Revised Fibromyalgia Impact Questionnaire Research Articles

Quality of life, distrust in health care system and adherence to medical recommendations in patients with fibromyalgia: a latent profile analysis

Introduction: Fibromyalgia is a very heterogeneous disorder. This heterogeneity is one of the reasons why researchers have tried to analyze different patient profiles and their relationship with quality of life. The aim of the present study was to identify: (1) latent profiles based on the Revised Fibromyalgia Impact Questionnaire’s scores, and (2) possible differences between them in quality of life, distrust in healthcare system, and adherence to medical recommendations. Methods : 707 FM patients (aged 18-85 years, 95% women) completed the Revised Fibromyalgia Impact Questionnaire, the 12-Item Short Form Health Survey, the Patient Adherence Scale, and the Health Care System Distrust Scale. Data were analyzed using latent profile analysis. Results : Three profiles were identified: (1) Low fibromyalgia impact profile (2) Moderate fibromyalgia impact profile, and (3) High fibromyalgia impact profile. Significant differences between these profiles were found in quality of life, adherence to medical recommendations, and distrust in healthcare system. Poor-sleep quality emerged as a significant high important symptom in the three profiles. Conclusion : The greater the fibromyalgia impact, the lower the quality of life, and the adherence to medical recommendations and the greater the mistrust in the healthcare system. Self-perceived sleep quality in fibromyalgia patients should require special attention from clinicians.

Therapeutic Effects of Ba-Duan-Jin versus Pregabalin for Fibromyalgia Treatment: Protocol for a Randomized Controlled Trial.

IntroductionFibromyalgia is characterized by multi-focal pain and is associated with fatigue, unrefreshing sleep and psychological impairment. Pregabalin is one of the most frequently used agents in fibromyalgia treatment. However, it has failed to demonstrate benefit over placebo for reducing fatigue and psychological impairment, and may cause adverse effects (e.g. somnolence, dizziness). “Ba-Duan-Jin” (BDJ) is a common form of “Qigong” exercise for health promotion in China. Growing evidence suggests that BDJ may achieve satisfactory control of fibromyalgia-related symptoms in Chinese patients. Therefore, we wish to ascertain if BDJ could overcome the disadvantages of pregabalin.MethodsA single-blind randomized controlled trial has been designed which will recruit 104 patients with fibromyalgia (age 18–70 years) with a visual analog scale (VAS) pain score of ≥ 40 mm These patients will be randomly assigned to one of two groups: (1) BDJ group (to undertake guided BDJ exercise and take a placebo capsule) or (2) pregabalin group (to take a pregabalin capsule and receive wellness education and guided muscle-relaxation exercises). The primary endpoint will be changes in the VAS score for pain. The secondary endpoints will be changes in the score for the Revised Fibromyalgia Impact Questionnaire, Multidimensional Fatigue Inventory-20, Pittsburgh Sleep Quality Index, Beck II Depression Inventory, Perceived Stress Scale and Short Form-36 Health Survey Questionnaire. These parameters will be assessed at 0, 4, 8, 12 and 24 weeks of follow-up.Planned OutcomesOur results are expected to provide more clinical evidence for the beneficial effects of BDJ in treating fibromyalgia.Trial RegistrationNCT03797560.

Fibromyalgia influences health-related quality of life and disease activity in psoriatic arthritis.

