Fibromyalgia Syndrome Symptoms Research Articles

High body mass index disrupts the homeostatic effects of pain inhibitory control in the symptomatology of patients with fibromyalgia

This study examines the influence of body mass index (BMI) on the relationship between quantitative sensory testing (QST) measures and clinical characteristics in fibromyalgia syndrome (FMS). Utilizing BMI as a categorical covariate (≥25 or ≥30kg/m²) in associations between QST metrics (Pain-60, conditioned pain modulation [CPM], and temporal summation of pain [TSP]) and FMS clinical features, we explored BMI's role as both a confounder (change-in-estimate criterion – change equal or higher than 10%) and effect modifier (interaction term). Significant interactions revealed overweight/obese BMI as a modifier in the relationship between CPM and both depression and symptom impact, with a homeostatic relationship between better clinical profile and pain inhibitory response observed solely in the normal weight group. Similar results were found for Pain-60 and depression. Additionally, BMI ≥30kg/m² modified TSP's effect on pain, demonstrating lower pain with increased TSP, exclusively in the non-obese group. This study highlights the significant role of BMI in moderating the relationships of important pain inhibitory control processes and pain intensity, depression, and the overall impact of FMS symptoms. Our results suggest that high BMI states disrupt the homeostatic effects of pain inhibition, reducing its salutogenic response in FMS participants. We discuss the mechanistic and therapeutic implications of targeting BMI in FMS clinical trials and the potential impact of this important relationship. PerspectiveThis investigation highlights the disruptive influence of high BMI on pain inhibitory control in fibromyalgia, unbalancing clinical symptoms such as pain and depression. It underscores the necessity of integrating BMI considerations into therapeutic approaches to enhance pain management and patient outcomes.

Depression with comorbid juvenile-onset fibromyalgia syndrome novel treatment plan using interpersonal psychotherapy: A case report.

Fibromyalgia syndrome (FMS) affects 2% to 4% of people, with increasing prevalence in Saudi Arabia reaching 13.4%. FMS can occur in adolescents, known as juvenile-onset fibromyalgia (JFM) with comorbidities including depression, anxiety, and psychological stress. Our patient presented to the child and adolescent psychiatry clinic at King Saud University Hospital Medical City. A year before coming to our clinic, at the age of 15 she was initially diagnosed with JFM followed by a comorbid persistent depressive disorder. As a novel treatment method, a combination treatment approach was used, including a pharmacological intervention with Duloxetine, and a non-pharmacological intervention with interpersonal psychotherapy for adolescents. She completed 16 weeks of therapy while monitoring for duloxetine response and side effects. Depressive symptoms were in remission by treatment's end and continued to be in her first month posttreatment follow-up, and the FMS symptoms were also controlled. Our present case highlights a combined approach to treat depression and JFM in adolescents as a novel intervention method thus we strongly recommend utilizing it for similar cases.

Exploring the Overlooked Depression, Anxiety, Insomnia and Fibromyalgia Syndrome Burden in Arab Women with Type 2 Diabetes: New Avenues for Chronic Disease Management.

Background and Objectives: Although physical health is always studied for women with diabetes, the mental health aspect is generally overlooked for this chronic disease. The present study aimed to examine the prevalence of psychosomatic symptoms, namely, fibromyalgia syndrome, depression, anxiety, and insomnia, and how these symptoms related to the medications used in a cohort of women diagnosed with type 2 diabetes (DM) in Jordan. Materials and Methods: This cross-sectional study recruited women diagnosed with type 2 diabetes, and validated scales (PSRS, PHQ-9, GAD-7, and ISI-A) for fibromyalgia syndrome, depression, anxiety, and insomnia were used. The associations between the different medications used and the dependent variables were examined using four separate multivariate logistic regression models. Results: Data were analyzed from 213 participants. Of them, 27.2% met the threshold for fibromyalgia syndrome diagnosis, 38% met the threshold for severe depression, 36.2% met the threshold for severe anxiety, and 39.9% met the threshold for severe insomnia. Fibromyalgia syndrome symptoms were significantly associated with glimepiride (OR = 1.92, CI = 1.00-3.68), β-blockers (OR = 2.21, CI = 1.03-4.70), diuretics (OR = 3.13, CI = 1.26-7.78), herbal remedies (OR = 2.12, CI = 0.98-4.55), and prescriptions for centrally acting medication (OR = 2.78, CI = 1.24-6.29). Significant associations were found between depression and diuretics (OR = 2.62, CI = 1.05-6.67), over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) (OR = 3.49, CI = 1.69-7.23), and herbal remedies (OR = 5.07, CI = 2.40-10.69). In addition, anxiety was significantly related to diuretics (OR = 2.48, CI = 1.02-6.02), and OTC NSAIDs (OR = 2.60, CI = 1.29-5.21). Significant associations were evident between insomnia and β-blockers (OR = 3.23, CI = 1.51-6.95), acetaminophen (OR = 2.09, CI = 1.06-4.08), NSAIDs (OR = 4.61, CI = 2.18-9.76), and herbal remedies (OR = 5.95, CI = 2.71-13.07). Conclusions: Medications are associated with high burden of fibromyalgia syndrome, depression, anxiety, and insomnia. These findings underscore the importance of revising and optimizing the pharmacotherapy of these vulnerable patients, performing close mental health monitoring and the implementation of non-pharmacological interventions by integrating mental health services for women with chronic diseases such as diabetes.

