Fibromyalgia Fatigue Research Articles

How to manage fatigue in fibromyalgia: nonpharmacological options.

The aim of this article is to suggest recommendations for the management of fatigue in fibromyalgia (FM) by reviewing and compiling findings of nonpharmacological treatment for fatigue in patients with FM. The management of fatigue in FM should incorporate regular physical exercise maintained for a longer period of time, which contributes to improved general health and facilitates coping with fatigue and other symptoms. The evidence is still low and the effect of exercise on fatigue in FM needs to be further studied. Patients with FM appear to benefit from general sleep hygiene advice and also need to develop individual strategies to manage the complex factors in everyday life that may be related to fatigue.

Effect of Pregabalin on Cardiovascular Responses to Exercise and Postexercise Pain and Fatigue in Fibromyalgia: A Randomized, Double-Blind, Crossover Pilot Study.

Pregabalin, an approved treatment for fibromyalgia (FM), has been shown to decrease sympathetic nervous system (SNS) activity and inhibit sympathetically maintained pain, but its effects on exercise responses have not been reported. Methods. Using a randomized double-blind crossover design, we assessed the effect of 5 weeks of pregabalin (versus placebo) on acute cardiovascular and subjective responses to moderate exercise in 19 FM patients. Blood pressure (BP), heart rate (HR), and ratings of perceived exertion (RPE) during exercise and ratings of pain, physical fatigue, and mental fatigue before, during, and for 48 hours after exercise were compared in patients on pregabalin versus placebo and also versus 18 healthy controls. Results. On placebo, exercise RPE and BP were significantly higher in FM patients than controls (p < 0.04). Pregabalin responders (n = 12, defined by patient satisfaction and symptom changes) had significantly lower exercise BP, HR, and RPE on pregabalin versus placebo (p < 0.03) and no longer differed from controls (p > 0.26). Cardiovascular responses of nonresponders (n = 7) were not altered by pregabalin. In responders, pregabalin improved ratings of fatigue and pain (p < 0.04), but negative effects on pain and fatigue were seen in nonresponders. Conclusions. These preliminary findings suggest that pregabalin may normalize cardiovascular and subjective responses to exercise in many FM patients.

Effects of Listening to Music versus Environmental Sounds in Passive and Active Situations on Levels of Pain and Fatigue in Fibromyalgia

In fibromyalgia, pain symptoms such as hyperalgesia and allodynia are associated with fatigue. Mechanisms underlying such symptoms can be modulated by listening to pleasant music. We expected that listening to music, because of its emotional impact, would have a greater modulating effect on the perception of pain and fatigue in patients with fibromyalgia than listening to nonmusical sounds. To investigate this hypothesis, we carried out a 4-week study in which patients with fibromyalgia listened to either preselected musical pieces or environmental sounds when they experienced pain in active (while carrying out a physical activity) or passive (at rest) situations. Concomitant changes of pain and fatigue levels were evaluated. When patients listened to music or environmental sounds at rest, pain and fatigue levels were significantly reduced after 20 minutes of listening, with no difference of effect magnitude between the two stimuli. This improvement persisted 10 minutes after the end of the listening session. In active situations, pain did not increase in presence of the two stimuli. Contrary to our expectations, music and environmental sounds produced a similar relieving effect on pain and fatigue, with no benefit gained by listening to pleasant music over environmental sounds.

Physical and Cognitive-Affective Factors Associated With Fatigue in Individuals With Fibromyalgia: A Multiple Regression Analysis

Purpose: The main objective of this study was to determine the extent to which physical and cognitive-affective factors are associated with fibromyalgia (FM) fatigue.Method: A quantitative descriptive design using correlation techniques and multiple regression analysis. The participants consisted of 302 members of the National Fibromyalgia &amp; Chronic Pain Association.Results: The results indicated all of the predictor variables were significantly related to FM fatigue; however, in the regression model, only pain intensity and sleep quality uniquely contributed to fatigue.Conclusions: These findings suggest that FM fatigue treatment should focus on physical factors before addressing other symptoms. The implications for rehabilitation counselors in developing evidence-based approaches to fatigue management are discussed.