Fibromyalgia syndrome (FMS) is common in patients of psoriatic arthritis (PsA), but the magnitude of its impact is uncertain. Thiscross-sectional study evaluated the impact of FMS on health-related quality of life (HRQoL) and disease activity in PsA. Adults classified with PsA (CASPAR criteria) at the rheumatology and dermatology outpatient clinics of PGIMER, Chandigarh, India between January 2014 and June 2015were recruited. All patients were assessed for FMS using the 2010 ACR criteria. Health-related quality of life was assessed using PROMIS-HAQ, HAQ-pain, HAQ-health and revised fibromyalgia impact questionnaire (FIQR). Disease activity measures (SJC, TJC, BASDAI, enthesitis, dactylitis, PASI) and PROMIS-HAQ were correlated with measures of FMS [FIQR, symptom severity scale (SSS) score and widespread pain index (WPI)]. Multivariate regression analyses were used to identify predictors of PROMIS-HAQ and FMS. Out of 106 PsA patients screened, 102 [50 (49%) females; mean age 43.8 (12.4) years] were included. 19 (18.3%) had FMS. Patients of PsA with FMS had significantly (p < 0.05) higher TJC (14vs7), SJC (10vs5), BASDAI (6.1vs4.1) and enthesitis (53 vs 33%), but no difference in dactylitis, severity of skin disease and disease duration. A significant positive correlation of measures of FMS (FIQR, SSS and WPI) with SJC, TJC and BASDAI was noted. PROMIS-HAQ, HAQ-pain and HAQ-health were significantly worse (p < 0.001) in patients of PsA with coexisting FMS. Presence of FMS was found to be an independent predictor of worse PROMIS-HAQ. Female gender and higher TJC independently predicted presence of FMS.To conclude, FMS is an important contributor towards poor HRQoL in patients of PsA and is associated with higher values of joint disease activity measures.

Management of Pain and Related Disabilities in Primary Fibromyalgia Using Neuromodulator Techniques, Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation

Background: Fibromyalgia syndrome (FMS) is a chronic condition that causes pain, stiffness, and tenderness in muscles, tendons, and joints. It is also characterized by disturbed sleep, fatigue, anxiety, depression, and disturbances in bowel function. Management of FMS is at present very challenging as it contains multiple etiological factors and psychological tendencies; though, a patient-centered approach is essential to deal with this problem. Objective: To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in improving pain and related disabilities in patients with primary (1ry) FM. Patients and Methods: Thirty patients with 1ry FM, 18 to 50 years old were randomized into 2 groups. Group I included 15 patients, who received 8 sessions (2/week for 4 consecutive weeks) of high frequency rTMS (10 Hz frequency) and Group II included 15 patients received 8 daily sessions of anodal tDCS (2 mA for 20 minutes) applied over the left primary motor cortex (M1). Results: Pain visual analogue scale (VAS), the revised Fibromyalgia Impact Questionnaire (FIQR), tender point scale, and Hospital Anxiety and Depression Scale (HADS) showed a significant decrease between baseline and follow-up assessments for both groups. Moreover, a significant change in all assessment scales was observed post-treatment when compared between both groups with more significant improvement in the group that received rTMS. Conclusion: Both rTMS and anodal tDCS of the left primary motor cortex showed marked improvement in symptoms of pain, functional disabilities and psychological status in patients with 1ry fibromyalgia. Both neuromodulator techniques can be considered as promising alternatives therapeutic options in the management of pain and related disabilities in FM.

The effects of COVID-19 fear and anxiety on symptom severity, sleep quality, and mood in patients with fibromyalgia: a pilot study

BackgroundDuring the COVID-19 pandemic, individuals faced psychological stress caused by fear and anxiety due to the high transmission and mortality rate of the disease, the social isolation, economic problems, and difficulties in reaching health services. Fibromyalgia (FM) is a chronic centralized pain sensitivity disorder. Psychological, physical and/or autoimmune stressors were found to increase FM symptoms. This pilot study aimed to evaluate the COVID-19 fear and anxiety level, and to examine their effect on disease severity, sleep quality, and mood in FM patients compared to control group.MethodsThis pilot study conducted as a cross-sectional study, and included 62 participants. Participants were divided into two groups: FM patient group (n = 31) and control group (n = 31). Symptom severity, sleep quality, and mood were determined using the Revised Fibromyalgia Impact Questionnaire (FIQR), Pitsburg Sleep Quality Index (PSQI), and Hospital Anxiety Depression Scale (HADS), respectively. In order to evaluate the level of COVID-19 fear and anxiety, the Fear of COVID-19 Scale (FCV-19S) and Coronavirus Anxiety Scale (CAS) were used compared to control group.ResultsFIQR, PSQI, HAD-A, HAD-D, FCV-19S and CAS scores were significantly higher in the FM group (p = 0.01). A positive significant correlation was found between FCV-19S and CAS results and FIQR, PSQI, and HAD-anx results in FM patients (p < 0.05).ConclusionThis pilot study showed that, the individuals with FM can be more affected by psychological stress, and this situation negatively affects the symptom severity, sleep quality, and mood in FM patients, so these patients should be closely monitored in terms of psychological stressors and their effects during pandemics. More studies with more participants are necessary to describe the challenges lived by fibromyalgia population.