Evaluation of fibromyalgia frequency and quality of life in Notalgia paresthetica patients

Based on the presence of chronic pain and the potential use of common treatment agents in Notalgia Paresthetica (NP) and Fibromyalgia Syndrome (FMS) for improvement, we aimed to investigate the frequency of FMS symptoms in NP patients and its impact on quality of life. This study is a case control cohort study including 26 patients diagnosed with NP and a total of 26 controls matched for age and gender. The 2016 revised fibromyalgia diagnostic criteria by the American College of Rheumatology (ACR) were used to inquire about FMS diagnosis criteria in the study. According to the 2016 ACR revised FMS diagnostic criteria, the frequency of FMS was significantly higher in the patient group (n = 9, 34.6%) compared to the control group (n = 2, 7.7%) (p = 0.042). The Wide Pain Index (WPI) score in the control group was 2.00 (3.25), while in the patient group, it was 4.00 (8.00), with a statistically significant difference between them (p < 0.035). Furthermore, significant statistical differences were found between the two groups in terms of Symptom Severity Scale (SSS), Fibromyalgia Score (FS), and FIQ (p < 0.035, p < 0.001, p < 0.001, respectively). In NP patients with accompanying FMS, Dermatology Life Quality Index was significantly more affected compared to those without FMS (p = 0.025). In conclusion, we recommend that NP patients be questioned about FMS, which is characterized by generalized pain, as well as regional neuropathic symptoms. Treatment success can be enhanced by using common agents in the treatment choice for accompanying FMS.

Cervical and Ocular Vestibular Evoked Myogenic Potentials in Fibromyalgia Syndrome Patients.

Fibromyalgia syndrome (FMS) is a chronic pain condition that may be associated with dysfunction in the central nervous system. The aim of this study was to assess the vestibulo-spinal reflex (VSR) and vestibulo-ocular reflex (VOR) in FMS using the cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) tests, respectively, and to evaluate their relation to disease severity. This study included 30 female FMS patients and 30 well-matched healthy controls. They underwent full history taking and assessment of the severity of dizziness/vertigo using the Dizziness Handicap Inventory; assessment of the severity of FMS symptoms using the Revised Fibromyalgia Impact Questionnaire; bedside examination of the dizzy patient; videonystagmography, cVEMP, and oVEMP tests; basic audiologic evaluation; and uncomfortable loudness level (UCL) testing. Dizziness was reported in 46.6% and vertigo in 11.1% of patients. Abnormalities in cVEMP (50%) and oVEMP (63.3%) were mostly unilateral, irrespective of FMS severity. Disease duration affected only the oVEMP amplitude. Fibromyalgia syndrome patients had a statistically significant lower UCL and narrower dynamic range compared to controls. The VSR and VOR are commonly affected in FMS patients, and findings suggest central sensitization involving the brain stem. We recommend routine cVEMP and oVEMP testing to assess brainstem function in FMS patients.

