Fibromyalgia Research Articles

Fibromyalgia in Patients with Obstructive Sleep Apnea Patients

Abstract Background Obstructive sleep apnea (OSA) and Fibromyalgia (FM) concomitantly form an extremely important association because in addition to its adverse effects on the quality of life, it contributes to the mortality rates. Studies evaluating the relationship between OSA, and FM have been conducted in very small patient groups. However, the results are controversial. In our study we aimed to investigate the prevalence of fibromyalgia in obstructive sleep apnea patients because of the similarities between the symptoms of FM and OSA. Methods This cross-sectional study was conducted upon 49 patients already diagnosed with OSA. Patients were recruited from the sleep lab of chest department Ain Shams university Hospitals in the period between August 2021 and August 2022. Overnight diagnostic PSG was performed to all patients Then we tested widespread pain index (WPI) and system severity scale (sss) on patients who have OSA by PSG to diagnose FM. The following investigations were done for patients who were suspected of having secondary fibromyalgia: Hepatitis C virus antibodies, Vitamin D level, Complete blood count, Thyroid functions, C-reactive protein, Erythrocyte sedimentation rate and Autoimmune markers. Results Out of 49 patients; 10.2% (5 patients) were fibromyalgia positive using WPI and SSS, and all of them had Secondary FM. The only significant negative correlation was observed between SSS score and REM latency (r: -0.370, P-value: 0.009). All other correlations were statistically non-significant. Conclusion Secondary FM among OSA patients is not uncommon. Monitoring serum Vitamin D levels in OSA patients in recommended.

Significance of Inflammatory Markers in Primary Fibromyalgia Syndrome and Their Relation in Assessing the Disease Severity

Abstract Background Fibromyalgia syndrome (FMS) is a musculoskeletal disorder characterized by diffuse chronic musculoskeletal pain associated with various other symptoms. Although the etiology and pathogenesis of FMS are still unclear, it was reported to have possible inflammatory basis. No laboratory marker is currently available to diagnose the disease. Aim of the Work to assess the serum levels of ESR, CRP, NLR, MPV and PDW in primary Fibromyalgia syndrome patients and their relation with the disease severity and depression scores. Patients and Methods The study included 30 FMS patients, diagnosed according to the 2010 ACR (American Colleague of Rheumatology) criteria who presented to Ain Shams University Physical Medicine and Rehabilitation clinic as well as 30 healthy volunteers who served as a control group. The following laboratory tests were assessed among both groups: Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Neutrophil Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). FMS patients filled out The Revised Fibromyalgia Impact Questionnaire (FIQR) and Montgomery Asberg Deprssion Score (MADRS) as well. Results MPV, NLR, ESR and CRP values were significantly higher among the patients’ group (p < 0.05). Statistically positive correlation was found between FIQR and each of CRP (p = 0.021) and ESR (p = 0.027) levels. Another statistically significant positive correlation was found between MADRS and CRP (p = 0.01). The NLR showed marginal positive significance with FIQR. Conclusion In the light of these previous results, we can state that the serum levels of the tested inflammatory markers being mainly the acute phase reactants, have a positive relation with disease severity and depression scores, which in turn affect the quality of daily living. Accordingly, we arise the possibility of using those markers as good indicators of ongoing inflammatory process among FMS patients reflecting the severity of the disease.

Effects of Diathermy on Pain in Women with Fibromyalgia: A Randomized Controlled Trial.

(1) Background: The main characteristic of fibromyalgia (FM) is generalized musculoskeletal pain. This may be accompanied by muscle and joint stiffness, sleep and mood disorders, anxiety and depression, cognitive dysfunction, and chronic fatigue. It is endemic in developed countries, with a higher prevalence among women than men, and its etiology is still unknown. Diagnosis is made based on chronic generalized pain and through the presence of tender points. The objective of this study was to analyze the efficacy of diathermy on pain in patients with fibromyalgia. (2) Methods: A single, blind, randomized experimental study was developed with a sample of 31 participants. Measurements were taken and recorded at three different intervals using the following measurement tools: the pressure pain threshold (PPT) at the tender points (TP) of the right and left trochanteric prominence with an algometer, the pain measurement scale, the Fibromyalgia Impact Questionnaire, the sleep quality index (PSQI, Pittsburgh), the Multidimensional Fatigue Inventory (MFI-S), and the scale for anxiety and depression (Hospital Anxiety and Depression Scale). Sociodemographic data were collected through Google Forms (age, height, weight, Body Mass Index). The intervention took place twice weekly across four weeks of sessions. (3) Results: Statistically significant results were obtained in the right and left trochanter PPT, as well as for anxiety and fatigue in the experimental group. The results obtained show that this treatment has managed to improve the quality of sleep, the impact of disease, chronic fatigue, and anxiety in patients with FM. (4) Conclusions: Diathermy is a tool that can help reduce pain. It can also improve the baseline levels of chronic fatigue, anxiety, the impact of the disease, and sleep quality in patients with fibromyalgia.