Marital adjustment in patients with fibromyalgia: its association with suicidal ideation and related factors. A cross-sectional study.

Fibromyalgia has been associated with suicidal ideation, suicide attempts and completed suicide. Non-married status is a risk factor for suicidal behaviours but the quality of the marital relationship has been scarcely investigated. The objectives of the present study were to evaluate, in patients with fibromyalgia, the relationship between marital adjustment suicidal ideation and potentially related variables: depression severity, sleep disturbance, perceived burdensomeness, thwarted belongingness, fibromyalgia severity and pain intensity. A survey was done in patients with fibromyalgia which collected sociodemographic data and included the following questionnaires: the Locke and Wallace Marital Adjustment Test, the Beck's Depression Inventory II, the Plutchik Suicide Risk Scale, a 10-item version of the Interpersonal Needs Questionnaire, the Insomnia Severity Index, and the Revised Fibromyalgia Impact Questionnaire. Suicidal ideation was assessed with item 9 of the Beck's Depression Inventory, and pain intensity was measured with the VAS scale of the Revised Fibromyalgia Impact Questionnaire. Of 257 participants 71 were single, 107 had a good marital adjustment and 79 a poor marital adjustment. Suicidal ideation was most frequent among patients with poor marital adjustment than among those with good marital adjustment or patients without partner. The poor marital adjustment group showed significantly worse scores in most of the remaining variables with the only exceptions of the FIQR and pain scores. In patients with fibromyalgia the degree of marital adjustment seems to be a relevant factor for suicidal ideation and related variables.

The effect of novel coronavirus disease-2019 (COVID-19) on fibromyalgia syndrome.

Fibromyalgia syndrome (FM) is a complex disease that is mainly characterised by chronic widespread pain, fatigue and sleep disturbances and may be precipitated or worsened by many stressors. The aim of this study was to observe the behaviour of FM symptoms during the course of coronavirus disease 2019 (COVID-19). Patients who had been diagnosed as having FM for ≥3 months were recruited between February and May 2020. The collected data were age, sex, educational level and marital status; height and weight; and the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Status 2019 (FASmod), and the Polysymptomatic Distress Scale (PDS). The patients were divided into those with or without concomitant COVID-19 infection. Eight hundred and ninety-seven (93%) of the 965 patients (881 women [91.3%] and 84 men [8.7%]) were followed up on an outpatient basis because of FM and 68 (7.0%) were either followed up as out-patients or hospitalised because of COVID-19. There was no difference in the sociodemographic data of the two groups, but there were statistically significant between-group differences in the results of the clinimetric tests. The major differences between the score of the items (those with the greatest disease impact) were the following related symptoms: sleep quality (FIQR15), fatigue/energy (FIQR13), pain (FIQR12), stiffness (FIQR14). The mean total and subdomain scores of all the tests were significantly higher in the patients with COVID-19, which suggests that global FM symptoms are more severe in patients with infection. Further studies of the post-COVID19 patients are being carried out in order to discover whether the worsened symptomatology continues because of their hypersensitised state.

Overactive bladder syndrome and sexual dysfunction in women with fibromyalgia and their relationship with disease severity.