Heightened interoception in adults with fibromyalgia

Previous research suggests that the processing of internal body sensations (interoception) affects how we experience pain. Some evidence suggests that people with fibromyalgia syndrome (FMS) – a condition characterised by chronic pain and fatigue – may have altered interoceptive processing. However, extant findings are inconclusive, and some tasks previously used to measure interoception are of questionable validity. Here, we used an alternative measure – the Phase Adjustment Task (PAT) – to examine cardiac interoceptive accuracy in adults with FMS. We examined: (i) the tolerability of the PAT in an FMS sample (N = 154); (ii) if there are differences in facets of interoception (PAT performance, PAT-related confidence, and scores on the Private Body Consciousness Scale) between an FMS sample and an age- and gender-matched pain-free sample (N = 94); and (iii) if subgroups of participants with FMS are identifiable according to interoceptive accuracy levels. We found the PAT was tolerable in the FMS sample, with additional task breaks and a recommended hand posture. The FMS sample were more likely to be classified as ‘interoceptive’ on the PAT, and had significantly higher self-reported interoception compared to the pain-free sample. Within the FMS sample, we identified a subgroup who demonstrated very strong evidence of being interoceptive, and concurrently had lower fibromyalgia symptom impact (although the effect size was small). Conversely, self-reported interoception was positively correlated with FMS symptom severity and impact. Overall, interoception may be an important factor to consider in understanding and managing FMS symptoms. We recommend future longitudinal work to better understand associations between fluctuating FMS symptoms and interoception.

Effect of Hypnosis on Pain, Anxiety, and Quality of Life in Female Patients with Fibromyalgia: Prospective, Randomized, Controlled Study

ABSTRACT This prospective, randomized, controlled study aimed to investigate the effects of standardized adjuvant hypnosis on pain, depression, anxiety, aerobic exercise practices, quality of life, and disease impact score in female patients with fibromyalgia syndrome (FMS). This study included 47 female patients with FMS who had been under treatment for at least six months. The hypnosis group (n = 24) received a total of three hypnosis sessions and was taught to patients’ self-hypnosis. The patients in this group practiced self-hypnosis for six months. During this period, all patients also continued their medical treatment. The Visual Analogue Scale (VAS) was used to determine the intensity of pain. At the end of the six-month follow-up period, it was determined that the patients of FMS with hypnosis therapy had lower pain intensity, FMS symptoms, depression, and anxiety symptoms, and better well-being than those in the control group (p < .05). Standardized hypnosis is an effective method in reducing pain, depression and anxiety symptoms and improving quality of life in patients with FMS.

Effectiveness of traditional Chinese exercise in patients with fibromyalgia syndrome: A systematic review and meta-analysis of randomized clinical trials.

Fibromyalgia syndrome (FMS) is a common disorder characterized by heterogeneous symptoms that leads to decreased functioning, work productivity, and quality of life. Exercise has been recommended for fibromyalgia treatment. Traditional Chinese exercise (TCE), including Taichi, Qigong, Badunjin, Wuqinxi, etc., as a kind of mind-body exercise, plays an important role in alleviating symptoms of FMS. The objective of this study is to summarize the available evidence, through meta-analysis, on the pain relief, quality of life, sleep improvement, and emotion regulation of FMS in TCE. Databases of PubMed, EMBASE, Cochrane library, Google scholar, CNKI, WANFANG DATA, VIP, etc. were used to search eligible studies that were published from the time of their inception to February 11, 2022, in English and Chinese. The included studies were divided into two groups: TCE group (experimental group) and control group. The Cochrane collaboration's tool was used to assess the risk of bias, and Revman5.4.1 software was used to synthesize and analyze the data. A total of 12 literatures were included in this study, which contained 781 patients, and 448 of them were included in the treatment group, 333 of others in control group. TCE significantly alleviated pain [SMD = -0.83, 95% CI (-1.15, -0.51), p < .00001], improved quality of life [SMD = -0.53, 95% CI (-0.86, -0.19), p = .002] and improved qualities of sleep [SMD = -0.41, 95% CI (-0.57, -0.24), p < .00001] and relieved depression [SMD = -0.40, 95% CI (-0.69, -0.10), p < .008]. TCE may be a way to reduce pain, improve the quality of life and sleep, and relieve depression for FMS, and it could be part of the FMS treatment.

Duloxetine: an effective treatment for fibromyalgia syndrome?