Evaluation of Inflammatory Markers in Patients with Fibromyalgia Syndrome in King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia: A Cross-Sectional Study

Objectives: The goal of this study was to examine various markers in patients with FMS, including the neutrophil/lymphocyte ratio (NLR),platelet/lymphocyte ratio (PLR), platelet distribution width (PDW), and mean platelet volume (MPV). Methods: This was a cross-sectional, retrospective study conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia,involving the examination of inflammatory markers, such as PDW, NLR, and MPV. The results were evaluated with IBM SPSS version 25, and a P-value of <0.05 was used to reject the null hypothesis. Results: In total, 396 participants were included in this study: 235 in the FMS group and 161 in the control group. MPV, PDW and NLR values are 10.31 ± 1.6 fL, 124.57 ± 70.0, 2.30 ± 3.2, respectively. The PDW in the control group (12.47 ± 2.5) was significantly higher than that in the FMS group (11.84 ± 2.4) (P = 0.003). Erythrocyte sedimentation rate and Vitamin D levels (P = 0.001) were significantly higher in the control group than in the FMS group, with values of 31.71 and 24.2 and 75.60 and 39.4, respectively. No significant differences were found in MPV and NLR values between the FMS and control groups. Conclusion: The findings in this study suggest that PDW and PLR are important inflammatory markers that may be beneficial in FMSdiagnosis.

Early maladaptive schemas as a risk factor for fibromyalgia: A case-control study.

There is evidence supporting the relationship between early stress and childhood trauma and the development of fibromyalgia (FM). Early maladaptive schemas (EMSs) are considered a consequence of early stress. Previous research has shown their role in maintaining stress responses and their relevance in other populations with pain. The main aim of this study has been to analyze the presence of EMSs in patients with FM compared to healthy adult women. In addition, the relationship between the strength of EMSs and pain intensity was tested. The total sample consisted of 167 women: 83 patients with FM and 84 healthy controls. Chi-square analyses showed that the percentage of participants with clinically significant scores is higher for patients with FM in 11 of the 18 EMSs evaluated. Moreover, discriminant analyses revealed that these EMS are useful to discriminate between FM and healthy controls, classifying 74.2% of original cases. In relation to the second aim, the mean pain intensity correlated with the strength of several EMSs: approval seeking, unrelenting standards, insufficient self-control, and mistrust/abuse. The current study highlights that a high rate of patients with FM have clinically significant EMSs compared to healthy matched controls, as has been found in other populations with pain. Besides, this study provides initial evidence that EMSs are positively associated with the pain experienced by patients with FM, suggesting the existence of a possible association between early stress and pain. Therefore, taking EMSs into account could be of great relevance to clinicians. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Role of micronutrients in the symptoms of fibromyalgia: a review of the literature and analysis of an Italian female sample.

Fibromyalgia (FM) is a multifactorial disease characterized principally by chronic, widespread pain impairing a patient's quality of life. The management of FM requires a multidisciplinary approach that combines pharmacological and non-pharmacological strategies. Growing evidence suggests a potential beneficial role of micronutrients such as minerals and vitamins. Overall, the role of these supplements remains controversial, but clinical trials on vitamin D, vitamin B12, magnesium, and iron supplementation seem to provide promising results. The aim of this study was to investigate their role in an Italian female sample. An exploratory cross-sectional study was done to assess the association of selected micronutrients with symptoms of FM by using the Fibromyalgia Impact Questionnaire (FIQ) in twenty consecutive female patients with FM. A literature review was also conducted. FIQ results revealed that vitamin D and magnesium deficiency appear to play a role in FM symptoms, mainly in physical function and stiffness. From the literature review, only two studies investigating the role of micronutrients in FM were retrieved. Screening for micronutrient deficiencies in FM patients and supplementing them when levels are low might help counteract FM symptoms.