Daily social enjoyment interrupts the cycle of same-day and next-day fatigue in women with fibromyalgia.

Fatigue is a debilitating symptom of fibromyalgia (FM) that has limited treatment options. Some evidence, however, has linked positive social engagement with reduced within-day fatigue. This study elaborated longitudinal within-day and across-day relations between FM fatigue and social enjoyment. One hundred seventy-six women with FM completed 21-day automated diaries assessing morning and end-of-day fatigue, and both afternoon social enjoyment and stress within two social domains: non-spousal and spousal. In the non-spousal domain, analysis supported a mediational path from lower morning fatigue to higher afternoon social enjoyment, which predicted lower end-of-day fatigue, and subsequently, lower next-morning fatigue. Enjoyment exerted a greater impact on within-day fatigue than did stress. Patterns in the spousal domain were similar, but the mediated path was nonsignificant. Positive social engagement offers relief from FM fatigue that carries over across days and may provide an additional target to enhance the effectiveness of current interventions.

SP0125 Management of Fibromyalgia

There is little consensus in the management of fibromyalgia (FM) leading to significant disparity of treatment protocols in different rheumatology and pain clinics. The problem in developing effective management guidelines...

THU0075 Assessment of the Degree by Which Fibromyalgia Patients Fulfill Each One of the Items Included in ALL 3 of the Existing Criteria which are Used to Define Inflammatory Back Pain

BackgroundAiming to assess whether Inflammatory back pain (IBP) criteria are met by patients with Fibromyalgia (FM) and which items from those used in IBP criteria offer best discriminatory ability between...

Effects of milnacipran on neurocognition, pain, and fatigue in fibromyalgia: a 13-week, randomized, placebo-controlled, crossover trial.

To investigate whether milnacipran is safe and effective in improving cognitive function in patients with fibromyalgia. Patients were randomly assigned to receive milnacipran or placebo for 6 weeks, followed by a 1-week washout and then crossover to the other arm for another 6 weeks. The overall trial lasted 13 weeks and was conducted between July 2011 and May 2013. Assessments were performed at each visit. Neurocognition was measured by the Brief Assessment of Cognition (BAC) and MATRICS. Pain was assessed by the visual analog scale (VAS) for pain. Global assessment of fibromyalgia symptoms was measured by the Fibromyalgia Impact Questionnaire (FIQ) and tender point examination. Depression was assessed by the Beck Depression Inventory (BDI). Fatigue was assessed by the Fatigue Severity Scale. Functional outcome was evaluated by the Health Assessment Questionnaire. The Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales and the Patients Clinical Global Impression of Change were used to measure the global impression of severity and improvement. 26 subjects were screened, and 20 subjects completed the trial. The change in verbal memory (P = .001) and the composite T score (P = .044) of the BAC and the change in the attention-vigilance domain T score (P = .042) were significantly improved, but there were no differences between the drug and placebo groups. The changes in the CGI-S scores were not significant, but the changes in the Clinical Impression-Improvement (CGI-I) scores showed worsening in the placebo group at week 1 (P = .032), week 2 (P = .024), week 4 (P = .024), and week 6 (P = .60) compared to baseline. The change in FIQ scores was not significant. Milnacipran may have a potential role in the improvement of pain, disability, and mood. The effect of milnacipran on cognition in fibromyalgia needs further research. ClinicalTrials.gov identifier: NCT01829243.

Influence of Weather on Daily Symptoms of Pain and Fatigue in Female Patients With Fibromyalgia: A Multilevel Regression Analysis