Duloxetine hydrochloride (duloxetine) is a powerful selective serotonin and norepinephrine reuptake inhibitor (SSRI), which in recent years has shown measurable success in treating a wide variety of disorders, including fibromyalgia syndrome (FMS). Among the clinical symptoms of FMS is the dysfunction of the monoamine systems in the nervous system, and since those are what duloxetine regulates, it is successful in managing its symptoms.1 Therefore, the United States Food and Drug Administration has cleared it for treating major depressive disorder, generalized anxiety disorder, for managing diabetic peripheral neuropathic pain and chronic musculoskeletal pain2. FMS is prevalent worldwide and affects nearly 1 in 20 people globally, including about 3 million adults in the United States3. Usually, patients diagnosed with FMS also have other chronic overlapping pain conditions and mental disorders, therefore it is uncommon to have FMS as an independent diagnosis4. Chronic stress exacerbates neuropathic pain by integrating stress affect–related information with nociceptive information in the amygdala’s central nucleus5,6. Its symptoms include restless sleep, fatigue, anxiety, depression, and problems regulating mood. There is a central magnification of pain signals, which evidence suggests is caused by the fact that both the ascending and descending pain pathways are functioning abnormally7. Although there is little evidence supporting this, it is believed that the symptoms are caused by neural over-sensitization, decreased conditioned pain modulation, combined with cognitive dysfunction, memory impairment, and altered information processing caused by negative events, stressful environments, or physical/emotional trauma8,9. Patients suffering from FMS have also been reported to experience a phenomenon known as fibrofog, which entails a decreased ability to think and process new information. The inference that disruptions in the perception of physiological pain, sleep, fatigue, cognition, and mood (hallmark symptoms of patients with FMS) may be consequences of abnormalities in serotonin and norepinephrine metabolism and transmission is supported by the fact they are both important regulators of these functions in healthy individuals10. Duloxetine works by reinforcing the serotonergic and adrenergic pathways involved in descending inhibition of pain at the dorsal horn of the spinal cord. The subsequent increased threshold for pain stimuli to reach the brain results in significant neuropathic pain relief. In a study, Write et al11 concluded that because the average FMS patient is on 3–6 medications to manage the symptoms, there may be an increased risk for the drug-to-drug interactions. Serotonin toxicities can develop from using serotonergic drugs and duloxetine simultaneously as it can lead to adverse drug-drug interactions12. Furthermore, little is known about how it may affect pregnancies or lead to complications for the mother and child before and after delivery. SSRIs increase the possibility of developing suicidality in children and young adults aged 18–24, which is one of its more tendentious side effects. Thus, the FDA has released a black box warning for duloxetine use13. Furthermore, duloxetine increases both levels of serotonin and norepinephrine, which directly results in tachycardia and hypertension14. Even though systematic reviews have proven its effectiveness in pain management, improving symptoms in up to 80% of patients, a careful examination of its adverse effects and advantages must be taken into consideration when prescribing SSRIs to any patient13,14. Diagnosis and eventual management of this disease are delayed because patients usually present with a variety of symptoms15. FMS patients must spend up to $35,920 on health care every year in the United States to treat the various symptoms of this disease16. Frequent physical therapy appointments to reduce stiffness, frequent blood work, and hospital visits take up significant time and place a financial strain on the patient. In a recent study, it was found that most patients with FMS view themselves as being moderate to severely disabled. The intensity of pain they experience and psychological factors (alexithymia and depression) were found to be the main reasons for this17. Clear, distinct guidelines for its diagnosis should be established so as not to delay the beginning of treatment, and awareness needs to be created among clinicians in third-world countries about this disease as well. Newer, more effective drugs need to be designed to not only improve the patient’s quality of life but to reduce the burden on the already overwhelmed health care systems as well. Ethical approval None. Sources of funding None. Authors’ contribution N.E.: wrote the article, suggested a topic, conducted a literature search A.E.: conducted a final review and corrections Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Naz Elahi.

The association between adverse childhood experiences, self-silencing behaviours and symptoms in women with fibromyalgia

ABSTRACT Poor adult health has consistently been associated with Adverse Childhood Experiences (ACEs). The process is not fully understood but is likely to involve a complex interaction of biological and psychosocial factors. Early life stress can affect the developing brain resulting in long-term hyper-responses to stress and raised inflammatory biomarkers. Women with fibromyalgia syndrome (FMS) frequently report ACEs and also self-sacrificial behaviours whereby they repress their own needs and emotions to preserve personal relationships. This behavioural profile (termed self-silencing) may develop following ACEs but has not previously been considered in the context of FMS. This study examined whether self-silencing mediates the link between ACEs and FMS symptoms. Women with (N = 539) and without (N = 184) an FMS diagnosis completed measures of Silencing-the-Self, health symptoms and ACEs. Number of ACEs and symptom levels were significantly associated in both groups. One aspect of self-silencing, care and self-sacrifice (putting others needs before your own) mediated the association between ACEs and symptoms in the FMS group only. Externalised self-perception (judging oneself according to perceived external standards) was negatively associated with symptoms but presented no mediating effects. Results present preliminary new information to explain the association between ACEs and FMS. Recognition of the factors which underlie symptomology is important in understanding the condition and supporting patients.