Effect of Cognitive-behavioral Stress Management Therapy on Pain Perception, Chronic Fatigue and Cognitive Empowerment of Women With Fibromyalgia Syndrome: A Randomized Clinical Trial

Effect of Cognitive-behavioral Stress Management Therapy on Pain Perception, Chronic Fatigue and Cognitive Empowerment of Women With Fibromyalgia Syndrome: A Randomized Clinical Trial

Navigating Pain: Exploring the Therapeutic Potential of Virtual Reality for Fibromyalgia Management

Background: Fibromyalgia syndrome (FMS) affects a significant portion of the global population, predominantly women, with profound impacts on quality of life due to widespread pain and associated symptoms. Traditional treatments, while beneficial, may not fully address all aspects of the condition. Virtual Reality (VR) therapy offers a novel approach, leveraging immersive environments to distract from pain and improve patient engagement. Methodology: This randomized controlled trial evaluated the efficacy of non-immersive VR therapy in managing FMS symptoms. Participants (n=52) were recruited from a tertiary care hospital and assigned to either VR therapy or standard care groups. Outcome measures included pain intensity, physical function (FIQ), and quality of life (SF-36), assessed at baseline, post-intervention (4 weeks), and follow-up (12 weeks). Results: VR therapy significantly reduced pain intensity compared to standard care (mean difference -2.5, p<0.001). While improvements in physical function and quality of life were observed in the VR group, they were not statistically significant. Importantly, VR therapy effectively reduced kinesiophobia, demonstrating its potential to enhance patient participation in physical activities crucial for managing FMS. Conclusion: VR therapy shows promise as a standalone treatment for reducing pain intensity and addressing kinesiophobia in FMS patients. Future research should focus on larger samples, longer follow-up periods, and standardized outcome measures to elucidate VR therapy's broader impacts on physical function and quality of life in fibromyalgia management. Keywords: Fibromyalgia, Virtual Reality Therapy, Pain Management, Kinesiophobia.

Association of Body Mass Index with Pain Perception, Anxiety, Depression, and Disability in Fibromyalgia Patients

Background: A disorder of uncertain origin, Fibromyalgia (FM) is accompanied by pervasive pain, tiredness, disturbed sleep, and cognitive deficit. It has been related to depression, manic-depressive illness, and chronic fatigue. FM is negatively affected by obesity on both clinical and biological parameters. Methods: A total of n=150 FM patients (132 Female and 18 Male) were included in the study. Initially, informed consent and demographic data were gathered from the participants. Afterwards, each patient's Body Mass Index (BMI) was calculated and classified into average weight, overweight, and obese categories. The Numeric Pain Rating Scale (NPRS) was used to quantify the intensity of pain, the Hamilton Anxiety Scale (HAM-A) was used to determine the participants’ anxiety levels, the Hamilton Rating Scale for Depression (HAM-D) was used to examine their depression levels, and Health Assessment Questionnaire Disability Index (HAQ-DI) was used to measure their functional status. All these questionnaires were self-administered by the participants. Results: In the NPRS, HAM-A, HAM-D, and HAQ-DI categories, no significant differences were found (p>0.05). However, between the BMI level and anxiety, a weak positive correlation was detected (r=0.195, p=0.017). BMI levels were not statistically significantly correlated with pain, depression, or disability (r=0.011, p=0.0897; r=0.048, p=0.562; r=0.072, p=0.383). Conclusion: The results of the study revealed that there is no significant association of pain perception, anxiety, depression and disability with increasing BMI among FM patients except for a weak positive correlation with anxiety. Keywords: Body Mass Index, Fibromyalgia, Pain, Obesity.

Surface-Enhanced Raman Spectroscopy Combined with Multivariate Analysis for Fingerprinting Clinically Similar Fibromyalgia and Long COVID Syndromes.

Fibromyalgia (FM) is a chronic central sensitivity syndrome characterized by augmented pain processing at diffuse body sites and presents as a multimorbid clinical condition. Long COVID (LC) is a heterogenous clinical syndrome that affects 10-20% of individuals following COVID-19 infection. FM and LC share similarities with regard to the pain and other clinical symptoms experienced, thereby posing a challenge for accurate diagnosis. This research explores the feasibility of using surface-enhanced Raman spectroscopy (SERS) combined with soft independent modelling of class analogies (SIMCAs) to develop classification models differentiating LC and FM. Venous blood samples were collected using two supports, dried bloodspot cards (DBS, n = 48 FM and n = 46 LC) and volumetric absorptive micro-sampling tips (VAMS, n = 39 FM and n = 39 LC). A semi-permeable membrane (10 kDa) was used to extract low molecular fraction (LMF) from the blood samples, and Raman spectra were acquired using SERS with gold nanoparticles (AuNPs). Soft independent modelling of class analogy (SIMCA) models developed with spectral data of blood samples collected in VAMS tips showed superior performance with a validation performance of 100% accuracy, sensitivity, and specificity, achieving an excellent classification accuracy of 0.86 area under the curve (AUC). Amide groups, aromatic and acidic amino acids were responsible for the discrimination patterns among FM and LC syndromes, emphasizing the findings from our previous studies. Overall, our results demonstrate the ability of AuNP SERS to identify unique metabolites that can be potentially used as spectral biomarkers to differentiate FM and LC.