The aim of this study was to evaluate the prevalence and severity of overactive bladder syndrome (OAB) and sexual dysfunction in fibromyalgia (FM) patients, as well as their relationship with disease severity. Consecutive adult female patients with FM were enrolled. Patients filled in a comprehensive questionnaire package including demographic variables, disease severity assessment (revised Fibromyalgia Impact Questionnaire [FIQR]), neuropathic pain features (PainDetect Questionnaire [PDQ]), severity of OAB symptoms (Overactive Bladder Symptom Score [OABSS]), and determining sexual functioning (Female Sexual Function Index [FSFI]). The study included 481 patients, 116 (24.11%) had mild OAB, 82 patients (17.04%) had moderate OAB, and 34 patients had serious OAB (7.06%). In 14.17% of patients the bladder condition was causing them major issues in terms of discomfort. In 7.87% of patients the bladder condition was causing them significant problems. Sexual dysfunctions were found in 91 patients (18.91%). Using the FSFI as dependent variable, multivariate analysis revealed a positive relationship between sexual dysfunction and variables of disease burden (FIQR, p<0.0001; PDQ, p<0.0001, widespread pain index [WPI], p=0.0037). Using OABSS as the dependent variable, multivariate regression revealed a substantial contribution from FIQR (p<0.0001), PDQ (p=0.0037), and WPI (p=0.0030). FM has the potential to affect both psychological and physiological processes in women with OAB and sexual dysfunction. These results emphasize the importance of a multidisciplinary approach to treat patients with overactive bladder syndrome and sexual dysfunction in FM.

Fibromyalgia severity according to age categories: results of a cross-sectional study from a large national database.

The role of age in influencing the severity of fibromyalgia (FM) is still controversial. The aim of this study is to define the contribution of age in the severity of FM from data from a large national database. This cross-sectional study included adult patients with FM diagnosed according to the 2010/2011 American College of Rheumatology criteria. Disease severity was assessed with the revised Fibromyalgia Impact Questionnaire (FIQR) and the modified Fibromyalgia Assessment Status (FAS 2019mod). Patients were grouped into five age categories (between 18-40 years, between 41-50 years, between 51-60 years, between 61-70 years, and ≥71 years). Differences in disease severity between groups were assessed by one-way analysis of variance (ANOVA). The study included 2889 patients (199 males and 2690 females), mean age of 52.58 (±11.82) years, with a mean FIQR score of 59.22 (±22.98) and a mean FAS 2019mod of 25.50 (±8.66). Comparing the mean values of the various indices between age categories, there were no statistically significant differences between the groups for FIQR total score and FAS 2019mod. However, the 60-70 years category showed the lowest scores for both scales. The main difference emerged for the FIQR physical function subscale, where the ≥71 years category showed significantly higher scores (p<0.05) compared the 18-40 years category. The severity of FM has a significant level of stationarity according to age categories. Patients between 60-70 years have a lower disease burden. Physical function is the health domain with the most significant difference between the groups.

Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia.

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Dietary Intake Assessment, Severity of Symptoms, and Pain in Women with Fibromyalgia

A cross-sectional study was conducted to assess dietary intake in 92 FMS compared to 96 healthy control patients and to examine the potential associations between daily intake and pain and the severity of symptoms in women with FMS. The tender point count (TPC), the Visual Analog Scale (VAS), and the Revised Fibromyalgia Impact Questionnaire (FIQR) were assessed. FIQ-R correlated negatively with phosphorus (r = -.230, p = .028), iron (r = -.320, p = 0.002), zinc (r = -.238, p = .023), vitamin B1 (r = -.218, p = .038), vitamin B6 (r = -.123, p = .012), folic acid (r = -.250, p = .017), and vitamin C (r = -.217, p = .039). A negative correlation was also found between VAS pain and the intake of vitamin B6 (r = -.322, p = .002). Lower intakes of certain micronutrients correlated with higher scores in FIQ-R and a lower intake of vitamin B6 correlated with higher scores in VAS pain, supporting the potential relevance of these micronutrients in the severity of symptoms and in levels of global pain in FMS women.

Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial.