Reduced midbrain raphe echogenicity in patients with fibromyalgia syndrome.

The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS. Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis. Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms. We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression.

The Mediating Role of Depression and Pain Catastrophizing in the Relationship between Functional Capacity and Pain Intensity in Patients with Fibromyalgia

Background Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition characterized by widespread pain, sleep problems (i.e., insomnia and unrefreshing sleep), fatigue, cognitive, and emotional difficulties. Although pain has been proposed the factor mostly impacting in the FMS patients' function, emotional and psychological FMS-associated factors are also known to exert a negative impact in quality of life and functional capacity. Nonetheless, the relationship between these factors and functional limitations in FMS patients is considered to be complex and not clearly defined. Therefore, the present study is aimed at assessing the associations between FMS functional capacity, FMS symptoms (pain, fatigue, insomnia, depression, and state and trait anxiety), and associated psychological factors such as pain catastrophizing, as well as the possible mediating role of these latter in the relationship between pain and FMS functional capacity. Method 115 women diagnoses with FMS completed a set of self-administered questionnaires to evaluate the clinical and psychological variables of the study. Results FMS functional capacity was positively associated with the majority of FMS symptoms except state anxiety. Regression analyses confirmed a greater prediction for FMS functional capacity by depression, fatigue, and pain catastrophizing, in this sequence. Both, pain catastrophizing and depression were important factors mediating the association between clinical pain (total and intensity) and FMS functional capacity. Conclusions Findings support a key role of pain catastrophizing and depression in the disability associated to pain in FMS. Treatment goals directed to lessen depression and pain catastrophizing levels should be promoted to reduce the impact of pain in FMS patients' daily function.

Interleukin-1 beta gene polymorphisms in patients with fibromyalgia syndrome

Background/Aim: Fibromyalgia syndrome (FMS) has been linked to a genetic background. Although there are conflicting results, it has been suggested that cytokines play a role in FMS etiology. Interleukin (IL)1β is a cytokine that has been linked to FMS symptoms and has been detected in the skin of FMS patients. We aimed to determine the possible relationship between IL1β -31 and IL1β -511 polymorphisms in FMS. Methods: In this cross-sectional study, we included patients who were diagnosed with FMS according to the American College of Rheumatology classification criteria. IL1β -31 (rs 1143627) and IL1β -511 (rs 16944) polymorphism genotyping was conducted in FMS patients (n=33) and healthy controls (n=41) using real-time polymerase chain reaction (RT-PCR). Results: IL1β -511 variations in patients with FMS and control groups were significantly different (P=0.010). The frequency of the IL1β -511 heterozygote AG genotype was significantly higher in controls (P=0.028). Additionally, the frequency of the IL1β -511 wild type A allele was significantly higher in the control group (P=0.003). The IL1β -31 genotypes and allele frequencies were not significantly different between the groups. Conclusion: The IL1β -511 wild type A allele could be a risk-reducing factor for FMS. The present study suggests that genetic variations of the IL1β gene could play an important role in FMS etiology.

Dermatological Findings in Fibromyalgia Syndrome and Their Effects on Quality of Life, Clinical Findings, and Depression

Purpose: The aim was to investigate the skin findings in patients with Fibromyalgia Syndrome (FMS), and the relations of these findings with the clinical symptoms of the disease, quality of life and depression levels of the patient. Materials and Methods: A total of 77 patients with FMS were included in the study as the study group, 74 individuals were included as the control group. The pain levels were evaluated with Visual Analogue Scale (VAS). The short form-36 (SF-36) was used to evaluate the quality of life levels of the patients. The Beck Depression Scale (BDS) was used to evaluate the depression levels of the patients. All participants were evaluated by the same dermatology specialist. Results: Although 37.1% patients who had FMS had at least one cutaneous symptom, 19.9% of the control group had at least one cutaneous symptom (p<0.01). According to the BDS, significant increases were detected in FMS patients (p=0.001). Significant decreases were detected in terms of all SF-36 parameters in the FMS group (p=0.001). There was at least one dermatological disease in 43% of the patients, and in 20.5% of the controls. Although no significant differences were detected between BDS and VAS scores of the FMS patients with and without dermatological findings, SF-36 total score and physical role strength score were found to be significantly lower in the patients who had dermatological symptoms. Conclusions: It must be known that there may be dermatological symptoms in FMS, a more multidisciplinary approach must be used in treatment and follow-up.