Effects of Electro-Muscle Stimulation Exercise Combined with Mat Pilates on Pain, Anxiety, and Strength in Sedentary Females with Fibromyalgia: A Single-Blind Randomized Controlled Trial.

Fibromyalgia syndrome (FM) is a chronic pain disorder that is ranked as one of the four most common rheumatological diseases in the world. This study aims to investigate the effects of an eight-week mat Pilates and electro-muscle stimulation (EMS) with combined mat Pilates exercises on pain, depression, anxiety, and strength in sedentary women. This study is a single-blind randomized controlled trial. A total of 30 sedentary female patients (Pilates (n = 15), EMS (n = 15)) diagnosed with FM were included in the study. The patients were subjected to Beck Depression (BDIs) and Anxiety Inventories (BAIs); a Fibromyalgia Impact Questionnaire (FIQ); five different Single-Leg Hop Tests (SLHTs); modified push-up (MPU), Handgrip Strength (HGS), Deep Squat (DSQ), V-Sit Flexor, bent-arm hang (BA), sit-up and Biering-Sørensen tests; and anthropometric tests before and after the 8-week exercise program. The eight weeks of mat Pilates exercises combined with mat Pilates and EMS revealed significant results (p < 0.05) in anthropometric data (abdomen, lower abdomen, hips) (p < 0.05) except for the results of chest circumference measurements (p > 0.05). In addition, there were statistically significant positive results in BDIs, BAIs, FIQs, lower extremity (all SLHTs and DSQ), upper extremity (MPU, HGS, BA), and core (V-SIT, sit-up, Biering-Sørensen test) strength test findings (p < 0.05). Combining the mat Pilates exercises with EMS is an effective and reliable method to improve the pain, anxiety, depression, and strength of female patients diagnosed with FM.

Relationships among Pain, Occupational Balance and Quality of Life in Women with Fibromyalgia Syndrome

Relationships among Pain, Occupational Balance and Quality of Life in Women with Fibromyalgia Syndrome

Adaptive and Compensatory Neural Signatures in Fibromyalgia: An Analysis of Resting-State and Stimulus-Evoked EEG Oscillations.

This study aimed to investigate clinical and physiological predictors of brain oscillatory activity in patients with fibromyalgia (FM), assessing resting-state power, event-related desynchronization (ERD), and event-related synchronization (ERS) during tasks. We performed a cross-sectional analysis, including clinical and neurophysiological data from 78 subjects with FM. Multivariate regression models were built to explore predictors of electroencephalography bands. Our findings show a negative correlation between beta oscillations and pain intensity; fibromyalgia duration is positively associated with increased oscillatory power at low frequencies and in the beta band; ERS oscillations in the theta and alpha bands seem to be correlated with better symptoms of FM; fatigue has a signature in the alpha band-a positive relationship in resting-state and a negative relationship in ERS oscillations. Specific neural signatures lead to potential clusters of neural adaptation, in which beta oscillatory activity in the resting state represents a more adaptive activity when pain levels are low and stimulus-evoked oscillations at lower frequencies are likely brain compensatory mechanisms. These neurophysiological changes may help to understand the impact of long-term chronic pain in the central nervous system and the descending inhibitory system in fibromyalgia subjects.

Trajectory of Change in the Severity of Symptoms in Patients with Fibromyalgia over 24 Months: Exploratory Analyses of a Combination Pharmacological Intervention.