Although patients with fibromyalgia often report that specific weather conditions aggravate their symptoms, empirical studies have not conclusively demonstrated such a relationship. Our aim was to examine the association between weather conditions and daily symptoms of pain and fatigue in fibromyalgia, and to identify patient characteristics explaining individual differences in weather sensitivity. Female patients with fibromyalgia (n = 333, mean age 47.0 years, mean time since diagnosis 3.5 years) completed questions on pain and fatigue on 28 consecutive days. Daily weather conditions, including air temperature, sunshine duration, precipitation, atmospheric pressure, and relative humidity, were obtained from the Royal Netherlands Meteorological Institute. Multilevel regression analysis was applied. In 5 (10%) of 50 analyses, weather variables showed a significant but small effect on either pain or fatigue. In 10 analyses (20%), significant, small differences between patients were observed in the random effects of the weather variables, suggesting that symptoms of patients were, to a small extent, differentially affected by some weather conditions, for example, high pain with either low or high atmospheric pressure. These individual differences were explained neither by demographic, functional, or mental patient characteristics, nor by season or weather variation during the assessment period. There is more evidence against than in support of a uniform influence of weather on daily pain and fatigue in female patients with fibromyalgia. Although individuals appear to be differentially sensitive to certain weather conditions, there is no indication that specific patient characteristics play a role in weather sensitivity.

High Prevalence of Fibromyalgia in Patients with HFE-related Hereditary Hemochromatosis

Subjects with HFE-related hereditary hemochromatosis (HH) may present with arthralgias, fatigue, and stiffness, yet little is known on the presence of fibromyalgia syndrome (FMS) in these subjects. We determined the prevalence of FMS in a cohort of subjects with HH and evaluated its relationship to subject demographics, disease status, and quality of life. In a cross-sectional study we collected data on 395 consecutive subjects diagnosed with HH who were attending a tertiary referral Hepatology outpatient clinic at Galway University Hospital, Ireland (between October 2009 and June 2010). Subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability. Univariate logistic regression was applied to determine risk factors independently associated with prevalent FMS in these subjects. Three hundred ninety-five subjects met the inclusion criteria. Mean age was 43 years (range, 21 to 59 y) and 260 (66%) were males. One hundred seventy (43%) of the subjects were diagnosed with FMS. Among those with fibromyalgia fatigue and ≥ 11 tender points were present in all of the subjects, widespread pain in 150 (88%), depression in 70 (41%), and arthralgia/joint stiffness in 70 (41%). In subjects with FMS 33% reported some functional impairment (HAQ-DI>0), with 10% reporting moderate-severe functional impairment (HAQ-DI ≥ 1.5). This study reveals a high prevalence of FMS (43%) among subjects with HFE-related hemochromatosis. Prospective studies are needed to better understand the risk factors for FMS in such patients.

THU0354 Attentional impairment in chronic central and peripheral pain: Controlled study

BackgroundPrimary fibromyalgia is accepted as “central pain syndrome” without inflammation. But rheumatoid arthritis (RA) is characterized by peripheral (nociceptive) pain with marked inflammation. It is well-known that acute and chronic...

AB0660 Serum coenzyme-q10 activity and oxidative status in patients with fibromyalgia

ObjectivesIn this study, we aimed to show the relationship between CoQ10 and fatigue symptoms of Fibromyalgia (FM).MethodsA total of 40 patients diagnosed as primary FM according to the ACR criteria...

Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue

To determine if peripheral neuropathology exists among the innervation of cutaneous arterioles and arteriole-venule shunts (AVS) in fibromyalgia (FM) patients. Cutaneous arterioles and AVS receive a convergence of vasoconstrictive sympathetic innervation, and vasodilatory small-fiber sensory innervation. Given our previous findings of peripheral pathologies in chronic pain conditions, we hypothesized that this vascular location may be a potential site of pathology and/or serotonergic and norepinephrine reuptake inhibitors (SNRI) drug action. Twenty-four female FM patients and nine female healthy control subjects were enrolled for study, with 14 additional female control subjects included from previous studies. AVS were identified in hypothenar skin biopsies from 18/24 FM patient and 14/23 control subjects. Multimolecular immunocytochemistry to assess different types of cutaneous innervation in 3 mm skin biopsies from glabrous hypothenar and trapezius regions. AVS had significantly increased innervation among FM patients. The excessive innervation consisted of a greater proportion of vasodilatory sensory fibers, compared with vasoconstrictive sympathetic fibers. In contrast, sensory and sympathetic innervation to arterioles remained normal. Importantly, the sensory fibers express α2C receptors, indicating that the sympathetic innervation exerts an inhibitory modulation of sensory activity. The excessive sensory innervation to the glabrous skin AVS is a likely source of severe pain and tenderness in the hands of FM patients. Importantly, glabrous AVS regulate blood flow to the skin in humans for thermoregulation and to other tissues such as skeletal muscle during periods of increased metabolic demand. Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM. SNRI compounds may provide partial therapeutic benefit by enhancing the impact of sympathetically mediated inhibitory modulation of the excess sensory innervation.