Symptomatology of Fibromyalgia Syndrome in Men: A Mixed-Method Pilot Study.

Fibromyalgia syndrome (FMS) is characterized by generalized chronic musculoskeletal pain, fatigue, and sleep disturbance, as well as cognitive, somatic, and other symptoms. Most people affected by FMS are women, and studies analyzing this condition in men are scarce. In this study, we discuss the physical and psychological symptoms of FMS in men, analyze the possible side effects of pharmacological therapies, and explore the impact of the illness comparing these results between the different classification groups according to sociodemographic variables (marital status, level of education, employment situation and number of people living at home). We used a sequential exploratory mixed method (MM). Qualitative information was obtained from two focus groups (n = 10). Structured questionnaires were administered to 23 men affected by FMS. The mean age of the participants was 51.7 years (SD = 9.64). The most common drugs used were antidepressants and anxiolytics (86.9%), followed by non-steroidal anti-inflammatory drugs (82.6%) and opioids (60.9%). Current level of pain was high (8.2; SD = 1.1), while perceived health and satisfaction with pharmacological treatments were low (4.6; SD = 2.6 and 3.5; SD = 3.2, respectively). The impact of FMS measured using the Fibromyalgia Impact Questionnaire (FIQ) was very high at 88.7 (SD = 8.2). Six categories related with symptoms and side effects of the medication were observed in the qualitative data: (1) main physical symptoms, (2) mood disorders, (3) insomnia and non-restorative sleep, (4) cognitive disturbance, (5) hypersensitivity, and (6) symptoms secondary to opioids. Pain and fatigue were the symptoms most often mentioned by the participants (70% and 80%, respectively). Other important symptoms were anxiety, depression, and memory and sleep disorders. The consumption of opioids causes further unwanted symptoms such as drowsiness and dependence, which makes it difficult for patients to perform basic everyday activities. We believe it is vitally important to continue investigating this symptomatology in order to improve diagnosis and treatment for these patients.

Evaluation of the Relationship between Proinflammatory Cytokine Levels and Clinical Findings of Fibromyalgia Syndrome.

Immune system has an important effect on pain-related disorders such as fibromyalgia syndrome (FMS). There is no specific laboratory technique for the diagnosis of FMS, but measuring serum proinflammatory cytokines may help. The purpose of our study was to determine the serum levels of immune mediators and their relationship with FMS symptoms. 25 healthy individuals and 29 FMS patients receiving pregabalin 150 mg/day for a minimum of 3 months were included in this study. FMS patients were diagnosed according to diagnostic criteria of the American College of Rheumatology (ACR 2010). Widespread pain index (WSI), fatigue, waking unrefreshed, cognitive symptoms, somatic symptoms, and Fibromyalgia Impact Questionnaire (FIQ) scores were evaluated in patients with FMS. Serum levels of proinflammatory cytokines (IL-2, IL-6, IL-12, IL-17, IFN-γ, TNF-α) were assessed using enzyme-linked immunosorbent assay (ELISA). Proinflammatory cytokine levels were higher in the control group than in patients with FMS (P<0.05). A positive correlation was found between age and WSI (P=0.037). In addition, a significant positive relationship was determined between IL-17 level and waking unrefreshed (P=0.049). There was no significant relationship between other cytokines and clinical findings. Lower proinflammatory cytokine levels identified in FMS patients may be related to pregabalin treatment, and there may be an impairment in the inflammatory response. On the contrary, IL-17 showed a positive correlation with waking unrefreshed.

Diagnostic difficulty, delayed diagnosis, and increased tendencies of surgical treatment in fibromyalgia syndrome.