The aim was to evaluate the effectiveness of strengthening exercises using the Swiss ball in patients with fibromyalgia through a randomized controlled trial with intention to treat analyses. A total of 60 patients with fibromyalgia met the inclusion criteria and were randomly allocated to either the Swiss ball exercise group (n=30) or a stretching group (n=30). All patients participated in 40-minute training sessions 3 times per week for 12 weeks. Pain (Visual Analogue Scale 0-100); muscle strength (One Repetition Maximum test); health status (Fibromyalgia Impact Questionnaire Revised); quality of life (Short Form-36 questionnaire) were evaluated at baseline, and after 6 and 12 weeks of training. The Swiss ball group showed a statistically significant improvement in VAS (0-100) (p<0.001), SF-36 (p<0.05) and Fibromyalgia Impact Questionnaire (p<0.001) compared with the stretching group. The results of this study proved that the treatment for fibromyalgia with strengthening exercises and the use of the Swiss ball led to improvement of pain, quality of life, muscle strength and decreased the need for medications for this disease compared to stretching exercises, without negative effects.

Repetitive transcranial magnetic stimulation (rTMS) versus transcranial direct current stimulation (tDCS) in the management of patients with fibromyalgia: A randomized controlled trial

ObjectivesThe aim of this study was to compare the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on pain and quality of life in patients with fibromyalgia. MethodsThirty participants were randomized into two groups of 15 patients, to receive 3 sessions of either high-frequency (10 Hz) rTMS or 2 mA, 20 min anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex (DLPFC) over 1 week. Pain was assessed using a Visual Analog Scale (VAS) before treatment, immediately after treatment, 6 and 12 weeks later. Quality of life was evaluated using the Revised Fibromyalgia Impact Questionnaire (FIQR) and psychiatric symptoms were measured using the Depression Anxiety Stress Scale-21 Item (DASS-21) before treatment, and 6 and 12 weeks after treatment. ResultsFor the VAS there was a significant time-group interaction, showing that the behavior of two groups differed regarding changes of VAS in favor of the RTMS group (df = 1.73, F = 4.80, p = <0.016). Time-group interaction effect on DASS-21 and FIQR was not significant. 66.6% of patients in rTMS group and 26.6% of patients in tDCS group experienced at least a 30% reduction of VAS from baseline to last follow-up (p = 0.028). DiscussionWith the methodology used in this study, both rTMS and tDCS were safe modalities and three sessions of rTMS over DLPFC had greater and longer lasting analgesic effects compared to tDCS in patients with FM. However, considering the limitations of this study, further studies are needed to explore the most effective modality.

High cost of illness in fibromyalgia patients in Iran, irrespective of disease severity: A prospective cost study.

This study aimed to estimate the economic burden of fibromyalgia (FM) in 6months, using a cost-diary, and to evaluate its relationship with the disease severity. This is a prospective cost-of-illness study on 62 participants with an FM diagnosis within a 6month period. Patients completed the questionnaires, including FIQR (Revised Fibromyalgia Impact Questionnaire) and SF-12 (12-item short-form survey). The cost-diary method was used to track the cost of the disease. The participants received six cost-diary booklets during the study period to report their FM-related costs, hours, and days of productivity loss. The final costs are reported in US dollars. Most of the participants were women (90.3%) with a mean (±SD) age of 40.80 (±5.50) years and a mean (±SD) FIQR score of 54.38 (±14.13). Moreover, 45.2% of patients fulfilled all six booklets, whereas 24.2% returned only one booklet. The participants showed a mean (±SD) direct healthcare, non-healthcare, and indirect cost of $2817.08 (±$1860.04), $1497.98(±$1358.21), and $1449.05(±$3637.41) per patient for 6months, respectively. Fibromyalgia is associated with high health-related and non-health-related costs in our country, irrespective of its severity. This study warrants urgent consideration in managing the disease burden on both patients and society.