Association of fibromyalgia with altered skeletal muscle characteristics which may contribute to postexertional fatigue in postmenopausal women

To identify muscle physiologic properties that may contribute to postexertional fatigue and malaise in women with fibromyalgia (FM). Healthy postmenopausal women with (n = 11) and without (n = 11) FM, ages 51-70 years, participated in this study. Physical characteristics and responses to self-reported questionnaires were evaluated. Strength loss and tissue oxygenation in response to a fatiguing exercise protocol were used to quantify fatigability and the local muscle hemodynamic profile. Muscle biopsies were performed to assess between-group differences in baseline muscle properties using histochemical, immunohistochemical, and electron microscopic analyses. There was no significant difference between healthy controls and FM patients in muscle fatigue in response to exercise. However, self-reported fatigue and pain were correlated with prolonged loss of strength following 12 minutes of recovery in patients with FM. Although there was no difference in percent succinate dehydrogenase (SDH)-positive (type I) and SDH-negative (type II) fibers or in mean fiber cross-sectional area between groups, FM patients exhibited greater variability in fiber size and altered fiber size distribution. In healthy controls only, fatigue resistance was strongly correlated with the size of SDH-positive fibers and hemoglobin oxygenation. In contrast, FM patients with the highest percentage of SDH-positive fibers recovered strength most effectively, and this was correlated with capillary density. However, overall, capillary density was lower in the FM group. Peripheral mechanisms, i.e., altered muscle fiber size distribution and decreased capillary density, may contribute to postexertional fatigue in FM. Understanding of these defects in fibromyalgic muscle may provide valuable insight with regard to treatment.

Validation of the Daily Diary of Fatigue Symptoms—Fibromyalgia (DFS-Fibro)

Introduction: Fatigue is an important fibromyalgia (FM) symptom, but existing measures of fatigue are unlikely to meet regulatory standards for clinical trial use. We describe the development and validation of the Daily Diary of Fatigue Symptoms—Fibromyalgia (DFS-Fibro), a 24-hour recall, patient-reported outcome (PRO) measure of fatigue in FM that is administered electronically (ePRO). Methods: There were 3 phases of work: 1) item generation based on concept elicitation interviews with FM patients, with clinical relevance confirmed by expert clinician review; 2) pilot testing/cognitive debriefing interviews with FM patients; and 3) psychometric validation using data from a methodology study with 145 FM patients. The measure was finalised based on both qualitative and quantitative findings. Results: Twenty-three items were generated in phase 1, some minor revisions were made following the pilot testing and cognitive debriefing (phase 2) but none were deleted. All patients found the measure easy to understand and use. Item reduction was conducted taking into account both the initial psychometric data and the earlier qualitative research, resulting in a final 5 item measure of the “symptom” of fatigue. The 5-item DFS-Fibro had very high internal consistency (alpha = 0.99), and strong test-re-test reliability (r > 0.84), convergent validity and known-groups validity. Conclusion: The DFS-Fibro has strong psychometric properties and strong face and content validity for the measurement of fatigue in FM.