Symptoms of fibromyalgia (FM) fluctuate and vary in severity. The current study aimed to evaluate the efficacy of palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) in FM patients over a 24-month period and to investigate the mediating function of pain catastrophizing subdomains in unfavorable relationships with disease severity levels in patients with FM. Patients were evaluated at baseline, after 12 months, and after 24 months, using different patient-reported measures (FIQR, FASmod, PSD, and PCS) to distinguish different levels of FM disease severity. A reduction of 30% or more from baseline was considered clinically important ("markedly improved"). A multivariate analysis was performed to identify the variables predictive of an FIQR reduction. Twenty-two patients (28.6%) were classified as "markedly improved", 16 patients (20.8%) as "slightly/moderately improved", and 39 patients (50.6%) as "not improved." The FIQR, FASmod, and PSD scores were significantly reduced at 24 months. The pain magnification domain score of the PCS was the only variable predictive of worse FIQR scores (Wald coefficient: -2.94; p = 0.047). These results suggest a potential long-term therapeutic role for the PEA + ALC combination, with pain magnification being the primary predictor of poor efficacy.

The Fibromyalgia Syndrome Management- A Short Review on Recent Trends

Background: Fibromyalgia (FM) is characterized by widespread musculoskeletal chronic pain, which compromises the patient’s quality of life and is a Somatic symptom disorder. A typical symptom seen in the patients is the lack of acceptance of the disease, since its pathophysiology is not clear. This work aims to clear few new treatment methods at a holistic level, that is, cognitive, physical, and pharmacological therapies. Methodology: A literature review was carried out form researchgate, google scholar, pubmed, scopus etc. that discusses treatment methods that relieves the pain and manage the symptoms of the disease. Results: Fibromyalgia symptoms can be managed by various treatment protocols that include a response to the mind through pain management, response to the body through physical activity, and response to the pain through pharmacological treatment. Conclusions: Treatment for fibromyalgia often involves medications along with complementary treatments, such as exercise, acupuncture, and life style modification.

The polymorphism Val158Met in the COMT gene: disrupted dopamine system in fibromyalgia patients?

The single-nucleotide polymorphism (SNP) rs4680 in the catechol-O-methyltransferase gene ( COMT ) is a missense variant (Val158Met) associated with altered activity of the COMT enzyme and suggested as a predictive feature for developing some chronic pain conditions. However, there are controversial results on its role in fibromyalgia (FM). Here, the SNP Val158Met was analyzed in 294 FM patients (without comorbidities) and 209 healthy controls (without chronic pain). The concurrent impact of Val158Met genotypes and FM comorbid disorders (depression and sleep impairment) on FM risk were tested. In addition, the genotypic distribution of FM patients in relation to pain intensity was evaluated. The G allele (Val) resulted in being more represented in the FM group (57.8%) compared with the control group (48.8%; P = 0.037). Logistic regression highlighted that having the G/G (Val/Val) homozygous genotype was associated with 2 times higher risk of having FM compared with the A/A (Met/Met) carriers ( P = 0.038), whereas depression and sleep impairment increased FM risk by 12 and 8 times, respectively ( P < 0.001). However, considering only the FM patient group, the A/A homozygous genotype was significantly associated with severe pain intensity ( P = 0.007). This study highlighted associations between the SNP Val158Met and both FM and pain intensity, suggesting a link between dopaminergic dysfunction and vulnerability to chronic pain. Further studies should explore this SNP in FM patients in conjunction with COMT enzymatic activity and other symptoms connected with the dopaminergic system such as depression or sleep impairment.

Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: A randomized controlled trial

BackgroundSleep disturbance is commonly seen in fibromyalgia syndrome (FMS); however, high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population. ObjectiveCraniosacral therapy (CST), Bowen therapy and exercises have been found to influence the autonomic nervous system, which plays a crucial role in sleep physiology. Given the paucity of evidence concerning these effects in individuals with FMS, our study tests the effectiveness of CST, Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS. Design, setting, participants and interventionA placebo-controlled randomized trial was conducted on 132 FMS participants with poor sleep at a hospital in Bangalore. The participants were randomly allocated to one of the four study groups, including CST, Bowen therapy, standard exercise program, and a manual placebo control group that received static touch. CST, Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks; the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks. After 12 weeks, all study participants performed the standard exercises at home for another 12 weeks. Main outcome measuresSleep quality, pressure pain threshold (PPT), quality of life and fibromyalgia impact, physical function, fatigue, pain catastrophizing, kinesiophobia, and positive–negative affect were recorded at baseline, and at weeks 12 and 24 of the intervention. ResultsAt the end of 12 weeks, the sleep quality improved significantly in the CST group (P = 0.037) and Bowen therapy group (P = 0.023), and the PPT improved significantly in the Bowen therapy group (P = 0.002) and the standard exercise group (P < 0.001), compared to the static touch group. These improvements were maintained at 24 weeks. No between-group differences were observed for other secondary outcomes. ConclusionCST and Bowen therapy improved sleep quality, and Bowen therapy and standard exercises improved pain threshold in the short term. These improvements were retained within the groups in the long term by adding exercises. CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS. Trial registration numberRegistered at Clinical Trials Registry of India with the number of CTRI/2020/04/024551.Please cite this article as: Ughreja RA, Venkatesan P, Gopalakrishna DB, Singh YP, Lakshmi VR. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: a randomized controlled trial. J Integr Med. 2024; 22(4): 474–484.