A study protocol for a randomized controlled trial of an anti-inflammatory nutritional intervention in patients with fibromyalgia

BackgroundThis study aims to analyze the effects of a potentially anti-inflammatory nutritional intervention in disease assessment parameters, inflammatory markers, and quality of life of fibromyalgia (FM) patients.MethodsA sample of 100 female patients diagnosed with FM, followed up at Portuguese Institute of Rheumatology (IPR) in Lisbon, is being randomly allocated in two groups. Patients in the intervention group are adopting an anti-inflammatory diet, characterized by the exemption of the intake of foods containing gluten, dairy, sugar, and ultra-processed foods, during 3 months. During the first month, a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet is implemented, along with the anti-inflammatory diet, followed by the reintroduction of all fruits and vegetables over a consecutive period of 2 months. Patients in the control group are adopting a diet based on general recommendations for healthy eating. The outcomes are pain, fatigue, quality of sleep, quality of life, gastrointestinal symptoms, and inflammation. Before and after the 3 months intervention, and also 1 month after beginning the intervention, the following questionnaires are applied: Revised Fibromyalgia Impact Questionnaire, visual analog pain scale, Brief Pain Inventory,visual analog scale from a list of common gastrointestinal and extraintestinal symptoms in FM, Short Form 36, Fatigue Severity Survey, and Pittsburg Sleep Quality Index. Ultra-sensitive serum C-reactive protein, eritrocyte sedimentation rate, and interleukin-8 are determined. Age, physical activity, anthropometric parameters, and body composition are being collected. Student’s t test will assess the association between the disease evaluation parameters, the inflammatory markers, and the dietary interventions.DiscussionThe results of this study are expected to determine whether a change in patient nutrition helps to alleviate symptoms, which would optimize medical intervention.Trial registrationwww.ClinicalTrials.gov NCT04007705. Registered on July 5, 2019.

Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia.

To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). A cohort study with a delayed treatment arm used as a comparator. Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada. Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire. Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period (n = 9). HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks. Safety was evaluated by the frequency and severity of adverse effects reported by patients. Feasibility was assessed by recruitment, retention, and HBOT compliance rates. Both groups were assessed at baseline, after HBOT intervention, and at 3 months' follow-up. Validated assessment tools were used to evaluate pain, psychological variables, fatigue, and sleep quality. A total of 17 patients completed the study. One patient withdrew after randomization. HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients. The efficacy of HBOT was evident in most of the outcomes in both groups. This improvement was sustained at 3-month follow-up assessment. HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment.

Impact of sleep disturbances and autonomic dysfunction on the quality of life of patients with fibromyalgia.

Fibromyalgia, a painful musculoskeletal disorder is associated with sleep disturbances as well as autonomic dysfunction. Pathophysiology of fibromyalgia is yet not clear and neuroanatomical proximity of sleep and autonomic centre prompts probable involvement of the two impacting the quality of life of fibromyalgia patients. Present study was done with the objective to explore the extent of sleep disturbances and/or autonomic dysfunction in fibromyalgia and asses their impact on quality of life of fibromyalgia patients. Thirty consecutive fibromyalgia patients (diagnosed by ACR 2010) from out-patient department and 30 age-gender matched controls were enrolled after the ethical clearance. All participants were evaluated for: (1) sleep using Pittsburgh sleep quality index and medical outcomes study sleep scale-12 Revised, (2) Quality of life by 36 item short-form health survey-36v2TM and revised fibromyalgia impact questionnaire (only patients). Autonomic functions of patients were evaluated by standard cardiovascular autonomic function tests by Ewing's battery and heart rate variability (5-min) measurement. Fibromyalgia patients had increased sleep disturbances compared to controls (39.46±11, 59.61±2.31; p=0.0001) and very poor sleep quality (13.63±4.15, 3.03±1.56; p=0.0001) as well as quality of life (p=0.0001) which further deteriorated with increasing severity of fibromyalgia. Twelve patients had autonomic dysfunction but it was neither associated with sleep disturbances nor with quality of life. Mild to moderate grade fibromyalgia patients have significant sleep disturbance, poor sleep quality which remarkably impacts their quality of life. Autonomic dysfunction is not an early feature of disease. The study suggests that full spectrum of sleep disturbances and sleep quality should be explored in fibromyalgia syndrome (FMS) patients.

Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial

BackgroundFibromyalgia is a chronic widespread pain condition that is associated with sleep disturbances and cognitive impairments. Neurofeedback has been demonstrated to improve pain, sleep quality, and fatigue. However, few studies have examined the effect of neurofeedback for patients with fibromyalgia. AimTo determine the effects of neurofeedback on pain intensity, symptom severity, sleep quality, and cognitive function in patients with fibromyalgia. DesignThis study was a randomized controlled trial. MethodEighty participants were randomized to a neurofeedback group (N = 60), receiving sensorimotor and alpha rhythm feedback for 8 weeks, or a telephone support group (N = 20). ResultsResults from the generalized estimating equation modelling revealed significant group-by-time interactions for Brief Pain Inventory pain severity (B = −1.35, SE = 0.46, p = .003) and pain interference (B = −1.75, SE = 0.41, p < .001), Revised Fibromyalgia Impact Questionnaire total scores (B = −16.41, SE = 3.76, p < .001), sleep onset latency (B = −25.33, SE = 9.02, p = .005), and Psychomotor Vigilance Test error (B = −1.38, SE = 0.55, p = .013) after adjustments for age, sex, duration of illness, and group differences at baseline. ConclusionsAn 8-week neurofeedback training regimen of sensorimotor rhythm and alpha brain waves significantly improved pain severity and interference, fibromyalgia symptom severity, sleep latency, and sustained attention in patients with fibromyalgia.

Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia.

Background: We analyzed the immediate effects of a Telerehabilitation Program (TP) based on aerobic exercise in women with fibromyalgia (FM) syndrome during the lockdown declared in Spain due to the COVID-19 pandemic. Methods: A single-blind randomized controlled trial was designed. Thirty-four women with FM were randomized into two groups: TP group and Control group. The intervention lasted 15 weeks, with 2 sessions per week. The TP based on aerobic exercise was guided by video and the intensity of each session was monitored using the Borg scale. Pain intensity (Visual Analogue Scale), mechanical pain sensitivity (algometer), number of tender points, FM impact (Revised Fibromyalgia Impact Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), physiological distress (Hospital Anxiety and Depression Scale), upper (Arm Curl Test) and lower-limb physical function (6-min Walk Test) were measured at baseline and after the intervention. Results: The TP group improved pain intensity (p = 0.022), mechanical pain sensitivity (p < 0.05), and psychological distress (p = 0.005), compared to the Control group. The Control group showed no statistically significant changes in any variable (p > 0.05). Conclusions: A TP based on aerobic exercise achieved improvements on pain intensity, mechanical pain sensitivity, and psychological distress compared to a Control group during the lockdown declared in Spain due to COVID-19 pandemic.

The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients

ObjectiveVarious studies have shown that overweight and obesity are central features of FM, but the real impact of a high BMI on clinical severity in patients with FM is still controversial. The aim of this study was to analyse the relationships between BMI categories and measures of symptom severity and functional impairment using data from a Web-based registry of patients with FM.MethodsAdult patients with an ACR 2010/2011 diagnosis of FM underwent a complete physical examination and laboratory tests and were asked to complete a package of questionnaires covering their sociodemographic and treatment details, in addition to the following disease-specific questionnaires: the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Status questionnaire (ModFAS) and the Polysymptomatic Distress Scale (PDS).ResultsA total of 2339 patients were recruited and divided into two weight categories, underweight/normal (U/N, n = 1127, 48.2%) and overweight/obese (O/O, n = 1212, 51.8%). The total and subscales of FIQR, ModFAS and PSD scores were significantly higher in the O/O patients, as were all the mean scores of the individual FIQR items (P < 0.001 for all).ConclusionOur findings demonstrate that O/O patients with FM are significantly more impaired than U/N patients in all the symptomatological and functional domains as measured using the FIQR, ModFAS and PDS, thus suggesting that being O/O has an additional effect on symptoms and function.