Usefulness of multiple dimensions of fatigue in fibromyalgia

To explore in which contexts ratings of multiple dimensions of fatigue are useful in fibromyalgia, and to compare multidimensional fatigue between women with fibromyalgia and healthy women. A cross-sectional study. The Multidimensional Fatigue Inventory (MFI-20), comprising 5 subscales of fatigue, was compared with the 1-dimensional subscale of fatigue from the Fibromyalgia Impact Questionnaire (FIQ) in 133 women with fibromyalgia (mean age 46 years; standard deviation 8.6), in association with socio-demographic and health-related aspects and analyses of explanatory variables of severe fatigue. The patients were also compared with 158 healthy women (mean age 45 years; standard deviation 9.1) for scores on MFI-20 and FIQ fatigue. The MFI-20 was associated with employment, physical activity and walking capacity (rs = -0.27 to -0.36), while FIQ fatigue was not. MFI-20 and FIQ fatigue were equally associated with pain, sleep, depression and anxiety (rs = 0.32-0.63). Regression analyses showed that the MFI-20 increased the explained variance (R2) for the models of pain intensity, sleep, depression and anxiety, by between 7 and 29 percentage points, compared with if FIQ fatigue alone was included in the models. Women with fibromyalgia rated their fatigue higher than healthy women for all subscales of the MFI-20 and the FIQ fatigue (p < 0.001). Dimensions of fatigue, assessed by the MFI-20, appear to be valuable in studies of employment, pain intensity, sleep, distress and physical function in women with fibromyalgia. The patients reported higher levels on all fatigue dimensions in comparison with healthy women.

Beyond pain in fibromyalgia: insights into the symptom of fatigue

Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.

Muscle fatigue in fibromyalgia is in the brain, not in the muscles: a case–control study of perceived versus objective muscle fatigue

ObjectiveTo investigate relationships between perceived and objectively measured muscle fatigue during exhausting muscle contractions in women with fibromyalgia (FM) compared with healthy controls (HC).MethodsWomen with FM and HC completed an...

Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia

Fibromyalgia (FM) is a disorder of widespread muscular pain. We investigated possible differences in surface electromyography (sEMG) in clinically unaffected muscle between patients with FM and controls. sEMG was performed on the biceps brachii muscle of 13 women with FM and 14 matched healthy controls during prolonged dynamic exercises, unloaded, and loaded up to 20% of maximum voluntary contraction. The sEMG parameters were: muscle fiber conduction velocity (CV); skewness of motor unit potential (peak) velocities; peak frequency (PF) (number of peaks per second); and average rectified voltage (ARV). There was significantly higher CV in the FM group. Although the FM group performed the tests equally well, their electromyographic fatigue was significantly less expressed compared with controls (in CV, PF, and ARV). In the patients with FM, we clearly showed functional abnormalities of the muscle membrane, which led to high conduction velocity and resistance to fatigue in electromyography.

Fatigue in fibromyalgia: a conceptual model informed by patient interviews

BackgroundFatigue is increasingly recognized as an important symptom in fibromyalgia (FM). Unknown however is how fatigue is experienced by individuals in the context of FM. We conducted qualitative research in order to better understand aspects of fatigue that might be unique to FM as well as the impact it has on patients' lives. The data obtained informed the development of a conceptual model of fatigue in FM.MethodsOpen-ended interviews were conducted with 40 individuals with FM (US [n = 20], Germany [n = 10] and France [n = 10]). Transcripts were analyzed using qualitative methods based upon grounded theory to identify key themes and concepts.ResultsParticipants were mostly female (70%) with a mean age of 48.7 years (range: 25-79). Thirty-one individuals (i.e., 77.5%) spontaneously described experiencing tiredness/lack of energy/fatigue due to FM. Participants discussed FM fatigue as being more severe, constant/persistent and unpredictable than normal tiredness. The conceptual model depicts the key elements of fatigue in FM from a patient perspective. This includes: an overwhelming feeling of tiredness (n = 17, 42.5%), not relieved by resting/sleeping (n = 15, 37.5%), not proportional to effort exerted (n = 25, 62.5%), associated with a feeling of weakness/heaviness (n = 20, 50%), interferes with motivation (n = 22, 55%), interferes with desired activities (n = 27, 67.5%), prolongs tasks (n = 15, 37.5%), and makes it difficult to concentrate (n = 21, 52.5%), think clearly (n = 12, 30%) or remember things (n = 9, 22.5%).ConclusionThe majority of individuals with FM who participated in this study experience fatigue and describe it as more severe than normal tiredness.