Portuguese and Spanish languages. Randomized clinical trials, only with patients with a clinical diagnosis of fibromyalgia and muscle stretching exercises as a therapeutic measure at least in one of the intervention groups were included. Included studies were assessed for methodological quality using PEDro scale and their references analyzed to highlight additional sources. The search amounted to an average of 6,794 items. Only five articles were selected, one being excluded because of its low methodological quality. Pain was assessed unanimously. The method and timing of interventions varied widely, there was poor mention of the parameters used in the stretches and absence of specific physical examinations. ResultsThere was significant improvement in all studies regarding pain, besides as related to quality of life and physical condition. ConclusionIt is clear the importance of muscle stretching in the treatment of FM, however, there is a need for further studies to establish the real benefits of the technique, because the majority of published studies shows low methodological quality and there is a lack of standardization regarding the use of this resource.

Dor, qualidade de vida, autopercepção de saúde e depressão de pacientes com fibromialgia, tratados com hidrocinesioterapia

ObjectivesThe 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 methodsWe evaluated 64 females divided into two groups: hydrocinesiother- apy (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. Partici- pants underwent a treatment in a hydrotherapy pool heated to 33°C over a period of 15 weeks, two sessions per week of 45minutes, 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 ResultsThere 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. ConclusionsThe study suggests that hydrocinesiotherapy was effective as an alternative therapy for fibromyalgia, however further studies are recommended to test the associa- tions 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.

Pain, quality of life, self-perception of health, and depression in patients with fibromyalgia treated with hydrokinesiotherapy

ObjectivesThe 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 methodsWe evaluated 64 females divided into two groups: hydrocinesiother- apy (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. Partici- pants underwent a treatment in a hydrotherapy pool heated to 33°C over a period of 15 weeks, two sessions per week of 45minutes, 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 ResultsThere 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. ConclusionsThe study suggests that hydrocinesiotherapy was effective as an alternative therapy for fibromyalgia, however further studies are recommended to test the associa- tions 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.

Incidence and predictors of secondary fibromyalgia in an early arthritis cohort

ObjectivesSecondary fibromyalgia (FM) is common among patients with inflammatory arthritis, but little is known about its incidence and the factors leading to its development. The authors examined the incidence of...

Evaluación de la cortisoluria en mujeres diagnosticadas de fibromialgia

Objective We propose a comparative study of urinary cortisol in a controlled simple group of patients diagnosed with fibromyalgia (FM) during a minimum time frame (3 years) vs. a normal group with the same characteristics of age and gender. Our objective is to demonstrate if urinary cortisol at lower levels than those found in the normal population, as long as FM is regarded, could help to evaluate the fatigue. Methods We determined the urinary cortisol in a group of 47 women with a clinical diagnosis of FM using the criteria from the American College of Rheumatology (ACR) 1990, with ages between 29 and 64 years, in whom an accurate sample was collected and cortisol was determined using an FPIA method. The results were compared with the urinary cortisol obtained in a group of 88 healthy women within the same age range as those with FM. Results Urinary cortisol in FM was 65.0 μg/l (median), which was significantly lower than that of the healthy group (80.0 μg/l), p<0.001. Conclusion 33.4% of patients with FM displayed urinary cortisol concentrations significantly lower than the group of women without FM.

¿Se puede ver el dolor?

Pain is a highly subjective experience that is difficult to measure objectively due to its varied expression. It is defined as a complex sensory-emotional experience, it is modulated by cognitive factors and involves a broad neural system. Functional neuroimaging has helped to define that neural circuit involved in the perception, modulation and response to painful experience, both in healthy controls and in patients with acute and chronic pain disorders. However, functional activation of the so-called “pain matrix” may also be differentially modulated by sensory and emotional processing components. The latter, for example, can influence the intensity to which a stimulus is perceived as painful. Such a threshold seems to be lower in patients with clinical diagnosis of fibromyalgia (FM) and has been linked to an abnormal pattern of activation of the “pain matrix” when assessed with functional magnetic resonance imaging (fMRI), considering a “syndrome of central susceptibility”. Supporting an aetiological explanation for FM, studies have noted that a significant proportion of patients with FM demonstrate this abnormal pattern of activation to stimuli of low intensity. Additionally, there is an important and significant temporal dimension to this activation pattern observed in FM patients, where areas commonly associated with the emotional experience of pain show a prolonged response to painful stimuli compared to healthy subjects. Accordingly, fMRI may assist in objectifying the experience of pain in patients with FM in response to nociceptive stimulation.