The Role of Obsessive Compulsive Traits in Fibromyalgia: Is Pain-Related Obsessive Ideation Involved in Pathogenesis?

Background and Objectives: Fibromyalgia syndrome (FMS) is defined as a chronic pain syndrome that is characterized by widespread pain, tenderness, and diffuse stiffness. In addition, neuropsychological symptoms such as fatigue, sleep disorders, poor mood, cognitive impairment, and headaches are often reported. Many reports have addressed the coexistence of affective disorders and anxiety with FMS, yet few have focused on its association with obsessive compulsive disorder (OCD). We investigated the occurrence of classical patterns of OCD in participants with FMS and assessed their effect on pain perception and functional impairment. Material and Methods: The research population included 37 patients diagnosed with FMS, treated at the Rheumatology Clinic in the Sheba Medical Center, Tel-Hashomer, Israel. We used validated questionnaires including a demographic questionnaire, a questionnaire on average and maximal pain intensity, the Eysenck Personality Questionnaire-Revised (EPQ-R), the Perceived Stress Scale, the Pain Catastrophizing Scale, the Pain Obsessive questionnaire, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results: Patients with FMS were found to have intrusive and obsessive thoughts regarding pain for several hours every day, causing a high degree of anxiety and high levels of pain, catastrophizing, and magnification, leading to helplessness and functional impairment. In total, 27% of the patients reported severe malfunction due to pain and pain ideation, and 49% demonstrated mild obsessive compulsive symptoms that were strongly correlated with pain intensity and functional impairment. Conclusions: Obsessive compulsive thinking patterns contribute to pain magnification and to the cognitive aspects of fibromyalgia syndrome.

Psychological Distress in Women with Fibromyalgia: The Roles of Body Appreciation, Self-Compassion, and Self-Criticism.

While past research detected a direct link between symptoms of fibromyalgia (FM) and psychological distress, body appreciation was suggested as a viable mediator of this link. The aim of the present study was to further develop an explanatory model for the effect of FM on women's psychological distress and identify possible protective and risk factors. Specifically, it was hypothesized that self-compassion would moderate the indirect effect of body appreciation and self-criticism on psychological distress in women with FM. This study comprised a total of 293 women, aged 20-68 (M = 34.8, SD = 12.3), of whom 146 were women with FM and 147 were heathy controls. All the women completed questionnaires regarding demographic characteristics, depression (PHQ-9), anxiety (GAD-7), self-criticism (DEQ-SC), body appreciation (BAS2), and the self-compassion scale (SCS). A moderated serial mediation model demonstrated lower body appreciation in participants with FM compared to controls. These lower levels of body appreciation, together with lower levels of self-compassion, were associated with greater self-criticism and, consequently, higher levels of psychological distress. The results emphasize the role of self-compassion as a protective mechanism against psychological distress among women with FM. Future studies should further investigate the effect of self-compassion-focused interventions on patients with FM.

Secondary fibromyalgia in children with immune-inflammatory rheumatic diseases

Patients with immune-inflammatory rheumatic diseases (IIRDs) often present with non-inflammatory musculoskeletal pain associated with nociceptive dysfunction, central sensitization, and secondary fibromyalgia (FM). In recent years, an increasing number of publications have appeared dealing with FM in rheumatoid arthritis and systemic connective tissue diseases in adult patients, while this problem is little discussed in pediatric rheumatology, partly due to the differences between the existing diagnostic criteria in children and adults, which complicate the diagnosis of juvenile secondary FM. The consequence of this is often the unfounded prescription or switching of synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs in patients who do not require intensified antirheumatic therapy, but rather psychotherapy and psychopharmacotherapy, as well as the wider use of physical and rehabilitation medicine methods. In a brief narrative review, we tried to trace the investigation of FM in a rheumatological clinic, including children with IIRD, from a historical perspective, to summarize current literature data on this problem and to point out possible solutions.