Aimed to evaluate the time elapsed between the onset of early symptoms and the diagnosis of fibromyalgia syndrome (FMS), the delays in diagnosis and frequent physician visits, increased tendencies of surgical treatment, and the effects of FMS symptoms on the post-surgical result. While there were 101 patients diagnosed with FMS in the 1st group, there were 100 patients in the 2nd group who presented with musculoskeletal complaints but were not diagnosed with FMS. In both groups, information on duration of complaints, time until diagnosis, and number of evaluating physicians were included. They were questioned in terms of whether they had undergone elective surgery before and after FMS diagnosis, and in terms of operation sites. Among these operations, the ones regarding the musculoskeletal system were evaluated, and the preoperative and postoperative, before and after FMS diagnosis. It was determined that the diagnosis of FMS was made late; the number of doctor visits increased in the period until the diagnosis, and the rate of surgical treatment was higher than in patients without FMS. It was determined that the patients who were operated on after being diagnosed with FMS gained from the operation while the rate of gaining from surgery was lower in patients with FMS symptoms who were operated on before the diagnosis was made. The diagnosis of FMS reduces healthcare use, including referrals and examinations. Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Key Points • Early detection of FMS reduces healthcare utilization and expenditure, including referrals and examinations. • Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Therefore, it is important to understand why the diagnosis of FMS is made in a delayed manner. • Providing pragmatic tools to improve the methodology of primary care providers may help with diagnosing FMS accurately. • Early diagnosis and treatment of FMS may lead to a decrease in the number of operations and an improvement in the results of the operation.

Social media use in patients with fibromyalgia and its effect on symptom severity and sleep quality

BackgroundThe aim of this study was to evaluate social media use in patients with fibromyalgia syndrome (FMS) and determine the effect of social media use on disease severity and sleep quality.Materials and methodsIn total, 205 social media using patients with similar characteristics were included in the study. The study group consisted of 103 patients with FMS, and the control group consisted of 102 patients without FMS. The FMS symptom severity scale and diffuse pain index were used to determine the disease severity in FMS patients, the sleep disorder short form questionnaire (PROMIS) was used to evaluate sleep quality, and the Social Media Addiction Scale-Adult Form was used to evaluate social media addiction. A visual analog scale was applied to evaluate pain in both the patient and control groups, and social media usage times were recorded.ResultsWe found that pain severity, sleep disturbance and social media addiction were higher in patients with FMS than in the control group, and there was no relationship between the rates of social media use in patients with FMS and the severity and prevalence of the disease.ConclusionThe use of social media is more frequent in patients with FMS, which can motivate healthcare professionals to evaluate social media habits in individuals with FMS.

A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope?

Fibromyalgia syndrome (FMS) is a pain disorder characterized by chronic widespread pain, fatigue, and sleep disturbance, in the absence of any well-defined underlying organic disease. The exact pathophysiology and the mechanism which links different factors related to the disease is still unknown. Due to unknown precise pathogenesis, the coexistence of other diseases, and overlapping clinical features, FMS diagnosis may be laborious. Various treatment strategies are used, only a few Food and Drug Administration (FDA) approved, still we are facing challenges regarding effective treatment. Recently, medicinal cannabis has proven to be effective in chronic pain conditions such as osteoarthritis, neuropathic pain, and other non-cancer chronic pain. However, further research is needed about how the cannabinoid system works with the pain pathway. Using the fact that medicinal cannabis is effective in the treatment of chronic pain and certain rheumatic diseases, in this review, we aim to analyze the role of the cannabinoid system in fibromyalgia syndrome.We followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines in searching PubMed, MEDLINE (through PubMed), PubMed Central, and Google Scholar using keywords "fibromyalgia, chronic pain, cannabis, cannabinoids, pharmacotherapy, alternative therapy" and Medical Subject Heading (MeSH) words.After applying inclusion/exclusion criteria and checking for the quality assessment, 22 articles were retrieved and used for the analysis of the role of cannabis in the treatment of fibromyalgia. The two main compounds of cannabis with analgesic and anti-inflammatory properties are cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), and their ratio determines the effect on various symptoms of FMS. We included studies regarding the use of cannabinoids in the treatment of fibromyalgia, investigating the use of nabilone, dronabinol (a synthetic analog of THC), Bedrocan (22.4 mg THC, <1 mg CBD), Bediol (13.4 mg THC, 17.8 mg CBD), and Bedrolite (18.4 mg CBD, <1 mg THC).In the era of the coronavirus disease 2019 (COVID-19) pandemic and opioid crisis, many adverse outcomes are observed in the patients suffering from FMS due to lack of any definitive treatment and promising outcomes from the known treatment options, which led to the need for effective and safer treatment alternatives.Although the studies reviewed in this article suggest that medical cannabis is a safe and effective treatment for fibromyalgia pain, several limitations regarding dosage, length of treatment, adverse effects, long-term follow-up, and dependence needs further investigation.

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.